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Guo H, Zhou R, Li M, Zhang S, Yi H, Wang L, Li T, Zhang C, Lu H. The use of Kumpfer's resilience framework in understanding the breastfeeding experience of employed mothers after returning to work: a qualitative study in China. Int Breastfeed J 2022; 17:13. [PMID: 35193604 PMCID: PMC8864792 DOI: 10.1186/s13006-022-00459-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The increasing numbers of women in the workforce is an inevitable trend in China. More and more employed women stop breastfeeding because of working stressors. Many mothers, however, overcome the challenges and insist on breastfeeding after returning to work. Their individual experience of breastfeeding may provide a new insight to promote and support breastfeeding on employed mothers. This study sought to understand mothers’ experience with insisting on breastfeeding after returning to work based on Kumpfer’s Resilience Framework in Chinese context. Methods This qualitative study was designed with semi-structured interviews. Purposive sampling and snowball sampling were employed to recruit 13 full-time working mothers with a stable job in the public sector who continued to breastfeed for 1 month or longer after returning to work in Haikou, Hainan Province, China. Interviews were conducted from January to March 2020 to capture participants’ experiences of breastfeed after returning to work. Grounded theory and Kumpfer’s Resilience Framework were used to analyze data via a systematic and iterative process. Results Employed mothers built resilience while continuing to breastfeed after returning to work. The core concept was "dynamic interaction". Other categories were the background and explanation of this phenomenon. For working mothers who continued to breastfeed, resilience involved "dynamic interaction", which started from "experiencing stressors" and "obtaining support", two environmental factors interacted with the individual to "build resilience qualities", which interact with environment led to “behavioral resilience”. And then the ongoing dynamic interaction between behavioral resilience and environment ultimately led to three different "weaning processes", including natural weaning, active weaning, and forced weaning. Conclusions This study identified the framework of resilience in mothers who were in the adversity of breastfeeding after returning to work based on Kumpfer’s Resilience Framework. It provided a new insight into the resilience of employed mothers around the world to continue breastfeeding and showed the different culture of breastfeeding on employed mothers.
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Affiliation(s)
- Honghua Guo
- International Nursing School, Hainan Medical University, Haikou, China
| | - Rong Zhou
- International Nursing School, Hainan Medical University, Haikou, China
| | - Minxiang Li
- Department of Nursing, Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Siqi Zhang
- International Nursing School, Hainan Medical University, Haikou, China
| | - Huanying Yi
- International Nursing School, Hainan Medical University, Haikou, China
| | - Linjie Wang
- International Nursing School, Hainan Medical University, Haikou, China
| | - Tong Li
- International Nursing School, Hainan Medical University, Haikou, China
| | - Caihong Zhang
- International Nursing School, Hainan Medical University, Haikou, China.
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China.
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Akma Jamil N, Khuan L, Theng Cheong A, Muda SM. An emerging trend in infant feeding practice: a scoping review on breastmilk sharing. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2020.11.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chang YS, Harger L, Beake S, Bick D. Women's and Employers' Experiences and Views of Combining Breastfeeding with a Return to Paid Employment: A Systematic Review of Qualitative Studies. J Midwifery Womens Health 2021; 66:641-655. [PMID: 34423557 DOI: 10.1111/jmwh.13243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Returning to paid employment is one of the reasons women stop breastfeeding earlier than they planned to. This systematic review aimed to provide insight into the experiences and views of women and employers on breastfeeding and returning to paid employment, with findings used to inform practice and policy. METHODS The review was guided by the Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence. Medline, CINAHL, PsycINFO, and Web of Science databases were searched for studies published in English. JBI's meta-aggregative approach informed data analysis. The studies in this analysis included women who stopped breastfeeding before, and those who continued breastfeeding after, returning to paid employment and the employers, work managers, or supervisors of women who continued breastfeeding after returning to paid employment. RESULTS Twenty-six articles presenting findings from 25 studies were included and critically appraised. Synthesized findings showed that women experienced physical and emotional difficulties and described gender and employment inequalities in accessing and receiving the support they needed. Women reported that the importance of their own motivation and having workplace legislation in place facilitated breastfeeding during employment. Support from employers, colleagues, and family members, as well as access to convenient child care, helped women continue breastfeeding on return to paid employment. Employers' personal experiences influenced their views on breastfeeding and working, and the need for more education and communication between employers and employers on breastfeeding in the workplace was recognized. DISCUSSION Support from family, work colleagues, and employers was important to reduce the physical and emotional challenges women experienced when combing breastfeeding with return to paid employment. Gender inequalities, especially in low- and middle-income countries, in accessing support exacerbated the difficulties women experienced. Limited data were identified regarding employers' experiences and views, suggesting an urgent need for further research to explore employers' and work colleagues' experiences and views.
