Exclusive breastfeeding: The role of midwives at pregnancy, childbirth and postpartum

Abstract

Background and purpose: The coverage of exclusive breastfeeding is reported to be low. The aim of this study was to explore the extent of the roles of midwives during pregnancy, childbirth and postpartum to increase exclusive breastfeeding. Methods: This study applied a qualitative approach by in-depth interviews based on interview guidelines to explore the role of midwives in increasing exclusive breastfeeding during pregnancy, childbirth and postpartum. This study was conducted in the area of Kuta I Public Health Center (PHC), Badung District, Bali Province from October 2017 to July 2018. Interviews were conducted with 12 informants chosen purposively, namely three PHC midwives, two private practice midwives, one nutrition program manager, four mothers who managed to provide exclusive breastfeeding and two who did not. Data were analyzed with a thematic approach. Results: This study shows that the roles of midwives are not optimal. The role that has been carried out during pregnancy is to provide information about breast care but not to practice breast care. During labor, the midwife facilitated the initiation of early breastfeeding except for mothers who experienced childbirth complications. During the postpartum period the midwife provides information about breastfeeding to working mothers and monitors exclusive breastfeeding at the integrated health services centers or in Indonesia called pos pelayanan terpadu (posyandu) until the infant reach the age of six months. Midwives provide information about breast care and how to overcome problems in breastfeeding, but do not facilitate the practice of both. All midwives do not conduct home visits for several reasons, such as distance to residents’ homes, high burden of tasks and lack of human resources. Midwives also provide counselling at posyandu on maternal and child nutrition but do not focus on exclusive breastfeeding. Conclusion: The roles of midwives in facilitating exclusive breastfeeding during pregnancy, childbirth and postpartum are still superficial and not in accordance with the guidelines for obstetric care. The roles of midwives need to be enhanced to increase exclusive breastfeeding.