Table 4.
Barriers experienced, and counter measures undertaken to ensure optimal breastfeeding among institutionalized mothers during COVID-19 pandemic.
| Perceived barriers | Examples of counter measures/innovations undertaken |
|---|---|
| * Inadequate client–provider interaction * Anxiety related to COVID-19 (Hesitancy of mother/ family members; Hesitancy of HCWs) |
Nursery staff were made more easily accessible to RDMs
•Centralized facility of audio and video for the family members to connect with the RDMs; mobile and video calling facility in the nursery for communication between doctor and RDM Strategies and content for counseling of RDMs was modified in the context of COVID-19 to increase its effectiveness •Shared picture of mothers breastfeeding with masks; counseling done individually and/or in smaller groups; other breastfeeding mothers involved in counseling of the RDMs to motivate for breastfeeding; senior doctors counseled mothers who were extremely depressed and resisted breastfeeding Repeated counseling of family members •Counseled to do away with anxiety and agree to breastfeeding by RDM; family members encouraged and involved in decision-making. |
| * Mother–baby discharged early/ separately | Optimizing time for discharge from hospital for mother–newborn dyads |
| * Reduced post-discharge follow-up |
Ensured seamless follow-up of RDMs and newborns after discharge
•Dedicated teams/ personnel and phone lines for telephonic and video calls assigned; developing robust checklist for scheduled calls for follow up |
| * Deployment of staff not trained in pandemic-appropriate skills * Staff shortage |
Staff management optimized for non-disruption of services while maintaining staff motivation and protection. •Rotational duties followed by quarantine; staff sensitization and training up-scaled for sustained motivation and skill enhancement; active involvement of senior staff and department leadership in the COVID ward to set an example; accommodation for HCWs with dedicated conveyance was arranged |
| * Logistic constraints * Frugal use of PPE * Need to harmonize Neonatology-Obstetric SOPs for Maternal-Newborn Care * Infection prevention protocols in hospitals | Infrastructural changes to meet improved IPC requirement, need for risk triaging, and for maximizing efficiency•Reassigning and redesigning of resources to facilitate and promote optimal breastfeeding; curtains and screens were put between beds for privacy to the RDM for breastfeeding/ expression; documentation of the patients done in the duty room and not along the bedside; created antenatal OPD for COVID cases only; installation of camera in the wards/ rooms for remote monitoring of patients |
|
Zoning according to risk for minimizing risk of exposure
•Zoning of nursery and maternity wards depending on the COVID status; separate red/ green zone depending on patient movement and location of wards |
|
|
Special IPC measures for crowd management
•Screening of accompanying family members for COVID-19 symptoms before allowing entry; sanitizer dispensers were installed at places; crowd management SOPs were developed |
|
|
Support mobilized for RDMs – both logistic and emotional
•Attendants allowed and arrangements were made for attendants to help mother with all IPC measures; RDM were asked to make notes of queries that were addressed |
COVID, Coronavirus disease; RDM, Recently delivered mother; PPE, Personal Protection Equipment; SOP, Standard Operating Procedure; IPC, Infection prevention and control; OPD, Outpatient department; HCW, Healthcare workers.