BREAST FEEDING LECTURES

1. SESSION 2
COMMUNICATION SKILLS
(LISTENING AND LEARNING)
1
Breastfeeding Promotion and Support
A Training Course for Health Professionals
Adapted from the Baby Friendly Hospital Initiative:
Revised, Updated and Expanded for Integrated Care (Section 3)
WHO/UNICEF 2009

2. Session Objectives:
At the end of this session, participants should
be able to:
1.Use non-verbal and verbal techniques to
encourage a mother to talk without asking
too many questions
2.Respond to a mother's feelings with
empathy
3.Avoid using words which suggest judgement
of the mother and baby.
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3. COMMUNICATION SKILLS
• Health workers are
trained to look for and
fix problems BUT
• Good communication
means respect for the
women’s own thoughts,
beliefs and culture
• NOT tell or advise a
person what YOU think
they should do
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4. COMMUNICATION SKILLS
Health workers should be able to do
more than just offer info
Help mothers to look at cause of any
difficulties
Suggest courses of action to help fix
problem
Sometimes just offer assurance she is
doing well
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5. COMMUNICATION SKILLS IN BF
• Counselling :a way of working with people in
which you try to understand how they feel
and help them to decide what to do.
• BF is not the only situation in which
counselling is useful.
• A BF mother may not talk about her feelings
easily
• You need the skill to listen, and to make her
feel that you are interested in her. This will
encourage her to tell you more.
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6. Identify Communication Skills of
Listening, Learning and Building
Confidence
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7. COMMUNICATION SKILLS IN
BREAST FEEDING
• Communication involves :
A. Listening and learning
B. Building confidence and giving
support
• Not just giving information
C. Arrange suitable follow-up and
support 7

8. A. Skills to Listen and Learn
1. Use helpful non verbal communication
2. Ask open questions
3. Encourage the mother to talk
4. Empatise the mother
5. Avoid words which sound judging 8

9. A. Skills to Listen and Learn
1 . Non-verbal Communication
•KEEP your head level
•Remove barriers- desk/folders
•Pay attention to mother -Avoid getting distracted
•Take time without hurrying – don’t look at your watch
•Only touch in appropriate way (hand/arm)
•Don’t touch her breasts/baby without permission
"Good morning, Pn Aniza. How is breastfeeding going for
you and the baby?“
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10. A. Skills to Listen and Learn
2. Ask open questions
• Open questions usually start with "How?
What? When? Where? Why?"
Eg. "How are you feeding your baby?“
• You need to assess the situation/difficulty
• Ask questions that encourages the mother
to talk
• Close questions do not give much info
– Start with “Are you? Did you? Has the baby?
– Sometimes suggest the “correct” answer
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11. A.Skills to Listen and Learn
3. Use responses and gestures which show
interest to Encourage mother to talk
• Show we are interested in what mother is
saying
• Use responses such as
– Nodding/smiling
– Simple response eg “Uh “ “Hmm”, “Go on…”
• Reflect back what the mother is saying
– Can help clarify the mother’s statement
• Mix reflecting back with other responses
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12. A.Skills to Listen and Learn
4.Emphatise
• Show you understand her feelings
• Looking at it from HER point of view
• Vs Sympathy
• Emphatise with her good feelings too, not
just bad feelings
• Find out how she feels about the situation
• Ask for more facts 12

