Compromised neonate

In this assignment, I will discuss the practical skill of facilitating a client with positioning and attachment and hand expression in which I have become competent in practicing. Using the clinical placement feedback form, I will be looking at the following aspects; positioning and attachment, communication and history taking. In accordance with the NMC (2002) Code of professional conduct, as in order to maintain confidentiality all names have been changed to protect identities. Aisha is a twenty-five year old, prima-gravida who had been on the postnatal ward for one day. Aisha had requested assistance with breastfeeding as she felt that Jake (baby) wasn’t getting enough milk.
I proceeded to explore Aisha’s feelings on pregnancy, her birthing experience and details of what feeding had been like until now. History taking is the key to patient assessment, it enables the health professionals to deliver a high standard of care. History taking allows for a better understanding of patients’ problems. Care priorities can then be identified and the appropriate interventions used to optimise care, Fawcett (2012).Taking a history can offer a number of clues to help work out the underlying cause of the problem and resolve the solution. Exploring Aisha’s history allowed me to understand what issues if any Aisha was having which was leading to her difficulty in breastfeeding; it also allowed me to provide holistic woman-centred care based on Aisha’s needs. Taking a woman’s history can reduce the need for her to revisit any painful experiences she may have had, when having to transfer care to another health professional they already have the details allowing them to work towards a solution.

In order to obtain a correct and relevant history, it is vital that good interpersonal skills are used to enhance the rapport between the midwife, the woman and her family. Good interpersonal communication skills include, active listening, exploring, prompting, tact and information giving these components are vital to establish a good rapport and obtain information. The use of active listening skills, information giving and open questions allowed me to extract relevant information from Aisha in order for me to assist her in the best way possible. A study by Schmied, et al, 2010, examined the women’s perceptions and experiences of breastfeeding support, both professionally and or peer led, exploring to the components of support that they deemed to be “supportive.” The findings focused on the importance of person-centred communication skills and of relationships in supporting a woman to breastfeed. Therefore to ensure effective relationships between midwives and clients, good communication is vital, in order for midwives to achieve positive outcomes their clients need to feel that they are genuinely cared for; this can be facilitated by the use of a mixture of verbal, non-verbal communication and open questions this allows midwives to show their concern.
Bacon (2012) states: ‘Communication skills are the lifeblood of any interaction whether personal, professional, social or otherwise (Murray et al, 2006). All of us practise skills in communication all the time. Communication is a complex process and involves a number of interacting factors as described by Scully and Dallas (2010). These factors can be physical (e.g. deafness or speech impairment), psychological (e.g. an anxious student), and social (e.g. a new mother at home with her baby). How midwives respond in each situation will require skilled thought. These skills need to be embedded within the midwife in order for her to respond compassionately and flexibly regardless of the circumstances with which she is faced.’ When communicating with a woman you have to be conscious of the language used, ensuring that it is positive regarding the woman’s ability to breastfeed effectively. Walker (2007) found that inadequate, insensitive or apathetic approaches to breastfeeding by health care providers usually result in early cessation of breastfeeding due to maternal frustration. I feel that the use of positive language and encouragement helped make Aisha’s experience a positive one, therefore helping to encourage her to continue to breast feed. Studies have shown that women who receive positive encouragement from health care professionals are more likely to breastfeed then those who receive no encouragement.
Positioning is defined as the relationship between the baby’s body and the mother’s body. Attachment is referred to as the relationship between the baby’s mouth and the mother’s breast. Wallace (2012) as cited in the British Journal of Midwifery showed that, a study undertaken by the Department of Health Breastfeeding Best Start (BBS) randomised, controlled trial has shown there is still confusion surrounding the terminology, Wallace (2012) states, it is important that midwives are aware of the difference so that they are able to give verbal instructions on attachment and position of their baby to women rather than an hands on approach. In a study by Inch and Law et al, 2007. training midwives in a 'hands off' positioning and attachment intervention found ‘the most common reasons cited by women for giving up breastfeeding early can be attributed to ineffective positioning and attachment and are therefore preventable.’ It concluded that there was a large variation in the breastfeeding knowledge between the midwives working in post-natal care. Recommendations included a workshop in positioning and attachment, and using a 'hands-off' approach, can increase midwives' knowledge of breastfeeding support. Following the history taking, I was able to build a rapport with Aisha, I asked Aisha to show me how she would normally feed baby, I noted that the difficultly Aisha had in feeding were due to the wrong positioning. I facilitated in showing her the correct position to hold baby and several other positions which she could also try out. Aisha had commented that she wasn’t sure if baby was getting enough milk, I explained signs of attachment and the things she should look out for, which would indicate that baby was getting enough milk. I felt that both I and Aisha have benefited from my knowledge of positioning and attachment as I was able to adopt the hands off approach, which in turn allowed me to facilitate Aisha correctly attaching and positioning her baby, giving her the confidence that she would be able to do so by herself once she had left the hospital.
To conclude I found this to be a valuable learning experience. Following my feedback from Jo Naylor I now feel that my confidence in this aspect of practice has increased and will continue to increase throughout the course. Previously to this experience I was unsure of my ability to facilitate a mother in this aspect. This experience has helped me re-enforce the importance of having good communication skills in midwifery, as this allows for information giving and receiving.