Maternity 1963 2003 Estate of Pablo PicassoArtists Rights

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“Maternity”, 1963, © 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York :

“Maternity”, 1963, © 2003 Estate of Pablo Picasso/Artists Rights Society (ARS), New York : ﺍﺑﺘکﺎﺭ ﻋﻤﻞ ﺑیﻤﺎﺭﺳﺘﺎﻥ ﻫﺎی ﺩﻭﺳﺘﺪﺍﺭ کﻮﺩک گﺴﺘﺮﺵ ﺑﺮﺍی ﻣﺮﺍﻗﺒﺖ ﻫﺎی ﺟﺎﻣﻊ ، ﺑﻪ ﺭﻭﺯﺭﺳﺎﻧی ، ﺍﺻﻼﺡ UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Original illustration by Jenny Corkery 3/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly

Original illustration by Jenny Corkery 3/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Original illustration by Jenny Corkery 4/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly

Original illustration by Jenny Corkery 4/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

5/1 ©UNICEF C 107 -2 Skin to Skin Contact and Early Breastfeeding UNICEF/WHO Breastfeeding

5/1 ©UNICEF C 107 -2 Skin to Skin Contact and Early Breastfeeding UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 UNICEF/HQ 92 -0369/ Roger Lemoyne, Thailand Skin to Skin Contact and Early Breastfeeding 5/2

Town, South Africa UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20

Town, South Africa UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Dr Nils Bergman, Cape First Skin to Skin Contact 5/3

Adapted from Breastfeeding Counselling: a training course, WHO/CHD/93. 4, UNICEF/NUT/93. 2 Parts of the

Adapted from Breastfeeding Counselling: a training course, WHO/CHD/93. 4, UNICEF/NUT/93. 2 Parts of the Breast 6/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 WHO/CHD/93. 4, UNICEF/NUT/93. 2 Breastfeeding Counselling: a training course, Helping the Oxytocin Reflex 6/2

Poor attachment UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour

Poor attachment UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 WHO/CHD/93. 4, UNICEF/NUT/93. 2 Good attachment Breastfeeding Counselling: a training course, What can you see? 6/3

Good attachment Poor attachment UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital –

Good attachment Poor attachment UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 WHO/CHD/93. 4, UNICEF/NUT/93. 2 Breastfeeding Counselling: a training course, What can you see? 6/4

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 WHO/CHD/93. 4, UNICEF/NUT/93. 2 In line Close Supported Facing Breastfeeding Counselling: a training course, Breastfeeding Positions 7/1

BREASTFEED OBSERVATION AID Mother's name ________________ Date __________ Baby's name _________________ Baby's age _______

BREASTFEED OBSERVATION AID Mother's name ________________ Date __________ Baby's name _________________ Baby's age _______ Signs that breastfeeding is going well: Signs of possible difficulty: GENERAL Mother: Mother looks healthy Mother looks ill or depressed Mother relaxed and comfortable Mother looks tense and uncomfortable Signs of bonding between mother and baby No mother/baby eye contact Baby: Baby looks healthy Baby looks sleepy or ill Baby calm and relaxed Baby is restless or crying Baby reaches or roots for breast if hungry Baby does not reach or root BREASTS Breasts look healthy Breasts look red, swollen, or sore No pain or discomfort Breast or nipple painful Breast well supported with fingers away from nipple Breasts held with fingers on areola BABY’S POSITION Baby’s head and body in line Baby’s neck and head twisted to feed Baby held close to mother’s body Baby not held close Baby’s whole body supported Baby supported by head and neck only Baby approaches breast, nose to nipple Baby approaches breast, lower lip/chin to nipple BABY’S ATTACHMENT More areola seen above baby’s top lip More areola seen below bottom lip Baby’s mouth open wide Baby’s mouth not open wide Lower lip turned outwards Lips pointing forward or turned in Baby’s chin touches breast Baby’s chin not touching breast SUCKLING Slow, deep sucks with pauses Rapid shallow sucks Cheeks round when suckling Cheeks pulled in when suckling Baby releases breast when finished Mother takes baby off the breast Mother notices signs of oxytocin reflex No signs of oxytocin reflex noticed Notes: UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 7/2

Assess a ©UNICEF C 107 -5 Breastfeed ﺍﺭﺯیﺎﺑی ﺗﻐﺬیﻪ ﺑﺎ ﺳیﻨﻪ 7/3 UNICEF/WHO Breastfeeding

Assess a ©UNICEF C 107 -5 Breastfeed ﺍﺭﺯیﺎﺑی ﺗﻐﺬیﻪ ﺑﺎ ﺳیﻨﻪ 7/3 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 ©UNICEF C 107 -7 Wide Open Mouth 7/4

©UNICEF C 107 -9 Assess a Breastfeed UNICEF/WHO Breastfeeding Promotion and Support in a

©UNICEF C 107 -9 Assess a Breastfeed UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 7/5

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Original illustration by Jenny Corkery 8/1 9/1

9/2 Case study 2 weeks old Healthy at birth Discharged Day 2 3 stools

9/2 Case study 2 weeks old Healthy at birth Discharged Day 2 3 stools in week 12% under birth weight Bottle with honey and water twice yesterday UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 UNICEF/HQ 91 -0168/ Betty Press, Kenya “Refusing” the breast WHO/CHD/93. 4, UNICEF/NUT/93. 2 Breastfeeding Counselling: a training course, “Sleeping all the time”

