What is in this session?
Breastfeeding plays a crucial role in the health, growth and development of babies and has benefits for the mother too. Women may need some help to successfully feed their babies. They demand support and reassurance as they learn this skill. This session focuses on the initiation of breastfeeding following birth and when and how to refer women who are experiencing difficulties.
What skills will I develop?
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Providing data and demonstrating breastfeeding techniques
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Encouragement and support
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Shared problem-solving
What am I going to larn?
By the end of this session you should be able to:
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Communicate the advantages and benefits of breastfeeding for both mother and babe
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Demonstrate how to breastfeed a baby, including positioning and attachment
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Appraise actual and potential difficulties and how to work with women on ways to overcome them
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Explain the opportunities for HIV-infected mothers to breast feed and improve HIV-free survival of their babe
Breastfeeding
During pregnancy and after the birth it is important to discuss with women the importance of exclusive breastfeeding for six months. Try to include the partner or other family unit members and communicate to them all virtually the benefits of breastfeeding for the female parent and infant, the process of breastfeeding and when and how long to feed for. You should besides discuss continued breastfeeding afterward 6 months and introduction of other foods in addition to chest milk. You might discover it useful to refer to more specialized breastfeeding tools and materials to back up your discussion.
What is so good almost breastfeeding?
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Breast milk provides all the nutrients that a baby needs for the beginning six months of life to grow and develop.
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Breast milk continues to provide loftier-quality nutrients and helps protect against infection up to two years of age or more.
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Breast milk protects babies from infections and illnesses.
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Babies find breast milk piece of cake to digest.
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The baby's body uses chest milk efficiently.
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Breastfeeding tin can contribute to nativity spacing.
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Breastfeeding helps the mother's uterus to contract reducing the take a chance of haemorrhage subsequently birth.
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Breastfeeding lowers the charge per unit of breast and ovarian cancer in the mother.
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Breastfeeding promotes a faster return to female parent'south pre-pregnancy weight.
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Breastfeeding promotes the emotional relationship, or bonding, between mother and baby.
REMINDER
Every bit well as benefits for the baby in terms of survival, breastfeeding has other advantages. It is easier to acquit out than feeding formula; it takes no preparation; is ever at the correct temperature, information technology is ever clean and is always available. It is the perfect nutrition for babies.
Communicate information on the advantages of breastfeeding (including health benefits, economic benefits, etc.), to assistance women decide which method of feeding they will choose. Be certain to as well discuss the risks of not breastfeeding. Reply any questions or concerns the woman may have. For example, some women do non realize that it is normal for the baby to lose weight in the outset three or 4 days subsequently nascence and that this is not a reflection of how she is breastfeeding or the quality of her breast milk. Women can yet breastfeed while taking most medications, such as antibiotics, antiretroviral or TB medication.
Some women may choose non to breastfeed. You should respect this decision, even if you disagree with it and back up her to replacement feed safely.
Women need support to help them make up one's mind and bear out their infant feeding choice
RISKS OF Non BREASTFEEDING
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Babies may go sick more than often with diarrhoea, malnutrition and pneumonia and are at increased risk of dying.
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Babies do not get natural protection to illnesses.
Initiating skin-to-skin contact and breastfeeding
Subsequently nativity, dry out the baby. Place him/her on the mother'south chest, preferably with skin-to-skin contact. Utilise a blanket to cover both baby and the mother, to keep the babe warm. When the baby seems gear up, encourage the mother to help the baby to her breast. Babies prove they are ready to have the chest when they get-go "rooting", or looking for the chest. Some babies demand encouragement to latch-on at this phase.
It is important for all mothers to start pare-to-skin contact from birth as soon as possible following birth – preferably in the first 60 minutes. They should permit their baby suckle when they appear to be ready. Some babies may take longer to starting time breastfeeding. As a health worker you take an important part in helping the mother to do this. Early contact volition help a mother to bond with her baby - that is, to develop a close, loving relationship. It besides makes it more likely that she volition first to breastfeed.
SKIN-TO-SKIN CONTACT HELPS
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to proceed the baby warm
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to establish breastfeeding
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to encourage mother-child bonding.
