The cultural context of breastfeeding on the labour ward

This study examines labour ward culture on two British labour wards, in terms of mother-baby contact and breastfeeding, which has not been empirically researched since 1985 (Garforth & Garcia 1989). ‘Aims’: to investigate the organisational culture; examine mothers' beliefs and experiences; and midwives' knowledge, beliefs and practices. ‘Objectives’: To compare organisational cultures; identify if midwifery practice is evidence based and factors which facilitate or detract from it; identify mothers' preferences, beliefs and levels of satisfaction. ‘Study Design’: Ethnography with case study and diagnostic analysis also utilised. Methods: observation and interviews: purposive sample of mothers (n = 50) and midwives (n = 51); interviews with Heads of Midwifery (n = 2); focus groups with midwives (n = 3); and documentary analysis. ‘Results’: Despite Trust strategies and Heads of Midwifery support for evidence-based practice, clinical guidelines and midwifery beliefs about mother-baby contact and early breastfeed were not usually congruent. Mother-baby contact after birth is usually interrupted for completion of tasks and some babies have multiple contact episodes, which has not been previously described in the literature. Completion of routine tasks for transfer of mothers and babies to postnatal ward takes precedence, because of organisational demands and insufficient resources. However, most mothers expressed feeling satisfied with contact achieved and support for breastfeeding. ‘Conclusion’: Findings of the study have contributed new insights and knowledge of labour ward culture. It is not conducive to uninterrupted mother-baby contact and is not evidence-based. ‘Recommendations’: The development of a learning culture and clinical leadership to promote evidence-based practice and woman-centred care is recommended. The unique period after birth should not be disturbed, to prioritise routine tasks