The breastfeeding experience of women with major difficulties who use the services of a breastfeeding clinic: a descriptive study

Breastfeeding and Bonding: A Surprising Role of Breastfeeding Difficulties

Aims: To explore the role of breastfeeding difficulties in bonding. Background: Studies published to date yielded varying results regarding the relationship between breastfeeding and bonding. In qualitative studies, mothers often describe breastfeeding as a bonding experience and regard breastfeeding difficulties as challenging. Only one quantitative study explored the impact of breastfeeding difficulties on bonding. Methods: A cross-sectional method was used and a self-report questionnaire was administered to a convenience sample of mothers with infants aged 0-6 months. Results: We found that having problem-free breastfeeding versus breastfeeding associated with breastfeeding difficulties led to a difference in bonding quality. Experiencing any breastfeeding difficulties was associated with bonding impairment (p = 0.000, r = 0.174), especially in cases of breast engorgement (p = 0.016, r = 0.094), a nonlatching baby (p = 0.000, r = 0.179), perceived low milk supply (p = 0.004, r = 0.112), and fussing at the breast (p = 0.000, r = 0.215). We also found a difference in bonding impairment between exclusively breastfeeding and exclusively bottle-feeding mothers (p = 0.001), but only when taking into account breastfeeding difficulties. Conclusions: Breastfeeding is a complex interaction that can be associated with mother-infant bonding in various ways. We found that breastfeeding difficulties were linked to bonding impairment, whereas exclusive breastfeeding without the presence of breastfeeding difficulties was not. Strategies to help achieve exclusive breastfeeding and prevent and resolve breastfeeding difficulties may help mothers fulfill the bonding potential with their infant.

Women's experiences of breastfeeding after a cesarean section: A meta-synthesis

AIM

The World Health Organization and United Nations Children's Fund recommend the early initiation of breastfeeding within the first hour postpartum for successful exclusive breastfeeding. However, cesarean section is a risk factor for unsuccessful early initiation of breastfeeding. Herein, we aim to explore women's experiences of breastfeeding after a cesarean section.

METHODS

We used the Joanna Briggs Institute framework in this meta-synthesis. We searched articles published from 1990 to 2022 on PubMed, CINAHL, Cochrane library, PsycInfo, and EMBASE to identify qualitative studies on women's experiences of breastfeeding after a cesarean section. We used the Critical Appraisal Skills Programme checklist for qualitative studies to assess the quality of the included studies.

RESULTS

Seven qualitative studies from five countries met the inclusion criteria, representing the views of 194 women who underwent cesarean sections. Six new categories were integrated into the women's experiences of breastfeeding after a cesarean section as follows: (i) Perceived values of breastfeeding, (ii) Emotional vulnerability in breastfeeding, (iii) Physical difficulties in breastfeeding, (iv) Inconvenient conditions in breastfeeding, (v) Inadequate resources for breastfeeding, and (vi) Support systems to enable breastfeeding.

CONCLUSIONS

We provide evidence showing that knowledge of the specific breastfeeding mechanism and provision of the most appropriate postsurgical care by healthcare providers just after a cesarean section can reduce the barriers to post-cesarean breastfeeding. Moreover, effective hospital policies and family support can result in the initiation of positive breastfeeding outcomes. Future studies that consider the cultural aspects of breastfeeding practice may generate additional insights into providing optimal postpartum care.

Emotional and informational social support from health visitors and breastfeeding outcomes in the UK

BACKGROUND

Shorter breastfeeding duration is associated with detrimental consequences for infant health/development and maternal health. Previous studies suggest social support is essential in maintaining breast/chest-feeding and helping to improve general infant feeding experiences. Public health bodies therefore work to support breastfeeding in the UK, yet UK breastfeeding rates continue to be one of the lowest globally. With this, a better understanding of the effectiveness and quality of infant feeding support is required. In the UK, health visitors (community public health nurses specialising in working with families with a child aged 0-5 years) have been positioned as one of the key providers of breast/chest-feeding support. Research evidence suggests that both inadequate informational support and poor/negative emotional support can lead to poor breastfeeding experiences and early breastfeeding cessation. Thus, this study tests the hypothesis that emotional support from health visitors moderates the relationship between informational support and breastfeeding duration/infant feeding experience among UK mothers.

METHODS

We ran cox and binary logistic regression models on data from 565 UK mothers, collected as part of a 2017-2018 retrospective online survey on social support and infant feeding.

RESULTS

Informational support, compared to emotional support, was a less important predictor of both breastfeeding duration and experience. Supportive emotional support with unhelpful or absent informational support was associated with the lowest hazard of breastfeeding cessation before 3 months. Results for breastfeeding experience followed similar trends, where positive experience was associated with supportive emotional and unhelpful informational support. Negative experiences were less consistent; however, a higher probability of negative experience was found when both types of support were reported as unsupportive.

