A qualitative study of women's views about how health professionals communicate about infant feeding

A Qualitative Exploration of the Attitudes and Experiences of Polish Breastfeeding Mothers in Ireland

BACKGROUND

Breastfeeding rates in Ireland are among the lowest in the world. Improving the prevalence of breastfeeding is an objective of the Irish Health Service Executive, with the recognition that this would improve public health. Polish people represent the largest immigrant group in Ireland, and Polish women are more likely to initiate breastfeeding than Irish women.

RESEARCH AIMS

This study had two aims: (1) to describe the breastfeeding experiences and attitudes among Polish mothers living in Ireland, and (2) to explore similarities and differences in infant feeding experiences, attitudes, and beliefs among Polish and Irish women, as perceived by Polish women.

METHODS

Semi-structured interviews were conducted in Polish with Polish mothers (N = 16) who had lived in Ireland for 10 years or less. Interviews were audio recorded, transcribed, and translated into English. Data were analyzed using qualitative thematic analysis. Coding was a cyclical process; codes were amended and refined through iterative reading of the transcripts. Themes were developed through categorization of codes and via in-depth discussion between two analysts.

RESULTS

Three major themes were developed after analyzing the data. First, there is no universal correct way to provide support for infant feeding; women would like individualized support based on their infant-feeding decisions. Second, breastfeeding is an inherent part of Polish culture and formula feeding is part of Irish culture. Finally, the Irish social environment is supportive of breastfeeding and breastfeeding in public is acceptable in Ireland.

CONCLUSIONS

Although the Irish social environment is supportive of breastfeeding, the infant-formula culture is a barrier to breastfeeding. Future research should explore ways to change societal attitudes towards breastfeeding in Ireland.

Determinants of optimum exclusive breastfeeding duration in rural India: a mixed method approach using cohort and content analysis design

BACKGROUND

Despite established benefits, exclusive breastfeeding (EBF) rate remains poor in India. This study measured the rate of early initiation of breastfeeding and EBF up to 42 days postpartum period and the reasons associated with early interruption of it.

METHODS

In this study we followed a cohort 319 mother-newborn dyads, on a scheduled day of each week for six postpartum weeks (42 postpartum days), during May 2017 - March 2019. We used standard maternal 24 h recall method to collect data on newborn feeding practices. Additionally, using content the analysis method, we analysed the data captured through open ended question on current breastfeeding practice and reasons to identify the sociocultural facilitators/barriers of exclusive breastfeeding .

RESULTS

Of the retained 306 newborns, early initiation of breastfeeding rate was 60% (184/306), whereas, EBF rate was 47% (143/306). Mothers' educational level did not emerge as a risk for unsuccessful breastfeeding practices, whereas, father being not the major earner of the family (Relative risk [RR] 2.4; 95% Confidence interval [CI] 1.7,3.3), mothers who did not believe that effect of breastfeeding is longstanding (RR 1.8; 95% CI 1.3, 2.1) emerged as a risk for unsuccessful EBF practices. Lack of self-conviction about EBF among mothers; significant family members' influence; cultural beliefs; emerged as major socio-environmental barriers of early interruption of exclusive breastfeeding. Repeated counselling by the healthcare provider particularly focusing on exclusive breastfeeding, supportive family environment in terms of the elders being aware of the positive health outcomes of it, and prior positive experience emerged as the socio-environmental facilitators for successful EBF until 42 postpartum days.

CONCLUSIONS

We conclude that the socio-environmental causes need to be addressed through the present healthcare delivery system for ensuring better infant feeding outcome.

Maternal perspectives on infant feeding practices in Soweto, South Africa

OBJECTIVE

To (i) describe the infant feeding practices of South African women living in Soweto and (ii) understand from the mothers' perspective what influences feeding practices.

DESIGN

Semi-structured focus group discussions (FGD) and in-depth interviews (IDI) were conducted, and data were analysed using thematic analysis.

SETTING

Soweto, South Africa.

PARTICIPANTS

Nineteen mothers were stratified into three FGD according to their baby's age as follows: 0-6-month-olds, 7-14-month-olds and 15-24-month-olds. Four mothers from each FGD then attended an IDI.

RESULTS

Although mothers understood that breast-feeding was beneficial, they reported short durations of exclusive breast-feeding. The diversity and quality of weaning foods were low, and 'junk' food items were commonly given. Infants were fed using bottles or spoons and feeding commonly occurred separately to family meal times. Feeding practices were influenced by mothers' beliefs that what babies eat is important for their health and that an unwillingness to eat is a sign of ill health. As such, mothers often force-fed their babies. In addition, mothers believed that feeding solid food to babies before 6 months of age was necessary. Family matriarchs were highly influential to mothers' feeding practices; however, their advice often contradicted that of health professionals.

CONCLUSIONS

In South Africa, interventions aimed at establishing healthier appetites and eating behaviours in early life should focus on: (i) fostering maternal self-efficacy around exclusive breast-feeding; (ii) challenging mixed feeding practices and encouraging more responsive feeding approaches and (iii) engaging family members to promote supportive household and community structures around infant feeding.

"They Just Need to Come Down a Little Bit to your Level": A Qualitative Study of Parents' Views and Experiences of Early Life Interventions to Promote Healthy Growth and Associated Behaviours

The first 1000 days is a critical window of opportunity to promote healthy growth and associated behaviours. Health professionals can play an important role, in part due to the large number of routine contacts they have with parents. There is an absence of research on the views of parents towards obesity prevention and the range of associated behaviours during this time period. This study aimed to elicit parents’ views on early life interventions to promote healthy growth/prevent childhood obesity, particularly those delivered by health professionals. Semi-structured interviews were conducted with 29 parents (24 mothers, 5 fathers) who were resident in Ireland and had at least one child aged under 30 months. Data were analysed using reflexive thematic analysis. Two central themes were generated: (1) navigating the uncertainty, stress, worries, and challenges of parenting whilst under scrutiny and (2) accessing support in the broader system. Parents would welcome support during this critical time period; particularly around feeding. Such support, however, needs to be practical, realistic, evidence-based, timely, accessible, multi-level, non-judgemental, and from trusted sources, including both health professionals and peers. Interventions to promote healthy growth and related behaviours need to be developed and implemented in a way that supports parents and their views and circumstances.

'Scrutinised, judged and sabotaged': A qualitative video diary study of first-time breastfeeding mothers

OBJECTIVE

To explore how support impacted on mothers' breastfeeding experiences in the first few weeks following birth.

