Technical training

1. TechnicalTraining on HBNC

2. Session ISession I

3. Session-I
• Services to be provided during home delivery
and 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

4. Hand washing
Step wise method

5. 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

6. ‘Five cleans’ to prevent infection

7. Keeping the Baby Warm

8. 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

9. Kangaroo Mother Care

10. KMC
• For preterm and Low Birth Weight Baby
• Mild to moderate hypothermia
• Skin to skin contact• Skin to skin contact

11. Clothing
• During summer season
the baby should only
wear a nappy
• In the winter season the• In the winter season the
baby should wear a
front-open sleeveless
shirt, socks and a cap

12. Positioning
• Put the baby between
mother’s breast in up
right position
• Turn the head to the
side in slightly extended
positionposition
• The hips and arms are
flexed in “frog” position
• Baby’s abdomen should
be at the level of the
mother epigastrium

13. Sleeping and resting
• If the mother likes, she
can rest and sleep with
the baby in kangaroo
position
• She needs to lay in a
semi-recumbent
position, with several
pillows under her upper
body

14. Breastfeeding
• The baby can be fed
while in the sling
• If the baby shows sign
of hunger, use the same
breastfeeding positionbreastfeeding position
as you normally use
without sling

15. Moving the baby in and out of the sling
• Hold the baby with one
hand placed behind the
neck and on the back
• Place the other hand
under the baby’sunder the baby’s
buttocks
• Move the baby to put
between mothers’
breast and tigh the sling

16. Carrying the baby
• The mother can do
what ever she likes: she
can walk, stand or sit
• Make sure that the sling
is tight firmly enoughis tight firmly enough
when the mother would
like to change position

17. Breastfeeding Technique

18. 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 to
the mother's body.
• The baby’s face should face the
mother's breast, with nose oppositemother's breast, with nose opposite
the nipple.
• The mouth should be wide open ,
well attached; upper and lower lips
are averted and cover the areola
completely with lower lip turned
outwards with the nipple in the
centre of the mouth orifice.

19. Incorrect Breastfeeding Technique

20. • If the baby is unable to
suckle, or if the mother is
unable to breastfeed the
baby directly, she can
express breast milk into a
clean bowl and then feed
Expressing milk by hand
clean bowl and then feed
the baby using a clean
spoon.
• Milk expressed after the
first 72 hours can be kept
at room temperature for
about six-eight hours.

21. Step 1
• Wash hands with soap
and water before
expression. Hold handle
or cuddle the baby.

22. Step 2
• Place a warm compress on
the breast for a few minutes
if desired.
• Put thumb and index finger
on the breast at rim of the
areola opposite each other.areola opposite each other.
Support the breast with
other three fingers.
• Press thumb and index
finger slightly inwards
towards the chest wall.

23. 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.

24. 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

25. Step 5
• Press the areola in the
same way from the
sides, this ensures that
milk is expressed from
all segments of the
breastbreast
• Do not squeeze the
nipple
• Avoid rubbing or sliding
fingers along the skin

26. Step 6
• Express one breast for
at least 3-5 minutes
until the flow slows;
then express the other
side; and then repeat on
both sidesboth sides
• To express milk
adequately it may take
20-30 minutes

27. Summary
1. Wash your hands well with soap and
water
2. Place a clean container below your
breast to collect milk
3. Massage the breast gently towards
the nipple
4. Place your thumb and index finger4. Place your thumb and index finger
opposite each other outside the
areola
5. Now press back towards your chest,
then gently squeeze to express milk
6. Repeat step 5 at different positions
around the areola

28. Some facts
• Cover the container of EBM with a clean cloth or lid
• Milk expressed after the first 72 hours can be kept
at room temperature for about six-eight hours and
in 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 fat
globules with the rest of the milk
• Feed with a cup or spoon or paladai
• Never bottle fed

29. Everson of retracted and inverted nipple

30. • Encourage the mother to gently pull out the
nipple 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 syringes
can also be used for correcting inverted
nipples.

31. • Cut the barrel of the syringe from the end where the
needle 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 open
end of the barrel in such a way that it encircles the nipple
and areola. Pull back the plunger, thus creating negative
pressure.

32. • Push the piston forward fully, and gently place the
open end of the barrel in such a way that it encircles
Step 1
open end of the barrel in such a way that it encircles
the nipple and areola. Pull back the plunger, thus
creating negative pressure.
• The nipple will be sucked into the barrel and pulled
out in the process.

33. THANK YOU