Nova Scotia Midwives’ Perceived Barriers and Facilitators to Baby-Friendly Initiative Implementation

Abstract

Background: Breastfeeding has numerous benefits for both breastfeeding parent and child, yet breastfeeding rates in Nova Scotia are among the lowest in Canada. The Baby-Friendly Initiative (BFI) is a breastfeeding promotion program designed to support the initiation, exclusivity, and duration of breastfeeding. While the BFI can improve breastfeeding outcomes, it is not implemented across Nova Scotia.

Methods: We used a qualitative descriptive design, employing semi-structured virtual interviews to understand midwives’ perceptions of barriers and facilitators to BFI implementation in Nova Scotia. Interview data were transcribed and analyzed using inductive-deductive qualitative content analysis guided by the Theoretical Domains Framework (TDF) and COM-B Model of Behaviour.

Results: Study participants (n = 2) identified barriers and facilitators related to 1) client education needed to support breastfeeding; 2) family, peer, and community supports needed for breastfeeding; and 3) equity in access to breastfeeding supports. Client education early in the perinatal period was seen as a key facilitator of BFI. Community supports were identified as essential enablers of breastfeeding and the BFI. Participants identified inequities in access to breastfeeding supports that could be addressed by widespread implementation of the midwifery care model.

Discussion: Our findings highlight the importance of midwifery care for supporting exclusive breastfeeding and BFI implementation. Continuity of care, consistent access to knowledge and supports, and family-centered social-emotional support throughout the perinatal period are key components of the midwifery care approach that should be adopted across the health system. Findings will be used to inform future research to support BFI implementation and breastfeeding across Nova Scotia.