DESIGN

A qualitative approach explored real-time experiences of breastfeeding captured by five first-time mothers in the South of England on camcorder as video diaries. A multi-dimensional approach involving thematic analysis ensured both the audio and visual elements of the data were analysed.

FINDINGS

Mothers felt 'under surveillance' by the biomedical approach to support from the healthcare team. At best mothers felt reassured that they were 'on the right track'. When mothers felt their breastfeeding was constantly being examined, criticised and threatened they felt 'scrutinised, judged and sabotaged'. When they found it difficult to access healthcare support, or they avoided it altogether to circumvent further scrutiny, they felt 'abandoned and alone'.

KEY CONCLUSIONS

Collecting audio-visual data in real-time adds fresh insights into how support impacts mothers' experiences of breastfeeding. The biomedical approach to support for breastfeeding is not effective. Scrutinising, judging and/or sabotaging mothers' attempts to breastfeed can have long-lasting effects on maternal emotional wellbeing.

IMPLICATIONS FOR PRACTICE

Breastfeeding support might be improved by adopting a more social model of care. Future research needs to explore how relationship-based support can be provided by the health service.

Toward Understanding How Social Factors Shaped a Behavioral Intervention on Healthier Infant Formula-Feeding

As part of a process evaluation, we explored in semi-structured interviews the experiences of 19 mothers who had taken part in a trial to reduce infant formula-milk intake and promote healthy weight gain, and reflections of three facilitators who delivered the intervention and control group protocols. Mothers appreciated the nonjudgmental support provided during the trial, after experiencing stigma and receiving limited advice on how, how much, and how often formula-milk should be given. The information mothers had previously found, printed on formula-milk tins, or provided by family, friends, and health professionals was often perceived as contradictory; the trial guidance also conflicted with social norms relating infant health positively with weight gain. For those recruited into the trial with older infants, who had already exceeded the recommendations, reducing formula-milk amounts was difficult. The findings highlight the difficulties of addressing a highly stigmatized, complex social practice with an individual, behavioral intervention approach.

Effective Communication Strategies for Nurses to Discuss Infant Feeding with New Mothers During Postpartum Hospitalization

During prenatal care and postpartum hospitalization, nurses have an important role in assisting new mothers to make informed decisions about feeding their newborn infants. There is overwhelming evidence that breastfeeding is beneficial for most new mothers and babies; therefore, perinatal nurses encourage breastfeeding. Newborn infant feeding conversations with women who have chosen to formula feed may be complicated and may cause tension in the nurse-patient relationship. Despite this potential difficulty, these conversations are essential to establish a feeding plan for the newborn infant and to promote healthy outcomes for mothers and babies. Tools are offered for nurses to guide conversations about infant feeding choices and to help to ensure that all mothers receive support and encouragement on their feeding choice.

A feasibility study of a multidimensional breastfeeding-support intervention in Ireland

BACKGROUND

Breastfeeding is the optimum mode of infant feeding. Despite this, most global populations do not achieve the World Health Organisation's recommendation of exclusive breast milk for the first 6 months of life. Irish breastfeeding rates are among the lowest in Europe, necessitating a well-designed breastfeeding-support intervention.

AIM

To evaluate the feasibility and acceptability of a multidimensional breastfeeding intervention in a rural and an urban maternity setting in Ireland.

DESIGN

A feasibility study of a breastfeeding-support intervention.

SETTING

Participants were recruited from The National Maternity Hospital (Dublin, urban) and Wexford General Hospital (Wexford, rural). Questionnaires were completed antenatally, at 6 weeks postpartum and at 3 months postpartum to assess acceptability of the intervention and determine breastfeeding status.

PARTICIPANTS

Pregnant women were recruited in the 3^rd trimester, alongside a support partner.

INTERVENTION

The intervention consisted of an antenatal class (including the physiology and practical approaches to breastfeeding), a one-to-one breastfeeding consultation with a lactation consultant after birth, access to a breastfeeding helpline, online resources, and a postnatal breastfeeding support group which included a one-to-one consultation with the lactation consultant.

RESULTS

One hundred women from The National Maternity Hospital, Dublin and 27 women from Wexford General Hospital were recruited. The antenatal class was attended by 77 women in Dublin and 23 in Wexford; thus, 100 women participated in the intervention. Seventy-six women had a one-to-one postnatal consultation with a lactation consultant in Dublin and 23 in Wexford. Fifty and 45 women in Dublin, and 15 and 15 in Wexford responded to the 6-week and 3-month questionnaires, respectively. At 3 months postpartum, 70% of respondents from Dublin and 60% from Wexford were breastfeeding. Mothers perceived the one-to-one consultation with the lactation consultant during postnatal hospitalization as the most helpful part of the intervention. Inclusion of a support partner was universally viewed positively as a means to support the mother's decision to initiate and continue breastfeeding.

CONCLUSION

This multidimensional intervention is well-accepted and feasible to carry out within an Irish cohort, in both urban and rural areas. Data from this feasibility study will be used to design a randomized controlled trial of a breastfeeding-support intervention.

A descriptive study of the health information needs of Kenyan women in the first 6 weeks postpartum

Background

A large number of maternal and neonatal deaths occur during birth and 48 h after birth. The benefits of postnatal care to the mother and newborn cannot be overemphasized as this is another opportunity where complications that might arise from pregnancy and childbirth can be treated, as well as the time to provide important information on maternal and newborn care after delivery. This study aimed to determine the information needs of mother-baby pairs in the first 6 weeks after birth.

Methods

An exploratory qualitative study using in-depth interviews at three points in time was conducted with 15 women who had their births at Moi Teaching and Referral Hospital, Kenya. The first interview was done within 48 h after birth followed by a telephone interview at 2 weeks and at 6 weeks after birth. Data were audio recorded and transcribed. Transcripts and field notes were analyzed using thematic content analysis and NVIVO 11 software. Ethical approval was obtained before commencement of studies and permission to conduct the study granted by the chief executive of the hospital.

Results

The only health needs that participants reported were unmet health information needs. Four major themes emerged from the study. ‘Connecting with baby’ centered on understanding and meeting baby’s needs, monitoring growth and progress and protecting the baby. The second theme: “Birth as a unique encounter’ is a blend of what was found to be new and a unique. The theme ‘Regaining self’ is a combination of managing self as a mother and handling discomfort related to birth. The final theme: ‘Disconnected information’ is a collection of unmet information needs, the need for clarity in information booklets and conflicting information by different providers.

