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      <h1 id="top">6.1 Practical skills</h1>
      <div class="section" id="Baby_Friendly_Step_5_and_Point_4"><h2>Baby Friendly Step 5 and Point 4</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"><h3></h3>
      <div><span style="font-weight: bold;"> Step 5 </span> of the Ten Steps to Successful Breastfeeding, and <span style="font-weight: bold;"> Point 4 </span> of the Seven-point Plan for the Protection, Promotion and Support of Breastfeeding in Community Health Care Settings both require health care professionals to teach women about the maintenance of breastfeeding.</div>
      <blockquote>
        <div>
          <cite style="font-style: italic;">Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants</cite>
          <span style="font-style: italic;">.</span>
        </div>
      </blockquote>
      <blockquote>
        <div>Support mothers to initiate (establish) and maintain (exclusive) breastfeeding (to 6 months). <span class="aside"> United Kingdom, Canada, New Zealand </span> <br /><br /> Inform women and their families about the management of breastfeeding and support them to establish and maintain exclusive breastfeeding to 6 months. <span class="aside"> Australia </span></div>
      </blockquote>
      <div>As well as assisting mothers to breastfeed their infant, as in the previous topic, these Points/Steps require staff to teach mothers the techniques of manual expression of breastmilk.</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>
      <div class="section" id="Expressing_breastmilk"><h2>Expressing breastmilk</h2>
    <div>
      <p> Some mothers may not be aware that they can remove breastmilk from their breasts for feeding to the baby later. In the case of low-birth-weight infants, breastfeeding success may depend on early and effective support with expressing breastmilk. Having the knowledge and skills to do it will encourage them to continue to provide essential breastmilk and for later, knowledge of expressing will encourage continued breastfeeding after a return to work, or during other times of separation.</p>
    </div>
    <div class="section" id="Hand_expressing"><h3>Hand expressing</h3>
      <div>
        <p class="listTitle">Many mothers prefer hand expression rather than using a pump because:</p>
        <ul>
          <li>Hands are always with you, and there are no parts to lose or break.</li>
          <li>Hand expression can be very effective and quick when the mother is experienced.</li>
          <li>Some mothers prefer the skin-to-skin stimulation from hand expression rather than the feel of plastic and sound of a pump.</li>
          <li>Hand expression is usually gentler than a pump, particularly if the mother's nipple is sore.</li>
          <li>There is less risk of cross-infection since the mother does not use equipment that may be also handled by others.</li>
        </ul>
        <p class="listTitle">Even a mother who does own a pump may have more success hand expressing</p>
        <ul>
          <li>to collect small volumes of colostrum antenatally, anticipating a postnatal medical problem, or</li>
          <li>to get just a few drops of milk to entice baby to latch, or</li>
          <li>to apply to a damaged nipple, or</li>
          <li>to remove just enough milk to allow her baby to latch to her engorged breast, or</li>
          <li>to relieve the discomfort from an engorged breast, or</li>
          <li>to clear a blocked duct, or</li>
          <li>to obtain milk for her baby who is unable to breastfeed, or</li>
          <li>to obtain milk for her baby when they are separated, or</li>
          <li>to obtain milk to pasteurize for her baby if she is HIV positive.</li>
        </ul>
        <p> Many health professionals also find hand expressing more effective and less wasteful for collecting colostrum. </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"><img src="design/books.png" class="icon" alt="" /><h3>Workbook Activity 6.2</h3><p>Complete Activity 6.2 in your workbook.</p></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>
      <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"><h3>How to hand express</h3>
        <div>
          <ul>
            <li>
              <span style="font-weight: bold;">Preparation<br /></span>
              <ul>
                <li>Mother should wash her hands;</li>
                <li>Prepare a clean wide-necked receptacle for the milk - a medicine cup, tea cup or bowl may be appropriate depending on volume expected.</li>
              </ul>
            </li>
            <li>
              <span style="font-weight: bold;">Technique</span>
              <br />
              <ul>
                <li>Mother may sit or stand comfortably - possibly where she can rest her arm or lean forward slightly over the container;</li>
                <li>Gently massage the breasts, running hands over the nipple and areola to stimulate the milk ejection reflex;</li>
                <li>Position the first finger and thumb on opposite sides of the nipple, at about the edge of the areola or about 2.5cm (1") from the base of the nipple;</li>
