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Abstract：
BACKGROUND: Breastfeeding is recognized as the gold standard of infant feeding and nutrition. The World Health Organization recommends exclusive breastfeeding (EBF) of infants for the first 6 months of life. A variety of factors may impact breastfeeding practices in-hospital which may continue after hospital discharge, such as the use of breastmilk substitutes (BMS). The Baby-Friendly Initiative (BFI), which aims to promote and support breastfeeding practices, established a target rate of 75% for EBF from birth to hospital discharge. Currently, this target is not being met at The Ottawa Hospital (TOH), indicating there is room for improvement in EBF rates. The purpose of this study is to explore health care professionals (HCP) decision-making around use of BMS and identify factors that drive the use of BMS with and without medical indications.
METHODS: In this qualitative study, semi-structured interviews were conducted with HCPs within TOH from January to June 2022. All participants had experience in maternity or postpartum care and were probed on factors influencing use of BMS at this institution. Interview transcripts were coded using an inductive approach.
RESULTS: A total of 18 HCPs were interviewed including physicians, midwives, lactation consultants, and registered nurses. Multilevel barriers influencing the use of BMS were categorized into patient, HCP, and institution-level factors. Subthemes that emerged ranged from parental preferences, training differences amongst HCPs, to budget and staffing issues. Over half of HCPs were prepared to answer questions on EBF and were familiar with the BFI. Although most were supportive of this institution receiving BFI designation, a few providers raised concerns of its impact on parents who would like to supplement.
CONCLUSIONS: Several modifiable factors influencing decision-making for use of BMS were identified. These findings will be used to inform unit leads, help identify effective strategies to address modifiable barriers, and develop tailored breastfeeding supports to improve EBF rates.
METHODS: In this qualitative study, semi-structured interviews were conducted with HCPs within TOH from January to June 2022. All participants had experience in maternity or postpartum care and were probed on factors influencing use of BMS at this institution. Interview transcripts were coded using an inductive approach.
RESULTS: A total of 18 HCPs were interviewed including physicians, midwives, lactation consultants, and registered nurses. Multilevel barriers influencing the use of BMS were categorized into patient, HCP, and institution-level factors. Subthemes that emerged ranged from parental preferences, training differences amongst HCPs, to budget and staffing issues. Over half of HCPs were prepared to answer questions on EBF and were familiar with the BFI. Although most were supportive of this institution receiving BFI designation, a few providers raised concerns of its impact on parents who would like to supplement.
CONCLUSIONS: Several modifiable factors influencing decision-making for use of BMS were identified. These findings will be used to inform unit leads, help identify effective strategies to address modifiable barriers, and develop tailored breastfeeding supports to improve EBF rates.
摘要：
背景：母乳喂养被认为是婴儿喂养和营养的黄金标准。世界卫生组织建议婴儿在生命的前6个月进行纯母乳喂养（EBF）。多种因素可能会影响医院内的母乳喂养做法，这种做法可能会在出院后继续。例如使用母乳替代品（BMS）。爱婴倡议（BFI）旨在促进和支持母乳喂养做法，从出生到出院的EBF目标率为75%。目前,渥太华医院（TOH）没有实现这一目标，这表明EBF利率还有改善的空间。这项研究的目的是探索卫生保健专业人员（HCP）围绕使用BMS的决策，并确定在有和没有医学适应症的情况下使用BMS的因素。
方法：在这项定性研究中，2022年1月至6月，在TOH内对HCP进行了半结构化访谈。所有参与者都有产妇或产后护理的经验，并在该机构探讨了影响BMS使用的因素。面试笔录使用归纳法进行编码。
结果：总共采访了18位HCPs，包括医生，助产士,哺乳顾问,注册护士影响BMS使用的多级障碍被分类为患者，HCP,和机构层面的因素。出现的子主题从父母的喜好，HCP之间的训练差异，预算和人员配备问题。超过一半的HCP准备回答有关EBF的问题，并且熟悉BFI。尽管大多数人都支持该机构获得BFI指定，一些提供者对其对想要补充的父母的影响表示担忧。
结论：确定了影响BMS使用决策的几个可改变因素。这些发现将被用来通知单位领导，帮助确定有效的策略来解决可修改的障碍，并制定量身定制的母乳喂养支持，以提高EBF率。
方法：在这项定性研究中，2022年1月至6月，在TOH内对HCP进行了半结构化访谈。所有参与者都有产妇或产后护理的经验，并在该机构探讨了影响BMS使用的因素。面试笔录使用归纳法进行编码。
结果：总共采访了18位HCPs，包括医生，助产士,哺乳顾问,注册护士影响BMS使用的多级障碍被分类为患者，HCP,和机构层面的因素。出现的子主题从父母的喜好，HCP之间的训练差异，预算和人员配备问题。超过一半的HCP准备回答有关EBF的问题，并且熟悉BFI。尽管大多数人都支持该机构获得BFI指定，一些提供者对其对想要补充的父母的影响表示担忧。
结论：确定了影响BMS使用决策的几个可改变因素。这些发现将被用来通知单位领导，帮助确定有效的策略来解决可修改的障碍，并制定量身定制的母乳喂养支持，以提高EBF率。
