3-months (12-weeks) postpartum: 5th infant feeding session
milk insufficiency, weight gain
During this final session, all women reported exclusively breastfeeding. The Lactation Specialist assessed the health of women and their infants. When following up on participants with significant concerns the Lactation Specialist found the participant who had been primarily expressing milk and feeding her baby with a cup was now breastfeeding well. Her baby had gained more weight than expected, and she reported she had stopped giving top-ups at about eight weeks postpartum. The infant who was referred for early HIV testing at the 4-week visit had been diagnosed with HIV sometime after six weeks and promptly started on ART. The infant was now breastfeeding well and had gained weight since the last visit. The infant’s mother had also been found to have a very high viral load and was receiving additional support and counseling for her own adherence to ART. Finally, the baby of the mother with excess foremilk had gained weight as expected since the 6-week visit.For a few women, worries around milk insufficiency persisted. These worries stemmed from babies being fussier and feeding more than usual. However, based on her assessment, satisfactory weight gain and the reported number of wet diapers, the Lactation Specialist was able to reassure women that their babies were adequately nourished. She reminded women that these were classic signs of a growth spurt, and that increased feeding was their baby’s way of stimulating an increase in milk supply.At this 12-week visit, just a few women continued to worry about the possibility of transmitting HIV to their babies, but more than half had new or continued questions or concerns about their personal health or their baby’s general health. Several women had questions or concerns about when and how to access family planning.Due to stockouts of reagents used for HIV testing, most women had their infant’s first HIV test (normally completed at six weeks postpartum) drawn at this time. This delay in infant testing underscores the importance of the referral made by the Lactation Specialist for early infant testing.After addressing women’s concerns, the LS shared information to prepare women for complementary feeding (to be initiated after 6 months postpartum—refer to Table The session concluded with a demonstration of how to prepare the baby’s first foods, and many women were surprised by how thick the food should be and how little their babies would initially be consuming. Afterwards, a copy of the visual tool reminding women of the information discussed was given to women to take home.