Breastfeeding counselling, guidance – using Information, Education and Communication (IEC)

Breastfeeding counseling involves providing guidance, support, and information to mothers and families to ensure successful breastfeeding. This form of counseling is typically offered by healthcare professionals, lactation consultants, or trained breastfeeding counselors. The primary goal is to empower and assist mothers in establishing and maintaining a positive breastfeeding relationship with their infants.

Breastfeeding is one of the most effective ways to ensure child health and survival. However, contrary to WHO recommendations, fewer than half of infants under 6 months old are exclusively breastfed.

Breastmilk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses. Breastmilk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life. 

Breastfed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Women who breastfeed also have a reduced risk of breast and ovarian cancers. Inappropriate marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates and duration worldwide.

Here are key aspects of breastfeeding counseling:

1. Education: Breastfeeding counselors educate mothers about the benefits of breastfeeding for both the mother and the baby. They provide information on proper latch and positioning, the importance of skin-to-skin contact, and the nutritional value of breast milk.
2. Support: Breastfeeding counselors offer emotional support to mothers, addressing concerns and challenges they may face during the breastfeeding journey. This support can be particularly important in the early days when mothers may be adjusting to breastfeeding and experiencing physical or emotional challenges.
3. Problem-solving: Breastfeeding counselors help mothers troubleshoot common breastfeeding issues such as latching difficulties, low milk supply, or nipple pain. They provide practical solutions and techniques to overcome these challenges, often through demonstrations and hands-on guidance.
4. Assessment: Counselors assess the breastfeeding process by observing a nursing session, checking for proper latch and positioning, and evaluating the baby’s overall feeding behavior. This helps identify any potential issues early on.
5. Promoting Confidence: Breastfeeding counseling aims to boost a mother’s confidence in her ability to breastfeed successfully. By providing information, encouragement, and positive reinforcement, counselors empower mothers to trust their instincts and navigate the challenges that may arise.
6. Addressing Special Cases: Breastfeeding counselors are trained to assist mothers in special situations, such as those with premature babies, multiples, or mothers with medical conditions. They offer tailored guidance to meet the unique needs of these situations.
7. Community and Group Support: In addition to individual counseling, there are often group sessions or support groups where mothers can share their experiences, ask questions, and receive guidance in a supportive community setting.
8. Follow-up: Breastfeeding counseling often includes follow-up sessions to track progress, address any new concerns, and provide ongoing support as needed.

Breastfeeding counseling is an essential component of maternal and infant healthcare, contributing to the overall well-being of both mothers and babies. It promotes the many benefits of breastfeeding and helps mothers navigate the challenges that may arise during their breastfeeding journey.

Breastfeeding Guidance

Breastfeeding guidance encompasses a range of information and support provided to mothers to help them successfully breastfeed their infants. Here are some key aspects of breastfeeding guidance:

• Early Initiation: Encourage mothers to initiate breastfeeding as soon as possible after birth, ideally within the first hour. This early contact supports the establishment of a strong breastfeeding bond and helps stimulate the mother’s milk supply.
• Proper Latch and Positioning: Provide guidance on how to achieve a proper latch and positioning during breastfeeding. A good latch ensures that the baby can effectively extract milk and reduces the likelihood of nipple pain or discomfort for the mother.
• Skin-to-Skin Contact: Emphasize the importance of skin-to-skin contact between the mother and baby. This practice helps regulate the baby’s temperature, promotes bonding, and encourages the baby to latch onto the breast.
• Feeding on Demand: Encourage responsive feeding, where the baby is allowed to feed on demand rather than on a strict schedule. This helps ensure that the baby gets enough milk and supports the establishment of a robust milk supply.
• Recognizing Hunger Cues: Educate mothers on how to recognize hunger cues in their infants. These cues may include rooting, sucking on fists, or increased alertness. Responding promptly to these cues can facilitate successful breastfeeding.
• Nursing Positions: Teach mothers different breastfeeding positions to find what works best for them and their babies. Common positions include the cradle hold, cross-cradle hold, football hold, and side-lying position.
• Breast Care: Provide guidance on proper breast care, including hygiene, nipple care, and addressing any concerns or discomfort. This may include using lanolin cream for sore nipples or ensuring proper breast support.
• Expressing and Storing Milk: Offer guidance on expressing breast milk, especially if the mother needs to be separated from her baby for a period. Provide information on safe storage of expressed milk and the use of breast pumps if necessary.
• Nutritional Considerations: Discuss the importance of a healthy diet for breastfeeding mothers. While breastfeeding is a natural process, maintaining adequate nutrition is crucial for the well-being of both the mother and the baby.
• Addressing Challenges: Prepare mothers for potential challenges they may face during breastfeeding, such as engorgement, mastitis, or latch issues. Provide information on how to address these challenges and when to seek professional help, such as from a lactation consultant.
• Support Networks: Encourage mothers to build a support network, including partners, family members, and friends. Having a supportive environment can significantly contribute to a mother’s confidence and success in breastfeeding.
• Postpartum Follow-Up: Schedule postpartum follow-up appointments or check-ins to assess breastfeeding progress, address any concerns, and provide ongoing support as needed.

