INTRODUCTION:

Breast milk alone is sufficient to meet an infant’s requirement for food and water in the first six months of life. With frequent, on-demand feedings, babies do not need water or any other liquids even in hot climates; mother’s milk is all they need for survival and optimal growth and development. Foods given to infants in the first six months of life do not improve growth and, instead, are dangerous when they replace mother’s milk, because they can result in frequent infections and poor growth and development.¹

According to World Health Organization (WHO), breastfeeding is one of the most natural and cost-effective processes of feeding infants aged less than 24 months to obtain the right amount of nutrition needed for healthy growth and development.

Benefits include reduced risk of conditions such as breast cancer, cardiovascular disease and rheumatoid arthritis in the mother, whilst aiding in mother’s weight reduction and enhancing close relationship with the child.

Benefits to the new born include good nutrient supply and immunity, decrease risk of sudden infant death and conditions such as type 1 diabetes.²

Breast feeding is the first fundamental right of the child. It provides a unique biological and emotional basis for the health development of the children. It offers infants and young children complete nutrition, early protection against illness and promote growth and development of the baby. Early initiation of breast feeding lowers the mother’s risk of postpartum haemorrhage and anaemia. Boosts mother’s immune system and reduces the incidence of diabetes and cancers.^1,2 Exclusive breastfeeding for the first four to six months of life and timely introduction of weaning foods are important for laying down proper foundations of growth in later childhood.³ This is due to the fact that by five to six months of age babies need additional food besides breast milk, which supplies energy, protein and other nutrients. Since this form one of the most sensitive periods, the combined effects of inadequate and un hygienically prepared supplemented food that is prone to infections may ultimately lead to increased risk of growth retardation.³

While breastfeeding rates have improved globally, disparities in breastfeeding practices persist particularly in rural and low resource settings. In LMICs, only 37% of children are breastfed exclusively for the first 6 months of life and India is no exception. According to the National Family and Health Survey-4, on average only 56% of Indian mothers practiced EBF for the full 6 months. As India leads the world in the number of preterm births, under 5 years malnutrition, and neonatal mortality, understanding the factors associated with exclusive breastfeeding can help improve the nutritional status for millions of infants. Furthermore, understanding factors that influence EBF practices can contribute to achieving the United Nations Sustainable Development Goal 3 (SGD3) of reducing neonatal mortality to at least as low as 12 neonatal deaths per 1000 live births by 2030.^4-13

Recently, maternal breastfeeding self-efficacy has been highlighted as an important psychometric factor for improving breastfeeding outcomes. Breastfeeding self-efficacy is defined as a mother’s confidence in her ability to breastfeed her new infant and has been positively associated with breastfeeding duration and exclusivity in various cultures and age groups. Theoretically, breastfeeding self-efficacy is influenced by the following four main sources of information: (a) performance accomplishments (e.g., past breastfeeding experiences), (b) vicarious experiences (e.g., watching other women breastfeed, peer counselling), (c) verbal persuasion (e.g., encouragement from influential others such as friends, family, and lactation consultants), and (d) influence of one’s physiological and/or affective states (e.g., pain, fatigue, anxiety, stress). Breastfeeding within the first hour of life is recognized as one of the most important actions for infant survival. Yet in India, only 41.6 % infants start breastfeeding within one hour of life.^14,15

Breastmilk alone is sufficient to meet an infant’s requirement for food and water in the first six months of life. With frequent, on-demand feedings, babies do not need water or any other liquids even in hot climates; mother’s milk is all they need for survival and optimal growth and development. Foods given to infants in the first six months of life do not improve growth and, instead, are dangerous when they replace mother’s milk, because they can result in frequent infections and poor growth and development. In India, 55 per cent of infants under six months are exclusively breastfeed.^16,17

OBJECTIVES OF THE STUDY:

1. To assess the Breastfeeding Practices among postnatal mothers.

2. To assess the Breastfeeding Self -Efficacy among postnatal mothers.

3. To correlate the breastfeeding practices with breastfeeding self-efficacy score among postnatal mothers.

4. To find out association between level of breast feeding practices among postnatal mothers with their selected demographic variables.

