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    <meta name="author" content="Denise Fisher" />
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      <h1 id="top">2.2 Listening skills</h1>
      <div>
    <p class="listTitle">Listening skills involve</p>
    <ul>
      <li>Reflecting back what you have understood the mother said.</li>
      <li>Appropriate questioning.</li>
    </ul>
  </div>
      <div class="section" id="Reflective_listening"><h2>Reflective listening</h2>
    <div>
      <p>Reflective listening communicates to the mother your interpretation of what she has said and how she feels, and does so in a way that demonstrates understanding and acceptance.</p>
    </div>
    <div class="section" id="Paraphrasing"><h3>Paraphrasing</h3>
      <div>
        <p> Paraphrasing typically explains or clarifies what was said. A good paraphrase is succinct, cutting directly to the message and is restated the way you understood the message. Paraphrasing is not parroting (or copying). Parroting stifles conversation, paraphrasing contributes to the communication between people. </p>
      </div>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><h3>An example:</h3>
        <div>
          <p>Mother: &ldquo;<q>I love my baby and I love breastfeeding her. My mother says it's the best thing for babies. But I'm so tired every day from getting up for the night feeds. I just wish my husband could give her a bottle sometimes.</q>&rdquo;</p>
          <p>Health care worker: &ldquo;<q>So breastfeeding is good, but fatigue is causing you to think of weaning.</q>&rdquo;</p>
          <p>At this point the mother will either agree or she'll disagree and clarify her intent.</p>
        </div>
      </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
      <div>
        <p>
				Applying paraphrasing more often in our everyday conversations would improve the fluency and accuracy of what was said and what was understood to have been said.
			</p>
      </div>
      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><h3>Paraphrasing exercise</h3>
        <div></div><div class="activity" id="activity_w">
<script type="text/javascript">
/* <![CDATA[ */
var wqs = {settings : {type : 'response'}, questions : [
	{ c : '<p>How would you paraphrase this conversation?</p><blockquote>John wants us to have another baby as soon as possible. You know\n				the problems I have getting pregnant and my doctor told us I might\n				not regain my fertility until I stop breastfeeding. Sharney is\n				only 10 months old and still a baby. Even if I do wean her I\n				probably won\'t get pregnant anyway.</blockquote>', r : '<blockquote>You don\'t want to wean Sharney so soon, particularly if it\'s not\n				going to make much difference to whether you can get pregnant again.</blockquote><p>\n				Is your response concise? Does your response capture the essence\n				of the conversation? Have you used your own words?\n			</p>' }
]};

/* ]]> */</script>
</div><script type="text/javascript">renderActivity('w');</script>
      </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
    </div>
    <div class="section" id="Reflecting_feelings"><h3>Reflecting feelings</h3>
      <div>
        <p>You don't have to state the mother's feelings if it isn't appropriate. However, you must be aware of what they are.</p>
        <p class="listTitle">How do you correctly interpret her feelings? Try these tips.</p>
        <ul>
          <li>Sometimes they may be spoken and leave you in no doubt: &ldquo;<q>I felt so angry when he said that to me.</q>&rdquo;</li>
          <li>You may need to infer it from the content: &ldquo;<q>I spent two hours yesterday when I was really busy helping her to breastfeed. Now she's artificially feeding, and says she was going to when she got home anyway.</q>&rdquo;</li>
          <li>Observe her body language. Much of your understanding of body language is 'innate'; something you pick up during a lifetime of interpersonal relationships. However, there is still so much you could learn. This is beyond the scope of this course but you will find it very rewarding if you pursue this interesting topic.</li>
          <li>How would you be feeling in that situation? Each person's emotional experience is unique, but by applying the previous points and thinking about how you would feel you can have a fairly good guess. If you reflect that feeling, eg. &ldquo;<q>That's so frustrating</q>&rdquo;, she will either agree readily or tell you how she actually feels.</li>