                <li>Push directly back towards the chest wall, then compress the breast between finger and thumb, and follow through by moving the pressure towards the nipple without sliding the fingers on the skin of the breast;</li>
                <li>It may take a minute or so to stimulate the milk ejection. Milk only flows easily during a milk ejection so continue expressing while milk flow is good for approx 2-3 minutes. Colostrum is quite viscous, so be patient;</li>
                <li>Swap breasts and repeat. The mother may like to do this on each breast several times;</li>
                <li>Stop expressing when milk flow slows to drips or the goal has been achieved (eg. areola is softened enough for infant to latch, or volume needed is achieved).</li>
              </ul>
            </li>
          </ul>
          <ul></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>
      <div class="captionBox"><img width="351" height="275" src="images/hand_expressing1_sc.gif" alt="Note: 1. the finger and thumb placement; 2. the pressure back towards the chest wall before, 3. compressing the breast tissue between finger and thumb." /><p>Note: 1. the finger and thumb placement; 2. the pressure back towards the chest wall before, 3. compressing the breast tissue between finger and thumb. <br />Photograph &copy;  S.Cox, IBCLC</p></div>
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<p> <br />Video &copy;  Australian Breastfeeding Association. Used with permission.</p></div>
    </div>
    <div class="section" id="Pumping_breastmilk"><h3>Pumping breastmilk</h3>
      <div>
        <p> There are many different types of breastpumps available on the market. All staff must be aware of the safety issues surrounding each pump, including adequate cleaning, and its correct use. Either get other competent staff to demonstrate its use, or ask the company representative to give a short educational session for the staff. <br /></p>
        <p>Manual and electric pumps can be equally as effective - the mother will need to consider cost and skills required to use each piece of apparatus. For example, some manual pumps can cause wrist strain which may exacerbate carpel tunnel syndrome; other mothers prefer the versatility of carrying a manual pump to work; electric pumps are very efficient for long term expressing circumstances.<br /></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"><img src="design/warning.png" class="icon" alt="" /><h3>Who is best to demonstrate pump usage to mothers?</h3>
        <div>
          <p>
				The pump company representative's job is to sell more pumps and encourage as many mothers as possible to use their pumps for as long as possible. Your role is to show a mother how to safely use a pump for only as long as it is absolutely necessary.
			</p>
          <p>
				Do <strong>not</strong> ask the company representative to speak to mothers about their pump.
			</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>
    <div class="section" id="Storing_breastmilk_for_a_healthy_baby"><h3>Storing breastmilk for a healthy baby</h3>
      <div>
        <p> If the mother is not going to use the expressed milk within the next few hours, store it safely. Glass and plastic containers with lids are suitable for use, as are breastmilk storage bags. </p>
        <p> There should be a means of noting the time and date of expressing the breastmilk on each container. For hospital use the identity of the mother and baby should also be clearly written. </p>
        <ul>
          <li>All storage equipment will be thoroughly clean.</li>
          <li>Refrigerate milk that will not be used within the next few hours.</li>
          <li>Freeze milk that will not be used within two days.</li>
        </ul>
        <table class="grid">
          <caption> NHMRC 2003 </caption>
          <thead>
            <tr>
              <th colspan="4">Storing Breastmilk for a Healthy Baby</th>
            </tr>
          </thead>
          <thead>
            <tr>
              <th>Breastmilk status</th>
              <th>Room temperature 26°C or lower</th>
              <th>Refrigerator (4°C or lower)</th>
              <th>Freezer</th>
            </tr>
          </thead>
          <tbody>
            <tr class="row0">
              <th>Freshly expressed into container</th>
              <td>6 - 8 hours; <br />when refrigerator available store milk there</td>
              <td>3 - 5 days; <br />store at back where coldest</td>
              <td>2 weeks freezer compartment inside refrigerator; 3 months in freezer section of refrigerator with separate door; 6 - 12 months in deep freeze (-18°C or lower)</td>
            </tr>
            <tr class="row1">
              <th>Previously frozen; thawed in refrigerator, but not warmed</th>
              <td>4 hours or less; <br />that is until the next feeding</td>
              <td>24 hours</td>
              <td>Do not refreeze</td>
            </tr>
            <tr class="row0">
              <th>Thawed outside refrigerator in warm water</th>
              <td>For completion of feeding</td>
              <td>4 hours or until next feeding</td>
              <td>Do not refreeze</td>
            </tr>
            <tr class="row1">
              <th>Infant has begun feeding<br />(ie. contact with baby's mouth)<br /></th>
