RLE: BREASTFEEDING – NEWBORN CARE
BREASTFEEDING
▪ Universally agreed that HUMAN
MILK is the preferred food for
newborns because it provides
numerous health benefits to both the
mother and infant.
▪ Remains the ideal nutritional
source for infants through the first
year of life.
NURSES are prime healthcare
professionals to teach women about the
benefits of breastfeeding
PHYSIOLOGY OF BREASTMILK
PRODUCTION
• Breast milk is formed in the
acinar or alveolar cells of the
mammary glands
• After delivering the placenta,
level of progesterone in a
woman’s body falls
dramatically, stimulating the
production of prolactin, an
anterior pituitary hormone
Prolactin – acts on the acinar
cells to stimulate the production of
milk
• Infant sucking = nerve impulses
from nipple to hypothalamus
stimulate production of
prolactin releasing factor.
• Colostrum
- thin, watery, yellow fluid
composed of protein, sugar, fat,
water, minerals, vitamins, and
maternal antibodies
- Secreted by the acinar breast
cells
- Easy to digest and capable of
providing adequate nutrition
until it is replaced by
transitional breast milk.
• Fore Milk – constantly forming
milk
• Oxytocin – released from the
posterior pituitary as baby
suck, causing mammary glands
to contract, forcing milk
forward through the nipples
(LET-DOWN REFLEX) – may
also be triggered by the
sound of a baby crying
- Causing smooth muscle
contraction, helps contract the
uterus
• Hind Milk – “new milk”; formed
after the let-down reflex
- Higher in fat than fore milk, and
makes a breastfed infant grow
most rapidly
BREASTFEEDING
CONTRAINDICATIONS
• An infant with Galactosemia (cannot
digest the lactose in milk)
• Herpes lesions on a mother’s
nipples
• Maternal exposure to radioactive
compounds (thyroid testing)
• Mothers receiving antimetabolites
or chemotherapeutic agents
• Mothers receiving prescribed
medication that would be harmful
to an infant (lithium/methotrexate)
• Active, untreated tuberculosis
• HIV positive
**The risk of not breastfeeding
outweighs the risk of breast milk
transmission of the virus
• Toxicology screens for substance
abuse is positive.
• Breastfeeding medicine
 RLE: BREASTFEEDING – NEWBORN CARE
ADVANTAGES OF
BREASTFEEDING FOR WOMEN
➢ Release of oxytocin aids in uterine
involution
➢ A protective function in preventing
breast cancer and possibly
ovarian cancer.
➢ May serve as a temporary family
planning method (LAM)
➢ Empowering effect
➢ Cost and time efficient
➢ Decreased risk of hip fractures
and osteoporosis
➢ Excellent opportunity to enhance a
true symbiotic bond between
mother and child
ADVANTAGES OF
BREASTFEEDING TO INFANTS
Immunonoglobulin A (IgA) – binds
large molecule of foreign proteins
Lactoferrin – an iron-binding protein
in breastmilk that interferes with
growth of pathogenic bacteria
Lysosome – actively destroys
bacteria
Leukocytes - provide protection
against common respiratory infectious
invaders
Lactobacillus bifidus (probiotic) -
specific growth-promoting factor
Ideal electrolyte and mineral – for
human infant growth
Lactose – an easily digested sugar
that provides ready glucose for rapid
brain growth
Protein – easily digested
Nitrogen – an infant can receive cell-
building materials from sources other
than just protein
Linoleic acid – an essential fatty acid
for skin integrity
Zinc – enough to supply the infant’s
needs
➢ Appear to be able to regulate their
calcium/phosphorus levels better
(decreased calcium may lead to
tetany or muscle spasm)
➢ Increased concentration of fatty
acid in commercial formulas may
bind calcium in the gastrointestinal
tract.
➢ Help prevent excessive weight
gain in infants
➢ Exclusive breastfeeding into the
infant’s fourth month can
decrease obesity as late as
adolescence
TECHNIQUES OF BREASTFEEDING
BEGINNING BREASTFEEDING
o Skin-to-skin contact
- placing undressed infant on the
mother’s chest against her
skin; when placed like this,
infant will root toward the nipple
and initiate a latch
- should be initiated within the
first hour of delivery
o Pumping with a hospital grade
pump or manual expression: an
alternative method to provide
breast milk to a newborn who is
unable to latch or separated
- Consists of supporting the
breast firmly then placing the
thumb and forefinger, first
pushing backward toward the
chest wall and then downward
until secretions begin to flow
 RLE: BREASTFEEDING – NEWBORN CARE
PROLONGED JAUNDICE IN
BREASTFED INFANTS
Hyperbilirubinemia – excess buildup of
bilirubin
- Women should feed frequently in
the immediate postpartum period
because colostrum is a natural
laxative and helps promote
passage of both meconium and
bile.
