Breastfeeding Management and LAM:
Training of Trainers
Audience: Physicians and midwives in primary health care services
Purpose: To prepare an effective cadre of physician and midwife trainers who are well equipped with knowledge, scientific concepts, and skills to provide quality training in lactation management and counseling on LAM to health workers at different MCH centers.
Content:

Technical

· Breast anatomy and biology of lactation
· Benefits of breastfeeding
· Attachment and positioning
· Increasing milk production
· Overcoming breastfeeding difficulties
· Breastfeeding infants in special situations
· Appropriate nutrition during lactation
· Methods of expressing, storing, and feeding expressed breast milk
· Relactation
· The lactational amenorrhea method (LAM)
· LAM counseling
· The International Code of Marketing of Breast-milk Substitutes
· MOH policy in relation to breastfeeding
· The Baby-Friendly Hospital Initiative

Skills

· Manage LAM through case studies and clinical practicum.
· Demonstrate proper counseling skills for lactating mothers, and pregnant women in an antenatal clinic.
· Assess a breastfeed.
· Manage a selected number of breast and nipple problems that may impact breastfeeding.
· Assess infant's growth pattern by using a growth chart.
· Use principles of adult learning; issues related to training adult learners; and the different types of teaching methods.
Methodology: This competency-based training course emphasizes both technical working knowledge on breastfeeding and LAM as well as teaching skills necessary for training health care providers. The course focuses on teaching practical skills relevant to breastfeeding and LAM, (e.g., breastfeeding case management, counseling and clinical support procedures, LAM counseling). The course includes a pre/post-test, lectures, presentations prepared by participants, discussions, use of audiovisual aids, and group work and practical sessions followed by presentations of studied cases.
Structure: The lactation management section is divided into 29 sessions; the LAM portion is organized into two units: basic LAM concepts; and providing LAM services. Each trainer prepares 10 case studies during the second week of the practical sessions (at least two cases/day), and presents one case study daily. At the clinical site, all practical sessions are observed and evaluated by peers. A total of at least 10 evaluation check lists are completed. Each trainer also prepares and conducts a micro-teaching session on one of the topics related to breastfeeding and LAM.
Materials: Training and reference materials are provided to the trainers. Handouts, transparencies, and slides accompany each session. They also include session content summaries; observation checklists; questions for working groups; illustrations on attachment, breastfeeding, fertility, and the LAM criteria; LAM case studies; and course evaluation.
Time: 82.5 hours (5 days in the first week and 6 days in the second week x 7.5 hours/day)
Languages: Arabic and English (Arabic available upon request.)
Applications: LINKAGES Project in Jordan
Date: Updated July 2000