Step 5: Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.

Every facility providing maternity services and care for newborn infants should:

Step 5: Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.

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Nursing staff should offer further assistance with breastfeeding within six hours of delivery and mothers should be shown how to express their milk or given written information on expression and/or advised where they could get help, should they need it...Mothers with babies in special care should be helped to initiate and maintain lactation by frequent expression of breastmilk...Staff should teach mothers positioning/attachment and techniques for manual expression of breastmilk.

Helping mothers to breastfeed effectively with a good technique is a vital step. If infants are separated from their mothers, or are unable to suckle, their mothers need to express their milk. Health workers need skills to help mothers do these things.

A situation can arise when the baby has to be separated from her mother for a specific medical reason. The fifth step is to show the mother how to maintain lactation by expression of breast milk or to visit her baby in the intensive case as often as possible.

What You Can Do.

Step 5: WABA Action Chart

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General
Helping mothers to breastfeed effectively with a good technique is a vital step. If infants are separated from their mothers, or are unable to suckle, their mothers need to express their milk. Health workers need skills to help mothers do these things.
Health System
Get to know the staff of maternity hospitals and primary care services in your area, show appreciation for their help for mothers, and make sure that they have the latest information.

Encourage them to show every mother how to position and attach her baby at the breast to prevent difficulties such as sore nipples and insufficiency of milk; and to teach all mothers to express their breast milk by hand, for comfort, to maintain their milk supply, and to ensure that babies can be fed with breast milk if they are separated. There is generally no need for a breast pump.
Community
Ensure that all mothers learn the techniques for breastfeeding and hand expression and how to overcome common difficulties.
National / Global
Advocate for skilled breastfeeding help to be available to all mothers as a routine part of Maternal and Child Health care, and for all health workers who care for mothers and babies to be trained to give effective help.

Key Points:

"Prenatal education should not influence group education on formula preparation."
"Prenatal education for those mothers who want information on formula preparation should take place on an individual basis."

Milk Production Cycle:

Milk removal stimulates milk production to maintain milk supply as required.
The baby's sucking stimulates the production of milk.
As long as the baby breastfeeds effectively, the mother will produce milk.
Milk removal must be continued during separation to maintain supply.

HIV Issues to Consider

Step 5: Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
Issues to consider while implementing this step in relation to feeding recommendations for children of HIV-infected mothers and for settings with high HIV prevalence.

Staff members will need to counsel mothers who have chosen to breastfeed (regardless of their HIV status) on how to maintain lactation by manual expression, how to store their breast milk safely, and how to feed their babies by cup.
They will also need to counsel HIV-positive mothers on locally available feeding options and the risks and benefits of each, so they can make informed infant feeding choices.
Staff members should counsel HIV-positive mothers who have chosen to breastfeed on the importance of doing it exclusively and how to avoid nipple damage and mastitis.
Staff members should help HIV-positive mothers who have chosen to breastfeed to plan and implement early cessation of breastfeeding.
Staff members will need to counsel HIV-positive mothers who have chosen replacement feeds on their preparation and use and how to care for their breasts while waiting for their milk to cease and how to manage engorgement.
Mothers should have responsibility for feeding while in the hospital. Instructions should be given privately.
Breast milk is particularly valuable for sick or low birth weight infants. Heat treating breast milk is an option.
If there is a breast-milk bank, WHO guidelines will need to be followed for heat treatment of breast milk. Wet nursing is an option as well, if the wet nurse is given proper support.
Staff members should try to encourage family and community support of HIV-positive mothers after discharge, but will need to respect the mothers' wishes in regards to disclosure of their status.