Understanding intimacy as experienced by breastfeeding women

Breastfeeding Duration and the Theory of Planned Behavior and Breastfeeding Self-Efficacy Framework: A Systematic Review of Observational Studies

Introduction Numerous studies have shown that the constructs of the Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB) and Breastfeeding Self-Efficacy (BSE) Framework can effectively identify relationships between maternal psychosocial factors and breastfeeding initiation. However, the ability of these theories to predict breastfeeding duration has not been adequately analyzed. The aim of the review was to examine the utility of the constructs of TRA/TPB and BSE to predict breastfeeding duration. Methods We conducted a literature search using Pubmed (1980-May 2015), Medline (1966-May 2015), CINAHL (1980-May 2015), EMBASE (1980-May 2015) and PsycINFO (1980-May 2015). We selected studies that were observational studies without randomization or blinding, using TRA, TPB or BSE as the framework for analysis. Only studies reporting on breastfeeding duration were included. Results Thirty studies were selected, which include four using TRA, 10 using TPB, 15 using BSE and one using a combination of TPB and BSE. Maternal intention and breastfeeding self-efficacy were found to be important predictors of breastfeeding duration. Inconsistent findings were found in assessing the relationship between maternal attitudes, subjective norms, perceived behavior control and breastfeeding duration. Discussion The inadequacy of these constructs in explaining breastfeeding duration indicates a need to further explore the role of maternal self-determination in breastfeeding behavior.

Using sertraline in postpartum and breastfeeding: balancing risks and benefits

INTRODUCTION

The World Health Organization recommends newborns to be breastfed but this may be challenging if the mother needs to be treated for depression, since strong evidence to inform treatment choice is missing.

AREAS COVERED

We provide a critical review of the literature to guide clinicians who are considering sertraline for the management of depression during postpartum.

EXPERT OPINION

Sertraline is one of the safest antidepressants during breastfeeding. In most cases, women already taking sertraline should be advised to breastfeed and continue the medication. We recommend to begin with low doses and to slowly increase the dose up, with careful monitoring of the newborn for adverse effects (irritability, poor feeding, or uneasy sleep, especially if the child was born premature or had low weight at birth). The target dose should be the lowest effective. When feasible, child exposure to the medication may be reduced by avoiding breastfeeding at the time when the antidepressant milk concentration is at its peak. A decision to switch to sertraline from ongoing and effective treatment should be taken only after a scrupulous evaluation of the potential risks and benefits of switching versus continuing the ongoing medication while monitoring the infant carefully.

Intimate partner violence and breastfeeding practices: a systematic review of observational studies

OBJECTIVE

To review the association between intimate partner violence and breastfeeding practices in the literature.

DATA SOURCES

The search was carried out in five databases, including MEDLINE, LILACS, SCOPUS, PsycoINFO, and Science Direct. The search strategy was carried out in February 2017. The authors included original studies with observational design, which investigated forms of intimate partner violence (including emotional, physical, and/or sexual) and breastfeeding practices. The quality of the studies was assessed based on the bias susceptibility through criteria specifically developed for this review.

SUMMARY OF DATA

The study included 12 original articles (10 cross-sectional, one case-control, and one cohort study) carried out in different countries. The forms of intimate partner violence observed were emotional, physical, and/or sexual. Breastfeeding was investigated by different tools and only assessed children between 2 days and 6 months of life. Of the 12 studies included in this review, eight found a lower breastfeeding intention, breastfeeding initiation, and exclusive breastfeeding during the first six months of the child's life, and a higher likelihood of early termination of exclusive breastfeeding among women living at home where violence was present. The quality varied between the studies and six were classified as having low bias susceptibility based on the assessed items.

CONCLUSIONS

Intimate partner violence is associated with inadequate breastfeeding practices of children aged 2 days to 6 months of life.

Fetal and neonatal levels of omega-3: effects on neurodevelopment, nutrition, and growth

Nutrition in pregnancy, during lactation, childhood, and later stages has a fundamental influence on overall development. There is a growing research interest on the role of key dietary nutrients in fetal health. Omega-3 polyunsaturated fatty acids (n-3 LCPUFAs) play an important role in brain development and function. Evidence from animal models of dietary n-3 LCPUFAs deficiency suggests that these fatty acids promote early brain development and regulate behavioral and neurochemical aspects related to mood disorders (stress responses, depression, and aggression and growth, memory, and cognitive functions). Preclinical and clinical studies suggest the role of n-3 LCPUFAs on neurodevelopment and growth. n-3 LCPUFAs may be an effective adjunctive factor for neural development, growth, and cognitive development, but further large-scale, well-controlled trials and preclinical studies are needed to examine its clinical mechanisms and possible benefits. The present paper discusses the use of n-3 LCPUFAs during different developmental stages and the investigation of different sources of consumption. The paper summarizes the role of n-3 LCPUFAs levels during critical periods and their effects on the children's neurodevelopment, nutrition, and growth.

