Interrupción temprana de la lactancia materna. Un estudio cualitativo

Content validation of the nursing diagnosis "Insufficient breast milk production (00216)"

PURPOSE

To review and validate the elements of the nursing diagnosis (ND) "Insufficient breast milk production" (00216) based on the literature and expert consensus, and to construct operational definitions (ODs) for its defining characteristics (DCs).

METHODS

It is a methodological study carried out in two phases. In the first phase, a scoping review was conducted, and in the second, a committee of experts reviewed the elements' content. Items with a Content Validity Index ≥0.8 were validated for relevance, clarity, and precision. Discussions were conducted until a consensus was reached on all items and criteria evaluated. The Ethics Committee approved the study.

FINDINGS

The final scoping review sample consisted of 61 articles, and 19 experts evaluated the content of the ND. All DCs were revised. Three at-risk populations, three associated conditions, and one related factor were added. Three elements had their category changed, and an element was deleted. Experts also validated ODs developed for all DCs.

CONCLUSION

"Insufficient breast milk production (00216)" was validated by experts. This study improved the ND through literature and expert consensus. New elements were added, and existing ones were revised.

IMPLICATIONS FOR NURSING PRACTICE

This study improves this ND based on scientific evidence and clinical expertise and potentially improves nurses' diagnostic accuracy through ODs.

What gypsy mothers say about breastfeeding

OBJECTIVE

To know and deepen in the evaluation, and experience of gypsy women with breastfeeding.

METHOD

Qualitative study with an interpretative phenomenological approach, through a focus group with the participation of six mothers of gypsy ethnicity, users of the Fuente de San Luis Health Center in the city of Valencia.

RESULTS

The barriers described by these mothers regarding breastfeeding refer to a lack of family support, an association of breastfeeding to sacrifice and to the dependence of the baby to the breast. From the accounts of these mothers it is perceived, a disinterest in breastfeeding and a lack of confidence in their own bilogy, which together with a low participation in maternal education activities, have meant the barriers that have mostly limited and largely hindered breastfeeding in this group of mothers.

CONCLUSIONS

It would be desirable to implement improvement actions that would pay more attention to promote, protect and support breastfeeding in this group.

Barriers and Facilitators for Exclusive Breastfeeding within the Health System and Public Policies from In-Depth Interviews to Primary Care Midwives in Tenerife (Canary Islands, Spain)

The aim of this study is to describe the perspectives of Primary Care midwives regarding factors that benefit or are detrimental to exclusive breastfeeding (EBF) within the health system and public policies. The study was carried out in Tenerife (Canary Islands, Spain) and is based on qualitative methodology. Twenty in-depth interviews were carried out with midwives who work in Primary Care centres in Tenerife, using a content analysis approach. The transcript data were then encoded following an inductive approach. The factors, according to midwives, that affect EBF, with regard to the healthcare system, are related to training of healthcare professionals in breastfeeding and their support to women during pregnancy, childbirth and postnatal care. Regarding public policies, midwives believe the maternity leave periods in Spain, together with a lack of laws and social policies to protect EBF are detrimental. The findings from our study show that there is a need to boost training and the role of professionals in EBF and, at the same time, promote protective policies that foster equality, favouring, among other issues, the work-life balance.

Exploring women's perceptions of pain when breastfeeding using online forums

BACKGROUND

Despite numerous benefits, many mothers stop breastfeeding soon after birth. A common reason for this is the experience of pain or discomfort. One resource which women use to share their breastfeeding challenges and seek support are online forums. This study aimed to collect data from online forums to explore 1) usage of forums as social support for breastfeeding-related pain; 2) experiences of breastfeeding-related pain; 3) perceptions and strategies to deal with breastfeeding-related pain; and 4) the impact of pain on breastfeeding duration.

METHODS

Data was gathered through searches of online forums based in the UK and USA: Netmums, What to Expect and Mumsnet using key terms: 'painful breastfeeding' and 'sore breastfeeding'. Data extraction took place in July 2018 and included posts made between 2012 and 2018. Data included 123 posts and 193 replies, analysed using thematic analysis.

RESULTS

The first theme identified was 'variation in types of pain', highlighting the variety of painful experiences and their descriptions. In particular, this theme reveals the large variety of different types of pain women experience at different stages throughout their breastfeeding journey, as well as the different pain characteristic they focus on in the description of their experience (i.e., location, sensory or physical aspects). Secondly, the theme 'perceived causes and explanations for pain' revealed how women interpret pain experiences either due to a recognised condition or behavioural cause. The third theme 'cessation of breastfeeding related to pain' identified. How women experience both physical and psychological struggles (e.g., guilt) related to breastfeeding cessation, with pain being a main factor in considering cessation of breastfeeding. Finally, the theme 'shared experiences and support' identified women's strong need for both practical and emotional support to deal with pain. Many women look for this support through the knowledge exchange offered on the online forums.

CONCLUSIONS

Pain was a key reason for breastfeeding cessation, commonly associated with strong feelings of guilt. The online forums provide a unique form of social support for breastfeeding women to find ways to cope with the pain, while highlighting the urgent need for more appropriate antenatal education on realistic expectation surrounding breastfeeding.

The role of emotions and injunctive norms in breastfeeding: a systematic review and meta-analysis

Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date in explaining breastfeeding behaviours. Specifically, prior research underestimates the importance of (1) specific emotions and (2) wider injunctive influences (i.e., societal and moral norms about what women feel they ought to be doing) in the breastfeeding experience. Therefore, we conducted a systematic review of quantitative, qualitative, and mixed-methods studies that explored whether injunctive norms and/ or specific emotions are associated with breastfeeding behaviours (i.e., intentions, initiation and duration). Seventy-two papers were included in this review; data were extracted and quality appraisals conducted for all included studies. A meta-analysis of effect sizes was performed with the quantitative data. A convergent qualitative synthesis of the data was conducted, resulting in the following line of argument: Breastfeeding is a social behaviour and not a personal/individual behaviour. From this line of argument, three themes with associated sub-themes were developed, highlighting the importance of both specific emotions and injunctive norms on breastfeeding behaviours. These influences are discussed in relation to both theoretical and practical implications, as well as future research.

Impact and Effectiveness of Group Strategies for Supporting Breastfeeding after Birth: A Systematic Review

Despite the multiple benefits of breastfeeding both for the mother and for the infant, during the first months there is a progressive decline in the number of mothers who continue breastfeeding, with most countries reporting lower than recommended figures. The objective of this review is to analyse the most effective group support practices for breastfeeding, as well as the characteristics associated to their success in maintaining breastfeeding. A systematic review has been conducted in the 2015–2020 period, in the following databases: MedLine, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and LILACS. The findings were summarized in narrative and table formats. A total of thirteen articles were included, eight of them being experimental studies and five observational. The findings show high heterogeneity regarding the characteristics of the interventions and their periodicity. The most successful group strategies to support and maintain breastfeeding during postpartum are those that combine peer support with the leadership or counselling of a health professional or IBCLC. However, more studies are necessary, randomized and with interventions of similar characteristics, which allow for better data comparison.

Hidden Realities of Infant Feeding: Systematic Review of Qualitative Findings from Parents

A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent's attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent's expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.