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