How midwives and nurses experience implementing ten steps to successful breastfeeding: a qualitative case study in an Indonesian maternity care facility.
Journal
International breastfeeding journal
ISSN: 1746-4358
Titre abrégé: Int Breastfeed J
Pays: England
ID NLM: 101251562
Informations de publication
Date de publication:
03 12 2022
03 12 2022
Historique:
received:
20
06
2022
accepted:
19
11
2022
entrez:
2
12
2022
pubmed:
3
12
2022
medline:
7
12
2022
Statut:
epublish
Résumé
The in-hospital stay following childbirth is a critical time for education and support of new mothers to establish breastfeeding. The WHO/UNICEF 'Ten Steps to Successful Breastfeeding (Ten Steps)' was launched globally in 1989 to encourage maternity services to educate and support mothers to breastfeed. The strategy is effective, however its uptake within health systems and facilities has been disappointing. We aimed to understand midwives' and nurses' experiences of implementing the Ten Steps in an Indonesian hospital. This qualitative study was conducted in an Indonesian hospital which has been implementing the Ten Steps since the hospital's establishment in 2012. Fourteen midwives and nurses participated in a focus group in January 2020. Data were analyzed using thematic analysis. We identified five themes that represented midwives' and nurses' experiences of implementing the Ten Steps in this Indonesian maternity unit: 1) Human rights of child and mother, 2) Dependency on precarious leadership, 3) Lack of budget prioritization, 4) Fragmented and inconsistent implementation of the Ten Steps across the health system, and 5) Negotiating with family, community and culture. The results highlighted a dependency on local hospital champions and a lack of budget prioritization as barriers to implementation, as well as health system gaps which prevented the enablement of mothers and families to establish and maintain breastfeeding successfully in Indonesian maternity services. As Indonesia has one of the largest populations in South East Asia, it is an important market for infant milk formula, and health services are commonly targeted for marketing these products. This makes it especially important that the government invest strongly in Ten Steps implementation. Continuity of care within and across the health system and leadership continuity are key factors in reinforcing its implementation. The study findings from this Indonesian maternity care facility re-emphasize WHO recommendations to integrate the Ten Steps into national health systems and increase pre-service education on breastfeeding for health care professionals.
Sections du résumé
BACKGROUND
The in-hospital stay following childbirth is a critical time for education and support of new mothers to establish breastfeeding. The WHO/UNICEF 'Ten Steps to Successful Breastfeeding (Ten Steps)' was launched globally in 1989 to encourage maternity services to educate and support mothers to breastfeed. The strategy is effective, however its uptake within health systems and facilities has been disappointing. We aimed to understand midwives' and nurses' experiences of implementing the Ten Steps in an Indonesian hospital.
METHODS
This qualitative study was conducted in an Indonesian hospital which has been implementing the Ten Steps since the hospital's establishment in 2012. Fourteen midwives and nurses participated in a focus group in January 2020. Data were analyzed using thematic analysis.
RESULTS
We identified five themes that represented midwives' and nurses' experiences of implementing the Ten Steps in this Indonesian maternity unit: 1) Human rights of child and mother, 2) Dependency on precarious leadership, 3) Lack of budget prioritization, 4) Fragmented and inconsistent implementation of the Ten Steps across the health system, and 5) Negotiating with family, community and culture. The results highlighted a dependency on local hospital champions and a lack of budget prioritization as barriers to implementation, as well as health system gaps which prevented the enablement of mothers and families to establish and maintain breastfeeding successfully in Indonesian maternity services.
CONCLUSIONS
As Indonesia has one of the largest populations in South East Asia, it is an important market for infant milk formula, and health services are commonly targeted for marketing these products. This makes it especially important that the government invest strongly in Ten Steps implementation. Continuity of care within and across the health system and leadership continuity are key factors in reinforcing its implementation. The study findings from this Indonesian maternity care facility re-emphasize WHO recommendations to integrate the Ten Steps into national health systems and increase pre-service education on breastfeeding for health care professionals.
