Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan;10(1):72-91.
doi: 10.1111/j.1740-8709.2012.00417.x. Epub 2012 Jun 19.

Goals, dilemmas and assumptions in infant feeding education and support. Applying theory of constraints thinking tools to develop new priorities for action

Heather Trickey  1 , Mary Newburn
Affiliations

Goals, dilemmas and assumptions in infant feeding education and support. Applying theory of constraints thinking tools to develop new priorities for action

Heather Trickey et al. Matern Child Nutr. 2014 Jan.

Abstract

Three important infant feeding support problems are addressed: (1) mothers who use formula milk can feel undersupported and judged; (2) mothers can feel underprepared for problems with breastfeeding; and (3) many mothers who might benefit from breastfeeding support do not access help. Theory of constraints (TOC) is used to examine these problems in relation to ante-natal education and post-natal support. TOC suggests that long-standing unresolved problems or 'undesirable effects' in any system (in this case a system to provide education and support) are caused by conflicts, or dilemmas, within the system, which might not be explicitly acknowledged. Potential solutions are missed by failure to question assumptions which, when interrogated, often turn out to be invalid. Three core dilemmas relating to the three problems are identified, articulated and explored using TOC methodology. These are whether to: (1) promote feeding choice or to promote breastfeeding; (2) present breastfeeding positively, as straightforward and rewarding, or focus on preparing mothers for problems; and (3) offer support proactively or ensure that mothers themselves initiate requests for support. Assumptions are identified and interrogated, leading to clarified priorities for action relating to each problem. These are (1) shift the focus from initial decision-making towards support for mothers throughout their feeding journeys, enabling and protecting decisions to breastfeed as one aspect of ongoing support; (2) to promote the concept of an early-weeks investment and adjustment period during which breastfeeding is established; and (3) to develop more proactive mother-centred models of support for all forms of infant feeding.

Keywords: breastfeeding; feeding problems; infant feeding; infant formula; policy analysis and development; social factors; support.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest. NCT is a parent‐support charity which provides support for breastfeeding.

Figures

Figure 1
Figure 1
Theory of constraints: conflict resolution diagram (CRD) (Source: Dettmer, 1997).
Figure 2
Figure 2
Promote breastfeeding or promote feeding choice?
Figure 3
Figure 3
‘Be prepared for problems’ or ‘breastfeeding is straightforward and rewarding’?
Figure 4
Figure 4
Proactively support or protect the mother's sense of agency?
See this image and copyright information in PMC

Comment in

References

    1. Australian Institute of Health and Welfare (2011) 2010 Australian National Infant Feeding Survey: Indicator Results. AIHW: Canberra.
    1. Bhavnani V. & Newburn M. (2010) Left to Your Own Devices: The Postnatal Care Experiences of 1260 First‐Time Mothers. NCT: London. Available at: http://www.nct.org.uk/professional/research/pregnancy-birth-and-postnata... (Accessed 30 April 2012).
    1. Blyth R., Creedy D.K., Dennis C.‐L., Moyle W., Pratt J. & De Vries S.M. (2002) Effect of maternal confidence on breastfeeding duration: an application of breastfeeding self‐efficacy theory. Birth 29, 278–284. - PubMed
    1. Bolling K., Grant C., Hamlyn B. & Thornton A. (2007) Infant Feeding Survey 2005. The Information Centre for Health and Social Care: London. Available at: http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyl... (Accessed 30 April 2012).
    1. Breastfeeding Manifesto Coalition (2007) Breastfeeding manifesto. Breastfeeding Manifesto Coalition: London. Available at: http://www.breastfeedingmanifesto.org.uk/ (Accessed 30 April 2012).

Publication types