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