Constructing compatibility : Managing breastfeeding and weaning from the mothers\u27 perspective

Breastfeeding involves phases of initiation, continuation, and weaning. Research to date has focused upon its initiation and continuation rather than the later phases, when the child is weaned from the breast. Selective aspects relating to weaning have been explored to determine infant feeding practices such as the timing of food introduction. However, that research has focused upon developing countries where the impact of infant feeding patterns and weaning practices have a significant impact on infant growth and child health. The weaning process or final phase of breastfeeding from the mothers\u27 perspective has not been examined within the western world. In order to fully understand this important maternal task, all phases of the experience must be explored. The management of weaning is affected by cultural, social, developmental, and psychological factors and is reflected in distinct infant feeding practices across cultures. The purpose of this grounded theory study was to analyse the maternal process of managing the later stages of established breastfeeding and, ultimately, weaning the child from the breast within a Western Australian context. A minimum time of six weeks postpartum was regarded as established breastfeeding whereas weaning was defined as the process that begins when the mother and/or the child decide to stop breastfeeding. Using the constant comparative method, analysis of thirty-three participants\u27 interview transcripts, field notes, nine postal questionnaires from fathers, and individual and discussion group interviews with child health nurses revealed a common social problem of incompatible expectations. All participants faced a dilemma in the management of their experience when personal expectations were found to be in opposition to others\u27 expectations. Although the focus of this study was on weaning, a key finding was that participants\u27 expectations on weaning could not be easily separated from their expectations regarding breastfeeding and mothering. Expectations in the areas of breastfeeding and weaning were interrelated as achievements or disappointments reflected upon mothering expectations. When faced with incompatible expectations from their child, partner, family, friends, health professionals, and society, these Western Australian mothers expressed feelings of confusion, self-doubt, and guilt. A process of constructing compatibility by adapting focus was adopted to compensate for this incompatibility and comprised three phases. Prior to engaging in this process, participants arrived at a turning point where individual tolerance levels of confusion, guilt, and self-doubt were reached. The first phase entitled shifting focus involved participants clarifying the relative importance they assigned to aspects of their breastfeeding. This clarification enabled them to take charge of their experience and reinforce personal expectations and goals. In the second phase, selective focusing, participants selectively chose to focus upon specific compatible sources to accentuate their influence and thereby diminish the impact of incompatible sources. When confronted with ongoing incompatible expectations throughout their experience, participants moved back to shifting focus to re-clarify personal expectations and reinforce subsequent decisions. During the final phase of confirming focus, mothers reflected upon their experiences and resolved decisions by verifying that their adapted focus achieved the desired compatibility. This substantive theory of the management of breastfeeding and weaning from the perspective of Western Australian mothers is discussed in relation to existing nursing and social science theories. Additionally, implications and recommendations based upon these findings are presented

A qualitative evaluation of a Young Parents Program (YPP) - Parent and facilitator perspectives

Issue addressed: Young parents (\u3c25 years) have lower engagement with health and community services and are more likely to experience negative outcomes in the perinatal period compared to older parents. The aim of this study was to evaluate the short to medium‐term outcomes of the Young Parents Program (YPP), specifically designed to engage and support young parents, using responsive and codesign strategies in a community setting. Methods: A qualitative case study used data from interviews with participating parents (n = 20) and a focus group with YPP facilitators (n = 5). Results: The findings report on the following short to medium‐term YPP outcomes for parents and children. Young parents: are engaged in early parenting services that are welcoming, non-judgemental and holistic; build parenting skills, knowledge, confidence and are tuned into their infants’ needs; are empowered to codesign program activities to meet their parenting and non-parenting needs; have developed friendships and a social support network in their local community; and, are linked into community services and resources. Their children are cared for and stimulated with age‐appropriate interactions and play. Conclusion: Flexible, responsive and codesigned programs for young parents are effective means of connecting parents to services, social support networks and can provide learning opportunities, which enhance both child and parent attachment and development. So what? Qualitative evaluation provides an understanding of contextual factors – required to inform effective design and delivery of young parent community programs

Women's Perceptions of Contributory Factors for Not Achieving a Vaginal Birth After Cesarean (VBAC)

