The Experience of Being the First to Breastfeed in a Family: An Interpretative Phenomenological Analysis

The benefits of breastfeeding for mother and baby are well established; however, only 37.5% of Scottish women are currently breastfeeding at six to eight weeks with less than 1% breastfeeding exclusively for six months, as recommended by UK and international health policy. Family influence is amongst the socio-demographic factors which affect breastfeeding initiation and duration and women who were not breastfed themselves are 25% less likely to initiate breastfeeding. While there is a growing body of literature which seeks to understand breastfeeding by exploring the perspectives of breastfeeding mothers, no studies can be found describing the experience of making a different feeding choice from that of one’s family-of-origin, nor of the potential impact of this decision on relationships with them. As such, this study exploring the experience of being the first in your family to breastfeed is novel. The aim of the study was to investigate the experience and meaning of being the first person to breastfeed in a family. Consequently, areas explored included women’s experience of initiating and sustaining breastfeeding when they have no immediate family history of breastfeeding, how women make sense of their decision to breastfeed and their understanding of how their decision has affected their relationships. A methodological development in the form of an Infant Feeding Genogram was used to record relevant demographic and family information and semi-structured interviews with fourteen women obtained in-depth narratives. Interpretative phenomenological analysis (IPA) was used as an approach and to analyse the data. Following the completion of idiographic analysis, cross participant analysis was undertaken and four superordinate themes emerged: Breaching Family and Social Norms; Volitions and Imperatives; Unprepared for the Challenge; and A Sacrifice but Worth It. Within these superordinate themes, 13 themes were identified and articulated. Findings from this research were synthesised to provide an account of how women experience being the first to breastfeeding in a family, make sense of their decisions and the impact this has on their relationships with their family. This provides an understanding of women’s experience in an original context, and the contextualising within the existing literature generates commonalities and highlights differences between the experience of this group of breastfeeding women and the wider cohort. The findings of this research inform recommendations for practice at both an individual and public health levels, and have implications for policy makers, health professionals and breastfeeding support organisations. It is asserted that policy makers and the health service need to acknowledge the unanticipated consequences of some current breastfeeding discourses associated with health promotion practices, and take a mother and family focussed approach to breastfeeding that acknowledges women’s embodied experience, which often includes breastfeeding difficulties. A mother and family centred approach can identify and adapt to women’s support needs in their own particular context, which may include very limited community and family support for their decision

Significant others, situations and their influences on infant feeding. Secondary analysis of data from: A prospective study exploring the early infant feeding experiences of parents and their significant others during the first 6 months of life: what would make a difference?

This study examines the range of influences on infant feeding behaviour from late pregnancy until six months after birth, which lead parents to introduce formula or solids, or to stop breastfeeding prior to the recommended six months. It reveals that a complex and dynamic combination of people, situations and personal experiences affect feeding behaviour initiation and maintenance and precipitate or prevent change

Significant others, situations and their influences on infant feeding. Secondary analysis of data from: A prospective study exploring the early infant feeding experiences of parents and their significant others during the first 6 months of life: what would make a difference?

This study examines the range of influences on infant feeding behaviour from late pregnancy until six months after birth, which lead parents to introduce formula or solids, or to stop breastfeeding prior to the recommended six months. It reveals that a complex and dynamic combination of people, situations and personal experiences affect feeding behaviour initiation and maintenance and precipitate or prevent change

Exploring the use and experience of an infant feeding genogram to facilitate an assets-based approach to support infant feeding

