Blurring the boundaries : breastfeeding as discursive construction and embodied experience

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.This thesis studies maternal subjectivity in a group of 25 Australian women in the 1990s. The research uses a poststructuralist perspective to answer the question: How do women create a maternal subjectivity and give meaning to their lives when they become mothers for the first time? Discourse analysis is used to analyse data collected through a series of interviews with women, from late pregnancy to six months after birth. The early finding that breastfeeding was central to women’s experience as mothers focused this research on the place of breastfeeding and the maternal body in the construction of contemporary motherhood. The majority of participating women constructed breastfeeding as crucial to their maternal identity. They were committed to breastfeeding. In their accounts, breastfeeding was ‘natural’ and ‘taken for granted’, pivotal to their relationship with their baby, ‘best for the baby’, and something that a ‘good’ mother does. Personal accounts of success and achievement were particularly prominent. Breastfeeding required ‘perseverance’ and became an ‘identity project’. Breastfeeding, however, was not only constructed in Foucauldian terms through varying discourses, but was simultaneously an ‘embodied’ experience, sensed and perceived by women in diverse ways. This embodied or ‘non-discursive’ dimension of breastfeeding was difficult for these women to articulate and is poorly understood by health professionals. For some, breastfeeding fostered a connected, intimate and sensual relationship with the baby. These women were comfortable with or tolerated the ‘blurred’ boundaries of self and ‘other’, mother and child. Other women, however, found breastfeeding to be disruptive of body boundaries and routines, and distorting of their known experience of their breasts and body. At times, they felt disconnected or desired ‘separation’ from their infants. This difficult and distressing breastfeeding experience challenges the public and professional discourses that persuade women to breastfeed. The connected and intimate embodied experience of breastfeeding, however, presents a threat to a woman’s sense of rational autonomy and independence. This thesis uses feminist and other poststructuralist and phenomenological theories, to explore the complexity of the relationship between personal embodied experiences and the public and professional discourses and practices of breastfeeding. The findings of this study challenge midwives, nurses and lactation consultants to understand the diversity of women’s personal experience of breastfeeding. Health professionals need to reflect upon their role in producing and reproducing the contradictions and tensions of motherhood and breastfeeding in the late 1990s

Modified spin-wave theory with ordering vector optimization I: frustrated bosons on the spatially anisotropic triangular lattice

We investigate a system of frustrated hardcore bosons, modeled by an XY antiferromagnet on the spatially anisotropic triangular lattice, using Takahashi's modified spin-wave (MSW) theory. In particular we implement ordering vector optimization on the ordered reference state of MSW theory, which leads to significant improvement of the theory and accounts for quantum corrections to the classically ordered state. The MSW results at zero temperature compare favorably to exact diagonalization (ED) and projected entangled-pair state (PEPS) calculations. The resulting zero-temperature phase diagram includes a 1D quasi-ordered phase, a 2D Neel ordered phase, and a 2D spiraling ordered phase. We have strong indications that the various ordered or quasi-ordered phases are separated by spin-liquid phases with short-range correlations, in analogy to what has been predicted for the Heisenberg model on the same lattice. Within MSW theory we also explore the finite-temperature phase diagram. We find that the zero-temperature long-range-ordered phases turn into quasi-ordered phases (up to a Berezinskii-Kosterlitz-Thouless temperature), while zero-temperature quasi-ordered phases become short-range correlated at finite temperature. These results show that modified spin-wave theory is very well suited for describing ordered and quasi-ordered phases of frustrated XY spins (or, equivalently, of frustrated lattice bosons) both at zero and finite temperatures. While MSW theory, just as other theoretical methods, cannot describe spin-liquid phases, its breakdown provides a fast method for singling out Hamiltonians which may feature these intriguing quantum phases. We thus suggest a tool for guiding our search for interesting systems whose properties are necessarily studied with a physical quantum simulator.Comment: 40 pages, 16 figure

Digging over that old ground: an Australian perspective of women's experience of psychosocial assessment and depression screening in pregnancy and following birth