5. To prepare and administer information booklet to postnatal mothers.

HYPOTHESIS:

1. H1: There will be a significant relationship between the breastfeeding practices and breastfeeding among postnatal mothers.

2. H2: There will be a significant association between the level of the breastfeeding practices with their selected demographic variables.

CONCEPTUAL FRAME WORK:

Conceptual frame work presents logically constructed concepts to provide a general explanation of the relationship among the concepts of the research study. It is a framework which provides the investigator guidelines in attaining the objectives of the study. The conceptual frame work of the present study is based on Social Cognitive Theory (SCT) provides a framework for analysing human motivation, thought, and action from a social cognitive perspective by Bandura, 1977a, 1978. Bandura’s SCT has been selected as a framework for the current study because it explains the process of acquisition of new behaviour patterns and change in behaviour as well as how behaviour is regulated and maintained. Motivation, thought, and action from a social cognitive perspective (Bandura, 1977a, 1978). Bandura’s SCT has been selected as a framework for the current study because it explains the process of acquisition of new behaviour patterns and change in behaviour as well as how behaviour is regulated and maintained.¹⁸Such as informational booklet on educational strategies Bandura’s SCT also provides effective educational strategies (e.g., modelling, rehearsal, reinforcement, and self- monitoring) that can be used in implementing an educational program. Such educational strategies were effective to influence behaviour either through direct action or through influence on self-efficacy or outcome expectations (Bandura 1977b, 1986)

It includes 3 concepts

Environment:

It includes provide the informational booklet to the breastfeeding practices to the postnatal mothers and previous information received from relatives, friends, neighbours, health personnel, newspaper and TV/Radio that would influence personal factor and behavioural factor in terms of practice breastfeeding.

Personal:

Drives, traits, wisdom, thought, feeling, believes, self-perception, goals intention and other motivational factors. The personal factor in this study includes educational qualification and parity of the postnatal mothers and the breastfeeding self-efficacy.

Behaviour:

Knowledge and skill to perform given behaviour. The behaviours factors include practicing correct technique of breastfeeding. In this study investigator aims to identify the extent to which exposure to information booklet will bring change in knowledge and practice of breastfeeding. Investigator also wants to see the association and relationship between personal factor (Parity, educational status of mothers, knowledge of breastfeeding.) and behavioural factor (practice of breastfeeding). And observe the LATCH assessment¹⁹.

MATERIALS AND METHODS:

RESEARCH APPROACH AND DESIGN:

A Quantitative non-experimental descriptive design adopted to conduct the study. Postnatal mothers and there neonates.

Sample and Sampling Technique:

With a sample size of 60 were selected by using Convenient sampling, subjects were selected, because of their convenient, accessibility and proximity to the researcher.

Criteria for Selection of Sampling:

Inclusion Criteria:

Sampling characteristics are the eligibility or inclusion criteria specification constraints population should be driven to the extent possible. people are able to participate in study design with ethical consideration.

The study included postnatal mothers who are

· Admitted in postnatal and pediatric units.

· Able to understand, read and write Telugu.

· Willing to participate in the study.

· Available at the time of data collection.

Setting of the Study:

The setting of the study included NRI General Hospital, Chinakakani, Guntur.

The tool for the study was chosen by the investigator based on the thorough review of literature and consultation with experts in the field of obstetrics and paediatrics. Tool includes 4 sub-sections.

Section -A

Based on objectives-demographic data included Mother Details-age, religion, occupation, education, income, residential area, type of gravida, mode of delivery, maternity leaves, Baby Details- Birth order, age of baby and Birth weight.

Section -B

The section consist of 15 items on knowledge regarding breast feeding. The item as developed as to cover the entire aspects of breast feeding self efficacy. Each item is closed ended multiple choice question. Each correct answer allotted a score of “one” and score “zero” for the incorrect answer. The maximum score for the section “B” is 15.

Score interpretation:

· 0-10 (<50%)- Inadequate practice

· 11-15 (51-75%) moderately adequate practice

· 16-20 (>75%) Adequate practice.

