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      <h1 id="top">2.3.1 Initiating breastfeeding</h1>
      <div class="section" id="Step_4"><h2>Step 4</h2>
    <div>
      <p>
        <span style="font-weight: bold;">Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed.</span>
      </p>
      <p>To implement this Step the focus has changed from <span style="font-weight: bold;">helping to breastfeed</span> to <span style="font-weight: bold;">facilitating the optimum environment</span> to stimulate baby's innate feeding reflexes, breastfeeding occurring with the least intervention from health care staff.</p>
      <p>This Step is one of the most critical Steps. Successful implementation of this Step ensures:</p>
      <p></p>
      <ul>
        <li>the rapid achievement of physiological stability in the neonate</li>
        <li>optimum bonding at a critical time for mother and infant</li>
        <li>facilitation of breastfeeding, and prevention of problems</li>
      </ul>
      <p></p>
    </div>
    <div class="section" id="Implementing_skin-to-skin_contact"><h3>Implementing skin-to-skin contact</h3>
      <div>
        <p> </p>
        <ul>
          <li> Skin-to-skin contact at this time is interpreted as the baby being naked except for a bonnet, if necessary, with baby's chest and body directly in contact with the mother's bare abdomen and chest. A light blanket covering both mother and baby will prevent heat loss. </li>
          <li> All routine procedures, such as drying the infant, Apgar score assessment, assessment of vital signs, are to be performed while in skin-to-skin contact with the mother. </li>
          <li> Skin-to-skin contact in the operating theatre can also be achieved, however if this is not possible, it should occur within a very short time of the mother arriving in the recovery area, or of being able to respond to her baby if she has had a general anesthetic. </li>
          <li> Babies are to be left undisturbed in skin-to-skin contact until after the first breastfeed. </li>
        </ul>
        <p> </p>
        <p> This care is to be given to ALL infants, regardless of feeding intention, ie infants to be artificially fed will benefit significantly from this care too. </p>
      </div>
      <div class="captionBox"><img width="640" height="435" src="images/birth_KSmall.jpg" alt="Physiological stability and bonding in one easy action." /><p>Physiological stability and bonding in one easy action. <br />&copy; K.Small MBBS</p></div>
      <div>
        <p><b> Exceptions: </b> Medically justified reasons for delaying contact. </p>
      </div>
      <div class="section" id="Initial_resuscitation_of_the_neonate"><h4>Initial resuscitation of the neonate</h4>
        <div><p> The Neonatal Resuscitation guide published by the American Academy of Pediatrics <span><sup><a href="#note1">1</a></sup></span> states that </p><ul><li> the newborn upper airway can be cleared by wiping the mouth and nose, <br /> </li><li> he can be dried, <br /> </li><li> assigned Apgar scores, </li><li> visually assessed, and <br /> </li><li> vital signs recorded </li></ul><span style="font-weight: bold;"> while in skin-to-skin contact with the mother </span> .</div>
      </div>
    </div>
    <div class="section" id="The_first_breastfeed"><h3>The first breastfeed</h3>
      <div>
        <p>
				Babies are born with innate reflexes that guide them to the breast and to breastfeed. Assisting the mother into a comfortable, semi-reclined position with her baby on her chest is the best way to facilitate this response.<sup><a href="#note2">2</a></sup>
			</p>
        <p>
				Guidance to the mother includes an explanation of the sequence of movements and actions through which the baby will progress before latching and suckling. These can be pointed out to the mother and her support persons as they occur. Emphasise the importance of not disturbing the baby until after the first breastfeed.
			</p>
      </div>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><a href="images/Klaus_Pediatrics1998.pdf" target="_blank"><img src="design/article.png" class="icon" alt="" /></a><h3><a href="images/Klaus_Pediatrics1998.pdf" target="_blank">Refresh your memory</a></h3>
        <div>
          <p>Click on the title or icon to open a paper that describes the sequence of movements and actions the baby will take before latching and suckling.</p>
        </div>
      </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
      <div>
        <p class="listTitle">This is an ideal time to reinforce the knowledge shared during the prenatal period. Indicate:</p>
        <ul foot="Signs of swallowing may be few at this stage.">
          <li>early feeding cues and the need to respond to them promptly,</li>
          <li>the wide gape baby makes as he latches, and the amount of breast tissue taken into his mouth,</li>
          <li>the deep jaw excursions baby makes as he sucks.</li>
        </ul>
      </div>
    </div>
    <div class="section" id="Refer_to_your_Policy"><h3>Refer to your Policy</h3>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/books.png" class="icon" alt="" /><h3></h3>
        <div>
          <p> Identify the policy statement that addresses the immediate care of the newborn baby, and where that care is to occur.</p>
        </div>
      </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
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      <div class="section" id="What_should_I_remember_"><h2>What should I remember?</h2>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/remember.png" class="icon" alt="" /><h3></h3>
      <div>
        <ul>
          <li>where the majority of infants should be to receive immediate post-birth care and resuscitation <br /></li>
          <li>how to facilitate skin-to-skin contact</li>
          <li>how long the infant and mother should initially remain undisturbed in skin-to-skin contact</li>
          <li>that infants have an innate ability to latch and breastfeed unassisted when placed in skin-to-skin contact<br /></li>
        </ul>
      </div>
    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
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      <div id="footnotes">
        <h3>Notes</h3>
        <ol>
          <li id="note1"><a href="references.html#katt10" title="See full details">#</a> Kattwinkel J et al. (2010) Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.</li>
          <li id="note2"><a href="references.html#cols08" title="See full details">#</a> Colson S et al. (2008) Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding.</li>
        </ol>
      </div>
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      <h1>Breastfeeding Policy Orientation</h1>
      <ol>
        <li>1.0 <a href="topic_1-0.html">Introduction</a></li>
        <li>2.0 <a href="topic_2-0.html">The Baby Friendly Initiative</a><ol><li>2.1 <a href="topic_2-1.html">Steps 1 &amp; 2; Points 1 &amp; 2</a></li><li>2.2 <a href="topic_2-2.html">Step/Point 3</a></li><li>2.3 <a href="topic_2-3.html">Initiating, managing &amp; maintaining breastfeeding</a><ol><li class="current">2.3.1 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_2-3-1.html">Initiating breastfeeding</a></li><li>2.3.2 <a href="topic_2-3-2.html">Managing Breastfeeding</a></li><li>2.3.3 <a href="topic_2-3-3.html">Maintenance of breastfeeding</a></li></ol></li><li>2.4 <a href="topic_2-4.html">Step 10 / Point 7</a></li><li>2.5 <a href="topic_2-5.html">Point 6</a></li><li>2.6 <a href="topic_2-6.html">Breast-milk Substitutes</a></li></ol></li>
        <li>3.0 International Policies<ol><li>3.1 <a href="topic_3-1.html">The WHO Code</a></li><li>3.2 <a href="topic_3-2.html">Infant &amp; Young Child Feeding</a></li></ol><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
        <li class="appendix"> <a href="full.html">Print version</a></li>
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