BACKGROUND: With cesarean rates around the world escalating, concern is growing around why women wanting a vaginal birth after cesarean (VBAC) are not achieving their goal. AIM: To gain an understanding of women’s perceptions of factors they felt contributed to not achieving a VBAC. SETTING AND PARTICIPANTS: Fifteen women were interviewed following a nonelective repeat cesarean section (NERCS). They had attended a Western Australian midwifery-led service, next birth after cesarean (NBAC), and labored but were not successful in achieving a VBAC because of reasons around delayed progress. Interview transcripts were analyzed using Colaizzi’s method of thematic analysis. FINDINGS: Five themes emerged: “Tentative commitment with lingering doubts,” “My body failed me,” “Compromised by a longer than tolerable labor,” “Unable to effectively self-advocate in a climate of power struggling and poor support,” and “The inflexibility of hospital processes.” The final theme included two subthemes: “Restrictive policies” on labor and use of the cardiotocography, “The CTG.” CONCLUSIONS: When labor did not progress as envisaged and hospital processes adversely affected how women were supported, women’s doubts around being able to achieve a VBAC were reinforced with a NERCS. Maternity services need to ensure clinical practice reflects best evidence while assuring staff are supportive of women’s choice

The woman, partner and midwife: An integration of three perspectives of labour when intrapartum transfer from a birth centre to a tertiary obstetric unit occurs

Background: When transfer in labour takes place from a birth centre to a tertiary maternity hospital the woman, her partner and the midwife (the triad) are involved, representing three different perspectives. The purpose of this paper is to explore the integration of these intrapartum transfer experiences for the birth triad. Methods: Giorgi's descriptive phenomenological method of analysis was used to explore the 'lived' experiences of Western Australian women, their partners and midwives across the birth journey. Forty-five interviews were conducted. Findings: Findings revealed that experiences of intrapartum transfer were unique to each member of the triad (woman, partner and midwife) and yet there were also shared experiences. All three had three themes in common: 'The same journey through three different lenses'; 'In my own world' and 'Talking about the birth'. The woman and partner shared two themes: 'Lost birth dream' and 'Grateful to return to a familiar environment'. The woman and midwife both had: 'Gratitude for continuity of care model' and the partner and midwife both found they were: 'Struggling to adapt to a changing care model' and their 'Inside knowledge was not appreciated'. Conclusion: Insight into the unique integrated experiences during a birth centre intrapartum transfer can inform midwives, empowering them to better support parents through antenatal education before and by offering discussion about the birth and transfer after. Translation of findings to practice also reinforces how midwives can support their colleagues by recognising the accompanying midwife's role and knowledge of the woman

A Western Australian Survey of Breastfeeding Initiation, Prevalence and Early Cessation Patterns

Objective: This paper reports on current initiation and prevalence rates, in Western Australia, differentiating ‘any’ breastfeeding with ‘exclusive’ breastfeeding whilst exploring patterns and reasons for stopping breastfeeding. The results presented are part of a larger study examining women’s perceptions of care and wellbeing in the early postnatal period. Methods: A cross sectional survey was used to examine infant feeding practices during the hospital stay and at 9 weeks post birth from Western Australian women with a registered live birth between February and June 2006. Results: Data obtained from 2,669 women revealed a 93% (n = 2,472) initiation rate of any breastfeeding. More multiparous women (73.5%) were exclusively breastfeeding in hospital compared to primiparous women (65.2%), which decreased to 57.1 and 49.2%, respectively at 9 weeks. Of those who had ceased by 9 weeks, more multiparous women (71.1%) ceased before 3 weeks. Reasons cited for ceasing in order of frequency were insufficient milk supply, infant related reasons, pain and discomfort and emotional reasons. Younger maternal age, primiparous women, lower maternal education levels, offering a combination of breast milk and formula in hospital and caesarean birth were significant independent predictors of early cessation. Conclusions: Although initiation rates including “any” breast milk are meeting NHMRC dietary guidelines of 90%, the 60% target of exclusive breastfeeding is not being achieved for 3 months or in fact at 9 weeks. Targeted support for at risk groups such as younger, less well-educated, primiparous women must continue. Evidence based policies to protect breastfeeding must address the practice of offering formula to breastfed infants in hospital and the impact of increasing interventions such as caesarean births