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Affiliation(s)
- Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Laura Harger
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.,Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Sarah Beake
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Warwick, United Kingdom
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Gebrekidan K, Hall H, Plummer V, Fooladi E. Exclusive breastfeeding continuation and associated factors among employed women in North Ethiopia: A cross-sectional study. PLoS One 2021; 16:e0252445. [PMID: 34324499 PMCID: PMC8321127 DOI: 10.1371/journal.pone.0252445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/11/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Exclusive Breastfeeding (EBF) can prevent up to 13% of under-five mortality in developing countries. In Sub-Saharan Africa the rate of EBF at six months remains very low at 36%. Different types of factors such as maternal, family and work-related factors are responsible for the low rate of EBF among employed women. This study aimed to assess the prevalence of EBF continuation and associated factors among employed women in North Ethiopia. MATERIALS AND METHODS A community-based, cross-sectional study was conducted in two towns of Tigray region, North Ethiopia. Employed women who had children between six months and two years were surveyed using multistage, convenience sampling. Women filled in a paper based validated questionnaire adopted from the Breastfeeding and Employment Study toolkit (BESt). The questions were grouped into four parts of sociodemographic characteristics, maternal characteristics, family support and work-related factors. Factors associated with EBF continuation as a binary outcome (yes/no) were determined using multivariable logistic regression. RESULTS Four-hundred and forty-nine women participated in this study with a mean (SD) age 30.4 (4.2) years. Two hundred and fifty-four (56.4%) participants exclusively breastfed their children for six months or more. The main reason for discontinuation of EBF was the requirement of women to return to paid employment (31.5%). Four-hundred and forty (98.2%) participants believed that breastfeeding has benefits either to the infant or to the mother. Three hundred and seventy-one (82.8%) of the participants received support from their family at home to assist with EBF, most commonly from their husbands and mothers. Having family support (adjusted odds ratio [AOR] = 2.1, 95%, CI 1.2-3.6; P = 0.005), having frequent breaks at work (AOR = 2.6, 95% CI, 1.4-4.8; P = 0.002) and the possibility of buying or borrowing required equipment for expressing breast milk (AOR = 1.7, 95% CI, 1.0-3.0; P = 0.033) were statistically associated with an increased chance of EBF. CONCLUSION Although returning to work was reported by the study participants as the main reason for discontinuation of EBF, families and managers' support play significant roles in EBF continuation, which in the absence of six-month's maternity leave for employed women in Ethiopia would be of benefit to both mothers and children.