A life course approach to the development of mental skills

A wide variety of factors across the life course jointly influence cognitive and emotional development. Indeed, research from a variety of disciplines strongly suggests that cognition and mental health are intertwined across the life course, by their common antecedents and underlying physiology in development and in their interplay across adult and later life. We suggest that cognitive and socioemotional function fuse to form skills for life supporting self-regulation, competence, and quality of life that persist into later life through linked reciprocal processes of genetic influence, nurturing, schooling, work, and lifestyle.

A meta-ethnographic synthesis of women's experience of breastfeeding

Despite considerable evidence and effort, breastfeeding duration rates in resource-rich countries such as Australia remain below World Health Organization recommendations. The literature on the experience of breastfeeding indicates that women construct and experience breastfeeding differently depending upon their own personal circumstances and the culture within which they live. Breastfeeding has also been described as a deeply personal experience, which can be associated with 'moral' decision-making. The aim of this synthesis was to better understand the social phenomenon of breastfeeding by making the hidden obvious. Using a meta-ethnographic approach, we analysed the findings from 17 qualitative studies exploring women's experience of breastfeeding. Commonly used metaphors, ideas and phrases across the national and international qualitative studies were identified. Two overarching themes emerged. Breastfeeding was described in terms of 'expectation' and 'reality', while the emotional aspects of breastfeeding were expressed in 'connected' or 'disconnected' terms. The prevalence of health professionals and public health discourses in the language women use to describe their experience, and the subsequent impact of this on maternal confidence and self-assessment of breastfeeding are discussed. This synthesis provides insight into some of the subtle ways health professionals can build maternal confidence and improve the experience of early mothering.

A descriptive account of New Zealand mothers’ responses to open-ended questions on their breast feeding experiences

OBJECTIVE

To describe the breast feeding experiences of mothers in New Zealand.

DESIGN

Descriptive, qualitative study. After a previous quantitative analysis of a questionnaire, the open-ended responses by the women were examined using a thematic analysis approach.

SETTING

Hawke's Bay, New Zealand.

PARTICIPANTS

153 primiparous and multiparous breast feeding women aged between 20 and 49 years, who had had a caesarean section or vaginal birth between 4 months and 3 years previously.

FINDINGS

Themes identified during the data analysis are as follows: persistence, determination, confidence and satisfaction; pain and limitation of mothering activities; conflicting advice and professionalism; and others' expectations.

CONCLUSIONS

Breast feeding experience could be detrimentally affected by physical factors, inconsistent health-professional support and others' expectations. Negative influences, however, were likely to be overcome by persistence, determination, confidence and satisfaction.

IMPLICATIONS FOR PRACTICE

Implications for midwifery practice from the study iterate the importance of consistency of advice and skills of health professionals, of listening and understanding women's responses to early breast feeding assistance and giving continuous encouragement and support throughout their breast feeding experience. To meet these recommendations, breast feeding education for health professionals needs to include technical expertise and communication skills. Recommendations for further research from this study include investigations into why women commit to breast feeding and an exploration of women's perceptions of midwives' breast feeding support.

Influence of intimate partner violence during pregnancy and early postpartum depressive symptoms on breastfeeding among chinese women in Hong Kong

Numerous studies show that breastfeeding is beneficial to both mothers and babies. This study explores two understudied correlates that may influence breastfeeding initiation: intimate partner violence during pregnancy and early postnatal depressive symptoms. A cross-sectional comparative study design investigated the correlates of feeding modes of 1200 Chinese mother and infant pairs in a university-affiliated regional hospital in Hong Kong. The prevalence rates of breastfeeding and mixed feeding were 42.25% and 26.25%, respectively. Women who had no experience of intimate partner violence during pregnancy were significantly more likely to initiate breastfeeding (adjusted odds ratio = 1.84; 95% confidence interval, 1.16-2.91) after adjustment for demographic, socioeconomic, and obstetric variables. Early postnatal depressive symptoms were not significantly associated with feeding modes in a multinomial logistic regression model. Midwives are in a key position to identify and intervene to encourage more successful breastfeeding practice.

Intimate partner violence around the time of pregnancy: association with breastfeeding behavior

OBJECTIVE

To assess associations of experiences of intimate partner violence (IPV) and breastfeeding behaviors among a large, population-based sample of U.S. women.