CONCLUSIONS

Our findings point to the importance of health visitors providing emotional support to bolster the continuation of breastfeeding and encourage a positive subjective experience of infant feeding. The emphasis of emotional support in our results encourages increased allocation of resources and training opportunities to ensure health visitors are able to provide enhanced emotional support. Lowering health visitors caseloads to allow for personalised care is just one actionable example that may improve breastfeeding outcomes in the UK.

The effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum: A systematic review

OBJECTIVE

The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. Studies suggest that the decline in global breastfeeding rate can be linked to lack of adequate breastfeeding education during prenatal stage. Therefore, this review aims to determine the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum.

METHOD

A systematic review of the studies identified by electronic database search (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Psych INFO, and Sociological Abstracts and Applied Social Sciences Index and Abstracts (ASSIA) published between 2014 - 2021.

RESULTS

A total of 14 studies met the inclusion criteria. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, increase in positive attitude to breastfeeding and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care.

CONCLUSION

Prenatal breastfeeding education increases women's knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrates a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcome inherent in all the studies can be attributed to prenatal breastfeeding education.

Breastfeeding difficulties in the first 6 weeks postpartum among mothers with chronic conditions: a latent class analysis

BACKGROUND

Breastfeeding difficulties frequently exacerbate one another and are common reasons for curtailed breastfeeding. Women with chronic conditions are at high risk of early breastfeeding cessation, yet limited evidence exists on the breastfeeding difficulties that co-occur in these mothers. The objective of this study was to explore clusters of breastfeeding difficulties experienced up to 6 weeks postpartum among mothers with chronic conditions and to examine associations between chronic condition types and breastfeeding difficulty clusters.

METHODS

We analyzed 348 mothers with chronic conditions enrolled in a prospective, community-based pregnancy cohort study from Alberta, Canada. Data were collected through self-report questionnaires. We used latent class analysis to identify clusters of early breastfeeding difficulties and multinomial logistic regression to examine whether types of chronic conditions were associated with these clusters, adjusting for maternal and obstetric factors.

RESULTS

We identified three clusters of breastfeeding difficulties. The "physiologically expected" cluster (51.1% of women) was characterized by leaking breasts and engorgement (reference outcome group); the "low milk production" cluster (15.4%) was discerned by low milk supply and infant weight concerns; and the "ineffective latch" cluster (33.5%) involved latch problems, sore nipples, and difficulty with positioning. Endocrine (adjusted relative risk ratio [RRR] 2.34, 95% CI 1.10-5.00), cardiovascular (adjusted RRR 2.75, 95% CI 1.01-7.81), and gastrointestinal (adjusted RRR 2.51, 95% CI 1.11-5.69) conditions were associated with the low milk production cluster, and gastrointestinal (adjusted RRR 2.44, 95% CI 1.25-4.77) conditions were additionally associated with the ineffective latch cluster.

CONCLUSION

Half of women with chronic conditions experienced clusters of breastfeeding difficulties corresponding either to low milk production or to ineffective latch in the first 6 weeks postpartum. Associations with chronic condition types suggest that connections between lactation physiology and disease pathophysiology should be considered when providing breastfeeding support.

Cacao Butter as Prophylaxis for Nipple Problems: A Pilot Randomized Controlled Study

Objective: Cacao butter is a type of oil extracted from the fruit of the Theobroma Cacao plant. This study was conducted to compare the use of breast milk and cacao butter for the prevention of nipple problems in the early postpartum period. Materials and Methods: This randomized controlled study involved 72 participants, who were randomized into the cacao and mother's milk groups. Data were collected using Descriptive questionnaire, Nipple assessment form, and IMDAT (Amount of Urine Output, Condition of Breasts, Amount of Stool, Weight Increase and Satisfaction Status). Results: On postpartum day 10, the rates of nipple pain (11.40% cacao group versus 40.50% mother's milk group), rashes (14.30% cacao group versus 35.10% mother's milk group), and cracks (14.30% cacao group versus 43.20% mother's milk group) significantly reduced in the cacao group when compared with the mother's milk group (p < 0.05). Conclusion: The application of cacao butter to the nipples is possibly a more effective method than the application of mother's milk for preventing nipple pain, rashes, or cracked nipples. Cacao butter can be used prophylactically to prevent nipple problems in the early postpartum period.

Breastfeeding education in Chinese hospitals: A cross-sectional study

BACKGROUND

Breastfeeding education plays a crucial role in improving breastfeeding outcomes and has been employed in many medical institutions across China.

OBJECTIVES

To describe the current situation of breastfeeding education provided by hospitals to women in China, and to identify relevant factors associated with the exclusive breastfeeding rate at hospital discharge and the early breastfeeding initiation rate.

DESIGN

A cross-sectional study design.

SETTINGS AND PARTICIPANTS

We used an online survey platform called WenjuanXing to collect data from 2985 hospitals in China.