Positioning and attachment
To help a mother learn how to breastfeed first encourage her to get herself into a comfortable position. Prove her how to hold the babe straight, with both the baby's head and body turned to face her breast and with the infant's nose opposite her nipple. She should hold the baby shut supporting the whole body, not just the cervix and shoulders. Refer to breastfeeding aids and materials to assist y'all become more familiar with right positioning and attachment.
Encourage and support women equally they learn to breastfeed
Discover the mother breastfeeding her baby and offering help and assist if needed. Expect for signs of good attachment and effective suckling (slow deep sucks with pauses). If the attachment is not good, encourage the mother to reposition the baby. Prove the mother how to take the baby off the breast, by inserting her little finger into the corner of the baby's mouth. Keep encouraging and reassuring the mother the whole time. Encourage her to reposition the baby until she feels comfortable and the baby is sucking well. Reassure her that there is no demand to rush, even if the baby is crying.
REMINDER
Right breastfeeding positioning occurs when the infant's:
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head and whole trunk are well supported and held close to mother
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confront and stomach face up the mother
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ear and shoulder are in one straight line, neck is non twisted.
Good attachment occurs when the babe's:
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mouth covers most of areola (dark office of the nipple) with some of the areola visible higher up the mouth
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mouth is wide open up
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chin touches the breast
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lower lip is turned outwards.
Effective suckling occurs when:
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tedious, deep house sucks alternating with bursts of suckling
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no other sounds except swallowing sounds are heard.
Exclusive breastfeeding
All mothers should be encouraged to exclusively breastfeed their babies until they are six months old. Exclusive breastfeeding means that the baby is not given any other food or drink, non fifty-fifty water. They are only given breast milk. Make certain that you or others in the facility do not give the infant annihilation that will interfere with exclusive breastfeeding.
REMINDER
To encourage and support exclusive breastfeeding there are key things you can exercise:
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Encourage breastfeeding frequently, day and dark, and advise the mother to allow the baby to feed for every bit long equally he/she wants. Tell her it is quite normal for a babe to feed upward to eight times a solar day. Explain to her the signs a baby will testify when he/she needs to be fed (such equally "rooting", looking for the nipple, sucking on the mitt).
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Reassure the parents that there is no need to give the baby any other drink or food, not even water – chest milk has all a infant needs.
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Help the female parent whenever she needs help and especially if she is a first fourth dimension or adolescent female parent or a mother with other special needs.
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Explain to the female parent she should let the infant finish the first breast and come off on its ain before offering the second chest.
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Encourage the mother to commencement each feed with a different breast. For instance, if the left chest is used to get-go one feed, at the next feeding starting time with the right breast.
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If information technology is necessary to express breast milk, show the mother how to exercise this and show her how to feed expressed chest milk by cup. You lot may need to refer her to a trained infant feeding counsellor for this.
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Reassure the mother that her body volition make plenty breast milk to satisfy her infant's needs. Simply considering a infant is crying, information technology does not mean that she does non accept plenty breast milk. A infant who is demanding more breast feeds may be growing. Past assuasive the baby to suckle more than oftentimes, her body will produce more than chest milk to run into her baby's needs.
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Explain that the mother can provide all the breast milk her baby needs for the get-go vi months and across.
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Explain that the female parent can proceed breastfeeding if she has to return to work or schoolhouse, either past expressing breast milk or feeding more often when she is at habitation.
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Advise her to seek help (or come back to encounter yous) if the baby is not feeding well or if she has whatever difficulties or concerns with breastfeeding, sore nipples or painful breasts. If needed, refer her to a trained infant feeding counsellor.
Action i
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To examine ways to improve how breastfeeding is supported and communicated to mothers.
In many health facilities breastfeeding is supported in a number of different means. This activeness is designed to become you lot and your colleagues to assess how y'all provide breastfeeding counselling and support, and what could be improved or strengthened.
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Get together the following information from ten women who have recently given nascence. If you are working in a group, each group member should do the same.
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At what signal in pregnancy did the health worker talk over breastfeeding with them?
