Two sides of breastfeeding support: experiences of women and midwives

Effect of continuity of team midwifery care on maternal and neonatal outcomes: a quasi-experimental study in Iran

Midwife-led continuity of care models have been linked to better clinical outcomes in certain developed countries. However, there is a paucity of research on these models in developing nations. This quasi-experimental study was conducted on primiparous women who referred to one private midwifery center and two public hospitals in Ahvaz, Iran to evaluate the effect of team midwifery care on maternal and neonatal outcomes of pregnant women in Iran. Two hundred women were allocated either into the experimental (n = 100) or control (n = 100) groups. Women in the experimental group, received team midwifery care, while women in the control group, received routine care. Data were collected using a demographic questionnaire, Mackey questionnaire, and a checklist. Women in the team midwifery care group experienced significantly higher rates of normal vaginal birth and exclusive breastfeeding compared to women in the control group. No statistically significant difference was observed between the two groups in terms of the rate of induction of labor and postpartum hemorrhage. The duration of labor was longer in the team midwifery care compared to the control group. Women in the team midwifery care group had a significantly higher rate of exclusive breastfeeding at six weeks postpartum compared to the control group (80 vs. 61%, p = 0.001). After excluding women with ruptured membranes and prolonged pregnancies, neonates in the intervention group had significantly higher first- and fifth-minute Apgar scores (p < 0.0001), and a lower rate of admission to intensive care unit in the intervention group compared to the control group (1 vs. 9%, p = 0.04). Also, women in the team midwifery group had skin-to-skin contact significantly earlier than those in the control group (33.87 ± 66.26 min vs. 111.98 ± 247.31 min, p = 0.578). Given the positive impact of continuous team midwifery care on maternal and neonatal outcomes, its implementation in maternity care systems, particularly in countries like Iran with high cesarean section rates, is strongly recommended.

Laid-back breastfeeding: knowledge, attitudes and practices of midwives and student midwives in Ireland

BACKGROUND

Despite concerted efforts by policy developers, health professionals and lay groups, breastfeeding rates in Ireland remain one of the lowest in world, with 63.6% of mothers initiating breastfeeding at birth, dropping to 37.6% of mothers breastfeeding exclusively on hospital discharge. Nipple trauma and difficulties with baby latching are major contributors to the introduction of formula and discontinuation of breastfeeding. Research shows laid-back breastfeeding (LBBF) significantly reduces breast problems such as sore and cracked nipples, engorgement, and mastitis as well as facilitating a better latch. Although the benefits of LBBF are well documented, this position does not seem to be routinely suggested to mothers as an option when establishing breastfeeding. This study aims to determine midwives' and student midwives' knowledge, attitudes, and practices of using laid-back breastfeeding in Ireland.

METHOD

A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021.

RESULTS

Two hundred and fifty-three valid responses were received from nine maternity units. Most participants (81.4%) were aware of laid-back breastfeeding. However, only 6.8% of respondents cited it as the position they most frequently use. Over one-third (38.34%) had never used this position with mothers. Those more likely to suggest LBBF had personal experience of it, were lactation consultants or working towards qualification, or had participated in specific education about LBBF. Barriers included lack of education, confidence, time, and experience. Further issues related to work culture, a tendency to continue using more familiar positions and concerns about mothers' anatomy and mothers' unfamiliarity with LBBF.

CONCLUSION

Although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers' and babies' intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.

Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context

High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed.

A qualitative analysis of women's postnatal experiences of breastfeeding supports during the perinatal period in Ireland

Ireland has among the lowest rates of breastfeeding worldwide. Despite policies to support breastfeeding, breastfeeding initiation and exclusivity remain low in Ireland. Greater knowledge about support received in the maternity unit may-in part-shed light on why this is so. Our aim was to analyse women's experiences of the breastfeeding supports available in the early postnatal period in Ireland. We conducted an analysis of an open-ended question on a cross-sectional survey about breastfeeding support conducted in the Republic of Ireland in 2022. Participants were asked to provide comments about the breastfeeding support they received in the maternity unit or during your home birth. Data were analysed using Braun and Clarke's six-step Thematic Analysis Framework. There were 5,412 unique responses to the survey and 2,264 responses to the question of interest. Two themes were generated from the data: (i) 'Breastfeeding support in theory but not in practice.' Although breastfeeding was promoted by healthcare professionals antenatally, breastfeeding challenges were rarely mentioned. Participants then felt unsupported in overcoming challenges postnatally. (ii) 'Support was either inaccessible due to lack of staff/time, inadequate; i.e., unhelpful or non-specific, and/or physically inappropriate.' Most participants described receiving supports that were less than optimal in aiding them to establish breastfeeding. While many described difficulties in accessing supports, others found support to be 'non-specific,' 'rushed' and sometimes 'rough.' A lack of knowledge, time and support from healthcare professionals was frequently described, which was often recognised as a failing of the healthcare system. Women require practical, informative, and specific breastfeeding support. Barriers such as lack of time and trained staff in the maternity unit need to be addressed.

Mothers of children with down syndrome: A qualitative study of experiences of breastfeeding and breastfeeding support

BACKGROUND

Children with down syndrome (DS) are breastfed to a lesser extent than infants in general, despite research showing that it is possible for these children to breastfeed successfully.

AIM

The aim was to describe how mothers of children with DS experienced breastfeeding and breastfeeding support from healthcare professionals.

METHOD

A qualitative study with an inductive approach. Individual interviews were performed with seven mothers from southern Sweden. The interviews were analysed using qualitative content analysis.