13. A.Skills to Listen and Learn
5. Avoid judging words
• Judging words include: right, wrong, well,
bad, good, problem
• Can make a woman feel
– like she is wrong
– Something wrong with the baby
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14. B.Skills to Build Confidence and Give Support
• Good communication skills help mother to feel
good and confident to carry out her decisions
• To help her build confidence:
Accept what a mother thinks and feels
Recognise and acknowledge what is right
Give practical help
Provide relevant information using suitable
language
Make one or two suggestions.
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15. B.Skills to Build Confidence and Give Support
1.Accept what a mother thinks and feels
• Acceptance without disagreeing
• Does not mean we agree she is right
• Accept what she is saying, give correct info
later
• Helps mother to trust you and encourages
her to continue the conversation
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16. B.Skills to Build Confidence and Give Support
2.Recognise and acknowledge what is right
• Recognise and praise what mother and baby
are achieving
– Tell mother how well baby is attaching
– Point out how clever the baby is in
detaching himself after feed
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17. B.Skills to Build Confidence and Give Support
3. Give practical help
• Milk will flow better if mother is
comfortable
– Offer another pillow
– Offer to hold baby while she goes to
wash
• May need clear practical help e.g how to
express milk
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18. B.Skills to Build Confidence and Give Support
4.Provide relevant information using suitable
language
• Find out what she needs to know at this
time
• Use suitable words that mother
understands
• Do not overwhelm her with information
5. Make suggestions, not COMMANDS
• Provide choices and let her decide
• Do not tell her what she should do
• Limit suggestions to 1 or 2
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19. C.Arrange follow-up and on-going support
• After a discussion, mother
may
– still have questions but
not time to discuss
– think of something else
– find it difficult to put
practice into action
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20. C.Arrange follow-up and on-going support
• Important to arrange follow-up and on-going
support
Learn what is available from family and friends
Offer a time to see or talk to her again
Encourage her to see you or another person for
help
Refer to community support group if possible
Refer her for more specialised counselling if
needed
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21. 2. Practice Communication Skills
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22. Demo 1: CLOSE QUESTIONS
• HW: "Good morning, pn. I am SN/JM ….Is (baby)
well?"
• Mother: "Yes, thank you."
• HW: "Are you breastfeeding him?"
• Mother: "Yes".
• HW: "Are you having any difficulties?"
• Mother: "No".
• HW: "Is he breastfeeding very often?"
• Mother: "Yes".
• Comment: The HW got "yes" and "no" for answers and
didn't learn much. It can be difficult to know what to say
next.".
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23. Demo 2: Open questions
• HW: "Good morning, pn. I am JM/SN. How is
baby?"
• Mother: "He is well, and he is very hungry."
• HW: "Tell me, how are you feeding him?"
• Mother: "He is breastfeeding. I just have to
give him one bottle feed in the evening."
• HW: "What made you decide to do that?"
• Mother: "He wants to feed too much at that
time, so I thought that my milk is not enough".
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24. Demo 3: Starting and continuing a conversation.
HW: "Good morning, (name). How are you and baby getting on?"
Mother: "Oh, we are both doing well thank you.“( ????)
HW: "How old is baby now?"
Mother: "He is 2 days old today."
HW: "What are you giving him to drink?"
Mother: "He is breastfeeding, and having drinks of water."
HW: "What made you decide to give the water?“ (Open)
Mother: "There is no milk in my breasts, and he doesn't want to
suck.“
Comment: open, specific, specific, open
Sometimes you might need to ask a closed question,
eg: "Are you giving him any other food or drink?" or
"Are you giving the other feeds by bottle?”
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25. Demo 4: Using responses and gestures
which show interest
• HW: "Good morning, pn. How is breastfeeding
going for you these days?"
• Mother: "Good morning. It is going quite well, I
think."
• HW: "Mmm." (nods, smiles)
• Mother: "Well, I was a bit worried the other day,
because he vomited."
• HW: "Oh dear!" (raises eyebrows, looks interested)
• Mother: "I wondered if it was something that I ate,
so that my milk did not suit him."
• HW: "Aha!" (nods sympathetically).
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26. Demo 5: Continuing to ask questions
• HW: "Good morning, pn. How are you and baby
today?"
• Mother: "He wants to feed too much - he is taking
my breast all the time!"
• HW: "About how often would you say?"
• Mother: "About every half an hour."
• HW: "Does he want to suck at night too?"
• Mother: "Yes".
• Comment: The HW asks factual questions, and the
mother gives less and less information.
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27. DEMO 6: REFLECTING BACK
• HW: "Good morning pn. How are you and baby today?"
• Mother: "He wants to feed too much - he is taking my breast
all the time!"
• HW: “ Baby is feeding very often?"
• Mother: "Yes. This week he is so hungry. I think that my milk
is drying up."
• HW: "He seems more hungry just for about a week?"
• Mother: "Yes, and my sister is telling me that I should give
him some bottle feeds as well."
• HW: "Your sister says that he needs something more?"
• Mother: "Yes. Which formula is best?“
• Comment: The HW reflects back what the mother says, so
the mother gives more information.
• But do not reflect ev. time……..
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28. Demo7: Mixing reflecting back with other responses
• HW: "Good morning. How are you and baby today?"
• Mo: "He wants to feed too much - he is taking my breast all the
time."
• HW: “Baby is feeding very often?"
• Mo: "Yes. This week he is so hungry. I think that my milk is
drying up."
• HW: "Oh dear!"
• Mo: "Yes, it is exhausting. My sister tells me that I should give
some bottle feeds and get some rest."
• HW: "Your sister wants you to give some bottle feeds?"
• Mo: "Yes - she says that I am foolish to struggle on like this."
• HW: "How do you feel about that?"
• Mo: "Well, I don't want to give bottle feeds.“
• Comment: conversation more natural,hw is learning more 28