METHODS

We designed a questionnaire to collect data. The Mann-Whitney U test and Pearson's chi-square test were used to identify the differences between the different types and levels of hospitals. Binary logistic regression analysis was used to analyze the factors associated with the exclusive breastfeeding rate at hospital discharge and the early breastfeeding initiation rate.

RESULTS

A total of 2941 hospitals were included in the data analysis. In 86% of hospitals midwives were providing breastfeeding education on weekdays during the daytime. Information on how to deal with mastitis (80.8%) and weaning methods (71.5%) was less commonly provided to women. The hospitals often conducted breastfeeding education through antenatal education sessions and bedside health education, while 34.2% of hospitals used smartphone applications. The obstacles to conducting breastfeeding education in hospitals were a lack of full-time staff dedicated to breastfeeding education (43.3%) and limited funds invested in breastfeeding education (42.5%). A lack of full-time staff dedicated to breastfeeding education (OR, 0.689; 95% CI, 0.498-0.953) and a lack of space (OR, 0.697; 95% CI, 0.487-0.997) were associated with the exclusive breastfeeding rate at hospital discharge. Furthermore, a lack of full-time staff dedicated to breastfeeding education (OR, 0.372; 95% CI, 0.235-0.589) was associated with the early breastfeeding initiation rate.

CONCLUSIONS

To improve breastfeeding outcomes, hospital managers and policymakers should increase the number of midwives and full-time staff who are dedicated to breastfeeding education, resolve the obstacles of limited funds and space for breastfeeding education, and explore more approaches to providing knowledge on breastfeeding to women and their families.

Testing the buffering hypothesis: Breastfeeding problems, cessation, and social support in the UK

OBJECTIVES

Physical breastfeeding problems can lead women to terminate breastfeeding earlier than planned. In high-income countries such as the UK, breastfeeding problems have been attributed to the cultural and individual "inexperience" of breastfeeding, ultimately leading to lower breastfeeding rates. Yet, cross-cultural evidence suggests breastfeeding problems still occur in contexts where breastfeeding is common, prolonged, and seen publicly. This suggests breastfeeding problems are not unusual and do not necessarily lead to breastfeeding cessation. As humans evolved to raise children cooperatively, what matters for breastfeeding continuation may be the availability of social support during the postnatal period. Here, we test the hypothesis that social support buffers mothers from the negative impact breastfeeding problems have on duration.

METHODS

We run Cox models on a sample of 565 UK mothers who completed a retrospective online survey about infant feeding and social support in 2017-2018.

RESULTS

Breastfeeding problems were important predictors of cessation; however, the direction of the effect was dependent on the problem type and type of support from a range of supporters. Helpful support for discomfort issues (blocked ducts, too much milk) was significantly associated with reduced hazards of cessation, as predicted. However, helpful support for reported milk insufficiency was assoicated with an increased hazard of cessation.

CONCLUSIONS

Experiencing breastfeeding problems is the norm, but its impact may be mitigated via social support. Working from an interdisciplinary approach, our results highlight that a wide range of supporters who provide different types of support have potential to influence maternal breastfeeding experience.

Maternal guilt and shame in the postpartum infant feeding context: A concept analysis

Background After birth, guilt and shame are differentially experienced by breastfeeding and formula feeding mothers. Despite this, currently utilized guilt and shame definitions lack context specificity, leaving concepts open to misinterpretation. Objective The current study aimed to develop infant feeding-specific definitions of postpartum guilt and shame. Methods Study selection involved a three-stage systematic screening process, outlined in Jackson et al. (2021). Walker and Avant's (2005, 2019) concept analysis framework was then applied to included articles to identify guilt-specific, shame-specific, and overlapping attributes, antecedents, and consequences. Results A guilt-specific, shame-specific, and overlapping definition were generated based on exclusive and overlapping antecedents, attributes, and consequences. Guilt and shame belonged to the empirical referent Moral Emotions, which may explain some of the overlapping antecedents, attributes, and consequences identified during analysis. Conclusions The overlapping definition provides a broad scope for shared characteristics, while specific definitions allow for more in-depth and focused investigations of guilt and shame experiences within an infant feeding context. Utilising context-specific definitions may serve to improve research homogeneity. Shame was found to be uniquely associated with postnatal depression. As such, suggestions are made for future research to further investigate the relationship between shame, infant feeding, and maternal wellbeing outcomes. Implications Identified antecedents may be used by healthcare professionals to provide additional support to mothers at risk of experiencing guilt and shame, to prevent the occurrence and consequences of these emotions.

