interactive session on how to counsel the breastfeeding mothers sothat we can really help the mothers in taking the decision on appropriate feeding practices for her baby

1. COUNSELING SKILLS ,BREASTFEEDING FOR WORKING WOMEN,
REFUSAL OF BREASTFEED, NOT ENOUGH MILK
Dr. Dasaratha Ramaiah
I/C Dept. of Paediatrics
RDT Children’s Hospital
Bathalapalli

2. Risk of neonatal mortality according to time of initiation
of breastfeeding
0.7
1.2
2.3
2.6
4.2
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
With in 1
hour
From 1 hour
to end of day
1
Day 2 Day 3 After day 3
Pediatrics 2006;117:380-386
Six times more risk of death
Source: Edmonds EK et al, 2007

3. U-5 child deaths (%) saved by universalisingU-5 child deaths (%) saved by universalising
key interventions in Indiakey interventions in India
1
2
3
4
6
15
4
6
15
0 2 4 6 8 10 12 14 16
Measles vaccine
Vitamin A
Water, sanitation, hygiene
Clean delivery
Complementary Feeding
Breastfeeding
Newborn resuscitation
Antibiotics for pneumonia
Oral rehydration therapy
Percentages
Lancet Child Survival Series,2003, Jones G et al. Indian J Pediatr 2006

4. Breastfeeding Saves Lives!
Source: Black RE et al, 2013

5. Breastfeeding promotion could potentially prevent
250,000 child deaths due to pneumonia
and diarrhea
UNICEF 2013 –Landscape Report

6. • Counseling Skills – Listening and Learning;
• Building Confi dence and Giving Support and
• Checking Understanding

7. • Counseling is a way of working with people in
which you understand how they feel, and help
them to decide what to do.

8. six skills for listening and learning

9. Skill 1. Use helpful non-verbal
communication
• Keep your head level
• Keep appropriate distance
• Pay attention
• Remove barriers
• Take time
• Touch appropriately

10. Skill 2. Ask open questions
• “How? What? When? Where? Why?”

11. • Example: ‘Closed’ Questions
Do you breastfeed your baby?
• ‘Open’ Questions
How are you feeding your baby?

12. • ‘Closed’ Questions
1. Does your baby sleep with you?
2. Are you often away from your baby?

13. Skill 3. Use responses and gestures
which show interest

14. Skill 4. Reflect back what the mother
says

15. • My mother says that I don't have enough milk.
a) Do you think you have enough?
b) Why does she think that?
c) She says that you have a low milk supply?

16. • He doesn't seem to want to suckle from me.
a) Has he had any bottle feeds?
b) How long has he been refusing?
c) He seems to be refusing to suckle?

17. • “My husband says our baby is old enough to
stop breastfeeding now.”

18. Skill 5. Empathize - show that you
understand how she feels

19. • My baby wants to feed so often at night that I
feel exhausted.
a. How many times does he feed altogether?
b. Does he wake you every night?
c. You are really tired with the night feeding.

20. • I feel there is no milk in my breasts, and my
baby is a day old already.
a. You are upset because your breast milk has
not come in yet?
b. Has he started suckling yet?
c. It always takes a few days for breast milk to
come in.

21. Skill 6. Avoid words which sound
judging

22. • Does he suckle well?
• Are his stools normal?
• Is he gaining enough weight?

23. Skills for building confidence and
giving support

24. Skill 1. Accept what a mother thinks
and feels
• Accepting means responding in a neutral way,
and not agreeing or disagreeing
• ‘Reflecting back’ and ‘responses and gestures
which show interest’ are both useful ways to
show acceptance

25. Skill 2. Recognize and praise what a
mother and baby are doing right

26. Skill 3. Give practical help
Which response is more appropriate?
“You should let the baby suckle now, to help your breastmilk to come in.”
“Let me try to make you more comfortable, and then I'll bring you a drink.”

27. Skill 4. Give a little, relevant
information

28. Skill 5. Use simple language

29. Skill 6. Make one or two suggestions,
not commands
• Command: “Keep the baby in bed with you so
that he can feed at night!”
• Suggestions:
“It might be easier to feed him at night if he
slept in bed with you.”
“Would it be easier to feed him at night if he
slept with you?”

30. • Command: “Feed him more often, whenever
he is hungry, then your milk supply will
increase!”
• Suggestions: Would you be able to breastfeed
him more often? That is a good way to build
up your milk supply

31. Checking understanding

32. Breastfeeding by Working
Mothers

33. • Exclusive breastfeeding for whole matenity
leave
• Start training cup feeds for the baby a week
before going back to work
• Continue breast feeding at night, early
morning, at any time you are at home
• Learn to express breastmilk soon after your
baby is born

34. • Express your breastmilk before you go to work
• Breastfeed your baby after expressing
• Teach the carer properly and carefully
- Not to use bottle.
- Not to give the baby a pacifier
• Express breastmilk 2-3 times while at work

35. REFUSAL OF BREASTFEED AND
CRYING

36. Illness, pain, sedation
• Infection, brain damage
• Pain from bruise (vaccum, forceps)
• Blocked nose
• Sore mouth (thrush, teething)
• Caffeine in coffee, tea, colas pass into
breastmilk – upset the baby

37. Difficulty with breastfeeding technique
• Bottle feeds, pacifiers
• Not getting much milk (poor attachment,
engorgement)
• Mother shaking breast
• Restricting feeds
• Oversupply of breastmilk

38. Change which upsets baby
• Separation from mother
• New carer, too many carers
• Change in family routine
• Change in perfume
• Mother menstruating

39. Apparent refusal
• Newborn- rooting
• Age 4-8 months- distraction
• Above 1 year – self weaning

40. Not enough milk

41. • Reliable signs of not getting enough milk:
- poor wt. gain (less than 500gm a month, less
than birthweight after 2 weeks)
• Passing small amount of concentrated urine
(less than 6 times a day, yellow and strong
smelling)

42. Most common reasons for not enough
breastmilk
• Delayed start
• Poor support
• Poor attachment
• Feeding at fixed times
• Infrequent feeds
• No night feeds
• Short feeds
• Bottles, pacifiers
• Other fluids (water, tea)

43. THANK YOU