Section -C

A tool to assess breastfeeding self-efficacy. Standardized tool of Breastfeeding self-efficacy short form scale by Dennis, (2002) it includes 14 items deals about the breastfeeding self-efficacy. It is graded on points score maximum score of 70, 1- not at all confident 2-confident, 3-some what confident, 4- confident 5- always confident graded of breastfeeding self -efficacy.

Interpretation of the self-efficacy:

· 1-40 – Low self -efficacy confident

· 41-60 – Moderate self- efficacy confident

· 61-70-High self -efficacy confident

Section-D:

Checklist on LATCH to assess the breastfeeding practices among postnatal mothers, the observational checklist includes 5 items.

· Latch

· Audible swallowing

· Type of nipple

· Comfort

· Hold

Each item scored on 0-poor, 1-moderate, 2-good observation. The total score on breastfeeding was categorized into 0-3 poor feeding, 4-7 moderate feeding, 8-10 High feeding.

Content Validity:

The prepared tool along with objectives were submitted to 2 doctors. The modifications and suggestions of expert were incorporated in the final preparation of the tool.

Reliability:

Reliability refers to the degree of consistences and the accuracy of the information obtained in the study. In the present study reliability of the tool was assessed by breastfeeding practices by split half method and spearman's brown prophecy formula showed score of 1.0. It indicates the tool was highly reliable. Breastfeeding Self-Efficacy short form scale (Dennis) Cronbach’s score is 0.97 it indicates the tool was reliable. LATCH Cronbach’s score is 0.98 it indicates tool was reliable.

Pilot Study:

Pilot study was conducted at NRI General hospital with purpose to find out feasibility and practicability of the study design. In the present study 10% sample taken for pilot study. The investigator selected from 6 postnatal mothers. The pilot study was conducted on 17/3/2019. The pilot study samples are not included in the main study. It was found to be a feasible and easily understandable for the subjects.

Ethical Consideration:

Ethical consideration was obtained from the institutional ethical committee permission was obtained from significant authorities and the consent was taken from the subject.

Collection of Data:

Data collection is the gathering of information needed to address a research problem. The data collected from 19.4.2019 to 21.4.2019, in NRI General Hospital, Chinnakakani Guntur. The formal permission was obtained from the Medical Superintendent of NRI General and Super Specialty Hospital, Chinnakakani, Guntur district. The convenient sampling used for selecting the sample, informed consent was taken from participants. Tool was distributed to the participants to fill the questionnaire on demographic variables, breastfeeding practices, breastfeeding self-efficacy scale and observation was taken by using the LATCH tool by the researcher during breast feeding. Tool was checked at the Centre for completeness and missing data was filled by the respondent.

Plan for Data Analysis:

Data analysis is the process of organizing and synthesizing the data so as to answer the research questions and test hypothesis by using the collected data the following methods were used to analyze data.

Descriptive Statistics:

Frequency and percentage were computed to summarize the demographic data, breastfeeding practices, observational checklist on LATCH parameters to analyse by item wise analysis. Chi-square test was used to analyse the association between Breast feeding practices with their selected variables. Correlation co-efficient to find out relationship between Breastfeeding Practices and Breast feeding Self-Efficacy.

RESULTS:

The results of the study based on the objectives sections were done. Descriptive and inferential statistics were used for analysis.

Section B

How are you feeding your baby?

Regarding breast feeding exclusively, the majority of respondents were exclusive breast feed 52(86.6%), breast feeding and breast milk substitutes were 8(13.3%). None of them the only breast milk substitutes and other milk feeding.

2. How long after births did hold you?

Regarding baby holding after birth the majority of the respondents were within 5 mins 18 (30%), immediately 15(25%), with in 30 min 10 (16.6%), with in 1 hour 8 (13.3%) can’t remember 5(8.3%), as soon as 1 was able to respond 4 (6.6%).

3. How did you hold at 1st time?

Regarding holding of baby at 1st time. The majority of respondents were hold wrapped baby without much skin contact 44 (73.3%) and skin to skin 16(26.6%).

4. If it took >5min after birth, what was the reason?

Regarding reason for not holding baby >5mins after birth, the majority of a respondents verbalized they had been on anesthesia and was not held 24(40%), baby need help or observation 21(35%), I didn’t have energy 10(16.6%). I was not given my baby this soon 3(5%) and other reasons 2(3.3%).

