It is well recognized that breast milk is the best form of nutrition for babies.
However, many women do not breastfeed or give up soon after birth.
A quantitative study aimed to estimate the separate effects of midwifery factors in the overall context of socio-demographic and clinical influences on breastfeeding.
Data from the 2006 National Maternity Survey were used.
Questions relating to infant feeding allowed calculation of rates of initiation of breastfeeding and rates of exclusive and any breastfeeding in the first few days and at 3 months.
Univariate analyses were carried out to estimate the associations between different and breastfeeding and logistic regression to estimate the specific effects of midwifery factors.
The most powerful explanatory factor was antenatal feeding intention.
Maternal age, absence of clinical problems in the baby and a short post-natal stay were important in the early days.
At 3 months, breastfeeding was associated with sociodemographic and intrapartum factors.
At all stages, breastfeeding was significantly associated with either receiving consistent advice, practical help and active encouragement from midwives.
The study confirmed that the antenatal decision about infant feeding is the most powerful predictor of infant feeding behaviour.
While some sociodemographic and clinical factors are important influences on breastfeeding, after adjustment for these, midwifery factors were still found to be influential.
A qualitative study was also carried out on the data provided by the same sample of women, the objective of which was to gain a better understanding of what is needed in the early days to enable women to initiate and continue breastfeeding.
The open text responses of 534 women who wrote about infant feeding were analysed thematically.
The main themes identified were "the mismatch between women's expectations and experiences" and "emotional reactions" at this time, "staff behavior and attitudes," and "the organization of care and facilities."
Sub-themes related to seeking help, conflicting advice, pressure to breastfeed, the nature of interactions with staff, and a lack of respect for women's choices, wishes, previous experience, and knowledge.
Many women who succeeded felt that they had "learned the hard way" and some of those who did not, felt they were perceived as "bad mothers" who had in some way "failed" at one of the earliest tasks of motherhood.
It was concluded that staff engagement and support was critical to success and that what women experienced as be staff perceptions affected how they saw themselves and what they took away from their early experience of infant feeding.