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Affiliation(s)
- Kahsu Gebrekidan
- Monash Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
- Mekelle University, College of Health Sciences, School of Nursing, Mekelle, Ethiopia
| | - Helen Hall
- Monash Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
| | - Virginia Plummer
- Monash Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
- Federation University Australia, School of Health, Berwick, Australia
| | - Ensieh Fooladi
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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Thomas CL, Murphy LD, Mills MJ, Zhang J, Fisher GG, Clancy RL. Employee lactation: A review and recommendations for research, practice, and policy. HUMAN RESOURCE MANAGEMENT REVIEW 2021. [DOI: 10.1016/j.hrmr.2021.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
BACKGROUND Numerous researchers have evaluated the influence of federal and workplace lactation policies on breastfeeding duration, however few have considered the experiences of breastfeeding people returning to school. RESEARCH AIM The aim of this study was to evaluate the availability, accessibility, acceptability, and quality of existing on-campus lactation spaces. METHODS In-depth interviews were conducted with student-parents (N = 18) who had expressed milk on campus. Data collection and thematic analysis were based on the availability, accessibility, acceptability, and quality framework for evaluating health services from the human rights literature and adapted for this study. RESULTS For most participants with proximal access to a designated lactation space, room availability was exceptional and quality was marginally adequate. The provision of breast pumps, in-room sinks, and study desks were important aspects of quality discussed by the participants. Not all participants made use of the university's designated lactation spaces due to either physical or informational inaccessibility. If designated lactation spaces were not convenient, participants found closer alternatives (e.g., bathroom, staff offices, or during the academic session). CONCLUSION Breastfeeding parents who return to school experience obstacles similar to those reported by employed parents who return to work. They require convenient access to appropriate spaces and sufficient privacy to express milk for their infants. In order to best support all learners, university leaders must consider the needs of this unique student population.
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Affiliation(s)
| | - Colleen Huebner
- 7284 School of Public Health, University of Washington, Seattle, WA, USA
| | - Whitney Waite
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
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Adda L, Opoku-Mensah K, Dako-Gyeke P. "Once the child is delivered, he is no more your baby," Exclusive Breastfeeding experiences of first-time mothers in Kassena-Nankana Municipality, Ghana - a qualitative study. BMC Pregnancy Childbirth 2020; 20:575. [PMID: 32993563 PMCID: PMC7526357 DOI: 10.1186/s12884-020-03272-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Exclusive Breastfeeding (EBF), for the first 6 months of life, is globally accepted as the preferred method for infant feeding. In Ghana, an estimated 84% of children < 2 months old are exclusively breastfed. But by age 4 to 5 months, only 49% continue to receive EBF. This situation continues to deteriorate. Thus, the need to explore perceptions, practices as well as factors that influence EBF in Ghana. Methods Using a qualitative design, four focus group discussions were conducted among first-time mothers and eight in-depth interviews with health workers and traditional birth attendants. The study was conducted in four communities in the Kassena-Nankana municipality of Ghana. Discussions and interviews were recorded and later transcribed verbatim to English language. The transcribed data was then coded with the aid of analysis computer software (Nvivo version 10.0) and later analyzed for the generation of themes. Results Exclusive breastfeeding is practiced among first-time mothers due to its perceived benefits; which include nutritional advantage, ability to enhance growth whilst boosting immunity and its economic value. However misconceptions as well as, certain cultural practices (e.g. giving herbal concoctions, breastmilk purification rites), and relational influences, may threaten a mother’s intention to exclusively breastfeed. Relational influences are mainly from mother in-laws, traditional birth attendants, grandmothers, herbalists and other older adults in the community. Conclusions Although first time mothers attempt EBF, external influences make it practically challenging. The availability and utilization of information on EBF was found to positively influence perceptions towards EBF, leading to change in attitude towards the act. Thus, the practice of community-based health services may be strengthened to provide support for first-time mothers as well as continuous education to the mother in laws, female elders and community leaders who influence decision making on breastfeeding of infants.
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Affiliation(s)
- Louisa Adda
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Ghana
| | - Kwabena Opoku-Mensah
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Ghana.