Conclusions

Participants used the hospital stay as an opportunity to receive more detailed information on how to take care of their babies both directly after birth and in the longer term. Participants had a range of unmet health information needs that extended beyond family planning and fertility. Needs extended to their own care and management of discomforts. The need for consistency in health information by different providers and updated printed material on postnatal care that includes sensitive information and allows opportunities for personalized information was highlighted.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1576-1) contains supplementary material, which is available to authorized users.

Breastfeeding and defeasible duties to benefit

For many women experiencing motherhood for the first time, the message they receive is clear: mothers who do not breastfeed ought to have good reasons not to; bottle feeding by choice is a failure of maternal duty. We argue that this pressure to breastfeed arises in part from two misconceptions about maternal duty: confusion about the scope of the duty to benefit and conflation between moral reasons and duties. While mothers have a general duty to benefit, we argue that this does not imply a duty to carry out any particular beneficent act. Therefore, the expectation that mothers should breastfeed unless they have sufficient countervailing reasons not to is morally unwarranted. Recognising the difference between reasons and duties can allow us to discuss the benefits of breastfeeding and the importance of supporting mothers who wish to breastfeed without subjecting mothers who bottle feed to guilt, blame and failure.

Resistance to breastfeeding: A Foucauldian analysis of breastfeeding support from health professionals

BACKGROUND

Despite widespread consensus regarding the health benefits of breastfeeding, the prevalence of six months exclusive breastfeeding is very low in developed countries including New Zealand.

AIM

This paper aims to evaluate the role that health professionals play in promoting exclusive breastfeeding in New Zealand.

METHODS

Qualitative research involving face to face postpartum interviews conducted four to six weeks after the birth with 30 new mothers who lived in New Zealand and had identified in a short antenatal questionnaire that they intended to practice exclusive breastfeeding for six months. Themes related to exclusive breastfeeding support from health professionals were extracted from the interview transcripts and interpreted using Foucault's ideas about governmentality and bio-power.

RESULTS

Four themes related to the quality of health care support were identified in the interview transcripts. 'Breastfeeding self-efficacy support from the community midwives', 'mothers need to know more about breastfeeding during pregnancy', 'experiencing difficulties breastfeeding' as well as 'pressure and resistance to breastfeeding'.

DISCUSSION

Most mothers in this research spoke about feeling pressured to breastfeed within the New Zealand health system. However, the participating mothers acknowledged the effective support that they had received from community midwives who respected their autonomy, strengthened their self-esteem and encouraged them to breastfeed.

CONCLUSION

Negative historical experiences related to the medicalization of infant feeding in Western countries suggests that health professionals need to provide effective skill support for breastfeeding mothers so that mothers do not consider it a form of "quiet coercion" or as an exercise of "power".

Understanding process and context in breastfeeding support interventions: The potential of qualitative research

Considerable effort has been made in recent years to gain a better understanding of the effectiveness of different interventions for supporting breastfeeding. However, research has tended to focus primarily on measuring outcomes and has paid comparatively little attention to the relational, organizational, and wider contextual processes that may impact delivery of an intervention. Supporting a woman with breastfeeding is an interpersonal encounter that may play out differently in different contexts, despite the apparently consistent aims and structure of an intervention. We consider the limitations of randomized controlled trials for building understanding of the ways in which different components of an intervention may impact breastfeeding women and how the messages conveyed through interactions with breastfeeding supporters might be received. We argue that qualitative methods are ideally suited to understanding psychosocial processes within breastfeeding interventions and have been underused. After briefly reviewing qualitative research to date into experiences of receiving and delivering breastfeeding support, we discuss the potential of theoretically informed qualitative methodologies to provide fuller understanding of intervention processes by focusing on three examples: phenomenology, ethnography, and discourse analysis. The paper concludes by noting some of the epistemological differences between the broadly positivist approach of trials and qualitative methodologies, and we suggest there is a need for further dialog as to how researchers might bridge these differences in order to develop a fuller and more holistic understanding of how best to support breastfeeding women.

Discontinuity of Breastfeeding Care: "There's No Captain of the Ship"

BACKGROUND

Breastfeeding rates in the United States are suboptimal. Health professionals (HPs) have a unique opportunity to support breastfeeding because of the frequency and timing of their visits with mothers and infants as well as their call by professional organizations to do so. The objective of this study was to understand HPs' perceived roles and experiences with providing breastfeeding-related care.

MATERIALS AND METHODS

In-depth qualitative interviews were conducted with 34 HPs (obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. Interviews were audio-recorded, transcribed, and verified for accuracy; content analysis was used to identify themes using a grounded theory approach.

RESULTS

The overarching theme was discontinuity in breastfeeding care across the continuum. Most HPs relied on other HPs to provide breastfeeding care, which resulted from and contributed to problematic gaps in care that were reported. A minority of HPs attempted to bridge gaps in breastfeeding care or improve continuity. Contributing to the discontinuity were a lack of time, lack of skills, inconsistent messages, and low communication across stages of care. HPs were unsure whether their help was effective and whether required follow-up was completed.

CONCLUSIONS

Despite HPs' recognition of breastfeeding as the best choice for infant feeding, breastfeeding care may be disjointed and a barrier to achieving breastfeeding recommendations. These problems should be investigated and systemically addressed in future research so that maternal-infant dyad breastfeeding care can be improved.

'I really needed help': What mothers say about their post-birth care in Queensland, Australia

BACKGROUND

Australian mothers consistently rate postnatal care as the poorest aspect of their maternity care, and researchers and policymakers have widely acknowledged the need for improvement in how postnatal care is provided.

AIM

To identify and analyse mothers' comments about postnatal care in their free text responses to an open ended question in the Having a Baby in Queensland Survey, 2010, and reflect on their implications for midwifery practice and maternity service policies.

METHODS

The survey assessed mothers' experiences of maternity care four months after birth. We analysed free-text data from an open-ended question inviting respondents to write 'anything else you would like to tell us'. Of the final survey sample (N=7193), 60% (N=4310) provided comments, 26% (N=1100) of which pertained to postnatal care. Analysis included the coding and enumeration of issues to identify the most common problems commented on by mothers. Comments were categorised according to whether they related to in-hospital or post-discharge care, and whether they were reported by women birthing in public or private birthing facilities.

RESULTS

The analysis revealed important differences in maternal experiences according to birthing sector: mothers birthing in public facilities were more likely to raise concerns about the quality and/or duration of their in-hospital stay than those in private facilities. Conversely, mothers who gave birth in private facilities were more likely to raise concerns about inadequate post-discharge care. Regardless of birthing sector, however, a substantial proportion of all mothers spontaneously raised concerns about their experiences of inadequate and/or inconsistent breastfeeding support.