RESULT

The mothers felt that the support varied, as some healthcare professionals were supportive, while others had preconceptions regarding breastfeeding and DS. They also experienced that the guidelines could be an obstacle in the encounter with healthcare professionals thereby affecting the possibility to establish breastfeeding. Information and support were important to the mothers, and when insufficient, they turned to the internet for help.

CONCLUSIONS

Mothers felt that healthcare professionals were bound to ward routines and guidelines, which could be contrary to their own and the family's wishes. They were also sensitive to the attitudes of healthcare professionals, which can affect their own state of mind. Healthcare professionals' preconceptions regarding breastfeeding and DS have not changed, despite research showing that infants with DS can breastfeed successfully. Increased awareness of the possibility to breastfeed an infant with DS is needed to provide better support to mothers.

Experiences that influence how trained providers support women with breastfeeding: A systematic review of qualitative evidence

INTRODUCTION

There is a need to improve breastfeeding support interventions as although many are evidence-based, a sequential increase in breastfeeding rates is not evident. It is crucial to understand why the implementation of evidence-based guidelines in practice does not always translate to positive experiences for women and improve breastfeeding rates. This systematic review aims to synthesise breastfeeding support experiences of trained support providers and their impact on breastfeeding support practices.

METHODS

A strategy was developed to search seven databases including Medline and CINAHL and grey literature for qualitative studies. Studies eligible for inclusion reported professional and trained peer experiences of supporting women to breastfeed. PRISMA guidelines were followed and included studies were quality appraised using the CASP Qualitative Checklist. A thematic synthesis of included studies was undertaken and confidence in the review findings was assessed using the CERQual tool. The study protocol, registered in the International Prospective Register of Systematic Reviews PROSPERO registration number: CRD42020207380, has been peer reviewed and published.

FINDINGS

A total of 977 records were screened, which identified 18 studies (21 papers) eligible for inclusion comprising 368 participants. Following quality appraisal, all studies were deemed suitable for inclusion. The thematic synthesis resulted in four analytical themes: 1) A personal philosophy of breastfeeding support 2) Teamwork and tensions in practice 3) Negotiating organisational constraints and 4) Encounters with breastfeeding women. Findings demonstrated that a range of experiences influence practice, and practice evolves on continued exposure to such experiences. The potential of each experience to facilitate or inhibit breastfeeding support provision is fluid and context specific.

CONCLUSIONS

Experiences, as named above, are modifiable factors contributing to the development of a philosophy of breastfeeding support based on what the provider believes works and is valuable in practice. Further research is required into the range of factors which underpin context-specific breastfeeding support practice, to improve both women's experiences and intervention effectiveness.

Intimate Partner Violence and Breastfeeding Behaviors: Does the Source of Breastfeeding Information Affect the Associations Between Prepregnancy or Prenatal IPV and Breastfeeding Behaviors of Women in the United States? A PRAMS 2018 Study

Background: Most countries do not meet World Health Organization's breastfeeding recommendations, and exposure to intimate partner violence (IPV) hinders positive breastfeeding behaviors. One in four U.S. women (43.6 million women) experiences IPV. This study aims to assess relationships between IPV, and breastfeeding initiation, duration, and early cessation among women in 42 U.S. states; and to evaluate possible modifying effect(s) of different breastfeeding information sources. Methods: Centers for Disease Control and Prevention's 2016-2018 Pregnancy Risk Assessment Monitoring System data (n = 105,230) were used to assess relationships between prepregnancy/prenatal IPV and breastfeeding initiation, duration, and early cessation; and modify effects of various breastfeeding information sources on study associations using multilogistic regression models. Results: About 1.4% of women experienced prenatal IPV with reduced odds of breastfeeding for 6 months or more (odds ratio [OR] = 0.74; 95% confidence interval = 0.58-0.94). Receiving breastfeeding information from baby's doctor modified early cessation (0.37 [0.18-0.78]) (p for interaction = 0.009) with prenatal IPV exposure. Among women exposed to prenatal IPV, breastfeeding initiation was stronger in women who received breastfeeding information from family/friends (2.46, [1.24-4.88]) (p for interaction = 0.010) or from breastfeeding support groups (3.03 [1.17-7.88]) (p for interaction = 0.023) compared to those who did not. Breastfeeding information from family/friends modified association between prepregnancy IPV and breastfeeding duration (0.67 [0.45-0.99]) (p for interaction = 0.042). Conclusions: Prenatal IPV is a risk factor for short-duration breastfeeding. Receiving information from doctors, nurses, support groups, and family/friends may improve breastfeeding behavior among IPV-exposed women. Interventions promoting breastfeeding information dissemination by family/friends, support groups, and doctors/nurses during hospital visits are encouraged.

The concept, importance and values of support during childbearing and breastfeeding - A discourse paper

BACKGROUND

Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing.

AIM

The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites.

DESIGN

Discourse paper.

METHODS

This discourse paper is based on our own experiences and is supported by literature and theory.

RESULTS

Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.