              <td>Only for completion of feeding</td>
              <td>Discard</td>
              <td>Discard</td>
            </tr>
          </tbody>
        </table>
        <p><span style="font-weight: bold;">Note:</span> Chilled breastmilk may be safely stored at 15°C for up to 24 hours. This is the temperature maintained in an insulated container with a freezer block, eg blue ice.<sup><a href="#note1">1</a></sup> </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"><img src="design/group.png" class="icon" alt="" /><h3></h3>
        <div>
          <p> Locate the guidelines to hand expressing and safe breastmilk storage that is provided for mothers in your Unit. Discuss this leaflet with each mother and give her a copy as she is taught this essential skill. Keep a copy of the leaflet in your Workbook.</p>
          <p><span style="font-style: italic;">There are no guidelines in your Unit for hand expressing and safe breastmilk storage</span>? Recreate the table of safe storage times and file it in your workbook; form a small group to develop a leaflet that can be presented at a Unit meeting to familiarise the staff with its content.</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>
    <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/competency-hand-expressing-adp.pdf" target="_blank"><img src="design/article.png" class="icon" alt="" /></a><h3><a href="images/competency-hand-expressing-adp.pdf" target="_blank">Hand Expressing Competency</a></h3>
      <div>
        <p>
				Click on the icon on the left and print the Hand Expressing Competency. Take this to your course facilitator or mentor and ask them to observe your practice and complete the assessment.
			</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 class="section" id="Using_the_expressed_breastmilk"><h3>Using the expressed breastmilk</h3>
      <div>
        <p class="listTitle">The order in which to use expressed breastmilk is</p>
        <ol>
          <li>First choice: All milk expressed in the first 4 days (colostrum); <span class="aside">assures baby receives the antibody-rich colostrum as soon as possible</span></li>
          <li>Second choice: Freshly expressed milk prior to refrigeration; <span class="aside">fresh breastmilk has the most active protective properties</span></li>
          <li>Third choice: Refrigerated breastmilk, using the oldest first; <span class="aside">decreases the need to freeze milk, which has a greater effect on immunological properties</span></li>
          <li>Finally: Frozen breastmilk that has been stored the longest; <span class="aside">to reduce the need to discard milk that has passed the use-by date</span></li>
        </ol>
      </div>
    </div>
  </div>
      <div class="section" id="Supporting_mothers_who_are_separated_from_their_infants"><h2>Supporting mothers who are separated from their infants</h2>
    <div>There may be many reasons a mother is unable to be with her infant at all the times the infant requires breastfeeding. These could include:<br /><ul><li>infant or mother requiring hospitalization (eg neonatal intensive care; medical or surgical event for mother or infant)</li><li>maternal appointments (eg dentist, solicitor, etc)</li><li>maternal work commitments</li><li>or perhaps just a child-free day of leisure for the mother.</li></ul><p>Occasional separations are usually easily handled by having some breastmilk already stored in the refrigerator or freezer for the child-carer to give to the infant. <br /></p></div>
    <div class="section" id="Employment_and_breastfeeding"><h3>Employment and breastfeeding</h3>
      <div>
        <p>
	An increasing number of women spend large amounts of time away from a baby or child who is still in the age range prior to earliest age of weaning ... ie the first two years. Returning to the paid workforce is the most common reason for regular separation of mother and baby, and a common reason given for premature weaning.
</p>
        <p class="listTitle">Your role as a professional is to</p>
        <ul>
          <li>Inform the mother of her right to breastfeed, and what workplace legislation will protect her right.</li>
          <li>Educate her on the value of continuing to provide breastmilk for her baby, despite separation.</li>
          <li>Discuss the issues she will need to address to be successful.</li>
          <li>Provide her with contacts for peer-support services, to talk with other women in her situation.</li>
        </ul>
        <p class="listTitle">Leaving her baby to go to work can be a highly emotional time for the mother. Continuing to provide breastmilk can</p>
        <ul>
          <li>present many challenges,</li>
          <li>help her to maintain an emotional connection to her baby, despite her physical absence,</li>
          <li>avoid the acute and chronic illnesses associated with artificial infant formula,</li>
          <li>make breastfeeding when they are reunited a very special, and close time.</li>
        </ul>
        <p>
	Enlisting support will assist the mother to meet her breastfeeding goals. An encompassing approach including her family, the child carer, her work colleagues and employer will provide support beneficial to continuing to provide breastmilk during periods of separation.