BACKGROUND: There is increasing recognition of the need to identify risk factors for poor mental health in pregnancy and following birth. In New South Wales, Australia, health policy mandates psychosocial assessment and depression screening for all women at the antenatal booking visit and at six to eight weeks after birth. Few studies have explored in-depth women’s experience of assessment and how disclosures of sensitive information are managed by midwives and nurses. This paper describes women’s experience of psychosocial assessment and depression screening examining the meaning they attribute to assessment and how this influences their response. METHODS: This qualitative ethnographic study included 34 women who were observed antenatally in the clinic with 18 midwives and 20 of the same women who were observed during their interaction with 13 child and family health nurses after birth in the home or the clinic environment. An observational tool, 4D&4R, together with field notes was used to record observations and were analysed descriptively using frequencies. Women also participated in face to face interviews. Field note and interview data was analysed thematically and similarities and differences across different time points were identified. RESULTS: Most participants reported that it was acceptable to them to be asked the psychosocial questions however they felt unprepared for the sensitive nature of the questions asked. Women with a history of trauma or loss were distressed by retelling their experiences. Five key themes emerged. Three themes; ’Unexpected: a bit out of the blue’, ‘Intrusive: very personal questions’ and ‘Uncomfortable: digging over that old ground’, describe the impact that assessment had on women. Women also emphasised that the approach taken by the midwife or nurse during assessment influenced their experience and in some cases what they reported. This is reflected in the themes titled: Approach: ’sensitivity and care’ and ’being watched’. CONCLUSIONS: The findings emphasise the need for health services to better prepare women for this assessment prior to and after birth. It is crucial that health professionals are educationally prepared for this work and receive ongoing training and support in order to always deliver care that is empathetic and sensitive to women who are disclosing personal information

Women's perceptions and experiences of breastfeeding support: A metasynthesis

Background: Both peer and professional support have been identified as important to the success of breastfeeding. The aim of this metasynthesis was to examine women’s perceptions and experiences of breastfeeding support, either professional or peer, in order to illuminate the components of support that they deem ‘supportive’. Methods: The metasynthesis included studies of both formal or ‘created’ peer and professional support for breastfeeding women but excluded studies of family or informal support. Qualitative studies were included as well as large scale surveys if they reported the analysis of qualitative data gathered through open ended responses. Primiparous and multiparous women who initiated breastfeeding were included. Only studies published in English, in peer reviewed journals and undertaken between 1990 and December 2007 were included. After assessment for relevance and quality, 31 studies were included in the metasynthesis. Meta-ethnographic methods were used to identify categories and themes. Results: The metasynthesis resulted in four categories comprising a total of 20 themes. The synthesis indicates that support for breastfeeding occurs along a continuum from authentic presence at one end, perceived as effective support, to disconnected encounters at the other, perceived as ineffective or even discouraging and counterproductive. Second, the synthesis identified a facilitative approach, versus a reductionist approach as contrasting styles of support women experienced as helpful or unhelpful. Conclusions: The findings of this metasynthesis emphasise the importance of person-centred communication skills and of relationships in supporting a woman to breastfeed. Organisational systems and services that facilitate continuity of care/r, for example continuity of midwifery care or peer support models, are more likely to facilitate an authentic presence

Ten steps or climbing a mountain: A study of Australian health professionals' perceptions of implementing the baby friendly health initiative to protect, promote and support breastfeeding

Background: The Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia. Methods: The study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis. Results: Three main themes were identified: ‘Belief and Commitment’; ‘Interpreting BFHI’ and ‘Climbing a Mountain’. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings. Conclusion: Despite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation

Australian parents’ use of universal child and family health services: A consumer survey

© 2018 John Wiley & Sons Ltd This study aimed to explore Australian parents’ use of universally available well-child health services. It used an online survey of 719 parents of children aged from birth to 5 years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents’ use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well-child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care

‘Being the bridge and the beacon’: a qualitative study of the characteristics and functions of the liaison role in child and family health services in Australia