Breastfeeding knowledge of mothers in protracted crises: the Gaza Strip example

The protection and support of breastfeeding is the most effective intervention to prevent child morbidity and mortality especially in humanitarian crisis.During the Palestine-Israel conflict healthcare services are understaffed and lack basic resources, with frequent power cuts and stock-outs of essential drugs and equipment. This case study seeks to answer the questions: (1) How does the protracted crisis in Gaza affect the breastfeeding practices of the most vulnerable population; and (2) What is the role that midwives can play in improving breastfeeding practices?The study was conducted using a mixed method approach with quantitative and qualitative methods. Purposeful selection of women and children was conducted utilising eligibility criteria, women with children less than 2 years of age were included. All the respondents were asked if they agreed to participate in the survey.A total of 63% practice early initiation of breastfeeding and 42% confirmed that their new-borns were given liquids other than breast milk during the first 3 days of life. Fifty percent of mothers addressed breast milk insufficiency by drinking additional fluids and 40% by using infant formula. Only 18% of women said that they received breastfeeding information during contact with health professionals throughout labour, delivery, and subsequent post-natal care visits. Many mothers during the focus group discussions (FGDs) confirm using milk to top up or replace breast milk.Myths and misconceptions around breastfeeding remain, while women do access antenatal care services and deliver in the health facilities. There is a need to a) adapt the recommendations of the operational guidance for infant and young child feeding in emergencies (IYCF-E) in the Gaza strip, to protect, promote and support breastfeeding and b) include skilled breastfeeding counselling in the pre-service and in-service training for midwives.Lessons learned included the importance of a) allocating additional research time, to account for interruption b) daily coordination with security officers to ensure safe access to localities c) identification of extra sites, in case of conflict escalation d) training of additional enumerators in case conflict escalation e) negotiation with authorities to ensure compliance with requirements.

Challenges, supports, and postpartum mental health symptoms among non-breastfeeding mothers

Women face a high degree of pressure to breastfeed. However, some women are not able to breastfeed, or choose not to. Few studies have examined the experiences of non-breastfeeding mothers, including their challenges, supports, and mental health sequelae. We sought to identify women's experiences with breastfeeding, specifically their reasons for not breastfeeding, challenges faced, and supports received, and the association between breastfeeding and postpartum mental health. Self-identified postpartum women (N = 70) completed a questionnaire investigating perinatal health. Open-ended responses were analyzed using thematic analysis and quantitative measures were analyzed using descriptive statistics and multivariate analysis of variance (MANOVA). Qualitative analysis identified two main themes reflecting reasons for not breastfeeding (maternal factors and infant factors) and three primary challenges associated with not breastfeeding (emotional health, physical health, and perceived lack of support). Authors identified two main themes categorizing non-breastfeeding mothers' experiences with support (sources of support and type of support). A MANOVA revealed significantly greater levels of distress, anxiety, and depression, and lower levels of social support, among non-breastfeeding, relative to breastfeeding mothers. Findings reveal limitations in the availability of information and resources for non-breastfeeding mothers. It is possible that the pressure women may experience regarding breastfeeding may contribute to increased psychological distress for mothers who cannot or choose not to breastfeed. Based on our findings, future research and applied action should target the development and evaluation of informational resources and supports for non-breastfeeding women.

UNICEF UK Baby Friendly Initiative: Providing, receiving and leading infant feeding care in a hospital maternity setting-A critical ethnography

Although breastfeeding is known to improve health, economic and environmental outcomes, breastfeeding initiation and continuation rates are low in the United Kingdom. The global WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) aims to reverse declining rates of breastfeeding by shifting the culture of infant feeding care provision throughout hospital maternity settings. In the United Kingdom, the global BFHI has been adapted by UNICEF UK reflecting a paradigm shift towards the experiences of women and families using maternity services. This research used a critical ethnographic approach to explore the influence of the national UNICEF UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England, over a period of 8 weeks, across four phases of data collection between 2011 and 2017. Twenty‐one staff and 26 service users were recruited and engaged in moderate‐level participant observation and/or guided interviews and conversations. Basic, organising and a final global theme emerged through thematic network analysis, describing the influence of the BFI on providing, receiving and leading infant feeding care in a hospital maternity setting. Using Antonovsky's sense of coherence construct, the findings discussed in this paper highlight how the BFI offers ‘informational’ (comprehensible), ‘practical’ (manageable) and ‘emotional’ (meaningful) support for both staff and service users, strengthened by effective, local leadership and a team approach. This is juxtaposed against the tensions and demands of the busy hospital maternity setting. It is recommended that ongoing infant feeding policy, practice and leadership balance relational and rational approaches for positive infant feeding care and experiences to flourish.

Using Simulation to Teach Breastfeeding Management Skills and Improve Breastfeeding Self-Efficacy

Breastfeeding rates in the United States continue to be variable and are not meeting benchmarks established by Healthy People 2020. The literature indicates that although breastfeeding knowledge of providers is paramount in the success of breastfeeding mothers, most receive minimal education regarding breastfeeding management. Recognizing a lack of opportunities for nursing students to practice breastfeeding management during clinical rotations, a breastfeeding simulation program was implemented for students prior to beginning Maternal Child Health clinicals. Students reported increased confidence in caring for breastfeeding dyads and enhanced comfort when providing care to a breastfeeding mother (breastfeeding self-efficacy). This hands-on educational approach can be utilized for any provider working with breastfeeding dyads.

Breastfeeding support at an Australian Breastfeeding Association drop-in service: a descriptive survey

Background

In Australia, during the early establishment phase of breastfeeding, women can access telephone peer support counselling provided by the Australian Breastfeeding Association (ABA) however options for face-to-face peer support are limited. The known factors which improve ongoing and exclusive breastfeeding include face-to-face support, peer and/or professional support, and trained personnel. This study aimed to examine women’s experiences of accessing one breastfeeding drop-in peer support service provided by trained peer support volunteer counsellors from the ABA.

Methods

Women who accessed the service were invited, in 2014, to participate in an anonymous online survey which collected both quantitative and qualitative data. Participants were asked about their experiences of breastfeeding support, as well as their experiences of the drop-in service. In total, 53 women completed the online survey, and subsequent analysis generated descriptive statistics and qualitative themes.