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Social representations of breastfeeding and infant formula: An exploratory study with mothers and health professionals to inform policy making. Appetite 2020; 151:104683. [DOI: 10.1016/j.appet.2020.104683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/21/2022]
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Gebrekidan K, Fooladi E, Plummer V, Hall H. Enablers and barriers of exclusive breastfeeding among employed women in low and lower middle-income countries. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 25:100514. [PMID: 32315815 DOI: 10.1016/j.srhc.2020.100514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/30/2020] [Accepted: 04/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This systematic review and narrative synthesis aims to explore the specific facilitators and barriers of exclusive breastfeeding (EBF) among employed mothers in low and lower middle-income countries. METHODS Primary quantitative and qualitative studies undertaken in low and lower middle-income countries published from 2003 to 2019 were included in the review. Two reviewers independently assessed each article for eligibility using standardized critical appraisal instruments from the Joanna Briggs Institute. RESULTS Seven papers were included in this review. The enabler and barrier factors to EBF are summarized into three categories including maternal factors (such as mode of delivery, number of children, knowledge and attitude on breastfeeding), social factors (such as support from husband, family and child day care), and work-related factors (such as duration of maternal leave, flexibility of work, and availability of physical facilities). CONCLUSION To increase EBF among employed women, employers should support them by offering flexible working hours, a minimum of six months maternity leave and providing breastfeeding facilities. Support from family and maternal factors were important factors that could positively affect EBF. Identification of modifiable barrier and facilitator factors may contribute to successful EBF in employed women thereby reducing mortality and morbidity in countries with limited resources.
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Affiliation(s)
- Kahsu Gebrekidan
- Monash Nursing and Midwifery, Monash University, Peninsula Campus, Building E, McMahons Road, Frankston, Victoria 3199, Australia.
| | - Ensieh Fooladi
- Monash Nursing and Midwifery, Monash University, Clayton Campus, Level 1, 10 Chancellors Walk, Wellington Road, Clayton, VIC 3800, Australia.
| | - Virginia Plummer
- Monash Nursing and Midwifery, Monash University, Peninsula Campus, Building E, McMahons Road, Frankston, Victoria 3199, Australia; Peninsula Health, Continuing Education Development Unit, PO Box 52, Frankston 3199, Australia.
| | - Helen Hall
- Monash Nursing and Midwifery, Monash University, Peninsula Campus, Building E, McMahons Road, Frankston, Victoria 3199, Australia.
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Dasoqi KA, Safadi R, Badran E, Basha AS, Jordan S, Ahmad M. Initiation and continuation of breastfeeding among Jordanian first-time mothers: a prospective cohort study. Int J Womens Health 2018; 10:571-577. [PMID: 30349401 PMCID: PMC6181471 DOI: 10.2147/ijwh.s175850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to examine the rates of initiation and continuation of breastfeeding (BF) and their relationship with mothers' sociodemographic, obstetric, neonatal, and medical interventions. Methods Data were collected from 199 first-time Jordanian mothers using medical records, face-to-face interviews within 24 hours of birth, and two telephone interviews at 6 weeks and 6 months after birth. Results The rate of BF initiation within the first 4 hours after birth was only 13%. The rate of exclusive BF at 6 weeks was 25.5%, and this rate dropped to 2.1% at 6 months. Mothers who initiated BF before discharge were older, were employed, had normal vaginal birth, and had undergone antenatal or after-birth BF education. Infants' birth weight or gender was not interrelated with BF initiation. There was no relationship between initiation and continuation of BF and use of medications for labor pain or for induction/augmentation. The only significant relationship was found between the dose of ergometrine and BF failure and painful BF at 6 weeks. Conclusion There is a need for increasing health care providers and public awareness about the role of intrapartum medications and procedures on the initiation and continuation of BF at 6 weeks and 6 months after birth.
