An interpretive phenomenological analysis of the experiences of mothers who continue to breastfeed despite facing difficulties.

BackgroundBreastfeeding offers many health benefits to mother and infant.ProblemBreastfeeding difficulties are common and are linked with postnatal distress.AimTo explore the lived experiences of breastfeeding continuation despite facing difficulties.MethodsQualitative semi-structured interviews were conducted with eight women who had experienced breastfeeding difficulties yet continued breastfeeding. Interviews were analysed using Interpretative Phenomenological Analysis (IPA).FindingsThe first superordinate theme, 'Radical acceptance of the imperfect' included sub-themes of: 'Taking it day-by-day', 'Breastfeeding takes a community', and, 'Finding what works for you'. The second superordinate theme, 'Determination and persistence' included sub-themes of: 'Adopting a headstrong attitude' and 'Transient challenges versus lifelong achievement'.DiscussionParticipants found radical acceptance of breastfeeding as an imperfect, variable process which enabled them to sustain breastfeeding despite challenges. Participants proactively drew on social and personal resources to navigate guidance and to find solutions which worked for their individual circumstances. Finally, open-mindedness, optimism, self-compassion, and being headstrong and determined were all personal qualities which facilitated breastfeeding during exceptionally difficult moments on their breastfeeding journey.ConclusionRecommendations are made for healthcare professionals: to provide emotional counselling during routine care (with an aim to instil breastfeeding self-efficacy) and to encourage breastfeeding advocacy among fathers and the maternal social support network (with an aim to further scaffold successful breastfeeding). Recommendations are also made for mothers: to develop and refine maternal confidence, patience, flexibility, self-compassion, and trust

Exploring the reasons why mothers do not breastfeed, to inform and enable better support

IntroductionInfant and maternal breastfeeding benefits are well documented, globally. Despite efforts to increase global breastfeeding rates, the majority of high-income settings fall short of recommended targets. Breastfeeding rates in the UK are especially poor, and physiological difficulties (e.g., inverted nipples), fail to account for the observed breastfeeding intention-behaviour gap.MethodThe current online study sought to investigate the infant feeding experiences of 624 UK formula feeding mothers, through open text survey responses.ResultsA content analysis identified the following clusters of reasons for formula feeding: Feeding Attitudes, Feeding Problems, Mental Health, and Sharing the Load.DiscussionFeeding Attitudes explained a large percentage of reasons given for formula feeding. Recommendations are made to improve antenatal breastfeeding education and to develop an intervention with an aim to improve maternal breastfeeding attitudes and subsequent practice. Feeding Problems also explained a large portion of combination feeding and started but stopped infant feeding accounts. The current paper calls for more comprehensive and tailored antenatal breastfeeding education to refine practical breastfeeding skills necessary for successful breastfeeding establishment and maintenance. Mental Health explained relatively small coverage. Suggestions are therefore made to train mental health practitioners on infant feeding with an aim to provide more extensive support, which may serve to disrupt the bidirectional relationship between poor mental health and poor breastfeeding outcomes. Finally, Sharing the Load explained moderate coverage across never breastfed, combination fed, and started but stopped feeding groups. Recommendations are made, in light of these findings, to tighten workplace legislation to protect breastfeeding women

The Beliefs About Breastfeeding Questionnaire (BAB‐Q) : a psychometric validation study

