 Hello everyone. So this is our last week. In my first session in this week, I'm going to take you through 45 points counseling PDF. This will be very, very helpful for you to counsel mother wherever you are. It is also important for you to go through this PDF many times because we have put in a lot of small, small points, which really makes a lot of difference in the field, you know. This is basically in English. We have it in multiple different languages. We will be loading this on the NPTEL website. You can download it. You can print it either on A3 chart or A4. A3 definitely will have much better graphics. You know, you'll be able to show mothers very easily. So here I'm going to start this PDF. So 45 points comes in the routine. It's like if it becomes a routine, mothers will not understand. I mean mothers will not forget. So that is important that you use this as a routine breastfeeding practice, you know, on a day to day basis. It's just like we have a routine in the morning, right? First time, first thing we do is we get up, then we do certain things. There are chores that we do, you know. And because we do that on a day to day basis, we don't forget any step. Similarly in this 45 points, we have put all this point in a routine way if mothers understand what to do first, then second, then third, then fourth. She will not forget her, you know, important aspects of breastfeeding. So here's my first point which I like to teach mothers about, you know, whenever I ask her in the field, when do you breastfeed the baby? And she always waits till baby cries or she always wakes up, you know. So here I have shown that there are some early hunger queues that she needs to know. And believe me, most of the mothers, even healthcare workers or practitioners, they don't know this early hunger queues. So here this is what I have shown that the first and the most important tip to recognize is the early hunger queues of the baby. If the mother recognized the baby's early hunger queues, then she can breastfeed baby using the cross cradle hole easily. So here this PDF I've created in cross cradle hole because we have seen really good results, you know. If she doesn't recognize early hunger queues, the baby will become restless and start crying because of hunger. So what happens, you know, when the baby is crying with hunger, it is very difficult to attach this baby, you know, extremely difficult. It takes time to calm down the baby and then reattach. So here this understanding of early hunger queues are very, very important. And, you know, the point is to have a deep attachment as early as possible. This will also increase mothers' anxiety. So the baby is crying a lot, you know, she will not attempt and then she will end up giving top feeds. Okay. So early hunger queues include babies moving its body. So baby will basically squirm, you know, this is squirming of the baby, you know, and then baby will basically, you know, kind of turn his or her head side to side. So we'll try to look for breast, you know, we'll open the mouth also, and then basically they will start salivating. They'll start putting hand in the mouth and then eventually it's crying. So when baby's crying, that's the very last stage of, you know, hunger. Okay. So you don't want to wait till the last minute, last stage when baby's crying becomes too difficult. So you explain to the mother what are early hunger queues. Again, squirming of the baby, you know, opening the mouth, rooting reflex, putting, you know, kind of trying to look for breast, you know, sideways, opening the mouth, you know, then putting hands or fingers in the mouth and then salivating. And last is your more irritable state and then crying. Okay. So these are important points. So once now, say, for example, in two hours, baby's not woken up. And at least in first three to four weeks, you know, I don't wait for more than two hours really. So during daytime, if it is more than two hours, I like to wake up the baby, you know, just because in India, we have a lot of catch-up growth to do, you know, if baby's gaining weight, you know, good 40 grams a day, then I'm not worried at all. But if baby's not gaining weight, I like to wake up the baby every at least, you know, after two hours to two and a half hours of not feeding. At nighttime, I like to wake up the baby at least after three hours of not feeding. Now, many times it happens that, you know, some babies, they feed a lot during evening time. Okay. And that is called your cluster feeding. So if baby's feeding very frequently, say every hour or so in evening hours or certain hours, then baby may have a prolonged sleep. In those cases, I don't bother baby to wake up in after three hours. So it all depends upon basically what is baby's feeding pattern. Okay. Second is your mother's preparation. So mother's preparation is also very, very important. Here we have shown that mother need to wash her hands. And, you know, another thing which is I think I really reiterate is to always explain