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Affiliation(s)
- Khadeejeh Al Dasoqi
- Department of Maternal and Child Health Nursing, School of Nursing, University of Jordan, Amman, Jordan,
| | - Reema Safadi
- Department of Maternal and Child Health Nursing, School of Nursing, University of Jordan, Amman, Jordan,
| | - Eman Badran
- Department of pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Asma Sa'd Basha
- Department of Obstetrics and Gynecology, School of Medicine, University of Jordan, Amman, Jordan
| | - Sue Jordan
- Department of Nursing, Swansea University, Swansea, UK
| | - Muayyad Ahmad
- Clinical Nursing Department, School of Nursing, University of Jordan, Amman, Jordan
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Alianmoghaddam N, Phibbs S, Benn C. Reasons for Stopping Exclusive Breastfeeding Between Three and Six Months: A Qualitative Study. J Pediatr Nurs 2018. [PMID: 29525214 DOI: 10.1016/j.pedn.2018.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Scant published qualitative literature exists focusing on why exclusive breastfeeding rates decline between three and six months. This study aims to develop an understanding of why exclusive breastfeeding tails off so dramatically between three and six months after birth in New Zealand. DESIGN AND METHODS A generic qualitative methodology was employed in this study and social constructionism selected as the main epistemological framework underpinning the research. This study was carried out between September 2013 and July 2014, involving face-to-face interviews with 30 women who were characterised as highly motivated to complete six months exclusive breastfeeding prior to the birth of their child. In order to gain an in-depth understanding of the research material, thematic analysis of the interview transcripts was completed using manual coding techniques. RESULTS After thematic analysis of the data four key themes were identified: 1) The good employee/good mother dilemma. 2) Breastfeeding is lovely, but six months exclusively is demanding. 3) Exclusive breastfeeding recommendations should be individualised. 4) Introducing solids early as a cultural practice. CONCLUSIONS Most studies have linked barriers to six months exclusive breastfeeding to difficulties within the mother-infant dyad, as well as negative maternal socioeconomic and socio-demographic characteristics. However, this study has shown that the maintenance of six months exclusive breastfeeding is also challenging for this group of mothers who were socially advantaged, well-educated and highly motivated to breastfeed their babies exclusively for six months.
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Affiliation(s)
| | - Suzanne Phibbs
- School of Public Health, Massey University, New Zealand.
| | - Cheryl Benn
- School of Public Health, Massey University, New Zealand.
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Holtzman O, Usherwood T. Australian general practitioners' knowledge, attitudes and practices towards breastfeeding. PLoS One 2018; 13:e0191854. [PMID: 29489841 PMCID: PMC5830034 DOI: 10.1371/journal.pone.0191854] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 01/14/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to explore the knowledge, attitudes and practices of established general practitioners (GPs) in relation to breastfeeding. 10 GPs in the Australian Nepean Blue Mountains Health District were interviewed and the interviews transcribed and analyzed thematically. Emergent themes from each interview were identified and then compared between and across the 10 interviews. Five themes emerged following the analysis: breastfeeding knowledge and training; attitudes towards breastfeeding; GPs' role in relation to breast feeding; GPs' practices; influence of male gender. All the GPs interviewed had positive attitudes towards breastfeeding, however they were often lacking in knowledge and conviction to be able to provide strong support to women during their breastfeeding journey. Some reported ambivalence in their encouragement of breastfeeding due to their desire to maintain a good relationship with women who chose not to feed this way. Nine of the GPs had little or no formal breastfeeding training and relied mainly on personal experience. Their clinics did not provide formal breastfeeding support including a written breastfeeding friendly policy and most GPs were not proactive in creating such an environment. We hope that the results from this study will assist in developing breastfeeding policies and professional education to support GPs in this role.
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Affiliation(s)
- Orit Holtzman
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Sydney, NSW, Australia
- Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
- * E-mail:
| | - Tim Usherwood
- Department of General Practice, Sydney Medical School Westmead, The University of Sydney, Sydney, NSW, Australia
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Lau Y, Htun TP, Lim PI, Ho-Lim SST, Chi C, Tsai C, Ong KW, Klainin-Yobas P. Breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women: A multi-group structural equation approach. Int J Nurs Stud 2017; 67:71-82. [DOI: 10.1016/j.ijnurstu.2016.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 11/28/2022]
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Corrigendum. J Adv Nurs 2016; 72:1711. [DOI: 10.1111/jan.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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