 Hello everyone, so we post two tutorials on importance of breastfeeding as well as complications of formula or animal's milk. Now we are going to talk about, actually you will be watching four tutorials, very important actually, timely initiation of breastfeeding, so breast crawl, okay, so normal vaginal delivery now we do recommend breast crawl for the baby, it will be crucial if you can pass on this message to mothers at how breast crawl is done, what exactly is expected, you know, what does baby do, why it is important, what is colostrum, what is colostrum, how much colostrum mother gets, you know, there are a lot of these questions that mothers have, so do go ahead and kind of understand this tutorial really well. After that, you know, we have another tutorial, actually it's a series of three tutorials where we have shown that how basically what needs to be done to prepare mother and all the doctors who are involved in say mother is going through caesarean, right, so we do expect doctors to do caesarean delivery, I mean, you know, to have a breast crawl done during caesarean, so as soon as the baby comes out, you know, we basically, you know, expect doctors to put that baby on mother, provided baby is healthy, you know, and there are no other medical issues, okay, if baby is really premature and you know, if baby is having any difficulty breathing or any other issue, obviously, you know, doctor needs to take that baby and work on that, but if there's, if everything is fine, then you know, even during caesarean, once a baby is out, you know, doctor can easily put that baby on mother's chest and they can have skin-to-skin contact, in fact, if baby is hungry, baby may even kind of latch on beautifully, and we know once, once a OR, once my mother comes out of OR, then, you know, we have also shown that baby can be taken on the mother to post natal ward and what are the different steps of breast crawl, so we have explained very beautifully on important stages of breast crawl, okay, so thank you so much, watch it, pass it on to everybody that you know, and, you know, if you have any question, feel free to ask us, thank you. Welcome to this spoken tutorial on breast crawl. In this tutorial, we will learn what is breast crawl, procedure for breast crawl and importance of breast crawl. Let us first understand what is breast crawl. A baby is born with an instinctive feeding behavior. Soon after delivery, upon placing her on the mother's bare abdomen, she can find her mother's breast and initiate breastfeeding. This entire process is called breast crawl. It is to be noted that breast crawl can be done on full term, stable babies who are born either by natural delivery or by caesarean delivery and who have cried well immediately after birth. Breast crawl is not performed on unstable babies with low birth weight, as they may suffer from respiratory problems like breathlessness. Now we will learn the procedure and later the importance for breast crawl. First, ensure that delivery room's temperature is around 26 degrees Celsius. Next is to clean the baby by placing her on the mother's bare abdomen. Clean her entire body thoroughly, except the hands with a clean dry cloth. Remember, the baby's hands should be kept wet. Do not remove the protective white coating on her skin while cleaning. It protects the baby if the weather is cold. After cleaning the baby, remove the wet cloth. After drying the baby, the birth attendant should feel pulsation of the cord. Once it stops pulsating, she should cut the cord. Next is to reposition the baby on her mother's bare abdomen in such a way that her tummy touches the mother's tummy. Her head is placed between mother's unwashed breast. Her mouth is below her mother's breast. Now the baby is positioned correctly for breast crawl. As moving forward is very natural for a newborn baby, she can easily crawl forward towards mother's breast. Next thing to do is cover the baby and mother together with a clean dry cloth to keep them warm. Place a cap on the baby's head. Please note, we have not shown the cap and cloth in subsequent images. This will help us to clearly observe the position of the baby during breast crawl. After covering the baby with the cloth, make the mother support the baby's back with her hand. Let's discuss a baby's abilities which helps in breast crawl. Baby is very alert and instinctive after delivery. The smell of her unclean hands stimulates her to salivate. Also, the baby with her limited vision can see her mother's face and the areola. Areola is the dark area around the nipple. Eventually the baby starts moving. Using her hands and legs, she gradually crawls towards her mother's breast. However, some babies start scrolling immediately and some take time. Upon reaching the breast, the baby first tries to grasp the breast with her hands. Do not disturb the baby and the mother at this point until she takes her first breast feed. Both the birth attendant and the mother should have patience during this procedure. A baby may take 30 to 60 minutes to reach up to the mother's breast for her first feed. During initiation of breastfeeding, baby will open her mouth wide and attach her to her breast. After finishing the feeding, let the baby