Breastfeeding and emerging motherhood identity: An interpretative phenomenological analysis of first time Chinese Australian mothers’ breastfeeding experiences

BackgroundChinese Australian mothers are more likely than the general Australian mothers to introduce formula in the first month of age. A better understanding of the context of formula introduction in the early weeks of birth can provide a deeper insight into how Chinese Australian mothers can be supported to continue exclusive breastfeeding.MethodsAn interpretative phenomenological analysis approach was used to examine the lived breastfeeding experiences of 11 first time Chinese mothers in Australia. The experiences of those who breastfed exclusively were compared to those who introduced formula in the first month after birth.FindingsAn overarching theme across all participants’ narratives was the meaning ascribed to breastfeeding in their emerging motherhood identity. Breastfeeding could be a pragmatic and a socially desirable method to nourish an infant but lacking personal identification to the mother. These mothers were more vulnerable to the early introduction of formula, especially when the support environment was lacking. Maternal identity conflict was common and negatively impacted exclusive breastfeeding and mothers’ mental health. In contrast, mothers who identified closely with breastfeeding showed greater persistence and enjoyment in breastfeeding and were more likely to continue breastfeeding exclusively. Health professionals were perceived to have an important influence in strengthening maternal breastfeeding motivation and self-efficacy.ConclusionBreastfeeding support to Chinese Australian mothers needs to consider how breastfeeding can be better integrated with their motherhood identity. Health professionals are well-positioned to facilitate this process through a better understanding of mothers’ cultural and social contexts around breastfeeding.     

Women’s experiences of messages relating to alcohol consumption,received during their first antenatal care visit: An interpretative phenomenological analysis

BackgroundDespite greater awareness of fetal alcohol spectrum disorder, there has not been similar attention paid to research regarding effective strategies for prevention.AimsTo explore and interpret the messages women receive during their first antenatal care visit, relating to alcohol consumption.MethodsParticipants were 12 females who had attended an initial antenatal care visit within the previous two years. They participated in semi-structured interviews about their experiences of the health messages they recalled receiving during their first antenatal care visit, with emphasis on messages relating to alcohol consumption.FindingsData were analysed using Interpretative Phenomenological Analysis which identified two superordinate themes: (1) Messages Received About Alcohol Consumption, and (2) Ways of Interpreting Messages Relating to Alcohol Consumption. Messages received by participants about alcohol consumption were generally consistent with national guidelines, stating that there is no safe level during pregnancy. Women interpreted these messages, however, within a broader, personal and socio-cultural context. This leads to women’s choices about alcohol consumption being informed by their individual understanding of risk. To facilitate open discussions about sensitive topics such as alcohol consumption, participants expressed a preference for antenatal support that is tailored to their individual needs.ConclusionStrategies to prevent fetal alcohol spectrum disorder need to include messages encouraging women to abstain during pregnancy, whilst at the same time, providing the type of individualised antenatal care that best enables this to be accomplished.     

Trying to conceive: An interpretive phenomenological analysis of couples’ experiences of pregnancy after stillbirth

ObjectiveStillbirth affects 1:200 pregnancies in high income countries. Most women are pregnant again within 12 months. Little is known about how couples negotiate a subsequent pregnancy. This paper presents findings from a study exploring the experiences of couples’ in pregnancy after stillbirth.MethodsQualitative, interpretive phenomenological analysis was used to conduct in-depth interviews with eight heterosexual couples in the immediate pregnancy after stillbirth. Couples were interviewed together to explore their dyadic, lived experiences of stillbirth and the pregnancy that follows.ResultsHoping for a born alive baby was one superordinate theme and Trying to conceive one of its subordinate themes, is presented here. Couples jointly negotiated their decision to get pregnant again, varying upon their individual circumstances, including their experiences of stillbirth. Gender differences were apparent in a couple’s agreement to pursue a pregnancy after stillbirth and may be explained by the desire of men to fully parent the baby who died before reaching a decision about a subsequent pregnancy. Sexual intercourse often became less about emotional connection and more about a means to achieve a pregnancy.ConclusionCouples spoke of the need for each partner to be in agreement with the decision for a pregnancy. The experiences of trying to conceive after stillbirth impacted the couple relationships. Couples who were able to discuss their feelings with one another appeared more cohesive than those who experienced communication challenges in the aftermath of loss. New insights into men’s thinking about the decision to get pregnant after stillbirth were revealed.     

