Licensed books on medicine
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POLICY AIMED AT SUPPORTING BREASTFEEDING In 1989, the World Health Organization and the United Nations Children's Fund issued a joint statement on the role of mother support services in the protection, promotion and support of breastfeeding. This statement provides the most up-to-date scientific knowledge and practical experience in organizing EB in the form of accurate, universally acceptable recommendations for women before and during pregnancy and after childbirth. The work of the UN Children's Fund is carried out in several directions. 1. Formation of the correct attitude of society to the EB. 2. Enhancing the role of medical institutions in supporting breastfeeding, training medical personnel. 3. Providing the maximum amount of information about the benefits of breastfeeding for mothers, women preparing for motherhood, and society as a whole. The WHO organization and the United Nations Children's Fund developed ten principles of successful breastfeeding for maternity hospitals and newborn care hospitals. TEN PRINCIPLES OF SUCCESSFUL BREASTFEEDING 1. Have a written policy on breastfeeding and regularly communicate it to all medical personnel. 2. Train all medical personnel in the necessary skills to implement this policy. 3. Inform all pregnant women about the benefits and methods of breastfeeding. 4. Helping mothers begin to breastfeed within the first half hour after delivery. 5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their children. 6. Do not give newborns any food or drink other than breast milk, with the exception of strict medical indications for this. 7. Practice round-the-clock co-location of mother and newborn. 8. Encourage breastfeeding at the request of the child, and not on a schedule. 9. Do not give to newborns who are breastfed no sedatives or devices that imitate the mother’s breast (nipples, pacifiers). 10. Encourage the establishment of breastfeeding support groups and refer mothers to these groups after discharge from the hospital or hospital. In 1981, WHO drafted the International Code of Marketing of Breast-milk Substitutes. This set of rules calls on all manufacturers of infant formula and other types of baby food to stop advertising their products. The main provisions of the Code are as follows: • advertising of breast milk substitutes should be prohibited; • the distribution of breast-milk substitutes is unacceptable, for example, the provision of free samples of baby food to mothers and medical personnel, as well as the publication of posters, posters, calendars; • on the labels of cans with infant formula should be a clear warning that the best food for the baby is breast milk, and information about the danger of IV • Labels should not contain a picture of a healthy child. Since the 90s of the last century, the Ministry of Health of the Russian Federation has actively pursued a policy of protecting and supporting breastfeeding in accordance with international standards. The Ministry of Health of the Russian Federation prepared a regulatory framework, issued information and methodological letters and orders: • Informational and methodological letter “Promotion and support of breastfeeding in the practical health care network” (1989); • Information letter on the maintenance of breastfeeding and an action plan in the Russian Federation for 19941995. (1994); • Instructional and methodological letter “Protection, encouragement and support of breastfeeding: an extension of the joint WHO / United Nations Children's Fund Declaration (1996); • Order No. 345 “On the improvement of measures for the prevention of nosocomial infections in obstetric hospitals” (1997); • Information letter “On the program of actions to improve the system of preventive and therapeutic diagnostic measures aimed at reducing the mortality rate of children in the first year of life” (1996); • Information letter "The system of organizational measures for the protection, promotion and support of breastfeeding infants on the experience of the bodies and healthcare institutions of the city of Elektrostal, Moscow region" (1998); • Regulations on the establishment of a health care system that corresponds to the “Child Friendly Hospital” status (1999); • A typical regional program of activities to support breastfeeding of babies (1999); • Development of the WHO / United Nations Children's Fund “Child-Friendly Hospital” initiative in the Russian Federation (2002); • The practice of protecting, supporting and promoting breastfeeding in children's outpatient clinics (2003); • Order No. 50 “On the improvement of obstetric and gynecological care in outpatient clinics” (2003). Modern approaches to the protection and support of breastfeeding are also reflected in the Guidelines of the Ministry of Health of the Russian Federation No. 225 "Modern principles and methods of feeding children in the first year of life" (1999). In addition, the importance of the problem of breastfeeding was enshrined in the Federal Target Program “Safe Motherhood” (1997) and the “Concept of State Policy in the Field of Healthy Nutrition of the Population of the Russian Federation for the