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Liao Q, Yuan J, Lok KYW, Ngu SF, Chen Y, Lam WWT. Learning from mothers' success in breastfeeding maintenance: coping strategies and cues to action. Front Psychol 2023; 14:1167272. [PMID: 37260966 PMCID: PMC10229069 DOI: 10.3389/fpsyg.2023.1167272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023] Open
Abstract
This study aimed to gain insight from mothers who were successful in breastfeeding maintenance to develop interventions for promoting breastfeeding maintenance. Following the phenomenological framework, this qualitative study recruited mothers who had maintained breastfeeding for at least 4 months for in-depth interviews. A total of 30 in-depth interviews were completed. We found that almost all participants had experienced an initial adjustment period. During this period, a social support network, personal perseverance in "trying" breastfeeding and "pumping," and adjusting expectations for breastfeeding to relieve themselves from the pressure of exclusive breastfeeding were important coping strategies. All participants then entered a stage of getting more attuned when breastfeeding was easier. During this period, seeking support from the online mother groups, deliberating medication that might affect breastfeeding, adjusting to accommodate breastfeeding and lives, and managing breastfeeding in public were the main strategies. For working mothers, despite workplace and employers' support, proactive adjustment for using the facilities and lactation breaks for breast milk expression was essential for breastfeeding continuation after returning to work. Throughout the whole journey, positive cues identified from their breastfeeding experiences that helped breastfeeding maintenance included enjoying breastfeeding, breastfeeding as a personal achievement, a healthy and thriving child, positive social feedback, bodily response, the convenience of breastfeeding, and breastfeeding as a motherhood commitment. To conclude, while mothers should be mentally prepared for the difficulties of breastfeeding, they should also be encouraged that things will always get easier as they persevere. Adjustments should be made to accommodate lives and other personal needs. Future studies should consider integrating relevant cues into existing psychosocial interventions for promoting breastfeeding maintenance.
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Affiliation(s)
- Qiuyan Liao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jiehu Yuan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Siew Fei Ngu
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yuyi Chen
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wendy Wing Tak Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Li Ka Shing Faculty of Medicine, Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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2
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Reno R, Whipps M, Wallenborn JT, Demirci J, Bogen DL, Gross RS, Mendelsohn AL, Morris PA, Shaw DS. Housing Insecurity, Housing Conditions, and Breastfeeding Behaviors for Medicaid-Eligible Families in Urban Settings. J Hum Lact 2022; 38:760-770. [PMID: 35775199 PMCID: PMC9596949 DOI: 10.1177/08903344221108073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Research exploring associations between exposure to social determinants of health and breastfeeding is needed to identify breastfeeding barriers. Housing insecurity and household conditions (chaos and crowding) may affect breastfeeding by increasing maternal stress and discomfort and decreasing time available to breastfeed. RESEARCH AIM We aimed to examine the relationships between housing insecurity, breastfeeding exclusivity intention during the early postnatal period, and breastfeeding exclusivity at 6 months postpartum among a sample "at risk" for suboptimal breastfeeding rates. METHODS This study is a secondary data analysis of a longitudinal study at two time periods. Data were collected from English- and Spanish-speaking, Medicaid-eligible mother-infant dyads (N = 361) at near-birth and child aged 6 months, in New York City and Pittsburgh. Structural equation modeling was used to examine direct and indirect effects of housing insecurity on breastfeeding exclusivity at child aged 6 months. RESULTS The path model showed that experiencing more markers of housing insecurity (i.e., foreclosure/eviction threat, history of homelessness, late rent) was predictive of significantly lower breastfeeding exclusivity at 6 months. This was partially mediated through less exclusive breastfeeding intention during the early postnatal period. Greater household crowding was associated with 6-month breastfeeding exclusivity when mediated by intention. Household crowding had differential effects by study site and participant race/ethnicity. CONCLUSION Refinement of housing insecurity as a multi-dimensional construct can lead to the development of standardized data collection instruments, inform future methodological decisions in research addressing social determinants of health, and can inform the development of responsive individual- and structural-level interventions.The data used in this study were collected as part of the SMART Beginnings Randomized Controlled Trial (NCT02459327 registered at ClinicalTrials.gov).
