Welcome Back

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(No Transcript)
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Welcome Back!

• Crossword Puzzle (Review of Session 3)
• Review answers as a large group
• See Crossword Puzzle Key (Handout 5)
• Preview of Session 4
• Silently read the topics for Session 4
• What are you most interested in learning about?

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Helping Mothers with Special Challenges
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Breastfeeding Challenges

• Twins
• Premature baby
• Premature twins
• Sick baby
• Baby with other medical problems
• Sick mother / diabetes

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How to Help

• Listen let her talk about her feelings
• Refer to a lactation specialist if they
• Have trouble breastfeeding
• Are told to stop breastfeeding
• Ask health care provider ways to treat problem
• Your support can make a difference!

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Discussion Twins

• Did any of you breastfeed twins or
• know a mother who has breastfed
• twins?

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Twins

• Most women make PLENTY of milk for twins
• Nature made it possible to feed 2 babies
• Breastfeeding can be easier and take less
• time than preparing bottles and formula for
• two babies

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Suggestions

• Start by feeding one baby at a time
• Comfortable - try feeding babies same time
• Baby with strongest suck start on different
• breast each time
• Milk removed from both breasts
• Reduces engorgement
• Helps maintain good milk supply

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More Suggestions

• Let babies sleep in same crib
• Get help shopping, cooking, cleaning, etc.
• Keep snacks nearby
• Rest when possible
• Join a twin or multiple support group

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Discussion Twins

• What positions do you think would be
• helpful for a mother breastfeeding two
• babies at the same time?
• Compare your list to page 96

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Activity Twins

• Activity
• Find a partner
• Practice teaching breastfeeding babies
• at same time
• Use dolls/stuffed animals
• Take turns being mother and peer
• counselor

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Discussion Premature Babies

• Has anyone had or known someone who
• has had a premature baby?
• What was it like for the mother?
• What helped her?
• What would have been helpful?

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Premature Babies

• 37 weeks or earlier
• May be tiny and weak or healthy
• Some cannot breastfeed in beginning
• May need to pump until baby can breastfeed
• Mother of premature baby makes special milk that
  meets babys needs

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Doctors Recommend Breastmilk

• Often prescribe breastmilk - premature babies
• Some add extra calories, vitamins and minerals
• Premature babies fed breastmilk
• Higher IQ - helps brain develop
• Sick less often
• Protects against necrotizing enterocolitis

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How to Help

• Let the mother know
• Giving breastmilk something only she can do
• Breastfeeding gets easier as baby grows
• Focus on breastfeeding/pumping - caring for baby
• Help her get a breast pump from WIC
• Instructions - pumping/storing/labeling
  breastmilk
• Provide extra help and support
• Be a good listener!

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Discussion Sick Baby

• Who has known a breastfeeding mother
• whose baby was sick or in the hospital?
• How did breastfeeding go?
• What happened?
• What could you have done to help?

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Babies Who are Sick

• Most get better faster with breastmilk
• Breastfeed to prevent dehydration
• Breastfeed more for comfort
• Some only want to breastfeed when sick
• Some too weak to breastfeed or do not want to
• Talk about pumping to keep up milk supply
• REFER her to babys health care
• provider or a lactation specialist

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Babies in the Hospital

• Encourage mother spend time with baby
• Breastfeed soon after any test or surgery
• Talk with health care provider
• If the baby cant breastfeed
• Pump as often as she would breastfeed
• Help get pump from WIC

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Mothers with Diabetes

• Hard time controlling sugar in blood
• Eat right, exercise and take medications
• Can get heart disease, kidney disease or
• become blind

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Mothers with Diabetes

• CAN breastfeed
• Breastfeeding
• Improves the mothers health
• May reduce how much medication needed
• May protect baby from getting diabetes later
• Most medications are OK with breastfeeding
• Suggest she talk to health care provider
• BEFORE baby is born

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Discussion

• Divide into small groups - answer these
• If you were sick (colds, flu, etc.) while you
• were breastfeeding, what did you do?
• What did others tell you to do?
• How could you help a mother who is sick keep
• breastfeeding?
• Share with the group

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Mothers with Minor Illnesses

• Most of the time - can continue breastfeeding
• Colds and flu do not pass through breastmilk
• By the time mother knows - baby already exposed
• Mothers give antibodies to their babies
• May keep the baby from getting sick
• Baby will get better faster
• Everyone should wash their hands
• before touching baby!

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Mothersin the Hospital

• Talk to her about
• Can baby stay with her in the hospital?
• Hospital let someone bring baby to breastfeed?
• Will hospital let her use their electric pump?
• If she cant pump on her own, can someone help?
• Where can she store milk in the hospital?
• Can she pump store breastmilk before
• going to hospital?

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Mothers Who are Sick

• Mother told not to breastfeed due to illness or
• treatment, talk to her about
• Pump throw away breastmilk - keep up supply
• Has she talked to a lactation specialist?
  Different
• medication that will work with breastfeeding.
• Get breastmilk from the human milk bank

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Activity

• What questions do you have about helping a
  mother who is sick or in the hospital continue to
  breastfeed?

