'I thought it would keep them all quiet'. Women's experiences of breastfeeding as illusions of compliance: an interpretive phenomenological study

Non-biological factors associated with postpartum depression among women in Shenzhen: a case-control study

Background

Postpartum depression (PPD) presents a significant public health challenge. While PPD's impact extends from maternal health to child development, cultural stigma and a lack of public awareness, particularly in developing countries, contribute to its underestimation and under diagnosed. This study investigated the non-biological associated factors for PPD in Shenzhen city due to its unique socioeconomic landscape, where rapid urbanization and migrant influx could uniquely impact maternal mental health. By identifying local PPD determinants, the research aimed to contribute to targeted mental health interventions in the region.

Method

Data were collected from May to December 2019 at the Luohu Maternal and Child Health Medical Center, Shenzhen. Inclusion criteria were postpartum women without psychiatric histories who live within the locality. The Chinese Edinburgh Postnatal Depression Scale was utilized to confirm PPD diagnosis. Participant information including demographics, economic status and postnatal factors were collected via structured questionnaires. Statistical analyses of t-tests, Wilcoxon rank-sum tests, chi-square tests, and logistic regression, were performed using SPSS 20.0, with significance set at p ≤ 0.05.

Results

The study included 430 healthy mothers and 73 PPD mothers. Several factors were found to significantly influence the onset of PPD (p < 0.05): age (OR = 0.921, 95% CI: 0.864-0.981); living with in-laws (OR = 2.133, 95% CI: 1.108-4.106); bottle feeding (OR = 3.757, 95% CI: 1.567-9.006); prenatal depression (OR = 3.515, 95% CI: 1.61-7.675); prenatal anxiety (OR = 6.072, 95% CI: 3.209-11.49); and adverse life events during pregnancy (OR = 3.287, 95% CI: 1.165-9.269). Other factors were not found to have a significant effect.

Conclusion

Our study found that in the developed city of Shenzhen in Southern China, living with in-laws, exclusive bottle feeding, prenatal anxiety, depression, and adverse life events are non-biological associated factors for postpartum depression. The findings emphasize the importance of considering a range of factors when addressing maternal mental health within a specific local regions. It calls for targeted interventions or prevention program that take into considering the specific cultural, social, and individual factors.

Social representations of breastfeeding in health science students: A first step to strengthening their training

AIM

This study aims to describe the social representations of breastfeeding among Mexican health science students.

BACKGROUND

Breastfeeding is a complex phenomenon involving biological, affective and sociocultural aspects. Its definition includes diverse beliefs, attitudes, traditions and myths. Being aware of the connections between biological and sociocultural concepts in the social representations of breastfeeding in health science students may facilitate our comprehension of their attitudes/behaviors towards breastfeeding.

DESIGN

A qualitative study was carried out based on the structuralist approach of the social representations theory.

METHODS

Data were collected with free-listing questionnaires with breastfeeding as an inducer word among a random sample of nutrition, medical and nursing undergraduate students (n=124). The analyses used were similitude/meanings of words, prototypical and categorical analyses.

RESULTS

The findings suggest that the structure of the social representation is composed of breastfeeding essentials (baby, mother, & milk), affective (attachment, love & link), biological (nutrition, breasts, & health) and sociocultural elements (taboo, responsibility, & economic). Only instrumental elements are found in the nucleus, whereas biological, affective and sociocultural elements are observed in the peripheries. Moreover, emerging thematic categories such as the "affective bond" and "feeding" introduced additional dimensions, thereby emphasizing the complexity and richness of the social representation of breastfeeding in the context of health science students.

CONCLUSIONS

The structure of the social representation of breastfeeding among some Mexican undergraduate health science students focuses on the instrumental aspects, emphasizing essential elements. However, they downplay more scientifically oriented elements specific to their academic training. These findings, when extrapolated to different contexts, present an opportunity that could assist the development of tailored and culturally adapted educational strategies to strengthen breastfeeding training for health students. This approach can significantly contribute to enhancing breastfeeding promotion in society by addressing practical, scientific and language-inclusive aspects in the training of health professionals.

