Infant feeding support component of Supporting Healthy Mothers
Debunk myths and misconceptions• Identify, HIV transmission• Breast, thrush, pains•, body•, foremilk/
COLD, BREAST, THRUSH
Using findings from a longitudinal qualitative exploration of women’s perinatal experiences in this setting, [Specific content and educational materials for the 
Prenatal Breastfeeding Support Session• Ensure the important benefits of exclusive breastfeeding for the first six months after birth are understood, benefits include:o Health benefits to the babyo Health benefits to the motherso Economic benefitso Perfect nutrition- Breastmilk (unlike porridge) is a complete food and contains everything a baby needs for the first 6months of life.• How breastfeeding workso Breastmilk supply and demand cycleo How to recognize effective milk exchangeo The size of the baby’s stomach during the first weeks postpartumo The change in the texture and composition of breastmilk during the first weeko The change in breastmilk during one feeding (foremilk/ hindmilk)• On demand feeding• Babies should not go more than 2 hours without feeding (also during the night)• When infants cluster feed and might seem to be feeding constantly and not sleeping this does not indicate a problem, but can be a growth spurt.• Empower moms to be comfortable with their baby’s unique feeding habits—some babies tank up eating a lot all at once, while others keep “snacking” as long as they are awake.• Moms should feed fully on one side before switching to the other side so babies receive both foremilk and hindmilk with each feeding.• When and how to express and store breast milk and prepare breastmilk, if applicable• Changes in the baby’s stool during the first days/ week postpartum• Signs that a baby is hungry/ full• Signs that a baby is getting enough milk• Infant medication administration• How to burp the baby to reduce gas pains• Mother’s diet and hydration• Mother’s adherence to ART• Role that partners and other supporters playCommon barriers include:• Previous negative experiences withbreastfeeding• Unsupportive family or friends• Unfounded beliefs: (i.e., breastmilk is not enough for baby boys)• Fear of HIV transmission• Breast health problems• Lack of food and water to support sufficient breastmilk production• Baby’s tummy to mom’s tummy and baby’s head and neck in alignment with baby’s body• What a deep latch looks likeo position of the baby’s lips and tongueo most of the areola covered by the baby’s mouth• What a deep latch feels likeo Not painful
2, 4, and 6-week Breastfeeding Support Sessions• General health of the mother and her baby• Signs of bonding between mother and baby• Position and latch• Effective milk exchange• Breast health• Frequency and duration of feeding• Diaper changes (frequency and contents)• Burping and “bicycle riding” to reduce gas pain• Reassess knowledge and opinions about best feeding practices as needed/• Identify and address difficulties and barriers to continued breastfeeding.• Infant’s weight• Breast assessment• # of wet/ soiled diapers• Observations of milk exchange during feeding.• Maternal adherence• Infant adherence• Identify and address difficulties and barriers• Related to breastfeeding practice• Related to infant care• Related to self-care• Related to adherence• For example:o Express milk from engorged breast.o Warm/ cold compresseso Recommend and assist with changes to latch or infant’s positiono Refer to primary care for treatment of thrush or mastitis• Acknowledge the hard work the mother is doing• Point out the progress being made• Reassure mother of adequacy of milk supply (as applicable)• Reinforce mother’s confidence• Congratulate her success related to breastfeeding, adherence and demonstrated knowledge
3-month Breastfeeding Support Session• Breastfeeding exclusively, why and why not?• Challenges or barriers• Infant growth• Congratulate and reassureCommon challenges during this time include:• Increased pressure to introduce complementary foods or stop breastfeeding• Increased difficulties with medication administration• Baby’s growth spurts/ cluster feeding• Baby more easily distracted during breastfeeding—a normal part of development• Teething• Explore the mother’s current knowledge and past experiences• Debunk myths and misconceptions• Identify and address potential challenges• Discuss:o How to assess baby’s readinesso When and why complementary feeding is neededo Recommended foods (types and amounts)o Recommended amount of watero Frequency of feedingo Positioning during feedingo Responsive feeding techniques• Thickness and amount for first feeds• Temperature• Current recommendations (24-months or beyond)• Considerations for deciding when to stop• How to gradually go about it• When infant HIV prophylaxis can be stoppedThe infant feeding support sessions were carried out between February 23, 2022 and November 9, 2022 in a private office within a sub-county hospital in Kisumu, Kenya. Prior to the first supportive session, the Research Coordinator provided the Lactation Specialist with the relevant information from the participant’s baseline survey so the Lactation Specialist could personalize the session according to the mother’s knowledge, experience, level of confidence and need for, as well as openness to, support. At each visit, participants met with the Research Coordinator who weighed their infant (at postpartum visits) and administered the corresponding electronic questionnaires including a variety of questions to assess infant feeding behaviors (including exclusive breastfeeding). Then, the Research Coordinator introduced the Lactation Specialist, and remained in the room to quietly observe while the Lactation Specialist conducted the infant feeding support sessions. Participants were provided with refreshments during the visit and reimbursed 800 Kenyan Shillings for the cost of their transportation to the clinic.The first breastfeeding support session occurred during the participant’s third trimester of pregnancy (see Table 