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Do they recall these discussions should accept started earlier in pregnancy or afterward, or was this the right time?
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Do they remember what was discussed with them? (Make a list of the different points discussed.)
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Did they feel the information was clear and piece of cake for them to understand?
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After nativity, what communication and support was given to them to breastfeed their babies? When was this given?
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Was pare-to-skin contact promoted after birth (the baby placed on the mother'south upper abdomen)? How presently later on birth was it started?
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Was ongoing support, advice and reassurance given to them? How was this given?
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Who gave them back up and communication once they were home? Did they feel they had enough back up and communication or did they need more than? What additional support and advice did they think would be helpful?
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What are some of the barriers women confront to exclusive breastfeeding and how can the wellness staff help them to solve these?
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Ask women for suggestions on how staff could improve respond to their needs.
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Discuss the responses with the remainder of the group working through this handbook if applicative. Do you lot demand to practice anything differently? How can yous as a team meliorate respond to the support women need to successfully breastfeed? With the manager, make a plan for whatsoever changes that should be introduced, including reviews to bank check on how you are progressing. For instance, you lot could bear out this activity again, half-dozen months after making changes to evaluate whether y'all have made whatever improvements.
Our View
Discussion of breastfeeding should start during pregnancy by asking women how they program to feed the baby. At this time you lot practice not need to overload women with likewise much information. Stick to the basic facts about the benefits of breastfeeding for the baby and for the female parent. Talk to women about the benefits of initiating skin-to-skin contact as shortly as possible following the birth (preferably within one hour) to facilitate early initiation of breastfeeding. You lot should help the mother with the first breastfeed to evidence her how to position and attach the baby. Demonstrations are of import as breasfeeding is a skill that mothers learn. Have dolls available to demonstrate position. Retrieve to provide as much back up and reassurance every bit each woman needs - information technology will vary according to the adult female.
Consider how yous might exist able to provide back up and reassurance to women once they accept left the health facility and are at abode. Once abode many women experience feeding bug such as engorged breasts or croaky nipples. Others may be pressured by family members to offer supplementary foods or drinks. How can you work with women to overcome some of these issues? I fashion is to talk with all family members on the importance of exclusive breastfeeding. You lot can as well brand sure you assess breastfeeding at any visit or coming together during the postnatal period. Likewise consider holding a special session for breastfeeding bug.
Often in the customs, groups exist to support women who are breastfeeding. Detect out what support exists, or contact women who have successfully breastfed and run across if they would be available to support women after birth.
Earlier belch and if the mother returns to the health facility during the postnatal period you lot demand to assess how breastfeeding is going. You should too appraise breastfeeding and provide relevant information during routine visits and at any time if there is feeding difficulty or the mother is concerned about feeding.
Supporting breastfeeding
Women need extra support, encouragement and reassurance while breastfeeding. Although nosotros view breastfeeding as a natural process, it is still a skill that has to be learned. Initially breastfeeding can seem demanding, every bit the baby may accept a desire to feed/suck frequently. Babies however, begin to establish their own pattern over fourth dimension, and the mother volition begin to feel more comfortable and at ease.
Some women besides find that the initial 'let down' reflex is very strong which causes them hurting or they get stiff after-pains as their wombs contract. Reassure them that this will laissez passer. The 'let down' reflex may likewise cause them to leak milk when they have sexual intercourse. Reassure them that this is normal and that they may need to tell their husband or partner that this is normal.
Sometimes husbands or partners may feel excluded from the breastfeeding procedure. Encourage them to be involved in other means. This may ease the state of affairs and help men to provide more support for breastfeeding; for example, by request him to fetch the baby for the feed, helping brand the woman comfortable, or looking after the other children while she is feeding. Massaging the baby, and humming to calm a crying baby are other very useful ways of involving men.
