a.     Provide appropriate, culturally sensitive and supportive labour companionship to mothers

b.    Encourage non-pharmacologic measures to help support women through labour (massage, aromatherapy, water injections, movement)

c.     Allow delivery to occure in the position preferred by the mother

d.    Dry the baby quickly, preserving the natural white cream (vernix) that soothes a baby’s new skin

e.     Place the baby bare skin-to-skin on mother’s bare chest, facing her and cover them together

f.      Allow the baby to seek the breast. The mother will stimulate the baby with her touch and may help position the baby closer to the nipple (Do not force the baby to the nipple)

g.    Keep the baby skin-to-skin with the mother until the first feeding is accomplished and as long as she desires thereafter

h.    Women who have surgical births should also have their infants skin-to-skin after delivery

i.      Delay intrusive or stressful procedures. The baby should be weighed, measured and given preventive medications AFTER the breastfeed

j.      No pre-lacteal liquids or feeds should be given unless there is a clear medical indication

A.   Colostrum is not good or even dangerous for babies. NO!

Colostrum is physiological and essential for the new born:

a.     First immunization- protects against intestinal and other infections

b.    Cleans up mucosa and reduce the severity of jaundice

B.    Infants need special teas or other fluids before breastfeeding. NO!

Any pre-lacteal feeds (feed given before breastfeeding has started) increase the infant’s risk of infection, reduce the likelihood of exclusive breastfeeding and shorten the duration of breastfeeding.

C.   Babies will not get enough food or fluid with only colostrums and breastmilk. NO!

Colostrum is sufficient for a baby’s first feeds. It is normal for a newborn to lose 3-6% of birth weight.

D.   Baby will get too cold. NO!

Babies are at safe temperatures when skin-to-skin with their mothers. Amazingly, the mother’s breast temperature rises 0.5 degrees C within 2 minutes of having the baby on her chest.

E.    Mothers are too exhausted after labour and delivery to feed their baby immediately. NO!

The surge of oxytocin that comes with skin-to-skin contact and breastfeeding helps to calm a mother after the birth of her baby.

F.    It is very important to suction the baby’s mouth, nose and oropharynx before the first breath to prevent inhaling birth fluids, especially if the baby had a bowel movement during the labour. NO!

Suctioning the normal healthy newborn does not reduce the occurrence of meconium aspiration and may injure the tissue of the mouth, throat or vocal cords. Gastric suction also interferce with breastfeeding.

G.   Vitamin K and medication to prevent gonorrhea eye infection must be given immediately after birth. NO!

The American College of Obstetrics and Gynaecology and the Academy of Breastfeeding Medicine state that these important preventive measures can be delayed for as long as an hour, until after the baby has breastfed, without risk to the infant. They should not in any case require separation of mother and baby.

H.   Women require pharmacologic intervention to cope with the pain of labour. Normally, NO!

Use of labour analgesia/anaesthesia may sedate the baby, hindering breast-seeking behavior and delaying initiation of breastfeeding for hours or days. Use of complementary therapies including having a companion during labour help women to cope with the pain and the obstetric outcome may be improved.

I.     It requires too much work and time to help the mother during this time. NO!

While the baby is on the mother’s chest, the both attendant can continue to do the usual assessment of mother and baby or other duties. The baby will find his or her own way to the breast.

Even women for whom replacement feeding is Acceptable, Feasible, Affordable Sustainable and Safe (AFASS) and who choose not to breastfeed, should have skin-to-skin contact with their babies. These mother-infant couples are particularly vulnerable. Skin-to-skin contact provides a special closeness, beginning the mother-child relationship.

If conditions are not AFASS, it is very important for mothers and infants to have skin-to-skin contact immediately after birth and to start breastfeeding in the first hour. For these babies, exclusive breastfeeding carries a lower risk of mother to child transmission of HIV than mixed feeding.

Remember: For women of unknown HIV status, exclusive breastfeeding is recommended. 

At the United Nations Millennium Summit in September 2000,b world leaders agreed on critical goals related to child mortality and hunger. Many of the poorest nations are lagging behind in reaching these MDGs. Initiating breastfeeding in the first hour can help achieve MDG#1 and #4. This was reconfirmed at the UN Standing Committee on Nutrition in 2003, where those assembled called for a global indicator for early initiation of breastfeeding.

MDG #1: Eradicate extreme poverty and hunger – reduce by half the proportion of people who suffer from hunger

Starting to breastfeed in the first hour of life is associated with increased rates of exclusive breastfeeding and longer duration of breastfeeding. This contributes significantly to meeting children’s nutritional needs during the first two years of life, thus preventing malnutrition and stunting which usually have their origin at this age.

MDG #4: Reduce child mortality- reduce by two-thirds the mortality rate among children under five

Most child deaths are caused by diarrhea and respiratory illness, which are more common and more serious with suboptimal breastfeeding. 8 about 45% of the deaths occur in the first month of life, which is a major barrier to attaining this MDG. Breastfeeding in the first hour could reduce newborn deaths and increasing optimal breastfeeding could reduce overall child mortality.

Preventing engorgement

• Fullness is normal in the early days. Over-fullness is not normal.

• Follow the practices:

- Facilitate skin-to-skin contact immediately after birth and initiate exclusive, unlimited breastfeeding within one hour after birth

- Show mothers who need help how to attach their baby at the breast - Show mothers how to express their milk

- Breastfeeding exclusively with no water or supplements - Keep mothers and babies together in a caring atmosphere - Encourage babies to feed at least 8-12 times in 24 hours during the early days

- Give no pacifiers, artificial teats, or bottles

Treating engorgement

• Remove the breast milk and promote continued lactation.

• Correct any problems with attachment.

• Gently express some milk to soften the areola and help the baby's attachment.

• Breastfeed more frequently.

• Apply cold compresses to the breasts after a breastfeed for comfort.

• Build the mother’s confidence and help her to be comfortable.