Gonzales Medical

and Children’s
Hospital Inc.
We support exclusive breastfeeding,
We support working moms.
How to keep the hospital a Baby-
Friendly Hospital?

 10steps to successful breastfeeding

(Revised 2018) launched y WHO and UNICEF
 Protect, promote and support breastfeeding
Critical management procedures:
 1a. Comply fully with the International Code of Marketing of Breast-milk
Substitutes and relevant World Health Assembly resolutions.
 1b. Have a written infant feeding policy that is routinely communicated to
staff and parents.
 1c. Establish ongoing monitoring and data-management systems.
 2. Ensure that staff have sufficient knowledge, competence and skills to
support breastfeeding.
Key clinical practices:
 3. Discuss the importance and management of breastfeeding with
pregnant women and their families.
 4. Facilitate immediate and uninterrupted skin-to-skin contact and support
mothers to initiate breastfeeding as soon as possible after birth.
 5. Support mothers to initiate and maintain breastfeeding and manage
common difficulties.
 6. Do not provide breastfed newborns any food or fluids other than breast
milk, unless medically indicated.
 7. Enable mothers and their infants to remain together and to practice
rooming-in 24 hours a day.
 8. Support mothers to recognize and respond to their infants’ cues for
feeding.
 9. Counsel mothers on the use and risks of feeding bottles, teats and
pacifiers.
 10. Coordinate discharge so that parents and their infants have timely
access to ongoing support and care.
Communicating with a breastfeeding
mother
 Use non-verbal communication
 Ask open questions
 Shows interest and reflect back what the mother says
 Empathize
 Avoid words that sound judging
 Build confidence by accepting what a mother thinks and feels
 Arrange for follow up and support suitable to the mother (family, friends,
community support group)
Practices that can help breastfeeding to
go well
 Having a companion during labor, which can help the mother to be more
comfortable and in control
 Avoid labour and birth interventions such as sedating pain relief and cesarean
sections unless they are medically indicated
 Have skin to skin contact immediately after birth, which keeps the baby warm
and gives an early start to breastfeeding
 Keeping the baby beside the mother (rooming in or bedding-in), so the baby is
easy to be fed as well as safe
 Learning feeding cues so the feeding is baby-led rather than to a schedule
 Feeding frequently, which helps to develop a good milk supply
 Breastfeeding exclusive with no supplements, bottles or artificial teats
 Birth practices and breastfeeding
 Support during labor- companion/family member can reduce perception of pain,
reduce stress, build confidence, provide massage.
 Non medication methods of pain relief- massage, verbal reassurance, quiet
environment, laboring and giving birth position of mother’s choice
 Light foods and fluids during labor
 there is no evidence that withholding of light food and dink from low risk women in
labour is beneficial as a routine practice
 IV fluids need to be used only for a clear medical indication as it can also limit the
woman’s movement. Prophylactic placement of IVF is considered unnecessary.
 Withholding food and drink during labor is an outdated practice that has been shown to
negatively affect birth outcomes.
 No evidence exist that suggests the placement of an IV in the low-risk intrapartum client
prevents poor outcomes (Elkins, Kerrise,Neilson, Crowther, Dulcey & Hotnett, 2000)
 Birth practices- minimal use of invasive procedures
 Assist with initiating breastfeeding- as long as there is a support person with the
mother and the baby, the baby can breastfeed even if the mother is still sleepy from
the anesthesia. Hep mothers to initiate breastfeeding within half-hour of birth.
 MILK CODE(E.O. 51)
DO’S DON’T’s
 Support and promote breastfeeding  Do not request/accept gifts of any
initiation during the first hour after sot from Milk Companies and their
birth representatives
 Support and promote exclusive  Do not request/accept samples of
breastfeeding for the 1st 6 months products or products covered by
of life the Milk Code to Milk Companies an
 their representatives
Therefore support and promote
continued breastfeeding with the  Do not allow the Milk Companies
introduction of complimentary and their representatives to
foods for 2 years and beyond support/conduct activities in your
communities/barangay and cities
Milk Code also prohibits DONATIONS OF PRODUCTS COVERED during
emergencies: infant formula, breastmilk substitute, feeding bottles,
artificial nipples and teats shall not be items for donation. No
acceptance of donation shall be issued.
 Essential Intrapartum
and Newborn Care (EINC)
1. Immediate and Thorough Drying
 Stimulates breathing and prevents hypothermia
 Dry at least 30 seconds, do a quick check of breathing while drying.
Start wiping from the eyes, mouth and nose, face and head going
down to the trunk. Replace wet linen with a new one
 Wipe gently. Do not wipe off the vernix.
 Routine suctioning not recommended unless mouth/nose are
blocked. (vigorous suctioning can create oral aversion-baby
protects himself by keeping his mouth closed)
We can do EINC to premature babies
as long as they are stable.
If newborn is not gasping or apneic,
continue with EINC.
 Essential Intrapartum
and Newborn Care (EINC)
2. Skin-to-skin Contact
 position prone on mother’s abdomen or chest
 Cover the newborn: dry linen and bonnet
 Room temperature must be 25-28 C
 Baby’s temperature: 36.5-37.5 C
 Essential Intrapartum
and Newborn Care (EINC)
3. Properly-Timed Cord Clamping
 Palpate umbilical cord to check for pulsations
 Clamp using the sterile plastic clamp 2cm from the base, then the
instrument clamp 5cm from the base
 Cut near the first clamp(not midway)
 Do not milk the cord towards the baby
 Observe for the oozing of blood. If blood oozes, place a 2nd tie
between the skin and the clamp
 Dry cord care is currently recommend.
 Essential Intrapartum
and Newborn Care (EINC)
4. Non-separation for the Early initiation of Breastfeeding
 baby should be prone on mother’s chest/in between the breasts with
head turned to one side
 Check baby’s breathing and color, check mother’s vital signs and massaged
uterus every 15 mins
 Warmth: check to see if feet are cold to touch if no thermometer
available
 Never leave the mother and baby unattended
 The baby may want to rest 20-30mins and even 120 minutes before
showing signs of readiness to feed

