The association between women's perceptions of professional support and problems experienced on breastfeeding cessation: a Western Australian study

An extension of the theory of planned behaviour to predict exclusive breastfeeding among Australian mother-father dyads using structural equation modelling

OBJECTIVES

The objective of this paper was to examine the predictors of breastfeeding exclusivity at two time-points (6 and 26 weeks postpartum) using a dyadic mother-father extended model of the theory of planned behaviour.

DESIGN/METHOD

A sample of 1139 first-time Australian mother-father dyads completed measures of each of the Theory of Planned Behaviour variables (intention, attitudes, subjective norms, and perceived behavioural control) and additional psychosocial and behavioural predictors of breastfeeding, including problems with breastfeeding, psychological distress, childcare stress, partner support, and the frequency and time of first public breastfeed. Confirmatory factor analyses were used to determine the factor structures of the latent constructs to be included in the structural model. Structural equation modelling was used to model pathways between variables.

RESULTS

Breastfeeding exclusivity at 6 weeks was significantly predicted by breastfeeding self-efficacy at 6 weeks, intention to exclusively breastfeed, and frequency of public breastfeeding over the month prior, whereas childcare stress, partner support, time of first public breastfeed, and fathers' variables (attitudes and subjective norms) had little influence. Self-efficacy mediated the relationship between mothers' attitudes, psychological distress, and breastfeeding problems with breastfeeding exclusivity at 6 weeks. Breastfeeding exclusivity at 26 weeks was significantly predicted by mothers' attitudes, self-efficacy, breastfeeding exclusivity at 6 weeks, and frequency of public breastfeeding in the month prior.

CONCLUSIONS

The results highlight the importance of breastfeeding self-efficacy and confidence to breastfeed in public as crucial constructs in promoting long-term exclusive breastfeeding and provides support for an extended theory of planned behaviour model in predicting breastfeeding outcomes.

"Breast is best"… until they say so

In this autoethnographic article, I discuss the consequences of being exposed to two competing breastfeeding discourses during my first mothering experience-the "self-regulated dyad" and the "externally regulated dyad" discourse. The former represents the ideal scenario and the evidence-based practices recommended by the World Health Organization (i.e., breastfeeding on demand, internally regulated by the dyad). The externally regulated discourse refers to the standardized health interventions that take over when difficulties arise (e.g., weight gain deviations and latching issues). Building on Kugelmann's critique about our blind reliance on "standardized health," existing evidence, and my breastfeeding journey, I argue that unqualified and unindividualized breastfeeding interventions are highly counterproductive. To illustrate these points, I discuss the implications of the polarized interpretation of pain and the limited dyadically focused support. I then move on to analyze how ambivalent social positioning around breastfeeding impacts our experience. In particular, I found that I was highly regarded as a "good, responsible mum" up till my baby was 6 months, and how breastfeeding became increasingly challenged by others when my daughter was approaching her first birthday. Here, I discuss how performing attachment mothering identity work allowed me to navigate these challenges. Against this backdrop, I reflect upon feminist ambivalent positionings on breastfeeding and the complexity of balancing the promotion of women's hard-earned rights while supporting them to engage in whatever baby-feeding choice they feel appropriate. I conclude that unless we acknowledge the physical and social complexities of the process, and our healthcare systems seriously invest in allocating human resources and training them appropriately, breastfeeding rates may continue to suffer and women continue to interiorize it as their own failure.

Caregivers' Experiences of Infant Feeding Problems: The Role of Self-Compassion and Stress Management

Introduction Infant feeding problems are strongly associated with caregiver stress, which in turn is linked to poorer outcomes for children. Self-compassion is a modifiable trait strongly associated with improved mental health and greater resilience. The purpose of this study was to investigate the relationships among self-compassion, stress management practices, and caregiver stress in a sample of parents who identified feeding problems in their infants. Method Parents who identified feeding problems in their infants completed an online survey. They described the feeding problems, completed the Self-Compassion Scale and the Perceived Stress Scale, and detailed their stress management practices. Results Higher self-compassion was strongly associated with lower overall stress and more modestly associated with lower feeding-related distress. More severe feeding problems were significantly more stressful for caregivers. Participants reported a wide variety of stress management approaches. Discussion These findings indicate that higher self-compassion is associated with lower caregiver stress for parents whose infants experience feeding problems. Implications for service providers are reviewed. Supplemental Material https://doi.org/10.23641/asha.14831028.

