Philadelphia Breastfeeding Resource Handbook 2005 
154 Pages/682KB
The Philadelphia Department of Public Health is involved in breastfeeding promotion in several ways: (a) dissemination and implementation of the Philadelphia Breastfeeding Policy that includes goals to increase public and professional awareness of breastfeeding as the best infant feeding choice for babies; (b) information and education for agencies providing prenatal, labor and delivery, postpartum, pediatric, and day care services; (c) commitment to update this Breastfeeding Resource Handbook on an ongoing basis; (d) dissemination of educational material, subject to the availability of funding.
Kay Hoover, M Ed, IBCLC, the lactation consultant, is available to conduct staff educational programs about breastfeeding. A three-day course (18 hours) is given four times a year at the Division of Maternal, Child and Family Health with continuing education units from the Pennsylvania State Nurses Association.
Common Question and Concerns of Health Care Practitioners
Birth Control and Breastfeeding
Natural family planning and barrier methods have no effect on lactation. If a woman wants a hormonal birth control while breastfeeding, the combination pills with estrogen and progestin should be avoided because they cut back on the milk supply. If using the progestin only methods (mini-pills, injectables, or implants), it is best to wait at least six weeks to ensure an adequate milk supply, and monitor the baby carefully for adequate weight gain after beginning the use of hormonal birth control.
When a baby is under six months, is totally breastfeeding (i.e. not getting anything else to eat), has all of his sucking needs met at the breast (i.e. no pacifier or thumb/finger sucking), is waking to breastfeed during the night, and the mother has not had a period, breastfeeding affords 98% protection from pregnancy. Breastfeeding could be used in conjunction with another form of birth control to make both more effective.
Contra-indications for Breastfeeding
When a mother is HIV positive, uses street drugs, or is an alcoholic.
When a baby has galactosemia
Immunizations and Breastfeeding
"A patient who has been identified as susceptible to rubella virus infection should receive the rubella vaccine in the postpartum period. Rubella vaccine can be administered before discharge, even if the patient is breastfeeding." 1
Hepatitis B vaccine and Flu vaccine may be given to a breastfeeding woman. The smallpox vaccine should not be given to any woman with a child under one year of age; however, the smallpox vaccine is not currently given to the general population.
Jaundice and Breastfeeding
"A review of available follow-up data for apparently healthy term infants whose serum bilirubin concentrations were as high as 25 mg/dl showed no apparent ill effects for these concentrations." 1
"Some evidence indicates that frequent breastfeeding (8-10 times per 24 hours) may reduce the incidence of hyperbilirubinemia." 1
"Supplementing nursing with water or dextrose-water will not lower serum bilirubin levels in jaundiced, healthy, breastfeeding infants." 1
"When an indirect serum bilirubin concentration is elevated by some pathologic cause, there is no reason to discontinue breastfeeding." 1
"In the absence of dehydration, routine supplementation (with dextrose-water) of infants receiving phototherapy is not indicated." 1
Postpone Putting Baby to Breast
group A streptococcus (mother may breastfeed when over acute stage and after 24 hr. treatment)
active tuberculosis (must wait until mother's treatment is established, at least two weeks)
active hepatitis B (give baby HBIG and hepatitis B vaccine) Baby may go to breast immediately after birth before given the immunity shots, but they should be given soon.
chronic carrier of hepatitis (ask for infectious disease opinion)
active herpes simplex lesions in the nipple area (may breastfeed after lesions are healed)
chickenpox "When maternal chickenpox occurs within 6 days of delivery or immediately postpartum and no lesions are present in the neonate, mother and infant should be isolated separately. Only half the infants born to mothers who developed the disease 7 to 15 days before delivery will develop the disease. They should receive zoster immune globulin (ZIG) ... If no lesions develop by the time the mother is noninfectious, the infant and the mother may be sent home together. When the mother and infant can be together, the child can be breastfed." 2
1 American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care (4th Edition). Elk Grove Village, IL: AAP, 151, 183-188, 1997.
2 RA Lawrence, RM Lawrence: Breastfeeding: A Guide for the Medical Profession (5th Edition). Philadelphia: Mosby, 1999, pp. 584-588
Statements About Breastfeeding from AAP, ADA, ILCA, USA, WHO, UNICEF
American Academy of Pediatrics
"Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth... Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet. It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired."
American College of Obstetricians and Gynecologists
"Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth... Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet. It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired." "Breastfeeding is a natural function: nearly every woman can breastfeed her child… The ACOG recommends that exclusive breastfeeding be continued until the infant is about 6 months old… The professional objectives are to encourage and enable as many women as possible to breastfeed and to help them continue as long as possible."
"It is the position of The American Dietetic Association (ADA) that public health and clinical efforts to promote breastfeeding should be sustained and strengthened. ADA strongly encourages the promotion and advocacy of activities that support longer duration of successful breastfeeding, in order to optimize the indisputable nutritional, immunological, psychological, and economic benefits." National initiation rates have increased, but few infants are being breastfed beyond 1 to 2 months of age. ... "The next challenge is to communicate the importance of sustained exclusive breastfeeding for 4 to 6 months and, optimally, breastfeeding with weaning foods for at least 12 months."
World Alliance for Breastfeeding Action
Innocenti Declaration: "...all women should be enabled to practice exclusive breastfeeding and all infants should be fed exclusively on breast milk from birth to 4 to 6 months of age. Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods, for up to two years of age or beyond."
International Lactation Consultant Association
"...almost all women are physically capable of nourishing their infants on breastmilk alone for the first half-year." "...adolescents should be encouraged to breastfeed." "...obstetric medication and anesthesia interfere with the innate feeding behavior of the infant, hence,...such medication should be used as sparingly as is compatible with maternal and infant health." "...the duration of human lactation worldwide is two or more years, and ...both mothers and their older children benefit from prolonged breastfeeding."
U.S. Department of Health and Human Services
"Infants should be exclusively breastfed during the first 4 to 6 months of life, preferably for a full 6 months. Ideally, breastfeeding should continue through the first year of life. This Blueprint for Action reaffirms the scientific evidence that breastfeeding is the best method for feeding most newborns, and that breastfeeding is beneficial to the infant's and the mother's health"
"Breastmilk alone is the best possible food and drink for a baby in the first four to six months of life. Babies should start to breastfeed as soon as possible after birth. Virtually every mother can breastfeed her baby. Frequent sucking is needed to produce enough breastmilk for the baby's needs. Bottle-feeding can lead to serious illness and death. Breastfeeding should continue well into the second year of a child's life and beyond."
BREASTFEEDING PROMOTION
1.5.04