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Session 2 Demonstrations

Cut and give relevant parts to those playing the parts in the demonstrations.
Demonstration 1:
A participant plays the part of the mother and sits on a chair in front of the group with a doll as her baby,
held in a feeding position.
A facilitator plays the health worker and says exactly the same words several
times:
“Good morning, how is breastfeeding going?” but says them with different nonverbal
communication each time. For example: stand over the mother or sit beside her; look at your
watch as you ask the question; lean forward and poke at the baby feeding (discuss this touching
with the participant first).

Demonstration 2A:

Health worker :

Good morning. Are you and your baby well today?

Mother

Yes, we are well.

:

Health worker :

Do you have any difficulties?

Mother

No

:

Health worker :

Is baby feeding often?

Mother

Yes

:

Good morning. How are you and your baby today?

Mother

We are well.

:

Health worker :

Tell me, how are you feeding your baby?

Mother

I breastfeed her often with one bottle in the evening.

:

Health worker :

What made you decide to give a bottle in the evening?

Mother

My baby wakes during the night, so my milk must not be enough for
her/him.

:

Ministry of Health Malaysia

Health worker :

Teaching Materials Aids

Demonstration 2B:

(Nods) Mother I don’t see why it is any of her business how I care for my baby. Demonstration 4A: Health worker : Good morning (name).Demonstration 3: Health worker : Good morning. When my child doesn’t feed I get worried too. : Ministry of Health Malaysia Health worker : Teaching Materials Aids Demonstration 4B: . I am worried he/she might be sick if he/she is not feeding well. : Health worker : Oh. Mother What do you do when your child doesn’t feed? : Good morning (name). : Health worker : I understand how you feel. How are you and (child’s name) today? Mother (Child’s name) is not feeding well for the last few days. tell me more. my sister is always making some comment about how I care for him. How are you and (child’s name) today? Mother (Child’s name) is not feeding well for the last few days and I don’t know what to do. how are you both today? Mother I am very tired. dear (looks concerned) Mother My sister says he shouldn’t be still waking at night. that I’m spoiling him. Mother Yes. : Health worker : You are worried about (name). : Health worker : Oh. the baby was awake a lot. : Health worker : Your sister says you are spoiling him? Mother Yes. I am very worried. I know exactly how you feel. : Health worker : Mmm.

so I am pleased. : Health worker : Well. Ministry of Health Malaysia Mother Teaching Materials Aids Demonstration 6A: . Your baby does not need a bottle of formula. : Health worker : She is obviously getting the breastmilk she needs. I am not sure. How is your baby growing this month? Can I see her growth chart? Mother The nurse said she has gained half a kilo this month. but I am not sure (looks worried) : Demonstration 5B: Health worker : Good morning. Did your baby gain enough weight since she was last weighed? Mother Well. : I give my baby a bottle of formula every evening because I don’t have enough milk for her. Yes. a bottle feed in the evening seems to settle some babies.Demonstration 5A: Health worker : Good morning. Health Worker : I am sure your milk is enough. I think so. Demonstration 6B: Mother : Health Worker : I give my baby a bottle of formula every evening because I don’t have enough milk for her. does she feed properly? Is your milk good? Mother I don’t know… I hope so.

I don’t know where to get the test. I'm worried the baby might get HIV. However. Have you had a test for HIV? Mother No. Now. Mother Oh.. the rate varies in different places. Health worker : If you have HIV there is a risk this could be passed to your baby. Health worker : Well now. you can pick up HIV and then you are more likely to transmit it to your baby. I can give you the details of who to talk to about getting a test. You think you may not have enough milk in the evening. However. I would decide . I would like to hear more about the test. : Ministry of Health Malaysia Health worker : Teaching Materials Aids Demonstration 7B: (if testing is available) . : Health worker : It is best to know if you have HIV or not before you decide how to feed your baby. you have left it very late to come for counselling. so if I were you. I'm worried the baby might get HIV. Approximately 5-15% of mothers who are HIV-positive transmit the virus through breastfeeding. the situation is this. What can I do for you today? Mother : I'm not sure if I should breastfeed my baby or not when he is born.Demonstration 6C: Mother : Health Worker : I give my baby a bottle of formula every evening because I don’t have enough milk for her. I see. if you don't breastfeed. your baby may be at risk of other potentially deadly illnesses such as gastrointestinal and respiratory infections.. If you have unsafe sex while you are breastfeeding. Demonstration 7A: Health worker : Good morning. It may be higher if the mother has acquired the infection recently or has a high viral load or symptomatic AIDS. What can I do for you today? Mother : I'm not sure if I should breastfeed my baby or not when he is born. Would you like that? Mother Yes. : Good morning.

There is no testing available here to find out for sure if you have HIV.Demonstration 7B: (if testing is not available) Health worker : Good morning. What can I do for you today? Mother : I'm not sure if I should breastfeed my baby or not when he is born. I didn’t know that. giving only breastmilk. Mother Oh. with no other foods or water. Health worker : If you have HIV there is a risk this could be passed to your baby. I'm worried the baby might get HIV. When you don’t know for sure if you have HIV and can’t get tested. protects your baby from many other illnesses such as diarrhoea. it is recommended that you breastfeed your baby. Yes. for the first six months. Ministry of Health Malaysia Health worker : Teaching Materials Aids : .

