Step 3

Promoting
Breastfeeding
during Pregnancy
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 woman’s 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
Mother’s 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 woman’s 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

Individual Guidelines in selecting

counseling suitable option

Privacy Support to carry out the

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
 GROUP
PRACTICE
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 woman’s 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)