Assessing and Addressing Healthcare Providers' Attitudinal Barriers to Improving Breastfeeding Support in the Maternity Setting

Background/Purpose: Breastfeeding support during the maternity stay is highly correlated with later breastfeeding success. However, the best practices based on the Ten Steps to Successful Breastfeeding, are not normative. This study, part of a larger study of maternity breastfeeding practices, assesses provider knowledge, attitude and practice of the Ten Steps to inform maternity nurses' training to improve the quality of breastfeeding support.

Data/Methods: The Carolina Global Breastfeeding Institute conducted an electronic survey, key informant interviews and semi-structured meetings with health care providers as part of baseline and mid-point assessment for the Breastfeeding-Friendly Healthcare Project. These tools assess providers' knowledge, attitudes and practices in relation to breastfeeding and the Ten Steps to Successful Breastfeeding before and following intervention activities. Quantitative findings are enriched by thematic content analysis of key informant interviews, which were organized around the same principles as the e-survey.

Results: In 2010, we reported that many professionals demonstrate a theoretical awareness of “best practices.” While some mal-adherence to evidence-based practice is due to lacking knowledge, most appears to be related to attitudes about breastfeeding, women and children, and patient care priorities. Specifically, the study found: 1) predominant belief that breastfeeding support is too time consuming, 2) mother's sleep is given priority over opportunities to support feeding, and 3) other anti-breastfeeding or pro-commercial formula attitudes that deleteriously effect implementation of evidence-based practice.

Recommendations: Nurse-level and other breastfeeding knowledge and skills training should include significant attention to attitudinal barriers to supporting breastfeeding.