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Affiliation(s)
- Rebecca Reno
- University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Mackenzie Whipps
- Steinhardt School of Culture, Education and Human Development, New York University, NY, USA
| | - Jordyn T Wallenborn
- University of California, Berkeley School of Public Health, Berkeley, CA, USA.,Swiss Tropical and Public Health Institute, University of Basel
| | - Jill Demirci
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel S Gross
- Department of Pediatrics, New York University Grossman School of Medicine, NY, USA
| | - Alan L Mendelsohn
- Department of Pediatrics, New York University Grossman School of Medicine, NY, USA
| | - Pamela A Morris
- Steinhardt School of Culture, Education and Human Development, New York University, NY, USA
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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3
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Deif R, Burch EM, Azar J, Yonis N, Abou Gabal M, El Kramani N, DakhlAllah D. Dysphoric Milk Ejection Reflex: The Psychoneurobiology of the Breastfeeding Experience. Front Glob Womens Health 2021; 2:669826. [PMID: 34816221 PMCID: PMC8594038 DOI: 10.3389/fgwh.2021.669826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Breastfeeding, given its biochemical and physiological basis, is known for its many benefits for both the lactating mother and the infant. Among the many challenges new breastfeeding mothers experience is the feeling of aversion in response to their newborn's suckling which has been termed dysphoric milk-ejection reflex (D-MER). Characterized by intense feelings of dysphoria which may eventually interfere with the mother's ability to breastfeed regularly, evidence suggests both the neurobiological and psychological basis of D-MER in an attempt to explain its complexity. Biologically, breastfeeding is expressed by the intracerebral release of oxytocin, an increased expression of oxytocin receptors in specific brain regions, increased mesocorticolimbic reward region activation, the secretion of prolactin and possibly the inhibition of dopamine. Hence, different theories explain D-MER in terms of disrupted neurotransmitter and hormonal activity. Breastfeeding has also proven to influence mood and stress reactivity in nursing mothers with a potential link with postpartum depression. Psychological theories attempt to explain D-MER from a sociopsychosexual lense shedding light on the significance of mother-infant attachment, the sexualization of the female body and the motherhood experience as a developmental stage in a woman's lifespan. The aim of this review is to provide a literature update of D-MER incorporating both neurobiological and psychological theories calling for raising awareness about the complexity of breastfeeding and for the need for mother-centered interventions for the management of D-MER and other postpartum-specific conditions.
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Affiliation(s)
- Reem Deif
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt
| | - Emily Michelle Burch
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt
| | - Jihan Azar
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt
| | - Nouran Yonis
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt
| | - Macy Abou Gabal
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt
| | - Nabila El Kramani
- Department of Biology, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt
| | - Duaa DakhlAllah
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt
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Truva T, Valasoulis G, Pouliakis A, Gkorezi-Ntavela I, Pappa D, Bargiota A, Garas A, Grivea I, Daponte A. The Effect of a Structured Individualized Educational Intervention on Breastfeeding Rates in Greek Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11359. [PMID: 34769876 PMCID: PMC8582789 DOI: 10.3390/ijerph182111359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Breastfeeding rates remain extremely low in Greece and women with gestational diabetes mellitus and hypothyroidism may experience additional difficulties. The aim of the study was to investigate the effect of a structured individualized lactation educational intervention by a midwife on increasing breastfeeding rates in women with endocrine disorders and low-risk women compared to women receiving standard care, 24 months after delivery. Two-hundred women made up the study population. Half of them were experiencing endocrine pregnancy disorders and 100 women constituted the low-risk pregnancy standard care control group. Women who were breastfeeding exclusively were significantly higher in the midwifery intervention group with endocrine disorders, namely breastfeeding continued at four months (breastfeeding: 20% vs. 12%, exclusive breastfeeding: 50% vs. 26%, p = 0.0228), and at six months after childbirth (breastfeeding: 54% vs. 28%, exclusive breastfeeding: 32% vs. 12%, p = 0.0011), compared to the standard care control group with endocrine disorder. The low-risk midwifery intervention group breastfed at four months (22% vs. 14%, p = 0.0428) and at six months (52% vs. 26%, p = 0.0018) at higher rates compared to the standard care control group. In addition, exclusive breastfeeding was significantly higher in the low-risk midwifery intervention group at four months (46% vs. 20%, p = 0.0102) and six months (38% vs. 4%, p < 0.0001) compared to the standard care control group. This study was the first attempt of a structured midwifery breastfeeding education in Greece and its major contribution reflects a significant positive impact on breastfeeding rates in terms of duration and exclusivity in women with gestational endocrine disorders as well as in low-risk women, and could possibly be applied and instituted in everyday clinical practice to increase the low breastfeeding rates in Greece.