10/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course

10/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Dr Nils Bergman, Cape Town, South Africa Kangaroo Mother Care

Dr Nils Bergman, Cape Town, South Africa Kangaroo Mother Care UNICEF/WHO Breastfeeding Promotion and

Dr Nils Bergman, Cape Town, South Africa Kangaroo Mother Care UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 10/2

10/3 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course

10/3 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 UNICEF/HQ 93 -0287/ Roger Lemoyne, China Positioning a preterm infant

UNICEF/HQ 92 -0260/ Lauren Goodsmith, Mauritania Twins Grow Well on Breastmilk 10/4 UNICEF/WHO Breastfeeding

UNICEF/HQ 92 -0260/ Lauren Goodsmith, Mauritania Twins Grow Well on Breastmilk 10/4 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

10/5 ©UNICEF C 107 -21 DANCER Hand Position UNICEF/WHO Breastfeeding Promotion and Support in

10/5 ©UNICEF C 107 -21 DANCER Hand Position UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 10/6 Kay Hoover and Barbara Wilson-Clay, from The Breastfeeding Atlas Chin Support

11/1 Hand Expression ©UNICEF 910164 F UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly

11/1 Hand Expression ©UNICEF 910164 F UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 A short course for administrators and policy makers WHO/NUT/96. 3, Wellstart International Promoting breastfeeding in health facilities: Cup Feeding 11/2

11/3 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course

11/3 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 Dr Ruskhana Haider, Dhaka, Bangladesh Supplementer

12/1 Babies can breastfeed from almost all of them. UNICEF/WHO Breastfeeding Promotion and Support

12/1 Babies can breastfeed from almost all of them. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 WHO/CHD/93. 4, UNICEF/NUT/93. 2 There are many different shapes and sizes of breast and nipple. Breastfeeding Counselling: a training course, Size and Shape

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 UNICEF C-107 -19 Full Breast 12/2

12/3 © UNICEF C-10 -25 Engorged Breast UNICEF/WHO Breastfeeding Promotion and Support in a

12/3 © UNICEF C-10 -25 Engorged Breast UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

©UNICEF C 107 -39 Mastitis 12/4 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly

©UNICEF C 107 -39 Mastitis 12/4 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 ©UNICEF C 107 -31 Sore Nipple 12/5

12/6 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course

12/6 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 ©UNICEF C 107 -32 Sore Nipple

12/7 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course

12/7 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 WHO/CHD/93. 4, UNICEF/NUT/93. 2 Breastfeeding Counselling: a training course, Syringe method for inverted nipples

©UNICEF C 107 -34 Candida on the nipple 12/8 UNICEF/WHO Breastfeeding Promotion and Support

©UNICEF C 107 -34 Candida on the nipple 12/8 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

©UNICEF C 107 - 33 Candida on the nipple 12/9 UNICEF/WHO Breastfeeding Promotion and

©UNICEF C 107 - 33 Candida on the nipple 12/9 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

©UNICEF C 107 -35 Tongue-tie 12/10 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly

©UNICEF C 107 -35 Tongue-tie 12/10 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

13/1 Lactational Amenorrhea Method (LAM) Ask the mother or advise her to ask herself

13/1 Lactational Amenorrhea Method (LAM) Ask the mother or advise her to ask herself these three questions: 1. Have your menses returned? YES NO 2. Are you giving supplements or are there long periods without breastfeeding either day or night? YES NO 3. Is your baby more than six months old? NO There is only a 1 -2% chance of pregnancy at this time. YES When the answer to ANY one of these questions becomes YES The mother’s chance of pregnancy is increased. For continued protection, and to achieve child spacing, a complementary family planning method needs to be used, and breastfeeding continue. Institute for Reproductive Health, Georgetown, Washington, DC UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Original illustration by Jenny Corkery 14/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly

Original illustration by Jenny Corkery 14/1 UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

15/1 Course Aims The aim of this course is that every staff member will

15/1 Course Aims The aim of this course is that every staff member will confidently support mothers to succeed with early and exclusive breastfeeding, and that this facility moves towards achieving Baby-Friendly designation. UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

15/2 Developing a Plan: Step One Where are we now? UNICEF/WHO Breastfeeding Promotion and

15/2 Developing a Plan: Step One Where are we now? UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Developing a Plan: Step Two 15/3 Where do we want to be? UNICEF/WHO Breastfeeding

Developing a Plan: Step Two 15/3 Where do we want to be? UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

15/4 Developing a Plan: Step Three How will we get there? UNICEF/WHO Breastfeeding Promotion

15/4 Developing a Plan: Step Three How will we get there? UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006

Developing a Plan: Step Four How will we know if we are there? UNICEF/WHO

Developing a Plan: Step Four How will we know if we are there? UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 15/5

Developing a Plan: Step Five How will we sustain it? UNICEF/WHO Breastfeeding Promotion and

Developing a Plan: Step Five How will we sustain it? UNICEF/WHO Breastfeeding Promotion and Support in a Baby-Friendly Hospital – 20 hour Course 2006 15/6