“LACTATION

MANAGEMENT
TRAINING”
 Rationale
In the Philippines, particularly, in our municipality, the problem is that most mothers are
not practicing breastfeeding early enough nor long enough to meet the needs of their
infants for good health. These result invidious child health problems which are so difficult
to solve once it has started.
It is now well accepted that breastfeeding can make major contribution to
lowering infant morbidity and mortality and also improving maternal health.
Breastfeeding infants have 21/2 times fewer illnesses and are 25 times less likely to die
from diarrhea. Likewise, mother who exclusively breastfeeding for 4-6 months have
delayed ovulation and this act as a natural birth spacer providing 30% more protection
against pregnancy. These advantages have made breastfeeding the simplest strategy for
effective implementation of safe Motherhood Program.
For successful breastfeeding promotion, health care providers (physicians, nurses,
midwives and support group) need to relearn and understand the complexities of
lactation, physiology and breastfeeding behaviors, so they can apply this knowledge to
the clinical care of mothers and infants, hence, this training on lactation management is
designed.
Objective

 After this lactation management training, the participants are

expected to:
 Disseminate the benefits of breastfeeding.
 Enumerate the policies and procedures of breastfeeding.
 State the disadvantages of pre-lacteals feeding.
 Be able to teach mothers on manual milk expression and
breastfeeding techniques.
 Demonstrate milk baking and milk collection and storage
procedure.
 Practice breastfeeding fertility and child spacing.
Introduction to breastfeeding.

Babies should be breastfed and/or receive expressed human

milk exclusively for the first six months of life. Breastfeeding
should continue with the addition of complementary foods
throughout the second half of the first year.

- The American Academy of Pediatrics

Anatomy of the breast
Mammary glands
 The mammary glands are accessory glands
present in the chest with specialized functions.
It is an apocrine type of gland and its main
function in females is to secrete milk.
 The mammary glands are predominantly
located in the pectoral region of the chest.
However, a part of the mammary gland, known
as the axillary tail, extends to the axilla, which
is the region below the armpits.
Ducts

 The ducts are the tubes that carry milk from the lobules
to the nipple. A collection of lobules along with a duct
form the terminal ductal lobular unit. There are many
terminal ductal lobular units present in the breast. Most
breast cancers start in the terminal ducts and are known
as ductal cancers.
 The ducts are the tubes that carry milk from the lobules
to the nipple. A collection of lobules along with a duct
form the terminal ductal lobular unit. There are many
terminal ductal lobular units present in the breast. Most
breast cancers start in the terminal ducts and are known
as ductal cancers.
 Areola
The areola is the darker, pigmented, round area
around the nipple. The areola has small bumps on
its surface. These are sebaceous glands that
release oily secretions that stop the areola and
nipple from cracking.
Nipple
The nipple is the raised projection in the
middle of the areola. About 15–20 ductsTrusted
Source connect to the nipple. The nipple
provides an exit for milk release during
breastfeeding. The nipple also contains smooth
muscles that can cause the nipple to become
erect.
Fatty tissue

Fatty tissue, along with fibrous tissue,

makes up the connective tissue that
holds all the structures within the
breasts in place. The fatty tissue fills
the space between glandular (lobes
and ducts) and fibrous (ligaments)
tissue.
From colostrum to milk
 Baby suckling stimulates milk
 Milk comes in 3-4 days postpartum
 Breasts may leak
 Breasts feel full with possible engorgement
 Baby swallows more
 Breastfeeding Benefits for Mom
 Less postpartum bleeding
 Lowers the risk of anemia
 Increased caloric intake
 Produces naturally soothing hormones

