Table 1 Research encounters and lactation support provided

Pregnancy

Susan met with the Research Coordinator for the first time. She consented to participate in the intervention feasibility trial, and survey data were collected including demographics and information about Susan’s health and adherence to ART.

4 days postpartum

Susan met with the Lactation Specialist for the first time. She reported she had been breastfeeding exclusively, but complained of red, sore nipples, and that her baby was breastfeeding “too much” which made her feel she was not producing enough milk. The Lactation Specialist assessed that Susan had difficulty positioning her baby and achieving an effective latch. She helped Susan to find a more comfortable position and deeper latch thereby reducing nipple pain and improving milk transfer. She also reassured Susan about her milk supply by hand expressing milk from her breast and provided information about the importance of feeding on demand to stimulate milk production.

2 weeks postpartum

Susan expressed continued concern that she was not producing enough milk. The Lactation Specialist assessed that Susan was still struggling with positioning and latch, she worked with Susan to improve her breastfeeding technique and provided reassurance. The Lactation Specialist was concerned about postpartum depression as Susan seemed detached from her baby and was not maintaining eye contact during breastfeeding

4 weeks postpartum

Susan reported that her son was frequently feeding but only for short periods. The Lactation Specialist continued to work with Susan on improving her breastfeeding technique. She also emphasized the importance of ensuring the baby receives more hindmilk (with frequent short feedings he may have been primarily taking in foremilk). Susan was receptive to the support provided at this time.

6 weeks postpartum

Susan mentioned worrying about her baby contracting HIV through breastmilk, and was unsure about the benefits of exclusive breastfeeding. The Lactation Specialist noticed notable improvement in breastfeeding technique especially achieving a consistently deeper and more effective latch. She continued to coach Susan to find a more comfortable position, reviewed the many benefits of breastfeeding, and reinforced the importance of maternal and infant adherence.

3 months postpartum

At the last supportive session, the Lactation Specialist noted Susan had a rash on her scalp and breasts and was concerned that Susan was still struggling to accept her status and/or her baby’s new diagnosis. She offered support and encouragement for continued breastfeeding as well as emphasized the importance of adherence to ART for Susan and her baby. The Lactation Specialist also provided information and support for continued exclusive breastfeeding as well as optimal infant feeding beyond six months postpartum (i.e., complementary feeding).

6 months postpartum

This was the final research encounter where Susan met with our Research Coordinator and participated in an in-depth exit interview.