</p>
      </div>
      <div>
        <p class="listTitle">There are numerous challenges mothers will face, many unique to individuals. Addressing the foreseeable challenges is best begun during pregnancy.</p>
        <ul>
          <li>
            <p class="listTitle">Discuss with her employer</p>
            <ul>
              <li>working shorter hours each day, or less days per week, at least initially</li>
              <li>whether her baby could be brought to her for breastfeeding, or she could visit her baby</li>
              <li>a venue that will be suitable for her to use to pump, or breastfeed</li>
              <li>the advantages to her employer of her continuing to breastfeed, particularly that her child will suffer less illnesses, requiring her to have less absences from work</li>
              <li>If necessary, inform her employer of her legislated rights.</li>
            </ul>
          </li>
          <li>
            <p class="listTitle">Choose her potential child carer</p>
            <ul>
              <li>one whose knowledge of care of breastmilk, and importance of infants remaining exclusively breastmilk-fed for the first 6 months<br /></li>
              <li>proximity to either her home, or her place of work, with possibility of going to or having baby come to her during the period</li>
            </ul>
          </li>
          <li>
            <p class="listTitle">Will she need to pump her breastmilk?</p>
            <ul>
              <li>Begin researching pumps to find one that will suit her.</li>
              <li>Where will she keep her pumped breastmilk?</li>
            </ul>
          </li>
        </ul>
      </div>
    </div>
  </div>
      <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>Teaching hand expression of breastmilk is an essential part of protecting, supporting and promoting breastfeeding - even if the mother intends to use a pump.</li>
          <li>The potential circumstances that may lead to expressing of breastmilk.</li>
          <li>How to hand express and teach this skill to mothers.</li>
          <li>To complete the Hand Expressing competency.</li>
          <li>The safe storage times and temperatures for each breastmilk status.</li>
          <li>The order in which to use expressed breastmilk.</li>
          <li>How you can support mothers who must be separated from their infants.<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>
  </div>
      <div class="section" id="Self-test_quiz"><h2>Self-test quiz</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"><h3></h3>
      <div></div><div class="activity" id="activity_rq">
<script type="text/javascript">
/* <![CDATA[ */
var rqqs = {settings : {type : 'matching', shuffle : 'both'}, questions : [
	new Matching('Hand expressing is the best technique for collecting..', 'colostrum'),
	new Matching('The technique of hand expression removes milk from the breasts by..', 'positive pressure'),
	new Matching('This event stimulates increased milk flow and enhances milk expression', 'milk ejection reflex'),
	new Matching('Breastpumps remove milk by this mechanism', 'negative pressure'),
	new Matching('Freshly expressed breastmilk may be stored like this for 6-8 hrs', 'room temperature'),
	new Matching('Freshly expressed breastmilk may be stored safely in a refrigerator for', '3-5 days'),
	new Matching('Breastmilk which has been thawed in warm water may be kept at room temperature for..', 'the completion of the feed'),
	new Matching('Breastmilk which was frozen and then thawed in a refrigerator may be safely kept in the refrigerator for..', '24hrs')
]};

/* ]]> */</script>
<p class="instructions">Match an item from the column on the left with an item from the column on the right. Click on an item in one column, then on its matching response from the other column</p></div><script type="text/javascript">renderActivity('rq');</script>
    </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>
      <div id="footnotes">
        <h3>Notes</h3>
        <ol>
          <li id="note1"><a href="references.html#hamo96" title="See full details">#</a> Hamosh M et al. (1996) Breastfeeding and the working mother: effect of time and temperature of short-term storage on proteolysis, lipolysis, and bacterial growth in milk.</li>
