Training of Roma Health Mediators in Reproductive Health

1. Demonstrate how to help a mother who is sitting
Ask the participant who is helping you to sit on the chair or bed that you have arranged.
[Note: She should hold the doll across her body in a common, but poor, position: loosely,
supporting only his head, with his body away from hers, so that she has to lean forward to
get her breast into his mouth]
Follow these steps:
• Greet the `mother' (by her name) and ask her baby's name. Ask her how she is and
ask one or two open questions about how breastfeeding is going. She replies that
breastfeeding is painful.
• Ask her if you may see how (baby's name) breastfeeds, and ask her to put him to
her breast as she usually does. Observe her breastfeeding for a few minutes.
• Explain what might help and ask if she would like you to show her. Say
something encouraging, like: "He really wants your breast milk, doesn't he?"
Then say: "Breastfeeding might be less painful if (baby's name) took more of your
breast in his mouth when he suckles. Would you like me to show you how?" If
she agrees, you can start to help her.
• Make sure that the `mother' is sitting in a comfortable, relaxed position.
o A low seat is usually best, if possible one that supports the mother's back. If
the seat is rather high, find a stool for her to put her feet on. Be careful not to
make her knees so high that her baby is too high for her breast. If she is sitting
in bed, pillows may help (if appropriate in the community).
o If she is sitting on the floor, make sure that her back is supported. If she
supports her baby on her knee, help her to hold the baby high enough so that
she does not lean forward to put him onto her breast.
• Sit down yourself, so that you also are comfortable and relaxed, in a convenient
position to help. You cannot help a mother satisfactorily if you are in an
uncomfortable position yourself.
• Explain to the ‘mother’ how to hold her baby. Show her what to do if necessary.
• Make sure that you make these four key points clear:
1. The baby's head and body should be in a straight line (a baby cannot suckle or
swallow easily if his neck is twisted or bent).
2. His face should face the breast, with his nose opposite the nipple (The baby's
whole body should almost face his mother's body. He should be turned away
just enough to be able to look at her face. This is the best position for him to
take the breast, because most nipples point slightly downward).
3. The mother should hold the baby’s body close to hers.
4. The mother is looking at the baby while breastfeeding him. If her baby is
newborn, she should support his bottom, and not just his head and shoulders.
• Show the mother how to support her breast with her hand and to offer it to her
baby:
o She should rest her fingers on her chest wall under her breast, so that her first
finger forms a support at the base of the breast.
o She can use her thumb to press the top of her breast slightly. This can improve
the shape of the breast so that it is easier for her baby to attach well. She
should not hold her breast too near to the nipple.
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RFHI/JSI Romania Training of RHMs in Reproductive Health Session 9: Breastfeeding