Results

Responses to the survey revealed that women attended the drop-in service with infants ranging in age from less than 1 week through to 12 months of age. Most women reported attending with infants aged 0–8 weeks of age (72%). The predominant presenting problems identified were sore/damaged nipples, difficulties with infant latching to the breast, or concerns about using nipple shields. Analysis of the open text qualitative responses revealed one overarching theme ‘Support to continue breastfeeding’ and four subthemes: ‘feeling listened to and not judged’; ‘emotional support and confidence building’; ‘the importance of face-to-face, practical support’; and ‘the need for ongoing, free access’.

Discussion

In this study many women were seeking support for ongoing breastfeeding difficulties. Health professionals who had limited breastfeeding knowledge and skills were identified as most unhelpful in providing support with ongoing breastfeeding difficulties. Women valued having access to trained peer counsellors, who had the capacity to provide non-judgemental, face-to-face support; who could sit through a feed; in a space that was ‘safe’; and who could enhance a woman’s confidence with breastfeeding over the course of her full breastfeeding journey.

Conclusions

Reactive peer support, provided in response to need, at an Australian Breastfeeding Association drop-in service, was described by participants as pivotal to enabling their ongoing breastfeeding.

Marital Adjustment and Prenatal Breastfeeding Efficacy of First Time Mothers in A Low-Income Community in The Philippines

Introduction: All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. This study aims to assess the level of marital satisfaction and its influence to prenatal breastfeeding self-efficacy in   first time mothers during late pregnancy.Methods: A descriptive correlational was conducted among 128 simple randomized prim gravid women who agreed to participate and had prenatal care check-up in the health center at the time of data gathering. The instruments used were 15-item Marital Adjustment Test (MAT) to measure marital adjustment and 14-item Breastfeeding Self efficacy Scale-Short Form (BSES-SF) as a measure of breastfeeding self-efficacy. Pearson’s correlation coefficient was utilized to test the relationships between the sample’s marital adjustment scores to correlate with BFSE of the respondents. Fisher’s t test was utilized to determine the significance of correlations. A p-value of equal to or less than .05 was considered statistically significant.Results: The study revealed that the sampled mothers have a high level of marital adjustment score (112.05± 21.83). Prenatal mothers responded in the study were highly confident and have high self-efficacy in breastfeeding first child currently bearing (4.55±.51). Lastly, it was found that there is no significant correlation between marital adjustment and prenatal breastfeeding self-efficacy (β=-.052, p-value=.280).Conclusion: It was found  that there is a high level of marital adjustment and breastfeeding self-efficacy among sampled mothers. However, there is no significant correlation between marital adjustment and prenatal breastfeeding self-efficacy. The study suggests incorporating co-parenting intervention involving father’s involvement and assistance with breastfeeding when creating interventions in 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.

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.

The perceptions and experiences of women with a body mass index ≥ 30 kg m2 who breastfeed: A meta-synthesis

Breastfeeding has copious health benefits for both mother and child, but rates of initiation and maintenance among women with a body mass index (BMI) ≥ 30 kg m² are low. Few interventions aiming to increase these rates have been successful, suggesting that breastfeeding behaviour in this group is not fully understood. Therefore, this review aimed to systematically identify and synthesise the qualitative literature that explored the perceptions and experiences of women with a BMI ≥ 30 kg m² who breastfed. The search identified five eligible papers, and a meta‐ethnographic approach was taken to synthesise the findings. One theme was identified: “weight amplifies breastfeeding difficulties,” revealing that women with a BMI ≥ 30 kg m² experience common breastfeeding difficulties to a greater degree. In particular, women with a BMI ≥ 30 kg m² struggle with the impact of medical intervention, doubt their ability to breastfeed, and need additional support. These findings can inform understanding of breastfeeding models, future research directions, intervention development, and antenatal and post‐natal care for women with a BMI ≥ 30 kg m².

The Moderating Effect of Urban Versus Rural Residence on the Relationship Between Type of Birth Attendant and Early Initiation of Breastfeeding in Ghana

BACKGROUND

Early initiation of breastfeeding increases the likelihood of longer duration of breastfeeding. Factors associated with breastfeeding include maternal sociodemographic, behavioral and health-related characteristics, infant health characteristics, and perinatal factors. Research aim: This study aimed to determine the association between type of birth attendant and early initiation of breastfeeding among women in Ghana.

METHODS

A cross-sectional study was conducted using women ( N = 3,087) who participated in the 2014 Ghana Demographic and Health Survey. The main outcome of interest was early initiation of breastfeeding, defined as provision of mother's milk to the infant within 1 hr of birth. Chi-square tests and multivariable logistic regression modeling were performed.

RESULTS

Breastfeeding was initiated within 1 hr of birth by 58.3% of women. In the multivariable model, there was a significant interaction between type of birth attendant and place of residence on early initiation of breastfeeding. For rural areas, compared with women who had a nurse or midwife as their birth attendant, the multivariable odds ratios [95% confidence intervals] for early initiation of breastfeeding were lower among women whose birth attendant was a relative or other, 0.20 [0.07, 0.55], p = .002; village health volunteer or traditional health practitioner, 0.21 [0.07, 0.62], p = .005; none, 0.34 [0.12, 0.93], p = .035; community health officer, 0.42 [0.21, 0.85], p = .016; and doctor, 0.48 [0.24, 0.96], p = .037. For urban areas, no significant association was detected between type of birth attendant and early initiation of breastfeeding.