Midwives' perceptions of being 'with woman': A phenomenological study

© 2019 The Author(s). Background: Being 'with woman' is a central construct of the midwifery profession however, minimal research has been undertaken to explore the phenomenon from the perspective of midwives. The aim of this study was to describe Western Australian midwives' perceptions of the phenomenon of being 'with woman' during the intrapartum period. Methods: Descriptive phenomenology was selected as the methodology for this study. Thirty one midwives working across a variety of care models participated in individual interviews. Giorgi's four stage phenomenological approach was employed to analyse data. Results: Three themes were extracted 1) Essential to professional identity; 2) Partnership with women; and 3) Woman-Centred Practice. Midwives described the importance of being 'with woman' to the work and identification of midwifery practice. Developing a connection with the woman and providing woman-centred care inclusive of the woman's support people was highlighted. Conclusions: For the first time, we are able to offer evidence of how midwives understand and perceive the phenomenon of being 'with woman' which has theoretical and practical utility. Findings from this study provide evidence that supports expert commentary and confirms that midwives conceptualise the phenomenon of being 'with woman' as essential to the identity and practice of the profession. Some previously identified 'good midwifery practices' were revealed as practical manifestations of the phenomenon. This new knowledge facilitates clarity and provides evidence to support statements of professional identity, which is useful for the development of educational curricula as well as supporting graduate and professional midwives. The findings emphasise the importance of the development of language around this important philosophical construct which permeates midwifery practice, enhances professional agency and supports the continued emphasis of being 'with woman' with new understanding of its applied practices in a variety of care models

A qualitative study of Western Australian women's perceptions of using a Snoezelen room for breastfeeding during their postpartum hospital stay

<p>Abstract</p> <p>Background</p> <p>There is limited evidence on the use of the Snoezelen concept for maternity clients. Snoezelen, a Dutch concept, initiated in the 1970s as a leisure activity for severely disabled people, involves creating an indoor environment using controllable stimuli to enhance comfort and relaxation. These specially designed rooms expose the user to multiple sensory stimulations combining vision, touch, sounds and aromas. The aim of this study was to provide insight into breastfeeding women's experience of using a Snoezelen room during hospitalisation.</p> <p>Methods</p> <p>A qualitative exploratory design was chosen to reveal women's perceptions of using the Snoezelen room. Osborne Park Hospital, the study setting is the second largest public provider of obstetric services in Western Australia. A purposive sample was drawn from breastfeeding women who used the Snoezelen room during their postpartum stay from March 2006 to March 2007. Saturation was achieved after eleven breastfeeding women were interviewed six weeks post discharge. Data analysis involved the constant comparison method.</p> <p>Results</p> <p>Participants entered the room feeling tired and emotional with an unsettled baby and breastfeeding issues aggravated by maternal stress and anxiety. All women indicated they were able to achieve relaxation while in the room and would recommend its use to other breastfeeding mothers. Two key themes revealed how the Snoezelen room facilitated maternal relaxation, which ultimately enhanced the breastfeeding experience. The first theme, "Finding Relaxation for the Breastfeeding Mother" incorporates three subthemes: 'Time out' for mother; Control in own personal space; and a Quiet/calm environment with homelike atmosphere. The second theme, "Enabling Focus on Breastfeeding", occurred after relaxation was achieved and involved four subthemes: Able to get one-on-one attention; Not physically exposed to others; Away from prying, judgemental eyes and Able to safely attempt breastfeeding alone knowing help is nearby.</p> <p>Conclusion</p> <p>Insight into how the Snoezelen room promoted relaxation also highlights what contributes to maternal anxiety during breastfeeding experiences in hospital. The findings offer health professionals the opportunity to consider adopting strategies such as a Snoezelen room in their hospital or being innovative in modifying the postpartum setting to promote relaxation for breastfeeding women.</p

A Multiple Component Intervention to Assist Young Pregnant Smokers to Cease Smoking: A Randomised Controlled Pilot Study

