Session 2: Helping mothers breastfeed

Purpose:

In this session, trainees analyze some common reasons given for termination of breastfeeding and use of breast milk substitutes. They also discuss activities to promote successful breastfeeding in the community.

Time: 1 hour

Materials:

- Handout - "Helping Mothers Breastfeed"

- Trainer's Reference - Breastfeeding Case Examples

- Flipchart and marking pens

Steps:

1. Read Breastfeeding Case Example #1 to the group. Ask the following questions:

- Why was the woman in this example weaning her daughter? (new pregnancy)

- Is this a common problem in your area?

- Is it necessary to terminate breastfeeding once you become pregnant?

2. Summarize the discussion. Although there are many taboos and cultural beliefs against breastfeeding when a mother becomes pregnant again, breastfeeding is not an uncommon practice during pregnancy in many developing countries. Beliefs in changes in breast milk volume or composition associated with a new pregnancy have not been confirmed by factual observations, nor have any ill effects been detected for either mother or infant. The main concern in such situations is that the mother's additional nutritional requirements are met. They will not be significant during the first trimester of pregnancy, a time when most lactating women would not even be aware of a new pregnancy.

3. Ask one of the trainees to read Case Example #2 to the group. In this example, the infant is not growing properly even though the mother is breastfeeding. Ask trainees to list the reasons why this infant might not be growing.

Responses should include:

- Giving other food decreases the suckling time at the breast, decreasing milk production

- Other foods may be contaminated and cause infections

4. Ask trainees what advice they might give the mother in Case Example #2. This can be done in a role play with discussion about the advice given.

5. The case examples describe several common reasons that women give for terminating and/or supplementing breastfeeding. Ask trainees: "What are some of the reasons given by women in your region who stop breastfeeding?" List these on the flipchart.

6. Discuss each of the reasons listed. You may wish to proceed with the following steps:

- Distribute the Handout - "Helping Mothers Breastfeed". This handout lists common problems that can cause a woman to stop breastfeeding. Review each of the problems and the suggested solutions, referring back to the list generated by the trainees.

- Identify the reasons on the list that are related to false beliefs or misconceptions. Give the facts. Discuss ways to change beliefs and dispel rumors through education and example.

- Review the rules for successful breastfeeding. (Session 1)

- Summarize: Most women can breastfeed successfully if they have access to information and support from their family and community. Only in rare cases will breastfeeding not be possible.

7. Divide into small work groups. Ask each group to brainstorm a list of activities that community groups and community program managers could organize to promote successful breastfeeding. Allow 10-15 minutes, then ask each group to present its list of ideas. These might include:

- Provide information and support for pregnant and breastfeeding women

- Education of community leaders especially women to promote breastfeeding

- Training of health workers and traditional healers, especially TBAs

- Acting to stop the misleading promotion and sale of infant formulas and feeding bottles

- Support for legislation for policies that support breastfeeding, such as maternity leave, creches, nursing breaks, etc..

8. Summarize the session by emphasizing the important role that community members, especially women, can play in providing information and support to breastfeeding mothers.

HANDOUT

HELPING MOTHERS BREASTFEED

POSSIBLE REASONS FOR TERMINATION OF BREASTFEEDING	SUGGESTED SOLUTIONS
Medical Practices that Promote Bottle Feeding: Hospital procedure may require separation of mother and infant at birth. Sugar water or formula maybe given during this period thus interfering with the beginning of breastfeeding and milk production in the breasts. Health workers may also be poorly informed, recommending that a woman stop breastfeeding unnecessarily	Promote rooming-in at hospitals. Eliminate bottle feeding of fluids to the infants. Talk to hospital officials about changing outdated practices that undermine breastfeeding Train health workers to provide correct information to breast-feeding women.
Social Forces: The use of infant formulas and feeding bottles by upper class women, promotion by formula companies, and Western attitudes toward breasts and sexuality have resulted in an increase in bottle feeding among poor women.	Educate community leaders, women and men. Provide support and encouragement for breastfeeding women.
Insufficient Milk:	Encourage the mother to breastfeed the baby more often. If possible the mother should eat more food every day and drink lots of liquids.
Pregnancy: When a woman finds she is again pregnant, she may stop breast- feeding .	Do not stop breastfeeding abruptly. A health woman can continue breastfeeding while pregnant gradually weaning her child. Encourage her to eat additional body-building, energy protective foods.
Temporary Separation of Mother and Infant: If the infant is breast- feeding less often, less milk will be produced.	Breastfeed frequently when reunited. Express milk manually during the separation.
Working Outside the home: Undernourished women produce less breast milk.	Encourage women to breastfeed at night and frequently when with their infants. Educate employers. Promote the passage and enforcement of labor regulations that encourage breastfeeding such maternity leave, legislation, creches, and nursing education.
Maternal Illness:	Breastfeeding is contraindicated only in cases of severe maternal illnesses, for example in the case of heart failure, or severe kidney, liver or lung disease. Most common illnesses in mothers are not in themselves reasons not to breastfeed.
Low-Birth Weight Infant: A large proportion of low-birth weight infants (below 2500 g) are born at term and behave as fully matured infants.	They can and should be breastfed. If the infant is pre term and unable to suck properly, the mother can express her milk and feed her child manually. The food of choice for preterm infants is breastmilk.

TRAINER'S REFERENCE

BREASTFEEDING CASE EXAMPLES

To the Trainer: Develop your own examples to illustrate the most frequent causes of early termination of breastfeeding and inadequate milk production. Examples can also be developed as role plays or dramas.

1. An example from Kenya

A healthy 12 month old girl came to the monthly village weighing activity with her mother. The nutrition worker congratulated her on how well her daughter was growing and encourages her to continue what she is doing. The mother is concerned because she has found out that she is pregnant and must stop breastfeeding. In Kenya, it is common for women to stop breastfeeding as soon as they find out they are pregnant again.

2. An example from Nepal

A three-month-old baby boy was brought to the village clinic with diarrhea and vomiting. The baby was pale and thin. When asked if she was breastfeeding, the mother said she was breastfeeding but that she did not have enough milk. To supplement her own milk she started giving buffalo milk in a bottle and porridge made from ground maize when the baby was about two months old. She said the baby had been sick with diarrhea three times in the last month and that he was getting thinner and thinner despite her efforts to feed him. The mother also looked pale and thin.