CONCLUSION

Findings from the study highlight the need for focused, context-specific, early initiation of breastfeeding promotion and intervention, especially for women and their birth attendants in rural areas.

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.

Educational intervention about breastfeeding among secondary school students

Purpose

Breastfeeding education in the school setting offers the opportunity to improve knowledge base and positively influence beliefs and intentions for students. The purpose of this paper is to analyze the effect of short education program among secondary school students on breastfeeding knowledge and intentions.

Design/methodology/approach

Total of 106 female and 155 male students from four different high schools in Bjelovar were given online questionnaire about intentions to breastfeed and test of knowledge about breastfeeding, both before and shortly after education. The effect of education and school on breastfeeding intentions and knowledge was examined using mixed design ANOVA. Univariate tests were used to examine relation of several independent variables to breastfeeding intention and knowledge scores before and after education.

Findings

Results showed statistically significant effect of education on both intentions and knowledge, whereas the effect of school was significant only for intentions. Students show more positive intentions and better knowledge about breastfeeding after education than before education.

Research limitations/implications

This paper does not entail validation of breastfeeding questionnaire and knowledge test. Due to comprehensiveness and report length, study on validity and reliability of measures is the subject of another paper.

Practical implications

The authors hope that results of the study will influence professional public in Croatia and encourage it to support implementation of breastfeeding education in curriculum.

Originality/value

This paper offers the first national intervention data in relation to breastfeeding intentions and knowledge among secondary school students. It provides an evidence for necessity of implementation of well-structured education module in regular curriculum of secondary education in Croatia.

A feasibility study of a multidimensional breastfeeding-support intervention in Ireland

BACKGROUND

Breastfeeding is the optimum mode of infant feeding. Despite this, most global populations do not achieve the World Health Organisation's recommendation of exclusive breast milk for the first 6 months of life. Irish breastfeeding rates are among the lowest in Europe, necessitating a well-designed breastfeeding-support intervention.

AIM

To evaluate the feasibility and acceptability of a multidimensional breastfeeding intervention in a rural and an urban maternity setting in Ireland.

DESIGN

A feasibility study of a breastfeeding-support intervention.

SETTING

Participants were recruited from The National Maternity Hospital (Dublin, urban) and Wexford General Hospital (Wexford, rural). Questionnaires were completed antenatally, at 6 weeks postpartum and at 3 months postpartum to assess acceptability of the intervention and determine breastfeeding status.

PARTICIPANTS

Pregnant women were recruited in the 3^rd trimester, alongside a support partner.

INTERVENTION

The intervention consisted of an antenatal class (including the physiology and practical approaches to breastfeeding), a one-to-one breastfeeding consultation with a lactation consultant after birth, access to a breastfeeding helpline, online resources, and a postnatal breastfeeding support group which included a one-to-one consultation with the lactation consultant.

RESULTS

One hundred women from The National Maternity Hospital, Dublin and 27 women from Wexford General Hospital were recruited. The antenatal class was attended by 77 women in Dublin and 23 in Wexford; thus, 100 women participated in the intervention. Seventy-six women had a one-to-one postnatal consultation with a lactation consultant in Dublin and 23 in Wexford. Fifty and 45 women in Dublin, and 15 and 15 in Wexford responded to the 6-week and 3-month questionnaires, respectively. At 3 months postpartum, 70% of respondents from Dublin and 60% from Wexford were breastfeeding. Mothers perceived the one-to-one consultation with the lactation consultant during postnatal hospitalization as the most helpful part of the intervention. Inclusion of a support partner was universally viewed positively as a means to support the mother's decision to initiate and continue breastfeeding.

CONCLUSION

This multidimensional intervention is well-accepted and feasible to carry out within an Irish cohort, in both urban and rural areas. Data from this feasibility study will be used to design a randomized controlled trial of a breastfeeding-support intervention.

It's more than just luck: A qualitative exploration of breastfeeding in rural Australia

It's more than just luck: A qualitative exploration of breastfeeding in rural Australia PROBLEM: Despite significant public health benefits, breastfeeding for six months continues to be challenging for women.

BACKGROUND

In the Mid North of South Australia, healthcare professionals were concerned that breastfeeding rates were lower than the national average and that a collaborative approach was needed to promote breastfeeding.

AIM

To explore the experiences of women and health professional in the Mid North, to inform interventions to improve breastfeeding longevity.

METHOD

Two focus groups were conducted to examine breastfeeding experience in the region. Focus group one included nine mothers who had breastfed more than six months and focus group two consisted of ten health professionals from the Mid North. Thematic analysis was used to analyse the data.

FINDINGS

Two overarching themes were identified; 'breastfeeding: It's more than just luck' represented the voices of the mothers and 'breastfeeding: It's everybody's business' captured the discussion between the health professionals. Women described themselves as lucky while acknowledging that their own persistence, as well as positive support was vital. Health professionals identified education and support as key foci, and a need for a holistic approach to improve breastfeeding rates.

DISCUSSION

Breastfeeding should be understood as a relationship, in which broadly applied solutions do not necessarily influence longevity, particularly in rural communities. Strategies should also reflect a realistic picture of breastfeeding and safeguard against idealistic expectation of the experience.

CONCLUSION

A holistic approach to improve breastfeeding rates is imperative. One of the most promising antidotes to the breastfeeding dilemma is the provision of midwifery continuity of care.

