‘Oh no, no, no, we haven׳t got time to be doing that’: Challenges encountered introducing a breast-feeding support intervention on a postnatal ward

Abstract

Objectiveto identify elements in the environment of a postnatal ward which impacted on the introduction of a breast-feeding support intervention. Designa concurrent, realist evaluation including practice observations and semi-structured interviews. Settinga typical British maternity ward. Participantsfive midwives and two maternity support workers were observed. Seven midwives and three maternity support workers were interviewed. Informed consent was obtained from all participants. Ethical approval was granted by the relevant authorities. Findingsa high level of non-compliance with the intervention was driven by a lack of time and staff, and the ward staffs׳ lack of control of the organisation of their time and space. This was compounded by a propensity towards task orientation, workload reduction and resistance to change – all of which supported the existing medical approach to care. Limited support for the intervention was underpinned by staff willingness to reconsider their views and a widespread frustration with current ways of working. Key conclusionsthis small, local study suggests that the environment and working conditions on a typical British postnatal ward present significant barriers to the introduction of breast-feeding support interventions requiring a relational approach to care. Implications for practicemidwives and maternity support workers need to be able to control their time and space, and feel able to provide the relational care they perceive that women need, before breast-feeding support interventions can be successfully implemented in practice. Frustration with current ways of working, and a willingness to consider other approaches, could be harnessed to initiate change that would benefit health professionals and the women and families in their care. However, without appropriate leadership or facilitation for change, this could alternatively encourage learned helplessness and passive resistance.