OG17.2 | Breastfeeding Counselling — Summary & Reflection

KEY TAKEAWAYS

Breastfeeding counselling is a structured clinical skill built on anatomical and physiological principles:

• Who and when: All mothers; high-priority groups include primiparae, flat/inverted nipples, preterm infants, post-caesarean; counselling starts antenatally and continues through the first weeks.
• Anatomy: The infant must take a deep asymmetric latch engaging the nipple-areola complex — tongue peristalsis extracts milk, not suction alone.
• Four positions: Cradle (routine); cross-cradle (newborns, learning latch); football (post-caesarean, large breasts, twins); side-lying (night feeds, perineal pain).
• Correct latch: Wide gape → chin-first approach → asymmetric latch → rounded cheeks + audible swallowing. Poor latch signs: dimpled cheeks, clicking, nipple-only feeding, pain throughout.
• Breast care: Hind-milk application + air-drying for sore nipples; frequent feeding + warm compress before + cold after for engorgement; hand expression → cup-feeding preferred over bottle.
• LATCH tool (0–10): Scores <8 identify need for targeted support; five domains (Latch, Audible swallowing, Type of nipple, Comfort, Hold).
• Counselling framework: Rapport → assess → identify problem → demonstrate technique → address misconceptions specifically (colostrum, thin milk, insufficient milk) → involve family → follow-up plan.
• When to refer: Persistent LATCH <8, suspected tongue-tie, inverted nipples grade II/III, nipple candidiasis, neonatal weight concerns.

REFLECT

Think about the communication challenges you anticipate in counselling a mother whose family is strongly opposed to breastfeeding. What specific misconceptions would you need to address? How would you balance the mother's autonomy with the evidence in favour of breastfeeding? Consider also the physical skill component — the latch correction and positioning demonstration. What would you need to practise before your OSCE to feel confident? Reflect on how technical skill and communication skill are inseparable in this competency.