        </ul>
      </div>
    </div>
  </div>
      <div class="section" id="Appropriate_questioning"><h2>Appropriate questioning</h2>
    <div>
      <p>Consider the following conversation:</p>
      <table class="dialogue"><tbody><tr class="speaker0"><th>Health worker:</th><td>Good morning. Are you feeling well today?</td></tr><tr class="speaker1"><th>Mother:</th><td>Yes. I'm well.</td></tr><tr class="speaker0"><th>Health worker:</th><td>Is baby breasfeeding OK?</td></tr><tr class="speaker1"><th>Mother:</th><td>Yes.</td></tr><tr class="speaker0"><th>Health worker:</th><td>Are you having any problems?</td></tr><tr class="speaker1"><th>Mother:</th><td>No.</td></tr></tbody></table>
      <p>Now consider how it could have been more productive.</p>
      <table class="dialogue"><tbody><tr class="speaker0"><th>Health worker:</th><td>Good morning. How are you feeling?</td></tr><tr class="speaker1"><th>Mother:</th><td>I'm feeling well. Thank you.</td></tr><tr class="speaker0"><th>Health worker:</th><td>Tell me about how breastfeeding your baby is going.</td></tr><tr class="speaker1"><th>Mother:</th><td>I breastfeed often during the day, and give him a bottle at night.</td></tr><tr class="speaker0"><th>Health worker:</th><td>What made you decide to give a bottle at night?</td></tr><tr class="speaker1"><th>Mother:</th><td>He wakes up at night, so I don't think my milk is strong enough to satisfy him.</td></tr></tbody></table>
      <p>Do you see how questions that require only a one-word answer (closed questions) limit the amount of information you receive, while open questions encourage more conversation?</p>
      <p> We often rely on questions excessively and use them poorly. Questions usually focus on our own intent, perspective, and concerns rather than on the mother's orientation. When that happens, questions are a barrier to communication. </p>
    </div>
    <div class="section" id="About_questioning"><h3>About questioning</h3>
      <div>
        <dl>
          <dt>Closed questions</dt>
          <dd> A closed question can be answered with either a single word or a short reply, eg yes/no. Closed questions direct the conversation, keeping control of the conversation with the questioner, and should therefore rarely be used. <br />This type of question is used to obtain information on a specific point. &ldquo;<q>Do you want to keep using the nipple shield?</q>&rdquo;; &ldquo;<q>How old are your other children?</q>&rdquo; Because these questions are so directed, the mother may reply with what she thinks you want to hear for fear of getting the question wrong. <br />Closed questions are useful for starting a conversation while retaining control, &ldquo;<q>It's great weather, isn't it?</q>&rdquo; and for facts, &ldquo;<q>What was your baby's birth weight?</q>&rdquo;</dd>
          <dt>
            <br />
          </dt>
          <dt>Open questions</dt>
          <dd> Open questions deliberately seek longer answers, asking the mother to think and reflect, before responding with opinions and feelings. The control of the conversation moves to the respondent. <br />The question should be designed to help her to clarify her own problem, rather than provide information for the interviewer. &ldquo;<q>How do you feel your baby is latching when you use the nipple shield?</q>&rdquo; &ldquo;<q>Can you describe what your other children do while baby is feeding?</q>&rdquo; </dd>
        </dl>
        <p><strong>Ask only one question at a time</strong> - and not too many even then.</p>
      </div>
    </div>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><h3>Converting closed to open questions</h3>
      <div></div><div class="activity" id="activity_x">
<script type="text/javascript">
/* <![CDATA[ */
var xqs = {settings : {type : 'response'}, questions : [
	{ c : '<p>Rewrite the following closed questions as open questions that will stimulate conversation.</p><ol><li>Are you breastfeeding your baby?</li><li>How many feeds a day are you giving baby?</li><li>Is he sleeping through the night yet?</li><li>Did your baby gain weight this week?</li></ol>', r : '<p> The following are suggested answers. Test your questions by seeing if they can be answered in only one or two words. </p><ol><li>Tell me about how you\'re feeding your baby.</li><li>What\'s your baby\'s feeding pattern like?</li><li>Can you describe to me baby\'s feeding and sleeping habits at night?</li><li>How do you feel baby is growing?</li></ol>' }
