The supporting role of the midwife during the first 14 days of breastfeeding: A descriptive qualitative study in maternity wards and primary healthcare

Introduction: In Flanders, Belgium, 78.2% of the women exclusively breastfeed their babies following birth. However, after three months just one third of those babies is breastfed exclusively. This is in contrast with the WHO recommendations of a minimum of six months. Studies reveal that women are not always satisfied with the breastfeeding support they receive from their midwives, which can lead to early cessation of breastfeeding. The general aim of this study is to gain an in-depth understanding of the supporting role of midwives in breastfeeding support during the first two weeks after birth and compare it to the needs of the breastfeeding women. Methods: A qualitative approach was used with an observational design and a focus group study. Two researchers performed non-participative observations in both hospital and primary healthcare settings. Midwife-mother interactions during breastfeeding support (midwives, n = 21; mothers, n = 59) were observed. Analysis of the data gathered from two focus groups with midwives (n = 10) and two focus groups with mothers (n = 9) provides an in-depth understanding of the supporting role of midwives during breastfeeding and helps to investigate whether that role corresponds to the mothers' needs both from the mothers' and the midwives' perspective. Observations and focus groups were analyzed using thematic analysis. Findings: The analysis showed that both midwives and mothers want the breastfeeding to be a success. Generally, the production of breastmilk is a priority, for both the midwives and the mothers. Overall a hands-on approach regarding breastfeeding support was observed, mainly in the hospital settings when compared with the findings from the primary healthcare settings. A hands-on approach often occurs without asking the mother's consent. During the breastfeeding support, a professional relationship between the midwife and the mother is fostered. In primary healthcare there is one - to - one support which is contrary to hospital care, resulting in a personalized relationship. Breastfeeding support is influenced by personal (e.g. negative belief in breastfeeding policies) and external context factors (e.g. time restraints). Conclusion: The research data revealed three topics on breastfeeding support by the midwife which were the focus, the approach and the relationship between the midwife and the mothers. The way the midwife provides this support varies due to the setting (hospital or primary health care) and due to personal convictions of midwives and mothers. The study shows the importance of providing breastfeeding support which is tailored to individual needs of the mother. (C) 2019 Elsevier Ltd. All rights reserved.