Attitudes on breast feeding among persons with HIV who have given birth and their perceptions of coercion during counseling on safe infant feeding practices

Persons with HIV can receive mixed messages about the safety of breastfeeding. We sought to assess if they felt coerced to formula feed when counseled about practices to reduce HIV transmission. Persons with HIV who had given birth were eligible to complete a survey to describe their experiences with infant feeding counseling and if they felt coerced to formula feed. An Iowa Infant Feeding Attitude Scale (IIFAS) assessed attitudes towards breastfeeding. Qualitative analyses were performed on narrative responses. One hundred surveys were collected from sites in Georgia, North Carolina, Pennsylvania, and South Carolina. The mean IIFAS score (n, 85) was 47 (SD 9.2), suggesting relatively favorable attitudes toward breastfeeding. Thirteen persons reported feeling coerced to formula feed. When controlling for choosing to give any breast milk, persons with any college education were more likely to report feeling coerced (aOR 9.8 [95% CI 1.8-52.5]). Qualitative analyses revealed three themes: perceiving breastfeeding as unsafe, engaging in shared decision-making, and resisting advice to formula feed. Persons with HIV desire to be counseled about safe infant feeding practices and have their questions answered without judgement. We highlight experiences of persons with HIV that reflect a need for a nuanced approach to infant feeding counseling.

Dysphoric Milk Ejection Reflex: Report of Two Cases and Postulated Mechanisms and Treatment

Background: The symptoms of Dysphoric Milk Ejection Reflex (D-MER) occur just before milk release, last no more than a few minutes, and then subside spontaneously, which are characterized by a sudden and transient feeling of dysphoria, depression, sadness, or other negative emotions. These emotions may adversely affect the mother's lactation behavior and mental health, negatively influence the mother-child relationship, and even result in self-harm or suicidal tendencies in lactating women. Case Presentation: We reported two cases of breastfeeding mothers with D-MER who experienced unpleasant emotions during lactation. Severely affected by D-MER symptoms, the mother in the first case chose to wean prematurely after struggling for 6 months, and her symptoms disappeared after weaning. With the help of professional guidance, the mother with D-MER in the second case actively adjusted and persisted in breastfeeding until her daughter was 18 months old, after that her symptoms vanished. Discussion: Awareness and knowledge of D-MER are insufficient among the public and health care professionals. D-MER is not a psychological disorder but a physiological issue caused by hormones, which is different from postpartum depression. The severity of D-MER symptoms can be evaluated by the assessment tool of the D-MER spectrum. Lactating women can relieve their symptoms through self-regulation, lifestyle changes, and professional guidance and treatments. Conclusions: The two cases studies about Chinese women with D-MER will enrich the knowledge of D-MER, and it might suggest some directions to health care workers for exploring scientific guidance and treatments for lactating women. Because the literature and published empirical studies about D-MER are scarce, further researches on the theory and interventions of D-MER are necessary.

Women's Perceptions and Experiences of Breastfeeding: a scoping review of the literature

BACKGROUND

Despite public health efforts to promote breastfeeding, global rates of breastfeeding continue to trail behind the goals identified by the World Health Organization. While the literature exploring breastfeeding beliefs and practices is growing, it offers various and sometimes conflicting explanations regarding women's attitudes towards and experiences of breastfeeding. This research explores existing empirical literature regarding women's perceptions about and experiences with breastfeeding. The overall goal of this research is to identify what barriers mothers face when attempting to breastfeed and what supports they need to guide their breastfeeding choices.

METHODS

This paper uses a scoping review methodology developed by Arksey and O'Malley. PubMed, CINAHL, Sociological Abstracts, and PsychInfo databases were searched utilizing a predetermined string of keywords. After removing duplicates, papers published in 2010-2020 in English were screened for eligibility. A literature extraction tool and thematic analysis were used to code and analyze the data.