the logic to the mother. So for any point that you're explaining, if you teach her the logic, she will not forget. Okay. So here the logic is basically, you know, she has to clean her hands with soap and water because that will prevent infection. Okay. Many times what happens is, you know, mother is busy doing other things, you know, she may have a visit to the toilet sometime, you know, it's just so overworked that sometimes she forgets to wash her hands. So here if it becomes part of a routine that before feeding the baby, she has to wash her hands, you know, she will not forget. Okay. And also you want to kind of explain to mother that, you know, in case if she is not washing her hands, there's a risk of she developing infection and then the risk of she passing on the infection to the baby. Okay. So that's, that's the reason that we ask mothers to wash their hands. Then she should basically drink a boiled and cold clean water. So here also I have explained that the reason mothers need to drink, you know, at least one glass of water, as she again forgets to drink water, you know, in her routine, she forgets to take care of herself. And if she's not well hydrated, you know, she in fact produces almost, you know, 750 to 850 ml of milk, as you saw in the tutorial. So we want to kind of make it a routine that every time she sits down, she drinks a glass of water. What I have seen in my project is many babies, they gain almost 50, 40 to 50 grams a day. In fact, in some of the projects, some of these babies are gaining 60 grams a day. So in those conditions, you know, mothers would be producing probably one to 1.5 liter of milk a day. So in those scenarios, especially in India, when you have, you know, hot weathers, even the humidity, you know, when it's very, very dry, you know, mothers tend to kind of lose a lot of fluid. Okay, so just make it a routine and tell her that if she drinks water, she will be more relaxed, she will calm down, she will be hydrated, and it will be easy for her to breastfeed the baby. Okay, if she's dehydrated, you know, she will not kind of, she will feel tired and she will, you know, kind of many times skip breastfeeding, you know, breastfeeding the baby. Okay, so here is a fourth point. In fourth point, what we have shown is basically she needs to sit comfortably on the floor, on the bed or on a chair with the feet well supported. Many times what happens, you know, many of these mothers, they sit on the chair on which their legs are not supported on the ground. So I do recommend that we put some stool or some, you know, something which supports her leg. Leg support is very, very important. My favorite position to sit for mother is literally on the bed with legs folded becomes much easier, especially when she's latching. Once she finished latching, then she can basically go in any position, you know, but while she's latching that sitting with folded legs really help, you know. So, and one more thing which is important is that her, you know, she should sit straight, you know, because obviously many mothers have this habit of drooping down like this or, you know, they are just, their back is not straight. They bend down to breastfeed the baby, you know. And if this happens, you know, say 10 to 12 times in 24 hours, it will really affect mother's, you know, kind of back, you know. So I do recommend that mothers kind of sit straight, make sure that she has a back support. So if she's sitting on the bed, make sure that there's a pillow behind it. So you arrange for the pillow. She should be comfortable. If she's comfortable, latching would be easy. Okay. So mother's comfort comes first really. She should keep her shoulder relaxed in a comfortable position. She should not droop her shoulders. So this is what I just mentioned. Mother should remove both the blouse and the bra covering her breast because the pressure exerted by them can cause a lump in the breast. Now, again, I have explained this earlier also in my life session is that, you know, you want to make sure that mother kind of gets this, you know, kurta or whatever that cloth that she's wearing, even the nightgown, but she has to have a, you know, button front open and it should basically open up till her navel. Okay. Many times she has just two or three buttons and what she does, she opens those one or two buttons and then she basically pull it down and then try to remove breast so that edge is pressing on the lower edge of breast, you know. So you don't want to do that. Many times what happens at mothers, they, sometimes they wear blouse, but they don't open all the buttons. So she may open just two buttons from below and then she will pull it up and at the same time, she has a tight bra worn inside. So she will pull that bra, tight bra and the blouse and then she will, all that pressure will come on her breast. Now remember that breast has, you know, your milk alveoli where the milk is being produced and then it has, you know, ducts, right? From where milk is kind of transferring