Supporting teenage mothers to initiate breastfeeding and developing a support intervention to increase breastfeeding rates in a vulnerable group - the importance of place

Background Not being breastfed is internationally considered to have a lifelong impact on morbidity and mortality. In the UK and other developed nations, adolescent mothers are among those least likely to breastfeed and require additional support to do so due to their unique developmental position. Evidence indicates that many young mothers who intend to breastfeed never initiate breastfeeding or stop soon after giving birth, and there may be factors in the UK health system or wider society preventing the success of breastfeeding support interventions. These considerations led to a two-phase investigation which aimed to study the context of breastfeeding support and evaluate a targeted breastfeeding support intervention for young women. Methods A realist evaluation framework was used. 83 UK health professionals responded to an e-questionnaire. Focus groups and interviews were conducted with 15 young mothers (aged 16-20) in Oxford, England. A breastfeeding support package was then developed and implemented on a UK postnatal ward for six months. A concurrent mixed methods evaluation was carried out. Each component of the investigation was analysed thematically using inductive content analysis. Ethical approval was received. Findings Young women appear motivated to breastfeed to show that they are good mothers. However, breastfeeding can alienate them from their families at a time when they need to be accepted in their new mothering role. Young mothers can feel disempowered after birth and like 'fish out of water' on the postnatal ward. A need was identified for proactive breastfeeding support from health professionals focusing on relational care, particularly as some maternity professionals displayed negative attitudes to teenage mothers and breastfeeding. Despite staff training developing a more positive and enabling attitude towards young women, much of the proposed support package proved impossible to implement in a busy, task-orientated medical environment where time, convenience, control, and individual staff beliefs were used as yardsticks to determine the acceptability of different aspects of care. Conclusion This study highlights the importance of proactive, relational breastfeeding support for young mothers. Such support requires a facilitative environment in order to be implemented successfully. It is suggested that such an environment could be created on the postnatal ward if midwives and MSWs created workplace communities and claimed ownership of their time and space. Action Learning may facilitate this process