RESULTS

In total, 59 papers were included in the review. Thematic analysis showed that mothers tend to assume that breastfeeding will be easy and find it difficult to cope with breastfeeding challenges. A lack of partner support and social networks, as well as advice from health care professionals, play critical roles in women's decision to breastfeed.

CONCLUSION

While breastfeeding mothers are generally aware of the benefits of breastfeeding, they experience barriers at individual, interpersonal, and organizational levels. It is important to acknowledge that breastfeeding is associated with challenges and provide adequate supports for mothers so that their experiences can be improved, and breastfeeding rates can reach those identified by the World Health Organization.

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.

The Effect of Maternal Self-Regulated Motivation on Breastfeeding Continuation

OBJECTIVE

Women frequently report breastfeeding problems in the early postpartum period. Women who have self-endorsed beliefs that breastfeeding benefits their babies and themselves are more likely to continue breastfeeding despite breastfeeding barriers. Maternal self-endorsed beliefs is a key component of maternal self-regulated motivation. The present study examined the association between maternal self-regulated motivation, breastfeeding duration and exclusivity in Chinese women.

METHODS

This was a prospective cohort study, of which we recruited participants in postnatal maternity units of publicly funded hospitals in Hong Kong. Postpartum women were asked to fill in the validated breastfeeding self-regulation questionnaire (BSRQ) before hospital discharge and their breastfeeding status was assessed by telephone follow-ups at 6 and 12 weeks postpartum. Multiple logistic regression was used to study the relationship between breastfeeding self-regulated motivation and the duration of breastfeeding at follow-up.

RESULTS

At 6 and 12 weeks postpartum, women who breastfed exclusively scored significantly higher in self-regulated motivation than those who formula-fed. The self-regulated motivation was associated with higher odds of exclusive breastfeeding at 6 weeks and any breastfeeding at 12 weeks postpartum.

CONCLUSIONS FOR PRACTICE

The study found that self-regulated motivation was positively related to breastfeeding duration. Maternal self-regulated motivation toward breastfeeding could be enhanced by the availability of social support and breastfeeding-friendly facilities, resulting in longer breastfeeding duration.

Self-conscious emotions and breastfeeding support: A focused synthesis of UK qualitative research

Research on women's experiences of infant feeding and related moral discourse suggests that self‐conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re‐examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self‐conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self‐conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self‐conscious emotions, the template also identified thoughts about self‐evaluation, perceptions of judgement and sense of exposure. Self‐conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding ‘support’ could present challenges to mothering identity and hence to emotional well‐being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self‐conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional ‘antennae’ if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self‐conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters.

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

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

Enablers and barriers to workplace breastfeeding in the Armed Forces: a systematic review

INTRODUCTION

The UK has no legislation protecting employees' access to breastfeeding facilities. Without specific breastfeeding policy, provisions to access workplace facilities can be inconsistent and negatively impact employees' breastfeeding duration, retention and morale, particularly servicewomen who work in varied and demanding military environments. This is an important policy area for the British Army to retain talented and trained soldiers.

METHODS

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement principles, PubMed, Embase, CINAHL and Pro-Quest Databases were searched for studies relevant to accessing appropriate breastfeeding facilities in UK workplaces and high-income countries' Armed Forces. Factors acting as barriers and enablers to accessing facilities were identified. UK government and Armed Forces' websites were searched for grey literature on existing policies and guidance for accessing facilities.

RESULTS

Barriers and enablers to access from 16 studies were described by three thematic areas: attitudes to breastfeeding, facility provisions and use of facilities. Factors which employers could influence included specific breastfeeding policy, universal workplace education, existence of suitable facilities and individualised breastfeeding plans. The key areas for policy development identified were clearly defined responsibilities; individualised risk assessments and breastfeeding plans; appropriate, but flexible, facility provision and access; signposting of relevant workplace accommodations; and physical fitness provisions.

