title: A critical ethnographic study of encounters between midwives and breast-feeding women in postnatal wards in England.
abstract: OBJECTIVE
  To explore the nature of interactions between midwives and breast-feeding women within postnatal wards.
  
  
  METHODS
  A critical ethnographic study using participant observation and focused interviews.
  
  
  METHODS
  Two maternity units in Northern England, UK.
  
  
  METHODS
  61 postnatal women and 39 midwives.
  
  
  RESULTS
  The interactions between midwives and women were encompassed by the global theme of 'taking time and touching base'. However, most encounters were characterised by an absence of 'taking time' or 'touching base'. This related to midwives' experiences of temporal pressure and inability to establish relationality with women due to their working patterns. The global theme was underpinned by five organising themes: 'communicating temporal pressure'; 'routines and procedures'; 'disconnected encounters'; 'managing breast feeding'; and 'rationing information'.
  
  
  CONCLUSIONS
  The organisational culture within the postnatal wards contributed to midwives experiencing profound temporal pressures and an inability to establish relationality with women. Within this context, the needs of breast-feeding women for emotional, esteem, informational and practical support were largely unmet.
  
  
  CONCLUSIONS
  Transformative action is required to dramatically reorganise the provision of hospital-based, postnatal ward midwifery care in parts of the UK. This should include a re-conceptualisation of caring time, with recognition that midwives need sufficient time in order to give time to others. This, in turn, requires recognition that caring time is cyclical and rhythmical, allowing for relationality, sociability, mutuality and reciprocity. The midwifery staffing structure in postnatal wards needs to be reviewed, as it is unacceptable to midwives and service users for staff to be rapidly relocated according to other demands within the institution. Most radically, it is argued that now is the time to reconsider the suitability of the hospital as the place and space within which women commence their breast-feeding journey.
authors.affiliation: Midwifery Studies Research Unit, University of Central Lancashire, Preston PR1 2HE, UK. fcdykes@uclan.ac.uk
authors.forename: Fiona
authors.initials: F
authors.lastname: Dykes
mesh_terms: D000293:Adolescent; D000328:Adult; D000884:Anthropology, Cultural; D001942:Breast Feeding / Q000208:ethnology / Q000523:psychology; D004739:England; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D008880:Midwifery / Q000592:standards*; D009035:Mothers / Q000193:education / Q000523:psychology; D033262:Narration; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015279:Organizational Culture; D010561:Personnel Staffing and Scheduling / Q000592:standards; D011181:Postnatal Care / Q000592:standards*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D016526:Workload / Q000592:standards