DR RAVARI 2014

Impact of Birthing Practices on Newborn Baby Care and

Breastfeeding

دكتر محمود راوريمتخصص کودکان

عضوكميته كشوري شيرمادردانشکده علوم پزشكي ساوه

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WOMEN NEVER FORGET THEIR BIRTH DAYS

Giving birth is one of the most significant events in a woman’s life.

Pregnancy, birth and breastfeeding are all part of the same continuum

DR RAVARI 2014

The medicalization of birth and postpartum processes has created additional barrier to successful breastfeeding

Birth interventions that disrupt the natural interaction between the mother and the infant in the immediate postpartum period can impact long-term breastfeeding success.

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The first minutes after birth are a very vulnerable period for both mother and newborn.

Babies born by cesarean may also suffer from the consequences of this type of birth process.

A mother's breastfeeding experience can be:

“Profoundly affected by what happens during the first hours after birth”

DR RAVARI 2014

Benefits of normal vaginal delivery For BabiesBIRTH CANAL

Lowered risk of respiratory problemsAs the babies pass through the vagina, pressure in the vaginal helps baby to expulse the amniotic fluid inside the lung. This can help babies to breathe better once they are outside the mothers' body.

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What physical effects may occur in babies more frequently with CESAREAN DELIVERY?Respiratory distress syndrome (TTN.HMD) elective CS

Pulmonary hypertensionNot breastfeedingNeonatal mortality

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CESAREAN SECTION

Risk of maternal death is 3.6 times higher for cesarean than vaginal birth.

Infants are 1.5 times more likely to die during elective first cesarean than vaginal birth.

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Benefits of normal vaginal delivery For Babies☻BIRTH CANAL

Babies will pick up a protective bacterial as they pass through the vagina. This bacterial can boost his or her immune system and make him or her less vulnerable to some infectious diseases and protection against childhood chronic disease

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CESAREAN DELIVERY VERSUS VAGINAL DELIVERY

Play in the development of childhood chronic disease(Autoimmune) Allergic diseases (Asthma, food allergy, allergic

rhinitis, Wheezing, Hay fever) and Cow's milk allergy/intolerance

Type 1 diabetesObesityInfluences neonatal mucosal immunity Increases the risk digestive , respiratory and

infectious diseaseIncreases the risk in adults for allergic

diseases(asthma)Influences the acquisition time of cariogenic

Bactria in children.

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Benefits of normal vaginal delivery For Babies

Endorphin levels are highest during vaginal deliveries in unmediated mothers.

During labor, endorphin levels rise during each contraction, most noticeably in the second stage of labor. Endorphin levels are highest just after birth. It takes two weeks after birth for endorphin levels in the body to return to normal.

Endorphin levels protect and serve babies during childbirth as well. Endorphins are elevated in newborns that experience distress during the birth process.

Endorphins stimulate the production of prolactin, the relaxing “mothering” hormone that aids in breastfeeding and mama-baby bonding after birth

Epidural Analgesia decrease maternal endorphin production and lower endorphin levels to the neonate during breast-feeding. Lower endorphin levels, in turn, may render the neonate less likely to suckle optimally

Endorphins in Childbirth:Body’s Natural Painkillers

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These high levels of circulating catecholamines cause the olfactory bulbs in the infant’s nares to be extremely sensitive to the odor cues that guide the infant towards the mother’s nipple

Benefits of normal vaginal delivery For BabiesHuman infants experience a catecholamine

surge immediately post birth secondary to compression of the fetal head and intermittent hypoxia during contractions.

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Benefits of normal vaginal delivery For BabiesNewborns from VAGINAL

DELIVERY, with high levels of catecholamines from the maternal circulation, are better equipped to adapt to extra uterine life than those delivered by cesarean section.

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NINE INSTINCTIVE STAGES

Skin

-to-S

kin

con

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wit

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their

moth

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STEP 4 BFHI

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Benefits of normal vaginal delivery For Babies Babies born by normal

delivery demonstrate more interest in pre-breastfeeding behaviors such as sucking mother's breasts. Babies born by normal delivery are also reported to nurse for longer periods within the first 90 minutes after birth, which has many benefits for both the mother and the baby

Higher breastfeeding success rate.

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INITIATION OF BREASTFEEDING

Self-attachment refers to the phenomenon that full term undrugged infants, left on their mother's chest undisturbed, will breastfeed spontaneously within one hour, without any assistance.

However, skin-to-skin contact is required in order for this behaviour to succeed. Mothers and babies should not be separated at birth.

The newborn actually stimulates hormonal responses (oxytocin) in the mother, which trigger caregiving and protective behaviours from the mother.

By kicking on the mothers abdomen � the baby helps the mothers uterus to contract strongly, preventing post-partum �bleeding.

Babies that are placed on their mother's bare chest are more likely to latch on to their mother's breast and are likely to latch on well, compared to babies that are not immediately placed on their mothers.

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SKIN-TO-SKIN CONTACT

Research has shown that early skin-to-skin contact between a mother and baby at birth reduces crying , decreased stress metabolic adaptation improves mother-baby interaction keeps the baby warmer facilitate the early initiation of exclusive breastfeeding helps women breastfeed successfully (effective suckling) and

for longer

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SKIN-TO-SKIN CONTACT

The first hour or so after birth are crucial for mother and baby in terms oftheir wellbeing, the opportunity to bond with each

other and, the first breastfeed.

SKIN-TO-SKIN CONTACT promotes all three of these

things.

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DYAD MOTHER AND INFANT PAIR

A baby knows instinctively that she is dependent on her mother to survive, and so if they are separated, the baby experiences distress and the mother does not experience the release of hormones that triggers her strong, protective 'mothering' instincts.

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MATERNAL INFANT SEPARATION

Separation “distress cry” when separated.

Levels of stress hormones rise and temperature, blood sugar, breathing, and heart rate become unstable when separated

Separation my lead to complications such as:hypothermia and

hypoglycemia, increased the likelihood of supplementation.

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BREASTFEEDING AFTER A CESAREAN

Babies born via c-section may be somewhat drowsy and lethargic, especially if the mother was exposed to analgesia and anesthetics for a prolonged period of time during labor.

Initiation of breastfeeding is often delayed

Urgent cesarean births have been associated with delayed milk production, possibly related to the stress involved(Risk factor in delayed Lactogenesis II)

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CAESAREAN BIRTH

Reduce initiation of breastfeeding, Increase the length of time before the

first breastfeed, Reduce the incidence of exclusive

breastfeeding, Significantly delay the onset of lactation Increase the likelihood of

supplementation.

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INDUCTION (OXYTOCIN)

Pitocin , when used to induce or stimulate labor, has an antidiuretic effect.

Edema may result from pitocin use, particulary in extremities such as the breast and nipple tissue ( meaty and flat) that make it difficult for infant to latch. it can take as long as 2 weeks for the edema is relieved.

Inducing laber >strong,close contarction> pressure on the baby head>more painful for the mother>more drugs>iv hydration>more need forceps or vacuum or surgery(episiotomy or CS)>duration epidural anesthesia> maternal fever >infant fever >more separation> sepsis workups.

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RE-EVALUATING CESAREAN

BIRTH

Cesareans with regional anesthesia is an option And mothers are able to breastfeed sooner

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