Objectives Questionnaires used to assess women’s beliefs as a predictor of breastfeeding behaviour are not theoretically informed or tested for psychometric validity and reliability. This study conducted a psychometric evaluation of the Beliefs About Breastfeeding Questionnaire (BAB-Q). Design A two-phase evaluation in an online cross-sectional questionnaire study (N = 278) and cohort study sample (N = 264). A ten-item questionnaire was proposed to assess women’s beliefs about the benefits and efforts of breastfeeding. Methods Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed construct validity and reliability. Multivariate regression analyses assessed validity in predicting breastfeeding behaviour and experiences. Results EFA found a shortened 8-item, 2-factor model had good fit (χ2 = 23.3, df = 13, p < .040; CFI = .99, TLI = .99, RMSEA = .05), with significant factor loadings. Factor 1 (benefit beliefs) and factor 2 (effort beliefs) accounted for 47 and 19.4% of the explained variance and correlated moderately (r = −.40). CFA confirmed the solution in the cohort sample (χ2 = 49.6 df = 19, p < .010; CFI = .97, TLI = .96, and RMSEA = .078). Adjusted regression analyses found beliefs did not reliably predict infant feeding practices. Women’s beliefs significantly predicted the likelihood that women experienced breastfeeding as ‘much more’ positive and negative than they expected. Conclusions The eight-item questionnaire showed good model fit with acceptable loadings, and good reliability for all subscales. The utility of the BAB-Q at predicting breastfeeding behaviour remains unclear and unsupported by empirical evidence. Further assessments of the predictive validity of the questionnaire in longitudinal studies with diverse beliefs and infant feeding practices are required

Breastfeeding experiences and support for women who are overweight or obese : a mixed methods systematic review

Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants’ shorter and longer‐term health. Exclusive breastfeeding to six months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation and duration compared to women with normal weight. This systematic review aimed to examine evidence of i) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, ii) support shown to be effective in increasing breastfeeding initiation and duration among these women, and iii) perceptions of healthcare professionals, peer supporters, partners and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public and experiencing stigma of obesity were also described. Support from healthcare professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence‐based support to women who are overweight or obese who want to breastfeed. Research on healthcare professionals, partners and family members’ experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions

Effectiveness of Social-psychological Interventions at Promoting Breastfeeding Initiation, Duration and Exclusivity:A Systematic Review and Meta-analysis

Evidence for the health benefits of breastfeeding is well substantiated but breastfeeding uptake and duration remains low worldwide. Individual level breastfeeding promotion programmes are behavioural interventions, targeting malleable social-psychological processes to change behaviour. This systematic review aimed to investigate whether such interventions are effective at improving breastfeeding initiation, duration and exclusivity, and breastfeeding support. A three-stage search strategy identified eligible articles from six databases. Nine controlled-clinical trials and 11 quasi-experimental trials were included. Random-effects meta-analyses identified significant improvements in rates of breastfeeding initiation (N = 2,213; OR = 2.32, 95% CI [1.33, 4.03], p = .003; I2 = 0%, p = .966) and suggested improved exclusive breastfeeding rates up to six months postpartum (N = 3,671; OR = 1.84, 95% CI [1.38, 2.45], p < .001; I2 = 68.7%, p < .001). After considering small-sample effects, estimates for exclusive breastfeeding across the postpartum period were non-significant. There were no improvements in women maintaining any (i.e., non-exclusive) breastfeeding to one, two, three, four or six months postpartum (N = 4,153; OR = 0.88, 95% CI [0.72, 1.09], p = .253). Evidence for improvements in perceived and actual breastfeeding support was limited. Sub-group analyses suggest standalone postnatal interventions targeting first-time mothers may support breastfeeding uptake. Findings should be interpreted cautiously as the quality of evidence for each outcome was low with a high risk of bias. Future efforts to support women to breastfeed should assimilate behaviour change research, with process evaluation to identify effective processes to inform a high-quality evidence-base for implementation in practice

Retrofitting houses with insulation to reduce health inequalities: a clustered, randomised trial in community settings.&quot; Social Science and Medicine.

Abstract Housing is one of the key determinants of health, but it has been a relatively neglected area for interventions targeting health. There has been very little research that has shown housing interventions are effective in improving health as housing interventions are complex and resource intensive. This study examined the health consequences of insulating New Zealand homes with a standard intervention package delivered by specially trained community retrofit teams in partnership with local organisations. The package was provided through a Government funded retrofit programme carried out by community groups throughout the country. Nearly fourteen hundred households in seven communities participated. Baseline measures of temperature and fuel use, and health care utilisation were collected during the winter months of 2001. Households were then randomised and those in th

Marketisation of Climate Change: Applying Chrematistics Framework to Warmth Rationing Issue in New Zealand

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