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Tuberculosis (TB)

• Lung disease treated with medication
• Close contact with person with active TB
• A mother with active TB can breastfeed after
• Taking medication for 2 weeks, and
• Health care provider tells her its OK
• Questions? REFER her to health care provider or a
  lactation specialist

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Hepatitis

• Liver infection
• Hepatitis A
• CAN breastfeed - protects the baby
• Hepatitis B
• Babies now get vaccines
• CAN breastfeed
• Hepatitis C
• CAN breastfeed - if doesnt have HIV

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Sexually Transmitted Infections (STI)

• Most mothers can breastfeed
• Most medications are safe
• Herpes or syphilis - can breastfeed
• (unless has open sores on her breasts)
• Can pump on that side until healed
• Any part of pump kit touches sore - throw out
  milk
• Refer to lactation specialist or health care
  provider - if open sore on breast

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Should NOT Breastfeed

• HIV - (Formula is a safe alternative)
• Human T-Cell Leukemia Virus
• Chemotherapy

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Activity

• Divide into groups of 3
• Complete item G on page 102
• Make sure each person is the counselor,
  mother and observer
• After each role-play, discuss questions on page
  103 within your group of 3
• Share how your counseling went with the large
  group

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Helping a Grieving Mother
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Helping with Grief

• Difficult challenge
• Mothers experience
• Extreme sadness
• Some will not want to talk
• Others want to talk / need a shoulder to cry on
• Some will be angry / depressed
• Others will be in denial
• Some need more time to adjust
• No right or wrong way to grieve

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How to Help

• Be a good listener understanding
• Let the mother talk about her feelings
• Remember her grief is her own
• Listening being supportive - BEST way to help
• When appropriate, recommend a support group
• Let lactation specialist know if mother
• needs help with breastfeeding/weaning

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Activity Grieving Mother

• In small groups
• Make a list of reasons a pregnant woman or
  someone who has recently given birth may be
  experiencing grief. (Compare to list on page 106)
• Discuss how your family friends helped you cope
  with a loss
• How did they make the situation a little easier?
• What would you avoid saying?
• Share with the large group

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Expressing Milk
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Expressing Milk

• Helps mother to start making milk
• Helps keep her milk supply up
• Mothers express breastmilk when
• Babies cannot breastfeed
• They are away from their babies

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Ways to Express Milk

• Hand expression
• Manual pumps
• Battery operated pumps
• Semi-automatic pumps
• Personal use electric pumps
• Hospital grade electric pumps
• Lactation specialist can help choose best pump
  (for situation)

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Discussion

• In small groups, share your experience
• with expressing milk
• How did you express milk?
• What was your reason for expressing milk?
• How did it work out?

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Expressing Milk By Hand

• Easy way for some mothers to express milk
• Some like this method better than using a pump
• Facilitator will demonstrate one method of hand
• expression (using a breast model)
• See steps on page 108
• Optional activity practice hand expression
  using a water balloon

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Pumps
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Manual Pumps

• Not expensive
• Used by mothers who will not be pumping very
  often
• 3 types of manual pumps
• Cylinder pumps
• (e.g. Medela manual pump)
• Trigger pumps
• Rubber bulb pumps
• (bicycle horn)

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Battery Operated Pumps

• Suction controlled
• Mothers who only pump a few times per week
• Batteries need to be changed often
• Used pumps may not work well
• Mothers should NEVER share a manual orbattery
  operated pump with other mothers!

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Electric Pumps

• For mothers who need to express milk many times
  during the day
• Pump both breasts at same time
• 3 types of pumps
• Semiautomatic
• Personal Use
• Hospital Grade

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Putting Together Pump Kit

• Watch facilitator put together a pump kit
  connect it to an electric pump
• Divide into groups
• Practice putting pump kit together

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Helpful Tips for Pumping

• Let mother know
• Normal for one breast to give more milk
• Normal for milk to change color
• Continue pumping after 1st Milk Ejection Reflex
• Milk flow will slow or stop
• Another MER will occur - more milk will flow

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Handle Store Breastmilk
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Activity

• Find and review Handout 6
• Collecting and Storing Breastmilk When
• Youre Away
• How would handout help a mother returning
• to work/school?
• Share in the large group
• What questions do you have about handling,
  storing and using breastmilk?

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Weaning
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Weaning

• Baby fed anything other than breastmilk
• Most of us think of weaning - stop breastfeeding
• In the U.S. often begins in the hospital
• Once mothers start giving formula - breastfeed
• less stop sooner

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Weaning

• Around world most mothers breastfeed - 3 yrs. old
• In the U.S. most mothers wean by 4 months
• If mother decides to wean before 1st birthday
• Give formula - NOT cows milk!
• Some babies wean themselves

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Weaning

• Wean slowly
• If stop suddenly
• Baby loses favorite way to be comforted
• Mothers breasts may become engorged
• Can be an emotional time for mother
• Some feel sad
• Others feel satisfied - ready to stop

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Weaning

• Examine your own beliefs about weaning so you can
  help each mother decide what is best for herself,
  her baby and her family

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Activity

• Find a partner and share
• How old was your baby when you or your baby
• started the weaning process?
• What were the reasons for weaning your baby?
• How did your baby react to breastfeeding less
  often or being weaned?
• How did you feel about weaning?

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Cultural Awareness

• Take a closer look at different ethnic groups
• and see how we are alike and different
• Information is not meant to stereotype
• Meant to help you be able to help many
• mothers breastfeed

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Activity Cultural Awareness

• Which ethnic group do you identify with most
• Find others that share your ethnicity - form
  group
• Make a list of answers to 5 questions on pg. 113
  (use flip chart)
• Share list with the larger group

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Closing Activity Homework
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Closing Activity

• Sunshine Wheels
• Complete this activity (item A on page 114)
• Revisit our Learning Tree
• What topics were covered today that you wanted to
  learn more about?

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Homework

• Practice the 3-Step Strategy
• Ask questions
• Affirm feelings
• Educate (when appropriate)
• More you practice - Easier it will become!