CONCLUSION

Women who birth in private facilities were more likely to spontaneously report concerns about their level of post-discharge care than women from public facilities in Queensland, and publically provided community based care is not sufficient to meet women's needs. Inadequate or inconsistent professional breastfeeding support remains a major issue for early parenting women regardless of birthing sector.

Artificial milk-feeding women׳s views of their feeding choice in Ireland

OBJECTIVE

despite the well-documented benefits of breast feeding to both mother and child, breast-feeding initiation rates in Ireland are the second lowest in Europe. This study set out to explore the views of women from low socio-economic groups in Ireland on their choice to feed their infants artificial milk, and to elicit factors that may encourage these women to breast feed in the future.

DESIGN

a qualitative descriptive approach was used.

METHODS

data were collected through recorded focus groups and individual interviews, using a semi-structured interview schedule. Data were transcribed verbatim.

SETTING

interviews took place in two regions in the Republic of Ireland, north and south.

PARTICIPANTS

a purposive sample was drawn from the population of 2572 women taking part in the Irish Infant Feeding Study who had never breast fed previously, had intended to, and had, fed this infant artificial milk and who had completed their education before they were 18 years of age. Two focus groups with two women in each were conducted and six women took part in individual interviews.

ANALYSIS

constant comparative analysis was performed to construct the categories and concepts that led to the final themes.

FINDINGS

these artificial milk-feeding women based their infant feeding decision on many social and experiential factors. The major influences on their decisions were: personal attitudes toward feeding methods, and external influences on infant feeding methods. Attitudes towards other women and feeding future infants reinforced a strong preference towards artificial milk feeding.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

it is apparent that a prevailing culture that is unreceptive to breast feeding and the lack of positive breast-feeding role models, contributed to a strong commitment to artificial milk feeding for these participants. Promotion of breast feeding must take account of the complex contexts in which women make decisions. Advice regarding breast feeding should take account of women׳s feelings and avoid undue pressure, while still promoting the benefits of breast feeding to women and their families.

Breast-feeding support in Ireland: a qualitative study of health-care professionals' and women's views

OBJECTIVE

To examine women's experience of professional support for breast-feeding and health-care professionals' experience of providing support.

DESIGN

We conducted semi-structured qualitative interviews among women with experience of breast-feeding and health-care professionals with infant feeding roles. Interviews with women were designed to explore their experience of support for breast-feeding antenatally, in hospital and postnatally. Interviews with health-care professionals were designed to explore their views on their role and experience in providing breast-feeding support. Interview transcripts were analysed using content analysis and aspects of Grounded Theory. Overarching themes and categories within the two sets were identified.

SETTING

Urban and suburban areas of North Dublin, Ireland.

SUBJECTS

Twenty-two women all of whom had experience of breast-feeding and fifty-eight health-care professionals.

RESULTS

Two overarching themes emerged and in each of these a number of categories were developed: theme 1, facilitators to breast-feeding support, within which being facilitated to breast-feed, having the right person at the right time, being discerning and breast-feeding support groups were discussed; and theme 2, barriers to breast-feeding support, within which time, conflicting information, medicalisation of breast-feeding and the role of health-care professionals in providing support for breast-feeding were discussed.

CONCLUSIONS

Breast-feeding is being placed within a medical model of care in Ireland which is dependent on health-care professionals. There is a need for training around breast-feeding for all health-care professionals; however, they are limited in their support due to external barriers such as lack of time. Alternative support such as peer support workers should be provided.

An interdisciplinary multidepartmental educational program toward baby friendly hospital designation

Our healthcare institution chose to strive for Baby Friendly Hospital Initiative (BFHI) designation to enhance our support of breastfeeding. To complete Baby Friendly Hospital Initiative Step 2, a 5-hour educational program of supervised clinical experience was designed incorporating learning needs identified through gap analysis. Five interdisciplinary simulation stations included (1) a video on practical aspects of skin-to-skin contact immediately after delivery, (2) a dynamic interactive exercise on skin to skin in the labor and delivery setting, (3) couplet care on admission to the maternal infant unit, (4) breast milk expression, and (5) common challenges. Small groups of staff rotated among stations in 45-minute intervals. Two hundred fifty staff completed this educational program and an additional 54 nurses have become certified breastfeeding counselors. Evaluations highly favored this model of active participation and our work toward achieving Baby-Friendly Hospital designation has been greatly enhanced.

Exploring the process of women's infant feeding decisions in the early postbirth period

Research indicates that multiple factors are associated with decisions women make about infant feeding, yet few studies have explored the decision-making process. In this article, we present the analysis that produced the core category "deconstructing best," previously reported as part of a grounded theory exploring 37 Australian women's infant feeding experiences and decisions in the first 6 weeks postbirth. We expand on the previous article by detailing and discussing the phases of the infant feeding decision-making process in relation to decision-making theory. Analysis demonstrates the importance of these early weeks in shaping women's infant feeding trajectories. Findings illustrate that information gathering encompassing multiple factors occurred at this time, and that complex and often competing goals were involved in the women's decisions. We suggest that acknowledging and assisting women to meet alternate goals in the postbirth period might help them meet their breastfeeding goals.

Health effects of infant feeding: Information for parents in leaflets and magazines in five European countries

Parents' decisions about whether to breastfeed their infant, and when to introduce complementary foods, are important public health issues. Breastfeeding has beneficial health effects and is widely promoted. Leaflets and magazine articles on infant feeding were collected in 2005, in five European countries (England, Finland, Germany, Hungary, Spain), and screened for statements that link feeding behaviours to infant health outcomes. A total of 127 leaflets contained 512 statements (0.38 / published page). Magazines contained approximately 1 article / month. Health outcomes were more intensively covered in England and Germany. Most statements referred to short term health implications. Lack of scientific agreement may underlie lack of cover of longer term health effects. Scope may exist to promote improved infant feeding practices by increasing the quantity and specificity of messages about health effects. Further research is required to evaluate the impact of alternative means of providing information on infant feeding practices.