Abstract Background A lack of perceived social support influences women’s infant feeding behaviours. The Infant Feeding Genogram is a visual co-constructed diagram which details people/services that can provide support to women and can facilitate a connection between mothers and their existing assets landscape. The aim of this study is to explore women’s and infant feeding helpers’ experiences and use of an infant feeding genogram delivered to the intervention group of the Assets-based infant feeding help Before and After birth (ABA) randomised feasibility trial. Methods 103 primiparous mothers aged 16+ years were recruited to the trial in two sites (Site A and Site B) with low breastfeeding prevalence in the UK. Infant feeding helpers co-constructed a genogram at the first antenatal meeting for the intervention group, and then provided proactive, woman-centered support from ~32 weeks gestation to up to 5 months postnatal. Infant feeding helpers and women’s experiences of the infant feeding genogram were collected via interviews or focus groups. Completed genograms were shared with researchers. Content analysis of the genograms and qualitative data from the interviews and focus groups were analysed thematically. Results Data comprised 32 completed genograms, and qualitative insights from all 13 infant feeding helpers (two focus groups; 4 interviews) and interviews with a purposive sample of 21 of 50 intervention group women between 4-21 weeks after birth. Content analysis of the genograms highlighted variations, with more personal, individualised genograms completed at Site B compared to Site A. The perceived impact of the genogram was related to the IFHs’ application of the tool. The genogram was either used as intended to raise women’s awareness of available assets and motivate help-seeking behaviour, or as a data collection tool with limited perceived utility. Negative and positive unintended consequences of genogram use were highlighted.Discussion/Conclusion The genogram has the potential to offer a woman, family and community-centred approach that focusses on building assets for infant feeding. However, variations in genogram application indicate that revised training is required to clarify the purpose and ensure it is used as intended

Significant others, situations and infant feeding behaviour change processes: a serial qualitative interview study

BackgroundExclusive breastfeeding until six months followed by the introduction of solids and continued breastfeeding is recommended by the World Health Organisation. The dominant approach to achieving this has been to educate and support women to start and continue breastfeeding rather than understanding behaviour change processes from a broader perspective.MethodSerial qualitative interviews examined the influences of significant others on women’s feeding behaviour. Thirty-six women and 37 nominated significant others participated in 220 interviews, conducted approximately four weekly from late pregnancy to six months after birth. Responses to summative structured questions at the end of each interview asking about significant influences on feeding decisions were compared and contrasted with formative semi-structured data within and between cases. Analysis focused on pivotal points where behaviour changed from exclusive breastfeeding to introducing formula, stopping breastfeeding or introducing solids. This enabled us to identify processes that decelerate or accelerate behaviour change and understand resolution processes afterwards.ResultsThe dominant goal motivating behaviour change was family wellbeing, rather than exclusive breastfeeding. Rather than one type of significant other emerging as the key influence, there was a complex interplay between the self-baby dyad, significant others, situations and personal or vicarious feeding history. Following behaviour change women turned to those most likely to confirm or resolve their decisions and maintain their confidence as mothers.ConclusionsApplying ecological models of behaviour would enable health service organisation, practice, policy and research to focus on enhancing family efficacy and wellbeing, improving family-centred communication and increasing opportunities for health professionals to be a constructive influence around pivotal points when feeding behaviour changes. A paradigm shift is recommended away from the dominant approach of support and education of individual women towards a more holistic, family-centred narrative approach, whilst acknowledging that breastfeeding is a practical skill that women and babies have to learn

Protocol for a feasibility trial for improving breastfeeding initiation and continuation: Assets-based infant feeding help Before and After birth (ABA)

Introduction: Breastfeeding improves the health of mothers and infants; the UK has low rates, with marked socio-economic inequalities. Whilst trials of peer support services have been effective in some settings, UK trials have not improved breastfeeding rates. Qualitative research suggests many women are alienated by the focus on breastfeeding. We propose a change from breastfeeding focussed interactions to respecting a woman’s feeding choices, inclusion of behaviour change theory and an increased intensity of contacts in the two weeks after birth when many women cease to breastfeed. This will take place alongside an assets-based approach which focuses on the positive capability of individuals, their social networks and communities. We propose a feasibility study for a multicentre randomised controlled trial of the ABA infant feeding service versus usual care. Methods and analysis: A two-arm, non-blinded randomised feasibility study will be conducted in two UK localities. Women expecting their first baby will be eligible, regardless of feeding intention. The ABA infant feeding intervention will apply a proactive, assets-based, woman-centred, non-judgemental approach, delivered antenatally and postnatally tailored through face-to face contacts, telephone and SMS texts. Outcomes will test the feasibility of delivering the intervention with recommended intensity and duration to disadvantaged women; acceptability to women, feeding helpers and professionals; and feasibility of a future randomised controlled trial, detailing recruitment rates, willingness to be randomised, follow-up rates at 3 days, 8 weeks and 6 months and level of outcome completion. Outcomes of the proposed full trial will also be collected. Mixed methods will include qualitative interviews with women/partners, feeding helpers and health service staff; feeding helper logs and review of audio-recorded helper-women interactions to assess intervention fidelity. Ethics and dissemination: Study results will inform the design of a larger multicentre RCT. The National Research Ethics Service Committee approved the study protocol. Trial registration number: ISRCTN14760978. STRENGTHS AND LIMITATIONS OF THE STUDY • This study uses a two-centre randomised controlled trial design to determine the feasibility of a definitive trial. • The intervention design draws on evidence from best practice to support women who want to breastfeed behavioural change theory and makes use of women’s personal social and community assets. • A process evaluation will explore reach, fidelity of intervention delivery and the experience of women, feeding helpers and other key stakeholders