 Lessens the risk of osteoporosis

 Lowers the risk of breast, ovarian, and uterine cancers
 Delays menstruation
 Breastfeeding Benefits for Baby
 Less spit up, gas, diarrhea, and constipation
 Healthier from the start
 Stronger immune system
 Better vision
 Lowers the risk of Sudden Infant Death
Syndrome (SIDS)
 Benefits of Skin to Skin
 Allows mom to see feeding cues
 Increases milk production
 Decreases crying and provides comfort
 Regulates baby’s heart rate, temperature, and blood
sugar
 Increases baby/caregiver bonding
Feeding cues:
 Rooting, turning head toward the breast
 Sucking on hand or thumb
 Smacking lips
 Tongue movements
 Restlessness
 Crying
POSITIONING
 POOR ATTACHMENT
 baby's mouth is not open wide.
 baby's lips are curled inwards.
 baby has only the nipple or a small amount of breast in the mouth.
 you hear a clicking sound when baby is sucking.
 you do not hear or see swallowing.
 you feel pain when breastfeeding.
 MOTHER-BABY FRIENDLY
HOSPITAL BREASTFEEDING
POLICY

The Mother-Baby Friendly Health Initiative - hospital breastfeeding

policy promotes, supports and encourages breastfeeding as the
optimal way for a woman to feed her baby. The hospital
acknowledges that breastfeeding offers important health benefits
for both the mother and child.
OBJECTIVE:

 To enable the staff to create an environment where more women

choose to breastfeed their babies, and are given sufficient information
and support to enable them to breastfeed exclusively for six months,
and then as a part of their infant’s diet beyond the first year of life.
 To ensure the health benefits of breastfeeding and the potential health
risks associated with formula feeding are discussed with all women and
their families, so they can make an informed choice about how they will
feed their babies.
 To encourage consistent, comprehensive and evidence based
breastfeeding information that is provided to parents by all health care
staff.
SCOPE:
This policy is directed to all health care staff and mothers
of babies to adhere to the Baby Friendly Health Initiative -
hospital breastfeeding policy.

POLICY:

The Mother-Baby Friendly – hospital breastfeeding

policy principles reflect the key elements of the
“Ten Steps to Successful Breastfeeding”.
 POLICY ON MOTHER- BABY FRIENDLY
HOSPITAL
 The hospital shall implement the ten steps to Successful Breastfeeding.
 Written breastfeeding policy is routinely communicated to all health care staff.
 Health care staff are trained in skills necessary to implement the policy.
 Pregnant women are informed about the benefits and management of breastfeeding.
 Help mothers initiate breastfeeding within half-hour of birth.
 Show mothers how to breastfeed, and how to maintain lactation even if they are
separated from their infants.
 Give newborn infants no food or drink other than breast milk, unless medically indicated.
 Practice rooming-in –allow mothers and infants to remain together 24hours a day.
 Encourage breastfeeding on demand.
 Give no artificial teats or pacifiers to breastfeeding infants.
 Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital.
The health facility shall not accept free supplies or samples and no
promotional materials from companies that manufacture or distribute breast
milk substitutes
The hospital shall foster optimal feeding and care for those infants that are
not breastfeed.
Mothers will be taught what kind of replacement feeding is acceptable,
feasible, affordable, sustainable and safe (AFASS) in her situation
How to obtain, prepare and feed the replacement feeds safely shall be
advised to mothers.
BREASTFEEDING POLICY Breast milk is the ideal food for babies. Health facilities should practice the following to protect, promote and support breastfeeding.

 All hospital personnel shall follow and promote breastfeeding policies. These policies
should be ported in strategic areas in the hospital for guidance.
 Health care staff and personnel is required to attend lactation management training and
refresher courses every six (6) months thereafter.
 Pregnant women and mother of infants should be informed about the benefits of
breastfeeding thru health education, pre-natal checkup and mother’s class
 Newborns should be put to mother’s breast immediately after delivery.
 All healthcare staff shall continue assisting post-partum mothers to breastfeed
successfully.
 All newborns should be given with breast milk exclusively.
 Mothers and their infants should stay together 24hours a day to continue breastfeeding.
 Mothers should breastfeed whenever the child needs it anytime.
 Feeding bottles, artificial teats, pacifiers or milk formula shall not be allowed inside the
hospital.
 Establish/ create breastfeeding support group composed of barangay workers where
breastfeeding and post-partum mothers are referred for follow up.
The Mother-Baby Friendly – hospital
breastfeeding policy principles reflect the key
elements of the
“Ten Steps to Successful
Breastfeeding”.
Step 1: Have a written breastfeeding policy that is routinely communicated
to all health care staff.