[Information Resource Network Analysis of Factors Influencing Breastfeeding Planning and Duration]

PURPOSE

This study aimed to identify the modifiable factors affecting breastfeeding planning and duration among healthy mothers and their use of breastfeeding information resources.

METHODS

A cross-sectional survey was conducted in a community setting. Four hundreds participants were recruited at five pediatric clinics and three community health centers located in Paju-si and Goyang-si, Gyeonggi-do, between January and May 2019. Based on the breastfeeding decision-making model, driven by Martens and Young's work, the survey items consisted of demographics, childbirth and breastfeeding characteristics, and breastfeeding information resources. In the analysis, 389 responses were used in the t-test, ANOVA, and logistic regression. Information resource networks were compared before and after childbirth including a subgroup analysis depending on the breastfeeding duration.

RESULTS

The modifiable factors affecting breastfeeding planning and duration were antenatal and postpartum breastfeeding education and the provision of information in the hospital. The frequency of Internet use and websites visited were notable and potentially modifiable factors, which were also observed in the networks showing different relationship patterns according to participant subgroups and times. The childbirth event increased the centralization of the network in the planned group, while the network of the non-planned group was more diffused after childbirth. The network of the short-term breastfeeding group was characterized by a more centralized pattern and the resources of high betweenness centrality than the long-term group.

CONCLUSION

Breastfeeding education is a consistent factor that affects breastfeeding behavior. A well-designed internet-based approach would be an effective nursing intervention to meet the needs of women seeking breastfeeding information and changing their behaviors.

Supporting, failing to support and undermining breastfeeding self-efficacy: Analysis of helpline calls

Although a complexity of factors explain early cessation of breastfeeding, the encounter of a problem is often a critical point in this decision. For this reason, breastfeeding self‐efficacy, a mother's evaluations of her ability to successfully overcome challenges, is an effective target in interventions to sustain breastfeeding. This study examined factors affecting the success of one such intervention, reactive telephone support. Across a 4‐week period, recordings of all calls to a nurse‐staffed parent helpline in Queensland, Australia were made. Of these calls, 60 were from mothers encountering a breastfeeding problem. Using a standard protocol, each call was scored for trajectories of mother's breastfeeding self‐efficacy from opening to close of call. Calls showing an upward trajectory were defined as supporting (53%), those with no change were defined as ineffective (25%), and those with downward trajectory as undermining (22%). Using trajectory scores, case exemplars were purposively selected for detailed analysis of interactional sequences to identify strategies that distinguished outcome. The supportive call was distinguished by information sharing, mutual trust and respectful relationships, and personalized affirmation and advice. The ineffective call focused on technical aspects of breastfeeding, whereas the undermining call made moral judgements of mother's behaviour. The findings identify interactional quality of telephone support, not simply provision, as the key success factor in reactive telephone support. The findings also present interactional quality as a potential explanation for inconsistent outcomes in evaluation of reactive telehealth interventions to support breastfeeding.

Maternal Emotions and Experiences of Mothers Who Had Breastfeeding Problems: A Qualitative Study

BACKGROUND AND PURPOSE

Many women are ceasing to breastfeed in the early period due to the breastfeeding problems and difficulties they perceive. Consequently, the approach and support of health professionals to mothers in the post-partum period is very important. The objective of the study is to determine the emotions and experiences of mothers who had breastfeeding problems by using Watson's Theory of Human Caring.

METHODS

The research is a descriptive and qualitative type of study. The data were collected from 20 women with the semi-structured interview method based on Watson's Theory. The data were analyzed according to the Caritas Processes of Watson's Theory.

