Session-11b-BREASTMILK-COLLECTION-EXPRESSION-HUMAN-MILK-BANK-BLUE.pptx

Medidas Medical Center INC
Lactation Training Management
Sesion 11
Session-11b-BREASTMILK-COLLECTION-EXPRESSION-HUMAN-MILK-BANK-BLUE

1. BREASTMILK COLLECTION, EXPRESSION AND HUMAN MILK BANK

2. OBJECTIVES Explain breastmilk collection Describe how to hand express Explain how to cup feed an infant Discuss human milk bank

3. OUTLINE INTRODUCTION BREASTMILK COLLECTION MILK EXPRESSION CUP FEEDING HUMAN MILK BANK SUMMARY

4. BREASTMILK COLLECTION

5. Plastic or glass container HOW WHERE Breast expression PUMP HAND EXPRESSION

6. SOURCE OF BREASTMILK WHEN As often as possible At work Own mother Wet nurse Other mothers = pasteurization

7. PREPARATION FOR EXPRESSION A. Hygiene 1. Maternal hygiene – daily bathing 2. Hand hygiene B. Container > clean glass or food-grade hard plastic acceptable for collection and > clean, dry, non-sterile containers are storage of milk.

8. Preparation for Expression C. Pump Equipment 1. Cleaning and maintenance a. Electric pump equipment b. pump tubings should be free of aerosols of milk or water D. Labeling of Container Name of Donor _________________________ Date Expressed ______Time Expressed _____ Pre-term _____Full term ___ Date Frozen_____

9. Preparation for Expression If collection is for your own baby IN YOUR HOME, just write date and number accordingly. ie Sept 4 # 1 Sept 4 # 2 …and so on DO NOT pool your milk. Put in small container just enough per feed. First in, first out policy

10. MILK EXPRESSION 1. Preparatory Phase Conducive environment Lactation Massage Technique - Massage - Stroke 2. Hand Expression 3. Mechanical Expression

11. For breast comfort To encourage baby to breastfeed To keep up milk production To obtain milk To pasteurize milk Why is it useful for a mother to know how to hand express?

12. Why mothers prefer hand expression to using a pump Hands are always with you Very effective and quick once experienced Mothers preference – STS stimulation Gentler than pump Less cross-infection

13. How to HAND EXPRESS The key steps: - Encourage the milk to flow. - Find the milk ducts. - Compress the breast over the ducts. - Repeat in all parts of the breast. Demo / practice ©UNICEF 910164F

14. Hand Expression

15. When to express? How long to express? To get colostrum 5-10min = a tsp To increase production 20min 6x/day To soften areola compress 3-4 times To clear blocked duct compress until cleared For storage 15-30min Colostrum may only come in drops ; ; ; ; ; As soon after delivery (after 6 hours) if the baby is not able to suckle

16. Reminders: Not touch mother’s breast Have PATIENCE and MORE practice Not to squeeze nipple Avoid sliding or rubbing breast Can express both breast simultaneously Expressing should not hurt

17. DEMONSTRATION (MILK EXPRESSION)

18. Cup Feeding

19. General reasons to cup feed Provide a positive oral experience for baby. Provide an alternative method of feeding Avoid nipple/teat confusion, Reduce the need for nasal and oral gastric tubes.

20. How to feed the baby by cup Wash your hands Place estimated amount of milk into the cup Hold baby sitting upright or semi-upright Hold the small cup of milk to the baby’s lips >Tip the cup so the milk just reaches lower lip >Cup rest lightly on the lower lip >Edges of the cup touches outer part of the upper lip

21. How to feed the baby by cup The baby becomes alert- opens mouth and eyes LBW takes milk with his tongue FT may suck, spilling some of it DO NOT pour milk… let him take it himself When he has enough – he closes his mouth 8. Measure intake over 24 hours – not just each feed.

22. Advantages of cup feeding vs bottle feeding or gavage feeding For the infant: Little energy expenditure is required. Infant can pace its own intake. Involvement of tongue and lips with cup feeding helps with the development of tongue movement. Infant may control the total volume of milk taken.

