Table 1 – Summary of qualitative themes with exemplary quotes

Workplace drivers

1) Responsive implementation of policies

Actually, I was lucky that the hospital understood me because I felt that 3 months were not enough. I was lucky that my… colleagues understood me, and I was allowed to extend my leave. It helped, I returned to work after passing the difficult period. When I came to work, it was good that my colleagues understand and let me have time for pumping. These things are necessary because it may be difficult if some colleagues don’t understand.TH1

2) Organizational support

For me I just have one funny idea– it would be nice to have a clinic for mothers who are breastfeeding because every mother who is breastfeeding has different challenges– it is not all the same. It would be great for mothers to have a training course. So for the mothers who are determined to breastfeed their children but face challenges they could receive advice and support.TH2

3) Arr-nar/kreng-jai (“not wanting to impose”)

I would say [maternity leave should be] 6 months, but I feel that it is too long and feel bad for our colleagues. 5 months and a half will do, just a little bit longer.TH1

4) Organizational leadership

Working here it feels like a family, looking after each other.CBO1

HCW personal outcomes

5) Breast milk production

You need to be very consistent with pumping milk because if not consistent, you will not produce as much milk as you need, and since you don’t have a baby to directly breastfeed to stimulate your breast milk production, your production will gradually go down… especially when you don’t have your baby nearby to directly breastfeed. When our baby is directly breastfeeding it induces the release of oxytocin which causes more milk to be produced. If there is no stimulation, and the brain is not triggered, eventually there will be no milk production.TH2

6) Mother-infant Bonding

After delivery the mother’s hormones can contribute to stress for the mother. Some patients will have depression from the hormones. When we let our child breastfeed we feel warmth in our heart, it will heal the heart. I also experienced quite often the feeling that I just suddenly want to cry– it is the hormonal effect. When I pick up my child and breastfeed that feeling disappears.TH2

HCW professional outcomes

7) Improved care for breastfeeding mothers

I can counsel better after I have babies. When I was single, I am not quite good at that. After breastfeeding my two babies, we can share our experiences. We can tell them how to hold the baby.CBO1

They ask me about herbal supplements and ways to increase milk production. I tell them that banana blossoms, ginger tea, and Kaeng Liang (Thai spicy mixed vegetable soup) can stimulate milk production, but also tell them that they can take some medicines to stimulate milk production… I had experienced the same problem. I had a low milk production when I had my first baby.… I sympathize with them because I was there before, so I want to help them. And I’m glad to help.TH1

Contextual factors

8) Family Support

I would give this suggestion: find one person who can take care of the baby well. A husband who is not using [alcohol or drugs], who loves babies and can take care of them well. When it is time for breastfeeding, he will give the baby to you to breastfeed. When the baby is finished breast feeding, he will take the baby back. For the baby, breastfeeding is important. If breastfeeding is regular and on time, your baby will grow beautiful…CBO2

9) Culture and traditions

I live close to a Burman community in my area. They are also very experienced about breastfeeding…. The hilltribe women [breastfeed] more than 2 years. So I can see even 2–3 years they can still breastfeed their children. [For hospital staff] I don’t really know how long because I didn’t ask them. But for some people around 6 and a half months.TH2

We disagree whether we should feed the baby with water following milk for the first 6 months. I don’t think so, but my babysitter, grandma, says it’s a must…TH1

10) Meta: Proximity and peace/

Separation and stress

I worried that people will not look after my baby really well. I worry that mosquitos would bite my baby while he was sleeping. Sometimes, I would bring a hammock and let him sleep here [at the clinic]. I felt more peace of mind when I did that.CBO2

That’s why this year if they don’t transfer me [to the city where my children live], I will resign… If I take care of my kids by myself, I feel more peace of mind.TH2