Many women find breastfeeding hard due to issues such as engorgement or sore nipples. Engorgement may happen a few days after birth or at any time when the baby's feeding pattern changes. The breasts become overfull with milk and tissue fluid; milk does not flow well and the skin is tight (especially the nipple). This makes it hard for the baby to latch on. Sometimes the skin looks ruby and the woman has a fever which ordinarily disappears in 24 hours. To prevent engorgement, help women to start breastfeeding shortly subsequently nativity, ensure adept zipper and encourage unrestricted breastfeeding. To treat engorgement, recommend that the mother puts warm compresses on her breasts or takes a warm shower and expresses enough milk to reduce discomfort which helps brand attachment easier. After expressing milk she can utilize cold compresses to reduce the inflammation. Cracked or sore nipples occur mainly because the baby is not attaching properly. Help the mother to make certain the babe is attaching properly.
Support for feeding preterm and/or low birth weight babies
Low nascency-weight or preterm babies should be fed their mother's own breast milk. The mother may need actress support to initiate breastfeeding or expressing breastmilk as presently as possible subsequently birth. Because low birth-weight babies can sometimes get hands tired when feeding, information technology is particularly important that the female parent feeds her baby every bit often as possible, responding to need and at least viii feeds during 24 hours, during the day and dark
If a female parent cannot feed her own baby, it is still best for a low nascence-weight baby to be fed human breast milk. Another woman could feed the babe, so long as she is not HIV-infected. Some facilities have established chest milk banks, where breast milk from healthy donor women is collected, pasteurised and kept frozen. If your facility does not have a chest milk bank, perhaps the local referral hospital can put you in contact with a breast milk banking concern. Try to discover out about breast milk banks in your area and keep this information available for mothers who cannot breastfeed for a while due to wellness problems. If the low birth-weight or preterm baby cannot exist fed breast milk, either by the female parent, a moisture nurse or from a breast milk bank, then the infant tin be given standard infant formula by cup. Look at Session 26 of the WHO Breastfeeding Counselling: A training course (http://www.who.int/maternal_child_adolescent/documents/who_cdr_93_3/en/), for further data on how to help a mother breastfeed a low nascency-weight baby.
Encouraging continuous skin-to-peel contact can help low birth weight babies go along warm and support breastfeeding on demand. Make sure parents are enlightened of all the newborn danger signs and that they empathise it is especially of import to bring a depression birth-weight newborn to a health facility if they have any worries, as these minor babies are at particular gamble from infections and feeding difficulties.
Back up for the mother who is non notwithstanding breastfeeding
If the mother or infant is ill or the baby is too modest to suckle y'all demand to give extra support and assistance. First teach the female parent how to express milk and feed the baby by cup. If you have not been trained to practice this, y'all should refer to an infant feeding counsellor where possible. If the mother and baby are separated for whatever reason then reassure the female parent about the baby's progress whenever she asks. Encourage the mother to start breastfeeding the baby as before long as she or the infant is able.
Support for breastfeeding twins
Many mothers who requite nativity to ii or more babies are worried they will not have enough milk. Reassure her that she volition take plenty milk for both babies. Encourage the mother to feed one baby at a fourth dimension until breastfeeding is established. Y'all tin can then evidence her different ways she can feed the babies and work with her to notice out which method she is most comfortable with. If 1 twin is weaker or smaller than the other, make sure that the weaker twin too gets plenty milk.
Advice to women who are not breastfeeding
Some women may not be able to breastfeed and others may choose non to. A woman's right to have an informed determination should be supported and respected. If after discussing the benefits of breastfeeding and the risks of non breastfeeding the mother decides not to breastfeed, she should be shown culling methods.
These mothers need to acquire how to safely set and feed formula to their babies. You may also have other women whose babies take died or who have had a stillbirth. These women may experience discomfort in their breasts for a period of time. Advise them non to stimulate the breasts or nipples. Show them how to support the breasts with a firm well plumbing fixtures bra or a cloth. Teach the mother how to express just a little milk to salvage discomfort but not plenty to stimulate more milk product.
REMINDER
Advise all women to seek care if their breasts go painful, bloated, and red or if they feel sick.
