Nutrition Counselling via Telephone

Hello Mirza Faris,

Can you please share your email address? I will then try to connect you with a friend who is using Skype for video consultations during this pandemic. Personally I feel there are several limitations of telphone counselling - especially if one cannot observe the mother and baby during breastfeeding.

All the best!

Hi Faris,

I have provided telephone counselling with the Australian Breastfeeding Association for a decade. Because you are not with the mother/caregiver in person when telephone counselling it makes the use of counselling skills, including empathy more important which means that the training of counsellors is very important. If counsellors are skilled, a natural form of assessment is possible. I would expect that any conversation would start with asking the mother what her concerns are and that the conversation would flow from there in asessing how well or poorly things are going for the infant. Once rapport with the mother is established through communication of empathy, mothers and caregivers feel comfortable answering any questions that the counsellor might have.  Many questions may be answered naturalistically as the mother talks about her concerns. The emotional needs of the mother are really important and if these are well supported, there is a much better outcome as the woman trusts the counsellor and is willing to answer questions/ provide information. Starting a conversation with a list of questions to assess the situation may not work well in terms of the mother being willing to engage with the call nor with getting good quality information. 

It is more challenging to assess positioning and attachment wihtout being able to see the infant, but it can be done. It relies on assisting the mother to describe what is happening. It can actually be quite empowering for mothers to be able to identify what is happening for them through a conversation. You need to ask about things like pain, what the nipple looks like after the baby comes off the breast, how much of the nipple and breast is in the infant's mouth and the position of the body of the baby (is the baby tummy to mummy). Information about output (wees and poos) also provides indications about how well the baby is feeding and therefore about attachment. If the baby is breastfeeding during the feed, it's possible to ask the woman questions and make adjustments so for example, if she says she has pain on feeding and the baby is not in the tummy-to-mummy position, we can ask her if she would like to try bringing her baby closer into her body and then asking her if it is less painful- if it is then that's an indication that that change in position has improved things. 

The Australian Breastfeeding Association has seen an increase in demand for telephone counselling with COVID-19 as mothers have been unable or unwilling to seek face-to-face medical care. I have a paper about this that should be available next week. Mothers have been in need of more reassurance than usual. ABA has released some resources for health professionals on assessing feeding without the ability to weigh that may be helpful https://abaprofessional.asn.au/assessing-newborn-intake-in-the-context-of-covid-19/

 It is possible to provide support that assists with issues considered quite complex. I assisted a woman who was a refugee held in a camp on Nauru to successfully relactate over the phone. I think it's an under utilised form of providing support in humanitarian settings. I think that a potential positive of using telephone counselling is that it may be possible to have more highly skilled counsellors and that this can compensate for not being able to be there in person.

I hope this is helpful. 

Karleen Gribble

Hi Faris,

I have supported over 2000 breastfeeding mothers with telephone breastfeeding counselling via the Australian Breastfeeding Association's National Breastfeeding Helpline. As Karleen has pointed out, adequate training for peer support counsellors is important. The Australian Breastfeeding Association counsellors receive extensive training before taking calls on the breastfeeding helpline. One of the most important aspects of their training is learing various counselling skills such as empathy, active listening and unconditional positive regard. These skills help develop rapport with the mothers the counsellors support and help make them feel comfortable to be able to opening share their concerns with the counsellor and can be followed up with open questions. 

While assessing positioning and attachment (P&A) is more challenging when undertaken over the phone, there are still important aspects which can be discussed and can be helpful to improve it. Before going into questions about P&A it's likely the counsellor would have already established what concerns the mother has and determined if tips to improve P&A are likely to be beneficial. If so, then the counsellor might ask the mother to describe various factors such as: How is she bringing her baby to the breast (eg is the mother moving her breast to the baby or the other way around? Is more of a baby-led or mother-led approach being used)? Is the mother allowing her breast to rest naturally where it falls when bringing her baby to her breast? Where are her baby's arms placed when attached (are they getting in between the mother's and baby's bodies meaning the baby cannot be attached as deeply)? What position is the mother in when she brings her baby to her breast (upright, reclined back, leaning forward?)? What does breastfeeding feel like (and follow-up questions about any pain she may be experiencing)? Is there any clothing getting in between the mother and her baby resulting in her baby not being attached as deeply (eg bunched up bra)? Is her baby in so close that her baby's cheeks are touching her breast? Is her baby's chin in touching her breast? Is her baby's whole body aligned and not twisted? What does her nipple look like when her baby comes off the breast? Also as Karleen indicated, it can be empowering for mothers to work out how they can improve P&A with the counsellor's guidance.

In addition to talking about P&A, it is common for counsellors to ask questions about what mothers see in their baby's nappies as this provides some information about the adequacy of a baby's intake.

Most of the calls I've taken on the breastfeeding helpline have been about providing mothers with reassurance that they're doing everything "right" and so a counsellor's knowledge about what's normal is very important and this is something which their ABA training prepares them very well for.

Hope this helps.

Renee Kam
 

Hi Faris,

You are wecome. Please consider collecting information about the implementation of this project and asessing how well it is working. Such information will be valuable for your organisation and (if it make it into a report) for others.

Kind Regards

Karleen