 The Mother-Baby Friendly -hospital breastfeeding policy should be communicated to all

health care staff in contact with pregnant women and mothers. All staff will be able to
access a copy of the Mother-Baby Friendly-hospital breastfeeding policy or information
flyer.
 Newly hired staff should be orientated on how to locate the Mother-Baby Friendly- hospital
breastfeeding policy and provided with a copy of the information flyer at orientation.
 The information flyer should be displayed in all areas throughout the hospital.
Step 2: Train all health care staff in the skills
necessary to implement this policy.
 All health care staff and support staff who have contact
with pregnant women and mothers should be trained in
breastfeeding management at a level appropriate to their
professional group.
 All clerical and ancillary staff should be orientated to the
policy and receive training to enable them to refer
breastfeeding queries appropriately.
 Refresher course should be six months thereafter.
Step 3: Inform all pregnant women about the benefits and
management of breastfeeding.

 All pregnant women should be given the opportunity to discuss infant

feeding on a one-to-one basis with a health care staff.

 All pregnant women should be provided with information on breastfeeding

and counseled on the importance of breastfeeding, contraindications to
breastfeeding, management of breastfeeding and the potential risks of
formula feeding.
Step 4: Place babies skin to skin contact with their mothers immediately
following birth for at least an hour and encourage mothers to recognize
when their babies are ready to breastfeed, offering help if needed.

 The health care staff should encourage all mothers to hold their babies with skin to skin
contact immediately after birth and continues for at least an hour.

 If skin to skin contact is interrupted for clinical reasons, it should be commenced/resumed

as soon as mother and baby are able.

 All mothers should be encouraged to offer the first breastfeed when the mother and baby
are ready.

 Mother and baby shall remain together throughout the entire hospital stay. Frequent skin-
to-skin contact should be encouraged.
Step 5: Show mothers how to breastfeed and how to maintain
lactation even if they are separated from their infants.

 Health care staff should ensure that mothers are offered the support necessary to
acquire the skills of positioning their baby to ensure effective attachment for
successful breastfeeding. They should be able to explain the necessary technique to
the mother, thereby helping her acquire this skill for herself.

 All breastfeeding mothers should be shown how to hand express their milk during
periods of separation from her baby, It is the responsibility of the health care staff
caring for both mother and baby to ensure the mother is given help and
encouragement to express milk and maintain lactation.

 The health care staff should encouraged mothers who are separated from their babies
to express milk at least six to eight times in a 24 hour period. They are shown how to
express by hand and pump.
Step 6: Give newborn infants no food or drink other than breast milk, unless
medically indicated.

 Health care staff should encourage all mothers to breastfeed exclusively for at least six
months and continue breastfeeding for at least the first year of life.

 The baby should not receive water or formula except in cases of medical indication and is
prescribed by a medical practitioner.

 If a mother requests that her breastfeeding newborn receive formula, staff shalll:
a. Explore with the mother her reasons for this request and address her concerns
b. Educate the mother about the negative consequences of feeding infant formula

 Extra effort should be made to encourage mothers to express breast milk, for
supplementation, if extra fluids or calories are required.
Step 7: Practice rooming-in, allow mothers and infants to remain
together 24 hours a day.

 All mothers and infants shall room-in together, including at night, regardless of feeding
preference.

 Separation of mothers and infants shall occur only if medically indicated and
justification is documented in the chart.

 Routine newborn procedures should be performed at the mother’s bedside.

 Mothers should be encouraged to continue to keep their babies near them when they
are at home, so they can learn how to interpret their baby’s needs and feeding cues.
Step 8: Encourage breastfeeding on demand

 Mothers should be taught: (1) to recognize infant feeding cues, (2)

that infants should feed on-demand, and (3) appropriate
expectations for feedings post-partum.

 No restrictions should be placed on mothers regarding frequency or

duration of breastfeeding unless clinically contraindicated.
Step 9: Give no artificial teats or dummies to breastfeeding infants.

 Use of feeding bottles, artificial teats and pacifiers should not be allowed in the hospital.

 Mothers should be advised of the detrimental effects of using feeding bottles, artificial teats
and pacifiers.