Knowledge of Breastfeeding Recommendations and Breastfeeding Duration: A Survival Analysis on Infant Feeding Practices II

BACKGROUND

According to the American Academy of Pediatrics, infants should be exclusively breastfed for the first 6 months of life followed by breastfeeding with complementary food for up to 2 years of age or beyond. Knowledge of breastfeeding recommendations may greatly influence breastfeeding practices; however, the association between a woman's knowledge of exclusive breastfeeding recommendations and breastfeeding duration is not well explored. This study aims to examine the relationship between knowledge of exclusive breastfeeding recommendations before birth and breastfeeding duration.

MATERIALS AND METHODS

Data from the prospective, longitudinal 2005-2007 Infant Feeding and Practices Study II were analyzed (N = 2,935). Knowledge of national breastfeeding recommendations (yes; no) was based on a survey question asking the recommended length of breastfeeding. Breastfeeding duration was reported in weeks and was analyzed as any breastfeeding or exclusive breastfeeding. Cox proportional hazard models were used to obtain crude and adjusted hazard ratios (HRs) and 95% confidence limits (CLs).

RESULTS

Overall, 91.7% of women did not exclusively breastfeed the recommended duration and one in five (21.4%) did not know current breastfeeding recommendations. Women without knowledge of exclusive breastfeeding recommendations had a lower probability of breastfeeding compared with women with knowledge of breastfeeding recommendations. Furthermore, after adjusting for confounders, women without knowledge of exclusive breastfeeding recommendations had 11% higher risk (HR = 1.11; 95% CL = 1.01-1.23) of ceasing breastfeeding at every point in time compared with women who reported knowledge of breastfeeding recommendations while exclusive breastfeeding was not significant.

CONCLUSIONS

Findings from this study provide evidence that a mother's knowledge of exclusive breastfeeding recommendations impacts breastfeeding practices. Healthcare providers and public health professionals should educate mothers about breastfeeding.

Understanding process and context in breastfeeding support interventions: The potential of qualitative research

Considerable effort has been made in recent years to gain a better understanding of the effectiveness of different interventions for supporting breastfeeding. However, research has tended to focus primarily on measuring outcomes and has paid comparatively little attention to the relational, organizational, and wider contextual processes that may impact delivery of an intervention. Supporting a woman with breastfeeding is an interpersonal encounter that may play out differently in different contexts, despite the apparently consistent aims and structure of an intervention. We consider the limitations of randomized controlled trials for building understanding of the ways in which different components of an intervention may impact breastfeeding women and how the messages conveyed through interactions with breastfeeding supporters might be received. We argue that qualitative methods are ideally suited to understanding psychosocial processes within breastfeeding interventions and have been underused. After briefly reviewing qualitative research to date into experiences of receiving and delivering breastfeeding support, we discuss the potential of theoretically informed qualitative methodologies to provide fuller understanding of intervention processes by focusing on three examples: phenomenology, ethnography, and discourse analysis. The paper concludes by noting some of the epistemological differences between the broadly positivist approach of trials and qualitative methodologies, and we suggest there is a need for further dialog as to how researchers might bridge these differences in order to develop a fuller and more holistic understanding of how best to support breastfeeding women.

The Correlation Between Breastfeeding Success in the Early Postpartum Period and the Perception of Self-Efficacy in Breastfeeding and Breast Problems in the Late Postpartum

INTRODUCTION

The research was conducted to determine the correlation between breastfeeding success in the early postpartum period and the perception of self-efficacy in breastfeeding and breast problems in late postpartum.

METHODS

This analytic and cross-sectional research was carried out at Aydın Obstetrics and Gynecology and Children's Diseases Hospital. Three hundred twenty-seven primipara mothers who had delivered a single baby of healthy term at 37 or more gestational weeks with no previous experience with breastfeeding and who agreed to cooperate participated in the research.

RESULTS

The mothers' mean gestational week of delivery was 39.25 ± 1.10 weeks, and it was found that 56.0% had delivered by cesarean section and 57.0% had started to breastfeed immediately after the birth. The mothers' LATCH mean score was 6.55 ± 0.86; their postnatal breastfeeding self-efficacy mean score was found to be 59.10 ± 7.21. Mothers who had high success in breastfeeding at early postpartum were found to experience fewer problems with their breasts (Z = -2.65, p < 0.05), gave birth by vaginal delivery (Z = -2.88, p < 0.05), and had not received anesthesia during the delivery (Z = -2.52, p < 0.05). In the correlation analysis, it was seen that mothers with high success in breastfeeding also had high self-efficacy scores (r = 0.210, p = 0.003).

CONCLUSION

The results of the research indicated that breastfeeding success in the early postpartum period reduced breast problems and increased the perception of breastfeeding self-efficacy in the late postpartum period.

Health Professionals' Attitudes and Beliefs About Breastfeeding

The aim of this descriptive study was to investigate how health-care providers perceived their role in breastfeeding and maternal support. Data was collected via interviews of 53 health-care professionals that provided care to breastfeeding women. The emerging themes included (a) understanding the benefits of breastfeeding: often lacking current knowledge, (b) lacking consistency: gaps between knowledge of benefits and actual clinical practice, (c) not knowing how to help: lack of assessment and therapeutic skills, and (d) understanding the barriers to breastfeeding: how health-care providers can make a difference. Data analysis suggests inconsistencies between the health-care provider's perceived support and behaviors, lack of knowledge, and significant lack of skill in the assessment and management of breastfeeding couples.