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Affiliation(s)
- Theoni Truva
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
| | - George Valasoulis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
- Hellenic National Public Health Organization—ECDC, 15123 Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, 12464 Athens, Greece;
| | - Irontianta Gkorezi-Ntavela
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
| | - Dimitra Pappa
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece; (D.P.); (A.B.)
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece; (D.P.); (A.B.)
| | - Antonios Garas
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
| | - Ioanna Grivea
- Department of Pediatrics, University of Thessaly, University Hospital of Larissa, 41334 Larissa, Greece;
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
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5
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Russell PS, Smith DM, Birtel MD, Hart KH, Golding SE. The role of emotions and injunctive norms in breastfeeding: a systematic review and meta-analysis. Health Psychol Rev 2021; 16:257-279. [PMID: 33618626 DOI: 10.1080/17437199.2021.1893783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date in explaining breastfeeding behaviours. Specifically, prior research underestimates the importance of (1) specific emotions and (2) wider injunctive influences (i.e., societal and moral norms about what women feel they ought to be doing) in the breastfeeding experience. Therefore, we conducted a systematic review of quantitative, qualitative, and mixed-methods studies that explored whether injunctive norms and/ or specific emotions are associated with breastfeeding behaviours (i.e., intentions, initiation and duration). Seventy-two papers were included in this review; data were extracted and quality appraisals conducted for all included studies. A meta-analysis of effect sizes was performed with the quantitative data. A convergent qualitative synthesis of the data was conducted, resulting in the following line of argument: Breastfeeding is a social behaviour and not a personal/individual behaviour. From this line of argument, three themes with associated sub-themes were developed, highlighting the importance of both specific emotions and injunctive norms on breastfeeding behaviours. These influences are discussed in relation to both theoretical and practical implications, as well as future research.
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Affiliation(s)
- Pascale Sophie Russell
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Debbie M Smith
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Kathryn H Hart
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sarah E Golding
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Gómez L, Verd S, de-la-Banda G, Cardo E, Servera M, Filgueira A, Ponce-Taylor J, Mulet M. Perinatal psychological interventions to promote breastfeeding: a narrative review. Int Breastfeed J 2021; 16:8. [PMID: 33407656 PMCID: PMC7789781 DOI: 10.1186/s13006-020-00348-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Emotional distress in mothers inhibits the let-down reflex, thus affecting breastfeeding self-efficacy. A breastfeeding mother may have to cope with both physical discomfort and psychological distress. However, literature on initiatives to improve breastfeeding rates has focused mainly on providing community-based peer support, or social policies. The aim of this review is to assess evidence on the effectiveness of a broad range of psychological interventions to facilitate breastfeeding for mothers facing difficulties around the time of delivery. Methods The review of the literature is derived from a search on Cochrane Library, PubMed, EBSCOhost, and PsycINFO for papers published since 1980. The approach was to explore quantitative and qualitative parameters. Quantitative parameters included breastfeeding initiation, duration, and composition. Qualitative parameters recorded the evaluation of maternal perceptions on breastfeeding success. The high heterogeneity of the studies led to a narrative review; 20 selected papers that report on breastfeeding outcomes and psychological programs met the inclusion criteria. Results The evidence on breastfeeding support through psychotherapy is heterogeneous and scant. Out of the included studies, 11 were randomized controlled trials, two were non-randomised trials, and two used a quasi-experimental design. None of the studies reported an increase in adverse breastfeeding outcomes. Three studies failed to report an association between psychological procedures and improved breastfeeding outcomes. A literature review showed that 17 (85%) analyses support stress-releasing techniques to facilitate breastfeeding. Conclusions This review suggests that relaxation interventions carefully tailored to address perinatal emotional distress may lead to important health benefits, including improvement in breastfeeding outcomes. There is also some indication that psychotherapy support while breastfeeding may have more impact than routine counselling. Conversely, this review did not find an association between self-hypnosis and breastfeeding outcomes. Data from this study can be used in designing prevention programs and future research with appropriate theoretical underpinning.