CONCLUSIONS

Five recommendations are presented: development, implementation and evaluation of breastfeeding policy; universal workplace breastfeeding education; the need for breastfeeding risk assessments and plans based on individual breastfeeding practice; written minimal and ideal standards for breastfeeding facilities and access, which considers workplace locations; and exceptions from deployment and physical fitness testing.

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.

UK mothers' experiences of bottle refusal by their breastfed baby

Little is known about bottle refusal by breastfed babies; however, an informal review of global online forums and social media suggested large numbers of mothers experiencing the scenario. This study aimed to explore UK mothers' experiences of bottle refusal by their breastfed baby in order to provide understanding of the scenario and enhance support for mothers experiencing it. A 22‐point online questionnaire was developed and completed by 841 UK mothers. Findings suggest that mothers introduced a bottle to their breastfed baby due to physical, psychological and socio‐cultural factors. Advice and support for mothers experiencing bottle refusal was not always helpful, and 27% of mothers reported bottle refusal as having a negative impact on their breastfeeding experience. When compared with eventual bottle acceptance, bottle refusal was significantly associated with previous experience of bottle refusal (p < .001), how frequently mothers intended to feed their baby by bottle and babies being younger at the first attempt to introduce a bottle (p < .001). This study provides a unique insight into the complexities of bottle refusal by breastfed babies and the impact it can have upon mothers' breastfeeding experiences. It generates knowledge and understanding that can help to inform practice and policies. In addition, a ‘normalising’ of the scenario could enable mothers, and those supporting them, to view and manage it more positively.

Commercialisation and commodification of breastfeeding: video diaries by first-time mothers

BACKGROUND

Many of aspects of our lives became increasingly commercialised in post-modern society. Although breastfeeding is perhaps a late comer to this process in recent years, it too has seen significant commercialisation facilitated by social media and our obsession with celebrity culture. This paper explores how the commercialisation and commodification of breastfeeding impacts mothers' experiences of breastfeeding.

METHODS

In a qualitative study, five mothers in the United Kingdom recorded their real-time breastfeeding experiences in video diaries. Using a multi-modal method of analysis, incorporating both visual and audio data, a thematic approach was applied.

FINDINGS

Women preparing for breastfeeding are exposed to increasing commercialisation. When things do not go to plan, women are even more exposed to commercial solutions. The impact of online marketing strategies fuelled their need for paraphernalia so that their dependence on such items became important aspects of their parenting and breastfeeding experiences.

CONCLUSIONS

The audio-visual data demonstrated the extent to which "essential" paraphernalia was used, offering new insights into how advertising influenced mothers' need for specialist equipment and services. Observing mothers in their video diaries, provided valuable insights into their parenting styles and how this affected their breastfeeding experience.

"The sweet and the bitter": mothers' experiences of breastfeeding in the early postpartum period: a qualitative exploratory study in China

Background

In China, the prevalence of exclusive breastfeeding at 6 months was only 20.8%. In promoting breastfeeding for newborns, a number of strategies have been initiated by Chinese government. These actions facilitated a high breastfeeding initiation of 77 to 99.9% in different regions. However, the exclusive breastfeeding rates remained low at 6 months resulting from a high rate of perceived insufficient breast milk and complementary feeding during the early days after childbirth. The aim of this study was to understand the experiences of women in Shenzhen with regard to breastfeeding in the first 6 weeks after giving birth, to identify the facilitators and barriers impacting their breastfeeding decisions and to identify their perceived support needs that might facilitate breastfeeding in the future.

Methods

This was a qualitative exploratory study. Data were collected in November 2018 through semi-structured, face-to-face, in-depth interviews. A purposive sample of early postpartum women was recruited from a postpartum clinic of a tertiary maternal hospital in Shenzhen, China. The dataset was analysed using inductive content analysis.

