Student midwives’ experiences on using a Hands-off Approach in breastfeeding counselling
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Midwifery Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
Publication date: 2023-10-24
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Tita Stanek Zidarič   

Midwifery Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
Eur J Midwifery 2023;7(Supplement 1):A179
The days after birth are very important for establishing successful breastfeeding. Adequate support and counselling for mothers during this period are essential to initiate and maintain adequate milk supply. Early discharge from hospital after vaginal birth has become common practise in Slovenia, which unfortunately means that mothers may experience most breastfeeding problems at home and with less support from health care professionals. Using hands-off technique to empower and to teach breastfeeding mothers who need to be able to attach their baby to the breast by themselves could be the key to successful breastfeeding after returning from hospital. This is, apart for the importance of not invading woman’s intimate space without necessity, one of the mail reasons why midwifery students are taught how to use a hands-off approach in breastfeeding counselling session. One of the planned study activities after clinical training, where they learn about different approaches to breastfeeding support, includes a mandatory written reflection on the counselling process/event using Gibb's model for reflective analysis as part of the clinical reasoning.

Material and Methods:
A qualitative methodological approach was used to analyse the textual content of 24 final-year student midwives enrolled in the elective course Breastfeeding and Lactation in 2022/2023. The aim of the study was to explore midwifery students' experiences of the hands-off approach in clinical training. Conventional qualitative content analysis was used to first determine the unit of meaning, which in this case was the third and fourth steps of Gibbs' reflective cycle. This was followed by condensation and coding. The codes were then categorised, and the final step was to identify the main theme. Both researchers conducted an independent analysis and after discussion a final consensus was reached.

Through the interpretation of the analysed text nineteen loose categories emerged revealing concepts that were subsequently integrated to form seven minor categories and ultimately refined into three major categories; “not easy at all” “personal satisfaction”, and “the importance of being insistent” –building towards the one core category–“awareness of effectiveness”.

Supporting women in their breastfeeding journey is very important. Showing them how to attach the baby by themselves is an important step in empowering them which may in long term lead to improved breastfeeding rates. The transition from the classical use of hands-on to a hands-off approach had proved challenging for the students. At the same time, they felt a sense of achievement when breastfeeding was successful for the breastfeeding dyad. The main conclusion to emerge from this study is that the students greatly valued the opportunity to counsel breastfeeding mothers. Through their activity and persistent but not intrusive help, they saw the results of their work - a confident mother who breastfeeds successfully.

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