RESULTS

It was determined that the health professionals did not show enough assistance, support and interest to the mothers who had breastfeeding problems and that the mothers expected respect, empathy, sincerity, understanding, trust, and assistance during this period.

IMPLICATION FOR PRACTICE

The use of the interview methods based on Watson's Theory of Human Caring in the determination of the difficulties and emotions experienced by the women who had breastfeeding problems will be a guide for the health professionals. It is thought that the approaches based on Watson's Caritas Processes that would be made to women who had breastfeeding problems would be effective for understanding their experience and emotions.

Women's advice to healthcare professionals regarding breastfeeding: "offer sensitive individualized breastfeeding support"- an interview study

Background

The World Health Organization recommends exclusive breastfeeding for 6 months followed by continued breastfeeding with complementary food up to 2 years of age or beyond. Few women achieve this recommendation in Sweden, and they often stop breastfeeding earlier than they would like. Investigating women’s advice to healthcare professionals is important for the provision of optimal breastfeeding support. The aim of this study was to explore women’s advice to healthcare professionals regarding support for continuing to breastfeed for at least 6 months.

Methods

This investigation used an exploratory study design, and a purposive sample of women was recruited between 2015 and 2016 through social media platforms. The work is a follow-up of an earlier study exploring women’s perceptions of the factors that assisted them in breastfeeding for at least 6 months. Telephone interviews were conducted with 139 Swedish women who reported that they had breastfed for at least 6 months. Women were asked the question, “Do you have any advice that you would like to give to healthcare professionals regarding breastfeeding support?”. The data were analysed using content analysis.

Results

The theme, “Professionals need to offer women sensitive, individualized breastfeeding support to promote a positive breastfeeding experience”, describes the women’s advice based on five categories: 1) providing evidence-based care, 2) preparing expectant parents during pregnancy, 3) creating a respectful and mutual dialogue, 4) offering individual solutions to breastfeeding problems, and 5) offering practical support.

Conclusions

This study highlights the importance of professionals providing evidence-based breastfeeding support in a sensitive and individualized manner. This consideration is an important prerequisite to strengthening women’s self-confidence and assisting them in reaching their breastfeeding goals, which may enhance the positive nature of their breastfeeding experience.

First-Time Mothers Have a Desire to Be Offered Professional Breastfeeding Support by Pediatric Nurses: An Evaluation of the Mother-Perceived-Professional Support Scale

BACKGROUND

Although the World Health Organization recommends exclusive breastfeeding for six months, the rate of breastfeeding has decreased worldwide. Breastfeeding is the natural way of feeding a baby, but it is a process that has to be learnt. It is not unusual for problems to occur and hence support for breastfeeding is vital. The aim of this study was to explore first-time mothers' experiences of the breastfeeding support offered by pediatric nurses, as well as to develop and evaluate the Mother Perceived Support from Professionals (MoPPS) scale.

METHODS

A qualitative design involving both inductive and deductive approaches was chosen. Nine first-time mothers were interviewed regarding their experiences of the breastfeeding support offered by pediatric nurses. Semistructured interviews were conducted. The mothers were also asked to grade their experiences of breastfeeding support on the MoPPS scale. A qualitative content analysis was applied when analyzing the data obtained using both the inductive (interviews) and deductive (MoPPS scale) approaches.

RESULTS

The results revealed that the mothers felt the desire to breastfeed, although they all experienced some difficulties. They wanted the pediatric nurses to be perceptive and provide professional support based on their own experiences. When the pediatric nurses took time and booked extra appointments, the mothers felt supported. The inductive analysis resulted in one theme: "When wanting to breastfeed, mothers have a desire to be offered professional breastfeeding support". Two main categories were identified, namely "Mothers wanted but lacked breastfeeding support" and "Mothers received professional support." The deductive analysis of the MoPPS scale showed similar results, and the questions were perceived as relevant to the aim. The mothers considered it important that the pediatric nurses had sufficient knowledge about breastfeeding. It was also considered important that the pediatric nurses involved the mothers' partners in the breastfeeding support. Therefore, we suggest that these areas should be included in the MoPPS scale for pediatric nurses.