from milk duct to mothers nipple, right? So if there is a block which kind of has a lot of pressure on it, it will, it will block the transfer of milk, okay, from alveoli to collecting duct or through nipple and in that case, what will happen? She will produce milk because, you know, milk, asinine or milk, alveoli are fine, but she will not be able to drain that milk. And then what eventually happens is then she will develop, you know, kind of swelling and then she'll develop mastitis or infection, you know, breast abscess. And then eventually once they have breast abscess, you know, they get incision and drainage and then there are a lot of complications. So point of the Spotify counseling, you know, PDF is that basically we are working on prevention of all the complications also, prevention of complications or breast abscess, prevention of complications or nipple sore, all those problems occur if you don't guide mother exactly how to do what to do, okay? So that is important. And the time that you tell mother to get this kind of count or, you know, or other of those kurtas in during ANC time, because by the time she comes to PNC, it's already too late. So you guide her during ANC time, but how she should buy clothes which are front open and, you know, much easier to breastfeed. Now, sometime I do see that some mothers buy those lactation gown, but the problem is they have this chain which are just literally one and a half inches long. And in those scenarios, what happens at a, you know, only nipple comes out and only a little bit of areola comes out and that will block her baby's latching, okay? So you tell them that there is no need to buy those lactation bras or lactation gown which are not giving her appropriate enough space for baby to latch on, okay? So you want to kind of, you know, ask her not to spend so much money, you know, okay? Then seventh point is your, now she's ready to breastfeed, okay? She has washed her hands, she has taken some water, she has taken the position where the baby is, okay? She has opened her breast completely. Now she is basically going to take that baby, okay? So many times what happens is baby may show some hunger cues and then again fall back asleep, you know, especially in first two, three weeks or so. So you want to make sure that you basically kind of wake up the baby completely and then put the baby on the breast, okay? So the way you wake up the baby is basically you want mothers should remove blanket or the bed sheet covering the baby, okay? So you just remove whatever extra blanket because I have seen again and again that mothers always have so many blankets and they take that blanket with the baby and try to latch the baby. This will cause a lot of hindrance in latching. So you tell her nothing to worry about, she can just put one pair of clothes on the baby, remove, you know, cap, remove socks, make baby kind of, you know, a little bit uncomfortable, okay? And that's the best way to wake up the baby. If baby, even for us, if we are kind of wrapped in so many blankets, we are very comfortably, very difficult for us to wake up, right? So similarly for babies also, I don't recommend putting on too many clothes while nursing the baby. Especially, you know, that they would be skin-to-skin contact because in cross-caddle hole, there is a, you know, amazing kind of skin-to-skin contact, you know, because babies put very close to mother's skin. So even if you don't have, you know, say one pair of, that should be okay. If it is very cold and obviously you want to have one pair, but remember that even in cold weather, you know, this cross-caddle hole kind of, you know, improves the skin-to-skin contact because baby is extremely close to a mother and that's why I recommend that mother should buy clothes in which both the breasts are exposed, you know, and she should be able to bring the baby in skin-to-skin contact, okay? So here I'll go through this point, number seven. To breastfeed, the mother should remove the blanket or the bedsheet covering the baby. She should also remove baby's caps, mittens and socks as well. In winter, she can dress a baby in warm clothes to breastfeed. She must not dress the baby in a very thick cloth because that cloth can become a barrier between mother and the baby while breastfeeding, okay? And latching always gets affected if baby has too many blanket covering, you know, mother, she just don't understand where to hold the baby, okay? Once the baby is deeply attached to the mother's breast, then she can cover its body with the cloth. So if once the baby is very well attached and mother kind of check the latch, then, you know, she can put the blanket on the top, you know, so that way it will cover her as well as the baby. But while attaching the baby, I don't recommend any of those. Another thing I don't recommend is pillows. Many mothers have this habit of buying, you know, those boppy pillows or those, you know, those pillows. So I recommend that while she's attaching the baby, do