Technical Training on HBNC

Session ISession I

Session-I

• Services to be provided during home deliveryand home visits

• Capacity building on– Hand washing

– 5 cleans during delivery– 5 cleans during delivery

– Correct method of wrapping the baby after birth

– Kangaroo Mother Care (KMC)

– Breastfeeding Technique

– Expressing milk by hand

– Everson of retracted and inverted nipple

Hand washing

� Step wise method

5 Cleans during delivery

� Hand washing-Clean Hand

� Clean place

� Clean Cloth for wrapping the baby

� Clean Cord cut with a clean blade

� Clean Cord clamp with clean thread

‘Five cleans’ to prevent infection

Keeping the Baby Warm

Steps in wrapping the baby

• First fold one corner of the piece of cloth

• Place the baby on the cloth

• Right fold

• Fold from below the foot

• Left Fold

Kangaroo Mother Care

KMC

• For preterm and Low Birth Weight Baby

• Mild to moderate hypothermia

• Skin to skin contact• Skin to skin contact

Clothing

• During summer seasonthe baby should onlywear a nappy

• In the winter season the• In the winter season thebaby should wear afront-open sleevelessshirt, socks and a cap

Positioning• Put the baby betweenmother’s breast in upright position

• Turn the head to theside in slightly extendedpositionposition

• The hips and arms areflexed in “frog” position

• Baby’s abdomen shouldbe at the level of themother epigastrium

Sleeping and resting

• If the mother likes, shecan rest and sleep withthe baby in kangarooposition

• She needs to lay in asemi-recumbentposition, with severalpillows under her upperbody

Breastfeeding

• The baby can be fedwhile in the sling

• If the baby shows signof hunger, use the samebreastfeeding positionbreastfeeding positionas you normally usewithout sling

Moving the baby in and out of the sling

• Hold the baby with onehand placed behind theneck and on the back

• Place the other handunder the baby’sunder the baby’sbuttocks

• Move the baby to putbetween mothers’breast and tigh the sling

Carrying the baby

• The mother can dowhat ever she likes: shecan walk, stand or sit

• Make sure that the slingis tight firmly enoughis tight firmly enoughwhen the mother wouldlike to change position

Breastfeeding Technique

Correct Breastfeeding Technique• While holding the baby, the mother

also supports the baby’s bottom,and not just the head or shoulders.

• The baby should be held close tothe mother's body.

• The baby’s face should face themother's breast, with nose oppositemother's breast, with nose oppositethe nipple.

• The mouth should be wide open ,well attached; upper and lower lipsare averted and cover the areolacompletely with lower lip turnedoutwards with the nipple in thecentre of the mouth orifice.

Incorrect Breastfeeding Technique

• If the baby is unable tosuckle, or if the mother isunable to breastfeed thebaby directly, she canexpress breast milk into aclean bowl and then feed

Expressing milk by hand

clean bowl and then feedthe baby using a cleanspoon.

• Milk expressed after thefirst 72 hours can be keptat room temperature forabout six-eight hours.

Step 1

• Wash hands with soapand water beforeexpression. Hold handleor cuddle the baby.

Step 2

• Place a warm compress onthe breast for a few minutesif desired.

• Put thumb and index fingeron the breast at rim of theareola opposite each other.areola opposite each other.Support the breast withother three fingers.

• Press thumb and indexfinger slightly inwardstowards the chest wall.

Step 3 • Gently massage the breast

starting from the chest

moving toward the nipple;

do this in a circle (near the

underarm, and then to the

bottom of the breast), sobottom of the breast), so

that all parts of the breast

are massaged.

• Lean forward and support

the bottom of the breast

with one hand.

Step 4 • Press the breast between

the fore finger and thumb.

Press and release, press and

release until the milk drips

out. This should not hurt

• Use a clean bottle or a cup

to collect the milk. Milk may

drip at the beginning and

then spray out after it starts

flowing

Step 5• Press the areola in thesame way from thesides, this ensures thatmilk is expressed fromall segments of thebreastbreast

• Do not squeeze thenipple

• Avoid rubbing or slidingfingers along the skin

Step 6

• Express one breast forat least 3-5 minutesuntil the flow slows;then express the otherside; and then repeat onboth sidesboth sides

• To express milkadequately it may take20-30 minutes

Summary1. Wash your hands well with soap and

water

2. Place a clean container below yourbreast to collect milk

3. Massage the breast gently towardsthe nipple

4. Place your thumb and index finger4. Place your thumb and index fingeropposite each other outside theareola

5. Now press back towards your chest,then gently squeeze to express milk

6. Repeat step 5 at different positionsaround the areola

Some facts • Cover the container of EBM with a clean cloth or lid

• Milk expressed after the first 72 hours can be keptat room temperature for about six-eight hours andin a refrigerator for 24 hours.

• EBM stays in good condition longer than animal milk

• Do not boil EBM• Do not boil EBM

• Before feeding gently shake the container mix fatglobules with the rest of the milk

• Feed with a cup or spoon or paladai

• Never bottle fed

Everson of retracted and inverted nipple

• Encourage the mother to gently pull out thenipple and roll it, several times in a day.

• A 10 cc or 20 cc disposable plastic syringes

Correcting inverted nipples

• A 10 cc or 20 cc disposable plastic syringescan also be used for correcting invertednipples.

• Cut the barrel of the syringe from the end where theneedle is attached.

Step 1

needle is attached.

• Take out the piston and put it in from the opposite end,which is the cut end of the syringe.

• Push the piston forward fully, and gently place the openend of the barrel in such a way that it encircles the nippleand areola. Pull back the plunger, thus creating negativepressure.

• Push the piston forward fully, and gently place theopen end of the barrel in such a way that it encircles

Step 1

open end of the barrel in such a way that it encirclesthe nipple and areola. Pull back the plunger, thuscreating negative pressure.

• The nipple will be sucked into the barrel and pulledout in the process.

THANK YOU