Mothers who are HIV-positive
Babies of HIV-positive mothers can do good from breastfeeding for all the aforementioned reasons outlined higher up. HIV may pass from an HIV-infected mother to her infant during pregnancy, childbirth and breastfeeding. Antiretroviral treatments can dramatically reduce the risk of mother-to-child transmission during breastfeeding and increase the risk of HIV-free survival of the baby (that is, staying complimentary of HIV infection and also staying alive). Although there is still a small gamble that the baby could go HIV positive fifty-fifty when the mother is being treated with antiretroviral drugs, babies who are not breastfed, but given replacement feeds, are more likely to die from infections.
National health authorities should accept a policy to indicate whether wellness services should promote and support breastfeeding or replacement feeding among HIV-infected mothers. You lot need to exist enlightened of this recommendation and you lot should develop the skills to back up women to achieve this. However, it is a mother'south right to choose how to feed her baby and you volition demand to support her selection. Mothers who are aware they are HIV infected should be counselled on prophylactic infant feeding by a trained infant feeding counsellor. Where specialist assist is not available, you should back up women as best y'all can.
Enquire her to echo back to yous in her own words to make certain she has understood the information correctly. Piece of work together to make a plan that she can implement in order to carry out safe infant feeding.
Women who are HIV-positive and plan to breastfeed demand back up, peculiarly in the early stages when breastfeeding is being initiated. Try to help the women to avoid getting mastitis or nipple damage, as these difficulties increase the risk of transmission to the baby. Propose the woman to return if she has any problems with her breasts.
Women who take chosen replacement feeding for their babies must have regular follow-up to ensure that the baby is growing and to support replacement feeding. These women demand extra support and reassurance, particularly if they are from a community where breastfeeding is the norm. Many communities may stigmatize or shun a adult female who chooses replacement feeding. Work with families and communities to back up women in their pick of infant feeding.
WHO RECOMMENDATIONS FOR Baby FEEDING FOR HIV-POSITIVE WOMEN
Mothers known to be HIV positive should be provided with lifelong antiretroviral therapy or antiretroviral prophylaxis (preventative treatment) to reduce HIV transmission to the baby during pregnancy, childbirth and breastfeeding.
National health regime should decide whether wellness services in that country should principally promote and support breastfeeding or promote and support replacement feeding among HIV-infected mothers.
In settings where national authorities recommend breastfeeding, HIV infected mothers and/ or their babies should be given antiretroviral treatment or prophylaxis to reduce the risk of transmission throughout the breastfeeding menstruation.
These mothers should exclusively breastfeed their babies for the first 6 months of life, and then introduce advisable complementary foods with connected breastfeeding for the showtime 12 months of life. Mothers should stop breastfeeding just when they can provide a safe and adequate diet.
If a mother decides to stop breastfeeding, she should do and then gradually inside one calendar month.
HIV infected mothers should only give commercial babe formula milk equally a replacement feed to their baby when specific weather of condom and hygiene, affordability and supply of formula, admission to health intendance and family support for replacement feeding are met.
Guidelines on HIV and infant feeding 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence
http://www.who.int/maternal_child_adolescent/documents/9789241599535/en/
What did I acquire?
Breastfeeding should be encouraged and supported for all women. In this session you lot examined how to explain the importance of exclusive breastfeeding for six months and continued breastfeeding up to ii years or beyond. You lot learned how to back up women and how to demonstrate ways to finer breastfeed soon later on the birth. Y'all also learned that mother who are HIV-infected can as well breastfeed and requite their baby all the benefits of breast milk with very little chance of transmitting HIV.
Take some time to reflect on how you can ameliorate your ain skills in communicating breastfeeding and demonstrating how to position and adhere the infant. You could use your notebook to write downwards tips or advice you can give to women who are experiencing problems.
Encourage women to learn from ane another; often women have helpful dwelling remedies or suggestions for alleviating some of the discomforts associated with breastfeeding in the early stages. Make up one's mind what back up exists in the customs. Make contacts with these groups.
Finally, remember that it is important for successful breastfeeding that the woman has the back up of her partner and her family.
What Type of Bottle Should the Nurse Advise the Patient to Purchase for the Baby?
Source: https://www.ncbi.nlm.nih.gov/books/NBK304199/
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