NURSING INTERVENTION
1. Provide Information regarding
lactation and proper positioning
techniques
a. The side-lying position –
mothers can rest while feeding;
difficult as initial feeding position
b. Sitting position – pillow under
the newborn
c. Football hold – supported on a
pillow; helpful if a mother has a
cesarean birth; helpful if the baby
has difficulty latching due to large
breasts or less prominent nipples
Rooting reflex – stimulated by
brushing the infant’s cheek with a
breast nipple; turning towards the
breast
Feeding cues – mouth opening,
eyes open, bringing hands to mouth
Frequent feeding – advantageous
to establish a milk supply
Release suction – insert a clean
finger in the corner of the infant’s
mouth or pull down the infant’s chin
2. Promote adequate sucking
▪ Breastfeeding newborn becomes
sleepy at the breast in the first 24
hours of life; Jaundice and
hypoglycemia causes sleepiness
at the breast as well
▪ Mother should keep the infant
awake to stimulate milk
production and ensure adequate
breast milk intake.
3. Provide information regarding
techniques for burping the
breastfed baby
▪ some infants swallow little to
great deal of air when
breastfeeding
▪ burp every after feeding by
laying the baby prone across the
lap or holding the baby in a sitting
position on the lap – supporting
the baby’s head and the other
patting the back
4. Support for a mother who is
breastfeeding multiple infants
Fatigue – sit in a comfortable chair
with feet elevated; good fluid intake
is necessary to maintain adequate
milk supply
– drink at least four 8-oz glasses
fluid a day; drink six glasses
– increase calorie intake by about
500
– avoid eating
uncooked/undercooked food
– avoid alcohol and caffeine
 RLE: BREASTFEEDING – NEWBORN CARE
COMMON CONCERNS OF
BREASTFEEDING PARENTS
Mother worries about amount of milk
being taken
Infant does not suck well
Mother reports infant’s stools are
loose and thin
Father feels shut out of parent-child
relationship
Mother reports sore nipples
Mother reports engorgement
BABY-FRIENDLY HOSPITAL
INITIATIVE (BFHI)
▪ An effort by UNICEF and the WHO
to designate maternity facilities as
‘baby-friendly’
PROGRAM GOALS
Encourage optimal breastfeeding
practices through prolonged,
exclusive and early initiated
breastfeeding
Proven to protect infants against
different infectious and chronic
diseases and essential for
cognitive development
THE PHILIPPINES
➢ Mother-Baby Friendly Hospital
Initiative (MBFHI) – Filipino
version of the initiative; launched by
the DOH in 1992 in line with the
Rooming-in and Breastfeeding Act of
1992 (RA 7600)
➢ RA 7600 – all private and
government private hospitals offering
maternity and newborn care may be
accredited as Mother-Baby Friendly
if they implement the 10 steps to
Successful Breastfeeding from
UNICEF/WHO criteria of BFI
▪ DOH accredited 83% of 1,700
targeted hospitals in the mid-1990s
▪ “Rooming-in and Breastfeeding
Act” of 1992 – rooming-in shall be
observed within 30 minutes after
birth
➢ ADMINISTRATIVE ORDER NO.
2007-0026 – revitalization of the
mother-Baby Friendly Hospital
Initiative in Health Facilities with
Maternity and Newborn Care
Services
➢ EXECUTIVE ORDER NO. 51 –
“National Code of Marketing of
Breastmilk Substitutes, Breastmilk,
Supplements, and Related Products”
➢ PHIC CIRCULAR NO. 26 S.2005 –
Included the mother-Baby friendly
hospital initiative as part of its
accreditation requirements for all
hospitals
➢ ADMINISTRATIVE ORDER NO.