Early and empirical high-dose cryoprecipitate for hemorrhage after traumatic injury: The CRYOSTAT-2 randomized clinical trial

Critical bleeding is associated with a high mortality rate in patients with trauma. Hemorrhage is exacerbated by a complex derangement of coagulation, including an acute fibrinogen deficiency. Management is fibrinogen replacement with cryoprecipitate transfusions or fibrinogen concentrate, usually administered relatively late during hemorrhage. To assess whether survival could be improved by administering an early and empirical high dose of cryoprecipitate to all patients with trauma and bleeding that required activation of a major hemorrhage protocol. CRYOSTAT-2 was an interventional, randomized, open-label, parallel-group controlled, international, multicenter study. Patients were enrolled at 26 UK and US major trauma centers from August 2017 to November 2021. Eligible patients were injured adults requiring activation of the hospital's major hemorrhage protocol with evidence of active hemorrhage, systolic blood pressure less than 90 mm Hg at any time, and receiving at least 1 U of a blood component transfusion. Patients were randomly assigned (in a 1:1 ratio) to receive standard care, which was the local major hemorrhage protocol (reviewed for guideline adherence), or cryoprecipitate, in which 3 pools of cryoprecipitate (6-g fibrinogen equivalent) were to be administered in addition to standard care within 90 minutes of randomization and 3 hours of injury. The primary outcome was all-cause mortality at 28 days in the intention-to-treat population. Among 1604 eligible patients, 799 were randomized to the cryoprecipitate group and 805 to the standard care group. Missing primary outcome data occurred in 73 patients (principally due to withdrawal of consent) and 1531 (95%) were included in the primary analysis population. The median (IQR) age of participants was 39 (26-55) years, 1251 (79%) were men, median (IQR) Injury Severity Score was 29 (18-43), 36% had penetrating injury, and 33% had systolic blood pressure less than 90 mm Hg at hospital arrival. All-cause 28-day mortality in the intention-to-treat population was 26.1% in the standard care group vs 25.3% in the cryoprecipitate group (odds ratio, 0.96 [95% CI, 0.75-1.23]; P = .74). There was no difference in safety outcomes or incidence of thrombotic events in the standard care vs cryoprecipitate group (12.9% vs 12.7%). Among patients with trauma and bleeding who required activation of a major hemorrhage protocol, the addition of early and empirical high-dose cryoprecipitate to standard care did not improve all cause 28-day mortality. ClinicalTrials.gov Identifier: NCT04704869; ISRCTN Identifier: ISRCTN14998314

The impact of peer support training on mothers' attitudes towards and knowledge of breastfeeding: Impact of breastfeeding peer support training

While the benefits of breastfeeding are well established, few Scottish women exclusively breastfeed, as recommended nationally and internationally. Breastfeeding peer support can help mothers to breastfeed for longer, but the training peer supporters receive is variable and few studies have measured the effectiveness of peer supporter training. This study aimed to compare mothers' attitudes towards and knowledge of breastfeeding before and after undertaking Breastfeeding Network (BfN) peer supporter training. This study used a quasi-experimental design to investigate levels of breastfeeding knowledge and attitudes in 28 women, immediately before and after the BfN peer supporter (Helper) training programme. Data were collected using the Infant Feeding Questionnaire. Mothers had high baseline scores for attitude (88.8%) and knowledge (76.4%). After training 78% of mothers improved their attitude scores. The mean difference in attitude scores was 4.9%, which was statistically significant (t = 4.44, P