CLC Interactive Competency -2 Questions and Answers

CLC Interactive Competency -2 Questions and Answers How can sessions be mother-focused? discover mother's concern don't make sessions counselor-focused How can the approach during counseling be effective? Be clearly open to addressing mother's concerns How can confidence be supported during counseling sessions? Clearly use the interaction to build the mother's confidence Why is it beneficial for moms to see other moms breastfeeding? What does research say? 1. The decision to initiate breastfeeding is influenced more by embodied knowledge than by gaining theoretical knowledge about its benefits 2. The decision doesn't come from prenatal education 3. Providers don't seem to adequately address family concerns about breastfeeding. Why do families choose not to breastfeed? 1. Families think that formula feeding is "easier" 2. They may be more comfortable with the idea of formula feeding. Why would parents prefer formula feeding? 1. Families think that formula feeding is "easier" 2. They may be more comfortable with the idea of formula feeding. So, it makes sense that breastfeeding is discouraged during pregnancy when we 1) make breastfeeding seem hard or "schoolish" or 2) focus on the advantages to the baby What are the two interventions for improving breastfeeding? 1. Normalize Breastfeeding 2. Positive Experiences Through Knowledgeable Peers How can we normalize breastfeeding? Think about adult benefits due to lactation - knowledge of breast cancer risk reduction may influence breastfeeding practices Change "fewer ear infections for the baby" to "you may have fewer pediatric visits for ear infections" Interact with people as though exclusive breastfeeding is the expected choice. "Women who decide not to breastfeed are not so much embracing this method of feeding (formula) as rejecting breastfeeding" How can we create positive experiences through knowleadgable peers? Confidence and empowerment increased with group based peer counseling; videos alone are ineffective Peer counselors provide support, information, and social learning Women's decision to breastfeed was found to be significantly associated with WIC peer counselor contacts La Leche League provides support, information and social learning through mother-to-mother support Mom2Mom, Global Why do men typically think negatively of breastfeeding? Men worry that breast will "get ugly" (research says the breasts changed after childbirth but not because breastfeeding Breastfeeding separates them and others from the woman Breastfeeding makes developing relationships with baby difficult Makes the father feel inadequate How do we address breastfeeding to fathers to create more acceptance? Making breastfeeding: - normal - achievable - desirable - breastfeeding protects from specific diseases and give list - breasts were made for breastfeeding How do US fathers feel about breastfeeding? What did support from fathers lead to? They are "eager to learn"! This can increase emotional support to mom, less chores for mom to do, and less fears about milk supply. What is good counseling NOT like? - talking to a friend - a teacher talking to a student - mechanical fixing of "what's wrong"; hands-on touch making mom feel like a machine - giving advice that would work for you - one-size fits all information (as found on the internet) - imposition of the counselor's agenda on the family What are breastfeeding counseling goals? - family concerns are heard and valued - baby feels heard and valued - counselor elicits "the whole story" before offering feedback or intervention - adults, baby and counselor are fully involved in problem solving - safety is always the primary focus (even over breastfeeding)! - technology and gadgets are used very carefully - open ended questions What can a good counseling session look like? - smiling - knowing normal -eye contact - take the "knowing style" into consideration - pay attention to worries - give praise What are the steps to a successful counseling session? 1. Gather information using questions that can't be answered with a single word 2. Verify what you've heard 3. Offer individualized information (not advice) 4. Work together to develop a plan 5. Review and fine tune the plan 6. Establish a follow-up plan and make needed referrals 7. Summarize, listen, & document Avoid loaded and judging words What is the OARS steps to motivational interviewing from Bershad? O: Open-ended questions (shows interest in what is on the client's mind today A: Affirmation (builds empathy and connection between client and counselor) R: Reflective Listening (deeper understanding) S: Summarize & Teachback (helps family be heard and gives them a plan) How can we demonstrate open-ended questions during sessions? Ask questions that can't be answered with a single word Use "how", "who", "what", "when", "where", etc don't use "why", but try to use "tell me about" How can we demonstrate affirmation during sessions? Listen for and call attention to examples of good actions/decisions to affirm Strive for genuine and specific recognition, not a generic response How can we demonstrate reflective listening during sessions? Listen for deeper understanding of the situation - hearing not only the words, but open to possible underlying meanings and beliefs Rephrase or paraphrase statements, or reflect on the meaning of what you heard to assure understanding How can we demonstrate summarize during sessions? Summarize strengths shared by client and action steps planned How can we demonstrate teach back during sessions? Ask client to demonstrate back a skill or learning Who needs greater support? - first time parents - mothers of late preterm infants born at 34-37 weeks gestation Women with family or financial problems - women experiencing Postpartum adjustment disorder (PPAD) What is Postpartum Adjustment Disorder (PPAD)? - 85% of women experience mood changes associated with hormonal changes, lack of support and many life changes - PPADs are not related to feeding choice - women with a history of Pre-Menstrual Syndrome (PMS) and prior dysphoric disorder have a higher risk of PPD - Postpartum Post Traumatic Stress Disorder (PP-PTSD) What percentage of women met the DSM-IV criteria for PTSD after childbirth? What are two conditions that significantly increase the odds? 9% 1) Depressive symptom scores 2) Total number of physical symptoms experienced since the birth What should be focused on during sessions? 