Health care costs are increased by not breastfeeding. will cost _____bottle brush for cleaning at ______ each. 1 litre per feed for washing and warming) It costs _____ to boil a litre of water x _____ litres per day. will cost _____teats at ______ each. plus the additional time in preparation that keeps mother from other family or financial pursuits. another litre of boiled water will be needed per bottle to rinse the sterilant from the bottles and teats before use. The use of feeding bottles is not recommended as they are difficult to keep clean. For the first six months. Milk Costs One tin of formula costs ______ for ______ grams. Sterilising ________ If chemical sterilising is used. be it an acute infection or a chronic condition. ____ litres of water will be boiled to make up these feeds. The value of breastfeeding extends past the first six months. or a total of ___ hours per day. Cost of preparing artificial feeds for a baby for six months Minimum wage of a nurse is Minimum wage of a female factory worker is Artificial feeding for one six months costs ________ ________ ________ ________ % of a nurse's wage ________ % of a factory worker's wage. about 20 kg. There are also long term costs of not breastfeeding. and to inform parents. (or calculate other methods such as boiling bottles and teats) Ministry of Health Malaysia ____ feeding bottles. However if they are used additional costs are: Bottles ________ Teats____________ Brush ________ Sterilising Costs Cost ____ per day to use chemical solution x 180 days. though this is obviously great. A monetary figure cannot be put on the psychological cost of illness or death of the baby or the mother. will cost Teaching Materials Aids Equipment Costs . That will cost Infant formula cost _______ Fuel Costs Following label instructions.Optional Activity: Cost of Not Breastfeeding The International Code of Marketing of Breastmilk Substitutes asks all health workers to know the financial implications of any decision not to breastfeed. and preparation takes ____ minutes each time. plus the extra water for warming and washing ______(approx. the mother must give about _____ artificial milk feeds during the first six months. the caregiver must prepare feeds____ times a day. multiplied by 180 days Fuel cost _____ Caregiver’s time: Following label instructions. at ______ each. of powdered infant formula are needed. which affect the family. To make calculations easier this chart only relates to the first six months. Do you know? This 16 worksheet is based on a UNICEF/WHO training activity and has been simplified to only include the direct cost of preparing feeds. the health and social welfare services and the taxpayers.

calms mother and baby and regulates breathing and heart rate. .allows the baby to find the breast and self-attach to start feeding. Teaching Materials Aids Skin to skin contact immediately after birth: .reduces infant crying. thus reducing stress and energy use.facilitates bonding between the mother and her baby.colonises the baby with the mother’s normal body bacteria. . . .keeps the baby warm. .Birth Practices Checklist Mother’s Name: _______________________________________________ Date and time of infant’s birth: ____________________________________ Type of birth: _____ Vaginal : Natural _____ Vacuum ______ Forceps ____ _____ C-section with epidural/spinal _____ C-section with general anaesthetic Skin-to-skin contact: Time started: ______ Time ended: _______ Duration of contact: ________ Reason for ending skin-to-skin contact: ____________________________________________________________________________________ ____________________________________________________________________________________ Time of baby’s first breastfeed: ______________ Date and time help offered with second breastfeed: _______________ Notes: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ________________________________________________________________________________ No additional foods or fluids are needed by the newborn baby – just breastmilk Ministry of Health Malaysia .

Carolina's baby is brought to her early the next morning .10 hours after birth. 8 AND 9) Carolina33 has a long labour for her first baby and no-one from her family was allowed to be with her. Her family will not be allowed to visit until the afternoon. the mattress sags and her back must be bent. but the nurse tells her she must always sit up to feed. The nurse says. She comes back in a few minutes and tells Carolina that she has weighed the baby and finds that he took only 25 grammes of milk. Ministry of Health Malaysia Teaching Materials Aids The nurse returns and takes the baby back to the nursery. dear. She is worried what her husband and his mother will say about it. But the baby is sleepy and suckles very weakly. Carolina thinks that she has no milk yet because her breasts are soft. The nurse tells her to breastfeed. She is sore from the birth and it hurts to sit. The nurse leaves Caroline to feed her baby. 7. She sees that he has a birthmark between her baby’s eyes. do you?" Carolina starts to take her baby while lying down. and pushes the breast toward her baby's mouth with her hand. When her baby is born. Then he is taken away to the nursery because it is night-time. The nurses look very busy and Caroline does not want to ask questions of them. he is wrapped in a blanket and shown to her briefly. The staff gives him a bottle of infant formula for the next two feeds. Carolina wonders if the birthmark on the baby's face was caused by something that she did wrong during the pregnancy. The nurse says. “How can you go home tomorrow if you can’t feed your baby properly?” . "You don't want the pain of sore nipples.CASE STUDY (SESSION 8: PRACTICES THAT ASSIST BREASTFEEDING STEPS 6. She is told to limit breastfeeding on each side to three minutes. Carolina sits up with difficulty. and that this was not an adequate feed. She holds her baby to her breast.