Supporting breast-feeding women from the perspective of the midwife: A systematic review of the literature

INTRODUCTION

In 2003 the World Health Organization (WHO) recommended that infants should be fed exclusively with breast milk until the age of six months. However, breast feeding rates remain lower than recommended. The crucial period for breast feeding support is the first two weeks after birth. During this period breast feeding support from the midwife is needed. The aim of this paper is to gain an in-depth understanding of the role of midwives in their support of breast-feeding women, from their own perspective.

METHODS

Two researchers independently conducted a systematic and comprehensive literature search. Studies needed an empirical qualitative research design (1), had to focus on the role of the midwife in the support of the breast-feeding woman from the midwife's perspective (2), and had to be published between January 2005 and December 2014 (3) in order to be included. Language restrictions were English, Dutch, German and French. Eight qualitative research studies were included, using mainly focus group and in-depth interview studies, which were reported in 11 papers representing 231 midwives and 24 maternity nurses. All but one study concerned midwives working in hospital settings. A critical appraisal was performed of each study.

FINDINGS

Midwives value breast feeding education and breast feeding support as a significant part of their role as a postnatal midwife. However, the ways in which a midwife approaches and supports the breast-feeding woman vary. We distinguished two perspectives: 'the midwife as technical expert' and 'the midwife as a skilled companion'. The 'technical expert' midwife is mainly breast centred, focuses on techniques, uses the hands on approach and sees a woman as a novice. The 'skilled companion' midwife is woman centred, focuses on the mother - infant relationship and uses a hands off approach during the breast feeding support. The midwives working in a hospital setting face many barriers when performing breast feeding support, such as time restraints, which makes it difficult for them to carry out their preferred role as a 'skilled companion'. These barriers can influence the breast feeding support negatively. Supporting factors, such as evidence based breast feeding guidelines, have a positive influence on the breast feeding support.

CONCLUSION

On the basis of findings of a synthesis of qualitative research studies, we conclude that the majority of the midwives provide breast feeding support as a technical expert and a minority as a skilled companion. Midwives prefer to be a skilled companion but face many barriers in their working contexts.

Mother's Beliefs, Attitudes, and Decision Making Related to Infant Feeding Choices

All mothers at some point make a decision about whether to breast- or formula feed their infant. Marital status, education, age, culture, and confidence have all been identified as variables affecting this decision. Previous research has concentrated on the decision-making process in breastfeeding mothers. This qualitative descriptive study investigated the beliefs, attitudes, and decisions of both breast- and formula-feeding mothers. Four categories were identified influencing maternal decision making: (a) infant nutritional benefits, (b) maternal benefits, (c) knowledge about infant feeding, and (d) personal and professional support. Analysis of the data indicated that mothers differed in their choice depending on whether they were infant- or maternal-centered and that most women combine both methods of feeding.

Nurses and midwives professional support increases with improved attitudes - design and effects of a longitudinal randomized controlled process-oriented intervention

Background

Becoming parents for the first time is challenging. Mothers need both social and professional support to handle these challenges. Professionals’ attitudes affect quality of care and support. So to improve professional support, an intervention consisting of a process-oriented training was performed. Due to the positive results of the intervention there is a need to illuminate the methodological approach further. The overall aim was therefore to describe a methodological approach to improve and evaluate health care professionals’ attitudes toward breastfeeding and parental support in order to improve quality of care in childbearing.

Methods

This study was a longitudinal randomized control intervention study, in which groups of mothers received care in childbearing from midwives and child health nurses. These health professionals had gone through a process-oriented training, or not. In order to improve attitudes of health professionals the training was based on evidence, practical skills and reflective processes (both private and professional experiences) in relation to breastfeeding and parental support. Included in the longitudinal study were health professionals from five intervention municipalities n = 36 and health professionals from five control municipalities n = 45. All mothers who fulfilled the inclusion criteria were consecutively identified from the hospital register and asked to participate in the study. Mothers who accepted to participate were included in the interventions group (n = 206) or control groups (n = 162, n = 172 respectively) based on which municipality they belonged to.

Results

The results of the process-oriented training improved the professionals’ attitudes toward breastfeeding and parental support. These improved attitudes in health professionals increased intervention-group mother’s satisfaction with professional and social support. Intervention-group mother’s relation to and feelings for their baby as well as breastfeeding was also improved.

Conclusion

These results stress the importance of professionals’ attitude in quality of care during childbearing, as well as pointing to the possibility to improve professionals’ attitudes with a process-oriented training.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR), trial registration: ACTRN12611000354987.

Making use of expertise: a qualitative analysis of the experience of breastfeeding support for first-time mothers

There is now a body of research evaluating breastfeeding interventions and exploring mothers' and health professionals' views on effective and ineffective breastfeeding support. However, this literature leaves relatively unexplored a number of questions about how breastfeeding women experience and make sense of their relationships with those trained to provide breastfeeding support. The present study collected qualitative data from 22 breastfeeding first-time mothers in the United Kingdom on their experiences of, and orientation towards, relationships with maternity care professionals and other breastfeeding advisors. The data were obtained from interviews and audio-diaries at two time points during the first 5 weeks post-partum. We discuss a key theme within the data of 'Making use of expertise' and three subthemes that capture the way in which the women's orientation towards those assumed to have breastfeeding expertise varied according to whether the women (1) adopted a position of consulting experts vs. one of deferring to feeding authorities; (2) experienced difficulty interpreting their own and their baby's bodies; and (3) experienced the expertise of health workers as empowering or disempowering. Although sometimes mothers felt empowered by aligning themselves with the scientific approach and 'normalising gaze' of health care professionals, at other times this gaze could be experienced as objectifying and diminishing. The merits and limitations of a person-centred approach to breastfeeding support are discussed in relation to using breastfeeding expertise in an empowering rather than disempowering way.