Results

A total of 22women were interviewed within the first 6 weeks after delivery. Three themes related to breastfeeding were identified from the transcribed interviews: “breastfeeding facilitators,” “breastfeeding barriers,” and “recommendations for breastfeeding promotion.”

Conclusions

Women experienced both joy and suffering in their journey of breastfeeding. Insufficient knowledge of breastfeeding, discomfort, intergenerational disagreements regarding nutritional supplements, and a lack of professional support contributed to difficulties and the threat of discontinuation. A supportive environment for breastfeeding is crucial for women’s decision on exclusive breastfeeding and the psychological wellbeing of breastfeeding women. Interventions that target to promote exclusive breastfeeding should include both new mothers and significant family members. Future studies could test the effectiveness of breastfeeding training for home visit nurses to promote exclusive breastfeeding in the early postpartum.

'Scrutinised, judged and sabotaged': A qualitative video diary study of first-time breastfeeding mothers

OBJECTIVE

To explore how support impacted on mothers' breastfeeding experiences in the first few weeks following birth.

DESIGN

A qualitative approach explored real-time experiences of breastfeeding captured by five first-time mothers in the South of England on camcorder as video diaries. A multi-dimensional approach involving thematic analysis ensured both the audio and visual elements of the data were analysed.

FINDINGS

Mothers felt 'under surveillance' by the biomedical approach to support from the healthcare team. At best mothers felt reassured that they were 'on the right track'. When mothers felt their breastfeeding was constantly being examined, criticised and threatened they felt 'scrutinised, judged and sabotaged'. When they found it difficult to access healthcare support, or they avoided it altogether to circumvent further scrutiny, they felt 'abandoned and alone'.

KEY CONCLUSIONS

Collecting audio-visual data in real-time adds fresh insights into how support impacts mothers' experiences of breastfeeding. The biomedical approach to support for breastfeeding is not effective. Scrutinising, judging and/or sabotaging mothers' attempts to breastfeed can have long-lasting effects on maternal emotional wellbeing.

IMPLICATIONS FOR PRACTICE

Breastfeeding support might be improved by adopting a more social model of care. Future research needs to explore how relationship-based support can be provided by the health service.

Development and psychometric testing of an instrument to assess existential aspects of mother's initial breastfeeding difficulties (ExBreastS)

OBJECTIVE

Mothers who have negative breastfeeding experiences due to initial breastfeeding difficulties are in demanding existential situations. Therefore, it is important for healthcare professionals to identify and address such breastfeeding problems. The aim of this study was to develop an instrument designed to assess existential aspects of mothers' initial breastfeeding difficulties and evaluate its psychometric properties.

METHODS

This study reports on the development of a new instrument and was carried out in three steps: (1) a questionnaire about various existential aspects of initial breastfeeding difficulties, based on 66 items derived from two phenomenological studies, was developed; (2) information was collected using the questionnaire; (3) and the resulting data were statistically analysed. Spearman's correlation coefficient was used to assess comparative validity; exploratory factor analysis with principal axis factoring and varimax rotation were used to assess construct validity; and Cronbach's alfa was used to assess internal consistency and reliability. Three hundred and nine Swedish-speaking mothers aged 20-46 participated in the study.

RESULTS

Correlation and factor analysis of the 66 items revealed that 16 of the items were of psychometric value and valid. Factor analysis generated three factors that accounted for 62.9% of the total variance: Mother-Child Interdependency, Exposure and Vulnerability and Security and Trust. The instrument shows adequate sensitivity to identify existential aspects of mothers' initial breastfeeding difficulties.

CONCLUSION

The instrument satisfactorily assesses existential aspects of initial breastfeeding difficulties and can be used as a sensitive tool by healthcare professionals to screen for and identify mothers who have negative breastfeeding experiences.

