Step 3

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
Children
Breastfeeding Mothers
is important Families
to :
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
Information on the risk
Assure & benefits of various
confidentiality feeding options

Guidelines in selecting
Individual
suitable option
counseling
Support to carry out the
Privacy
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

 3/2

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
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)