© 2016 John Wiley & Sons Ltd Aims and objectives: This article explores the characteristics and functions of the liaison role in child and family health services in Australia. Background: Liaison roles are increasingly being used to improve communication between health services and professionals and to facilitate access to support for individuals and families in need. Nurses are commonly, although not always, the professionals who undertake these roles. Research on the role and outcomes of liaison positions in child and family health services is limited in Australia and internationally. Design: A qualitative interpretive design informed this study. Interviews and focus groups were conducted with 40 liaison and other health professionals, primarily nurses, working with families with newborn and young children in two Australian States. Data were analysed thematically. Results: Three major themes were identified reflecting the importance of defining the role and tasks which included building bridges between services and professionals, supporting families during transition between services and supporting clinicians. Several facilitators and barriers were identified, including concerns about sustainability of the roles. Conclusions: Professionals working in a liaison role in child and family health services emphasise that these positions have the potential to link services and professionals, thereby providing more effective care pathways for children and families especially for those with complex and multiple vulnerabilities. While a few children and family health services in Australia provide liaison services, the extent of liaison support and the outcomes for families in Australia is unknown. Relevance to clinical practice: Nurses working with children and families are the most likely health professionals to undertake a liaison role. In many nursing contexts, liaison roles are relatively new and those in the role have the responsibility to define the key purpose of their role. Liaison roles are multifaceted requiring the nurse to have excellent communication and negotiation skills to effectively link diverse professionals and services, while simultaneously engaging with and supporting vulnerable families and children. Nurses in these roles also support and educate clinical colleagues

Phase Space Tomography of Matter-Wave Diffraction in the Talbot Regime

We report on the theoretical investigation of Wigner distribution function (WDF) reconstruction of the motional quantum state of large molecules in de Broglie interference. De Broglie interference of fullerenes and as the like already proves the wavelike behaviour of these heavy particles, while we aim to extract more quantitative information about the superposition quantum state in motion. We simulate the reconstruction of the WDF numerically based on an analytic probability distribution and investigate its properties by variation of parameters, which are relevant for the experiment. Even though the WDF described in the near-field experiment cannot be reconstructed completely, we observe negativity even in the partially reconstructed WDF. We further consider incoherent factors to simulate the experimental situation such as a finite number of slits, collimation, and particle-slit van der Waals interaction. From this we find experimental conditions to reconstruct the WDF from Talbot interference fringes in molecule Talbot-Lau interferometry.Comment: 16 pages, 9 figures, accepted at New Journal of Physic

Australian parents’ experiences with universal child and family health services

© 2018 Australian College of Nursing Ltd Background: Australian governments provide free services to promote maternal and child health, and to support parenting for families with children up to age five. Services are principally provided by dedicated child and family health nurses, but also by general practitioners, practice nurses, pharmacy nurses and midwives. Aim: This study aimed to examine the experiences of families with young children across Australia in accessing and receiving health care for well children, parenting support and advice from a range of providers. Methods: The study used quantitative and qualitative data from an online survey of 719 parents and carers with children aged up to five years. Findings: On quantitative scales, most respondents rated healthcare providers favourably for accessibility, credibility and their approach to families. However, qualitative responses revealed widely varying reactions to child and family health provision. Parents described both positive and negative experiences, highlighting elements of practice that are critical to consumer engagement. Discussion: Parents require health care and support that are accessible, consistent, affordable, encouraging, trustworthy, evidence-based and non-judgemental. Parents feel more confidence in the information and care provided by health professionals who are well-informed, resourceful and who respect their knowledge and beliefs. Conclusion: The findings demonstrate ways in which child and family health providers can engage and effectively support families with young children

Characteristics and changes in characteristics of women and babies admitted to residential parenting services in New South Wales, Australia in the first year following birth: A population-based data linkage study 2000-2012

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth. Design A linked population data cohort study was undertaken for the years 2000-2012. Setting New South Wales (NSW), Australia. Participants All women giving birth and babies born in NSW were compared with those admitted to RPS. Results During the time period there were a total of 1 097 762 births (2000-2012) in NSW and 32 991 admissions to RPS. Women in cohort 1: (those admitted to RPS) were older at the time of birth, more likely to be admitted as a private patient at the time of birth, be born in Australia and be having their first baby compared with women in cohort 2 (those not admitted to an RPS). Women admitted to RPS experienced more birth intervention (induction, instrumental birth, caesarean section), had more multiple births and were more likely to have a male infant. Their babies were also more likely to be resuscitated and have experienced birth trauma to the scalp. Between 2000 and 2012 the average age of women in the RPS increased by nearly 2 years; their infants were older on admission and women were less likely to smoke. Over the time period there was a drop in the numbers of women admitted to RPS having a normal vaginal birth and an increase in women having an instrumental birth. Conclusion Women who access RPS in the first year after birth are more socially advantaged and have higher birth intervention than those who do not, due in part to higher numbers birthing in the private sector where intervention rates are high. The rise in women admitted to RPS (2000-2012) who have had instrumental births is intriguing as overall rates did not increase