'There's a Little Bit of Tension There': perspectives of mothers and early childhood educators on breast-feeding in child care centers.

Objective: To explore mothers' and early childhood (EC) educators' experiences of breast-feeding/breast milk provision and breast-feeding support in child care centres (CCC) in the USA.

Design: We conducted one-time, semi-structured phone interviews with mothers and EC educators to examine perceptions of support, accommodations and barriers to breast-feeding in CCC. We administered a background survey to assess participant characteristics and quantify perceived degree of breast-feeding support in the workplace (mothers) and CCC (mothers and EC educators).

Setting: US-based CCC.

Participants: Fifty working mothers using CCC for their infants and twenty-two EC educators.

Results: Interview themes and background surveys reflected neutral feelings towards breast-feeding support received (mothers) and provided (EC educators) in CCC. Maternal expectations for breast-feeding support in CCC were generally low; workplace and social support for breast-feeding were perceived as the most important factors impacting breast-feeding. EC educators' capacity to offer breast-feeding support was constrained by CCC infant feeding regulations, inadequate breast-feeding training and time limitations. Tensions arose when mothers attempted to manage low milk supply at the CCC level by requesting EC educators to individualise feeding or milk storage practices for their infant.

Conclusions: Breast-feeding efforts of working mothers are undermined in multiple settings, including the workplace and CCC. Improving breast-feeding outcomes for this population requires structural/policy changes that: (1) maximise opportunities for continued, direct breast-feeding and maternal/infant proximity and (2) enforce evidence-based CCC feeding protocols and standards and EC educator lactation training.