in the same position for an hour or so. Doing so helps improve the bonding between the mother and the baby. However, if mother has taken any medicines, please consult her doctor. Sometimes it might happen that after delivery, mother will have to move from the delivery room to another room. In such cases, after shifting the mother to another room, give skin-to-skin contact to mother and the baby immediately by placing the baby on the mother's abdomen, as discussed earlier. Now, let's discuss breast crawl for babies born by caesarean section. To do so, babies should be placed on their mother's chest instead of the abdomen in such a way that baby's legs should be towards mother's head, the chest and tummy should be on mother's shoulder and mouth should be on the breast. Allow the baby to suckle on the breast as long as possible in the operation theatre. Remember, immediately after delivery, skin-to-skin contact is most important than any other newborn care. Note that only after completion of breast crawl, post-delivery newborn care should be given. Now, let's discuss the importance of breast crawl for the newborn baby. Breast crawl enables the baby to get mother's first milk called colostrum. It is yellowish in colour and thick in consistency. Note that after delivery, the quantity of colostrum the baby will consume during each breastfeeding session will increase gradually. Baby will consume 5 millilitres on first day, 10 millilitres on second day, 25 millilitres on third day, 40 millilitres on fourth day and 55 millilitres on fifth day. From each breast in each breastfeeding session, this is sufficient for a newborn baby. Therefore, baby should not be fed anything apart from colostrum. Colostrum is considered as the first vaccination for a baby and contains infection-fighting protein, which boosts the immunity of a baby. It is the first source of energy for a baby after the mother's delivery. Colostrum also prevents low blood glucose level. It helps to maintain the other body processes of a baby. It supports healthy brain development. It helps the baby to pass her first stool. Breast crawl also keeps the baby warm due to skin-to-skin contact with the mother. Baby self-learns how to attach deeply to her mother's breast. Breast crawl passes on mother's healthy bacteria to her baby. These bacteria enter the baby's gut and fight infections. Ultimately, this boosts the immunity of the baby. Breast crawl also provides a feeling of love and security to a baby and initiates the bond between mother and her baby. Benefits of breast crawl extends to the mother as well. Leg movements of a baby puts pressure on her mother's womb. This pressure helps in uterine contraction and in removal of placenta. Initiation of breastfeeding increases oxytocin in the mother's body. The rise in oxytocin helps in removal of placenta too. Thus, breast crawl reduces the blood loss and prevents anemia in mothers. Anemia is a condition where number of red blood cells goes down. It could lead to fatigue and weakness in the mother. Therefore, breast crawl is highly beneficial natural process for both the mother and her baby. This brings us to the end of this tutorial. Welcome to this spoken tutorial on preparation for breastfeeding after C-section. In this tutorial, we will learn about benefits of skin-to-skin contact in the operating room and preparation for skin-to-skin contact after C-section. In this tutorial, the operating room will be called OR. Skin-to-skin contact will be called STS. Let us begin. Early STS in the operating room is important for the mother and the newborn. It could benefit them during the surgery and the immediate post-operative period. It strongly affects the long-term and short-term health. It makes breastfeeding easier. During skin-to-skin contact, mothers are highly focused on their newborn baby. This focus on the baby helps them feel less pain. When they feel less pain, their anxiety level decreases. This helps in maintaining normal heart rates of the mother and the baby. This also helps in maintaining normal blood pressures of both. During skin-to-skin contact, mothers and babies keep each other warm. This helps in maintaining their normal body temperature. So, STS should be done in the operating room immediately after delivery. It is essential that the hospital staff is comfortable with the process. For this, adequate and appropriate preparation is necessary. Such preparation must be done both before and during the caesarean delivery. It involves all those responsible for newborn care. They include the mother and her immediate relatives. They also include the doctors, nurses and the operating room staff. Educate these people about the reason for introducing STS in the operating room. Explain to them as to how the mother and newborn baby will benefit. They may be anxious about beginning skin-to-skin contact in the operating room. To reduce the worry, assure them of the safety of mothers and babies. Safety and well-being of mothers and babies will always be the first priority. Concerns arising in the operating room are to be calmly and clearly dealt with. During the surgery, doctors may sense a medical emergency related to the mother. In such cases, skin-to-skin contact in the