not use any of those pillows because when you have those pillows, you know, the control that mother needs to have to attach to baby, it kind of goes down, you know, that control is not there when the baby is sleeping on the boppy pillow, okay? So please avoid any of those pillows while attaching the baby. Once the baby is attached, then you can, for mother's comfort, you can do whatever that mother feels comfortable. But while in the process of latching the baby, I want mother to hold the baby, you know, in her hand and basically maneuver or control the whole basically body, baby's neck, baby's body, everything should be controlled by mother's hand and not by boppy pillow, okay? So that's what I wanted to make sure. There is another way to wake up the baby which is very, very powerful is to put the baby in a sitting position. So what I do is once they, you know, once you remove a lot of clothes, you know, and once baby is wearing only one pair of on-sea, then I tell mother to put the baby in a sitting position like this, you know, and she can bring the baby a little bit forward, okay? And here this is a very good way of waking up the baby. I mean, if you put this baby in this position, literally within a couple of minutes, you will see that baby will open the eyes and will start looking for the breast, okay? So this is another very powerful way of waking up the baby. And I use this technique even when baby goes to sleep on the breast or even when we need to burp the baby, you know, the sitting position and make sure that you bring the kind of trunk a little bit forward this way as you can try yourself, you know, when you bring your trunk forward, you will see that the stomach is getting compressed and once the stomach gets compressed, now they wake up, okay? So you can try this in the field, okay? Now the point eight is how to hold the baby. So here now you have woke up the baby, okay? Here is the, you have woken up the baby now, okay? And now what you're going to do, you're going to basically bring the baby, suppose I'm going to breastfeed on one side, okay? So with the other hand, okay? And this is cross little hole so that you know that, you know, you hold the baby from the opposite hand from the breast that you're going to breastfeed and then you put the fingers behind the ears, okay? And then basically, you know, put baby's leg on other side. So here let's see what this says that mother should hold the baby's head with the hand on the other side of the breast. So here is, you know, other side of the breast from which she wants to breastfeed, okay? So here this is where, this is the graphic. So here mother is breastfeeding from the right side and then mother is holding the baby from the left hand, okay? So this is what, this is called cross cradle, okay? If she wants to feed from the right breast, you should hold the baby's head with the left hand. She should support the baby's body, okay? So this is the right breast. This is the left breast. She is holding the baby from left hand, okay? Here now she has, we have shown that how mother has kind of held the baby and has given the full body support. So here again I'm going to show, this is the right side that I'm going to breastfeed or demonstrate breastfeeding. So here with, this is my right side. So here I'm going to hold the baby with my left hand, okay? And support the hand, okay? Support the full body, okay? And then basically this is how it's going to be, okay? So we'll go more in detail. Just make sure that how I'm sitting. I'm sitting with my back straight, okay? Of course in, you know, in mother you want to give some back support also. So if there is a pillow behind you can put the pillow, okay? But this is called cross cradle because I'm holding the baby from the opposite hand from where I'm going to breastfeed, okay? Then you have, she should hold the baby's legs properly under the armpit of the same hand with which she is holding the baby's head so that it's, the body doesn't slide downward. If possible she should try to place the baby's hip joint in her elbow. So this is really, really important. The reason being that many times, you know, if we don't support the hip, okay? Then baby tend to slip down and if baby tend to slip down what will happen? The latch will come out, okay? So what I've mentioned over here is that you basically put the legs very deep into the armpit just like how we hold the clutch purse, you know? And then you ask mother to bring baby's hip a little bit outward, okay? So here in this position what is happening? The hip is sitting on the elbow joint, okay? So just here in this position again baby is sitting, baby is in a sitting position, okay? So this is what I'm doing is making baby sit on my elbow, baby has a good full body support, okay? It'd be easy for baby, baby sitting and resting on mother's elbow joint, okay? Then 10th point is now mother must hold the baby in a correct position and bring it to her breast. She should not bend down, she should bring the baby