Do Maternal Stress and Depressive Symptoms in Perinatal Period Predict the Lactation Mastitis Occurrence? A Retrospective Longitudinal Study in Greek Women

Background: The aim of this study is to investigate whether symptoms of anxiety and depression disorders in women during the perinatal period predict the occurrence of lactation mastitis. Methods: This is a retrospective longitudinal study of 622 Greek women who were monitored from pregnancy until the first year postpartum (during the period January 2015–May 2018). The Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal Anxiety Screening Scale (PASS) were administered at four time points: (a) 24th–28th gestation week, (b) 34th–38th gestation week, (c) 6 weeks postpartum, and (d) 12 months postpartum. Multivariate binary logistic regression analyses were performed. Results: Results showed that (a) increased EPDS (p < 0.02) and PASS (p < 0.05) scores during the last period before birth, (b) increased EPDS score at 6 weeks postpartum (p < 0.02), (c) PMS symptoms (p < 0.03), (d) traumatic life events during the last year (p < 0.03), and (e) the existence of a history of psychotherapy (before pregnancy) (p = 0.050) appear to be the psycho-emotional factors that can predict the possible occurrence of lactation mastitis in a breastfeeding mother. Conclusions: The association between women’s poor mental health and the occurrence of a physical health problem, such as lactation mastitis, is recognized. This study highlights the important role of early and timely detection of perinatal mental health disorders.

Guilt, shame, and postpartum infant feeding outcomes: A systematic review

Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: 'underprepared and ineffectively supported', 'morality and perceived judgement' (breastfeeding), 'frustration with infant feeding care' and 'failures, fears and forbidden practice' (formula feeding). Both guilt and shame were associated with self-perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.

Crucial Contributions : A Biocultural Study of Grandmothering During the Perinatal Period

Maternal grandmothers play a key role in allomaternal care, directly caring for and provisioning their grandchildren as well as helping their daughters with household chores and productive labor. Previous studies have investigated these contributions across a broad time period, from infancy through toddlerhood. Here, we extend and refine the grandmothering literature to investigate the perinatal period as a critical window for grandmaternal contributions. We propose that mother-daughter co-residence during this period affords targeted grandmaternal effort during a period of heightened vulnerability and appreciable impact. We conducted two focus groups and 37 semi-structured interviews with Himba women. Interviews focused on experiences from their first and, if applicable, their most recent birth and included information on social support, domains of teaching and learning, and infant feeding practices. Our qualitative findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being. We show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants. These findings demonstrate that the role of grandmother can be crucial, even when alloparenting is common and breastfeeding is frequent and highly visible. Situated within the broader anthropological and clinical literature, these findings substantiate the claim that humans have evolved in an adaptive sociocultural perinatal complex in which grandmothers provide significant contributions to the health and well-being of their reproductive-age daughters and grandchildren.

Typologies of postnatal support and breastfeeding at two months in the UK: Response to comments by Harpur & Haddon

We welcome the comments by Harpur and Haddon (2020) on our paper on the typologies of social support and its associations with breastfeeding at two months in a UK sample. We share their concerns around the under-acknowledged costs of breastfeeding, and the need for a truly family-centred approach to breastfeeding support. However, they are mistaken to assume we do not view breastfeeding problems as an important cost of breastfeeding: We explicitly comment on breastfeeding challenges within our paper, and such challenges are theoretically incorporated into the "costs of breastfeeding" following an evolutionary anthropological framework. They are also incorrect in their statement that we recommend breastfeeding promotion messages to wider family members. In fact, we outline in our manuscript that breastfeeding promotional messages can have negative consequences for mothers, and are unlikely to be supportive. What we do suggest is a family-centred approach that recognises that women interact with, and may be supported by, a wide range of individuals (including fathers and grandmothers); and the importance of taking a nuanced approach to support without assuming that all types of support necessarily leads to "more breastfeeding." We hope our response is useful in clarifying the key points of our paper.

Valuing breastfeeding: a qualitative study of women's experiences of a financial incentive scheme for breastfeeding

BACKGROUND

A cluster randomised controlled trial of a financial incentive for breastfeeding conducted in areas with low breastfeeding rates in the UK reported a statistically significant increase in breastfeeding at 6-8 weeks. In this paper we report an analysis of interviews with women eligible for the scheme, exploring their experiences and perceptions of the scheme and its impact on breastfeeding to support the interpretation of the results of the trial.

METHODS

Semi-structured interviews were carried out with 35 women eligible for the scheme during the feasibility and trial stages. All interviews were recorded and verbatim transcripts analysed using a Framework Analysis approach.

RESULTS

Women reported that their decisions about infant feeding were influenced by the behaviours and beliefs of their family and friends, socio-cultural norms and by health and practical considerations. They were generally positive about the scheme, and felt valued for the effort involved in breastfeeding. The vouchers were frequently described as a reward, a bonus and something to look forward to, and helping women keep going with their breastfeeding. They were often perceived as compensation for the difficulties women encountered during breastfeeding. The scheme was not thought to make a difference to mothers who were strongly against breastfeeding. However, women did believe the scheme would help normalise breastfeeding, influence those who were undecided and help women to keep going with breastfeeding and reach key milestones e.g. 6 weeks or 3 months.

