Step 3

Promoting Breastfeeding during Pregnancy

90 min

Session Objectives
1. Outline information that needs to be discussed with pregnant women 2. Explain antenatal breast preparation, what is effective and what is not 3. Identify women that needs extra attention 4. Outline information for HIV + pregnant women 5. Practice communication skills when discussing with pregnant women

Fatima & Miriam

Fatima expecting her first baby

Miriam expecting her second baby

Discussion of breastfeeding with pregnant women

Step 3 Inform all pregnant women of the benefits and management of breastfeeding.
CULTURE varies Therefore it is important to EDUCATE women about breastfeeding As early as possible Identify mothers and babies at risk of breastfeeding (BF) difficulties

To make an INFORMED DECISION

a. INFORMATION b. UNDERSTANDING c. CONFIDENCE d. SUPPORT

Informed decision
1. What

Information?

On the importance of breastfeeding Risk of replacement feeding

. Accurate and factual . NOT opinion of HW nor . marketing Information of milk companies
cont

2. UNDERSTANDING In words that are suitable for the woman In the context of her situation 3. CONFIDENCE Built womans confidence in her ability to exclusively breastfeed

4. SUPPORT -To carry out her feeding decision -This includes support to successfully feed her baby and overcome any difficulties

Woman needs to BELIEVE that she can carry out her decision
HW needs TO CHECK with the woman that the information and support needs are met

Group talk with pregnant women

-Mother who breastfed can be asked to share her experience -Identify difficulties / How to prevent it -Cultural issues

-Teach how to position and attach

-Use dolls / breast models

Importance of breastfeeding
Breastfeeding is important to :

Children Mothers Families Community

Risk to children who are NOT breastfed

1. More likely to get sick or die from diarrhea and GI infections or chest infections 2. Become underweight, not grow well 3. Overweight and to have later heart problems

Women who DO NOT breastfeed are likely to:

1. Develop anemia, retain fat deposited during pregnancy later obesity 2. Become pregnant soon 3. May develop breast cancer 4. May have hip fracture in older age

Benefits to the FAMILY

ECONOMICAL 1. Readily available / no preparation 2. Simple / no equipment needed 3. Reduced absences of parents from work 4. No lost of income

Mothers milk IS ALL that a baby needs

Exclusive breastfeeding recommended 1st six months (NO other fluids needed) Breastfeeding continues to be important after the first 6 mos. Mothers milk is suited for her own baby (changes to meet the needs of the baby) BM is unique - antibodies

What are the practices that can help breastfeeding go well?

Hospital practices: - Companion during labor - Avoidance of labor & birth interventions - Skin to skin immediately after birth - Rooming-in / bedding-in - Know feeding signs / frequent feed - Exclusive BF

What are the practices that can help breastfeeding go well ?

TEACHING how to position and attach the baby correctly. GIVING support when needed.

Information on HIV
- All women are offered voluntary and confidential HIV counseling and testing - About 5-15% of babies born to HIV infected mother will become HIV + through BF ( 1 in 20 or 1 in7 )

Information on HIV
- Risk of illness & death from NOT exclusively BF is higher than the risk of HIV transmission from BF

- Majority of women are NOT infected with HIV - BF is recommended for women who : do not know their status & who are HIV negative

How can a pregnant woman get counseling and testing for HIV in your local area?

Individual Discussion with pregnant woman

How will a pregnancy care provider find out if a pregnant woman knows the importance of breastfeeding or has a question?

Ask the pregnant woman: What do you know about breastfeeding?

- Practice communication skills - Let her discuss her worries & concerns - 2 way discussion (focus) - Reflect and Reinforce her knowledge - Identify non-supporters in the family - Motivate to join
Antenatal check list

Antenatal breast preparation

- REASSURE that most women

breastfeed with NO problem

- Ears, nose, feet etc. comes in various

shape, sizes but still work perfectly well

- Practices like using creams, nipple

exercises does NOT assist BF

Breast examination during pregnancy can be helpful if it is used to :

- Built her confidence that her breast is increasing in size preparatory to BF -Check for breast surgery scars, lumps give reassurance

The ideal antenatal preparation is to use the time

> to discuss womans knowledge, beliefs and feelings about BF > to built her confidence in her ability to exclusively breastfeed her baby.

Women who need extra attention

- Previous BF difficulty
- Has non-supportive family member

- Is depressed / isolated / without support

- Young, single, with intention to give baby -

for adoption

- Previous breast surgery / trauma

- Has chronic illness needing medication - Has high risk baby / PT/ twins etc - HIV + mother (tested)

Can you breastfeed an older baby during a succeeding pregnancy?

No need to stop Has history of premature labor/ uterine cramping - consult Should take care of herself eat & rest Breast tender in mid-trimester ? Shortage of family food ? HIV + ?

If mother is NOT breastfeeding has medical reason / tested and is HIV positive / informed personal decision
Discuss replacement feeding Assist how to prepare feeds (individual teaching)

Antenatal discussion with women who are HIV positive

Assure confidentiality
Individual counseling Privacy Information on the risk & benefits of various feeding options Guidelines in selecting suitable option Support to carry out the choice

A woman who is not planning to breastfeed needs to know:

- Feeding options and should be AFASS - Her needs (milk, water, equipment, cost, time) - Type of formula suited for her baby - Learn to prepare formula NEVER mix feed

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WHO/UNICEF Infant Feeding Recommendation for HIV-positive Women

- When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and then should be discontinued as soon as it is feasible.

Breastfeeding and emergency situations - Mother does not need perfect calm
- Be supportive, build confidence

- Relaxation, if possible

GROUP PRACTICE

Summary
- BF is important for her baby and herself

Exclusive BF is recommended for 6 months & up to years and beyond

Frequent BF continues to be important after complementary foods are added Practices such as skin to skin, early initiation of BF, rooming- in, frequent baby-led feeding, good positioning / attachment, exclusive BF

Summary
Support is available to her Ideal antenatal preparation is that which builds the womans confidence Some woman needs extra attention

Offer all pregnant woman voluntary & confidential HIV counseling and testing WHO/UNICEF recommendation for infant feeding of a HIV positive tested mother (AFASS)