When reality does not meet expectations: the importance of consistent communication, support, and anticipatory guidance for high-risk mothers who plan to breastfeed

The association between women's perceptions of professional support and problems experienced on breastfeeding cessation: a Western Australian study

A cross-sectional survey was used to determine the association among women's breastfeeding problems, their perceptions of support from midwives and child health nurses, and breastfeeding cessation in the first 10 weeks postbirth in a sample of Western Australian women (N = 2669). Primiparous women (75.8%) experienced significantly more problems that multiparous women (52.6%). Although 78.8% of all women agreed or strongly agreed that staff were helpful with feeding, 53.4% confirmed that different midwives offered different feeding advice; however, receiving different advice from midwives around feeding was not associated with breastfeeding cessation. Differences in breastfeeding cessation were associated with parity. Primiparous women's cessation was associated with experiencing any breastfeeding problems, unhelpful hospital midwives, and unhelpful information from child health nurses, whereas for multiparous women, this included 2 or more breastfeeding problems, not being able to choose when to feed, and unhelpful information from child health nurses.

‘Breaking the rules’ in baby-feeding practice in the UK: deviance and good practice?

OBJECTIVE

to discover the views of midwives in relation to baby feeding.

DESIGN AND METHOD

qualitative using grounded theory. Data collection used in-depth interviews with 30 midwives who volunteered to participate. Field notes of the interaction between the researcher and participant were also recorded as data. The constant comparison process was used to generate codes and subsequent conceptualisations from the data.

SETTING

two maternity units in the North of England, UK.

FINDINGS

the core category of this study is called 'surviving' baby feeding, and the findings reported here are a significant theme that emerged. These midwives described a management strategy termed 'breaking the rules' for supporting mothers with baby feeding. The concept 'breaking the rules' represented practices that were not congruent with evidence-based, baby-feeding policy and recommendations, or with some practices that were usual in the local working environment. These midwives were aware of their actions but described how they 'hid' their behaviour from mothers and from their peers. Some of the behaviour described showed that these midwives 'broke the rules' in relation to professional requirements and the facilitation of informed decision making about feeding practices with the women in their care. However, some midwives reported examples of practice that is woman-centred, and supportive of baby feeding, but this was not acceptable to others in the working environment.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

deviant behaviour was described by these midwives in relation to informed decision making and options for mothers in baby-feeding practice. These midwives 'knowingly concealed' their deviant practices from others. These behaviours should be taken seriously as they risk being negligent in relation to UK statutory professional requirements. However, practices that depart from those that are normal in the local working environment are not always negative and detrimental to the recipients of care; they can be positive. There needs to be more research, open discussion and debate about midwifery practice that does not always 'fit in' with professional, and 'normal' expectations. In this study, the term 'baby feeding' relates to how babies' nutritional needs are met.