2005-0023 – Identified Fourmula
One for Health as the implementing
mechanism for health sector reforms
➢ REPUBLIC ACT NO. 10028 –
“Expanded Breastfeeding
Promotion Act” of 2009
▪ An act providing incentives to all
health institutions
 RLE: BREASTFEEDING – NEWBORN CARE

▪ let the baby

sleep on his
IMPLEMENTING GUIDELINES: back or side
▪ keep the baby
A. Steps to a Mother-Friendly/Safe away from
Motherhood Initiative smoke or
B. Ten steps to Successful people smoking
Breastfeeding ▪ keep the baby
C. Responsibilities of the Hospital away from sick
children or
Staff Relative to EO 51 adults
D. Capacity Building
E. Roles and Responsibilities
NEWBORN CARE CORD CARE
POSTNATAL ENVIRONMENT ▪ wash hands before and after cord
care
▪ 25-28°C is required to help keep ▪ DO NOT put anything on the
the newborn warm umbilical cord stump
▪ Mother and Baby should be kept ▪ Fold the diaper below the stump
together from birth, in bed or ▪ Keep the stump loosely covered
very near each other to help get to with clean clothes
know her newborn and form an ▪ Is stump is wet, wash it with clean
early close loving relationship water and soap then dry
▪ Make sure the newborn is thoroughly with clean cloth
sleeping on his/her back and ▪ Explain to the mother that she
NOT on his front should seek care if umbilicus is red
▪ Use of bed nets or draining pus or blood
▪ DO NOT bandage the stump or
abdomen
EVERYDAY CARE OF THE ▪ DO NOT apply any substances or
NEWBORN medicine to stump
✓ Support ▪ Bathe the baby ▪ AVOID touching the stump
exclusive ▪ Wash the baby unnecessarily
breastfeeding in a warm,
day and night draft-free room
✓ Counsel the ▪ use warm water
mother on for bathing NEWBORN EXAMINATION:
breastfeeding ▪ wash the baby’s
and proper face, neck, ▪ Allows to assess and monitor the
positioning and underarms daily newborn’s condition and give prompt
attachment ▪ wash the and appropriate care and treatment
✓ Skin-to-skin; if buttocks when as early as possible
not, wrap baby soiled; dry
in a clean, dry, thoroughly STEPS
warm cloth ▪ use the bed net
day and night o Assess – gathering information
for a sleeping o Ask, Check Record – mother and
baby newborn’s information
 RLE: BREASTFEEDING – NEWBORN CARE

o Look, Listen, Feel, Record ➢ Vital Signs

Look – visual examination ▪ Temperature (36.5 – 37.5°C)
Listen – Breathing sounds ▪ Heart Rate (120 – 160 bpm)
(grunting, cry) ▪ Respiratory Rate (30 – 60)
Feel – assessing for warmth ➢ Weight
Record – documentation ▪ 2,500 grams or more (up to 4kg)
o Classify
Normal – advice for home care and
PHYSICAL EXAMINATION
follow-up
Problem – treatment can be given o Check for breathing difficulties
without the need for referral o Look at the head, trunk and all limbs
Emergency – requires immediate of the baby
treatment or referral to a higher- o Check for abdominal distention
level facility o Check for possible birth injuries
(bumps, bruises and swelling,
ASSESSING THE NEWBORN
position of legs, arm movement)
➢ APGAR Score o If above birth injuries are present,
A standardized evaluation of explain to parents that these are
newborn’s condition to determine likely to disappear in a week or two,
how well the newborn s adjusting to and do not need special treatment
extrauterine life o Look for malformations (club foot,
1-minute score – determines how odd/unusual appearance, open
well the baby tolerated the birthing tissue on head, abdomen or back, no
process anal opening, etc)
5-minute score – tells how well the • If present, REFER and:
baby is doing outside the mother’s ✓ Cover any open tissue
womb with sterile gauze and
A – Appearance INTERPRETATION: keep warm before referral
P - Pulse ✓ Pass a nasogastric tube if
0-3 = In serious danger, needs
G - Grimace immediate resuscitation the baby has an
A - Activity abdominal malformation or
4-6 = condition is guarded
R – Respiration no anal opening (Keep it
7-10 = in best possible health open during transport to
minimize risk of abdominal
➢ Anthropometric Measurements: distention or bloating)
▪ Length (48.5 – 53.75 cms) o Look for signs of fracture
▪ Head Circumference (33-35 o Look at the baby’s skin for
cms) cuts/abrasions
▪ Chest Circumference (31-33 o Look into the baby’s mouth for cleft
cms) palate of lip
▪ Abdominal Circumference (30- o Inform the mother of your
32 cms) examination findings