Back to Home Page of CD3WD Project or Back to list of CD3WD Publications

		Infant Feeding in Emergencies: A Guide for Mothers (WHO, 1997, 48 p.)
			(introduction...)
			Foreword
			Introduction
			Why is breastfeeding so important?
			Are commercially-made baby milks as good as breastfeeding?
			Why are commercially-made baby milks not so good?
			But can every woman breastfeed?
			But why don't the experts tell us this if breastfeeding is so important?
			Do babies also need tea and water?
			When do babies need more than just breast-milk?
			So a sick baby should go on breastfeeding?
			Do breastfed babies get fewer diseases?
			But my friend's baby got ill and he was breastfed
			So breastfeeding is like a medicine?
			People say that stress stops the milk, so during stressful times how can we breastfeed?
			What about women who have lost a lot of weight? Can they produce milk?
			Do we need special nutrition for breastfeeding?
			But what about anaemic women? Does breastfeeding drain their strength?
			Someone told me breastfeeding stopped you getting pregnant, but isn't that just a story?
			How does breastfeeding work?
			What about women with small breasts or flat nipples?
			You said the baby has a part too. What can he do?
			Why is the baby's suckling-action important?
			How does a baby stimulate the milk?
			The first principle of breastfeeding: good attachment
			Why does good attachment not always come naturally to the baby?
			Why does the baby not always get this right?
			Sometimes it is hard to get a baby close because he is swaddled and his clothing gets in the way
			Even if my baby attaches well, how can I be sure there will be enough milk?
			You said earlier that milk changes during a feed. Can you explain that?
			But I thought you must feed from both breasts?
			You said earlier that confidence was important but not everyone has that. What can we do?
			I know women with breastfeeding problems. Can they be helped?
			My mother told me that you always get sore nipples and you just have to put up with them
			What about special creams for sore nipples? How can we get them during an emergency?
			With this baby-led feeding how can I be hygienic and wash my nipples?
			So if I get my baby well-attached, I will never get sore nipples?
			You say breastfeeding should not hurt, but what about the engorgement that every woman gets a few days after the birth?
			You mentioned blocked ducts, mastitis and abscess. Are they common and how can we treat them?
			All these problems make breastfeeding look too difficult
			You said earlier that you can breastfeed even if you have stopped completely. How can this be done?
			Food supplies can be precarious. How can we feed the babies over 6 months who need more than breast-milk alone?
			What about premature or very small babies?
			I can see the reason for expressing milk for sick or premature babies, but must all women learn to express?
			How do I express milk?
			I can see that breastfeeding is possible in most cases, but we still have to face the times when it is not possible: emergencies create orphans, abandoned babies and severely ill or wounded mothers
			Is it possible to feed a baby artificially without a bottle?
			How do you cup-feed a baby?
			A final word

How do I express milk?

Even where women have the choice to use pumps, many prefer hand expression. Hand expression imitates a baby's suckling action more naturally. Also sterilization of breast pumps is essential for safety and may be difficult to control in emergencies.

· Wash your hands thoroughly.
· Have a clean cup or container with a wide neck.
· Make yourself comfortable.

The following instructions are just guidelines. You find the way that suits you (Figures 6a, 6b and 6c).

· Hold your breast with your four fingers underneath and your thumb on top behind the nipple. Do not squeeze the nipple.

· Gently feel the little thickenings inside your breast under the areola. These are 'lactiferous sinuses' which is where the milk collects as it comes down.

· Compress your fingers and thumb rhythmically in a way that suits you.

· Move your hand round your breast, expressing milk from the sinuses.

· Do the same with the other breast.

· If you prefer use both hands on each breast.

You may find that your milk does not 'come down' as quickly as when your baby is near you. Think about your baby. If you have a photo look at it or smell some of his clothing. Ask someone to massage your back gently. This is where women can help and support each other. If you can find another mother who has hand expressed already, ask her to teach you.

Two helpful methods to teach another woman are:

· if you are lactating let her watch you do it

OR

· make sure she is comfortable, then stand behind her and guide her own hand on her breast. In this way she has had practice under your guidance.

Figure 6a

Figure 6b

Figure 6c