The Psychosocial and Emotional Experience of Breastfeeding: Reflections of Mothers

Breastfeeding is acknowledged as optimal infant nutrition, yet despite high initiation rates, early cessation remains common. To understand why, we asked mothers in Western Canada how they felt about their breastfeeding experience. A total of 191 women (response rate 35%) responded to a survey distributed by public health nurses. While many women felt positive about their overall breastfeeding experience, others shared mixed or negative emotions. Several themes were evident: (a) Most women reported a variety of positive aspects beyond the health benefits, (b) lactation difficulties were commonly reported, and (c) diversity among the reflections highlights the uniqueness of each breastfeeding journey. The findings reaffirm the need for breastfeeding programs to holistically promote the range of positive aspects while providing realistic information on common challenges and strategies to overcome these. Mothers require individualized support that assesses psychosocial and emotional needs and offers encouragement, reassurance, and acknowledgment of the range of experiences.

Women's use of nipple shields-Their influence on breastfeeding duration after a process-oriented education for health professionals

AIM

This study investigated if a process-oriented training for health professionals will influence women's use and reasons for using a nipple shield, the baby's weight, and the duration of breastfeeding.

MATERIALS AND METHODS

An intervention was performed for health professionals that included a process-oriented training program on breastfeeding support. Primiparas living in either the intervention municipality or in a control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with those for the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, at 3 months, and at 9 months postpartum.

RESULTS

The mothers' use of nipple shields related to the finding that if the women had a higher body mass index in the beginning of the pregnancy, the babies had difficulty in grasping over the nipple, and the mothers had pain or wound on the nipple. For the mothers in the IG group, there was no significant difference if they had used nipple shields or not in relation to breastfeeding duration. In contrast, the mothers in the control groups had a significant shorter breastfeeding duration if they had used nipple shields. In the IG, there were no significant difference between the use of nipple shields and the babies' weights at 3 or 9 months. The babies of women in the CGB who used nipple shields had a significantly lower weight at 3 months than the babies of those who did not use nipple shields (p=0.02).

CONCLUSIONS

A process-oriented training in breastfeeding counseling prolongs the duration of breastfeeding for women with breastfeeding problems, where the problems are remedied by the use of nipple shields.

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.

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.

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

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

Strategies to support breastfeeding: a review

BACKGROUND

Mothers need to be given support, confidence and encouragement to successful breastfeeding. The importance of breastfeeding support has been addressed in numerous studies. However, reviews to explore strategies to support breastfeeding are sparse.

AIM

The study aims to explore strategies to support breastfeeding. It was also aimed to reveal how the international papers compare with the Turkish situation.

METHODS

Searches of CINAHL, PubMed, ScienceDirect, Scopus, Web of Science databases, Cochrane databases, Turkish health databases were conducted for data collection. The search was limited to articles published between the years 1995 and 2011, focusing on the strategies related to the support received by mothers. Two experts independently read and analysed 38 articles.

FINDINGS

Thirty-eight papers were included in this review. The findings identified strategies to support breastfeeding. These include collaboration with community and family members; confidence building; appropriate ratio of staffing levels; development of communication skills; and 'closing the gap' in inequalities in health.

CONCLUSION

Mothers benefit from strategies that encourage breastfeeding, with guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs.

Managing the first period at home with a newborn: a grounded theory study of mothers' experiences

AIM

The article aims to present a theoretical account of mothers' first period at home with their newborn in Norway.

BACKGROUND

Mothers' well-being affects their babies and is therefore an important priority for public health. Early discharge after childbirth is common in many countries. In Norway, this has been practised for 5-10 years but without any distinct agreement between maternity hospitals and the community health services and without documented follow-up care. Knowledge is lacking in how mothers deal with the first period at home with the baby.

METHOD

Seven focus group discussions were conducted with 26 mothers who had babies 1.5-3 months old. The grounded theory method was used to gather and analyse data.

RESULTS

The mothers were strongly concerned about preserving their control and integrity in the new situation. This main concern was resolved by the strategy of prioritizing newborn care. The strategy encompassed a process of developing competence as a mother, changing focus in relationships, stretching to the critical level and seeking recognition. These parallel processes were inter-related, sometimes mutually supportive and sometimes conflicting. When conflicts occurred, prioritizing newborn care guided mothers in finding solutions. Breaches of the implied conditions in health care tended to increase mothers' level of strain and uncertainty and to influence their efficacy in breastfeeding the baby.

CONCLUSION

Being a mother to a newborn is a dynamic and extensive process. Succeeding in breastfeeding seems especially sensitive and essential in motherhood. The idea that giving birth is a simple and normal situation may obscure the importance of seamless health care and the need for professional support and information.

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

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

Support through patient internet-communities: Lived experience of Russian in vitro fertilization patients

The article is concerned with the life experiences of infertile women going through infertility treatment and their need for social and psychological support, which they try to find in their immediate social environment. The Internet has become one place where everyone can find “people like oneself.” The best support is received from these people who are in the same life situation and are able and willing to share their lived experiences with each other. Communication via the Internet and the formation of a virtual community of patients has both positive and negative aspects, all of which are examined in the article. On the one hand, it creates a psychologically favorable atmosphere and might potentially increase the success rate of IVF treatment. On the other, this leads to the seclusion of patients within the circle of “similar people” and sometimes to negative attitudes towards people outside the circle. The article is based on the author's “netnography” research of a virtual community of Russian In-Vitro Fertilization (IVF)¹ patients.