up to her breast. So here this is what I mentioned that, you know, she needs to bring the baby up, she should not be bending down, so it should not be like this, she should be bringing the baby up, okay? Now correct way of holding the head because this again I see a lot of issues in the field especially, you know, when you're helping the mother, mother has a tendency of holding the head like this, okay? And this is really not good because again when somebody pushes the head, you know, from here, from the back of the head, they tend to kind of press it on the head and when you press the hand on baby's head, you tend to flex it and when you flex the neck, it'll be easy, it'll be very difficult for baby to swallow, okay? So this is an important aspect of 45 point is how you hold the head. Now remember that we have a bone just behind our ears, it's called mastoid bone. So if you can hold onto mastoid bone and, you know, keep your fingers on that bone rather than on the head, you'll be able to basically, you know, flex or extend the neck, okay? So that is important. 12th point is, so here this is how you kind of hold baby's, you know, head, not like this, not like this but, you know, both fingers should be on the mastoid bone, okay? And then basically the wrist of the mother should be holding the baby's head, it should rest between baby's shoulder blade. The mother must support baby's entire body with the hand with which she's holding the baby. So here like when I'm holding mother baby's head what I'm doing is with my palm, I'm supporting baby's back, okay? So this is important that, you know, I'm supporting baby's back with the help of my palm, okay? What should be the position of the baby's body for breastfeeding? So here these are most important points which W has mentioned. So I would like to mention over here also that baby's ear, shoulder and hip should be in a straight line. So here you can see that basically when we are sitting or when we are eating, we always have our bodies in straight line. We will never be able to eat like this, you know? So similarly when baby's feeding, baby's head, you know, in a sense, a baby's ears, shoulder joint and the hip joint should be in a straight line, okay? If baby's neck is twisted like this, what will happen? Basically the ears will come in front, one ear will come in front and one ear will kind of, will be back, okay? And it will not basically align with the shoulder joint or the hip joint. So you want to make sure that whenever you bring the baby to breastfeed, baby should have a, you know, absolutely straight line position, okay? So here in this position when I'm bringing the baby to in a cross-cruel hold, you know, baby should be like this and not up looking like that or not down looking like that, okay? It should be absolutely straight. So it should be, like exactly the baby should be facing the breast and not mother's face because if baby is facing mother's face, it would be like this, okay? So please this is really, really important because many times what happens that the way mother brings the baby is, you know, the whole body may be straight but the neck is twisted because what she's doing is she's bringing the, she's trying to put baby's face so that baby is looking at mother's face. This is not needed, okay? You tell her that basically the face should be facing the breast, you know? Just like how we eat, we eat, when we eat, we eat, we see it in our plate, we don't look up, right? Our focus is on the food that we are eating. So exactly same way baby's face should be focusing on the breast of the mother, not that mother's face, okay? This way we'll turn baby's neck like this, okay? All right. Another thing is, so that is very important point that baby should be in a straight line. One more important point I want to reiterate that baby should be in an absolute horizontal position, okay? Many times I see that mothers, they tend to bring the baby in a diagonal position. In a diagonal position, what is happening? You're not supporting the whole body, okay? So I do not recommend diagonal position. You tell the mother that you put the baby in absolutely horizontal position such that baby's hip are supporting, are getting supported by the elbow joint, okay? So this is your perfect position of straight line, you know? Kind of ears are in line with shoulder joint as well as the hip joint, okay? And completely straight line, okay? The 14th point that I want to show over here is the baby's stomach should gently press against mother's chest. So here when you bring the baby in a cross cradle hole, you want to make sure that the baby's chest is rotated towards mother, okay? Because many times what we see in a cradle hole is, you know, baby's brought like this, but what is happening is the chest is facing upward, okay? And baby's kind of hands are rotated, okay? So you want to make sure that basically you bring the chest, mother's chest and baby's chest close to each other, okay? So they should be in contact with each