Discontinuity of Breastfeeding Care: “There's No Captain of the Ship”

Abstract

Background: Breastfeeding rates in the United States are suboptimal. Health professionals (HPs) have a unique opportunity to support breastfeeding because of the frequency and timing of their visits with mothers and infants as well as their call by professional organizations to do so. The objective of this study was to understand HPs' perceived roles and experiences with providing breastfeeding-related care. Materials and Methods: In-depth qualitative interviews were conducted with 34 HPs (obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. Interviews were audio-recorded, transcribed, and verified for accuracy; content analysis was used to identify themes using a grounded theory approach. Results: The overarching theme was discontinuity in breastfeeding care across the continuum. Most HPs relied on other HPs to provide breastfeeding care, which resulted from and contributed to problematic gaps in care that were reported. A minority of HPs attempted to bridge gaps in breastfeeding care or improve continuity. Contributing to the discontinuity were a lack of time, lack of skills, inconsistent messages, and low communication across stages of care. HPs were unsure whether their help was effective and whether required follow-up was completed. Conclusions: Despite HPs' recognition of breastfeeding as the best choice for infant feeding, breastfeeding care may be disjointed and a barrier to achieving breastfeeding recommendations. These problems should be investigated and systemically addressed in future research so that maternal-infant dyad breastfeeding care can be improved.

Breastfeeding: Beyond Nutrition. Breastfeeding Support: Beyond Biology

“…Garner et al 3 performed a series of indepth qualitative interviews of healthcare workers and confirmed what many of us have perceived (i.e., that there is a discontinuity of care of breastfeeding mothers reflected not only in the lack of specific knowledge but also the more problematic reality of the absence of a guiding responsible hand, or, as phrased by the authors, ''there's no captain of the ship''). The problem that they document highlights the need to provide more attention to organizational, structural, system analyses and the need for incorporating expertise in these matters if we are going to move forward in supporting the mother and infant.…”

Vulnerable mothers' experiences breastfeeding with an enhanced community lactation support program

“…Previous research suggests that breastfeeding intention is a significant predictor for initiation and duration, but early breastfeeding experiences may mediate its effect on duration (DiGirolamo, Thompson, Martorell, Fein, & Grummer‐Strawn, ; Mitra, Khoury, Hinton, & Carothers, ). Unfortunately, qualitative and quantitative studies have highlighted that there are gaps in breastfeeding support, and this disproportionately affects vulnerable women (Chalmers et al, ; Garner et al, ).…”

Caring for Women Experiencing Breast Engorgement: A Case Report

“…Recent studies have shown that interprofessional care is important to increase rates of breastfeeding and provide adequate support for women ,. One qualitative study found a discontinuity in lactation support across a continuum of health care providers . As there is no one clearly effective treatment for breast engorgement, and women interface with multiple different health care providers in the postpartum period, women often receive conflicting advice on how to deal with breastfeeding problems when they arise.…”

“…28,29 One qualitative study found a discontinuity in lactation support across a continuum of health care providers. 30 As there is no one clearly effective treatment for breast engorgement, and women interface with multiple different health care providers in the postpartum period, women often receive conflicting advice on how to deal with breastfeeding problems when they arise. This case study demonstrated that conflicting advice from multiple sources was overwhelming and not evidence based.…”