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MAINN Talk On BFHI by Anna Byrom Reviewed By Liz O’Sullivan

Anna Byrom of the University of Central Lancashire, a Lecturer in Midwifery, gave the first keynote talk on Day 3 of the conference, for which she received a standing ovation. She described some results from her PhD, an ethnographic study that she has been working on for the last 9 years. For her PhD, Anna explored the cultural impact of implementing the Baby Friendly Hospital Initiative (BFHI) in a maternity unit in the North-West of England. Her focus was on the impacts on staff but also the perceptions and views of families, given that the surrounding areas had a high prevalence of formula feeding. Given that she has been doing her PhD part-time, she was also able to observe changes in practice with the change in guidance in the UK that was introduced in 2012, which encouraged staff to focus on person-centred care.

Anna outlined key themes that she developed from her ethnographic data. The first she described was the environment and, in this case, it was likened to a fast-food restaurant as there was often pressure to free up beds and process women and babies through the system. The maternity unit was described as being very fast-paced, and the postnatal ward was described as being the last stop on a conveyor belt. Because the postnatal ward was so busy, women often shut themselves off and pulled the curtains around their beds. This meant that breastfeeding was not often visible on the wards. In addition, women often stopped breastfeeding when they had visitors, further decreasing the visibility of breastfeeding.

In spite of the fast pace and the background prevalence of formula feeding in the community, the Baby Friendly ideals were ingrained in the practice of the staff at this maternity unit. Anna constantly witnessed examples of infant-feeding education being prioritised and staff ensuring that they fit it into their day. Staff said that they just don’t even think about it anymore, it is simply an integral part of their job. The staff took time to help mothers with feeding and simply sitting with mothers as they fed their babies—as opposed to sitting over them—was highlighted as a particularly supportive activity.

The fact that the Baby Friendly ideals were ingrained in the practice of the midwifery staff was the dominant message from this talk and it was reflected again in the Q&A session. Anna was asked her experience of how the delivery of care changed in times when the unit was better funded compared to times when it was not. She felt that mothers and babies received better care when the unit was better staffed; however, even when the unit was short-staffed, the midwives still did their best to provide care related to breastfeeding, though they often felt/wished that they could do more. The most salient take-home message, for me, was that when breastfeeding is viewed as important by healthcare providers, they will do what they can to provide whatever support and care they can. It is not just the case of having a policy like BFHI in place that is important, the staff have to buy in to the policy and believe in the value of it.


Liz O’Sullivan October 2019.

Liz received a bursary of €100 from ALCI to attend the Nutrition and Nurture in Infancy and Childhood: Bio-cultural Perspectives MAINN Conference.

Further Reading


Presenting at the ILCA 2023 In-person Conference in Las Vegas:  A Personal Account


ILCA 2023 Conference Presentation: Building Policy Coalitions


WHO/Unicef Congress