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Welcome Back! Crossword Puzzle (Review of Session 3) Review answers as a large group See “Crossword Puzzle Key” (Handout #5) Preview of Session 4 Silently read the topics for Session 4 What are you most interested in learning about? Helping Mothers with Special Challenges

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Welcome back l.jpg

Welcome Back!

  • Crossword Puzzle (Review of Session 3)

    • Review answers as a large group

    • See “Crossword Puzzle Key” (Handout #5)

  • Preview of Session 4

    • Silently read the topics for Session 4

    • What are you most interested in learning about?


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Helping Mothers with Special Challenges


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Breastfeeding Challenges

  • Twins

  • Premature baby

  • Premature twins

  • Sick baby

  • Baby with other medical problems

  • Sick mother / diabetes


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How to Help

  • Listen – let her talk about her feelings

  • Refer to a lactation specialist if they…

    • Have trouble breastfeeding

    • Are told to stop breastfeeding

  • Ask health care provider ways to treat problem

  • Your support can make a difference!


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Discussion: Twins

  • Did any of you breastfeed twins or

    know a mother who has breastfed

    twins?


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Twins

  • Most women make PLENTY of milk for twins

  • Nature made it possible to feed 2 babies

  • Breastfeeding can be easier and take less

    time than preparing bottles and formula for

    two babies


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Suggestions

  • Start by feeding one baby at a time

  • Comfortable - try feeding babies same time

  • Baby with strongest suck start on different

    breast each time

    • Milk removed from both breasts

    • Reduces engorgement

    • Helps maintain good milk supply


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More Suggestions

  • Let babies sleep in same crib

  • Get help shopping, cooking, cleaning, etc.

  • Keep snacks nearby

  • Rest when possible

  • Join a twin or multiple support group


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Discussion: Twins

  • What positions do you think would be

    helpful for a mother breastfeeding two

    babies at the same time?

  • Compare your list to page 96


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Activity: Twins

  • Activity

    • Find a partner

    • Practice teaching breastfeeding babies

      at same time

    • Use dolls/stuffed animals

    • Take turns being mother and peer

      counselor


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Discussion: Premature Babies

  • Has anyone had or known someone who

    has had a premature baby?

  • What was it like for the mother?

  • What helped her?

  • What would have been helpful?


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Premature Babies

  • 37 weeks or earlier

  • May be tiny and weak or healthy

  • Some cannot breastfeed in beginning

  • May need to pump until baby can breastfeed

  • Mother of premature baby makes special milk that meets baby’s needs


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Doctors Recommend Breastmilk

  • Often prescribe breastmilk - premature babies

    • Some add extra calories, vitamins and minerals

    • Premature babies fed breastmilk:

      • Higher IQ - helps brain develop

      • Sick less often

      • Protects against necrotizing enterocolitis


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How to Help

  • Let the mother know:

    • Giving breastmilk – something only she can do

    • Breastfeeding gets easier as baby grows

    • Focus on breastfeeding/pumping - caring for baby

  • Help her get a breast pump from WIC

  • Instructions - pumping/storing/labeling breastmilk

  • Provide extra help and support

  • Be a good listener!


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Discussion: Sick Baby

  • Who has known a breastfeeding mother

    whose baby was sick or in the hospital?

  • How did breastfeeding go?

  • What happened?

  • What could you have done to help?


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Babies Who are Sick

  • Most get better faster with breastmilk

  • Breastfeed to prevent dehydration

  • Breastfeed more for comfort

  • Some only want to breastfeed when sick

  • Some too weak to breastfeed or do not want to

    • Talk about pumping to keep up milk supply

    • REFER her to baby’s health care

      provider or a lactation specialist


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Babies in the Hospital

  • Encourage mother spend time with baby

  • Breastfeed soon after any test or surgery

  • Talk with health care provider

  • If the baby can’t breastfeed…

    • Pump as often as she would breastfeed

    • Help get pump from WIC


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Mothers with Diabetes

  • Hard time controlling sugar in blood

  • Eat right, exercise and take medications

  • Can get heart disease, kidney disease or

    become blind


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Mothers with Diabetes

  • CAN breastfeed

  • Breastfeeding:

    • Improves the mother’s health

    • May reduce how much medication needed

    • May protect baby from getting diabetes later

  • Most medications are OK with breastfeeding

  • Suggest she talk to health care provider

    BEFORE baby is born


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Discussion

  • Divide into small groups - answer these:

    • If you were sick (colds, flu, etc.) while you

      were breastfeeding, what did you do?