The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed-methods systematic review

Global evidence demonstrates that adherence to the Baby Friendly Initiative (BFI) has a positive impact on multiple child health outcomes, including breastfeeding initiation and duration up to 1 year post-partum. However, it is currently unclear whether these findings extend to specific countries with resource-rich environments. This mixed-methods systematic review aims to (a) examine the impact of BFI implementation (hospital and community) on maternal and infant health outcomes in the United Kingdom (UK) and (b) explore the experiences and views of women receiving BFI-compliant care in the UK. Two authors independently extracted data including study design, participants, and results. There is no UK data available relating to wider maternal or infant health outcomes. Two quantitative studies indicate that Baby Friendly Hospital Initiative implementation has a positive impact on breastfeeding outcomes up to 1 week post-partum but this is not sustained. There was also some evidence for the positive impact of individual steps of Baby Friendly Community Initiative (n = 3) on breastfeeding up to 8 weeks post-partum. Future work is needed to confirm whether BFI (hospital and community) is effective in supporting longer term breastfeeding and wider maternal and infant health outcomes in the UK. A meta-synthesis of five qualitative studies found that support from health professionals is highly influential to women's experiences of BFI-compliant care, but current delivery of BFI may promote unrealistic expectations of breastfeeding, not meet women's individual needs, and foster negative emotional experiences. These findings reinforce conclusions that the current approach to BFI needs to be situationally modified in resource-rich settings.

Evaluation of Maternal Functioning in Mothers of Infants Admitted to the Neonatal Intensive Care Unit

Objective: Factors associated with maternal functioning in biological mothers whose infants were admitted to a Neonatal Intensive Care Unit (NICU) were identified as measured by a modified version of the Barkin Index of Maternal Functioning. Materials and Methods: This multivariable regression analysis explored sociodemographic and clinical data from 146 mother-infant dyads admitted to a Level III NICU between February 2015 and May 2016. Eligible dyads included: (1) adult biological mothers with singleton infants discharged home alive after NICU admission meeting criteria and (2) infants discharged home alive from the NICU with adult, biological mothers after a minimum 6-day admission. Results: Lower scores on the Edinburgh Postnatal Depression Scale (p < 0.0001), and an infant admission diagnosis of hypoglycemia (p = 0.0295) were significantly associated with higher levels of maternal functioning. Conclusions: The significant association between maternal functioning and depressive symptom score is corroborated by the literature. Results relative to a diagnosis of infant hypoglycemia and higher levels of maternal functioning are intriguing, considering current literature linking increased postpartum depression to gestational diabetes. The severity of other possible admission diagnoses may provide a partial explanation. We believe this is the first study suggesting a potential role between infant admission diagnosis and the level of maternal functioning.

Women’s experiences of formula feeding their infants: an interpretative phenomenological study

Objective

This study aimed to explore the experiences of women in the process of formula feeding their infants. The World Health Organization has emphasized the importance of breastfeeding for infant health. After decades of breastfeeding promotions, breastfeeding rates in Hong Kong have been rising consistently; however, the low continuation rate is alarming. This study explores women’s experiences with formula feeding their infants, including factors affecting their decision to do so.

Methods

A qualitative approach using an interpretative phenomenological analysis (IPA) was adopted as the study design. Data were collected from 2014 to 2015 through individual in-depth unstructured interviews with 16 women, conducted between 3 and 12 months after the birth of their infant. Data were analyzed using IPA.

Results

Three main themes emerged as follows: (1) self-struggle, with the subthemes of feeling like a milk cow and feeling trapped; (2) family conflict, with the subtheme of sharing the spotlight; and (3) interpersonal tensions, with the subthemes of embarrassment, staring, and innocence. Many mothers suffered various stressors and frustrations during breastfeeding. These findings suggest a number of pertinent areas that need to be considered in preparing an infant feeding campaign.