CONCLUSIONS

The MoPPS scale can be a useful tool for helping pediatric nurses to offer mothers professional breastfeeding support. Indeed, when offering breastfeeding support, pediatric nurses can use the items included on the MoPPS scale as guidance.

Can a phone call make a difference? Breastfeeding self-efficacy and nurse responses to mother's calls for help

Telephone support is a format that presents an opportunity to sustain breastfeeding at a time when mothers identify themselves as at risk of cessation. The interactive mechanisms by which support is provided have not, however, been well investigated. We aimed to identify characteristics of calls that support breastfeeding self-efficacy. Thematic analysis of 149 calls from mothers seeking help for breastfeeding made to a 24-hour parenting helpline over a four week period, in Brisbane, Australia. Call-takers were 12 qualified and experienced maternal and child health nurses. Calls classified according to changes in breastfeeding self-efficacy across the call were thematically analysed to identify distinguishing interactional characteristics. Key interactional characteristics that served to build self-efficacy were privileging the mother, teamwork and credible affirmation while those that failed to build self-efficacy were laissez-faire affirmation and pragmatic problem-solving responses. Nurse responses that undermined caller self-efficacy conceptualized breastfeeding as a problem. Telephone helplines have potential to enhance mothers' confidence and sustain breastfeeding when there is a call for help, this study highlights that the style of interaction is critical. The findings identify the need for specific training to increase awareness of interactional styles and delivery of advice through telehealth formats.

Early breastfeeding problems: A mixed method study of mothers' experiences

OBJECTIVES

Breastfeeding problems are common and associated with early cessation. Still length of postpartum hospital stay has been reduced. This leaves new mothers to establish breastfeeding at home with less support from health care professionals. The objective was to explore mothers' perspectives on when breastfeeding problems were the most challenging and prominent early postnatal. The aim was also to identify possible factors associated with the breastfeeding problems.

METHODS

In a cross-sectional study, a mixed method approach was used to analyse postal survey data from 1437 mothers with full term singleton infants. Content analysis was used to analyse mothers' open text descriptions of their most challenging breastfeeding problem. Multiple logistic regression was used to calculate odds ratios for early breastfeeding problems according to sociodemographic- and psychosocial factors.

RESULTS

Up to 40% of the mothers had experienced early breastfeeding problems. The problems were associated with the mother, the infant and to lack of support from health care professionals. Most prominent problems were infant's inability to latch on (40%) and mothers having sore, wounded and cracked nipples (38%). Pain often occurred when experiencing breastfeeding problems. Factors associated with the problems were primiparity, lower self-efficacy and lower self-perceived knowledge of breastfeeding. Mothers with no or short education reported less frequently breastfeeding problems.

CONCLUSIONS

Breastfeeding problems occurred frequently in the early postnatal period and often caused breastfeeding to be painful. Health care professionals should prepare mothers to deal with possible breastfeeding problems. New support options should be reviewed in an early postnatal discharge setting.

Resistance to breastfeeding: A Foucauldian analysis of breastfeeding support from health professionals

BACKGROUND

Despite widespread consensus regarding the health benefits of breastfeeding, the prevalence of six months exclusive breastfeeding is very low in developed countries including New Zealand.

AIM

This paper aims to evaluate the role that health professionals play in promoting exclusive breastfeeding in New Zealand.

METHODS

Qualitative research involving face to face postpartum interviews conducted four to six weeks after the birth with 30 new mothers who lived in New Zealand and had identified in a short antenatal questionnaire that they intended to practice exclusive breastfeeding for six months. Themes related to exclusive breastfeeding support from health professionals were extracted from the interview transcripts and interpreted using Foucault's ideas about governmentality and bio-power.

RESULTS

Four themes related to the quality of health care support were identified in the interview transcripts. 'Breastfeeding self-efficacy support from the community midwives', 'mothers need to know more about breastfeeding during pregnancy', 'experiencing difficulties breastfeeding' as well as 'pressure and resistance to breastfeeding'.