29. Demo 8: Empathizing
HW: "Good morning, pn. How are you and baby today?"
Mother: “Baby is refusing to breastfeed - he doesn't seem to like
my milk now!"
HW: "You feel that he doesn't like you now?"
Mother: "Yes, it's as if he doesn't love me - it just started
suddenly this week, after his grandmother came to live with us.
She likes so much to give him a bottle feed!"
HW: "You feel that she wants to be the one to feed him?"
Mother: "Yes - she wants to take him over from me!“
Comment: The HW empathizes with the mother's feelings and
learns some very important things - without asking direct
questions.
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30. Demo 9: Empathizing with a mother's good
feelings
HW: "Good morning, pn. How is breastfeeding going for you and
baby ?"
Mother: "He is suckling well and he seems quite contented after
feeds now."
HW: "You must feel pleased that it is going so well".
Mother: "Yes, I am so happy that I don't have to give bottle
feeds."
HW: "You really enjoy breastfeeding. That's wonderful.“
Comment: It is important to make a mother feel that you are
interested in her, even if she does not have a problem.
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31. Demo 10: Using judging words
• HW: "Good morning, pn. Is baby breastfeeding
normally?"
• Mother: "Well - I think so."
• HW: "Do you think that you have enough breastmilk for
him?"
• Mother: "I don't know.......I hope so, but maybe not ..."
(She looks worried.)
• HW: "Has he gained weight well this month? May I see
his growth chart?"
• Mother: "I don't know........“
• Comment: The HCW is not learning anything useful, but
she is making the mother very worried.
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32. Demo11: AVOID JUDGING WORDS
• HW: "Good morning, pn. How is breastfeeding going for
you and baby?"
• Mother: "It's going very well. We both enjoy it!"
• HW: "How is his weight? Can I see his growth chart?"
• Mother: "Nurse said that he gained more than half a kilo
this month. I was pleased."
• HW: "He is obviously getting all the breastmilk that he
needs.“
• Comment: The HW learnt what she needed to know
without making the mother worried.
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33. SUMMARY: COMMUNICATION SKILLS
• Communication involves listening and building
confidence, and not just giving information
• 1.Listening and learning
Use helpful non verbal communication
Show interest, reflect back and emphatise
Avoid judging words
• 2.Building confidence and giving support
Accept what a mother thinks and feels
Recognise and acknowlege what is right
Give practical help and relevant information
• 3. Arrange suitable follow-up and support 33

34. REVISION :Skills to Listen and Learn
1. Use helpful non verbal
communication
2. Ask open questions
3. Encourage mother to talk
4. Emphatise the mother
5. Avoid words which sound
judging
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35. REVISION : Non-verbal Communication
•KEEP your head level
•Remove barriers- desk/folders
•Pay attention to mother -Avoid getting
distracted
•Take time without hurrying – don’t look at
your watch
•Only touch in appropriate way
(hand/arm)
35

36. THANK YOU
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