Identifiants
pubmed: 36461020
doi: 10.1186/s13006-022-00524-2
pii: 10.1186/s13006-022-00524-2
pmc: PMC9719222
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
84Informations de copyright
© 2022. The Author(s).
Références
Acta Paediatr. 2015 Dec;104(467):114-34
pubmed: 26183031
Breastfeed Med. 2016 Oct;11:413-5
pubmed: 27682459
Int Breastfeed J. 2020 Apr 8;15(1):23
pubmed: 32268920
J Hum Lact. 2022 Aug;38(3):564-569
pubmed: 35726490
J Pediatr. 2019 Mar;206:6-7
pubmed: 30798838
J Hum Lact. 2022 Nov;38(4):780-791
pubmed: 35792378
JAMA Netw Open. 2019 Oct 2;2(10):e1913401
pubmed: 31617928
Nutr Rev. 2020 Oct 1;78(10):866-883
pubmed: 31968101
Int J Equity Health. 2021 Jan 7;20(1):22
pubmed: 33413439
BMC Public Health. 2018 Apr 2;18(1):424
pubmed: 29606106
Appetite. 2022 Mar 1;170:105907
pubmed: 34979175
J Hum Lact. 2017 May;33(2):422-434
pubmed: 28196329
Matern Child Nutr. 2016 Jul;12(3):375-80
pubmed: 27161881
J Gen Intern Med. 2022 Oct;37(13):3411-3418
pubmed: 35060006
Acta Paediatr. 2020 Sep;109(9):1787-1790
pubmed: 31965623
J Relig Health. 2021 Feb;60(1):362-373
pubmed: 31093832
MCN Am J Matern Child Nurs. 2018 Jan/Feb;43(1):38-43
pubmed: 29215422
Aust Health Rev. 2018 Feb;42(1):72-81
pubmed: 28160787
Birth. 2011 Sep;38(3):238-45
pubmed: 21884232
Acad Med. 2021 Jun 1;96(6):808-812
pubmed: 34031302
Breastfeed Med. 2020 Dec;15(12):814-815
pubmed: 33320793
Lancet. 2016 Jan 30;387(10017):416
pubmed: 26869553
Lancet Glob Health. 2019 Nov;7(11):e1484-e1486
pubmed: 31607455
Acta Paediatr. 2015 Dec;104(467):30-7
pubmed: 26192560
Yale J Biol Med. 2021 Sep 30;94(3):429-458
pubmed: 34602882
Midwifery. 2018 Jul;62:220-229
pubmed: 29723790
JAMA Oncol. 2020 Jun 1;6(6):e200421
pubmed: 32239218
Breastfeed Med. 2016 Jun;11:222-30
pubmed: 27082284
Health Policy Plan. 2019 Jul 1;34(6):407-417
pubmed: 31236559
BMC Pediatr. 2018 Feb 9;18(1):48
pubmed: 29426317
Asia Pac J Public Health. 2016 Jan;28(1):7-14
pubmed: 26792873
BMJ Open. 2020 Oct 15;10(10):e039418
pubmed: 33060090
S Afr Med J. 2019 Nov 27;109(12):902-906
pubmed: 31865949
Int Breastfeed J. 2015 Feb 23;10:8
pubmed: 25873985
J Med Internet Res. 2017 Nov 01;19(11):e367
pubmed: 29092808
Matern Child Nutr. 2016 Jul;12(3):402-17
pubmed: 26924775
Women Birth. 2022 Feb;35(1):59-69
pubmed: 33741311
Matern Child Health J. 2011 Jul;15(5):597-609
pubmed: 20571902
J Am Heart Assoc. 2022 Jan 18;11(2):e022746
pubmed: 35014854
JAMA. 2001 Jan 24-31;285(4):413-20
pubmed: 11242425
Int Breastfeed J. 2022 Mar 5;17(1):18
pubmed: 35248090