COUNSELING SKILLS ,BREASTFEEDING FOR WORKING WOMEN, REFUSAL OF BREASTFEED, NOT ENOUGH MILK
Dr. Dasaratha RamaiahI/C Dept. of PaediatricsRDT Children’s HospitalBathalapalli
Risk of neonatal mortality according to time of initiation of breastfeeding
0.71.2
2.32.6
4.2
00.5
11.5
22.5
33.5
44.5
With in 1hour
From 1 hourto 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
U-5 child deaths (%) saved by universalising U-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
Breastfeeding promotion could potentially prevent 250,000 child deaths due to pneumonia
and diarrhea
UNICEF 2013 –Landscape Report
• Counseling Skills – Listening and Learning;• Building Confi dence and Giving Support and• Checking Understanding
• Counseling is a way of working with people in which you understand how they feel, and help them to decide what to do.
Skill 1. Use helpful non-verbal communication
• Keep your head level• Keep appropriate distance• Pay attention• Remove barriers• Take time• Touch appropriately
• Example: ‘Closed’ Questions Do you breastfeed your baby? • ‘Open’ Questions How are you feeding your baby?
• 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?
• 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?
• 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.
• 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.
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
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.”
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?”
• 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
• 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
• 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
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
Difficulty with breastfeeding technique
• Bottle feeds, pacifiers• Not getting much milk (poor attachment,
engorgement)• Mother shaking breast• Restricting feeds• Oversupply of breastmilk
Change which upsets baby
• Separation from mother• New carer, too many carers• Change in family routine• Change in perfume• Mother menstruating
• 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)
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)