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 conciusions/implications for practice: healthcare professionals need to be aware that they may not be helping mothers in the tonger-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 rote modelling 'settling' skills are time consuming and have resource implications for the maternity services. (C) 2003 Elsevier Ltd. All rights reserved.