1. Providing less information to help with recall 2. Communication centered around mothers' concerns 3. Supporting the desire to Exclusively Breastfeed At what times are babies born with double the odds of supplementation? 10pm-9am What is important to know about the start to successful breastfeeding? Doulas can be used for more successful breastfeeding. Pain medications are complicated with breastfeeding. Mothers with labor meds typically need extra breastfeeding support. They may also have a delayed onset of "Milk Coming In" (DOL) What does research suggest in regards to the optimal start of breastfeeding? - avoid longer durations, delay administration of epidurals - conservative use of IV fluids - close follow-up and good breastfeeding support - continuous support in labor (doula) - reduce the need for pharmacologic pain management through Lamaze or other childbirth education, breathing and relaxation, hypnosis, acupuncture, acupressure etc What else can we do to support EBF during the hospital stay? Implement the 10 steps to successful breastfeeding - bags containing breastfeeding supplies or no bag at all were positively associated with exclusive breastfeeding at 10 weeks and 6 months - weaning risk is greater when hospital practices do not support breastfeeding - a positive relationship was found between mPINC score and in-hospital exclusive breastfeeding, any breastfeeding and exclusive breastfeeding at 8 weeks - use quality improvement measures to identify and change unhelpful practices What does the Perinatal Care Core Measure Set include? 1. Decreased elective deliveries 2. Decreased cesarean section 3. Increased antenatal steroids 4. Decreased health care - associated bloodstream infections in newborns 5. Increased exclusive breast milk feeding The quality measure anticipates that hospitals will implement a strict definition of acceptable criteria for supplementation and work toward 100% exclusive breast milk feeding Why is step 4 in the Ten Steps to Successful Breastfeeding important? Skin to skin should be encouraged in the first hour and encouraging early feeding. It is a good starting point in changing practices. The same 9 states were observed during the first skin to skin practice within the first 1.5/2 hours. Why is cesarean birth a barrier to breastfeeding? Perhaps due to later initiation of breastfeeding or more separation or more supplementation or greater weight loss. Better post-op pain control improves breastfeeding outcomes the baby's gut microbiome is affected by antibiotic use, mode and place of birth. S2S after cesarean may increase breastfeeding initiation, reduce formula supplementation in hospital and maintain infant temperature What should you do if the mother cannot provide skin to skin? The partner can provide S2S. They were comforted. They stopped crying, became calmer, and reached a drowsy state earlier than the infants in the cot group. How long does it take for babies exposed to labor medication to self-attach after initiating skin to skin? at least 2 hours How do the babies know where to attach? areola has a higher temperature Why is smell important for newborns in early stages? 1. Exposure to the mother's odor may facilitate the infant's adaptation to the early postnatal environment 2. Mother's areolae and milk odor appear to attract and guide neonates to the odor source, especially if they were exposed to the contractions of labor. Maternal breast milk calms newborns during painful procedures. 3. Women are rewarded when they smell babies! Body odors of unfamiliar 2 day old babies elicits activation in reward-related cerebral areas of women regardless of their maternal status What does S2S promote? - decreased rate of primary postpartum hemorrhage - faster expulsion of the placenta - correct suckling - less crying - decreased rate of primary postpartum hemorrhage - faster expulsion of the placenta - Skin-to-skin babies are warmer. Their mother's breasts are warmer too! When babies are in close proximity to mom, what are the benefits? - families can observe for feeding cues - baby can be held skin-to-skin - babies can smell the milk - babies can be fed at their best time - learning happens together - slept slightly longer - higher quality of sleep - more likely to exclusively breastfeed What were the effects of depressive symptoms on breastfeeding? - breastfeeding was not accomplished in the first 2 hours - had an almost 4 fold increase in NOT exclusive breastfeeding at 6 weeks postpartum - women reporting depressive symptoms during pregnancy seem to be more vulnerable to the effects of postponed first breastfeeding on exclusive breastfeeding What are risks of delayed breastfeeding in the hours after birth for mom? - decreased prolactin receptors activated - decreased oxytocin/uterine contractions - decreased milk volume - decreased opportunities to practice with colostrum - decreased confidence - increased risk of supplementation