DISCUSSION

Most mothers in this research spoke about feeling pressured to breastfeed within the New Zealand health system. However, the participating mothers acknowledged the effective support that they had received from community midwives who respected their autonomy, strengthened their self-esteem and encouraged them to breastfeed.

CONCLUSION

Negative historical experiences related to the medicalization of infant feeding in Western countries suggests that health professionals need to provide effective skill support for breastfeeding mothers so that mothers do not consider it a form of "quiet coercion" or as an exercise of "power".

What Do Women Really Want? Lessons for Breastfeeding Promotion and Education

BACKGROUND

Promoting breastfeeding is a strategic priority, but breastfeeding rates remain low in the United Kingdom. Women value breastfeeding promotion and education, but a different strategy may be needed to continue to raise breastfeeding rates. New mothers, as the experts, are best placed to inform these changes. The current study explored new mothers' attitudes toward breastfeeding education and promotion, evaluating experiences and examining ideas for change.

MATERIALS AND METHODS

One thousand one hundred thirty mothers with a baby aged 0-2 years old who had planned to breastfeed at birth completed a questionnaire consisting of both closed and open-ended questions exploring their attitudes to breastfeeding promotion and support.

RESULTS

Overall, the findings showed that mothers valued breastfeeding information, but believed that changes needed to be made to current messages. Key themes included a move away from the perception that breastfeeding is best (rather than normal), emphasis on wider values other than the health benefits of breastfeeding, and a message that every feed, rather than just 6 months exclusive breastfeeding, matters. Mothers also highlighted the need for promotion and education to target family members and wider society rather than simply mothers themselves, all of whom influenced both directly or indirectly maternal decision and ability to breastfeed. Mothers suggested ideas for promotional campaigns or how specific groups or methods could be used to increase support, including education for children, TV adverts, and using established online sources of breastfeeding information.

CONCLUSIONS

The findings are important both for those supporting new mothers to breastfeed and those involved in breastfeeding policy and promotional messages.

Mothers’ Perspectives on Effective Assistance With Breastfeeding Problems

Purpose: This qualitative study investigated maternal views on effective support strategies in the face of breastfeeding difficulties.

Methods: In semistructured interviews, 15 women who had encountered breastfeeding problems reflected on their experiences.

Results: Participants reported that managing breastfeeding problems was complex and that the level of provider competence in addressing these difficulties was variable. Social media emerged as a highly prevalent source of support among women facing breastfeeding problems.

Discussion: Virtual and face-to-face support strategies are compared; implications for providers are reviewed.

'I really needed help': What mothers say about their post-birth care in Queensland, Australia

BACKGROUND

Australian mothers consistently rate postnatal care as the poorest aspect of their maternity care, and researchers and policymakers have widely acknowledged the need for improvement in how postnatal care is provided.

AIM

To identify and analyse mothers' comments about postnatal care in their free text responses to an open ended question in the Having a Baby in Queensland Survey, 2010, and reflect on their implications for midwifery practice and maternity service policies.

METHODS

The survey assessed mothers' experiences of maternity care four months after birth. We analysed free-text data from an open-ended question inviting respondents to write 'anything else you would like to tell us'. Of the final survey sample (N=7193), 60% (N=4310) provided comments, 26% (N=1100) of which pertained to postnatal care. Analysis included the coding and enumeration of issues to identify the most common problems commented on by mothers. Comments were categorised according to whether they related to in-hospital or post-discharge care, and whether they were reported by women birthing in public or private birthing facilities.

RESULTS

The analysis revealed important differences in maternal experiences according to birthing sector: mothers birthing in public facilities were more likely to raise concerns about the quality and/or duration of their in-hospital stay than those in private facilities. Conversely, mothers who gave birth in private facilities were more likely to raise concerns about inadequate post-discharge care. Regardless of birthing sector, however, a substantial proportion of all mothers spontaneously raised concerns about their experiences of inadequate and/or inconsistent breastfeeding support.