23. Advantages to cup feeding vs bottle feeding or gavage feeding For the infant: Opportunity to develop the coordination of suck/sipping, swallowing and breathing. Do not have to suffer the distress caused by the passing of gastric tubes. Avoids nipple/teat confusion. Simple shape is easier to clean

24. For the Health Professional Simple to learn and simple to teach. Non-invasive technique. Good eye-to-eye contact with infant. Parents can be closely involved with oral feeding at a very early stage. Having parents cup feed frees staff to do other tasks. Simple shape can be easily cleaned. Advantages to cup feeding vs bottle feeding or gavage feeding

25. Cup feeding disadvantages Spillage Incorrect positioning of the infant or the cup allows milk to be poured into the infants mouth. This can be potentially dangerous and cause aspiration.

26. DEMONSTRATION (CUP FEEDING)

27. HUMAN MILK BANK

28. DONOR MILK BANK > a service established for the purpose of collecting, screening, processing and distributing donated human milk to the specific medical needs of individuals for whom it is prescribed.

29. DONOR HUMAN MILK > a human milk given by unpaid lactating women not biologically related to the recipient.

30. WHY USE DONOR MILK? Donor milk offers many benefits for the infant. Contains growth factors aside from its immunoglobulin Other reasons for prescribing donor milk.

31. Had normal pregnancy and delivery. Is serogically negative for syphilis and hepa -b surface antigen. Has no infection acute or chronic. Not taking medications, smoking or using excessive alcohol. Is capable of carrying out sterile technique or neat personally. If donating for other infant, own child is healthy without jaundice. QUALIFICATION OF DONOR

32. MILK STORAGE Store in small amounts Place container of Expressed Breastmilk in the coldest part of the ref or freezer Warm milk Bowl of warm water (excessive heat will destroy enzymes and protein) “Slow defrost” - preferred Consume thawed milk

33. WHEN REFRIGERATOR IS NOT AVAILABLE Use evaporative cooling container. Water soaked earthen jar, cover with cloth that reaches down the water. Place in coolest part of the house.

34. STORAGE GUIDELINES FRESH MILK Room Temperature 20°C - 37°C = 4 hrs. 15°C - 25°C = 8 hrs. Below 15°C = 24hrs. > Milk should not be stored above 37 °C Refrigerated (2-4 °C) = 8 days If temperature of the refrigerator is not kept constant = 3-5 days BFHI 20-hrs course

35. STORAGE GUIDELINES FRESH MILK Freezer compartment of a refrigerator = 2 weeks Freezer of a 2 door refrigerator (-20 °C) = 3 months Deep freezer = 6 months Thawed in ref. = 24 hrs. 20 hrs course

36. MILK PROCESSING

37. JFMH Human Milk Bank March 6, 2008

38. Receiving area

39. Consultant’s Office Expression and pasteutizer area

40. Expression Lounge

41. Single breast pumping

42. Double pumping

43. COLLECTED EXPRESSED BREASTMILK

44. SCRUBBING Each pasteurization team member thoroughly scrubs her hands with antimicrobial soap before putting on gloves; gloves are always used when handling milk as part of the pasteurization process.

45. POOLING OF COLLECTED EBM UNDER LAMINAR HOOD USING ASEPTIC TECHNIQUE MIXING and POOLING

46. POOLED HUMAN MILK UNDER THE LAMINAR HOOD

47. FILLING BOTTLES 100 ml bottles are filled with milk prior to pasteurization.

48. SPECIAL FEED PASTEURIZER JFMH

49. POOLED MILK IN SPECIAL BOTTLES ARE PLACEDINSIDE PASTEURIZER

50. PASTEURIZATION

51. PASTEURIZED REMOVED AND COOLED SAMPLE TAKEN FOR LABORATORY

52. LAB TESTING Milk samples are taken before & after the pasteurization process and cultured to check for bacterial growth. Contaminated milk is discarded.

53. PASTEURIZED EBM NOW STORED IN FREEZER

54. PASTEURIZED MILK Milk is now ready for freezing and storage. It can be dispensed after samples are cultured and show no bacterial growth.

55. SUMMARY To maintain lactation, mothers should learn how to collect,express her breastmilk , store it and learn ways to feed her baby not interfering with breastfeeding.

56. “ A new born baby has only three demands. They are warm in their arms of its mother, food from her breast and security in knowledge of her presence. Breastfeeding satisfies all three!” Grandly Dick - Read

57. Thank you