CONCLUSIONS

The scheme was acceptable to women, who perceived it as rewarding and valuing them for breastfeeding. Women reported that the scheme could raise awareness of breastfeeding and encourage its normalisation. This provides a possible mechanism of action to explain the results of the trial.

TRIAL REGISTRATION

The trial is registered with the ISRCTN registry, number 44898617 , https://www.isrctn.com.

Commentary on the article "Postpartum women's use of medicines and breastfeeding practices: a systematic review"

This commentary follows the article of Moni R. Saha and her co-authors, entitled "Postpartum women's use of medicines and breastfeeding practices: a systematic review." As highlighted in this systematic review, medication use is common during the postpartum period often creating difficulty for mothers. Several studies illustrate the negative impact medication has on breastfeeding, initiation and duration despite reassuring advice from health professionals. Current data only describe the use of medication and behavior adopted by mothers when medication is prescribed. The factors influencing maternal behaviors have not been studied. Behaviors depend on knowledge, representations and attitudes. To better understand the behaviors of mothers faced with medication, we conducted a qualitative study, utilizing semi-structured interviews to investigate knowledge, risk perception and difficulties women experienced. The study consisted of a description and comparison of the perceived needs of two populations: 19 breastfeeding mothers and 12 health professionals. Divergences between the two populations were highlighted, focusing specifically, on knowledge needed by the women. This commentary is intended to highlight the need for further research essential to explain the influences on maternal behavior when medication is a consideration, allowing health professionals to better help mothers deal with these situations frequently affecting their breastfeeding plans.

Parent Reports of Exclusive Breastfeeding After Attending a Combined Midwifery and Chiropractic Feeding Clinic in the United Kingdom: A Cross-Sectional Service Evaluation

This service evaluation investigated an interdisciplinary allied professional health care strategy to address the problem of suboptimal breastfeeding. A clinic of midwives and chiropractors was developed in a university-affiliated clinic in the United Kingdom to care for suboptimal feeding through a multidisciplinary approach. No studies have previously investigated the effect of such an approach. The aim was to assess any impact to the breastfeeding dyad and maternal satisfaction after attending the multidisciplinary clinic through a service evaluation. Eighty-five initial questionnaires were completed and 72 (85%) follow-up questionnaires were returned. On follow-up, 93% of mothers reported an improvement in feeding as well as satisfaction with the care provided. Prior to treatment, 26% of the infants were exclusively breastfed. At the follow-up survey, 86% of mothers reported exclusive breastfeeding. The relative risk ratio for exclusive breastfeeding after attending the multidisciplinary clinic was 3.6 (95% confidence interval = 2.4-5.4).

Existential security is a necessary condition for continued breastfeeding despite severe initial difficulties: a lifeworld hermeneutical study

Background

The majority of new mothers in Sweden initiate breastfeeding and many experience initial difficulties. This experience is an important cause of early breastfeeding cessation. To increase understanding, there is a need to explore the lived experiences of the decision to continue or cease breastfeeding. The aim of this study is therefore to explain and understand how this decision is influenced by the meaning of severe initial difficulties.

Methods

A lifeworld hermeneutical approach was used for the study. The study was conducted in Sweden with eight mothers who experienced severe difficulties with initial breastfeeding. All except one were interviewed on two different occasions resulting in fifteen interviews. The interviews were conducted between 2010 and 2013.

Results

Mothers who experience severe difficulties with initial breastfeeding feel both overtaken and violated not only by their own infants and their own bodies but also by their anger, expectations, loneliness and care from health professionals. These feelings of being overtaken and invaded provoke an existential crisis and place mothers at a turning point in which these feelings are compared and put in relation to one another in the negotiation of the decision to continue or cease breastfeeding. This decision thus depends on the possibility of feeling secure with the breastfeeding relationship. If insecurity dominates, this can, in severe cases, create a feeling of fear of breastfeeding that is so great that there is no alternative but to stop breastfeeding.

Conclusions

Existential security in the breastfeeding relationship seems to be an underlying factor for confidence and therefore a necessary condition for continued breastfeeding when having severe initial breastfeeding difficulties. Unresolved feelings of insecurity may be a serious barrier to further breastfeeding that can result in a fear of breastfeeding. Such fear can force the mother to cease breastfeeding. This study highlights how women are situated in a complex cultural and biological context of breastfeeding that has existential consequences for them. An existential crisis forces mothers into a turning point for the breastfeeding decision. In the existential crisis, mothers’ responsibility for the mother-infant relationship guides continuing or ceasing breastfeeding.

Experience of non-breastfeeding mothers

Background:

Breastfeeding is currently strongly recommended by midwives and paediatricians, and the recommendations are based on documents provided by the World Health Organization and public health authorities worldwide.

Research question:

The underlying question is, how are non-breastfeeding mothers affected emotionally when informed that breastfeeding is the safest and healthiest option?

