Elsevier

Midwifery

Volume 20, Issue 2, June 2004, Pages 194-204
Midwifery

Supplementing breast-fed babies in the UK to protect their mothers from tiredness or distress

https://doi.org/10.1016/j.midw.2003.09.002Get rights and content

Abstract

Objective:

to explore mothers’ and healthcare professionals’ beliefs, expectations and experiences in relation to supplementation of breast feeding in the postnatal ward and newborn-baby unit.

Design and method:

a qualitative study using an ethnographic approach which involved participant observation and interviews. Analysis of the observation data informed who would be approached for interview and interviews also guided further observation work. Categories and themes were generated from the field notes and interviews.

Setting:

a maternity unit in the South of England using six methods of supplementary feeding.

Participants:

30 mothers, 17 midwives, four neonatal nurses, three paediatricians, three senior house officers and 3 healthcare assistants were interviewed in the postnatal ward and newborn-baby unit over a period of nine months in 2002.

Findings:

a major theme was the healthcare professionals’ desire to protect the mothers from tiredness or distress, although this at times conflicted with their role in promoting breast feeding. The categories ‘protecting the mother from guilt’, ‘making it easy to give up’ and ‘protecting the mother from distress’ were linked to this theme. Sometimes midwives suggested supplementation because they perceived mothers to be tired, sometimes mothers themselves made the request. Thus the researcher constructs of ‘midwife led’ and ‘mother led’ supplementation emerged.

Key conclusions/implications for practice:

healthcare professionals need to be aware that they may not be helping mothers in the longer-term when supplementation is used as a quick ‘solution’ to a mother's tiredness or distress. However, other strategies such as providing emotional support or role modelling ‘settling’ skills are time consuming and have resource implications for the maternity services.

Introduction

The health benefits to newborn babies of being breast fed are well established (Howie et al., 1990; Saarinen and Kajosaari, 1995; Wilson et al., 1998). UK national surveys of baby feeding have consistently shown that giving additional fluids to breast-fed babies in hospital following birth is associated with earlier discontinuation of breast feeding (Martin and White, 1988; White et al., 1992; Foster et al., 1997). In the latest such survey (Hamlyn et al., 2002), 40% of breast-fed babies given a bottle in hospital had discontinued breast feeding within two weeks of birth, as opposed to 13% who had not been given one. This is against the background of a general recommendation of exclusive breast feeding for the first six months of life (Kramer and Kakuma, 2002).

Despite a specific criterion for the WHO/ UNICEF Baby Friendly Hospital award relating to restricting supplementation (Division of Child Health and Development, 1998), it is not an uncommon practice in the UK, with Hamlyn et al. (2002) reporting 28% of breast-fed babies to have been given at least one bottle in hospital. Some work has been conducted in the developed world to try to determine which method of supplementation is least detrimental to subsequent breast-feeding success (Jones, 1994; Lang et al., 1994; Schubiger et al., 1997; Brown et al., 1999; Mosley et al., 2001) but the question has yet to be answered definitively.

There also appeared to be a lack of evidence concerning mothers’ and healthcare professionals’ beliefs, expectations and experiences in relation to supplementation and this prompted the work described. It was felt that this could help to inform both clinical practice and further research.

Section snippets

Research design

An ethnographic approach was adopted since the purpose of the research was an exploration of the actions and perspectives of a group of mothers and healthcare professionals with a common interest in breast feeding. They became the key informants for this study. Ethnography is not only able to inform culture-specific care (Baillie, 1995) but also investigates routines and other processes in a group or culture, especially in areas where evidence is sparse (Fetterman, 1998). This type of inquiry

Findings

Extensive observation was conducted in the postnatal wards and NBU and 30 mothers and 30 healthcare professionals were interviewed over a nine-month period.

Discussion and conclusion

The study involved participant observation where the research assistant was known to be carrying out research in the setting. Her background in psychology helped her to stay a genuinely ‘naı̈ve observer’. As she was not a healthcare professional she did not experience role-conflict and withdrawal from the setting to write notes did not prove problematic or disruptive to client care.

The study was restricted to one maternity unit in the South of England, and therefore generalisations can only be

Acknowledgments

This work would not have been possible without the co-operation of the mothers and healthcare professionals who so willingly gave consent to be observed and interviewed. We also owe especial thanks to the lactation consultant within the unit for generosity with time and input, the managers for facilitating access, MB our lay advisor, to Kate Galvin (Director of Research, IHCS) for her most helpful contribution concerning the methodological approach and to Fiona Dykes for commenting on a draft

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