Background: Breastfeeding preterm infants is shown to have important health benefits for both infants and mothers. A
positive relationship between mothers and healthcare teams and supportive practices tend to facilitate maternal competence
and promote early initiation of breastfeeding within neonatal intensive care units (NICUs).
Purpose: The aim of this study was to understand attitudes and behaviors of healthcare professionals toward breastfeeding
practices and supporting mothers of preterm infants.
Methods: This study adopted an ethnographic research design that involved 135 hours of participant observation over a
6-month period and semistructured interviews of 10 nurses and 5 physicians.
Results: Data analysis suggests that while staff members agree with the benefits of breastfeeding for preterm infants,
the actual implementation of a breastfeeding policy within NICUs is problematic. Three key themes emerged. The first
described the contradiction that exists between the staff beliefs and behaviors in relation to breastfeeding and supporting
mothers. The second theme was related to staff working conditions , which described the lack of institutional support and
barriers to supporting breastfeeding. The final theme of controlling relationships captured the essence of the practitioner
to mother association. Together, these elements revealed a situation whereby the staff appeared more preoccupied with
addressing the task of caring for the babies than with supporting mothers in feeding and subsequently caring for their
Implications for Practice: The institutional barriers to breastfeeding promotion within NICUs should be addressed by
healthcare providers. Actions that provide a supportive environment within NICUs for both mothers and nurses are essential
to improve the overall quality of care.
Implications for Research: Future research may include an examination of hospital policies and practices of promoting
breastfeeding for pre