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Website counselling and assessing a breatfeed Website counselling and assessing a breatfeed Presentation Transcript

  • Counseling and Assessing Breastfeeding
    By
    Amal El- Taweel
    MD-IBCLC
  • Consider the mother and baby as the Long Case we used to take in the exams of Medical School i.e.:
    History (listening and learning skills).
    Examination (assessing a breastfeed).
    Management (Building confidence).
  • Good communication
    means that you respect the women’s own thoughts, beliefs, and culture.
    It does not mean that you tell or advise a person what you think they should do or to push a woman towards a particular action.
  • Role of health worker
    Health workers need to be able to do more than just offer information. It is part of their job to help mothers look at the cause of any difficulties they have (diagnosis)
    and to suggest courses of action that can help fix the problem.
    Often there is no problem to be fixed; the mother just needs assurance that she is doing well.
  • You can use communication skills to
    Listen and learn about the woman’s beliefs, level of knowledge and her practices;
    Build her confidence and praise practices that you want to encourage;
    Offer information
    Suggest changes the woman could consider if changes are needed
    Arrange follow up with her.
  • Concept of Counseling
    The concept of `counseling' is new. Some languages use the same word as `advising'. However, counseling means more than simple advising.
    Often, when you advise people, you tell them what you think they should do.
    When you counsel a mother, you help her to decide what is best for her, and you help her to develop confidence.
    You listen to her, and try to understand how she feels, so that you can help her more effectively.
  • What and Why
    Counseling is a way of working with people in which you understand how they feel, and help them to decide what to do.
    You gain their confidence, cooperation, compliance.
    This reflects positively on your diagnosis and management.
  • Listening and Learning Skills
    These are the tools by which you take a good history.
  • Listening and Learning Skills
    The counselor listens carefully to learn.
    Begin with helpful Non Verbal Communication:
    -Introduce your self with a smile.
    -Offer a chair with no barriers between both of you.
    -Keep your head level and eye contact.
    -Use appropriate touch.
    -Take time and show interest.
  • Non-verbal communication
    - It is the body language that we use and what we observe of the mother’s body language.
    - We may observe that a mother is sitting in an uncomfortable position, or that she is looking around concerned that others are listening, and is not able to concentrate on feeding her baby.
    We receive this useful non-verbal communication from the mother
    - When you talk with the mother in a place that is comfortable and where she feels safe, this helps her to feel more like talking with you.
  • Open Ended Questions
    WH not verb beginning questions.
    - Make client tell you more.
    - Make client at ease.
    - Inform you more.
    Some closed ended questions are unavoidable such as factual or personal history questions. Keep them as few as possible.
  • Show Interest
    Responses:
    -Ah, mm, yes.
    Gestures:
    - nodding.
    - eye brow raising.
    - face expression.
  • Reflect Back
    Restate, rephrase, to:
    - Clarify.
    - Show attention.
    - Show understanding.
    Summarize to:
    - Clarify again.
    - Bring back to focus.
    - Client can complete a missing point.
  • Empathize
    Impersonate client then appreciate her feelings.
    - Do not think what if YOU were in the same situation. Think of HER in that situation.
    - Do not SYMPATHIZE with her.
    - Do not imply her complaint is insignificant.
  • Judgmental Words
    Avoid using judgmental words, like:
    • Well :كويس
    • Normal : طبيعي
    • Enough :كافي
    • Problem : مشكلة
    • Fail :يفشل
    • Wrong :غلط
  • Tips
    Give Privacy.
    Show respect and expect it in return.
    Don't reflect on your self or turn the conversation to you.
    Use Humor.
    Be tactful to sensitive issues.
    Try to bridge the social distance.
  • Assessing A Breastfeed
    (Examination)
  • BREASTFEED OBSERVATION AID
    Signs that breastfeeding is going well: Signs of possible difficulty:
    GENERAL
    Mother: Mother:
     Mother looks healthy  Mother looks ill or depressed
     Mother relaxed and comfortable  Mother looks tense and uncomfortable
     Signs of bonding between mother and baby  No mother/baby eye contact
    Baby: Baby:
     Baby looks healthy  Baby looks sleepy or ill
     Baby calm and relaxed  Baby is restless or crying
     Baby reaches or roots for breast if hungry  Baby does not reach or root
    BREASTS
     Breasts look healthy  Breasts look red, swollen, or sore
    • No pain or discomfort  Breast or nipple painful
    • Breast well supported with fingers away from nipple  Breasts held with fingers on areola
    BABY’S POSITION
     Baby’s head and body in line  Baby’s neck and head twisted to feed
     Baby held close to mother’s body  Baby not held close
     Baby’s whole body supported  Baby supported by head and neck only
     Baby approaches breast, nose to nipple  Baby approaches breast, lower lip/chin to nipple
    BABY’S ATTACHMENT
     More areola seen above baby’s top lip More areola seen below bottom lip
     Baby’s mouth open wide  Baby’s mouth not open wide
     Lower lip turned outwards  Lips pointing forward or turned in
     Baby’s chin touches breast  Baby’s chin not touching breast
    SUCKLING
     Slow, deep sucks with pauses  Rapid shallow sucks
     Cheeks round when suckling  Cheeks pulled in when suckling
     Baby releases breast when finished  Mother takes baby off the breast
    • Mother notices signs of oxytocin reflex  No signs of oxytocin reflex noticed
    7/2
  • Positioning
    Mother comfortable, not leaning over the baby.
    Baby: Straight.
    Close.
    Supported.
    Facing.
    Hold: C hold of the breast not scissors
  • Breastfeeding Positions
    7/1
    In line
    Close
    Supported
    Facing
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
  • C Hold
  • Chin Support(Dancer hold)
    10/6
    Kay Hoover and Barbara Wilson-Clay, from The Breastfeeding Atlas
  • Attachment or Latch on
    More areola seen above baby’s top lip.
    Baby’s mouth open wide.
    Lower lip turned outwards.
    Baby’s chin touches breast.
  • What can you see?
    6/3
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
    Good attachment
    Poor attachment
  • 6/4
    What can you see?
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
    Good attachment
    Poor attachment
  • Assess a Breastfeed
    7/5
    ©UNICEF C107-9
  • Assess a Breastfeed
    7/6
    UNICEF/HQ91-0168/ Betty Press, Kenya
  • Case study
    9/2
    2 weeks old
    Healthy at birth Discharged Day 2
    “Sleeping all the time”
    “Refusing” the breast
    3 stools in a week
    12% under birth weight
    Bottle with honey and water twice yesterday
    UNICEF/HQ91-0168/ Betty Press, Kenya
    Breastfeeding Counselling: a training course,
    WHO/CHD/93.4, UNICEF/NUT/93.2
  • Thank you