Research design:

The method used is an anonymous web-based qualitative survey exploring the narratives of non-breastfeeding mothers, published on Thesistools.com . The aim is to achieve qualitative knowledge about the emotions of non-breastfeeding mothers.

Participants and research context:

Participants were based in Sweden, the United Kingdom and the Netherlands and were selected through a purposeful sample.

Ethical considerations:

The online survey anonymizes responses automatically, and all respondents had to tick a box agreeing to be quoted anonymously in scientific articles. The study conforms to research ethics guidelines.

Findings:

Respondents describe how they were affected, and the following themes emerged in studying their descriptions: depression, anxiety and pain, feeling failed as a mother and woman, loss of freedom/feeling trapped, relief and guilt.

Discussion:

The themes are discussed against the background of the ethics of care and a theory of ethically responsible risk communication.

Conclusion:

Three conclusions are made. First, the message should become more empathetic. Second, information should be given in an attentive dialogue. Third, information providers should evaluate effects in a more inclusive way.

Process-oriented training in breastfeeding for health professionals decreases women's experiences of breastfeeding challenges

BACKGROUND

The World Health Organization recommends promoting exclusive breastfeeding for six months. Women often end breastfeeding earlier than planned, however women who continue to breastfeed despite problems often experience good support and counselling from health professionals. The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, on women's satisfaction with breastfeeding counselling, problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months.

METHODS

An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. This study was conducted in Sweden, in 2000 - 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n = 540) were invited to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n = 162) started before the intervention was initiated. Data for control group B (n = 172) were collected simultaneously with the intervention group (IG) (n = 206). Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months.

RESULTS

Women in IG were more satisfied with the breastfeeding counselling (p = 0.008) and felt the breastfeeding counselling was more coherent (p = 0.002) compared to control groups, when exclusive breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p = 0.01).

CONCLUSION

A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in line with their planned breastfeeding duration, compared to women who had breastfeeding duration < 3 months.

TRIAL REGISTRATION

ACTRN12611000354987.

Misunderstood as mothers: women's stories of being hospitalized for illness in the postpartum period

AIM

This paper aims to explore women's experiences with healthcare providers to ascertain ways health care may be improved for women disrupted in their mothering.

BACKGROUND

Women can find it difficult to relinquish care even when they are acutely unwell requiring hospitalization. Despite mothering being a priority for women, many healthcare professionals do not understand the importance of continuing to mother during maternal illness.

DESIGN

This research used a qualitative methodology drawing on principles of feminism and storytelling.

METHODS

Women's stories were collected through face-to-face interviews, email and via the telephone. The twenty-seven women who participated were from either Australia or the USA, had between one and six children and identified themselves as having been disrupted in their mothering by illness. Data were collected in 2011 and were analysed thematically.

FINDINGS

The majority of participants had been hospitalized at some point in time for acute illness. A subset of participants reported feeling judged by nurses and that their efforts to continue to mother their newborn children despite their illness were misunderstood and not facilitated.

CONCLUSION

Findings from this study suggest that women are more likely to remember times that health professionals failed to understand the primacy that mothering held for them or facilitate their efforts to continue to mother despite illness. Nurses and midwives should regularly reflect on their personal values in regard to mothering, validate women's attempts to mother to the best of their ability during illness and find ways to support and empower women in their mothering.

Do maternal quality of life and breastfeeding difficulties influence the continuation of exclusive breastfeeding?

Objectives. This study was conducted to determine whether maternal quality of life (QOL) and breastfeeding difficulties influence the continuation of exclusive breastfeeding (EBF). Methods. In a survey, 358 consecutive pregnant women filled out a quality of life questionnaire in the third trimester of pregnancy and the breastfeeding experience scale at 4 weeks postpartum. We assessed breastfeeding practices every month up to 6 months postpartum. Results. Only 11.8% of women continued EBF at six months. Mothers who continued EBF at 2 and 4 months postpartum had better QOL in late pregnancy than mothers who discontinued it (P < 0.05). There were no significant differences between the two groups in QOL scores at 6 months postpartum. Mothers who continued EBF at 2 months postpartum experienced less breastfeeding difficultties during one month postpartum than mothers who discontinued it (P < 0.05). Conclusion. In attempts to promote EBF, mothers with poor QOL or breastfeeding difficulties in early postpartum should be identified and helped.

