Jessi Paguaga dándole lactancia materna a su primera leche a su bebé. ©UNICEF/Nicaragua-2015/A. Jirón
2 de November de 2015

By Anielka Jirón. Twenty-two-year-old Jessi Amarelin Paguaga Muñoz entered the delivery room of the “Alfonso Moncada Guillén” Hospital in the municipality of Ocotal, department of Nueva Segovia, at 1:40 pm on July 30, 2015. Forty minutes later, she experienced the most transcendental moment of her life: the birth of her first baby.


When the contractions changed from not very intense to painful and frequent, Jessi heard a nurse tell the doctor, "She’s 10 centimetres now." At that moment she did not understand that the measurement in centimetres, from one to ten, referred to the dilation of her cervix, which opens the birth canal and allows the baby to come out. She was preparing to have a natural, or vaginal, birth.
In the delivery room they performed an episiotomy on her, which is a small cut to facilitate the baby’s birth. After breathing deeply and pushing several times, the cries of a newborn infant let Jessi know that the miracle of life had come to a successful conclusion and she would finally get to see the being she had carried around in her womb for nine months.


María del Rosario Joya, who is head of teaching and of the hospital’s delivery and childbirth area, placed the newborn baby on Jessi’s chest. That first emotional link between mother and daughter helped Jessi give her baby a first present: her mother’s milk. The little girl immediately latched onto her breast and started to suck expertly. As Joya explained, “Skin-to-skin contact helps maintain the baby’s temperature and if the child is sucking, it helps produce a quicker uterine involution and to reduce the bleeding.”


This young women from Nueva Segovia, who throughout the childbirth had looked relaxed and pain-resistant, concluded her labour with the expulsion of the placenta. At that moment, Jessi’s face reflected just how tired the birth pains and the joy of seeing her daughter breastfeeding had left her. “I want to give her my love and affection,” she said.


Luckily, Jessi’s delivery took place in a hospital in the department of Nueva Segovia that is part of the child- and mother-friendly health unit strategy, which guarantees early skin-to-skin contact and breastfeeding within the baby’s first hour of life. “Guaranteeing skin-to-skin contact, breastfeeding and the mother’s rights during her stay in the hospital is part of our institutional policy,” explained Dr. Gustavo Turcios, a gyneco-obstetrician from the “Alfonso Moncada Guillén” Hospital.


The first immunization


The colostrum, which is the liquid produced by the mother’s breasts following childbirth, is highly nutritious and rich in anti-infective properties, so breastfeeding during the first hour of a baby’s life amounts to its first immunization. "When the three fundamental elements of love, warmth and breastfeeding are provided, that helps avoid common childhood diseases. Breastfeeding is the newborn baby’s first vaccination, which guarantees a reduction in morbi-mortality," stressed Dr. Turcios.


In addition to promoting early skin-to-skin contact, the health personnel of the child- and mother-friendly health units teach the mothers to manually extract their milk so that it can be stored and then given to the baby by the person responsible if the mother is absent or working. The baby will therefore not lose the benefits of and preference for its mother’s milk. It is also stressed that stored breast milk should be given in a cup, not a bottle, so that the infant does not lose familiarity with the mother’s nipple and develop a preference for a bottle teat. This also prevents the kind of damage to the oral cavity produced by bottles and reduces the prevalence of illnesses.


One result of this initiative has been an increase in the percentage of babies that have received breastfeeding in their first hour of life, which has in turn helped reduce neonatal mortality by up to 22%.


Humanized childbirth


During her 40 minutes of labour, Jessi had the time to take several decisions. The health personnel consulted her about her preferred position for the birth, the food she wanted and the person who would accompany her during that time. "I chose the gynaecological position that is most comfortable for me. I didn’t want my aunt, who is the only person accompanying me, to enter the delivery room, because she was very nervous,” Jessi commented.


personal del minsa
The health personnel from Ocotal’s “Alfonso Moncada Guillen” Hospital who delivered Jessi’s baby (from left to right)

Humanized childbirth is one of the 13 steps of the breastfeeding policy that guarantees women’s rights before, during and after childbirth in relation to four aspects: birth position, food, privacy and skin-to-skin contact. “It’s about providing friendly accompaniment that is close to the woman, respecting her beliefs and decisions as long as it does not jeopardize the wellbeing of the mother and the baby,” Dr. Turcios explained.