5. For about how long your baby did you hold your baby this 1st time? Regarding how long you held the baby at 1st time the majority of respondents were less than 30mins 25(41.6%), 30mins to one hour 12(20%), one hour or more 9(15%), more than hours 8(13.3%) and others 2(3.3%).

6. Did you have any help with positioning and attaching your baby for breast feeding before discharge?

Regarding support for positioning and attaching the baby. The majority of respondents were with support 50(83.4%) and without support 10(16.6%).

7. Did anyone show you or give you information on how could express your milk by hand?

Regarding expression of breast milk majority of respondents were obtained information 50(83.4%) and did not obtain information 10(16.6%).

8. Where was your baby while you were in maternity services after giving birth? Regarding where the baby in your maternity services after giving birth the majority of respondent’s babies were not with them 33(55%), my baby is always with me 27(45%).

9. What advise has been given about how often to feed your baby?

Regarding advice as how often to feed baby taken majority of respondents were every hour 18(30%), no advise given 17(28.3%) every time my baby seems hungry 15(25%), every 1-2 hour 8(13.6%), and every 2-3 hours and also others are 1(1.6%).

10. What advise have you been given about how long your baby suckle?

Regarding advise about been length of baby suckle. The majority of respondents were in for as long as my baby wants to 24(40%). No, advise given and also limited time 15(25%) and others 6(10%).

11. If yes, why was your baby given the supplements?

Regarding baby supplements majority of respondents were didn’t know reason 20(33.3%), my doctor or staff recommended but not provided reason 14(23.3%), requested it 12(20%), others 9 (15%) and my doctor other staff recommended the supplements 5(8.3%).

12. If supplements given, how they feeding?

Regarding how they feed supplements the majority of respondents were a bottle with a teat or nipple 16(26%), spoon 3(5%) and cup 2(3.3%).

13. Has your baby sucked on a pacifier as far as you know? While you have been in maternity unit?

Regarding baby the sucking on a pacifier majority of respondents are known about sucked on a pacifier 29(48.3%) no usage of pacifier 17(28.3%) and don’t know about reason for suck on a pacifier 14(23.3%).

14. Have you been suggestions by anyone about how or where to get help, if you have problems with feeding your baby after you return home?

Regarding have you get help on problems with feeding your baby after you return home. The majority of participants said yes 45(75%) and no 15(25%).

15. If yes what suggestions have you been given?

The data presented in table 2 shows what suggestions have you got. The majority of respondents were get to visit the hospital 24(36.6%) get help from mother support (or) peer and also others 5(8.3%) none of them help from another communication services.

Section C

Latch:

Regarding majority of respondents were good latch 32(53.4%), moderate latch 20(33.3%), and poor latch were 8(13.3%).

Audible swallowing:

Regarding majority of respondents were good audible swallowing 28(46%), moderate swallowing 26(43.8%), and poor swallowing 7(11.6%).

Type of nipple

Regarding type of nipple majority of respondents were moderate type of nipple 27(45%), good type of nipple 21(35%), and poor type of nipple 12(20%).

Comfort:

Regarding comfort majority of respondents were good comfort 42(70%), moderate comfort 12(20%), and poor comfort 6(10%).

Hold positioning:

Regarding hold positioning majority of respondent were moderate positioning 35(58.4%), good positioning 17(28.3%) and poor positioning 8(13.3%).

It deals with the analysis of data related to association between Breastfeeding practices with socio-demographic variables.

Percentage Distribution Of Postnatal Mothers By Age:

Regarding the age of mother. Majority of respondent were in the age group of 20-25years 24(40%) and 26-30years 15(25%), below 20 years 11(18.4%), 26-30 years 15 (25%), 31-35years 6(10%), above 35 years 4(6.6%).

Percentage Distribution of Motherstype of Gravida

Regarding type of gravid of mother. Majority of respondents were primi gravida 31(51.6%) and multi gravid 29(48.4%).

Percentage Distribution of Mother by Residential Area:

Regarding the type of residential area majority of respondents resides in urban 33(55%), whereas slum 19(31.6%), and in rural area 8 (13.3%).

Table Association between the breastfeeding practices with demographic variables.