An Assessment of the Breastfeeding Practices and Infant Feeding Pattern among Mothers in Mauritius

Proper breastfeeding practices are effective ways for reducing childhood morbidity and mortality. While many mothers understand the importance of breastfeeding, others are less knowledgeable on the benefits of breastfeeding and weaning. The aim in here is to assess breastfeeding pattern, infant formula feeding pattern, and weaning introduction in Mauritius and to investigate the factors that influence infant nutrition. 500 mothers were interviewed using a questionnaire which was designed to elicit information on infant feeding practices. Statistical analyses were done using SPSS (version 13.0), whereby chi-square tests were used to evaluate relationships between different selected variables. The prevalence of breastfeeding practice in Mauritius has risen from 72% in 1991 to 93.4% as found in this study, while only 17.9% breastfed their children exclusively for the first 6 months, and the mean duration of EBF (exclusive breastfeeding) is 2.10 months. Complementary feeding was more commonly initiated around 4-6 months (75.2%). Despite the fact that 60.6% of mothers initiate breastfeeding and 26.1% of mothers are found to breastfeed up to 2 years, the practice of EBF for the first 6 months is low (17.9%). Factors found to influence infant feeding practices are type of delivery, parity, alcohol consumption, occupation, education, and breast problems.

Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial

Background

Infants with latch-on problems cause stress for parents and staff, often resulting in early termination of breastfeeding. Healthy newborns experiencing skin-to-skin contact at birth are pre-programmed to find the mother’s breast. This study investigates if skin-to-skin contact between mothers with older infants having severe latching on problems would resolve the problem.

Methods

Mother-infant pairs with severe latch-on problems, that were not resolved during screening procedures at two maternity hospitals in Stockholm 1998–2004, were randomly assigned to skin-to-skin contact (experimental group) or not (control group) during breastfeeding. Breastfeeding counseling was given to both groups according to a standard model. Participants were unaware of their treatment group. Objectives were to compare treatment groups concerning the proportion of infants regularly latching on, the time from intervention to regular latching on and maternal emotions and pain before and during breastfeeding.

Results

On hundred and three mother-infant pairs with severe latch-on problems 1–16 weeks postpartum were randomly assigned and analyzed. There was no significant difference between the groups in the proportion of infants starting regular latching-on (75% experimental group, vs. 86% control group). Experimental group infants, who latched on, had a significantly shorter median time from start of intervention to regular latching on than control infants, 2.0 weeks (Q₁ = 1.0, Q₃ = 3.7) vs. 4.7 weeks (Q₁ = 2.0, Q₃ = 8.0), (p-value = 0.020). However, more infants in the experimental group (94%), with a history of “strong reaction” during “hands-on latch intervention”, latched-on within 3 weeks compared to 33% in the control infants (Fisher Exact test p-value = 0.0001). Mothers in the experimental group (n = 53) had a more positive breastfeeding experience according to the Breastfeeding Emotional Scale during the intervention than mothers in the control group (n = 50) (p-value = 0.022).

Conclusions

Skin-to-skin contact during breastfeeding seems to immediately enhance maternal positive feelings and shorten the time it takes to resolve severe latch-on problems in the infants who started to latch. An underlying mechanism may be that skin-to-skin contact with the mother during breastfeeding may calm infants with earlier strong reaction to “hands on latch intervention” and relieve the stress which may have blocked the infant’s inborn biological program to find the breast and latch on.

Trial registration

Karolinska Clinical Trial Registration number CT20100055

Alternative hospital gift bags and breastfeeding exclusivity

The type of gift bags given to new mothers at the time of discharge from the hospital can influence their confidence in breastfeeding. Most hospitals in the US continue to distribute commercial gift bags containing formula samples despite the reported negative influence of commercial bags on the duration of breastfeeding. This study compared breastfeeding outcomes in women receiving three different kinds of gift bags at discharge. A prospective intervention study was conducted during 2009-2010 in New Jersey. Three breastfeeding cohorts were recruited and assigned to three groups: COMMERCIAL received discharge bags containing formula samples, BF-INFO received breastfeeding information and supplies, and PUMP received breastfeeding information/supplies plus a manual breast pump. Follow-up contacts were at 2, 4, and 12 postpartum weeks to determine breastfeeding outcome. The mean durations of exclusive (EBF) and partial breastfeeding were compared between groups using ANOVA. A total of 386 participants completed the study. The mean EBF duration (weeks) in the PUMP (n = 138, 8.28 ± 4.86) and BF-INFO (n = 121, 7.87 ± 4.63) were significantly longer (P < 0.01) than COMMERCIAL (n = 127, 6.12 ± 4.49). The rate of EBF through 12 weeks in PUMP was most consistent. The mean duration of partial breastfeeding showed similar results: significantly longer in PUMP and BF-INFO than COMMERCIAL (P < 0.01).

Use of electronic communication by physician breastfeeding experts for support of the breastfeeding mother

BACKGROUND

Breastfeeding initiation and duration increase because of physician encouragement. However, many physicians have not received education on breastfeeding, and some may not have a supportive attitude or commitment to breastfeeding. Patients identify dissatisfaction with their current provider as a motivating factor in seeking health information on the Internet. This survey was performed to determine how many physicians with an interest and expertise in breastfeeding are being contacted for breastfeeding information over the Internet and to examine physicians' attitudes to these requests.

