title: 'Oh no, no, no, we haven׳t got time to be doing that': Challenges encountered introducing a breast-feeding support intervention on a postnatal ward.
abstract: OBJECTIVE
  to identify elements in the environment of a postnatal ward which impacted on the introduction of a breast-feeding support intervention.
  
  
  METHODS
  a concurrent, realist evaluation including practice observations and semi-structured interviews.
  
  
  METHODS
  a typical British maternity ward.
  
  
  METHODS
  five midwives and two maternity support workers were observed. Seven midwives and three maternity support workers were interviewed. Informed consent was obtained from all participants. Ethical approval was granted by the relevant authorities.
  
  
  RESULTS
  a high level of non-compliance with the intervention was driven by a lack of time and staff, and the ward staffs׳ lack of control of the organisation of their time and space. This was compounded by a propensity towards task orientation, workload reduction and resistance to change - all of which supported the existing medical approach to care. Limited support for the intervention was underpinned by staff willingness to reconsider their views and a widespread frustration with current ways of working.
  
  
  CONCLUSIONS
  this small, local study suggests that the environment and working conditions on a typical British postnatal ward present significant barriers to the introduction of breast-feeding support interventions requiring a relational approach to care.
  
  
  CONCLUSIONS
  midwives and maternity support workers need to be able to control their time and space, and feel able to provide the relational care they perceive that women need, before breast-feeding support interventions can be successfully implemented in practice. Frustration with current ways of working, and a willingness to consider other approaches, could be harnessed to initiate change that would benefit health professionals and the women and families in their care. However, without appropriate leadership or facilitation for change, this could alternatively encourage learned helplessness and passive resistance.
authors.affiliation: University of West London, Boston Manor Road, Brentford TW8 9GA, UK. Electronic address: lhunter@brookes.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Hunter
authors.affiliation: University of West London, Boston Manor Road, Brentford TW8 9GA, UK. Electronic address: Julia.magill-cuerden@uwl.ac.uk.
authors.forename: Julia
authors.initials: J
authors.lastname: Magill-Cuerden
authors.affiliation: City University, Northampton Square, London EC1V 0HB, UK. Electronic address: Christine.McCourt.1@city.ac.uk.
authors.forename: Christine
authors.initials: C
authors.lastname: McCourt
mesh_terms: D001942:Breast Feeding; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D000068101:Maternal-Child Health Services; D008880:Midwifery; D024802:Nurse's Role; D011181:Postnatal Care; D011247:Pregnancy; D013222:State Medicine; D016526:Workload
keywords: Breast-feeding support; Postnatal care; Realist evaluation; Research context; Ward environment