using good communication skills and learns that: • - Anna and the baby were discharged on the second postpartum day. and her mother-in-law are returning to the hospital because the baby is "sleeping all the time" and has passed only three stools this week. the mother-in-law began offering tea with honey in a bottle twice a day. When he falls off the breast he gets upset. Teaching Materials Aids • . The baby has very little of the breast in his mouth and falls off the breast easily. Questions that the midwife might ask include: Can you tell me a little about the first day or two after the birth? How did the baby feed in the first few days? How do you feel the baby is feeding now? Does the baby get anything other than breastmilk? Ministry of Health Malaysia The midwife also observes a breastfeed and sees that the baby is held loosely and that he must bend his neck to reach the breast. When the outpatient clinic midwife weighs the baby. - Anna received very little instruction on breastfeeding while she was in the postpartum ward. • The midwife asks about the events of the last week. moves his head around. crying and has difficulty getting attached again.CASE STUDY (SESSION 9: MILK SUPPLY) • Anna gave birth to a healthy boy in the hospital two weeks ago. the baby. Today she. - Anna feels that her baby is refusing her breasts. - Yesterday. she finds him 12% under birth weight.

Ministry of Health Malaysia • They have looked for help. waking the baby if necessary. If needed. - the signs of having enough milk What follow-up will you offer? - See the mother and baby in 1-2 days if possible to check if feeding and weight gain has improved. the mother-in-law is caring. - Continue assistance and follow-up until baby is feeding and gaining well. - to avoid giving water (or honey and tea) using a bottle and teat. - the removal of milk makes more milk. Also useful to know: - to use plenty of skin to skin contact to help the baby learn that the breast is a comfortable place to be and to help stimulate prolactin release. Teaching Materials Aids • .CASE STUDY (SESSION 9: MILK SUPPLY) Discussion questions: (with possible answers) What are the good elements in this situation that you can build upon? - • • What are three main things this family needs to know now? - how to position and attach the baby for effective feeding. how to express breastmilk and give to the baby by cup. - to feed frequently (2 hourly or more often). and the bottle has been given only for one day. - to allow the baby to finish one breast before going to the other breast.

e. What does she think about offering more variety of foods rather than only porridge? g. 2. He gets four bottle feeds a day of formula. A busy mother may rush breastfeeding. How much does the baby take in the feeds when she is away. Where do the mother and baby sleep? (Together?) How does the baby feed during the night? Giving some vegetable. Ministry of Health Malaysia f. Teaching Materials Aids e. He eats two meals of porridge every day and he breastfeeds whenever I am at home from my job. could this be reduced. How often is ‘whenever I am home’? Could more time be spent with the baby. What would the mother like the situation to be? 3. What has the mother tried already? Has the mother any thoughts on what she could try? a. is the baby with her and breastfeeding on her day off if she is shopping or visiting? d. This morning when he woke up he also did not want the breast at all. do you think this might be happening? b. What is the feed like? Some babies can be distracted when breastfeeding. or meat would give a wider range of foods and the baby may not be as full as when he has just porridge. Breastmilk continues to be an important source of food into the second year. so maybe I should stop breastfeeding. Sometimes babies of this age refuse the breast due to teething or a sore mouth. fruit. Remember to listen to the mother and to respond in a way that encourages her to talk and to explore her own situation. c.GROUP SUPPORT – CLASS ACTIVITY (SESSION 14 : ON-GOING SUPPORT FOR MOTHERS – STEP 10) Sample “problem”1: Johan is eight months old and healthy. Yesterday he refused to breastfeed during the evening and the night.g. especially in the afternoon so the baby is ready for a breastfeed when the mother comes home? . Possible discussion points 1.

she cries again very soon. what are some suggestions for soothing a crying baby? Teaching Materials Aids c. Sometimes after I finish feeding her. Remember to listen to the mother and to respond in a way that encourages her to talk and to explore her own situation. But she doesn't get satisfied. to have contact or wants to be more comfortable before the clock says that it is time to feed. What does the mother think about carrying the baby more and giving the breast when the baby is unsettled to sooth the baby? Ministry of Health Malaysia If the baby is growing well. What would the mother like the situation to be? 3. . Sometimes a baby needs some help to feed well. Sometimes a baby wants to be fed. I think my milk is going away.GROUP SUPPORT – CLASS ACTIVITY (SESSION 14 : ON-GOING SUPPORT FOR MOTHERS – STEP 10) Sample “problem”2: Sara is three months old and she is breastfeeding quite frequently. Will I need to start giving her foods from a spoon or other milk? Possible discussion points 1. Has the mother asked a knowledgeable person to look at the way that the baby is feeding? b. What has the mother tried already? Has the mother any thoughts on what she could try? a. 2.