CONCLUSION

Women who birth in private facilities were more likely to spontaneously report concerns about their level of post-discharge care than women from public facilities in Queensland, and publically provided community based care is not sufficient to meet women's needs. Inadequate or inconsistent professional breastfeeding support remains a major issue for early parenting women regardless of birthing sector.

Fathers' experiences of supporting breastfeeding: challenges for breastfeeding promotion and education

Increasing breastfeeding rates is a strategic priority in the UK and understanding the factors that promote and encourage breastfeeding is critical to achieving this. It is established that women who have strong social support from their partner are more likely to initiate and continue breastfeeding. However, little research has explored the fathers' role in breastfeeding support and more importantly, the information and guidance he may need. In the current study, 117 men whose partner had given birth in the previous 2 years and initiated breastfeeding at birth completed an open-ended questionnaire exploring their experiences of breastfeeding, the information and support they received and their ideas for future breastfeeding education and promotion aimed at fathers and families. Overall, the findings showed that fathers were encouraging of breastfeeding and wanted to be able to support their partner. However, they often felt left out of the breastfeeding relationships and helpless to support their partner at this time. Many reported being excluded from antenatal breastfeeding education or being considered unimportant in post-natal support. Men wanted more information about breastfeeding to be directed towards them alongside ideas about how they could practically support their partner. The importance of support mechanisms for themselves during this time was also raised. The results highlight the need for health professionals to direct support and information towards fathers as well as the mother-infant dyad and to recognise their importance in promoting and enabling breastfeeding.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION

ACTRN12611000354987.

Multiparous mothers: Breastfeeding support provided by nurses

The study aimed to identify the informational, practical and emotional support that multiparous mothers had received from nurses in the early postpartum period.This is a descriptive and cross-sectional study on 278 multiparous mothers who took part in the research prior to their discharge from a maternity hospital in Ankara, Turkey. The instrument used was a 38-item questionnaire. Experiencing breastfeeding problems was the only statistically significant predictor of in-hospital supplementation (P < 0.01, OR 0.028, 95% CI 0.005-0.159). There were no statistically significant association between some predictor variables with regard to breastfeeding support and breastfeeding outcomes including in-hospital formula supplementation and breastfeeding problems. No significant associations are indicative for the need of more effective implementation of informational, practical and emotional breastfeeding support for multiparous mothers in easing their adjustment to breastfeeding. Nurses can encourage multiparous mothers to maintain breastfeeding through individual teaching, giving mothers a sense of security, providing understanding care and telling about what to do with regard to breastfeeding problems. Antenatal education and support could be more likely to make a difference.

Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system

BACKGROUND

The Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women's informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Health Initiative (BFHI) the translation of evidence into practice has not been uniform, as demonstrated by a varying number of maternity facilities in each State and Territory currently accredited as 'baby friendly'. This variance has persisted regardless of BFHI implementation in Australia gaining 'in principle' support at a national and governmental level as well as inclusion in health policy in several states. There are many stakeholders that exert an influence on policy development and health care practices.

AIM

Identify a theory and model to examine where and how barriers occur in the gap between evidence and practice in the uptake of the BFHI in Australia.

RESULTS

Knowledge translation theory and the research to practice pipeline model are used to examine the identified barriers to BFHI implementation and accreditation in Australia.

CONCLUSION

Australian and international studies have identified similar issues that have either enabled implementation of the BFHI or acted as a barrier. Knowledge translation theory and the research to practice pipeline model is of practical value to examine barriers. Recommendations in the form of specific targeted strategies to facilitate knowledge transfer and supportive practices into the Australian health care system and current midwifery practice are included.

Midwives’ Time and Presence: A Key Factor in Facilitating Breastfeeding Support for New Mothers

BACKGROUND: There is now a plethora of work that has examined new mothers’ experiences of receiving breastfeeding support. However, there remains limited literature describing women’s experiences of receiving this support from midwives in the early postnatal period.

AIM: The study aimed to explore and describe women’s experiences of receiving breastfeeding support from midwives in the early postnatal period.

