Formula Milk Supplementation on the Postnatal Ward; A Cross-Sectional Analytical Study of Midwives’ Perceptions and Behavior


Infant formula supplementation for non-medical reasons negatively impacts breastfeeding. We explored the association between midwives’ non-clinical supplementation rates and their experience, knowledge and attitudes towards formula supplements.
Feeding records from 400 infants born during a seven week period were reviewed and 40 maternity staff were interviewed on the postnatal unit of a London maternity hospital. Midwives’ non-clinical supplementation rates were calculated using the total hours worked. Generalized linear model was used to assess the relationship between midwives’ supplementation rate and their experience, knowledge and attitude.
One hundred-forty eight of 400 infants (37%) received formula supplements postnatally, in 90% cases for non-medical reasons. All staff received breastfeeding training, however two thirds were unable to describe three appropriate supplementation. Midwives reported time constraints and workload as key barriers to supporting breastfeeding. Multivariate analyses showed that midwife attitude toward formula supplementation were independently associated with non-clinical supplementation rate, with midwives who judged that infant formula supplementation mattered most, supplementing least and vice versa (p=0.01).
In a busy postnatal unit with high non-clinical supplementation rates, we found the only variable associated with supplementation rate was midwife attitude to formula supplementation. This suggests that midwife attitude may be an important target for interventions to promote exclusive breastfeeding.
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