Objective: Australian rates of cigarette smoking are the lowest in the world. Young pregnant smokers are a sub population where smoking remains high. This pilot study assessed the feasibility of a multi-component intervention (Carbon Monoxide testing, motivational interviewing and a non-smoking buddy) to assist young pregnant women to cease smoking. Methods: Between October 2013 and June 2015, this multi-centred West Australian study recruited pregnant smokers aged 16 to 24, attending their first antenatal visit. Women (n=80) were randomised to the intervention and standard smoking cessation advice (n=43) or standard smoking cessation advice alone (n=37). At 36 weeks gestation and six weeks post birth, cessation rates were compared between groups using repeated measures survival analysis and reduction in smoking was examined using repeated measures linear regression on the number of cigarettes smoked. Results: The majority (89%) of women were unemployed or not in education, used illicit drugs (43%) and had experienced sexual abuse (23%). Involvement with child protection services was common (38%). Cigarette initiation occurred at a mean age of 13 years, median number of cigarettes smoked at baseline was 10 in both groups. Smoking cessation in intervention and controls were 17% vs. 14% at 36 weeks and 23% vs. 7% 6 weeks post birth. No significant differences in cessation or smoking reduction between groups were found individually or in the repeated events analysis. Conclusion: Given the low number of participants our findings cannot conclusively rule out this multi-component intervention. We believe it remains possible this intervention may prove effective in a larger group of participants and in another setting. Monitoring trends in this vulnerable, difficult to engage group of pregnant young women is important if we are to continue to devise effective interventions

Effectiveness of a mindfulness-based childbirth education pilot study on maternal self-efficacy and fear of childbirth

Introduction: This pilot study tested the feasibility and effectiveness of using Mindfulness-Based Childbirth Education (MBCE), a novel integration of mindfulness meditation and skills-based childbirth education, for mental health promotion with pregnant women. The MBCE protocol aimed to reduce fear of birth, anxiety, and stress and improve maternal self-efficacy. This pilot study also aimed to determine the acceptability and feasibility of the MBCE protocol. Methods: A single-arm pilot study of the MBCE intervention using a repeated-measures design was used to analyze data before and after the MBCE intervention to determine change trends with key outcome variables: mindfulness; depression, anxiety, and stress; childbirth self-efficacy; and fear of childbirth. Pregnant women (18-28 weeks’ gestation) and their support companions attended weekly MBCE group sessions over 8 weeks in an Australian community setting.Results: Of the 18 women who began and completed the intervention, missing data allowed for complete data from12 participants to be analyzed. Statistically significant improvements and large effect sizes were observed for childbirth self-efficacy and fear of childbirth. Improvements in depression, mindfulness, and birth outcome expectations were underpowered. At postnatal follow-up significant improvements were found in anxiety, whereas improvements in mindfulness, stress, and fear of birth were significant at a less conservative alpha level. Discussion: This pilot study demonstrated that a blended mindfulness and skills-based childbirth education intervention was acceptable to women and was associated with improvements in women’s sense of control and confidence in giving birth. Previous findings that low self-efficacy and high childbirth fear are linked to greater labor pain, stress reactivity, and trauma suggest the observed improvements in these variables have important implications for improving maternal mental health and associated child health outcomes. Ways in which these outcomes can be achieved through improved childbirth education are discussed

Reproductive planning, vitamin knowledge and use, and lifestyle risks of women attending pregnancy care with a severe mental illness

Objective Women with severe mental illnesses are a vulnerable population and little is known about their reproductive planning needs. The aim of our study was to describe rates of unintended pregnancies, postpartum contraception, identify use and knowledge of prenatal/pregnancy vitamins and identify modifiable lifestyle risks. Design Mixed methods study incorporating a cross-sectional survey and prospective pregnancy data collection Setting A multidisciplinary antenatal clinic in Australia Method Thirty-eight pregnant women with severe mental illnesses: schizophrenia, schizoaffective, bipolar and severe post-traumatic stress disorder Main outcome measures Unintended pregnancy rates, immediate postpartum contraception, use of prenatal and pregnancy vitamins and knowledge sources, obesity, and use and cessation rates for smoking, and substances, and comorbid medical conditions Results Overall 42% of women had unintended pregnancy, with those with schizophrenia at most risk (56%). A long acting reversible contraception was inserted in 5 women (13%), with 45% having no immediate contraception prescribed prior to postnatal discharge. Women's main source of vitamin supplementation for pregnancy was from general practitioners. Prenatal folic acid use occurred in 37%, with rates differing for those with a diagnosis of bipolar disorder (52%) and schizophrenia (25%). Vitamin deficiencies occurred in pregnancy, with iron deficiency (ferritin Discussion Addressing gaps in use of effective contraception, proactive reproductive planning and lifestyle management may improve outcomes for women with mental illnesses and their babies.Peer reviewe