Indicators of ‘good’ feeding,breastfeeding latch,and feeding experiences among healthy women with healthy infants: A qualitative pathway analysis using Grounded Theory

BackgroundBreastfeeding behaviour remains a public health priority worldwide. Despite evidence-based guidelines, healthy women who give birth to healthy, term infants continue to face barriers to breastfeeding. Understanding women’s experiences of feeding in the early postnatal period is crucial to identify how support may be better tailored to improve breastfeeding outcomes, including women’s experiences.QuestionTo understand women’s experiences of infant feeding amongst healthy women who give birth to healthy, average-weight, term infants.MethodsGrounded Theory methodology was used to analyse data from a nested qualitative interview study. Twelve women between four and twelve months postpartum were recruited from a longitudinal cohort study and public advertisements. Semi-structured face-to-face interviews were audio-recorded and transcribed for analysis.FindingsThree distinct themes were found, subsuming identified super-categories: Perceived indicators of ‘good’ feeding (infant ‘output’; infant crying; weight gain; feeding frequency and duration); Women’s experiences of breastfeeding latch (‘good’ latch; ‘bad’ latch with pain and discomfort); and Overall breastfeeding experience (positive; negative; and uncertain). Data suggest women give precedence to their latch experiences over indicators of ‘good’ feeding, highlighting breastfeeding latch as a possible mediating factor to the overall breastfeeding experience. Feeding experience can be achieved through four distinct pathways.DiscussionThe physical and psychological impacts of latch pain were pronounced. Even amongst healthy women with healthy infants, a positive breastfeeding experience overall was uncommon, highlighting the difficulties women continue to encounter. Understanding women’s perceptions of ‘good’ feeding, and ensuring a pain-free latch, may better support women to have a positive breastfeeding experience.     

Mothers’ attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa

BackgroundIn American Samoa, initiation of breastfeeding is almost universal but exclusive breastfeeding, a promising target for obesity prevention, is short in duration.Aims(1) To examine American Samoan mothers’ feeding experiences and attitudes and beliefs about infant feeding and (2) to identify potential barriers to exclusive breastfeeding.MethodsEighteen semi-structured interviews were conducted with American Samoan mothers at 16–32 days postpartum. Interviews focused on mother's knowledge and beliefs about infant feeding, how their infants were fed, why the mother had chosen this mode of infant feeding, and how decisions about feeding were made within her social surroundings. A thematic qualitative analysis was conducted to identify salient themes in the data.FindingsIntention to exclusively breastfeed did not predict practice; most women supplemented with formula despite intending to exclusively breastfeed. The benefits of breastfeeding were well-recognized, but the importance of exclusivity was missed. Formula-use was not preferred but considered an innocuous “back-up option” where breastfeeding was not possible or not sufficient for infant satiety. Identified barriers to exclusive breastfeeding included: the convenience of formula; perceptions among mothers that they were not producing enough breast milk; and pain while breastfeeding. The important support role of family for infant feeding could be utilized in intervention design.ConclusionThis study identified barriers to exclusive breastfeeding that can be immediately addressed by providers of breastfeeding support services. Further research is needed to address the common perception of insufficient milk in this setting.     

‘The calm before the storm’: A qualitative study of fathers’ experiences of early labour

BackgroundEarly labour care presents a challenge for maternity services and is a cause of dissatisfaction for women planning birth in an obstetric or midwifery unit who may feel unsupported or unwelcome at their planned place of birth. Little is known about the perspectives of men who support their partner during early labour.MethodsOpportunity sample offathers (n = 12) in the UK who had been present during their partner’s labour in the previous twelve months. Semi-structured interviews were audio-recorded and transcribed before thematic analysis.ResultsFathers learned about the stages of labour during antenatal education and felt well prepared for early labour but found their knowledge difficult to apply, and relied on their partners to decide when to travel to the planned place of birth. Early labour was described as the ‘calm before the storm’ during which they carried out practical tasks or rested to ensure they could fulfil their role when labour progressed. However, men frequently felt ‘like a spare part’ during the later stages of labour.DiscussionThe study has implications for antenatal educators, midwives and others supporting couples during pregnancy and labour. It supports reconsideration of how information about labour progress can be most usefully conveyed to couples. Professionals could acknowledge the value of supportive tasks carried out by fathers that might otherwise be experienced as doing ‘nothing’. Further research should recruit more diverse samples of men and same-sex couples. Dyadic data collection methods may be of value.     