        </ol>
      </div>
      <div id="footer"><a href="topic_6-0.html" rel="prev" class="prev">&laquo; Previous</a><a href="topic_6-2.html" rel="next" class="next">Next &raquo;</a><br style="clear: both" /><a href="#top" id="topLink">Back to top</a><a href="javascript: window.print()" id="printLink">Print this page</a><span class="noPrint"> | </span>&copy; 2012 Health e-Learning<p class="printOnly">COPYRIGHT: You are permitted to print ONE (1) copy for your personal use only. No graphics, tables, quizzes, videos, etc, may be used in any form without express written consent. Author: Denise Fisher</p></div>
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    <div id="menu">
      <h1>Breastfeeding Essentials</h1>
      <ol>
        <li>1.0 <a href="topic_1-0.html">Why Breastfeeding is Important</a><ol><li>1.1 <a href="topic_1-1.html">Biochemistry</a></li><li>1.2 <a href="topic_1-2.html">Immunology</a></li><li>1.3 <a href="topic_1-3.html">Relative risks</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Communication Skills</a><ol><li>2.1 <a href="topic_2-1.html">Non-verbal</a></li><li>2.2 <a href="topic_2-2.html">Listening skills</a></li><li>2.3 <a href="topic_2-3.html">Building confidence</a></li><li>2.4 <a href="topic_2-4.html">An example</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Pregnancy Care</a><ol><li>3.1 <a href="topic_3-1.html">The feeding decision</a></li><li>3.2 <a href="topic_3-2.html">The barriers</a></li><li>3.3 <a href="topic_3-3.html">Physical preparation</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">The Birth Experience</a><ol><li>4.1 <a href="topic_4-1.html">The first hours</a></li><li>4.2 <a href="topic_4-2.html">Labor interventions</a></li><li>4.3 <a href="topic_4-3.html">Postnatal interventions</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Breastfeeding the Baby</a><ol><li>5.1 <a href="topic_5-1.html">Positioning Principles</a></li><li>5.2 <a href="topic_5-2.html">Breastmilk transfer</a></li><li>5.3 <a href="topic_5-3.html">Assessing breastfeeding</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">A time to learn</a><ol><li class="current">6.1 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_6-1.html">Practical skills</a></li><li>6.2 <a href="topic_6-2.html">Breastfeeding messages</a></li><li>6.3 <a href="topic_6-3.html">Normal growth</a></li><li>6.4 <a href="topic_6-4.html">Sleep</a></li><li>6.5 <a href="topic_6-5.html">Psychological support</a></li><li>6.6 <a href="topic_6-6.html">Discharge planning</a></li></ol></li>
        <li>7.0 <a href="topic_7-0.html">Infant Challenges</a><ol><li>7.1 <a href="topic_7-1.html">Late preterm infant; Non-latching</a></li><li>7.2 <a href="topic_7-2.html">Hypoglycemia; Jaundice</a></li><li>7.3 <a href="topic_7-3.html">Supplementation</a></li><li>7.4 <a href="topic_7-4.html">Crying baby</a></li><li>7.5 <a href="topic_7-5.html">Inadequate weight gain</a><ol><li>7.5.1 <a href="topic_7-5-1.html">Feeding-line device at the breast</a></li><li>7.5.2 <a href="topic_7-5-2.html">Cup feeding</a></li><li>7.5.3 <a href="topic_7-5-3.html">Finger Feeding</a></li><li>7.5.4 <a href="topic_7-5-4.html">Bottle feeding</a></li></ol></li></ol></li>
        <li>8.0 <a href="topic_8-0.html">Maternal Challenges</a><ol><li>8.1 <a href="topic_8-1.html">Engorgement</a></li><li>8.2 <a href="topic_8-2.html">Nipple Pain</a></li><li>8.3 <a href="topic_8-3.html">Breast Problems</a></li><li>8.4 <a href="topic_8-4.html">Insufficient breastmilk</a></li><li>8.5 <a href="topic_8-5.html">Medical, Surgical Issues</a></li></ol></li>
        <li>9.0 <a href="topic_9-0.html">Promotion, Protection and Support</a><ol><li>9.1 <a href="topic_9-1.html">The International Code of Marketing of Breastmilk Substitutes</a></li><li>9.2 <a href="topic_9-2.html">The Baby Friendly Initiative</a></li><li>9.3 <a href="topic_9-3.html">Young Child Feeding</a></li><li>9.4 <a href="topic_9-4.html">Local initiatives</a></li><li>9.5 <a href="topic_9-5.html">Infant feeding in emergencies</a></li></ol></li>
        <li>10.0 <a href="topic_10-0.html">Closing session</a><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>
      </ol>
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