The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals' perspectives on the implementation of the Baby-Friendly Hospital Initiative

The health benefits of breastfeeding for mothers and babies are well documented in the scientificliterature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an importantdeterminant 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 hospitalswith a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seemto represent a major challenge to maternity units. This article builds upon previous research that has identifieda number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack ofintra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcareprofessionals 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. Dataanalysis followed thematic analysis.Results: Midwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalizationvs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternityunits. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguardingvs. 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 asspatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter-professionalteamwork 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 theimplementation of programs such as BFHI, the different perspectives of health professionals should be brought togetherand the potential for integrating different forms of knowledge and practices should be considered.