METHODS

Data were collected from women giving birth to live infants in 26 U.S. states and participating in the 2000-2003 Pregnancy Risk Assessment Monitoring System (PRAMS) (n = 118,579). Logistic regression analyses were conducted to assess the relations of experiences of IPV in the year prior to and during pregnancy to initiation and early cessation of breastfeeding.

RESULTS

Approximately 1 in 17 (5.8%) women delivering liveborn infants reported IPV either during or in the year prior to pregnancy. In crude logistic regression analyses, women who reported IPV in the year prior to pregnancy but not during pregnancy (OR 1.45, CI 1.26- 1.66), IPV during pregnancy but not in the year prior to pregnancy (OR 1.35, CI 1.11-1.64), and women reporting experiencing IPV across both periods (OR 1.52, CI 1.34-1.72) were significantly less likely to breastfeed the infants born subsequent to this pregnancy. Similarly, women reporting IPV around the time of pregnancy who initiated breastfeeding were more likely to cease breastfeeding by 4 weeks postpartum (ORs 1.41-1.71). In analyses adjusted for demographics and current smoking, however, experiences of IPV did not relate to women's risk for either outcome.

CONCLUSIONS

Although other factors beyond experiences of IPV may better predict a woman's decision or ability to breastfeed, abused women are overrepresented among mothers who do not or prematurely cease to breastfeed and should be identified and referred to appropriate services.

Student nurses' attitudes and beliefs about breast-feeding

This study explored the breast-feeding attitudes and beliefs of students newly enrolled in an urban university baccalaureate nursing program. A qualitative approach was used to conduct in-depth semistructured interviews with 12 students prior to their formal course work in maternal-child nursing. Four themes emerged from the data analysis: 1. Personal experiences are important in the development of breast-feeding attitudes and beliefs. 2. The students generally believed that breast-feeding offered benefits for babies and mothers, but the beliefs were stronger for those who grew up with breast-feeding as the norm. 3. All the students believed that there were barriers to breast-feeding in the United States that they identified as the societal view of the breast, dependence/independence conflicts, and concerns about intimacy. 4. The students identified an educational rather than promotional role for nurses in breast-feeding because of conflicts about personal choice. This study suggests that students need help identifying their attitudes and beliefs about breast-feeding and reflecting how their personal experiences influence breast-feeding promotion.

Mental health, attachment and breastfeeding: implications for adopted children and their mothers

Breastfeeding an adopted child has previously been discussed as something that is nice to do but without potential for significant benefit. This paper reviews the evidence in physiological and behavioural research, that breastfeeding can play a significant role in developing the attachment relationship between child and mother. As illustrated in the case studies presented, in instances of adoption and particularly where the child has experienced abuse or neglect, the impact of breastfeeding can be considerable. Breastfeeding may assist attachment development via the provision of regular intimate interaction between mother and child; the calming, relaxing and analgesic impact of breastfeeding on children; and the stress relieving and maternal sensitivity promoting influence of breastfeeding on mothers. The impact of breastfeeding as observed in cases of adoption has applicability to all breastfeeding situations, but may be especially relevant to other at risk dyads, such as those families with a history of intergenerational relationship trauma; this deserves further investigation.

Australian women's stories of their baby-feeding decisions in pregnancy

OBJECTIVE

To describe the baby-feeding decisions of a group of Australian women prior to birth.

DESIGN, SETTING AND PARTICIPANTS

A qualitative study using face-to-face in depth interviews was undertaken with 29 women. All interviews were audio-tape recorded and transcribed verbatim. Data were analysed using thematic analysis.

FINDINGS

The women observed and sought information from a variety of sources as well as exploring their own understandings of themselves and their breasts. Based on this knowledge the women made their antenatal baby-feeding decisions. These baby-feeding decisions grouped into four thematic groups, 'assuming I'll breast feed'; 'definitely going to breast feed'; 'playing it by ear' and 'definitely going to bottle feed'. Each of these standpoints was associated with, and precipitated a number of behaviours and strategies.

IMPLICATIONS

The findings of this research highlight the need for antenatal educators and midwives who provide care in pregnancy to acknowledge a range of experiences and expectations of women and to provide diverse educational opportunities to meet a range of needs. There is a need for further research to identify how midwives can encourage and assist women to explore and challenge their assumptions about breast feeding as they relate to other aspects of their lives.

