'Breaking the rules' in baby-feeding practice in the UK: deviance and good practice?
OBJECTIVE
to discover the views of midwives in relation to baby feeding.


METHODS
qualitative using grounded theory. Data collection used in-depth interviews with 30 midwives who volunteered to participate. Field notes of the interaction between the researcher and participant were also recorded as data. The constant comparison process was used to generate codes and subsequent conceptualisations from the data.


METHODS
two maternity units in the North of England, UK.


RESULTS
the core category of this study is called 'surviving' baby feeding, and the findings reported here are a significant theme that emerged. These midwives described a management strategy termed 'breaking the rules' for supporting mothers with baby feeding. The concept 'breaking the rules' represented practices that were not congruent with evidence-based, baby-feeding policy and recommendations, or with some practices that were usual in the local working environment. These midwives were aware of their actions but described how they 'hid' their behaviour from mothers and from their peers. Some of the behaviour described showed that these midwives 'broke the rules' in relation to professional requirements and the facilitation of informed decision making about feeding practices with the women in their care. However, some midwives reported examples of practice that is woman-centred, and supportive of baby feeding, but this was not acceptable to others in the working environment.


CONCLUSIONS
deviant behaviour was described by these midwives in relation to informed decision making and options for mothers in baby-feeding practice. These midwives 'knowingly concealed' their deviant practices from others. These behaviours should be taken seriously as they risk being negligent in relation to UK statutory professional requirements. However, practices that depart from those that are normal in the local working environment are not always negative and detrimental to the recipients of care; they can be positive. There needs to be more research, open discussion and debate about midwifery practice that does not always 'fit in' with professional, and 'normal' expectations. In this study, the term 'baby feeding' relates to how babies' nutritional needs are met.
Furber
Christine M
CM
School of Nursing, Midwifery and Social Work, The University of Manchester Gateway House, Piccadilly South, Manchester, M60 7LP, UK. christine.furber@man.ac.uk
Thomson
Ann M
AM
D001942:Breast Feeding; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007224:Infant Care / Q000379:methods* / Q000523:psychology; D007231:Infant, Newborn; D008880:Midwifery / Q000379:methods*; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology; D033262:Narration; D024802:Nurse's Role; D015404:Nursing Methodology Research; D011795:Surveys and Questionnaires; D006113:United Kingdom