Step 10: Foster the establishment of breastfeeding support groups and refer
mothers to them on discharge.

 Breastfeeding mothers should be referred to community breastfeeding resources and

support groups composed of barangay workers for follow-up.
IMPORTANCE OF ROOMING-IN:
Proper technique for expressing milk by hand:
1.Position your thumb above the nipple and your fingers
below the nipple about 1-2 inches behind your nipple. ...
2.Press your fingers and thumb back toward your chest.
3.Gently compress your fingers and thumb together.
4.Release and then repeat in a rhythmic pattern: Press,
Compress, Release.
 Guidance on applying
The “Ten Steps” for
the “Ten Steps” in
Successful
facilities with high
Breastfeeding
HIV prevalence
Step 1: Have a written policy
on breastfeeding that is
routinely communicated to all
health care staff.
Expand the policy to focus on
infant feeding, including
guidance on the provision of
support for HIV positive
mothers and their infants.

Step 1: Have a written policy on breastfeeding that is routinely

communicated to all health care staff.
Step 2: Train all health care staff in Ensure that the training includes
skills necessary to implement this information on infant feeding
policy. options for HIV-positive women
and how to support them.
Step 3: Inform all pregnant women about
the benefits and management of
breastfeeding.
Where voluntary testing and counselling for
HIV and PTMCT is available, counsel all
pregnant women on the benefits of
knowing their HIV status so that, if they are
positive, they can make informed decisions
about infant feeding, considering the risks
and benefits of various options. Counsel
HIV-positive mothers on the various feeding
options available to them and how to select
options that are acceptable, feasible,
affordable, sustainable and safe. Promote
breastfeeding for women who are HIV
negative or of unknown status.
Step 4: Help mothers initiate Place all babies in skin-to-skin
breastfeeding within a half-hour of contact with their mothers
birth. immediately following birth for at
least an hour. Encourage mothers
who have chosen to breastfeed to
recognize when their babies are
ready to breastfeed, offering help
if needed. Offer mothers who are
HIV positive and have chosen not to
breastfeed help in keeping their
infants from accessing their
breasts.
Step 5: Show mothers how to
breastfeed, and how to maintain
lactation even if they should be
separated from their infants.
Show mothers who have chosen to
replacement feed how to prepare
and give other feeds, as well as how
to maintain optimal feeding
practices and dry up their breast
milk while maintaining breast
health.
Step 6: Give newborn infants no
food or drink other than breast
milk, unless medically indicated.
Counsel HIV positive mothers on
the importance of feeding their
babies exclusively by the option
they have chosen (breastfeeding or
replacement feeding) and the risks
of mixed feeding (that is, giving
both the breast and replacement
feeds).
Step 7: Practise rooming-in — allow Protect the privacy and confidentiality
mothers and infants to remain of mother’ HIV status by providing the
together — 24 hours a day. same routine care to all mothers and
babies, including rooming-in.

Step 8: Encourage breastfeeding on Address the individual needs of

demand. mothers and infants who are not
breastfeeding, encouraging
replacement feeding at least 8 times a
day.
Step 9: Give no artificial teats Apply this step for both
or pacifiers (also called breastfeeding and non-
dummies or soothers) to breastfeeding infants.
breastfeeding infants.
Step 10: Foster the establishment of Provide on-going support from the hospital or
breastfeeding support groups and refer mothers clinic and foster community support for HIV
to them on discharge from the hospital or clinic. positive mothers to help them maintain the
feeding method of their choice and avoid mixed
feeding. Offer infant feeding counselling and
support, particularly at key points when feeding
decisions may be reconsidered, such as the
time of early infant diagnosis and at six months
of age. If HIV positive mothers are
breastfeeding, counsel them to exclusively
breastfeed for the first 6 months of life unless
replacement feeding is acceptable, feasible,
affordable, sustainable and safe for them and
their infants before that time.
“A newborn baby has only three demands. They
are warmth in the arms of its mother, food from
her breasts and security in the knowledge of
her presence. Breastfeeding satisfies all three.”
-Grantly Dick-Read
THANK
YOU….