Medicalization and women's knowledge: the construction of understandings of infant feeding experiences in post-WW II New Zealand

For most of the twentieth century infant feeding knowledge has been constructed by medical scientists and health professionals. However, for a short time around the 1970s, New Zealand women (re)claimed the power to author their own knowledge based upon experience. This coincided with a dramatic return to breastfeeding on a national scale. Using New Zealand women's narratives of their infant feeding experiences over the past 50 years, this article brings to the foreground the importance of women's subjective construction of knowledge, their positioning within it, and the suppression of rudimentary discourses when that power is removed or relinquished in the process of remedicalization.

Contemporary breast-feeding policy and practice: implications for midwives

In this paper, the authors draw upon recent Australian research to provide a critical commentary on the current policies and professional practices surrounding breast feeding. These studies, conducted by the first and second authors, explored aspects of the breast-feeding experience, with the findings highlighting areas for concern in relation to the promotion and support of breast feeding in western societies. Of particular concern to the authors was the number of women in these studies who equated breastfeeding with being a 'good' mother. This perception meant that some women maintained a strong commitment to breast feeding despite enormous difficulties. In this paper we firstly, overview the findings of these studies and use women's stories to illustrate their perseverance and their intense commitment to breast feeding. In the second part of the paper, we consider the consequences of the strong public rhetoric surrounding breast feeding in Australia and challenge some of the assumptions underlying policies and professional practices related to breast feeding. We examine the consequences of 'professionalising' breast feeding, and make suggestions for a way forward in the promotion of breast feeding that encompasses the range of perspectives held by women. In conclusion, the authors highlight the complexity of establishing appropriate breast-feeding policies that guide professional practices in a flexible manner, allowing for diversity in individual breast-feeding experiences.

A comparison of perspectives on breastfeeding between two generations of black American women

PURPOSE

To determine differences in breastfeeding perspectives between two generations of black American women with and without access to governmental food assistance programs (i.e., WIC).

DATA SOURCES

Descriptive, comparative study of a convenience sample of 118 black American women in their childbearing years and beyond conducted in a primary rural health care clinic serving an indigent population.

CONCLUSIONS

A significant difference was found between breastfeeding perceptions and rate among younger black American women on WIC program and their mothers without access to these programs. The availability of free formula through WIC programs has partially influenced the rate of breastfeeding among the young black American women. The other significant influencing factor was public embarrassment at breastfeeding.

IMPLICATIONS FOR PRACTICE

An extensive educational campaign is needed in order to influence the public's perceptions of breastfeeding as an embarrassment. The success of programs such as WIC must be measured beyond the first six months of an infant's life.

When and how to use mood stabilizers during breastfeeding

For many women with bipolar disorder, treatment with mood stabilizers is indicated to decrease the risk of a recurrence of depression, mania, or psychosis during the postpartum period. Because breastfeeding during this time exposes infants to these medications, a risk-benefit analysis is crucial for the mother and her physician when deciding whether to breastfeed. This article reviews the risks and benefits to mothers and nursing infants with regard to untreated mental illness, breastfeeding, and medication exposure during breastfeeding. Reports of breast milk and infant serum drug concentrations are summarized. Adverse events reported with lithium, valproate, and carbamazepine are also described. The current available data and their limitations are further summarized to allow physicians to assess more accurately the risks and benefits of the use of mood stabilizers during breastfeeding. Finally, a list of practical recommendations is provided.

Connection and pleasure, disruption and distress: women's experience of breastfeeding

Interview data collected in a recent study of first time motherhood were used to explore the experience of breastfeeding. Twenty-five Australian women participated in a series of semistructured interviews begun during late pregnancy and continuing until 6 months postpartum. Discourse analysis was used to examine the transcribed data. The analysis revealed that breastfeeding was central to these women's experience of motherhood. The majority of women were strongly committed to breastfeeding. Their decision to breastfeed was influenced by a range of public and professional discourses. Breastfeeding was also an embodied experience that was difficult to articulate. For some, this embodied experience was connected, harmonious and pleasurable and for others, disruptive, unpleasant, and violent. This paper describes the embodied experience of breastfeeding and highlights the complexity of the relationship between embodied experience and contemporary meanings and context of breastfeeding.

The power of support groups: influence on infant feeding trends in New Zealand

By outlining infant feeding trends and the essential characteristics of support groups, this paper reveals how important such groups and their development have been in shaping the history of infant feeding in twentieth-century New Zealand. The paper draws, in particular, on the histories, growth, and influence of the Royal New Zealand Plunket Society, Parents Centre New Zealand, and La Leche League New Zealand. It demonstrates the importance of such middle-class groups in changing practices and attitudes within society. In general, this paper is a call for recognition of the importance of lay support groups in the improvement of health outcomes.