Liquid gold from the milk bar: constructions of breastmilk and breastfeeding women in the language and practices of midwives

Midwives are the main health professional group providing support and assistance to women during the early establishment of breastfeeding. In published accounts of early breastfeeding experiences women report high levels of dissatisfaction with health professional support. To gain an understanding of this dissatisfaction, we examined the way in which midwives represent breastmilk and construct breastfeeding women in their interactions. Seventy seven women and seventy six midwives at two maternity units in NSW, Australia, participated in this study. Eighty five interactions between a midwife and a breastfeeding woman were observed and audio recorded during the first week after birth. In addition, data were collected through observation of nine parenting education sessions, interviews with 23 women following discharge, and 11 managers and lactation consultants (collected between October 2008 and September 2009). Discourse analysis was used to analyse the transcribed interactions, and interview data. The analysis revealed that midwives prioritised both colostrum and mature breastmilk as a 'precious resource', essential for the health and wellbeing of the infant and mother. References to breastmilk as 'liquid gold' were both verbal and implied. Within this discourse, the production and acquisition of 'liquid gold' appeared to be privileged over the process of breastfeeding and women were, at times, positioned as incompetent operators of their bodily 'equipment', lacking knowledge and skill in breastfeeding. In this context breastfeeding became constructed as a manufacturing process for a demanding consumer. The approach taken by midwives revealed an intensive focus on nutrition to the exclusion of relational communication and support. The findings indicate the need to challenge the current 'disciplinary' and 'technological' practices used by midwives when providing breastfeeding support and the need for a cultural change in postnatal care.

Discursive constructions of infant feeding: The dilemma of mothers’ ‘guilt’

Recent feminist and sociological scholarship has problematised the underlying medical assumptions in the established literature on infant feeding by attending to the social and discursive construction of breastfeeding practice. Such work has suggested that the pervasive cultural discourse around breastfeeding as the ‘morally correct’ choice has implications for actual decisions and practices as well as subjective judgements and feelings, particularly those of guilt and inadequacy. The present study employs a discursive approach to analyse the ways in which childcare materials published since 2000 construct the issue of infant feeding. In particular, we focus upon the ways in which these materials attend to the possible implications of pro-breastfeeding discourses for mothers’ subjective experience of guilt. We highlight a focus within the materials on not ‘ feeling’ guilty, as opposed to affirmations that formula feeding mothers are not guilty. The complex and potentially problematic nature of such public health messages in terms of gendered subjectivities is considered.

An Oral, Motor, Medical, and Behavioral Approach to Pediatric Feeding and Swallowing Disorders: An Interdisciplinary Model

Feeding and swallowing problems are reported in 10-25% of all children, 40-70% in premature infants, and 70-90% in children with medical/developmental delays (Graham, 1985; Rogers & Arvedson, 2005; Sullivan et al., 2000). The etiologies of feeding disorders are as varied as the multiple disciplines, approaches, and interventions available. This paper illustrates, through case presentation, an interdisciplinary feeding team model that incorporates an oral, motor, medical, and behavioral approach to treating children with feeding disorders.

Women's perceptions of their healthcare experience when they choose not to breastfeed

RESEARCH QUESTION

How do women who choose not to breastfeed perceive their healthcare experience?

METHOD

This qualitative research study used a phenomenographic approach to explore the healthcare experience of women who do not breastfeed. Seven women were interviewed about their healthcare experience relating to their choice of feeding, approximately 4 weeks after giving birth. Six conceptions were identified and an outcome space was developed to demonstrate the relationships and meaning of the conceptions in a visual format.

FINDINGS

There were five unmet needs identified by the participants during this study. These needs included equity, self sufficiency, support, education and the need not to feel pressured.

CONCLUSION

Women in this study who chose not to breastfeed identified important areas where they felt that their needs were not met. In keeping with the Code of Ethics for Nurses and Midwives, the identified needs of women who do not breastfeed must be addressed in a caring, compassionate and just manner. The care and education of women who formula feed should be of the highest standard possible, even if the choice not to breastfeed is not the preferred choice of healthcare professionals.

[Communication and satisfaction among primiparas in a public health service]

OBJECTIVE

To analyze first-time mothers communication with health professionals, and to explore satisfaction, needs and expectation towards healthcare services.

METHOD

Qualitative design using in-deep interviews and phenomenology was used. First-time mothers from Huercal-Overa (Almería) were intentionally selected in 2010 and were included in the study. A hermeneutic analysis was performed.

RESULTS

Six meta-categories were obtained. Saturation of information was found with nine interviews. The meta-categories were the following: 1) Health professionals; 2) Pregnancy, partum and postpartum; 3) Communication; 4) Child nutrition; 5) Feelings; 6) Others. The mothers perceived as exciting this new experience and expressed feelings of fear, anguish and high sensitiveness. These feelings are increased by the information received from the family circle and the professionals which is referred low and contradictory. All professionals were positively considered, specially the midwife. The following negative experiences were identified: contractions, dilation and delivery. The end of the stay at the hospital was considered early and the time for consultation was short for the mothers. There is a demand about more information on breast feeding. Mothers wish health professionals to respect their decisions.

CONCLUSIONS

The study found some areas for improvement in the communication between firs-time mothers and health professionals which could be taken into account in satisfaction promotion plans in regards to healthcare services.

Women's perceptions and experiences of breastfeeding support: a metasynthesis

BACKGROUND

Both peer and professional support have been identified as important to the success of breastfeeding. The aim of this metasynthesis was to examine women's perceptions and experiences of breastfeeding support, either professional or peer, to illuminate the components of support that they deemed "supportive."

METHODS

The metasynthesis included studies of both formal or "created" peer and professional support for breastfeeding women but excluded studies of family or informal support. Qualitative studies were included as well as large-scale surveys if they reported the analysis of qualitative data gathered through open-ended responses. Primiparas and multiparas who initiated breastfeeding were included. Studies published in English, in peer-reviewed journals, and undertaken between January 1990 and December 2007 were included. After assessment for relevance and quality, 31 studies were included. Meta-ethnographic methods were used to identify categories and themes.

RESULTS

The metasynthesis resulted in four categories comprising 20 themes. The synthesis indicated that support for breastfeeding occurred along a continuum from authentic presence at one end, perceived as effective support, to disconnected encounters at the other, perceived as ineffective or even discouraging and counterproductive. A facilitative approach versus a reductionist approach was identified as contrasting styles of support that women experienced as helpful or unhelpful.

CONCLUSIONS

The findings emphasize the importance of person-centered communication skills and of relationships in supporting a woman to breastfeed. Organizational systems and services that facilitate continuity of caregiver, for example continuity of midwifery care or peer support models, are more likely to facilitate an authentic presence, involving supportive care and a trusting relationship with professionals.

