Session Objectives
On completion of this session, participants will be able to:
Observe a breastfeed using the Breastfeed Observation Checklist.
Assist a mother to learn to position and attach her baby for breastfeeding.
Use communication skills when assisting a mother.
Total time 120 minutes
Travel time to and from the clinical practice area is NOT included in this time.
Materials
Breastfeed Observation Aid from Session 7 – two copies for each participant.
List of Communication Skills from Session 2 – a copy for each participant.
Preparation for Clinical Practice
Make sure that you know where the clinical practice will be held, and where each facilitator should take her group. If you did not do so in a preparatory week, visit the wards or clinics where you will go, introduce yourself to the staff members in charge, and make sure that they are prepared for the session.
The session time does not include time for travel to a clinical practice site. Add extra time to the timetable if participants must leave the building to go to another site.
1. Explain the clinical practice
20 minutes
This clinical practice will give you an opportunity to:
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Practice assessing a breastfeed using the Breastfeed Observation Aid.
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Practice using your communication skills.
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Help a mother to position and attach her baby for breastfeeding.
You work in groups of four plus a facilitator with each group. To start with, the whole group of four people works together. One person talks to a mother, while the other members of the group observe. When everyone knows what to do, you can work in pairs, while the facilitator circulates.
The midwife will tell us which women are suitable to talk with and who have their breastfeeding babies with them on the ward.
One participant will talk to a mother:
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Introduce yourself to the mother, and ask permission to talk to her. If she does not want to be observed, thank her and find another mother. Introduce your partner/small group, and explain that you are interested in infant feeding.
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Ask permission to watch her baby feed. Avoid saying that you want to watch how she is ‘breastfeeding’ as this may make her feel nervous. If the baby is heavily wrapped in blankets ask the mother to unwrap the blankets so that you can see.
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Try to find a chair or stool to sit on. If necessary, and if permissible, sit on the bed so that you are at the mother’s level.
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If the baby is feeding, ask the mother to continue as she is doing. If the baby is not feeding, ask the mother to offer a feed in the normal way at any time that her baby seems ready. If the baby is willing to feed at this time, ask the mother’s permission to watch the feed. If the baby is not interested in feeding, thank the mother and go to another mother.
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Before or after the breastfeed, ask the mother some open questions about how she is, how her baby is, and how feeding is going, to start the conversation. Encourage the mother to talk about herself and her baby. Practise as many of the listening and learning skills as possible.
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Remember to praise what mothers are doing right and offer a small amount of relevant information if appropriate.
The partner or rest of the small group (of four people) will observe:
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Stand quietly in the background. Try to be as still and quiet as possible. Do not comment, or talk among yourselves.
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Make general observations of the mother and baby. Notice for example: does she look happy? Does she have formula or a feeding bottle with her?
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Make general observations of the conversation between the mother and the participant. Notice for example: Who does most of the talking? Does the participant ask open questions? Does the mother talk freely, and seem to enjoy it?
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Make specific observations of the participant’s communication skills. Notice if she or he uses helpful non-verbal communication, if she or he uses judging words, or if she or he asks many closed questions to which the mother says ‘yes’ and ‘no’.
When you observe a breastfeed:
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Stay quietly watching the mother and baby as the feed continues.
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While you observe, fill in a Breastfeed Observation Aid. Explain to the mother that you are using an Aid to help you remember the new skills that you are learning.
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Mark a tick beside each sign that you observe.
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Under ‘Notes:’ at the bottom of the form, write anything else that you observe which seems important for breastfeeding.
When you have finished observing a mother:
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Thank the mother for her time and cooperation, and say something to encourag0 and support her.
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Go with the group into another room or private area to discuss your observations.
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Discuss what you noticed about the breastfeed and what you noticed about the communication skills that the participant used.
If the mother needs help
When a pair finds a mother who needs help positioning her baby at the breast, tell the facilitator of your small group. Then practice helping the mother, while your facilitator observes you, and helps if necessary.
When a pair has finished helping a mother, if needed, move away from the mother for a discussion. The participant should comment on her or his own performance first. Then the facilitator can praise what they did well, give them relevant information and suggest changes that could be made the next time they help a mother.
Before you leave the ward or clinic, tell the staff member which mothers you have suggested to change their positioning and attachment so that the staff member can follow-up with these mothers.
Each participant should talk to at least one mother and observe a breastfeed. Not all mothers will need help to position and attach their babies.
While you are in a ward or clinic, notice:
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if babies room-in with their mothers;
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-whether or not babies are given formula, or glucose water;
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-whether or not feeding bottles are used;
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-the presence or absence of advertisements for baby milk;
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-whether sick mothers and babies are admitted to hospital together;
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-how low-birth-weight babies are fed.
Do not comment on your observations, or show any disapproval, while in the health facility. Wait until the facilitator invites participants to comment privately, or in the classroom.
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Ask if the participants understand what they are to do during the clinical practice and answer any questions. Give directions how to reach the clinical practice area.
2. Conduct the clinical practice
80 minutes
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For the facilitator of each small group:
When you arrive at the clinical practice area:
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Introduce yourself and your group to the staff member in charge.
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Ask which mothers and babies it would be appropriate to talk to, and where they are.
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Try to find a mother and baby who are breastfeeding, or a mother who thinks that her baby may want to feed soon. If this is not possible, talk to any mother and baby.
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Remember to praise what mothers are doing right and offer a small amount of relevant information if appropriate.
When a participant finds a mother who needs help with positioning and attaching her baby, observe the participant assisting that mother, giving any necessary help as needed.
When the participant has finished talking with the mother, take the group away from the mother, and discuss what the participants observed. Ask them:
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What did they observe generally about the mother and baby?
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What signs from the Breastfeed Observation Aid did they observe?
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Which communication skills did they observe?
If the mother and baby showed any signs of good or poor positioning and attachment that participants did not see, point them out.
Before your group leaves the ward or clinic, tell the staff member which mothers you have suggested to change their positioning and attachment so that the staff member can follow-up with these mothers.
3. Discuss the clinical practice
20 minutes
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The whole class comes back together to discuss the clinical practice.
Ask one participant from each group to report briefly on what they learnt.
Ask them to comment:
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On their experiences using the Breastfeed Observation Aid and the list of Communication Skills.
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On any special situations of mothers and babies and what they learnt from these situations.
Encourage participants report only on points of special interest; they do not need to report on details of every individual mother.
Participants may continue to practice their skills of observing and assisting mothers at other times if this is acceptable to the mothers and to the hospital ward or clinic. Encourage participants to practice in pairs so that one can observe the skills used and discuss them afterwards with the other participant.
Review any points about the clinical practice that will help the next clinical practice to go better.
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Ask if there are any questions.
