title: The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals' perspectives on the implementation of the Baby-Friendly Hospital Initiative.
abstract: BACKGROUND
  The health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice.
  
  
  METHODS
  In this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis.
  
  
  RESULTS
  Midwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice.
  
  
  CONCLUSIONS
  Differing approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter-professional teamwork and collaboration are widely espoused goals of contemporary healthcare improvement strategies. Yet, critical debate on how these goals can be integrated into practice is needed. To enable collaboration and facilitate the implementation of programs such as BFHI, the different perspectives of health professionals should be brought together and the potential for integrating different forms of knowledge and practices should be considered.
authors.affiliation: Ludwig Boltzmann Institute Health Promotion Research, Ludwig Boltzmann Gesellschaft, Untere Donaustraße 47, 1020, Vienna, Austria. c_wieczorek@yahoo.de.
authors.forename: Christina C
authors.initials: CC
authors.lastname: Wieczorek
authors.affiliation: Ludwig Boltzmann Institute Health Promotion Research, Ludwig Boltzmann Gesellschaft, Untere Donaustraße 47, 1020, Vienna, Austria.|School of Applied Social Science, University of Brighton, Mayfield House, Falmer, BN1 9PH, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Marent
authors.affiliation: Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Dorner
authors.affiliation: Ludwig Boltzmann Institute Health Promotion Research, Ludwig Boltzmann Gesellschaft, Untere Donaustraße 47, 1020, Vienna, Austria.|Faculty of Social Sciences, University of Vienna, Rooseveltplatz 2, 1090, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dür
mesh_terms: D001291:Attitude of Health Personnel; D001317:Austria; D001942:Breast Feeding; D003299:Cooperative Behavior; D005260:Female; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008427:Maternal Health Services; D009775:Obstetrics and Gynecology Department, Hospital; D036801:Parturition; D011247:Pregnancy; D015397:Program Evaluation; D036301:Qualitative Research
keywords: Baby-Friendly Hospital Initiative; Breastfeeding; Collaboration; Division of labor; Health services research; Healthcare professions; Teamwork