Day 3 activities started at 8.47am with an opening prayer led by Dr. Oluwayemi. The first session was the continuation of module 4 on breastfeeding titled: How breastfeeding works. It was facilitated by Dr. Oluwayemi Isaac and Mrs. Awe Omotola, with Dr. Adejuwon as the supervising facilitator. The learning objectives were:

  1. To be able to name the main parts of the breast and describe their functions.
  2. To be able to describe the hormonal control of production and ejection of breast milk.
  3. To be able to describe the difference between good and poor attachment of a baby at the breast.
  4. To be able to describe the difference between effective and ineffective suckling.

The key point centred on the four signs of good attachments which are: the baby’s mouth should be wide open; the mother should see more of the darker skin (areola) above the baby’s mouth than below; the baby’s lower lip should be turned outwards, and; the baby’s chin should be touching the mother’s breast. It was noted that more prolactin is produced at night, so breastfeeding at night is especially helpful for keeping up the milk supply. The session ended at 10.45am.  Questions, answers and observations were then taken.

The second presentation for the day was taken by Dr. Babatola Adefunke and Mrs. Ayodeji Precious, with Mrs. Eunice Kodak as the supervising facilitator. The topic was assessing breastfeeding. Learning objectives were:

  1. To be able to assess breastfeeding by observing a mother breastfeeding her baby.
  2. To identify a mother who may need help.
  3. To recognize signs of good and poor attachment and positioning.
  4. Explain the contents and arrangement of the job aid: Breastfeeding observation.
  5. The usefulness of breastfeeding observation form was discussed helping to know and identify signs of possible difficulties with breastfeeding.

Signs of effective suckling are that the baby should take slow, deep suckles, sometimes pausing, while the mother should  be able to see or hear your baby swallowing after one or two suckles. Suckling should also comfortable and pain-free for the mother, and the breast should be softer after the feed. Also, when the baby finishes the feed, he should release the breast, and look contended and relaxed.

The next presentation started at 11.06am titled: Positioning a baby at the breast. It was facilitated by Mrs. Fayemi Moradeke and Dr. Adeline Adaje, with Dr. Adeniyi was the supervising facilitator. The learning objectives were:

  1. To be able to explain the four key signs of good positioning
  2. To be able to describe how a mother should support her breast for feeding
  3. To demonstrate the main positions- sitting, lying, underarm and across.
  4. To help a mother to position her baby at the breast, using ‘the four key signs of good positioning’ in different positions. The signs of good positioning include: the baby’s head and body should be in line; the baby should be held close to mother’s body; the baby’s whole body should be supported; the baby should approach the breast, with nose to nipple. The different ways to position a baby for breastfeeding are: the cradle position (the most commonly used), the cross-cradle position (good for small babies), the side-lying position (used to rest while breastfeeding and at night), the under-arm position (used after caesarean  section, if the nipples are painful, or if the mother is breastfeeding twins or a small baby).
  5. Good positioning for breastfeeding helps the mother to successfully breastfeed.
  6. The signs of good positioning and attachment are useful for assessing the situation with the mother.
  7. A mother/baby pair who need assistance should be offered  Skilled  assistance to successfully breastfeed.

The session ended at 12:00 noon followed by teabreak.

The training reconvened at 12.45pm, and the topic ‘Taking a feeding history (0-6 months)’ was facilitated by Dr. Ajibola Ayotunde and Dr. Ajayi Kayode, with Mr. Femi Ayeni as the supervising facilitator. Learning objectives for the session included:

  1. To be able to take a feeding history of an infant aged 0 up to 6 months.
  2. To demonstrate appropriate use of the job aid: feeding history – 0 up to 6 months.

Children with feeding difficulties who are not being exclusively breastfed require assistance to adopt the recommended practice.