SUBJECTS AND METHODS

An e-mail describing the survey, inviting participation, and containing a link to the online questionnaire was posted on the Web site of the Academy of Breastfeeding Medicine and as well as on the Listserv of the American Academy of Pediatrics-Section on Breastfeeding. Information collected included physician training, successes and challenges related to providing breastfeeding medicine support by e-mail, and current level of e-mail communication with patients regarding breastfeeding issues.

RESULTS

One-fourth of physicians in our survey receive e-mails with questions about breastfeeding issues from patients with whom they have no preexisting relationships. More receive e-mail from known patients. This suggests that breastfeeding mothers seek expert information on the Internet. Over half of the physicians replied to e-mails individually and without any financial reimbursement.

CONCLUSIONS

Many breastfeeding mothers reach out to breastfeeding experts over the Internet. Our findings suggest that physicians who provide care to breastfeeding mothers need further education on breastfeeding to provide adequate support to their own patients.

When breastfeeding is unsuccessful--mothers' experiences after giving up breastfeeding

Some mothers have to give up breastfeeding even though they want to breastfeed. To give up breastfeeding can be a sensitive issue in a time when breastfeeding is promoted as the healthiest for mother and child. The aim of this study was to describe mothers' experiences after they gave up breastfeeding even though they intended to breastfeed. A qualitative social constructive approach was used to describe mothers' experiences after giving up breastfeeding. Danish first-time mothers who had expected and wanted to breastfeed were interviewed 4 months after birth. The interviews were analysed by meaning condensation. The mothers experienced that giving up breastfeeding was a crucial but necessary decision for the child's health and well-being. They tried to 'be on the side of the angels' by caring for and bonding with the child. The mothers were divided between expressing milk or formula feeding and initially felt especially insecure about which method to choose when not breastfeeding. It was difficult for them to face the world with a bottle, but they did not ask for help. The mothers found it hard to explain the difficulty they had experienced breastfeeding and they were concerned about what to do the next time around. The mothers always tried to do what they perceived was best for their child, but they were in a vulnerable position and not always supported and understood by the surroundings. Therefore, health professionals who focus on making new mothers feel successful need to be aware that mothers who have to give up breastfeeding need special attention and support.

Severe breastfeeding difficulties: Existential lostness as a mother-Women's lived experiences of initiating breastfeeding under severe difficulties

A majority of women in Sweden initiate breastfeeding but almost a quarter stop or wean the infant in the first few weeks after birth because of difficulties. In order to develop care that facilitates initiation of breastfeeding and enables mothers to realize their expectations concerning breastfeeding, it is necessary to understand what having severe breastfeeding difficulties means for women who experience them. The aim of this study is to describe the lived experiences of initiating breastfeeding under severe difficulties. A reflective lifeworld research design was used. Eight women, seven primiparous and one multipara, were interviewed within 2 months of giving birth. The essential meaning of the phenomenon is described as "Existential lostness as a mother forcing oneself into a constant fight". This pattern is further explicated through its constituents; shattered expectations, a lost time for closeness, being of no use to the infant, being forced to expose oneself, and gaining strength through sharing. The results show that mothers with severe breastfeeding difficulties feel alone and exposed because of their suffering and are lost in motherhood. Thus, adequate care for mothers should enhance the forming of a caring relationship through sharing rather than exposing.

An evaluation of hospital breastfeeding policies in the Philadelphia metropolitan area 1994-2009: a comparison with the baby-friendly hospital initiative ten steps

OBJECTIVE

The purpose of this study was to describe current breastfeeding policies and practices among Philadelphia, PA metropolitan hospitals and changes in their policies and practices over time.

METHODS

In-person group interviews were conducted to obtain a composite picture of actual breastfeeding policies and practices. One questionnaire per hospital was completed based on responses from group consensus. Twenty-five hospitals providing maternity care were contacted. Information was obtained from personnel representing different areas of maternity services. Hospitals were classified according to the degree to which they were implementing the Ten Steps to Successful Breastfeeding.

RESULTS

Mean breastfeeding rates at suburban hospitals were significantly higher than urban hospitals (72% vs. 49%, p = 0.015). Most hospitals were classified as high or moderately high implementers on six of the Ten Steps, including staff training (67%), printed information distributed to breastfeeding mothers (94%), breastfeeding initiation (61%), oral breastfeeding instruction given to mothers (83%), infant feeding schedules (89%), and hospital postpartum support (83%). Most hospitals reported partial or low implementation on two maternity practices: infant formula supplementation (61%) and rooming-in (72%).

CONCLUSIONS

In the past 15 years, hospitals in the Philadelphia area have an increased awareness about breastfeeding and enhanced support of breastfeeding by healthcare professionals. In spite of an increase in overall breastfeeding rates, formula supplementation in hospitals and contact time between mothers and their newborns continue to be areas of concern.