Conclusions

The findings of this study reinforce our knowledge of women’s struggles with multiple sources of pressure, such as career demands, childcare demands, and family life after giving birth. All mothers should be given assistance in making informed decisions about the optimal approach to feeding their babies given their individual situation and be provided with support to pursue their chosen feeding method.

The emotional and practical experiences of formula-feeding mothers

The majority of infant-feeding research is focused on identifying mother's reasons for the cessation of breastfeeding. The experience of mothers who choose to use formula is largely overlooked in quantitative designs. This study aimed to describe the emotional and practical experiences of mothers who formula feed in any quantity, and examine whether these experiences would vary among different cohorts of formula-feeding mothers according to prenatal feeding intention and postnatal feeding method. A total of 890 mothers of infants up to 26 weeks of age, who were currently formula feeding in any quantity, were recruited through relevant international social media sites via advertisements providing a link to an online survey. Predictors of emotional experiences included guilt, stigma, satisfaction, and defense as a result of their infant feeding choices. Practical predictor variables included support received from health professionals, respect displayed by their everyday environment, and main sources of infant feeding information. Descriptive findings from the overall sample highlighted a worryingly high percentage of mother's experienced negative emotions as a result of their decision to use formula. Multinomial logit models revealed that negative emotions such as guilt, dissatisfaction, and stigma were directly associated with feeding intention and method. The evidence suggests that the current approach to infant-feeding promotion and support may be paradoxically related to significant issues with emotional well-being. These findings support criticisms of how infant-feeding recommendations are framed by health care professionals and policy makers, and highlight a need to address formula feeding in a more balanced, woman-centered manner.

'Both parents should care for babies': A cross-sectional, cross-cultural comparison of adolescents' breastfeeding intentions, and the influence of shared-parenting beliefs

BACKGROUND

Many young men and women expect to co-parent their newborn infant. This may have a positive or negative impact on decisions to breastfeed, which is an important health behaviour, influenced by cultural and psycho-social norms. We investigated the relationship between shared parenting, infant feeding beliefs and intentions in male and female (non-parent) adolescents, comparing Nordic countries (Sweden, Norway, Finland) with high breastfeeding rates with others with low rates (Scotland, USA).

METHODS

We utilised cross-sectional surveys of male and female adolescents (n = 1064, age 12-18) administered directly in schools or via the internet. We assessed attitudes to breast and formula feeding and shared parenting, using a Theory of Planned Behaviour framework, assessing beliefs, attitudes, norms and control as predictors of intention.

RESULTS

Male and female adolescents' breastfeeding intentions varied in line with national cultural norms. Young people from Nordic countries (high breastfeeding rates) were significantly more likely to intend to breastfeed than those from Scotland or the USA (low breastfeeding rates). Positive beliefs about breastfeeding, norms and 'exposure' to breastfeeding and feeding confidence were consistently stronger in Nordic countries, whereas young people in Scotland had more positive beliefs, norms and 'exposure' to formula feeding. Differences in parenting beliefs, norms and confidence were less consistent. In logistic regression, cultural group, positive breastfeeding beliefs and exposure, norms, and shared parenting beliefs were significant predictors of breastfeeding feeding intention.

CONCLUSIONS

Positive beliefs about shared parenting and equal gender norms were related to future breastfeeding intentions for female and male adolescents. Health education programmes for young people could encourage positive breastfeeding choices by considering how this would fit with young people's ideal parenting roles, and by emphasising benefits of complementary maternal and paternal roles in breastfeeding newborn infants.

Improving Breastfeeding Support by Understanding Women's Perspectives and Emotional Experiences of Breastfeeding

Exclusive breastfeeding for at least 6 months is universally acknowledged as the optimal means of infant nutrition. However, current studies show that most women are not following this recommendation. Many studies address the issue of increasing breastfeeding rates, but fewer explore the perspectives and experiences of breastfeeding women. In this article we review the literature and identify common themes in women's breastfeeding experiences. Nurses and other health care providers stand to help or hinder breastfeeding women, and they must be aware of and sensitive to women's personal experiences and perspectives to understand how to best promote and support women in their attempts to meet their breastfeeding goals.

