Experiences with limiting pacifier use during the hospital stay: A multi-site qualitative study of nursing staff members and medical providers

Background: The Ten Steps to Successful Breastfeeding are a set of hospital-based practices shown to support mothers' achievement of breastfeeding. Step 9 is that pacifiers and artificial nipples are not provided to breastfeeding infants. This study explores the experiences of nursing staff members and providers across six hospitals vis-à-vis limiting hospital-based pacifier use among breastfeeding infants. Methods: Twenty-two key informants were interviewed across six hospitals to explore their experiences with the Ten Steps to Successful Breastfeeding. Informants were asked about their thoughts and experiences related to Step 9: that pacifiers and artificial nipples not be provided to breastfeeding infants. A codebook outlined coding procedures used to analyze transcribed interviews. Results: Physicians and nurses noted several factors that reduced their commitment to implementing Step 9: lack of belief in ‘nipple confusion', personal experience that pacifiers did not inhibit breastfeeding, belief that sometimes infants simply need to suck, and that we need to give patients pacifiers since they want them. Factors that helped overcome these perceptions and served to increase support for Step 9 included education on the biological ties between pacifiers and breastfeeding, epidemiological evidence on the relationship between pacifier use and breastfeeding, and contextualized strategies. Conclusions: Targeted education materials that explain both the biological and epidemiological evidence is needed along with efforts that account for local context.