S. No	Demographic variable	Moderately adequate		Inadequate		Adequate		Chi-square and Df	p-value significance
S. No	Demographic variable	f	%	f	%	F	%	Chi-square and Df	p-value significance
1.	Age of mother							10.7 Df 8	NS (15.5)
	Below 20 years	2	3.3%	5	8.3%	3	5%
	20-25 years	3	5%	19	31.6%	0	0%
	26-30 years	3	5%	10	16.6%	3	5%
	31-35 years	1	1.5%	2	3.3%	3	5%
	Above 35 years	3	5%	4	6.6%	0	0%
2.	Religion							18.4, Df 4	**(9.49)
	Hindu	5	8.3%	25	41.6%	2	3.3%
	Christian	6	10%	5	8.3%	7	11.6%
	Muslim	0	0%	10	16.6%	0
	Any other specify….
3	Socio-economic status							11.05 Df 6	NS(12.5)
	Upper	3	5%	10	16.6%	6	10%
	Upper Middle	2	3.3%	14	23.3%	1	1.6%
	Lower Middle	4	6.6%	5	8.3%	0	0%
	Upper Lower	2	3.3%	11	18.3%	0	0%
	Lower	1	1.6%	0	0%	2	3.3%
4.	Residential Area							27.2 Df 4	**(9.49)
	Rural	4	6.6%	29	48.3%	2	3.3%
	Urban	5	8.3%	10	16.6%	1	1.6%
	Slum	2	3.3%	1	1.6%	6	10%
5.	Type of gravida							0.54 Df 2	NS (5.99)
	Primi gravida	8	13.3%	27	45%	5	8.3%
	Multi gravida	3	5%	13	21.6%	4	6.6%
6.	Mode of delivery							11.5 Df 4	*(9.49)
	Normal vaginal delivery	3	5%	20	33.3%	2	3.3%
	LSCS	8	13.3%	15	25%	1	1.6%
	Instrumental delivery	0	0%	5	8.3%	6	10%
7.	Birth order of child							11.2 Df 4	*(9.49)
	1^st child	9	15.1%	13	21.6%	2	3.3%
	2^nd child	2	3.3%	22	36.6%0	7	11.6%
	3^rd child	0	0%	5	8.3%	0	0%
8.	Age of baby in days							8.79 Df 2	*(5.99)
	0-7 days	10	16.6%	30	50%	3	5%
	7-14 days	1	1.6%	10	16.6%	6	10%
9.	Birth weight in kgs							9.74 Df 6	NS (12.59)
	<2.5 kgs	3	5%	4	6.6%	1	1.6%
	2.6-3.0 kgs	6	10%	24	40%	4	6.6%
	3.1-3.5 kgs	2	3.3%	7	11.6%	4	6.6%
	>3.5kgs	0	0%	5	8.3%	0	0%

Note: Not significant=NS (p value >0.05), significant =*(p value 0.01<p<0.05), highly significant = **(p value <0.01)

Data presented in table-1 shows that frequency, percentage distribution, and chi-square value association between the breastfeeding practices with selected socio-demographic variables.

DISCUSSION:

The first objective of the study is to assess breastfeeding practices among postnatal mothers.

Item wise analysis

With regard to type of feeding, the majority of respondent were breastfeeding exclusively 52(86.6). With regard to, the majority of respondent hold baby were 18(30%). With regard to, the majority of respondent were in wrapped without much skin contact 44(73.3%).

With regard to, the majority of respondent were in I had been given anaesthesia and was so not held 24(40%). With regard to how long did you hold your baby this first time the majority of respondent were holding baby for less than 30 min 25(41.6%). With regard to, help with positioning and attaching your baby the majority of respondent were yes 50(83.3%).

With regard to the majority of respondent took support and obtained information of Exclusive Breast Milk were 50(83.3%). With regard to, the majority of respondent my baby always with me both day and night were 27(45%). With regard to, the majority of respondent took advices on feeding the baby were in every hour were 18(28.3).

With regard to, the majority of respondent baby sucked as long as baby wants to were 24(40%). With regard to supplements, the majority of the respondents were don’t know reason (33.3%). With Regard to mode of feeding supplements, the majority of respondent were bottle with teat or nipple 16(32%).

