Baby friendly Initiative university education standards create positive changes in midwifery students’ reported knowledge, three year case study

Objective: To identify the impact of incorporating the BFI Education Standards (2002) into a midwifery programme.
Design: A 3 year longitudinal case study using qualitative and quantitative methods. Documentary evidence, questionnaires and interviews a year apart were collected.
Setting: Five NHS Trusts in the Midlands, UK.
Participants: A cohort of 3 year midwifery students and their mentors.
Interventions: Integration of BFI Education Standards (2002).
Measurements and Findings: Students enter midwifery with varied personal knowledge, skills and experiences of infant feeding. Knowledge regularly used is anatomy of the breast, physiology of lactation and a limited number of the benefits of breastfeeding. The challenges of using formula are not broached and constituents of breast and formula milk little used. Skills relating to breastfeeding such as ‘hands off technique’ to positioning and attachment, hand expressing, use of breast pumps were developed over the 3 years as communication skills were mastered. Formula feeding skills were less overtly acquired in clinical practice. Students at the point of qualification considered themselves competent in supporting ‘normal’ infant feeding situations however would seek guidance for more complex scenarios.
Key conclusions: Outcomes were independent of Trust BFI status although the more congruent the philosophy of care the easier it was for student learning. All students and mentors identified a greater knowledge and skill set from early on in the programme. Their attitude to breastfeeding were more positive and the time they were prepared to spend with breastfeeding women in a facilitative, self-efficacious model of care had increased. Positive outcomes from women reinforced this model. Communication skills develop from directive and generalised to discursive, facilitative and individualised by the third year. All students became or remained positive toward breastfeeding however concerns were raised about coercion and ensuring women still had choice in their infant feeding method.
Implications for practice: Midwifery education programmes need to incorporate the attitudinal basis of the infant feeding material delivered as well as a firm foundation in skills and knowledge.