UNICEF UK Baby Friendly Initiative: Providing, receiving and leading infant feeding care in a hospital maternity setting—A critical ethnography

Abstract

Although breastfeeding is known to improve health, economic and environmental outcomes, breastfeeding initiation and continuation rates are low in the United Kingdom. The global WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) aims to reverse declining rates of breastfeeding by shifting the culture of infant feeding care provision throughout hospital maternity settings. In the United Kingdom, the global BFHI has been adapted by UNICEF UK reflecting a paradigm shift towards the experiences of women and families using maternity services. This research used a critical ethnographic approach to explore the influence of the national UNICEF UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England, over a period of 8 weeks, across four phases of data collection between 2011 and 2017. Twenty-one staff and 26 service users were recruited and engaged in moderate-level participant observation and/or guided interviews and conversations. Basic, organising and a final global theme emerged through thematic network analysis, describing the influence of the BFI on providing, receiving and leading infant feeding care in a hospital maternity setting. Using Antonovsky's sense of coherence construct, the findings discussed in this paper highlight how the BFI offers 'informational' (comprehensible), 'practical' (manageable) and 'emotional' (meaningful) support for both staff and service users, strengthened by effective, local leadership and a team approach. This is juxtaposed against the tensions and demands of the busy hospital maternity setting. It is recommended that ongoing infant feeding policy, practice and leadership balance relational and rational approaches for positive infant feeding care and experiences to flourish.

Maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals: An integrative review

“…The qualitative findings showed positive maternal experiences ( Miller et al., 2018 , Byrom et al., 2020 ). Mothers were mostly satisfied with the Ten Steps practices they encountered in the hospital ( Miller et al., 2018 ) and experienced a good balance within the practical support and information they were provided with by the healthcare professionals ( Byrom et al., 2020 ).…”

“…Three studies had a qualitative approach. The data collection methods comprised semi-structured interviews (n=1) of African American mothers ( Miller et al., 2018 ), in-depth qualitative interviews (n=1) of Taiwanese mothers of infants with breast milk jaundice ( Chu et al., 2019 ) and short interviews as a part of an ethnographic study of mothers in a Baby-Friendly hospital ( Byrom et al., 2020 ). Data were collected either in the birth hospital, in a BFHI-affiliated clinic or at home after hospital discharge.…”

“… Over half of mothers (59 % vs 48 % non-BFH, p<0.001) experienced all four hospital practices (first contact skin-to-skin, first feed within 60 min, rooming-in all the time and exclusive breastfeeding). 7/11 Byrom et al., (2020) , UK To explore the influence of the national UNICEF UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England A critical ethnographic study, a convenience sample of 26 members of maternity staff and 21 service users (n = 16 mothers, n = 5 fathers). Observations and short interviews with mothers and fathers to clarify participant actions, thoughts and feelings related to particular care experiences while in the hospital.…”

“…The qualitative findings showed positive maternal experiences (Miller et al, 2018, Byrom et al, 2020. Mothers were mostly satisfied with the Ten Steps practices they encountered in the hospital (Miller et al, 2018) and experienced a good balance within the practical support and information they were provided with by the healthcare professionals (Byrom et al, 2020). The care and support provided by the professionals was also experienced as 'emotionally engaging' helping mothers to feel reassured and confident in caring and feeding their infant as well as responsive to their needs (Byrom et al, 2020).…”

Psychosocial predictors of post‐natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post‐natal guilt and shame, and post‐natal anxiety and depression within an infant feeding context

“…Removing breastfeeding imperatives from infant feeding discussions, encouraging incremental goal setting and normalising common breastfeeding difficulties during routine care is recommended. These recommendations echo calls to action detailed in pre-existing infant feeding literature (e.g., Brown et al, 2011;Byrom et al, 2021) and policy documentation (UNICEF, 2022). Standardising perinatal mental health and infant feeding training as routine among health care staff (McLelland et al, 2015;Myors et al, 2012;Webb et al, 2021),…”