Aboriginal and Torres Strait Islander women's experiences accessing standard hospital care for birth in South Australia - A phenomenological study

BACKGROUND

Aboriginal and Torres Strait Islander women, hereafter called Indigenous women, can experience a lack of understanding of their cultural needs when accessing maternity care in the standard hospital care system.

AIM

To explore the lived experiences described by Indigenous women accessing labour and birth care in the standard hospital care system at a tertiary public hospital in South Australia.

METHODS

An interpretive Heideggerian phenomenological approach was used. Indigenous women who accessed standard care voluntarily agreed to participate in semi-structured interviews with Indigenous interviewers. The interviews were transcribed and analysed informed by van Manen's approach.

FINDINGS

Thematic analysis revealed six main themes: "knowing what is best and wanting the best for my baby", "communicating my way", "how they made me feel", "all of my physical needs were met", "we have resilience and strength despite our hardships" and "recognising my culture".

CONCLUSION

Indigenous women in this study expressed and shared some of their cultural needs, identifying culturally unsafe practices. Recommendations to address these include the extension of current care planners to include cultural needs; Aboriginal Maternal Infant Care (AMIC) workers for women from rural and remote areas; AMIC workers on call to assist the women and midwives; increased education, employment and retention of Indigenous midwives; increased review into the women's experiences; removal of signs on the door restricting visitors in the birth suite; flexibility in the application of hospital rules and regulations; and changes to birthing services in rural and remote areas so women may not have to relocate for birth.

Rates and determinants of early initiation of breastfeeding and exclusive breast feeding at 42 days postnatal in six low and middle-income countries: A prospective cohort study

Background

Early initiation of breastfeeding after birth and exclusive breastfeeding through six months of age confers many health benefits for infants; both are crucial high impact, low-cost interventions. However, determining accurate global rates of these crucial activities has been challenging. We use population-based data to describe: (1) rates of early initiation of breastfeeding (defined as within 1 hour of birth) and of exclusive breastfeeding at 42 days post-partum; and (2) factors associated with failure to initiate early breastfeeding and exclusive breastfeeding at 42 days post-partum.

Methods

Prospectively collected data from women and their live-born infants enrolled in the Global Network’s Maternal and Newborn Health Registry between January 1, 2010-December 31, 2013 included women-infant dyads in 106 geographic areas (clusters) at 7 research sites in 6 countries (Kenya, Zambia, India [2 sites], Pakistan, Argentina and Guatemala). Rates and risk factors for failure to initiate early breastfeeding were investigated for the entire cohort and rates and risk factors for failure to maintain exclusive breastfeeding was assessed in a sub-sample studied at 42 days post-partum.

Result

A total of 255,495 live-born women-infant dyads were included in the study. Rates and determinants for the exclusive breastfeeding sub-study at 42 days post-partum were assessed from among a sub-sample of 105,563 subjects. Although there was heterogeneity by site, and early initiation of breastfeeding after delivery was high, the Pakistan site had the lowest rates of early initiation of breastfeeding. The Pakistan site also had the highest rate of lack of exclusive breastfeeding at 42 days post-partum. Across all regions, factors associated with failure to initiate early breastfeeding included nulliparity, caesarean section, low birth weight, resuscitation with bag and mask, and failure to place baby on the mother’s chest after delivery. Factors associated with failure to achieve exclusive breastfeeding at 42 days varied across the sites. The only factor significant in all sites was multiple gestation.

Conclusions

In this large, prospective, population-based, observational study, rates of both early initiation of breastfeeding and exclusive breastfeeding at 42 days post-partum were high, except in Pakistan. Factors associated with these key breastfeeding indicators should assist with more effective strategies to scale-up these crucial public health interventions.

Trial registration

Registration at the Clinicaltrials.gov website (ID# NCT01073475).