Techniques
Psychology: Confidence, Mood and the Mind
Confidence, mood and the mind
Breastfeeding self-efficacy - a mother's belief she can breastfeed - is the most consistently modifiable predictor of duration and exclusivity. Bandura's four sources apply directly: mastery experience (a good feed), vicarious experience (seeing someone like her succeed), verbal persuasion (specific encouragement, not flattery), and physiologic state (pain and exhaustion erode confidence).
Perinatal mood and anxiety disorders are common: roughly 1 in 7 women experience postpartum depression. Screen with a validated tool such as the EPDS and know your referral pathway; anxiety, birth trauma, obsessive intrusive thoughts, and grief after loss all affect feeding. Depression does not require stopping breastfeeding, and many antidepressants are compatible.
Use motivational interviewing and the stages of change: a mother in precontemplation does not need a lecture. Reflective listening, open questions and affirmation reduce defensiveness. Trauma-informed care means asking permission before touching a breast and explaining each step.
Traps: labelling a normal cluster-feeding evening as "low supply" driven by anxiety, or assuming a feeding problem explains a mother's distress when the reverse may be true. Ask about feelings, sleep and support, not just volumes.
Rule of thumb: name the feeling before giving the plan - "That sounds exhausting and frightening" comes before the latch check.
Clinical Skills: Assessment and Follow-Up
Assessment and follow-up
Start with history: pregnancy and birth, blood loss, medicines, prior breast surgery, diabetes and thyroid disease; then the infant's gestational age, birth weight, feeding frequency and duration, diapers, stools, supplements and any jaundice.
Examine both: breasts for fullness, nipple shape and trauma, redness; the infant for tone, hydration, alertness, oral anatomy (tongue mobility, palate, frenulum) and suck. Observe at least one whole feed - this is the highest-yield skill you have.
Weight is the core objective measure. Expect up to 7–10% loss by day 3–5, regain to birth weight by about day 10–14, then roughly 20–30 g/day. A single weight is far less informative than a trend plotted on WHO growth standards, which are the correct reference for breastfed infants.
Output: wet diapers and stools increase over the first week; by day 5–6 expect at least six wet diapers and frequent stools; stool colour transitions from meconium to yellow.
Test weighing (before and after a feed) needs a calibrated scale and is only an estimate of intake.
Document findings, the plan, and the follow-up interval; refer for poor weight gain, jaundice, suspected tongue-tie with feeding difficulty, maternal mental health concerns, or a breast mass.
Rule of thumb: weight loss over 10%, or any loss still present at day 10, triggers a full feeding assessment, not reassurance.