other. So this way, baby will also get skin to skin touch with the mother as well as they will be close enough to have a good deep attachment to the baby, okay? Okay? Now the fourth point which is very important, which is basically the baby's nostril should be in line with mother's nipple. So at this point, actually, you know, we have, we really focus a lot that the nostril of the baby should be in front of the nipple. Why not tip? The reason we don't want tip to be in front of the nipple, because if you have a tip in front of the nipple, what will happen? There won't be any extension of the neck, okay? Now here what we're trying to do is it's just like the example of drinking water. So when we drink water, we always kind of tilt our neck backward a little bit and then swallow water. Similarly, you want to bring the baby in a neck extension position because when you're extending your neck, what is happening? Your lips and chin are going in deeper, you know, at a lower area, you know, because you want a lower latch. At the same time, baby's neck is extended. So when baby's neck is extended, what is happening? The neck is in the direct line with the nipple, okay? And that is very, very important that you want to have a, you know, extension of neck. And this is the best way to kind of, you know, bring the baby to breast is to extension of neck. Neck, you know, the nose will not get embedded. Nose will be out from the breast. Nose will not be touching the breast, okay? So that is important. Okay. Then is just like how adults extend their neck backward while drinking water. The mother must extend baby's neck backward by tilting his face upward and bringing his chin close to the breast. This moment will bring the baby's neck to mother's nipple. So here again, I'm going to teach you like how, what, how we want to bring babies, you know, near to the nipple. So here, again, I'll show it over here. So here, of course, baby's coming, okay? Say for example, this is the cross-caddle hole, okay? And here, what you want to do, you want to bring the baby so that the near is in front of the nipple, near, okay? So here you can see how baby's neck is getting extended, okay? And the lips are more towards the lower, lower lips are, okay? And it's just the near which is getting in line with the nipple, okay? If you bring baby straight on, like this nipple, nipple to nose to nipple. So in this position, what happens? The nose is getting compressed. So here, you know, when baby opens the mouth, what will happen? Both the upper and the lower lip will go in the mouth. At the same time, the nose will get compressed, okay? And there won't be any extension of neck. So a little bit of extension will help to swallow the milk, okay? And suppose the baby is too far, kind of, you know, on the top of the nipple. So if baby is like too far, okay? Like this, then what will happen? Baby will have to bend the neck forward, okay? And then only upper lip will go in the mouth. So you, in those situations, nose will get compressed. Then upper lip will be in the mouth and neck will be flexed. So there are three things happening if baby is brought too lateral to the, to the nipple, okay? So here in this position, what I would do? I would pull baby's leg down, okay? Towards, towards the leg and then again, extend the neck and then bring the baby so that the mouth is more towards the lower lip and the neck is extended, okay? So this is a position. Extremely important because this is a docking position. So if you can dock the baby well, we will be able to kind of grasp the Arilla pretty well, no Arilla latch. Remember, it's not full Arilla because every healthcare workers that I come in contact with, they say, poora Arilla jana chie, poora Arilla, it's not full Arilla. It's only low Arilla latch, okay? All right. Then you have holding the breast. So when you're holding the breast, now remember one thing that many of these mothers have big breast, okay? Big Arilla and baby's mouths are small. They are not so big like us, right? So we have to basically help mother to understand how to hold the breast so she can contour it properly and it becomes easy for mother to breastfeed the baby or just latch, deep attachment, okay? So here I want to show that how mother should hold the breast. Now, again, I want to teach you the concept because this concept will help you not only in cross-critical hold but it will help you in all the other holes that you may want to try, okay? Like for example, you know, football hole or sideline hole or any of those holes. So here the concept is that basically whenever we eat, you know, our fingers are always parallel to lips, right? So if you are eating a say big burger or anything big, our fingers are parallel to lips. So here when you press those, you know, your burger, what you're doing is basically your fingers are parallel to your lips, okay? And then you extend and then you put that burger on the lower lip and then you can take, you take a bite. Similarly, now here baby's