Period to 2005” (1998). PHYSIOLOGY OF BREASTFEEDING The synthesis of milk in the alveoli is a complex process involving four secretory mechanisms: exocytosis, synthesis and transport of fats, secretion of ions and water, as well as the transfer of immunoglobulins from the extracellular space. In the hormonal regulation of lactopoiesis in women, the leading role belongs to the pituitary hormone prolactin. During pregnancy, its synergist is placental lactogen. These hormones are responsible for the formation of specific prolactin receptors in the epithelial cells of the mammary gland, the growth and development of alveolar tissue, and the readiness of the intracellular metabolic mechanisms for the synthesis of the main nutrients of breast milk. The implementation of the action of prolactin occurs after the birth of the child. After a decrease in the concentration of estrogen and progesterone produced by the placenta in the blood, tissue resistance to the lactopoietic action of prolactin is removed. With a sufficient level of prolactin, the rate of formation of lactation depends almost exclusively on the dynamics of reducing the concentration of estrogen and progesterone. The main function of prolactin is to provide basic, long-term mechanisms of lactopoiesis or, more strictly, galactopoiesis (accumulation of secreted milk). Among the factors that determine the production of prolactin, the leading place is occupied by neuro-reflex mechanisms. Not a single endocrine regulation mechanism and not a single secretory function in the human body depend so much on the tactile-mechanical stimulation of certain peripheral receptors, as a function of galactopoiesis. Irritation of the nipple and areola area by actively sucking a child leads to a steady increase in production and release of prolactin. The prolactin reflex that occurs when sucking, has its critical period of formation and is adequately formed only in those cases when using an early attachment to the breast. For the formation and consolidation of the lactation neurohormonal reflex, the activity and power of sucking, sufficient frequency of application are also important. The adequacy of the term, frequency and technology of attachment of the child to the breast actually affect the state of lactation of the woman. The prolactin background, which is preserved after childbirth, can be considered as a kind of phylogenetically formed “safeguarding” mechanism that ensures the minimum duration of lactation for the period when its reflex regulation is formed. At the same time, oxytocin is formed in the posterior lobe of the pituitary gland, which stimulates the contraction of the myoepithelial cells of the acini and milk ducts, which contribute to the release of milk. In the forefront in the regulation of lactation is the reflex effect of the act of sucking: exhaustion - pituitary - oxytocin - milk secretion. Emptying the acini is a stimulus for the secretion of milk, which continues without the involvement of prolactin. Thus, the mammary gland acquires a true automatism of functioning. The automatism of the mammary gland function is greatly influenced by the mother’s psyche, stressful situations, social factors and other causes. However, the main point that supports sufficient milk production is the elimination of its stagnation. With increasing pressure in the acini decreases apocrine secretion. Along with stimulating mechanisms to meet the growing needs of the child in milk, there are mechanisms that prevent the development of its excessive amount. The volume of milk produced by each gland is strictly regulated by the efficiency of milk suction. A normal full-term baby at the time of birth has everything in order to successfully suck the breast. When feeding a child, a number of reflexes are included, which its nature has endowed during evolution. This is a search reflex that forces a child to look for a nipple, opening his mouth wide, exciting reflex - finding a nipple, the child independently seizes it with his mouth, and sucking - consisting of rhythmic jaw movements, due to the created negative pressure and peristaltic movements, the tongue removes milk from the milk glands and moves it in the oropharynx, where the swallowing reflex is next included. TECHNOLOGY OF BREASTFEEDING For successful and prolonged breastfeeding, it is necessary to take into account the physiological mechanisms that contribute to the separation of milk from a woman. The first few days after birth are important. The probability that the mother will breastfeed her child is higher if the child is with her from birth. As soon as the child was born, it is necessary to allow the mother to touch him. A healthy newborn should be placed on the mother's belly to make skin-to-skin contact. There is no need to force the baby to immediately suck the breasts, most of the children after birth themselves are ready for this. At this time, children, as a rule, are very lively and agile, they have a very strong sucking reflex. This kind of contact in the first hours of the birth of a child into the world is very important for establishing a connection between mother and child.
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