Using video narratives of women's lived experience of breastfeeding in midwifery education: exploring its impact on midwives' attitudes to breastfeeding

Strong evidence supports the health benefits of breastfeeding contributing to the public health campaign to improve initiation and duration of breastfeeding globally, yet breastfeeding continuation rates are persistently low in the UK. Inadequate support from health professionals appears to be an underlying feature, aggravated by a dearth of professional education that uses a biopsychosocial approach. This paper describes how using women's video narratives of their lived experience of breastfeeding within higher education impacted positively on the attitudes of a group of midwives in relation to supporting breastfeeding women. It reports on the qualitative element of a two-phase sequential mixed methods study where focus group methods generated rich data about how and why the educational intervention altered attitudes. Analysis was thematic. Six major themes emerged, 'listening and learning from real women's experiences'; 'generation of emotions'; 'acquisition of new knowledge and learning'; 'reflection on practice'; 'promotion of independent learning' and 'sharing learning and ideas with peers'. 'Listening and learning from real women's experiences' was central to learning, and was pivotal to attitudinal change, motivating an intense need to improve practice. Findings support the value of using women's video narratives within midwifery education, through their power to integrate affective and cognitive learning, and to promote a transformative learning process. This novel approach brings value-added learning benefits by enhancing the potential to improve attitudes towards supporting breastfeeding women and improving clinical practice.

Breastfeeding support - the importance of self-efficacy for low-income women

Breastfeeding is a key determinant in promoting public health and reducing health inequality. Low-income women have a significantly lower level of breastfeeding. Midwives in the UK have been encouraged to implement the World Health Organization/United Nations Children's Fund's Ten Steps to Successful Breastfeeding, but to date, there has been no evaluation of the impact of the training initiative on the breastfeeding behaviours of low-income women. As part of a wider study, this qualitative component was designed to answer the question - what are the views and experiences of low-income women (defined by Jarman scores) in relation to their breastfeeding support received in the post-natal period? A sample of seven women was interviewed. The in-depth interviews were analysed using a qualitative, thematic approach based on the self-efficacy theory. The four themes that emerged from the data were the following: breastfeeding related to the woman's self-confidence, the social environment in which the woman lived, knowledge of breastfeeding and the influence of maternity services on breastfeeding outcomes. These themes were interpreted in relation to the self-efficacy theory. The findings suggest that the components that inform self-efficacy are consistent with the themes from the data, suggesting that midwives and other health professionals should take the psychosocial aspects of breastfeeding support into account. As this important feature of breastfeeding support is not explicitly part of the current Ten Steps to Successful Breastfeeding, we suggest that further research and debate could inform expansion of these minimum standards to include the psychosocial aspects.

Qualitative study on WIC Program strategies to promote breastfeeding practices in Puerto Rico: what do nutritionist/dietician's think?

The purpose of this study is to better understand Nutritionist-Dietician opinions concerning WIC Program strategies to promote breastfeeding in Puerto Rico. Four groups of nutritionists-dietitians were recruited to take part in focus group discussions. Each focus group lasted for approximately 1 h and the researchers completed a debriefing sheet after each meeting. The group discussions were taped and transcribed. The participants identified hospital barriers, lack of family support and problems related to the mother as the three principal reasons that Puerto Rican mothers do not breastfeed their babies or stop breastfeeding early. An individual meeting was the most frequently mentioned WIC strategy that was meant to convince mothers to breastfeed their infants. Nevertheless, the focus group participants recognized that the effort and time available for such meetings is limited. From these groups, one theme that emerged is that the WIC Program in Puerto Rico should collaborate with hospitals to arrange for WIC-sponsored nutritionist-dietitians to visit the WIC participants during their maternity hospital stay, and in their homes.

Health care and social service providers' descriptions of pacific islander mothers' breastfeeding patterns

INTRODUCTION

Despite recommendations and numerous health benefits attributed to breastfeeding, rates in the United States are below desired levels, particularly within vulnerable populations. In Hawaií, breastfeeding rates are higher than national averages except in Native Hawaiian and other Pacific Islander populations. Health care and social service providers are integral to successful breastfeeding promotion efforts. They are in an ideal position to reflect on the context in which their clients live and on its relationship to breastfeeding activities. The aim of this study was to describe health care and social service providers' perceptions of the influences on the breastfeeding patterns of Pacific Islander women.

METHODS

Focus ethnographic methods were used to collect interview data from health care and social service providers (N=20) serving Native Hawaiian and Pacific Islander women in one rural community. An iterative analysis process of coding and categorizing, followed by conceptual abstraction into patterns, was completed.

RESULTS

Four patterns emerged: shaped by connections, lived unfamiliarity, stressed by circumstance, and missed opportunities. Participants' insights concerning the needs of this population yielded population-specific issues and health care system issues affecting breastfeeding promotion. A number of gaps in breastfeeding services were identified.

DISCUSSION

Sociocultural, maternal knowledge, and workload barriers to successful breastfeeding predominated providers' perspectives. Broader system and community level issues were implied, but not directly addressed. The nature of successful breastfeeding support and promotion requires inclusion of this broader level perspective.

Breastfeeding ambivalence among low-income African American and Puerto Rican women in north and central Brooklyn

This study explores low-income African American and Puerto Rican women's conceptions and practices around breastfeeding. It examines the impact of such diverse factors as social constructions of the body, local mores around infant care, the practicalities of food availability, in the context of interactions with family members and friends, institutions, and others in women's neighborhoods. The study employed ethnographic methods, including interviews and participant observation, with 28 families in two low-income Brooklyn neighborhoods. While women in this study felt that breastfeeding was the best way to feed their infants, their commitment turned to ambivalence in the face of their perceptions about the dangers of breast milk, the virtues of formula, and the practical and sociocultural challenges of breastfeeding. Women's ambivalence resulted in a widespread complementary feeding pattern that included breast milk and formula, and resulted in short breastfeeding durations. Findings suggest the critical role of breastfeeding "ambivalence" in driving thought and action in women's lives. Ambivalence erodes the permanence of breastfeeding intention, and makes feeding practices provisional. Ambivalence challenges breastfeeding promotion strategies, resulting in weakened public health messages and a difficult-to-realize public health goal.