The ‘fallacy of normalcy’: A content analysis of women's online post-childbirth health-related support

BackgroundOnline forums have changed traditional sources of seeking help because they provide an anonymous and non-judgemental environment particularly suited for women with post-childbirth problems.QuestionWhat support is given to mothers who have posted questions about post-childbirth morbidities?MethodsA total of 333 messages posted on a post-childbirth online forum were loaded into NVIVO 12 Pro and were analysed using content and thematic analysis. Content analysis identified the major health problems, and thematic analysis was used for identifying motivations and the support offered.FindingsSeventeen different health problems were discussed on posts, with a strong emphasis on pelvic problems, followed by mental health concerns. The key motivation for seeking online help identified using ‘typology of advice solicitation’ was request for opinion or information (48.85%). The two main support themes were: peer to peer support (82%) and normalisation (not always appropriate) of post-childbirth problems (18%). Most of the support offered was emotional (56.9%) followed by practical (22.7%) and informational support (20.4%).DiscussionPostpartum adjustment of post-childbirth experiences can be supportive but if ill-informed may provide a barrier to safe and reliable health care.ConclusionWe recommend women have access to online forums moderated by healthcare providers who can notify participants when a problem requires support from a relevant health professional opinion.     

Using Rasch analysis to identify midwifery students’ learning about providing breastfeeding support

AimTo report on a study measuring midwifery students’ self-reported abilities in teaching and supervising breastfeeding mothers. Abilities were assessed at two time intervals, before and after completing a maternal and infant nutrition topic with simultaneous clinical opportunities to consolidate their skills.MethodA convenience sample of midwifery students in an Australian university completed a pre- and post-intervention survey to assess their self-rated ability to teach and supervise breastfeeding mothers. Rasch analysis was used to gain conjoint estimates of students’ self-reported abilities to teach and supervise breastfeeding mothers across 37 items with varying complexity of care needs. Rasch analysis was used to determine validity and reliability of the 37-item tool, to develop a hierarchical linear scale reflecting difficulty of breastfeeding supportive activities, and to determine student learning between the two time points.ResultsFrom 95 responses, 34 of the 37 items met the requirement for unidimensionality. Outcomes identified that midwifery students’ self-efficacy measures for breastfeeding support abilities can be reliably estimated. A hierarchical scale for learning these clinical skills has been generated to inform curricula development and learning processes. While there was an overall increase in the ease of difficulty of 21 items in the survey at time point two, eight items were identified as becoming more difficult.ConclusionThe findings of this study challenge midwifery educators to reconsider the educational activities provided for midwifery students’ that aim to develop the requisite skills to provide effective breastfeeding support, including the provision of specific clinical opportunities to learn from breastfeeding women.     

‘No sugar’, ‘no junk food’, ‘do more exercise’ – moving beyond simple messages to improve the health of Aboriginal women with Hyperglycaemia in Pregnancy in the Northern Territory – A phenomenological study

BackgroundGlobally, rates of hyperglycaemia in pregnancy are highest among Indigenous women. The highest prevalence has been documented among Aboriginal women in the Northern Territory of Australia. Despite knowledge of this for over two decades, there has been very limited examination of the specific needs and experiences of Aboriginal women regarding this condition.QuestionHow do Aboriginal women with hyperglycaemia in pregnancy understand and experience this condition, and how can their care be improved?MethodsA phenomenological methodology underpinned semi-structured in-depth interviews with 35 Aboriginal women and seven health professionals across the Northern Territory. Data were inductively analysed.FindingsThe findings revealed that in general, participants in this study could recite simple health messaging regarding diabetes (e.g. ‘no sugar’), but many lacked in-depth knowledge and this affected the management of their condition. Nevertheless, many identified pregnancy as a powerful motivator for change, signalling scope to improve health messaging. Women consistently expressed the need for diabetes education that was culturally appropriate, a clear desire for maternity care that was family-centred, based on respectful relationships with the same care provider, and respected Aboriginal ways of knowing and being.ConclusionExisting health messaging around hyperglycaemia in pregnancy has limited reach with Aboriginal women in the Northern Territory. Reducing the burden of hyperglycaemia in pregnancy among these women requires a sustained commitment to redesign of maternity and diabetes care to incorporate the cultural and social context of women’s lives.     