coming in a cross-critical hold and here what is happening? There is a bit kind of a similar big size arula or breast, you know, sitting in front of the baby. So in this position, in this cross-critical hold, what is happening that baby's lips are vertical, okay? So like for example, in this position, if you look at it, you know, in a cross-critical position, baby's lips are completely vertical, right? So you will be holding the breast in a vertical position. So your fingers would be parallel to baby's lips and you'll be holding either from the top or you'll be holding from the bottom, okay? So that is important that, you know, another thing what is happening in this position, you know, baby's upper lip is at kind of nine o'clock position and the lower lip is at three o'clock position on my right breast, okay? So that is, so you want to keep those fingers right where the lips are. So the one finger would be coming at nine o'clock and one finger would be coming at three o'clock position, okay? So here again, we'll go back but I just wanted to teach you the concept that whichever may be the position. Like for example, here in this, you know, your football hold, your upper lip over here is coming at 12 o'clock position, you know, just imagine that your breast is a clock, okay? So here in this one, upper lip is coming at 12 and the lower lip is coming at six, so your fingers will be parallel to lips, so one finger would be at 12 o'clock position and another finger would be at a six o'clock position. And another thing what is happening is your baby's lips in this position, your baby's lips, the first, the upper one is coming at three o'clock and the lower one is coming at nine, so you will be putting your fingers right parallel to baby's lips, okay? So remember the concept, you put your fingers where baby's lips are, okay? Don't worry about you, see all that because you will forget in the field, where the lips are, you put your fingers, okay? So that's the concept is exactly where our lips are, we put our fingers to kind of make the food, you know, smaller or the say any burger smaller so that we can take a big bite, okay? So that's the concept. So here let's see what happens at cross-caddle hold. The mother should hold the breast in a U-shaped hold from the bottom with the hand on the same side of the breast from which she wants to feed the baby. So here in this basically, this is the right side that I'm feeding, here I basically first work on the position of the baby, make sure the hips are out, you know, baby's kind of nears are across, nostrils are across, nipples. Here baby's now ready to feed, okay? So now I'm going to hold the breast, so the way I'm going to hold the breast is I'm going to put my fingers at, you know, nine o'clock position and at the three o'clock position, okay? And hold it in a U-shape, okay? So that it becomes easy to contour the breast and then it becomes easy for baby to latch, okay? So here again, going back again, imagine that there is a clock on mother's breast. The mother's nipple is in the center of this clock. If the baby will be breastfeeding from the right breast, then the tip of the thumb of mother's right hand should be at a nine o'clock position and the tip of the other fingers of the right hand should be at the three o'clock position, okay? So exactly same what I've explained right now. So here is the right breast, so the thumb would be at a nine o'clock position and other fingers would be at three o'clock position, okay? So this is how I have explained, okay? So right hand would be this way and the left hand would be in a different, you know, different, you know? So your thumb would be at three o'clock position and the fingers would be the nine o'clock position, just opposite, okay? One more thing which I have mentioned over here, the tip of U shape should fall at six o'clock position on this clock. So your tip of your U, this one, should be at six o'clock position, okay? So this is important. This is how the mother should hold the breast in U shape hold from the bottom, okay? So that's important. The mother's thumb and her fingers must be placed in an equal distance from the nipple, okay? So this is also very important because many times what happens is that mother put one finger on the very close and another one very far. So here if she does, then the whole erylla will kind of turn. You don't want the erylla and the nipple to turn in one particular direction. You want to have an equal distance, you know, from the nipple, both fingers should be at the equal distance, okay? There should be distance of three fingers between mother's nipple and her thumb and between her nipple and her other fingers. So what happens many times, no? Mothers, they tend to just hold the nipple and then they try to put it in baby's mouth, okay? This is too close. It will, there will be only nipple feeling. Or sometimes mothers put their fingers too far. If it's too far also, the breast will not control, okay? So you want to put it at the right