Using community maternity care assistants to facilitate family-focused breastfeeding support

Increasing breastfeeding rates, particularly in lower socio-economic areas, would have considerable impact upon public health. Social support has been found to have direct and positive effects on breastfeeding rates, and fathers' attitudes have an important influence on the initiation and continuation of breastfeeding. In the UK, trained maternity care assistants (MCAs) are increasingly being used to support community midwives by providing post-natal women with breastfeeding support. The current study aimed to evaluate the feasibility and acceptability of MCAs involving fathers from economically deprived communities in antenatal breastfeeding discussions to equip them to provide support and encouragement. Eleven couples who took part in the intervention were interviewed post-natally. MCAs, midwives and midwifery managers gave their views on the intervention and role of MCAs in the community. The study showed that MCAs with appropriate training are very effective at delivering antenatal breastfeeding information, which both mothers and other family members value. MCAs found giving such breastfeeding support both enjoyable and fulfilling, while involving fathers and family members proved a practical way of encouraging them to be more supportive. Midwives and midwifery managers were positive about involving MCAs in giving the antenatal intervention, but did not see the routine introduction of this type of session for couples being possible at present due to current staffing problems. Involving fathers in breastfeeding support may start to increase knowledge and change attitudes towards breastfeeding in communities where formula feeding is seen as the normal way to feed a baby.

Women's experiences of infant feeding support in the first 6 weeks post-birth

Research suggests women find the first 2 to 6 weeks to be the most difficult time for breastfeeding. It has been identified that women need and seek support with breastfeeding during this time. Support is a difficult concept to define. When discussed by professionals, support for breastfeeding is generally viewed in terms of providing information and educational interventions. There is little understanding of the different elements of breastfeeding support strategies and the mechanisms by which support operates. Further, there is a paucity of qualitative research specifically reporting women's experiences and expectations of professional support. This paper describes women's expectations and experiences of 'infant feeding support' provided by health professionals in the first 6 weeks post-birth. The findings are drawn from a grounded theory study exploring women's infant feeding decisions in the first 6 weeks post-birth. Participants were recruited from a variety of socio-demographic areas of Sydney and the NSW Central Coast, Australia in 2003-2004. The women in this study discussed aspects of what they considered helpful and/or unhelpful in terms of professional support. In addition, they also provided insight into aspects of interactions that were deemed important to them as new mothers learning to feed their babies. The results are presented in three sections: expecting support, experiencing support and evaluating support. The findings help to better understand components of professional practices and behaviours that can be considered supportive. The support behaviours are far more complex than simply increasing education and knowledge of infant feeding. They demonstrate the need for sensitive individualized care and show that this type of support can increase women's confidence to breastfeed.

The lived experience of mothers of children with chronic feeding and/or swallowing difficulties

The purpose of this phenomenologic study was to describe the lived experiences of seven mothers who were providing home-based care for their children with feeding and/or swallowing difficulties. Data were collected using semistructured interviews and were analysed as per Colaizzi's method of inductive reduction. Results suggest that the mothers' experiences can be understood as two continuing journeys that were not mutually exclusive. The first, "Deconstruction: A journey of loss and disempowerment," comprised three essences: (1) losing the mother dream, (2) everything changes: living life on the margins, and (3) disempowered: from mother to onlooker. The second journey was "Reconstruction: Getting through the brokenness" with the essences of (4) letting go of the dream and valuing the real, (5) self-empowered: becoming the enabler, (6) facilitating the journey, and (7) the continuing journey: negotiating balance. The phenomenon of being the mother of a child with chronic feeding and/or swallowing difficulties continued to be a transformative experience in which personal growth emerged along with chronic sorrow and periodic resurgence of struggle and loss. Implications call for healthcare professionals to incorporate maternal meanings and needs in providing appropriate family-focused intervention.

A meta-synthesis of women's perceptions and experiences of breastfeeding support

BACKGROUND

Breastfeeding conveys significant health benefits to infants and mothers yet in many affluent nations breastfeeding rates continue to decline across the early months following birth. Both peer and professional support have been identified as important to the success of breastfeeding. What is not known are the key components or elements of support that are effective in increasing the duration of breastfeeding?

OBJECTIVES

The aim of this meta-synthesis was to examine women's perceptions and experiences of breastfeeding support, either professional or peer, in order to illuminate the components of support that they deem 'supportive'. A secondary aim was to describe any differences between components of Peer and Professional support.

SELECTION CRITERIA

Both primiparous and multiparous women who initiated breastfeeding were included in the study. Studies that included a specific demographic sub-group, such as adolescents, were included. Studies focused on a specific clinical sub-group, such as women post-caesarean, were not included.

TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST

This meta-synthesis focused on maternal experiences of breastfeeding support. The meta-synthesis included both formal or 'created' peer and professional support for breastfeeding women but excluded studies of family or informal support for breastfeeding.

TYPES OF STUDIES

Primarily qualitative studies were included in the review. Studies such as large scale surveys were also included if they reported in sufficient detail the analysis of qualitative data gathered through open ended responses or included in depth interviews. Only studies published or available in English, in peer reviewed journals and undertaken between 1990 and December 2007 were included.

SEARCH STRATEGY

Key data bases were searched. The following search terms were individually added to the main keyword - breastfeeding: qualitative research, breast feeding support, peer support, professional support, postnatal support, post-natal support, volunteer support, lay support, breastfeeding counsellors, lactation consultants, social support, health education, breastfeeding education and lactation. Delimiters applied were humans, English language and years 1990-2007.

METHODOLOGICAL QUALITY

JBI-QARI (Qualitative Assessment and Review Instrument) was used to assess the quality of 38 articles selected for full review. Seven were excluded primarily because they included little qualitative data relevant to the review focus. The studies reviewed were generally of reasonable quality in terms of clarity, appropriate methodology, credibility and evidence cited to support the conclusions drawn. However, most included relatively limited discussion of theoretical or conceptual perspectives, discussion of relevant literature and reflection on the roles of the researchers.

DATA COLLECTION AND SYNTHESIS

JBI-QARI was used to manage and appraise textual data, Meta-ethnographic methods were used to develop 'interpretive explanations and understanding of breastfeeding support. Each study was systematically reviewed, reading and re-reading papers to create a list of themes through 'reciprocal translation'. Both first order and second order constructs were used to create the themes and these were then synthesised into four interpretive categories.

RESULTS

The meta-synthesis resulted in four categories comprising a total of 20 themes. The synthesis indicates that support for breastfeeding occurs along a continuum from authentic presence at one end, perceived as effective support, to disconnected encounters at the other, perceived as ineffective or even discouraging and counter productive. Second, the synthesis identified a facilitative approach, versus a reductionist approach as contrasting styles of support women experienced as helpful or unhelpful.

