Healthcare Provider Attitudes Towards Breastfeeding Mothers And Infants In Serbia

Healthcare providers, from OBGYNs and midwives to pediatricians and nurses, play a significant role in shaping, directly or indirectly, both mothers’ attitudes towards breastfeeding and the future of their breastfeeding relationship with their babies. Early advice and practical support, as well as breastfeeding-related practices within hospitals, can make or break a mother’s breastfeeding success — and nearly half of Serbian moms reported that they received practical tips on getting started with nursing within the maternity hospital, with nearly an equal amount letting us know that they encountered breastfeeding challenges but received healthcare provider help to overcome them. In contrast, less than one percent explicitly said that they asked for help but didn't receive any.

Our finding that a shocking 26% of respondents saw their doctors, nurses, and midwives as “well-informed about breastfeeding, but not interested in doing their jobs” is even more intriguing.

• "They feed formula before they bring the babies to the mothers." [Remember, babies are kept in hospital nurseries unless the mother has opted into a Baby Friendly ward. The babies are then brought to the mothers at certain intervals for breastfeeding.]
• "When I said nursing hurt, they advised me to switch to formula."
• "I asked for help, and the nurse replied: What? You don't expect me to nurse him for you, do you?"
• "When I developed mastitis, a nurse told me it was because I was 'uneducated' and proceeded to yell at me, 'if you want to play around with your body like that, you'll see how much pain you get in return now'."
• "A nurse expressed milk from my breasts without first washing her hands."
• "When my breasts hurt badly after I gave birth to my first child, I asked a nurse for help and she yelled at me, without taking a look at my breasts: 'If it hurts, then massage them!'"
• “I was told: ‘You have inverted nipples so you can't breastfeed. What a shame.’”
• "Nurses told me that breast milk doesn’t meet the needs of small babies and they’d feed them formula right after."
• "When I told a pediatrician that my 18 month old was still nursing, he told me I was creating a living Oedipus complex."

SteadyHealth spoke with pediatrician Gordana Mucibabic, who cited "a combination of factors surrounding the mother, the newborn, and their social surroundings" as the reason for which many mothers give up on breastfeeding, adding that breastfeeding mothers' relatives should ideally "ensure a peaceful and comfortable atmosphere in the home, along with an appropriate maternal diet" and that "effort, investment, and patience" are needed on the part of healthcare providers.

READ Western Balkan Moms Eager To Breastfeed, But Thwarted By Corruption And Old Wives' Tales

Meanwhile, Milena Popevic, a peer-to-peer breastfeeding advisor with the Serbian Association of Parents, holds the view that "hospital staff fills mothers' heads" with the idea that they don't have milk, adding:

"It’s not unusual for staff to say: ‘You got nothing; you won’t be able to breastfeed’. Or they say, ‘we have to use formula because your milk hasn't come in yet’, though they already have colostrum."

Ivana Dimitrijevic-Robertson, a La Leche League leader from Belgrade, agreed, and also pointed to a subtle promotion of formula as one of the underlying reasons for which mothers:

"It is very common that mothers of newborns experience some pressure from the health visitors who visit the mothers at home within the few days following hospital release to offer a particular brand of formula to the baby without indicating a clear reason, or assessing the breastfeeding dyad appropriately."

Our survey revealed that a complex interplay between social myths, unmotivated maternity care providers, and lack of healthcare provider education explains why exclusive breastfeeding rates in Serbia are sub-optimal, despite near-universal maternal beliefs in the nutritional superiority of breast milk. Tackling this problem, likewise, requires the partnership of mothers, breastfeeding activism groups, the media, healthcare providers, and policy makers.