After the 1st breastfeeding:

• Erythromycin eye ointment may not be applied
immediately after delivery. No study has examined the
outcomes of differential timing of application.
 Breast care
 Wash with water once a day only
 Nicotine
and alcohol decrease breastmilk
production.
 Tight
fitting bra may cause blocked ducts
and worsen mastitis.
Nutrition for breastfeeding mothers

 Enough variety of foods

 Malnourish woman- still produces good quality of
milk
Breastfeeding and family planning

 Lactation Amenorrhea Method

 Suppresses ovulation
 Criteria: baby is less than 6 months old, no menstruation,
exclusive breastfeeding
 Breastfeeding and Diseases
 Contraindication for breastmilk donation: HIV, Hepa B
 Mothers with HIV and Hepa B can breastfed as long as they re on anti-retroviral or treated.
 breastfeeding w/o ART- 15-25% risk of transmission
 BReastfeeding w/ ART- <1% risk of transmission
 Stop feeding if with wound
 HIV mothers need: patient education, informed and shared consent, emphasis on ART, no
mixed feeding (it will cause damage on intestinal lining of the baby which can cause entry
of HIV virus)
 Mother should temporarily not breastfeed and not feed EBM to infants if:
o Infected with untreated TB
o undergoing diagnostic imaging w/ radiopharmaceuticals
o W/ active Chickenpox, measles
o w/ active Herpes Simplex virus infection with lesions present on the breast (Mother can
breastfeed from the unaffected breast; cover the lesions of the affected breast)
 If woman chose not to BF but no access to formula and clean and oiled water all the time,
advise to breastfeed while both her and her baby are taking ART. (MUST BE AFASS)
 OTHER INFANT FEEDING OPTIONS FOR
HIV (+) MOTHERS
 BREASTMILK HEATED TO 62.5 C for 30 mins and cooled immediately
 Wet nursing by an HIV (-) woman
 Feeding commercial infant formula
 May stop BF once a nutritionally adequate and safe diet without breastmilk
can be provided.
 Can mix-feed after 6 months
 Target result
 Viral load+ undetected (<34 copies/ml to not > 1000 copies/ml)
 CD4 count+ 500-1,500 cells/mm3
 Take ART for life.
Monitor plasma viral load every 1-2
months during pregnancy
What to do if the milk does not flow?
 A mother needs to be relaxed for her milk to flow. If she is tense, expressing
her milk can be much more difficult.
 We can help mother to relax by:
 Applying warm compress to the breast
 Massage to the back and neck
 Breast and nipple massage
 Need to build mother’s confidence
 Mos common reason for low milk production is not enough milk is removed
from the breast.
 Sucking of the baby is the stimulant for milk production.
 Avoid nipple confusion.
 Breastmilk storage
Fresh milk =25-37 C 4 HRS
=15-25 C 8 HRS
=BELOW 15 C 24 HRS
Refrigerated =2-4 C 8 DAYS
Freezer =1 door ref 2 weeks
=2 door ref (separate) 3 months
=deep freezer 6 months

-label container
-Use oldest milk first
-Frozen milk once thawed should be used within 24 hours

Breastmilk at Milk Banks is

prioritized for babies in the NICU
whose mothers are seriously ill.
 Positioning of the baby

 baby’s head should be in line

 Mother should hold baby’s body close to hers
 Support whole body
 Baby’s face should face the breast
 Expanded Maternity Leave Law
RA 11210 (Feb 20, 2019)
 105 days paid maternity leave (previously 60 days)
 Single mothers: can have an additional 15-days paid leave
 7 out of 105 days are transferrable to child’s father (married or not), on top
of the 7 day Paternity Leave Act (RA 8187). May also allocate to an alternate
caregiver, in the absence of the child’s father.
 Penalties: fine not less that 20,000php nor more that 200,000php
 Imprisonment of not less than 6 years or more than 12 years.