position and what we have experienced in the field that if mothers were putting three fingers over here, three fingers over here, that's when basically the contouring was perfect, you know, and that was not blocking baby's attachment to lower erylla, okay? So three fingers over here, so here one finger and three fingers over here, so another one over here. So this is how you should hold the breast, okay? At this point, it is important to keep holding baby's body in a complete horizontal plane so that baby's upper lip is at nine o'clock and it's lower lip is at three o'clock position. Because your fingers are at three o'clock, nine o'clock position, you want to make sure that baby's lips are also at that position, okay? And that would be possible only if baby's in a complete horizontal position. If baby's in a diagonal position like this, then you can see the lips are coming up at around 10 o'clock and 5 o'clock, okay? If baby's very vertical, then you will see that upper lip is coming at 12 o'clock and 6 o'clock. So that's why this is important that you make sure that baby's in completely horizontal position that your lips are totally vertical, okay? In this position, the mother's thumb will be in front of baby's upper lip and her fingers will be behind the baby's lower lip, okay? And mother's fingers on the breast should be placed parallel to baby's lips. So this is, that's why we are saying that in cross-coded hold, you want to hold the breast in a U shape, okay? With fingers parallel to baby's lips, okay? All right. Here I've shown the example also so you can show this graphic to mother, like how she holds when she's eating something big, you know her fingers are parallel to her own lips, right? Similarly, when she holds the breast, she wants to make sure that she keeps her fingers parallel to baby's lips so it becomes easy for baby to have a big deep attachment, okay? Now, let's see number 22 point. So the black area around the nipple is called areola. So when you're talking about areola, areola, I know you need to tell mother what areola is. When the baby opens his mouth widely, the mother must bring the baby to the breast and compress her breast. This will make sure that the lower part of the areola where the baby's lower lip is placed will easily go into baby's mouth, okay? Holding the breast correctly and compressing it at the right time in the right way will ensure that the baby attaches deeply to the lower part of the areola. So this part is one of the most important skill, okay? So if mother can understand this skill well and try to teach her the skill during ANC time, okay? So that she already knows, you know, you have breast model, you have doll, you know, so teach her this during ANC time before she delivers because then becomes too difficult. You know, once the baby is there, there are 100,000 advices which will come from everybody, you know? So if she knows this, then she will know exactly what to do, okay? And in any hold, this will be helpful, okay? Okay. It is important the breast is evenly compressed by mother's thumb and the finger. The mother should not hold only the nipple and put it in the baby's mouth. So of course, there is no holding of just, you know, not in a V shape. So your breast should not be held in a V shape. It should not be V shape, it should be U shape, okay? And here I've also mentioned the point will come that the breast should be held only by the tip of the finger, okay? Not the full finger because if you have a full finger attached, then what will happen? It will come in the way for, in the way of baby's latching. So you basically, if you remember, you know, how you hold the dirty hand or dirty clothes, right? You hold it always like this with the tip of the finger, right? So you want to hold the breast also with the tip of the finger. What I teach mother is like, I tell her that, you know, most of his mothers, they know how crab looks like, like crab claws of crabs. Those crab claws are like this. I said, you hold your breast in a claw shape, you know, like, as if she's holding, that the crab is holding the breast, okay? So it will be only with the tip of the finger, okay? So this is how it should be. Okay. The mother should not compress her breast in V shape hold. The baby will only attach nipple in this hole and we'll get very little milk, okay? So here now we are ready. One more thing you want to make sure that the U of that, so the dip of the U will be coming at six o'clock position. So if your hands are two sideways like this, you know, that U will not fall at six o'clock position, okay? The dip, the dip of the U, okay? So you make sure that you tell the mother to bring her shoulder closer to the trunk and then put that U, you know, the dip of the U at a six o'clock position and only holding with the help of tip and not the full finger, okay? I will come back in the second session and I will complete this chart where we have discussed 45 points, okay? So here I'll take your permission and thank you so much.