]};

/* ]]> */</script>
</div><script type="text/javascript">renderActivity('x');</script>
    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
  </div>
      <div class="section" id="What_should_I_remember_"><h2>What should I remember?</h2>
    <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><img src="design/remember.png" class="icon" alt="" /><h3></h3>
      <div>
        <ul>
          <li>the two aspects of listening skills</li>
          <li>the goal of paraphrasing, and how to paraphrase<br /></li>
          <li>the best use of closed and open questions<br /></li>
        </ul>
      </div>
    </td><td class="middleright" style="background: repeat-y url(design/callout_06.png);"><img src="design/callout_06.png" width="10" height="80" alt="" /></td></tr></tbody></table>
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      <h1>Breastfeeding Essentials</h1>
      <ol>
        <li>1.0 <a href="topic_1-0.html">Why Breastfeeding is Important</a><ol><li>1.1 <a href="topic_1-1.html">Biochemistry</a></li><li>1.2 <a href="topic_1-2.html">Immunology</a></li><li>1.3 <a href="topic_1-3.html">Relative risks</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Communication Skills</a><ol><li>2.1 <a href="topic_2-1.html">Non-verbal</a></li><li class="current">2.2 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_2-2.html">Listening skills</a></li><li>2.3 <a href="topic_2-3.html">Building confidence</a></li><li>2.4 <a href="topic_2-4.html">An example</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Pregnancy Care</a><ol><li>3.1 <a href="topic_3-1.html">The feeding decision</a></li><li>3.2 <a href="topic_3-2.html">The barriers</a></li><li>3.3 <a href="topic_3-3.html">Physical preparation</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">The Birth Experience</a><ol><li>4.1 <a href="topic_4-1.html">The first hours</a></li><li>4.2 <a href="topic_4-2.html">Labor interventions</a></li><li>4.3 <a href="topic_4-3.html">Postnatal interventions</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Breastfeeding the Baby</a><ol><li>5.1 <a href="topic_5-1.html">Positioning Principles</a></li><li>5.2 <a href="topic_5-2.html">Breastmilk transfer</a></li><li>5.3 <a href="topic_5-3.html">Assessing breastfeeding</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">A time to learn</a><ol><li>6.1 <a href="topic_6-1.html">Practical skills</a></li><li>6.2 <a href="topic_6-2.html">Breastfeeding messages</a></li><li>6.3 <a href="topic_6-3.html">Normal growth</a></li><li>6.4 <a href="topic_6-4.html">Sleep</a></li><li>6.5 <a href="topic_6-5.html">Psychological support</a></li><li>6.6 <a href="topic_6-6.html">Discharge planning</a></li></ol></li>
        <li>7.0 <a href="topic_7-0.html">Infant Challenges</a><ol><li>7.1 <a href="topic_7-1.html">Late preterm infant; Non-latching</a></li><li>7.2 <a href="topic_7-2.html">Hypoglycemia; Jaundice</a></li><li>7.3 <a href="topic_7-3.html">Supplementation</a></li><li>7.4 <a href="topic_7-4.html">Crying baby</a></li><li>7.5 <a href="topic_7-5.html">Inadequate weight gain</a><ol><li>7.5.1 <a href="topic_7-5-1.html">Feeding-line device at the breast</a></li><li>7.5.2 <a href="topic_7-5-2.html">Cup feeding</a></li><li>7.5.3 <a href="topic_7-5-3.html">Finger Feeding</a></li><li>7.5.4 <a href="topic_7-5-4.html">Bottle feeding</a></li></ol></li></ol></li>
        <li>8.0 <a href="topic_8-0.html">Maternal Challenges</a><ol><li>8.1 <a href="topic_8-1.html">Engorgement</a></li><li>8.2 <a href="topic_8-2.html">Nipple Pain</a></li><li>8.3 <a href="topic_8-3.html">Breast Problems</a></li><li>8.4 <a href="topic_8-4.html">Insufficient breastmilk</a></li><li>8.5 <a href="topic_8-5.html">Medical, Surgical Issues</a></li></ol></li>
        <li>9.0 <a href="topic_9-0.html">Promotion, Protection and Support</a><ol><li>9.1 <a href="topic_9-1.html">The International Code of Marketing of Breastmilk Substitutes</a></li><li>9.2 <a href="topic_9-2.html">The Baby Friendly Initiative</a></li><li>9.3 <a href="topic_9-3.html">Young Child Feeding</a></li><li>9.4 <a href="topic_9-4.html">Local initiatives</a></li><li>9.5 <a href="topic_9-5.html">Infant feeding in emergencies</a></li></ol></li>
        <li>10.0 <a href="topic_10-0.html">Closing session</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
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