Yes. At least at first, it seems more awkward. It's more difficult to "read" nonverbal cues, especially of the baby, as often the camera is trained on the parent's face.

Instead of me being able to move or adjust my position to see better, I have to ask the parent to adjust the camera angle or how they position themselves for the camera. Often that means I can no longer see their face, again cutting out possibly important nonverbal cues. It may also make them feel more awkward, so I try to only use this after taking time to develop rapport and to limit the length of time I have them do it.

In addition to the above, my adaptations so far have been to ask more open-ended questions, such as how they are feeling about a possible change I suggest or how a change of position or latch (or other suggestion I offer) makes them feel when they try it. I also have asked them to get closer to the microphone and I turn up my volume to try to hear any cues that might help me assess what is going on while the baby is suckling.  

So far, remote counselling seems to be about as effective as in-person counseling, though my sample size is too small to draw any real conclusions.

 

Our teams and the organizations we work with have made a lot of creative adaptions to working online. Many of the organizations have launched online support groups, and are finding that their attendance has gone up. Our CHEERing team has made many very short infant feeding based videos in many languages that have gone out to refugee camps ans settings direct. Best of all though, our strategy to train women onsite who are true peers (for example, a resident at the refugee shelter) has paid off in spades, as we have not needed to go remote, our peer counselor was already in situ. What we have done, however, is to provide increased telephone support to the peer counselor herself to answer any more complicated issues (such as lack of weight gain) as they arose. I believe this situation has resulted in many adaptive requirements that are improvements over the previous models.

That is excellent, Anne! This strategy is exactly what I have always suggested for disaster prone areas, but somehow it has not been taken up by the international/ national organizations involved. I am sure lessons from the CHEER programme will be extremely useful for advocacy. Thank you for sharing.