CONCLUSIONS

The findings of this meta-synthesis emphasise the importance of person-centred communication skills and of relationships in supporting a woman to breastfeed. Authentic presence is best supported by building a trusting relationship, demonstrating empathy, listening and being responsive to a woman's needs. Organisational systems and services that facilitate continuity of care/r and time spent with the woman, for example continuity of midwifery care or peer support models, are more likely to facilitate an authentic presence. The findings suggest the need to increase opportunities to offer women across all social groups access to peer support.

IMPLICATIONS FOR PRACTICE

The review indicates several changes in direction for practice to foster provision of support that women consider helpful and enabling, rather than disabling. These include service design that facilitates effective relationships to be established between supporters and the woman, including greater continuity of carer, Midwives need to work in service models that enable them to provide more individualised, rather than standard care and advice, to spend time and provide practical help to those women who need it. Antenatal education needs to be more learner-centred, using pedagogic models based on adult-learning principles, and should provide women with information that is realistic, detailed and positively encouraging. Midwifery education needs to integrate sufficient focus on developing midwives' communication and information giving skills. Schemes to offer peer support should be developed further, using a pro-active approach, including home visits and support groups.

IMPLICATIONS FOR RESEARCH

Further research is warranted on schemes to develop peer models of support. Research is also needed to investigate in more depth the service models and conditions that are conducive to midwives' ability to offer effective support for breastfeeding.

A systematic review of decision support needs of parents making child health decisions

OBJECTIVE

To identify the decision support needs of parents attempting to make an informed health decision on behalf of a child.

CONTEXT

The first step towards implementing patient decision support is to assess patients' information and decision-making needs.

SEARCH STRATEGY

A systematic search of key bibliographic databases for decision support studies was performed in 2005. Reference lists of relevant review articles and key authors were searched. Three relevant journals were hand searched.

INCLUSION CRITERIA

Non-intervention studies containing data on decision support needs of parents making child health decisions.

DATA EXTRACTION AND SYNTHESIS

Data were extracted on study characteristics, decision focus and decision support needs. Studies were quality assessed using a pre-defined set of criteria. Data synthesis used the UK Evidence for Policy and Practice Information and Co-ordinating Centre approach.

MAIN RESULTS

One-hundred and forty nine studies were included across various child health decisions, settings and study designs. Thematic analysis of decision support needs indicated three key issues: (i) information (including suggestions about the content, delivery, source, timing); (ii) talking to others (including concerns about pressure from others); and (iii) feeling a sense of control over the process that could be influenced by emotionally charged decisions, the consultation process, and structural or service barriers. These were consistent across decision type, study design and whether or not the study focused on informed decision making.

Supporting breastfeeding mothers: qualitative synthesis

AIM

This paper is a report of a synthesis of mothers' and healthcare professionals' experiences and perceptions of breastfeeding support.

BACKGROUND

Despite increasing knowledge, breastfeeding rates remain relatively static and mothers continue to report dissatisfaction with their experiences of breastfeeding. Greater understanding of breastfeeding may be achieved through rigorous qualitative research, and there has been a recent increase in such studies.

DATA SOURCES

Electronic databases and citation lists of published papers were searched for articles listed between 1990 and 2005 and updated in May 2007. Studies were included if they used qualitative methods, were published in English, explored an aspect of breastfeeding and were based in a westernized country.

REVIEW METHODS

Papers were included if they reported studies using qualitative methods to explore breastfeeding and were published in English and based in a westernized country. Each study was reviewed and assessed independently, key themes extracted and grouped, and secondary thematic analysis used to explore key concepts.

RESULTS

From the 1990-2005 search, five themes emerged in health service support of breastfeeding: the mother-health professional relationship, skilled help, pressures of time, medicalization of breastfeeding and the ward as a public place. Social support had two themes: compatible and incompatible support. One additional theme emerged from the update to 2007: health professional relationships.

CONCLUSION

Mothers tended to rate social support as more important than health service support. Health service support was described unfavourably with emphasis on time pressures, lack of availability of healthcare professionals or guidance, promotion of unhelpful practices and conflicting advice. Changes are required within the health services to address the needs of both mothers and staff.

The breastfeeding experience of women with major difficulties who use the services of a breastfeeding clinic: a descriptive study

Background

Many women experience breastfeeding difficulties. Sometimes these difficulties lead to breastfeeding cessation. Breastfeeding clinics provide support for women facing such problems. This study aims to describe the breastfeeding experience of women, particularly those who use the services of the breastfeeding clinic located in the Greater Quebec City area.

Methods

This is a descriptive study based on information gathered through telephone questionnaires that were administered in 2006 to a sample of 86 women and semi-structured interviews conducted with 12 of these women.

Results

Painful nipples/breasts, low milk supply and latching difficulties were the three most frequent major breastfeeding problems identified by women. Their personal characteristics as well as the moral and physical support provided by family and friends and by health professional and clinicians at the breastfeeding clinic were the factors identified most often as having a positive influence on the breastfeeding experience.

Conclusion

The results suggest that breastfeeding clinics have a critical role to play in improving the breastfeeding experience of women with major difficulties.

The power of language: a secondary analysis of a qualitative study exploring English midwives' support of mother's baby-feeding practice

OBJECTIVE

to explore the use of language by midwives reporting their experiences of baby-feeding practice.

DESIGN

A qualitative approach incorporating a secondary analysis of data previously collected in a study based on grounded theory principles. Data were collected using in-depth interviews. The secondary analysis involved a content analysis method.

SETTING

two maternity services in the north of England.

PARTICIPANTS

30 midwives who worked across all clinical areas.

FINDINGS

these midwives' explanations of how they supported women with baby feeding suggest that they used language to direct women towards decisions that the midwives thought best, without prior exploration of the woman's understanding and beliefs of baby feeding. Women were often described as 'girls' and 'ladies' indicating the power differentials in their relationship. The midwives were aware that, at times, the language they used was contradictory to woman-centred maternity care.

KEY CONCLUSIONS

language may be used to control childbearing women and direct them to decisions that the midwife wants, rather than enabling the woman to make her own decisions. The terms used by midwives to relate to women, such as 'girls' and 'ladies', may be a strategy used to improve a midwife's perception of her status in maternity care.

IMPLICATIONS FOR PRACTICE

language may be used to undermine women. It is important that the language used when interacting with women is considered carefully in order to facilitate an unbiased perspective and to promote partnership. The word 'women', rather than 'girls' or 'ladies', should be used when referring to users of the maternity services.