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NCBI Bookshelf. Geneva: World Health Organization; Breastfeeding plays a crucial role in the health, growth and development of babies and has benefits for the mother too. Women may need some help to successfully feed their babies. They need support and reassurance as they learn this skill.

This session focuses on the initiation of breastfeeding following birth and when and how to refer women who are experiencing difficulties. During pregnancy and after the birth it is important to discuss with women the importance of exclusive breastfeeding for six months.

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Try to include the partner or other family members and communicate to them all about the benefits of breastfeeding for the mother and baby, the process of breastfeeding and when and how long to feed for. You should also discuss continued breastfeeding after six months and introduction of other foods in addition to breast milk.

You might find it useful to refer to more specialized breastfeeding tools and materials to support your discussion. As well as benefits for the baby in terms of survival, breastfeeding has other advantages. It is easier to carry out than feeding formula; it takes no preparation; is always at the correct temperature, it is always clean and is always available. It is the perfect nutrition for babies. Communicate information on the advantages of breastfeeding including health benefits, economic benefits, etc.

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Be sure to also discuss the risks of not breastfeeding. Answer any questions or concerns the woman may have. For example, some women do not realize that it is normal for the baby to lose weight in the first three or four days after birth and that this is not a reflection of how she is breastfeeding or the quality of her breast milk. Women can still breastfeed while taking most medications, such as antibiotics, antiretroviral or TB medication. Some women may choose not to breastfeed. You should respect this decision, even if you disagree with it and support her to replacement feed safely.

After birth, dry the baby.

Use a blanket to cover both baby and the mother, to keep the baby warm. When the baby seems ready, encourage the mother to help the baby to her breast. Some babies need encouragement to latch-on at this stage. It is important for all mothers to start skin-to-skin contact from birth as soon as possible following birth — preferably in the first hour. They should let their baby suckle when they appear to be ready.

Some babies may take longer to start breastfeeding. As a health worker you have an important role in helping the mother to do this.

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Early contact will help a mother to bond with her baby - that is, to develop a close, loving relationship. It also makes it more likely that she will start to breastfeed. To help a mother learn how to breastfeed first encourage her to get herself into a comfortable position. Show her how to hold the baby straight, with both the baby's head and body turned to face her breast and with the baby's nose opposite her nipple.

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She should hold the baby close supporting the whole body, not just the neck and shoulders. Refer to breastfeeding aids and materials to help you become more familiar with correct positioning and attachment. Observe the mother breastfeeding her baby and offer help and assistance if needed. Look for s of good attachment and effective suckling slow deep sucks with pauses. If the attachment is not good, encourage the mother to reposition the baby.

Show the mother how to take the baby off the breast, by inserting her little finger into the corner of the baby's mouth. Keep encouraging and reassuring the mother the whole time. Encourage her to reposition the baby until she feels comfortable and the baby is sucking well. Reassure her that there is no need to rush, even if the baby is crying. All mothers should be encouraged to exclusively breastfeed their babies until they are six months old.

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Exclusive breastfeeding means that the baby is not given any other food or drink, not even water. They are only given breast milk. Make sure that you or others in the facility do not give the baby anything that will interfere with exclusive breastfeeding. To examine ways to improve how breastfeeding is supported and communicated to mothers. In many health facilities breastfeeding is supported in a of different ways. This activity is deed to get you and your colleagues to assess how you provide breastfeeding counselling and support, and what could be improved or strengthened.

Our View. Discussion of breastfeeding should start during pregnancy by asking women how they plan to feed the baby. At this time you do not need to overload women with too much information. Stick to the basic facts about the benefits of breastfeeding for the baby and for the mother.

Talk to women about the benefits of initiating skin-to-skin contact as soon as possible following the birth preferably within one hour to facilitate early initiation of breastfeeding.

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You should help the mother with the first breastfeed to show her how to position and attach the baby. Demonstrations are important as breasfeeding is a skill that mothers learn. Have dolls available to demonstrate position. Remember to provide as much support and reassurance as each woman needs - it will vary according to the woman. Consider how you might be able to provide support and reassurance to women once they have left the health facility and are at home.

Once home many women experience feeding problems such as engorged breasts or cracked nipples.

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Others may be pressured by family members to offer supplementary foods or drinks. How can you work with women to overcome some of these problems? One way is to talk with all family members on the importance of exclusive breastfeeding. You can also make sure you assess breastfeeding at any visit or meeting during the postnatal period. Also consider holding a special session for breastfeeding problems. Often in the community, groups exist to support women who are breastfeeding.

Find out what support exists, or contact women who have successfully breastfed and see if they would be available to support women after birth. Before discharge and if the mother returns to the health facility during the postnatal period you need to assess how breastfeeding is going.

You should also assess breastfeeding and provide relevant information during routine visits and at any time if there is feeding difficulty or the mother is concerned about feeding. Women need extra support, encouragement and reassurance while breastfeeding. Although we view breastfeeding as a natural process, it is still a skill that has to be learned. Babies however, begin to establish their own pattern over time, and the mother will begin to feel more comfortable and at ease.

Reassure them that this will pass. Reassure them that this is normal and that they may need to tell their husband or partner that this is normal. Sometimes husbands or partners may feel excluded from the breastfeeding process.

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Encourage them to be involved in other ways. This may ease the situation and help men to provide more support for breastfeeding; for example, by asking him to fetch the baby for the feed, helping make the woman comfortable, or looking after the other children while she is feeding.

Massaging the baby, and humming to calm a crying baby are other very useful ways of involving men. Many women find breastfeeding difficult due to problems such as engorgement or sore nipples. Engorgement may happen a few days after birth or at any time when the baby's feeding pattern changes. The breasts become overfull with milk and tissue fluid; milk does not flow well and the skin is tight especially the nipple.

This makes it difficult for the baby to latch on. Sometimes the skin looks red and the woman has a fever which usually disappears in 24 hours. To prevent engorgement, help women to start breastfeeding soon after birth, ensure good attachment and encourage unrestricted breastfeeding. To treat engorgement, recommend that the mother puts warm compresses on her breasts or takes a warm shower and expresses enough milk to reduce discomfort which helps make attachment easier.

After expressing milk she can use cold compresses to reduce the inflammation.

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Cracked or sore nipples occur mainly because the baby is not attaching properly. Help the mother to make sure the baby is attaching properly. Low birth-weight or preterm babies should be fed their mother's own breast milk. The mother may need extra support to initiate breastfeeding or expressing breastmilk as soon as possible after birth.

Because low birth-weight babies can sometimes get easily tired when feeding, it is particularly important that the mother feeds her baby as often as possible, responding to demand and at least 8 feeds during 24 hours, during the day and night.