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    <meta name="author" content="Denise Fisher" />
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      <h1 id="top">2.1 Preparation Before Birth</h1>
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            <td class="body"><img src="images/key_icon.gif" class="icon" alt="" /><h3>Key Points - Case Study B</h3>
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			Joanne asks you what she can do before the baby is born to help her successfully breastfeed.
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			The <cite>Ten Steps to Successful Breastfeeding</cite>, designed by the <img alt="External" src="design/external.gif" /><a href="http://www.who.int/en/" title="External link" target="_blank">WHO</a> and <img alt="External" src="design/external.gif" /><a href="http://www.unicef.org/" title="External link" target="_blank">UNICEF</a> summarise the maternity practices needed to support and encourage breastfeeding.
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		<dl><dt><a href="topic_2-1.html"><cite>Topic 2.1: Preparation Before Birth</cite></a></dt><dd class="topic-paragraph">Inform all pregnant women about the benefits and management of breastfeeding</dd></dl>
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			The <cite>Ten Steps to Successful Breastfeeding</cite>, designed by the <img alt="External" src="design/external.gif" /><a href="http://www.who.int/en/" title="External link" target="_blank">WHO</a> and <img alt="External" src="design/external.gif" /><a href="http://www.unicef.org/" title="External link" target="_blank">UNICEF</a> summarise the maternity practices needed to support and encourage breastfeeding.
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		<p class="listTitle">Every facility providing maternity services and care for newborn infants should:</p><ol><li>Have a written breastfeeding policy that is routinely communicated to all health care staff.</li><li>Train all health care staff in skills necessary to implement the policy.</li><li>Inform all pregnancy women about the benefits and management of breastfeeding.</li><li>Help mothers initiate breastfeeding within a half-hour of birth.</li><li>Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infant.</li><li>Give newborn infants no food or drink other than breastmilk, unless medically indicated</li><li>Practice rooming-in - allow mothers and infants to remain together  24 hours a day.</li><li>Encourage breastfeeding on demand.</li><li>Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.</li><li>Foster establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.</li></ol>
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		<strong>Step 3</strong> &ldquo;<q>Inform all pregnant women about the benefits and management of breastfeeding</q>&rdquo;
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		Joanne should be encouraged to access breastfeeding information and support within her local community. Women who feel they have sufficient knowledge and information about breastfeeding before their babies are born are more likely to continue to breastfeed<sup><a href="#note1">1</a>,</sup><sup><a href="#note2">2</a></sup>. Some studies have found no effect of antenatal breastfeeding education on breastfeeding initiation or duration <sup><a href="#note3">3</a>,</sup><sup><a href="#note4">4</a></sup>especially if breastfeeding initiation rates are already high. Others have found a positive relationship between antenatal breastfeeding education and breastfeeding initiation <sup><a href="#note5">5</a>,</sup><sup><a href="#note6">6</a></sup> and duration<sup><a href="#note7">7</a>,</sup><sup><a href="#note8">8</a></sup> particularly if breastfeeding skills are also taught<sup><a href="#note9">9</a>,</sup><sup><a href="#note10">10</a></sup>. Individual sessions with a lactation consultant or other qualified person appear more beneficial than a non-individualised instruction<sup><a href="#note8">8</a></sup>. Therefore, it is the breastfeeding information and support received during the antenatal period to prepare mothers that is important rather than attendance at a specific class. McLeod<sup><a href="#note1">1</a></sup> suggests that as well as creating realistic breastfeeding expectations and providing consistent and relevant breastfeeding information, antenatal breastfeeding preparation also needs to include &ldquo;<q>quality ongoing support from partners, family, friends, professionals and the community</q>&rdquo;.
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		There is no evidence that antenatal nipple preparation, including the use of creams or ointments prevents nipple tenderness or damage in the postpartum period and is therefore not necessary<sup><a href="#note11">11</a>,</sup><sup><a href="#note12">12</a></sup> although some women find gentle breast massage during their pregnancy enables them to become more familiar with handling their breasts.