METHOD: A qualitative descriptive approach was used. Six first-time mothers who initiated breastfeeding after birth consented to be involved and participated in an in-depth interview. The techniques associated with dimensional analysis and constant comparison were used to analyze the data set.

FINDINGS: Two categories were identified that described women’s experiences of midwifery breastfeeding support. These were related to the midwives’ ability to spend and give the gift of time to women. Alternatively, the midwife’s busyness and inability to be present for the woman was considered a barrier to receiving positive breastfeeding support and the woman’s ability to problem solve any breastfeeding issues.

CONCLUSION: The findings of this study confirm both the importance of midwives spending time providing breastfeeding support and the negative consequences of a lack of time given for the provision of this support. Mothers have asked for midwives to be present; investing time in them, listening to them, and helping them solve problems. Current care models present barriers contributing to both the perceptions and realities of midwives’ lack of time, presenting a need to reconsider the design of maternity care environments and to adopt a caseload approach where women receive relationship-based care.

The professionalising of breast feeding--where are we a decade on?

This paper is an empirically informed opinion piece revisiting an argument published in Midwifery 10 years ago, that the increasing professionalisation of breast feeding was not supporting women in Australia in sustaining breast feeding. We present the last 10 years of primary research on the topic, explore major policy initiatives and the establishment and growth of lactation consultants in Australia to see if this has made a difference to sustained rates of breast feeding. We present an analysis of the only consistently collected national statistics on breast feeding and compare this with national and state level government data collections from the last decade. We have found that the considerable effort invested in trying to improve duration of breast feeding amongst women in Australia appears to have failed to improve sustained breast-feeding rates. We argue that this situation might be related to losing sight of the embodied nature of breast feeding and the relationships that must exist between the mother and baby, the knowledge and skills women quickly develop, and a loss of woman to woman support. We conclude that midwives have a major role in avoiding us reproducing similar, unintended, negative consequences to those resulting from increasing obstetrician managed normal birth. These include midwifery scrutiny and involvement in policy development and institutional practices and the design of services.

Association Between Mode of Birth and Self-Reported Maternal Physical and Psychological Health Problems at 10 Weeks Postpartum

AIM:To determine the association between mode of birth and physical and psychological health problems reported at 10 weeks postpartum.

METHODS:A cross-sectional, self-report survey was completed by 2,699 Western Australian women at 10 weeks postpartum. Information on birth mode and physical and psychological health was sought. Descriptive statistics and frequency distributions were performed to describe the sample. Logistic regression was used to determine the association between mode of birth and the reported number of physical health problems (two or more and three or more) and two psychological health problems.

RESULTS:The occurrence of physical health problems for all women were incontinence (11.5%), no bowel control (2.6%), backache (41%), heavy bleeding (14.1%), and excessive fatigue or tiredness (35.7%). A significant association was found between all cesarean sections (elective and emergency) and the number of physical health problems compared to spontaneous vaginal births. Women who had an emergency cesarean were most likely (OR= 3.15, CI = 2.40–4.13,p< 0.0005) to report two or more physical problems, whereas women who had an elective cesarean were more likely (OR= 2.75, CI = 2.08–3.63,p< 0.0005) to report three or more physical problems.

Nearly 15% of women reported being unhappy for more than a few days. This was highest in women having an emergency cesarean (16.4%) and lowest in women giving birth spontaneously (13.5%). Some 6.4% of women stated they were constantly reliving negative thoughts of birth and/or labor. Women who had an emergency cesarean were more likely (OR= 3.10, CI = 1.96–4.89,p< 0.0005) to choose this item and they were also more likely (OR= 2.04, CI = 1.01–4.13,p< 0.047) to experience both psychological health items.

CONCLUSION:Women’s reports of health problems within the first 10 weeks postpartum are concerning and warrant ongoing attention. The prevalence of health problems was higher in women who had experienced a cesarean. This information on morbidity postbirth is essential for women and their care providers in making informed decisions around available birth options.