    • What did others tell you to do?

    • How could you help a mother who is sick keep

      breastfeeding?

    • Share with the group


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Mothers with Minor Illnesses

  • Most of the time - can continue breastfeeding

  • Colds and flu do not pass through breastmilk

  • By the time mother knows - baby already exposed

  • Mothers give antibodies to their babies

    • May keep the baby from getting sick

    • Baby will get better faster

  • Everyone should wash their hands

    before touching baby!


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Mothersin the Hospital

  • Talk to her about:

    • Can baby stay with her in the hospital?

    • Hospital let someone bring baby to breastfeed?

    • Will hospital let her use their electric pump?

    • If she can’t pump on her own, can someone help?

    • Where can she store milk in the hospital?

    • Can she pump & store breastmilk before

      going to hospital?


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Mothers Who are Sick

  • Mother told not to breastfeed due to illness or

    treatment, talk to her about…

    • Pump & throw away breastmilk - keep up supply

    • Has she talked to a lactation specialist? Different

      medication that will work with breastfeeding.

    • Get breastmilk from the human milk bank


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Activity

  • What questions do you have about helping a mother who is sick or in the hospital continue to breastfeed?


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Tuberculosis (TB)

  • Lung disease treated with medication

  • Close contact with person with active TB

  • A mother with active TB can breastfeed after:

    • Taking medication for 2 weeks, and

    • Health care provider tells her it’s OK

  • Questions? REFER her to health care provider or a lactation specialist


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Hepatitis

  • Liver infection

    • Hepatitis A

      • CAN breastfeed - protects the baby

    • Hepatitis B

      • Babies now get vaccines

      • CAN breastfeed

    • Hepatitis C

      • CAN breastfeed - if doesn’t have HIV


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Sexually Transmitted Infections (STI)

  • Most mothers can breastfeed

  • Most medications are safe

  • Herpes or syphilis - can breastfeed

    (unless has open sores on her breasts)

  • Can pump on that side until healed

    • Any part of pump kit touches sore - throw out milk

  • Refer to lactation specialist or health care provider - if open sore on breast


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Should NOT Breastfeed

  • HIV - (Formula is a safe alternative)

  • Human T-Cell Leukemia Virus

  • Chemotherapy


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Activity

  • Divide into groups of 3

  • Complete item G on page 102

    • Make sure each person is the “counselor”, “mother” and “observer”

    • After each role-play, discuss questions on page 103 within your group of 3

  • Share how your “counseling” went with the large group


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Helping a Grieving Mother


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Helping with Grief

  • Difficult challenge

  • Mothers experience…

    • Extreme sadness

    • Some will not want to talk

    • Others want to talk / need a shoulder to cry on

    • Some will be angry / depressed

    • Others will be in denial

    • Some need more time to adjust

  • No right or wrong way to grieve


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How to Help

  • Be a good listener & understanding

  • Let the mother talk about her feelings

  • Remember her grief is her own

  • Listening & being supportive - BEST way to help

  • When appropriate, recommend a support group

  • Let lactation specialist know if mother

    needs help with breastfeeding/weaning


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Activity: Grieving Mother

  • In small groups…

    • Make a list of reasons a pregnant woman or someone who has recently given birth may be experiencing grief. (Compare to list on page 106)

    • Discuss how your family & friends helped you cope with a loss…

      • How did they make the situation a little easier?

      • What would you avoid saying?

  • Share with the large group


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Expressing Milk


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Expressing Milk

  • Helps mother to start making milk

  • Helps keep her milk supply up

  • Mothers express breastmilk when:

    • Babies cannot breastfeed

    • They are away from their babies


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Ways to Express Milk

  • Hand expression

  • Manual pumps

  • Battery operated pumps

  • Semi-automatic pumps

  • Personal use electric pumps

  • Hospital grade electric pumps

  • Lactation specialist can help choose best pump (for situation)


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    Discussion

    • In small groups, share your experience

      with expressing milk

      • How did you express milk?