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Affiliation(s)
- Lidia Gómez
- Department of Child Psychiatry, Son Espases Hospital, Valldemossa road, 07120, Palma de Mallorca, Spain.,Baleares Medical Research Council (IdISBa), Valldemossa road, 07120, Palma de Mallorca, Spain
| | - Sergio Verd
- Baleares Medical Research Council (IdISBa), Valldemossa road, 07120, Palma de Mallorca, Spain. .,Pediatric Unit, La Vileta Surgery, Department of Primary Care, Matamusinos street, 07013, Palma de Mallorca, Spain.
| | - Gloria de-la-Banda
- Department of Psychology, Baleares Islands University, Valldemossa road, 07122, Palma de Mallorca, Spain
| | - Esther Cardo
- Pediatric Unit, La Vileta Surgery, Department of Primary Care, Matamusinos street, 07013, Palma de Mallorca, Spain.,Department of Paediatrics, Hospital Son Llatzer, Manacor road, 07128, Palma de Mallorca, Spain
| | - Mateu Servera
- Department of Psychology, Baleares Islands University, Valldemossa road, 07122, Palma de Mallorca, Spain
| | - Ana Filgueira
- Department of Paediatrics, Hospital Son Llatzer, Manacor road, 07128, Palma de Mallorca, Spain
| | - Jaume Ponce-Taylor
- Accidents & Emergency Unit, Department of Primary Care, Illes Balears street., 07014, Palma de Mallorca, Spain
| | - Margarita Mulet
- Mental Health Unit, Department of Primary Care, Simo Tort street, 07500, Mallorca, Manacor, Spain
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7
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Davie P, Bick D, Chilcot J. The Beliefs About Breastfeeding Questionnaire (BAB-Q): A psychometric validation study. Br J Health Psychol 2020; 26:482-504. [PMID: 33340201 PMCID: PMC8247407 DOI: 10.1111/bjhp.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/19/2020] [Indexed: 11/27/2022]
Abstract
Objectives Questionnaires used to assess women’s beliefs as a predictor of breastfeeding behaviour are not theoretically informed or tested for psychometric validity and reliability. This study conducted a psychometric evaluation of the Beliefs About Breastfeeding Questionnaire (BAB‐Q). Design A two‐phase evaluation in an online cross‐sectional questionnaire study (N = 278) and cohort study sample (N = 264). A ten‐item questionnaire was proposed to assess women’s beliefs about the benefits and efforts of breastfeeding. Methods Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed construct validity and reliability. Multivariate regression analyses assessed validity in predicting breastfeeding behaviour and experiences. Results EFA found a shortened 8‐item, 2‐factor model had good fit (χ2 = 23.3, df = 13, p < .040; CFI = .99, TLI = .99, RMSEA = .05), with significant factor loadings. Factor 1 (benefit beliefs) and factor 2 (effort beliefs) accounted for 47 and 19.4% of the explained variance and correlated moderately (r = −.40). CFA confirmed the solution in the cohort sample (χ2 = 49.6 df = 19, p < .010; CFI = .97, TLI = .96, and RMSEA = .078). Adjusted regression analyses found beliefs did not reliably predict infant feeding practices. Women’s beliefs significantly predicted the likelihood that women experienced breastfeeding as ‘much more’ positive and negative than they expected. Conclusions The eight‐item questionnaire showed good model fit with acceptable loadings, and good reliability for all subscales. The utility of the BAB‐Q at predicting breastfeeding behaviour remains unclear and unsupported by empirical evidence. Further assessments of the predictive validity of the questionnaire in longitudinal studies with diverse beliefs and infant feeding practices are required.
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Affiliation(s)
- Philippa Davie
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Guy's Hospital, King's College London, UK
| | - Debra Bick
- Professor of Clinical Trials in Maternal Health, Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, UK.,Department of Women and Children's Health, Faculty of Life Sciences and Medicine, St Thomas' Hospital, King's College London, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Guy's Hospital, King's College London, UK
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