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        <h3>Notes</h3>
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          <li id="note1"><a href="references.html#mcle02" title="See full details">#</a> McLeod D et al. (2002) Factors influencing continuation of breastfeeding in a cohort of women</li>
          <li id="note2"><a href="references.html#chez03" title="See full details">#</a> Chezem J et al. (2003) Breastfeeding knowledge, breastfeeding confidence, and infant feeding plans: effects on actual feeding practices</li>
          <li id="note3"><a href="references.html#lave05" title="See full details">#</a> Lavender T et al. (2005) Breastfeeding expectations versus reality: a cluster randomised controlled trial</li>
          <li id="note4"><a href="references.html#fors04" title="See full details">#</a> Forster D et al. (2004) Two mid-pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial</li>
          <li id="note5"><a href="references.html#desh00" title="See full details">#</a> Deshpande AD et al. (2000) Breast-feeding education and support: association with the decision to breast-feed</li>
          <li id="note6"><a href="references.html#giug94" title="See full details">#</a> Giugliani ER et al. (1994) Effect of breastfeeding support from different sources on mothers' decisions to breastfeed</li>
          <li id="note7"><a href="references.html#sull07" title="See full details">#</a> Su LL et al. (2007) Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial</li>
          <li id="note8"><a href="references.html#matt07" title="See full details">#</a> Mattar CN et al. (2007) Simple antenatal preparation to improve breastfeeding practice: a randomized controlled trial</li>
          <li id="note9"><a href="references.html#duff97" title="See full details">#</a> Duffy EP et al. (1997) Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates.</li>
          <li id="note10"><a href="references.html#pugi96" title="See full details">#</a> Pugin E et al. (1996) Does prenatal breastfeeding skills group education increase the effectiveness of a comprehensive breastfeeding promotion program?</li>
          <li id="note11"><a href="references.html#more05a" title="See full details">#</a> Moreland-Schultz K et al. (2005) Prevention of and therapies for nipple pain: a systematic review</li>
          <li id="note12"><a href="references.html#hewa87" title="See full details">#</a> Hewat RJ et al. (1987) A comparison of the effectiveness of two methods of nipple care</li>
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      <h1>Breastfeeding Essentials</h1>
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        <li>0.1 <a href="topic_0-1.html">Introduction</a></li>
        <li>1.0 <a href="topic_1-0.html">Case Study A (Joanne)</a><ol><li>1.1 <a href="topic_1-1.html">Discussing breastfeeding</a></li><li>1.2 <a href="topic_1-2.html">What information to give</a></li><li>1.3 <a href="topic_1-3.html">Effects of Breastfeeding alternatives</a></li><li>1.4 <a href="topic_1-4.html">Common breastfeeding concerns</a></li><li>1.5 <a href="topic_1-5.html">Breast examination</a></li><li>1.6 <a href="topic_1-6.html">Contraindications to breastfeeding</a></li><li>1.7 <a href="topic_1-7.html">Conditions related to lactation outcomes</a></li><li>1.8 <a href="topic_1-8.html">Medications</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Case Study B (Joanne)</a><ol><li class="current">2.1 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_2-1.html">Preparation Before Birth</a></li><li>2.2 <a href="topic_2-2.html">Birthing Factors that Affect Breastfeeding</a></li><li>2.3 <a href="topic_2-3.html">Management After Birth</a></li><li>2.4 <a href="topic_2-4.html">Poor Attachment</a></li><li>2.5 <a href="topic_2-5.html">Hypoglycaemia</a></li><li>2.6 <a href="topic_2-6.html">Relationship between Jaundice and Breastfeeding</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Case Study C (Joanne)</a><ol><li>3.1 <a href="topic_3-1.html">Early problems</a></li><li>3.2 <a href="topic_3-2.html">Risk of SIDS</a></li><li>3.3 <a href="topic_3-3.html">Contraception</a></li><li>3.4 <a href="topic_3-4.html">Milk composition</a></li><li>3.5 <a href="topic_3-5.html">Slowing of growth</a></li><li>3.6 <a href="topic_3-6.html">Introducing solids</a></li><li>3.7 <a href="topic_3-7.html">Weaning</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">Case Study D (Sally)</a><ol><li>4.1 <a href="topic_4-1.html">Initial assessment</a></li><li>4.2 <a href="topic_4-2.html">Milk production</a></li><li>4.3 <a href="topic_4-3.html">Causes of inadequate infant growth</a></li><li>4.4 <a href="topic_4-4.html">Increasing milk supply</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Case Study E (Anna)</a><ol><li>5.1 <a href="topic_5-1.html">Sore nipples</a></li><li>5.2 <a href="topic_5-2.html">Factors causing nipple damage</a></li><li>5.3 <a href="topic_5-3.html">General treatment for sore nipples</a></li><li>5.4 <a href="topic_5-4.html">Further causes of nipple pain</a></li><li>5.5 <a href="topic_5-5.html">Mastitis – diagnosis</a></li><li>5.6 <a href="topic_5-6.html">Mastitis – treatment and complications</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">In conclusion</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
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