With regard sucking on a pacifier, the majority of respondent were 29(48.3%). With regard to, getting suggestions a problem of feeding the majority of respondent received suggestions were in yes 45(75%). With regard to, suggestions the majority of respondent were got help from professionals 22(36.6%).

The table 3 discusses about breastfeeding practices of majority of participants had moderately adequate practices 40(66.6%) and the mean and standard deviation were 8.6, 0.56.

The second objective of the study is to assess the breast feeding self-efficacy among postnatal mothers.

Discusses about analysis of Breastfeeding Self-Efficacy Table 6 showed item wise analysis on Breastfeeding self-efficacy were with regard to baby getting enough milk the majority of respondents were always confident 25(41.6%). With regard to Successfully cope with breastfeeding like I have with other challenging tasks. the majority of respondents were both confident and also always confident 20(33.3%). With regard to Breast feed baby without formula supplements the majority of respondent were always confident 28(46.6%).

With regard to Ensure that baby is properly latched, the majority of respondent were always confident 25(41. 6%). With regard to Manage breast feeding situation with my satisfaction, the majority of respondents were always confident 25(41.6%). With regard to Manage to breast feed even if baby is crying, the majority of respondents were always confident 23(38.3%).

With regard to Keep wanting to breast feed, the majority of respondent were always confident 24(41.6%). With regard to Comfortably breastfeed with family members present, the majority of respondents were always confident 25(41.6%). With regard to Be satisfied with family members present, the majority of respondents were always confident 26(43.3%). With regard to Deal with the fact that breast feeding can be time consuming, the majority of respondent were always confident 27(45%).

With regard to Feeding baby on one breast before switching to other breast, the majority of respondents were always confident 25(41.6%). With regard to Continue to breastfeed baby for every feeding, the majority of respondents were always confident 26(43.3%). With regard to Manage to keep up with baby's breastfeeding demands, the majority of respondents were always confident 28(46.6%). With regard to Tell when the baby is finished breastfeeding, the majority of respondents were always confident 35(58.3%).

Breastfeeding self-efficacy score showed mothers were high confident 26(43.4%). Mean and standard deviation scores were 28.16, 4.7.

The third objective of the study to correlate breastfeeding practices with breastfeeding self-efficacy among postnatal mothers.

In this study to the co relational coefficient breastfeeding practices with breastfeeding self-efficacy value is 1.0 which refers they were strongly positive correlated.

The data related to the breast-feeding practices frequency and percentage distribution of inadequate practices were 11(18.4%), moderately adequate practices were 40(66.6%), and adequate practices were 9(16%), mean and standard deviation of Inadequate practices were 1.1, 0.4 moderately adequate practices were 8.6, 0.56 and adequate practices were 2.7, 1.97.

The data related to breast feeding self-efficacy frequency and percentage low confident 14(23.3%), moderate confident 20(33.3%) and high confident 26(43.4%). Mean and standard deviation low confident 4.9(2.07), moderate confident 17(4.18) and high confident 28.16 (4.7).

The fourth objective of the study to find out the association between level of breastfeeding self-efficacy among postnatal mothers with their selected variables:

The breastfeeding practices with their selected demographic variables. The significant associated variables are Religion, Residential area, Mode of delivery, birth order of child, Age of the baby.

The fifth objective is to prepare and administer a booklet to postnatal mothers:

In this study prepare and administered informational booklet regarding the breast-feeding practices and administered the postnatal mothers after a collecting the data, in a view to guide good practices and solve problems about latching.

RECOMMENDATIONS:

The following recommendations were made for further based on study findings:

· A study can be done to assess the breast-feeding practices on a large scale

· A longitudinal, prospective study can be done to assess the breast feeding self-efficacy on exclusive Breastfeeding.

· A study to correlate between knowledge effectiveness of breast feeding practices and breast feeding self-efficacy.

· A study on mobile based teaching materials a breastfeeding practice.

CONCLUSION:

The following conclusion were formed on the bases of the study results

The findings revealed that information booklet improved the breast-feeding practices among postnatal mother's.

The findings revealed that the improve the breast feeding self-efficacy of postnatal mother's.

