Session 15.

Clinical practice session 2: Building

confidence and giving support – assisting with a
breastfeed

Objectives

After completing this session, participants will be able to:

▪ demonstrate appropriate skills for building confidence and giving support when counselling a mother on
feeding her infant
▪ assist a mother to position and attach her baby at the breast.

The following notes are instructions about how to do the practical session. Please read them before the practical
session to remind you what to do during the session.

During the practical session

1) You will work in groups of three to four with one trainer.
2) Each person will take turns talking to a mother.
3) The other members of the group will observe.

You will need

 Two copies of the JOB AID: BREASTFEEDING SESSION OBSERVATION.
 One copy of the CHECKLIST: COUNSELLING SKILLS.
 Pencil and paper.

Please leave your books or manuals in the classroom.

Preparation
We will spend time today preparing for the clinical practice in the maternity wards. Remember the goal is for each health
worker to practise with a mother/parent/caregiver and their baby. Each clinical practice session will have different goals. So,
please be attentive during the preparation time and allow your trainer to assist you.

Counsellor
1) Introduce yourself to the mother and ask permission to talk to her.
2) Introduce the group and explain that you are interested in infant feeding.
3) Ask the mother if you may observe how her baby is feeding.
4) Try to find a chair or stool to sit on. If necessary, and if allowed in the facility, sit on the bed.

If the baby is feeding

1) Ask the mother to continue as she is doing.
2) Ask the mother’s permission for the group to watch the feed.
3) Remember: before making any suggestions, observe the breastfeeding session.

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If the baby is not feeding
1) Ask the mother to give a feed in her usual way at when the baby seems ready.
2) If baby is not feeding, you can ask mother open-ended questions about her experience.

Practise the six skills for building confidence and giving support. In particular, try to do these things:
• praise two things the mother and baby are doing well
• give the mother two pieces of relevant information useful to her now.

Help a mother to position and attach her baby to her breast, if needed. When you find a mother who needs help
positioning her baby at the breast, you can practise assisting the mother while your trainer observes you. Your trainer
will help you, if necessary.

Observer
1) Stand quietly in the background.
2) Try to be as quiet as possible.
3) Do not comment, or talk among yourselves.

Make general observations of the mother and baby.

For example: Does she look happy? Does she have formula or a feeding bottle with her? Make general observations of
the conversation between the mother and the participant.
For example: Who does most of the talking? Does the mother talk freely, and seem to enjoy it?

Make specific observations of the participant’s (the counsellor) counselling skills. Mark a ✓ on your CHECKLIST:
COUNSELLING SKILLS when the counsellor uses a skill, to help you remember for the discussion.

When a mother and her baby breastfeed, observe the feed using the JOB AID: BREASTFEEDING SESSION OBSERVATION and put
ticks in the boxes.

Thank the mother for her time and say something to praise and support her.
When you have finished helping a mother, if discussion with your trainer is needed, move away from the mother.

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 COMMON MISTAKES

1) Do not say you are interested in breastfeeding

The mother's behaviour may change. She may feel judged and not feel free to talk about formula
feeding. You should say you are interested in “infant feeding” or in “how babies feed”.

2) Do not give a mother help or advice

In Practical session 2 when a mother needs help, you should inform your trainer and a member of staff
from the ward or clinic. You then practise helping the mother and baby while they observe, and they
can guide you, and, if necessary, give you feedback on how you did.

3) Do not allow the forms (JOB AID) to become a barrier

The participant who has the counsellor's role should not make notes while talking. They may refer to the
forms to remind themselves what to do, but they should only write afterwards. The participants who are
observing can make notes.

4) Do not ask a mother if you may observe how she is breastfeeding.

The statement may make the mother feel evaluated or judged. Instead, you can ask if you can observe
how her baby is feeding.


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 CHECKLIST: COUNSELLING SKILLS

Name of counsellor: _________________________________________________________

Name of observer: __________________________________________
Date of visit: ______________________________________________________

(√ for Yes and × for No)

Did the counsellor
Use listening and learning skills
❑ Keep the head level with mother/parent/caregiver?
❑ Pay attention (eye contact)?
❑ Remove barriers (tables and notes)?
❑ Take time? Allow the mother/parent/caregiver time to talk?
❑ Use appropriate touch?
❑ Ask open questions?
❑ Use responses and gestures that showed interest?
❑ Reflect back what the mother/parent/caregiver said?
❑ Empathize – showing that he or she understood how the mother/parent/caregiver feels?
❑ Avoid using words that sound judging?

Use skills for building confidence and giving support

❑ Accept what the mother/parent/caregiver thinks and feels?
❑ Recognize and praise what the mother/parent/caregiver and baby are doing well?
❑ Give practical help?
❑ Give a little, relevant information?
❑ Use simple language?
❑ Make one or two suggestions, not commands?

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 COUNSELLING SKILLS

Listening and learning skills

• Use helpful non-verbal communication
• Ask open questions
• Use responses and gestures showing interest
• Reflect back what the mother/parent/caregiver says
• Empathize – show you understand how the mother/parent/caregiver feels
• Avoid using judging words

Building confidence and giving support skills

• Accept what a mother/parent/caregiver thinks and feels
• Recognize and praise what a mother/parent/caregiver and baby are doing well
• Give practical help
• Give specific, relevant information
• Use simple language
• Make one or two suggestions, not commands

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 JOB AID: BREASTFEEDING SESSION OBSERVATION

Mother’s name _______________________________ Date ____________________

Baby's name _________________________________ Baby's age ______________

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  Breast held with fingers on areola
away from nipple

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 wide open  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

174 Baby-friendly Hospital Initiative training course for maternity staff: Participant’s manual