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Registered Charity No (England and Wales): 801395 (Scotland): SC041592 | Registered Company No: 2370573

ABILITY

SO

CIA

L

Find Strength in Numbers

Find strength in numbers

•  Build social capital

»  Include those who are creating the problem in

solving the problem

»  Turn disablers into enablers

»  Create and support teams

»  Ensure solidarity

Grandmother Breastfeeding Support:

What Do Mothers Need and Want?

•  Health care practitioners need to ask grandmothers about

their infant feeding beliefs and practices

•  Help grandmothers find ways other than feeding to support new mothers and to bond with their grandchildren

•  Give mothers permission to breastfeed in family

gatherings

•  Confront and understand the cultural sources of their

infant feeding practices and beliefs about breastfeeding

Grassley J, Eschiti V. Birth. Dec 2008;35(4):329-335.

Jane Grassley PhD, RN, IBCLC

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http://www.dshs.state.tx.us/wichd/bf/african_americanbf.shtm

MOTIVATION

ST

RU

CT

UR

AL

Design Rewards and

Demand Accountability

Structural motivation

•  Use incentives and punishments wisely

»  Start with intrinsic and social motivators

»  Celebrate small wins & reward good behavior

»  Make sure rewards are linked to vital behaviors, not outcomes

»  Consider small, heartfelt tokens of appreciation

»  Use punishment sparingly

•  First, take a shot across the bow

•  Follow through if behavior persists

http://bfmed.wordpress.com/2010/05/13/celebrating-the-journey/

Jennifer Thomas, MD

ABILITY

ST

RU

CT

UR

AL

Change the Environment

Structural ability

•  Look for the influence of things

»  Clues from the environment profoundly influence

behavior

»  Make the invisible visible

»  Pay attention to physical space

•  Create opportunities for informal contact and

communication

»  Make the behavior unavoidable

Obstetrician

Pediatrician

Lactation consultant

Photo: Denise Both & Kerri Frischknecht, Breastfeeding: An Illustrated Guide to Diagnosis and Treatment © Elsevier 2008

ObstetriObstetrician

cianPediatricianPedi

Lactatioation n Lactatioation Lactation consultaultant ulta

Family Physician Midwife

Structural Ability: Integrating Care

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http://www.nbcbayarea.com/the-scene/archive/Lactating-Women-Getting-Second-Looks-in-Marin.html http://www.pressherald.com/archive/cardboard-cutouts-will-bring-breastfeeding-campaign-to-

life_2009-08-01.html

JACOB RUTKA/THE GRID

http://www.thegridto.com/city/places/whats-the-meaning-of-this-the-endless-bench/

http://www.themilktruck.org/

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MOTIVATION ABILITY

PE

RS

ON

AL

•  Share personal stories

•  Set honest expectations

•  Teach cues •  Build efficacy

•  Rehearse recovery

strategies

SO

CIA

L

•  Plan for social support

•  Create new social networks

•  Ensure training for supporters

•  Address disablers

ST

RU

CT

UR

AL

•  Celebrate small wins

•  Align incentives with personal,

social motives

•  Integrate systems of care

•  Make breastfeeding

visible

Can I do it?

Is it worth

it?

Addressing common breastfeeding challenges

Pacifiers use restricted in mother-baby unit

Kair LR et al (2013). "Pacifier Restriction and Exclusive

Breastfeeding." Pediatrics 131(4): e1101-e1107.

Case study: Restricting pacifiers reduces

exclusive breastfeeding rates

MOTIVATION ABILITY

PE

RS

ON

AL

Make the Undesirable

Desirable

Surpass Your Limits

SO

CIA

L

Harness Peer Pressure

Find Strength in Numbers

ST

RU

CT

UR

AL

Design Rewards and

Demand Accountability

Change the Environment

‘No specific script

was instituted to

verbally instruct

parents on infant

soothing techniques

or use of pacifiers.’

‘If you give your

healthy newborn a

pacifier, it can

make it harder for

your baby to learn

to breastfeed and

decrease your

milk supply.’

‘Pacifiers began to

be stored in a

standard, locked,

supply management

system.’

Over-determine Vital Behaviors

•  To change a vital behavior, draw on at least four sources of influence

A single hand cannot nurse a child.

- Swahili Proverb

Photo: Quintessence Foundation / http://www.babyfriendly.ca

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Research Partners

Kim Andringa

Martha Cox

Mala Elam

Barbara Fredrickson

Susan Girdler

Karen Grewen

Karen Hardy

Samantha Meltzer-Brody

Kim Newton

Chris Raines

David Rubinow

Brenda Pearson

Cort Pederson

Cathi Propper

John Thorp

University of North Carolina

Division of Maternal-Fetal Medicine

Department of Psychiatry

Center for Developmental Science

Frank Porter Graham Institute

UNC Hospitals Lactation Department

National Institutes of Health

UNC Hospital Lactation

Diane Asbill

Rebecca Costello

Michelle Davis

Robyn Lewis

Claudia Perry

Janet Sligh

Eva Barrios

Hannah Edens

Rhonda Lanning

Wanda Oakley

Elley Schopler

Jamila Squires

Mary Terrell

Noah, Sam, Max

& Geoff Green