There was a significant relation between breast feeding practice and self-efficacy.

Booklet:

Informational Booklet on Breast Feeding Practices:

Definition of exclusive breast feeding:

Exclusive breastfeeding is defined as no other foods or drink, not even water except breastmilk for 6 months of life but allows the infant to ORS, drops and syrups.

Meaning:

Exclusive breastfeeding that is the infant only receives breast milk without any additional food or drink. Breastfeeding on demand that is as often as the child wants day and night.

Changes in composition:

3 phases

· Cholestrum

· Transitional

· Mature milk

Nutrients in breast milk:

It contains proteins, carbohydrates, fats, vitamins, minerals, enzymes.

After delivery:

The best time to begin breastfeeding is almost after baby is born. Baby is usually alert right after the birth, and when placed on chest, the baby may more to your breast and begin sucking.

Skin to skin contact:

Have your nurse placed your baby directly on your chest with a blanket over the two of you, snuggle the baby on your chest in the valley between your breasts. Ideally leave, the baby there for at least 30 min or until the baby breastfeeds.

Frequent Nursing:

Nurse frequently for the first few days, every 1-3 hours to help build a good milk supply.

Getting started:

The key to successful breastfeed is proper positioning of your breast and your baby to fully latch on your breast use a pillow to help support your baby's body.

Breastfeeding positions:

You will need to find the position or positions that are most comfortable for both you and your baby that way your baby will not latch on and apply pressure at the same spot every time.

The positions are:

· The cradle holds

· Cross cradle hold

· Football hold

· Lying down

Breast milk:

· It contains the perfect balance of nutrients

· Convenient, always available, and is delivered

· Uterus involution

· Reduces risk of breast cancer

· Saves money

Feeding schedule:

Feed your baby every 1-2hours during the 1st few days. This will help stimulate milk production, and lesser or prevent enforcement once your milk does come in.

Lactation:

keep your baby near you to avoid having to move too much

Positioning of the baby:

Have your baby’s face and body with your baby’s head at the level of your breast. If you can draw a straight line from your baby’s shoulder to hip, you have your baby in the correct position.

Position of breast:

Think of cupping your breast with C or U shape.

Alternative breasts:

Alternative the side you start breastfeeding because your baby sucks more efficiently on the first breast used. If your baby does not nurse the second breast or completely drain the second breast begin nursing on that breast at the next feeding.

Removing baby from the great:

If it is necessary to reposition to your baby during a feeding or get a better latch, gently slip one of your figures into the corner of your baby’s mouth to 1st break the suction.

Breastfeeding frequency:

Your baby will need to breastfeed every 1-2 hours at least 9-12times in a 24 hrs period for at least 10min.

Nursing longer than 30min is not recommended as it will lead to sore nipples.

Supplies and demand:

Allow your baby is fully drain at least one breast during each feeding.

After the other breast after your baby empties the 1st breast.

Waking your baby to feed:

Every baby is born with his or her own treatment and need for sleep. Most babies will sleep for 8-12 hrs in their 1st 2-3 days during in the 1st few weeks, your baby will need waken up to feed.

Latch on Technique:

The mother techniques to help the infants latch on to the breast. The infant should be awake and hungry.

Eliciting Latch on:

After positioning the infant face, the breast, instruct the mother to hold her breast to that the nipple brushes against the centre of the infant’s lower lip. the infant will respond by opening the mouth, although up to a minute of stroking may be necessary.

Good Latching	Poor Latching
· Baby	· Baby
· Baby chin was touches the breast	· Baby is latching on just nipple
· Baby does not have her lips out like a fish	· Baby sucking in her cheeks only
· See the swallowing	· Not seen the swallowing
· Baby getting enough milk satisfy	· Baby is not getting enough milk
· Baby turn the ears	· Baby not turn the ears
· Not get any smacking sounds	· Get the smacking sounds
· Mother not get any breast pain	· Mother get breast pain
· Increase milk production	· Decrease milk production

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Received on 30.04.2022 Modified on 15.05.2022

Int. J. of Advances in Nur. Management. 2022; 10(3):211-220.

DOI: 10.52711/2454-2652.2022.00051