      • What was your reason for expressing milk?

      • How did it work out?


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    Expressing Milk By Hand

    • Easy way for some mothers to express milk

    • Some like this method better than using a pump

    • Facilitator will demonstrate one method of hand

      expression (using a breast model)

    • See steps on page 108

    • Optional activity – practice hand expression using a water balloon


    Pumps l.jpg

    Pumps


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    Manual Pumps

    • Not expensive

    • Used by mothers who will not be pumping very often

    • 3 types of manual pumps:

      • Cylinder pumps

        (e.g. Medela manual pump)

      • Trigger pumps

      • Rubber bulb pumps

        (bicycle horn)


    Battery operated pumps l.jpg

    Battery Operated Pumps

    • Suction controlled

    • Mothers who only pump a few times per week

    • Batteries need to be changed often

    • Used pumps may not work well

  • Mothers should NEVER share a manual orbattery operated pump with other mothers!


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    Electric Pumps

    • For mothers who need to express milk many times during the day

    • Pump both breasts at same time

    • 3 types of pumps

      • Semiautomatic

      • Personal Use

      • Hospital Grade


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    Putting Together Pump Kit

    • Watch facilitator put together a pump kit & connect it to an electric pump

    • Divide into groups

      • Practice putting pump kit together


    Helpful tips for pumping l.jpg

    Helpful Tips for Pumping

    • Let mother know…

      • Normal for one breast to give more milk

      • Normal for milk to change color

      • Continue pumping after 1st Milk Ejection Reflex

        • Milk flow will slow or stop

        • Another MER will occur - more milk will flow


    Handle store breastmilk l.jpg

    Handle & Store Breastmilk


    Activity47 l.jpg

    Activity

    • Find and review Handout #6

      “Collecting and Storing Breastmilk When

      You’re Away”

      • How would handout help a mother returning

        to work/school?

    • Share in the large group

    • What questions do you have about handling, storing and using breastmilk?


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    Weaning


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    Weaning

    • Baby fed anything other than breastmilk

    • Most of us think of weaning - stop breastfeeding

    • In the U.S. – often begins in the hospital

    • Once mothers start giving formula - breastfeed

      less & stop sooner


    Weaning50 l.jpg

    Weaning

    • Around world most mothers breastfeed - 3 yrs. old

    • In the U.S. – most mothers wean by 4 months

    • If mother decides to wean before 1st birthday

      Give formula - NOT cow’s milk!

    • Some babies wean themselves


    Weaning51 l.jpg

    Weaning

    • Wean slowly

    • If stop suddenly…

      • Baby loses favorite way to be comforted

      • Mother’s breasts may become engorged

    • Can be an emotional time for mother

      • Some feel sad

      • Others feel satisfied - ready to stop


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    Weaning

    • Examine your own beliefs about weaning so you can help each mother decide what is best for herself, her baby and her family


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    Activity

    • Find a partner and share:

      • How old was your baby when you or your baby

        started the weaning process?

      • What were the reasons for weaning your baby?

      • How did your baby react to breastfeeding less often or being weaned?

      • How did you feel about weaning?


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    Cultural Awareness

    • Take a closer look at different ethnic groups

      and see how we are alike and different

    • Information is not meant to “stereotype”

    • Meant to help you be able to help many

      mothers breastfeed


    Activity cultural awareness l.jpg

    Activity: Cultural Awareness

    • Which ethnic group do you identify with most

    • Find others that share your ethnicity - form group

      • Make a list of answers to 5 questions on pg. 113 (use flip chart)

    • Share list with the larger group


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    Closing Activity & Homework


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    Closing Activity

    • Sunshine Wheels

      • Complete this activity (item A on page 114)

    • Revisit our “Learning Tree”

      • What topics were covered today that you wanted to learn more about?


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    Homework

    • Practice the 3-Step Strategy

      • Ask questions

      • Affirm feelings

      • Educate (when appropriate)

    • More you practice - Easier it will become!


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