operating room may not be completed. The newborn will be taken up for requisite care in an appropriate setting. Before the delivery, a nurse should be assigned to help in the operating room. She should introduce herself to the mother. She must confirm that the mother wants STS in the operating room. Next, let's discuss the steps to be followed in the OR before the delivery. In the operating room, the mother's arms may be tied to the arm boards. The arm board with the IV line is preferred to be tied to the left arm. The other board with the blood pressure cuff is tied to the right arm. In such cases, the assigned nurse can be helpful. She should ask the doctor if the right arm can be released for STS. She should tell the mother that this arm would be used to hold the baby for STS. This arm will be straightened every few minutes to measure her blood pressure. She must maintain the room temperature at 25 degrees Celsius. This temperature is suitable for the baby's arrival. The nurse must ensure that the mother is not wearing a bra. Mother's gown should be unbuttoned. This will help lower it easily to uncover her chest when placing the baby. The nurse must notice the position of intravenous lines. This will help her avoid them when placing the baby. Lastly, she must keep a diaper or nappy, warmed towels and blankets ready. They will be used to dry and cover the baby. The preparation for skin-to-skin contact in the operating room is now complete. How to start STS in the operating room is discussed in another tutorial. Please visit our website for more details. This brings us to the end of this tutorial. Welcome to the spoken tutorial on the procedure for skin-to-skin contact after C section. In this tutorial, we will learn about how to perform skin-to-skin contact after C section delivery. Guidelines for monitoring the baby during skin-to-skin contact. In this tutorial, the operating room will be called OR. Skin-to-skin contact will be called STS. Let us begin. Early STS in the operating room is essential for the mother and the newborn. Its benefits are discussed in another tutorial in the same series. Its preparation before the delivery is also discussed in the same tutorial. Please visit our website to watch it before going through this tutorial. Now, let's discuss the procedure of skin-to-skin contact in the operating room. At this stage, the baby is delivered. The umbilical cord is clamped and cut. The surgery is still going on. Now, the nurse should take the baby from the doctor. She should confirm that the baby is healthy and crying. Then, she should wipe the baby dry quickly. She should wrap the baby in a dry, sterile and warm operating room towel. Then, she should take the baby to the mother. She should let the babies and the mother's cheeks touch for at least 30 seconds. If the mother wants to kiss or hold the baby, the nurse should assist her. The nurse must consult the doctor before assisting the mother. She should inform the operating doctor about the readiness to start STS. Now, with both her hands, she should place the baby on the mother's chest. The baby's head should be on the lower part of the mother's neck and upper chest. Let the baby's head and face touch either of the breasts of the mother. Then, position the baby's chest, abdomen and legs correctly. They should rest on the mother's lower chest and upper abdomen. This is the first or the longitudinal position for STS in the operating room. The mother can easily hold the newborn in this position. Baby can also be placed in a second position called the horizontal position. In this position, there is less interference with the doctor's operating area. The baby's head should be placed on one breast. Her abdomen and legs should be comfortably placed on the other breast. The nurse should cover the baby with the towel that she was wrapped in. Using the diaper for the baby is a choice. It will avoid the possibility of meconium getting on the mother. It is difficult to clean it up in the operating room. During skin-to-skin contact, a cap is not required to keep the baby warm. It appears to be annoying to many babies. It may interfere with their normal sucking reflex. It can be put on the baby later during other hospital procedures. They include weighing, vitamin K injection and footprint marking. Another discomfort for the babies is the umbilical clamp. Traditionally, the umbilical cord is cut at least 3-5 cm from its base. Then it is tied with a thread or clamped. The hard plastic umbilical clamp is too close to the baby's navel. It comes in between the baby and mother's body during STS. The baby lifts her body to avoid pressing against it during STS. This discomfort can be easily avoided. The cord must be cut and clamped. 