Table 1 Barriers and Feasible Solutions

 Baby too weak to suck

Mothers counseled and demonstrated with hands on practice on feeding expressed breast milk

 Colostrum discarded; pre-lacteal feeds given; feel that baby needs water during summer

Counseled about benefits of feeding colostrum; exclusive breastfeeding and disadvantages of pre-lacteal feeding. Also counseled about adequacy of water content for the baby in breast milk

 Scanty milk flow soon after birth; inadequacy of breast milk, feels that baby should be given top milk

Explained to mothers that baby does not need milk in large volumes during the initial few days after birth and that frequent breastfeeding increases milk flow

 Inverted, small or cracked nipples; engorged breasts, breast abscess

Demonstration on use of syringe to pull out nipple; feed expressed breast milk till cracked nipple heals; mothers taught to practice hot fomentation and express breast milk; facilitated referral for treatment of breast abscess

 No milk secretion, mother severely ill

Lactation support provided. If mother severely ill, option of breast feeding by wet nurse suggested to the family. If not available, top milk advised with appropriate hygiene and preparation methods

 Heat and humidity, especially during summers

Family counseled to use fan or cooler without exposing baby directly or use hand fans during power cuts. Water sprinkled on floor, floor mopped with cold water to reduce room temperature

 Lack of privacy

For single room homes, partition with cloth, plastic curtain or a vertically placed jute cot was used for privacy. In households with more than one room, mother moved to a separate room.

 Abdominal pain post delivery, postpartum fatigue, mother ill or too weak

Mother assisted to sit comfortably using pillow or soft clothes and change positions often (semi-reclining, supine) or give KMC while moving around. Family members counseled to help mother and to give adequate food to the mother. Mothers referred to health facility if unwell. If other family members not available, encouraged to call relatives or neighbours to help.

 Reluctance to wear front open clothes either due to cultural reasons or shyness

Long binders similar to shirts worn in the setting that cover the mother’s body, designed. Alternatively, mothers advised to wear husband’s shirts or night gown.

 Heat from mother’s abdomen gets transmitted to baby causing diarrhea or vomiting, concern that baby’s stomach would get pressed and cause vomiting

Counseled that heat from mother’s body is essential for a LBW baby who is unable to maintain own body temperature. Baby feels comfortable and secure when placed on mother’s body and the stomach does not get pressed in this position

 Concern regarding possibility of injuring umbilical stump and bleeding in SSC due to friction with mother’s skin

Family counseled and reassured that SSC position does not cause friction or injury to umbilical stump.

 Fear of neck deformity in baby if kept with head turned on one side, in the same position for long; difficulty in placing baby in SSC due to lack of neck control

Counseled that KMC position, if followed correctly, does not cause deformity; and baby’s neck is well supported and rests on mother’s breasts;

 SSC would be interrupted as the baby needs to be removed from SSC frequently to clean stool

Mothers demonstrated on how to clean the baby without removing from SSC position

 Concern that baby would not allow the mother to resume routine work after the period of rest is over due to excessive attachment

Counseled about the importance of doing KMC and its long term effect on baby’s growth and development. Also that KMC promotes healthy bonding rather than dependency.

 Fear that mother’s infections could pass on to the baby through sweat

Family counseled and assured that infections are not transmitted through sweat

 Refusal to undress the baby for KMC in winter; feared that the baby will catch cold

Family advised to keep doors and windows shut and use room heater, whenever possible. Mother demonstrated on how to undress baby after placing in SSC position; use of sleeveless front open woolen sweaters promoted for the baby in families who insisted on woolen clothing

 Apprehensions about giving SSC at night: fear of suffocating or smothering the baby if she falls asleep and turns to her side crushing the baby

Demonstrated how to lie down with support on either side with pillows or blankets, or rolled up old clothes (if pillows not available) to prevent her from turning on her side. This way they could avoid smothering the baby while asleep

 Inability to practice SSC while moving around

Mother encouraged to use binders

 Refusal to use tube top elastic binders: fear of suffocating the baby

Mothers demonstrated on placing baby in SSC in regular clothes. Tube tops given to women who felt comfortable

 Difficulty in doing KMC for twins

Mother assisted in placing both babies in SSC simultaneously; family members requested for help

 Lack of time due to household responsibilities

Mother-in-law and other family members counseled and encouraged to share household chores.

 Limited family support, particularly in nuclear families

Mother encouraged to call relatives or neighbors or practice KMC for longer hours at night