The 5th presentation for the day started at 1.27pm, and it dealt with common breastfeeding difficulties. It was facilitated by Dr. Kamal Alabi and Mrs. Adebayo Funmilola, and the supervising facilitator was Mrs. Alapo. Funmilola. The learning objective was to be able to identify the causes of, and help mothers with (a) ‘not enough milk’ ( b) ‘a crying baby (c) ‘refusal to breastfeed’. Participants were distributed into three groups who handled each of the three identified breastfeeding difficulties. Reliable signs that a baby is not getting enough milk and reasons were discussed. Crying babies and causes were discussed. Reasons why a child will refuse to breastfeed, and ways to help mothers facing these challenges were also discussed. The  session ended at 2.40 pm.

The sixth presentation commenced at 2.44 pm where the topic ‘Expressing breastmilk’ was taken by  Mrs. Adeleke Kudirat and Dr. Ajimati Adedamola, with Mrs. Akinbinu as the supervising facilitator. Learning objectives were:

  1. To be able to list the situation when expressing breast milk is useful.
  2. To be able to explain how to stimulate the oxytocin reflex.
  3. To be able to rub a mother’s back to stimulate the oxytocin reflex.
  4. To demonstrate how to select and prepare a container for expressing breast milk.
  5. To describe how to store bread milk.
  6. To  be able to explain  to a mother the steps of expressing breast milk by hand.

Demonstration was done on how to stimulate oxytocin reflex by helping a woman to rub her back. Demonstration was also done on expressing breastmilk, and emphasis was laid on teaching the mother to do it herself. The session ended at 3.35pm..

The 7th presentation centred on cup feeding which was a build up on expressing breast milk. It started at 3: 47pm and ended at 4: 20pm. It was facilitated by Mrs. Omolekan Titilayo and Mr. Sule Adedayo, and Dr. Adejuwon was the supervising facilitator. The learning objectives were:

  1. To be able to list the advantages of cup feeding
  2. To be able to be estimate the volume of milk to give to a baby according to weight,
  3. To be able to demonstrate how to cup-feed safely.

Role play was done to demonstrate feeding a baby by cup. It was emphasised that  using a spoon to feed a child is no longer acceptable, while using a feeding bottle is totally discouraged.

The 8th presentation for the day was taken by Dr. Adeoye and Mrs. Ogidiolu Stella, with Dr. Olusa as the supervising facilitator. It centred on breast conditions . It started at 4.25pm and ended at 5.17pm. Learning objective was to be able to recognize and describe how to manage these common breast conditions such as flat, inverted, long and big nipples; engorgement, blocked duct and mastitis; sore nipples and nipple fissure.

Preparation for and using a syringe for treatment of inverted nipples was described. Differences between full breasts and engorged breasts were discussed. Treatment of breast engorgement, blocked ducts, mastitis (also in HIV positive women) , nipple fissure and Candida infection were also discussed. Questions and answers/clarifications about the session were taken after the lunch break and the session  ended at 6.34pm.

This was followed by the 9th presentation which was a clinical practice session about breast conditions. It started at 6.34pm and ended by 6.47pm, and was facilitated by Dr. Oluyinka Aderibigbe and Mrs. Oke Folasade. Mrs Eunice Kodak was the supervising facilitator. Clinical practice on identification,  causes and treatment of some breast conditions were taken.

The 10th and last presentation for the day was taken by Mrs. Opeyemi Funmilayo and Dr. Akinsoto Esther. The supervising facilitator was Mrs. Akinbinu. It started at 6.48pm and ended at 7.25pm. The topic was sustaining breastfeeding. The learning objectives are:

  1. To be able to help mothers to continue breastfeeding for up to 2 years or beyond, and;
  2. To be able to support breastfeeding when they see mothers and babies for other reasons.

The role of health workers in supporting and encouraging women to breastfeed their babies as part of their regular work, and the seven basic contacts that all mothers need were discussed. Role play about how an health worker can use postnatal contact to reinforce breastfeeding was done. Another role play about saying too little and maximising contact by interacting with mothers was also done. It was observed that it takes time to wean a child, and the use of a child growth monitoring card by the mother was discussed. Such times should be used also as an opportunity to talk to her about sustaining breastfeeding. The importance of  breastfeeding support groups  was equally emphasised.