8 to 10 inches long. This way the clamp will not be directly between the baby and the mother. The cord can be reclamped and cut shorter at any time after first breastfeeding. It can also be done at the time of the baby's first bath. Avoid routine suctioning of the baby's mouth or nostrils during early STS. It is often a very bad oral experience for the baby. It can irritate the baby. It can also interfere with her heart rate and rhythm. Most babies are able to clear their own secretions with no trouble. If the baby is having difficulty clearing oral secretions, consult a doctor. A nurse should visually observe the baby while on the mother's chest. This monitoring should continue until the surgery is complete. She should constantly check the position of the baby's head. Baby's nostrils must always be visible. Baby's temperature, blood circulation, breathing and colour must remain stable. Baby should not slide off the mother's chest towards her neck. If this happens, the nurse should gently reposition the baby. She should not lift the baby off the mother's skin while repositioning. The baby may advance to the crawling stage while in the operating room. She may also move irregularly and search for the breast to suckle. In such cases, the nurse can gently grip the baby's leg or thigh. This will ensure that the baby stays on the mother's chest. It is important to continue STS after completion of the surgery. This is discussed in detail in another tutorial of the same series. This brings us to the end of this tutorial. Welcome to the spoken tutorial on continuation of skin-to-skin contact after surgery. In this tutorial, we will learn about steps to continue skin-to-skin contact after the surgery is complete. In this tutorial, the operating room will be called OR. Skin-to-skin contact will be called STS. Let us begin. Early STS in the operating room is important for the mother and the newborn. Its benefits and procedure are discussed in other tutorials of the same series. Please visit our website for more details. Now let's discuss how to continue STS after completion of the surgery. At this stage, the sterile drip has been removed. The mother is ready for transfer to the stretcher. She will be taken to the recovery room on the stretcher. Before sliding the mother on to the stretcher, the baby should be repositioned. The nurse should slowly and gently move the baby's legs to a vertical position. Baby's head should be between the mother's breasts. The mother can cross her arms over her baby. The nurse can place her hands on the top of the mother's hands. This will secure the baby during the mother's transfer to the stretcher. Now she can be slid over to the stretcher. This is a simple process. The baby should never leave the mother's chest during the transfer. She can be in the same position on the way to the recovery room. So the baby continues going through the nine stages towards the first breastfeeding. There are nine natural stages or behaviours of a baby after birth. The first stage is the baby crying immediately after birth. The second stage is relaxation during which the baby is very quiet and still. Third stage is awakening which starts with small movements of the baby's head. The baby opens her eyes and shows some mouth activity. Fourth is the activity stage during which the baby opens up her eyes widely. She touches the mother's chest with her open mouth and lips. She shows increased suckling movements. She turns her face towards her mother's breast. Fifth stage is resting in which the baby rests until she is ready to move again. Sixth stage is crawling in which the baby tries to reach the mother's breast. After reaching the breast, seventh stage called familiarization begins. In this stage the baby licks, touches and massages the breast and the nipple. Then baby latches deeply to the breast to begin the eighth stage called suckling. Lastly, the ninth natural stage is sleeping. Baby should never be lifted from the mother's chest. Ensure one hour of uninterrupted STS in the immediate post-delivery period. At least this one hour must be given to the mother and the baby. Otherwise the baby may become distressed and lose focus. It could interfere with the adaptability of the baby's body after birth. Before birth baby was in the protected, calm and warm environment in the womb. Her body has to adapt to a bright, noisy and cold life outside the womb. When the baby is replaced the nine stages must start all over again. Baby will have to advance through all the stages once again. Doing this second time will be quicker. However this will delay breastfeeding. About one and a half hours, two, two hours after birth new bonds fall into deep sleep. However sleeping is the last of the nine instinctive behaviors. The eight instinctive behaviors must be complete before the baby sleeps. If she has been interrupted several times the baby may not complete them. Baby will not experience suckling before sleeping. It will happen several hours later when the baby awakens. After the baby awakens she should be placed skin to skin again. Baby will go through all the nine stages again. She will find the breast and attach deeply. This instinctive behavior may be present for the first four to six months after birth. This behavior should be encouraged especially in the first few days. This will help the mother and the baby grow accustomed to breastfeeding. In the first few days only STS is ideal for successful breastfeeding. It will activate the baby's instinctive feeding behaviors. This will help the baby to quickly learn how to latch correctly. Later the baby will be able to consistently latch deeply even without STS. This brings us to the end of this tutorial. Thank you for joining.