Session 2

1. Identify communication skills of listening and learning, and building confidence

2. Practice the use of these skills with a worksheet

Every one of us is not the same as each other. We are not even the same as people who are biologically close to is, our parents, our siblings for example.

In the same way our clients are not the same as each other even if the speak the same language or live in the same neighborhood.

Social context is an important part of understanding a mother as an individual. When we attempt to get to know the mother in her social context we improve our chances of communicating with her in a way that is helpful and raises her level of confidence. This is patient centered

care.

Communication that is biomedically driven does not get assimilated

Communication that is patient-centered enhances learning and relation building(Taveras et al. 2004)

Personal perspectives of the health care professional can influence work with new mothers. This includes personal past experience, beliefs and attitudes.

Traditional medical-cultural perspectives on breastfeeding are enmeshed in professionals’ interactions with mothers.

Sociocultural diversity influences childbirth experiences

Diverse family models: single mothers, lesbian couples, etc.

Effects of domestic violence on health care in pregnancy and childbearing

Health care providers need to acknowledge the magnitude of this problem and assess each new mother for the risk of abuse to her and her new infant.

Explore the range of mother’s emotions associated with this pregnancy

Assess mother’s coping skills and resources: what skills and resources does she have to cope with stress?

New mother health concerns beyond baby: relationship, lack of control, returning to work, contraception/family planning, etc.

Ask open-ended questions to assess this mother’s unique experience

Closed question suggests ‘correct answer’ and the mother may give it whether true or not

Affirm the new mother’s experiences and concerns through use of eye contact, focused attention, and acknowledgment of her statements

Collaborate with the new mother/family system on a plan of health care

Assess mother’s strengths, needs and resources Work with mother to prioritize and set goals that the

health care team can help her achieve Formulate strategies to help her reach her goals Educate her significant others regarding needs and

affirm strengths Provide resources Commit to a follow-up plan for mother/infant care

Listening and learning Skills to build confidence and give support Arranging follow-up and support suitable to

the mother’s situation

Involves listening and building confidence, and not just giving information,

Respect the women’s own thoughts, beliefs, and culture. offer appropriate information to address her questions

Assess for other needs (problem evaluation, reassurance, etc.)

Sit at the same level and close to the motherRemove any physical barriers such as a desk or

folders of papers in your armsPay attention to the mother, avoid getting

distracted, and show you are listening.Take time without hurrying or looking at your

watch.Only touch her in an appropriate way (such as a

hand on her arm).

Ask open-ended questions Show interest and reflect back Empathize Clarify judging words

Health worker: Good morning. Are you and your baby well today?

Mother: Yes, we are well. HW: Do you have any difficulties? M: No HW: Is baby feeding often? M: Yes

HW: Good morning. How are you and your baby today?

M: We are well. HW: Tell me, how are you feeding your baby? M: I breastfeed her often with one bottle in the

evening. HW: What made you decide to give a bottle in

the evening? M: My baby wakes during the night, so my milk

must not be enough for her/him.

Show interest in what the mother is saying by using responses such as “Um Hmm”, or “Go on…”.

Repeat or reflect back what the mother is saying. This shows that you are listening.

It is helpful to mix reflecting back with other responses, for example, “Oh, really, go on,” or ask an open question

HW: Good morning, how are you both today?

M: I am very tired; the baby was awake a lot.

HW: Oh, dear (looks concerned) M: My sister says he shouldn’t be still waking at night, that I’m

spoiling him. HW: Your sister says you are spoiling him? M: Yes, my sister is always making some comment about how I care

for him. HW: Mmm. (Nods) M: I don’t see why it is any of her business how I care for my baby. HW: Oh, tell me more.

Empathy shows that you are hearing what the mother is saying and trying to understand how she feels. You are looking at the situation from her point of view.

Sympathy is different. When you sympathise with a person, you are looking at it from your point of view.

It is helpful to empathise with the mother’s good feelings too, not just her bad feelings.

HW: Good morning Rania. How are you and your baby today?

M: Joseph is not feeding well for the last few days. I don’t know what to do.

HW: I understand how you feel. When my child doesn’t feed I get worried too. I know exactly how you feel.

M: What do you do when your child doesn’t feed?

HW: Good morning Rania. How are you and Joseph today?

M: He is not feeding well for the last few days and I don’t know what to do.

HW: You are worried about your baby? M: Yes, I am worried he might be sick if he is

not feeding well.

Words that may sound like you are judging include: right, wrong, well, bad, good, enough, properly, adequate, problem. Words like this can make a woman feel that she has a standard to reach or that her baby is not behaving normally.

HW: Good morning. Did your baby gain enough weight since she was last weighed?

M: Well, I am not sure. I think so. HW: Well, does she feed properly? Is your

milk good? M: I don’t know… I hope so, but I am not sure

(looks worried)

HW: Good morning. How is your baby growing this month? Can I see her growth chart?

M: The nurse said she has gained half a kilo this month, so I am pleased.

HW: She is obviously getting the breastmilk she needs.

Accept what a mother thinks and feels Recognise and acknowledge what a mother

and baby are doing right Give practical help Give a little relevant information using suitable

language Make suggestions, not commands

M: I give my baby a bottle of formula every evening because I don’t have enough milk for her.

HW: I am sure your milk is enough. Your baby does not need a bottle of formula.

M: I give my baby a bottle of formula every evening because I don’t have enough milk for her.

HW: Yes, a bottle feed in the evening seems to settle some babies.

Agreeing with a mistaken idea may not help the mother and baby

M: I give my baby a bottle of formula every evening because I don’t have enough milk for her.

HW: I see. You think you may not have enough milk in the evening.

HW: Good morning. What can I do for you today? M: I'm not sure if I should breastfeed my baby or not when he is

born. I'm worried the baby might get HIV. HW: If you have HIV there is a risk this could be passed to your

baby. Have you had a test for HIV? M: No. I don’t know where to get the test. HW: It is best to know if you have HIV or not before you decide

how to feed your baby. I can give you the details of who to talk to about getting a test. Would you like that?

M: Yes, I would like to hear more about the test.

HW gives relavant information in a language the mother can understand and makes suggestions not commands

Learn what help may be available from her family and friends or how she plans to get more help

Be sure that she knows what on-going help is available from the maternity care facility

Encourage her to see you or another person for help if she has doubts or questions

Refer her to a community support group Refer her for more specialized counseling if needed Support her role in making the best decision for herself

and her baby