title: Supporting breast-feeding women from the perspective of the midwife: A systematic review of the literature.
abstract: BACKGROUND
  In 2003 the World Health Organization (WHO) recommended that infants should be fed exclusively with breast milk until the age of six months. However, breast feeding rates remain lower than recommended. The crucial period for breast feeding support is the first two weeks after birth. During this period breast feeding support from the midwife is needed. The aim of this paper is to gain an in-depth understanding of the role of midwives in their support of breast-feeding women, from their own perspective.
  
  
  METHODS
  Two researchers independently conducted a systematic and comprehensive literature search. Studies needed an empirical qualitative research design (1), had to focus on the role of the midwife in the support of the breast-feeding woman from the midwife's perspective (2), and had to be published between January 2005 and December 2014 (3) in order to be included. Language restrictions were English, Dutch, German and French. Eight qualitative research studies were included, using mainly focus group and in-depth interview studies, which were reported in 11 papers representing 231 midwives and 24 maternity nurses. All but one study concerned midwives working in hospital settings. A critical appraisal was performed of each study.
  
  
  RESULTS
  Midwives value breast feeding education and breast feeding support as a significant part of their role as a postnatal midwife. However, the ways in which a midwife approaches and supports the breast-feeding woman vary. We distinguished two perspectives: 'the midwife as technical expert' and 'the midwife as a skilled companion'. The 'technical expert' midwife is mainly breast centred, focuses on techniques, uses the hands on approach and sees a woman as a novice. The 'skilled companion' midwife is woman centred, focuses on the mother - infant relationship and uses a hands off approach during the breast feeding support. The midwives working in a hospital setting face many barriers when performing breast feeding support, such as time restraints, which makes it difficult for them to carry out their preferred role as a 'skilled companion'. These barriers can influence the breast feeding support negatively. Supporting factors, such as evidence based breast feeding guidelines, have a positive influence on the breast feeding support.
  
  
  CONCLUSIONS
  On the basis of findings of a synthesis of qualitative research studies, we conclude that the majority of the midwives provide breast feeding support as a technical expert and a minority as a skilled companion. Midwives prefer to be a skilled companion but face many barriers in their working contexts.
authors.affiliation: UCLL, University Colleges Leuven-Limburg, Faculty of Health and Social Work, Research Unit Healthy Living, Genk, Belgium.
authors.forename: Marlies
authors.initials: M
authors.lastname: Swerts
authors.affiliation: UCLL, University Colleges Leuven-Limburg, Faculty of Health and Social Work, Research Unit Healthy Living, Genk, Belgium.
authors.forename: Ellen
authors.initials: E
authors.lastname: Westhof
authors.affiliation: UCLL, University Colleges Leuven-Limburg, Faculty of Health and Social Work, Research Unit Healthy Living, Genk, Belgium; CRIC, Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
authors.forename: Annick
authors.initials: A
authors.lastname: Bogaerts
authors.affiliation: UCLL, University Colleges Leuven-Limburg, Faculty of Health and Social Work, Research Unit Healthy Living, Genk, Belgium. Electronic address: Joke.lemiengre@ucll.be.
authors.forename: Joke
authors.initials: J
authors.lastname: Lemiengre
mesh_terms: D001942:Breast Feeding / Q000379:methods*; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods / Q000592:standards; D024802:Nurse's Role / Q000523:psychology*; D017060:Patient Satisfaction; D010465:Perception; D011181:Postnatal Care / Q000379:methods / Q000592:standards*; D011247:Pregnancy
keywords: Attitudes; Breast feeding; Midwife; Qualitative; Research; Role; Support