ERACS and The Success of

Early Initiation of Breastfeeding

dr. Nenden Nursyamsi Agustina, SpA

Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Unsoed/
RSUD Prof Margono Soekarjo Purwokerto
 Outlines

01 02
Introduction Human Milk

03 04
Breastfeeding ERACS
05
Conclusion
 Introduction
● The prevalence of exclusive breastfeeding and early initiation of
breastfeeding in Indonesia, is still low 37.3% and 58.2%

● Cesarean delivery increased from 12.3% in 2012 → 17.0% in 2017 →

36% in 2019

● Women who gave birth by cesarean section were less likely to

breastfeed earlier
 Human Milk: an Orchestra of Benefits

Garssen J. Clinical Evidence for the Role of Prebiotics and Synbiotics in Immune Modulation. In: Abdul Latif AH, et all, editors. Perspectives and Updates on Food Allergy.
Niograph. Kuala Lumpur.2016
Kim SY, Yi DY. Components of human breast milk: from macronutrient to microbiome and microRNA. Clin Exp Pediatr. 2020;63(8)
 Bench Marking Complete Nutrition in Brain Development

Breast Milk ≅ Brain Composition

Protein = 5.2%
Carbohydrates = 39.4%
Fat = 55%

https://blogs.commons.georgetown.edu
 Physiology of Lactation

www.BrainKart.com
 Stages of Breast Milk

Antibodies + living immune cells → baby’s first dose of “natural vaccine”

- Foremilk < 15 minutes → fat

- Hindmilk > 15 minutes →  fat
 The Interactive Theory of Breastfeeding Model &
Recommendations

Meyer S. Using the Interactive eory of Breastfeeding to Promote Breastfeeding within the Indigenous Population.Nursing Capstones.2019; 226
 Ten Steps to Successful Breastfeeding
1. Maintain a written breastfeeding policy that is routinely communicated to all health care staff. 

2. Train all health care staff in skills necessary to implement this policy. 

3. Inform all pregnant women about the benefits and management of breastfeeding. 

4. Help mothers initiate breastfeeding within one hour of birth. 

5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their
infants. 

6. Give infants no food or drink other than breastmilk, unless medically indicated. 

7. Practice “rooming-in”—allow mothers and infants to remain together 24 hours a day. 

8. Encourage unrestricted breastfeeding. 

9. Give no pacifiers or artificial nipples to breastfeeding infants. 

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge 
from
the hospital or clinic.
 Factors Related to Successful Breastfeeding

Crucial Factors

Vaginal Delivery
or
C-Section

Early
Breastfeeding

Santana GS, et all. Factors associated with breastfeeding maintenance for 12 months or more: a systematic review. J. Pediatr. (Rio J.) vol.94 no.2 Porto Alegre Mar./Apr. 2018
The Effect of C-Section on Delay lactogenesis
Caesarean Section

Post operative pain Stress/fatique Blood loss Infant problems Early breastfeeding

Pain relief drugs Inhibit oxytocin Anemia RDS NICU admission

Separation from mother

Supress Decreased milk Breastfeesing

Stress hormone
Breastfeeding supply difficulties

Delay/Failure
Lactogenesis
 Cesarian Delivery on Early Breastfeeding Practices

Chen C, et all. Influences of Cesarean Delivery on Breastfeeding Practices and Duration: A Prospective Cohort Study. J Hum Lact;2018
 Early breastfeeding comparing all types of CD with VD

There was a negative association between prelabor CD and early breastfeeding

Prior E, et al. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr 2012; 95:1113–35.
 Why Do We Need ERACS?
● Multi-modal intervention

● Reduce operative stress

● Support organ function

● Reduced morbidity

● Accelerate convalence

“make artificial labor more physiological”

 Components of Enhanced Recovery Protocol for Cesarean Delivery

Ituk U and Habib AS. Enhanced recovery after cesarean delivery.F1000Research 2018, 7(F1000 Faculty Rev):513
 Benefits of ERACS

Better patient
Better bonding
experience

More family Better

centered breastfeeding

Less Reduction in
painfull/stressful length of stay
 Benefits for Babby

Temperature
management Skin to skin
contact
Psychological effects
Delayed cord Early
clamping Breastfeeding
 Continuation of any breastfeeding at 6 mo comparing all types
of CD with VD for mothers who initiated breastfeeding

If breastfeeding is initiated, mode of delivery has no apparent effect on the number of mothers
still breastfeeding at 6 mo.
Prior E, et al. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr 2012; 95:1113–35.
 Conclusion
● Breast milk is the best nutrition for the baby

● Early initiation of breastfeeding is one of the keys to

the success of exclusive breastfeeding

● ERACS has the potential to support early initiation

of breastfeeding
Thank You
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