WHO Response

WHO actively promotes breastfeeding as the best source of nourishment for infants and young children, and is working to increase the rate of exclusive breastfeeding for the first 6 months up to at least 50% by 2025. 

WHO and UNICEF created the Global Breastfeeding Collective to rally political, legal, financial, and public support for breastfeeding. The Collective brings together implementers and donors from governments, philanthropies, international organizations, and civil society. 

WHO’s Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes, also known as NetCode, works to ensure that breast-milk substitutes are not marketed inappropriately. Additionally, WHO provides training courses for health workers to provide skilled support to breastfeeding mothers, help them overcome problems, and monitor the growth of children.

Breastfeeding Communication

Communicate information on the advantages of breastfeeding (including health benefits, economic benefits, etc.), to help women decide which method of feeding they will choose. Be sure to also discuss the risks of not breastfeeding. Answer any questions or concerns the woman may have. For example, some women do not realize that it is normal for the baby to lose weight in the first three or four days after birth and that this is not a reflection of how she is breastfeeding or the quality of her breast milk. Women can still breastfeed while taking most medications, such as antibiotics, antiretroviral or TB medication.

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Some women may choose not to breastfeed. You should respect this decision, even if you disagree with it and support her to replacement feed safely.

Use Non-Verbal Communication

In the context of breastfeeding, nonverbal communication is crucial for creating a comfortable and supportive environment. Here are ways to use nonverbal cues during breastfeeding guidance:

• Warm Greeting:
  • Begin the interaction with a warm and welcoming smile. This nonverbal gesture helps establish a positive and supportive atmosphere from the start.
• Eye Contact:
  • Maintain gentle eye contact to convey attentiveness and connection. This reassures the mother that you are fully present and engaged in providing support.
• Touch:
  • Use gentle and reassuring touch to provide comfort. For example, placing a supportive hand on the mother’s shoulder or back can convey empathy and encouragement.
• Comfortable Seating Arrangement:
  • Arrange seating in a way that is comfortable and conducive to open communication. Consider creating a cozy and private space that allows for relaxed conversation.
• Demonstrative Actions:
  • Use nonverbal cues to demonstrate proper breastfeeding techniques. Mimicking the correct latch or positioning with hand gestures can be more effective than verbal instructions alone.
• Posture:
  • Maintain an open and relaxed posture to put the mother at ease. Avoid any body language that might convey tension or discomfort, as this can impact the mother’s confidence.
• Mirroring:
  • Subtly mirror the mother’s body language to establish rapport. This nonverbal technique can create a sense of connection and understanding.
• Nodding and Facial Expressions:
  • Use affirmative nods and supportive facial expressions to convey understanding and encouragement. This nonverbal feedback reassures the mother that her concerns are valid and being heard.
• Active Listening:
  • Demonstrate active listening through nonverbal cues such as nodding, maintaining eye contact, and responding appropriately to the mother’s cues. This helps build trust and rapport.
• Respecting Personal Space:
  • Be mindful of personal space and physical boundaries. Respect the mother’s comfort level and adjust your proximity accordingly to ensure a sense of safety and trust.
• Empathetic Gestures:
  • Use gestures that convey empathy, such as a sympathetic facial expression or a gentle touch on the arm. These nonverbal cues can help the mother feel supported emotionally.
• Tone of Voice:
  • Although technically a verbal aspect, the tone of voice is an essential nonverbal component. Maintain a calm and soothing tone to convey reassurance and support.

REMINDER

To encourage and support exclusive breastfeeding there are key things you can do:

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1. Encourage breastfeeding frequently, day and night, and advise the mother to allow the baby to feed for as long as he/she wants. Tell her it is quite normal for a baby to feed up to eight times a day. Explain to her the signs a baby will show when he/she needs to be fed (such as “rooting”, looking for the nipple, sucking on the hand).
2. Reassure the parents that there is no need to give the baby any other drink or food, not even water – breast milk has all a baby needs.
3. Help the mother whenever she needs assistance and especially if she is a first time or adolescent mother or a mother with other special needs.
4. Explain to the mother she should let the baby finish the first breast and come off on its own before offering the second breast.
5. Encourage the mother to start each feed with a different breast. For example, if the left breast is used to start one feed, at the next feeding start with the right breast.
6. If it is necessary to express breast milk, show the mother how to do this and show her how to feed expressed breast milk by cup. You may need to refer her to a trained infant feeding counsellor for this.
7. Reassure the mother that her body will make enough breast milk to satisfy her baby’s needs. Just because a baby is crying, it does not mean that she does not have enough breast milk. A baby who is demanding more breast feeds may be growing. By allowing the baby to suckle more often, her body will produce more breast milk to meet her baby’s needs.
8. Explain that the mother can provide all the breast milk her baby needs for the first 6 months and beyond.
9. Explain that the mother can continue breastfeeding if she has to return to work or school, either by expressing breast milk or feeding more often when she is at home.
10. Advise her to seek help (or come back to see you) if the baby is not feeding well or if she has any difficulties or concerns with breastfeeding, sore nipples or painful breasts. If needed, refer her to a trained infant feeding counsellor.