Breastfeeding counselling for mothers attending primary health services in Mexico

The intervention consisted of providing breastfeeding interpersonal counseling (IC), which focused on solving the main breastfeeding obstacle identified by the mother. The information provided included brochures and posters explained by a nurse to the mother before the infant was immunized. There were 5 brochures for obstacles with more practical information - Pain: How to get a good latch, when do you need to ask for professional support - Perception of insufficient milk (PIM): How do you know you are producing enough milk for your baby - Infant dissatisfaction: Understand 3 normal infant behaviors: Crying and hunger-satiety cues, sleep, breastfeeding on demand (No schedule setting) - Family support: How Dad/Grandparents can support a breastfeeding mother - Work: Rights and regulations, milk expression For the other 5 obstacles with a more psychological-social content we used posters with a main message and a picture with a “real breastfeeding mom” from Tijuana. These images were taken with permission from a local campaign and were pre-tested. All the educational material was based on a previous formative research conducted in a similar population in Tijuana, Mexico. Five nurses were trained for interpersonal counseling. First, a 4-hour session was held, in which 2 medical interns provided general background on breastfeeding, as well as information about the 10 main obstacles to breastfeeding identified from previous formative research. A second 4-hour session was held guided by a community promoter focused on the WHO breastfeeding counseling training course. The focus of this session was to develop communication skills for “Listening and Learning” (open questions, empathize, avoid judging words) and “Building Confidence and Give Support” (accept what a mother thinks and feels, recognize and praise what she is doing right; give small bits of relevant information; use simple language; make suggestions, not commands). To evaluate nurses´ counseling performance, supervised practice sessions were conducted with mothers from the target population, until consistency between trainees was determined. Due to the workload of the health center, only 3 nurses completed the training, and only 1 was able to participate in the intervention. Mothers with infants requesting immunization services at a Primary health care center, were approached in the waiting room of the health center and given the necessary information about the study. If mothers showed interest in participating, informed consent was presented to be read and signed. Subsequently, a questionnaire was applied to obtain sociodemographic data, as well as instruments to assess attitudes, self-efficacy and breastfeeding practices. The following step was to identify their main obstacle to breastfeeding from a list with the 10 obstacles established in previous formative research. Two additional options were available: adding another obstacle or expressing not having a breastfeeding problem. Participants assigned to the intervention group received one session of breastfeeding face to face IC by the trained nurse lasting between 5 and 10 min. Participants assigned to the control group received counseling on immunizations. Both groups were scheduled for their next vaccination dose for 2 months afterward. Follow-up data were obtained by the medical interns at the subsequent visit service. If participants did not attend the 2 month follow-up, they were contacted by telephone to assess attitudes, self-efficacy, and breastfeeding practices. To assess and monitor adherence to the intervention the nurse registered information about breastfeeding IC completion and duration. The nurse was under supervision of the medical interns along all intervention. Medical interns reported to principal investigator every week and any time a special case or question was encountered.