What are health care professionals’ decision-making needs when supporting infant feeding choices? Results of a qualitative investigation

Objectives Although on balance, human milk confers more health benefits in comparison to formula, breastfeeding may not be the optimal choice for a given family at a given time. Shared decision-making (SDM) can improve patient-centred care for infant feeding choices. We aimed to identify the decision-making needs, challenges, and opportunities among health care professionals supporting infant feeding choices. Methods In-depth, one-on-one interviews were conducted with health care professionals (registered and public health nurses, physicians, midwives, lactation consultants, dieticians) in British Columbia who had expertise in supporting families’ infant feeding decisions. Data collection and analysis were concurrent and followed thematic analysis principles. Results Analysis of interviews (n=28) highlighted that participants misunderstood that SDM is a process, not necessarily a shared final decision. Participants engaged in information exchange to support each parent to breastfeed, but gave limited consideration to other feeding options and plans. There were three critical time points where an SDM approach may better support infant feeding choices: 1) before pregnancy when parents are considering options and making plans, 2) during the early postpartum in hospital where decisional conflict may be high as parents’ choices are put into practice and feeding challenges arise, and 3) from hospital discharge to 6 months in primary and community care, when parents adjust to the reality of feeding their infant. Conclusions Health care professionals engage in some components of SDM to achieve their breastfeeding health promotion objectives, but there is room for improvement to decrease bias, improve values-informed decision-making, and support the Baby-Friendly Initiative.