The ‘What’, ‘Why’ and ‘How’ of Employee Well-Being: A New Model

This paper examines the ‘what’, ‘why’ and ‘how’ of employee well-being. Beginning with the ‘what’ of well-being, the construct of mental health was explored with the aim of building a model of employee well-being. It was proposed that employee well-being consists of three core components: (1) subjective well-being; (2) workplace well-being and (3) psychological well-being. Following this, the ‘why’ of employee well-being was investigated; that is, why employee well-being should be an important matter for organisations. It was argued that employee well-being is an important precursor to organisational well-being, as indicated by its links to employee turnover and performance. The next section was concerned with the ‘how’ of employee well-being; that is, how well-being can be reliably enhanced. Drawing on two models of strengths and a practice model of psychological assessment, it was asserted that strength-based development can reliably enhance employee well-being. A solid framework for understanding and measuring employee well-being is offered in the hope that it will foster a more integrated approach to assessing and optimising employee well-being.

The dangers of using ‘negative durations’ to estimate pre- and post-migration fertility

To keep childbearing that occurs before and after migration separate from each other, many analysts apply a technique that uses ‘negative durations’ to estimate the childbearing risks that migrants have before they migrate. This strategy can lead to incorrect results and should be abandoned. In this research note, we use data for births and internal migration in Sweden to highlight how the two types of behaviour can be kept apart conceptually and analytically without use of ‘negative durations’. The procedures used can easily be generalized to any similarly linked pair of behaviours.     

Influence of grandmothers on breastfeeding practices in a rural community in Papua New Guinea: A critical discourse analysis of first-time mothers’ perspectives

BackgroundAlmost all babies are breastfed in Papua New Guinea (PNG); yet appropriate breastfeeding practices are not always followed.AimTo explore the perspectives of first-time mothers in rural PNG on how the language and discourse of grandmothers about infant feeding influence their breastfeeding practices.MethodsA critical discourse analysis (CDA) approach was used to theoretically frame the analysis of twenty first-time mothers’ narratives.FindingsAnalysis revealed three themes: (i) prescribed knowledge repository, (ii) social control and dominance, and (iii) disapproval and role conflict, which provides an understanding of grandmothers’ differing views and positions on infant feeding practices and their influence on breastfeeding.ConclusionThis study shows that grandmothers remain influential in infant feeding practices in rural PNG. There appears to be a societal expectation that empowers grandmothers in the maternal decision-making processes regarding breastfeeding practice. Grandmothers’ influence includes the early introduction of complementary foods to infants less than six months old. Interventions aimed at promoting, protecting, and supporting breastfeeding need to include grandmothers.     

Determined to stop? Longitudinal analysis of the desire to have no more children in rural Mozambique

Classic demographic theories conceptualize desired family size as a fixed goal that guides fertility intentions over the childbearing years. However, a growing body of research shows that fertility plans, even nominally long-term plans for completed childbearing, change in response to short-term conditions. Because of data limitations, much of this research has focused on low-fertility contexts, but short-term conditions are likely to be even more important in high-fertility contexts. This paper uses three waves of survey data collected in rural Mozambique to study predictors of the desire to stop childbearing in a context of relatively high fertility and high individual and social instability. We use fixed effects models to assess how women’s desires to stop childbearing are shaped by demographic factors, household economic conditions, and health status, controlling for constant individual characteristics. Results provide evidence that fertility desires both reflect stable underlying goals and evolve in response to individual and social circumstances.     

Women’s experiences of decision-making and attitudes in relation to induction of labour: A survey study

BackgroundRates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women’s mode of birth preferences and experiences of shared decision-making for induction of labour.MethodAn antenatal survey of women booked for an induction at eight Sydney hospitals was conducted. A bespoke questionnaire was created assessing women’s demographics, indication for induction, pregnancy model of care, initial birth preferences, and their experience of the decision-making process.ResultsOf 189 survey respondents (58% nulliparous), major reported reasons for induction included prolonged pregnancy (38%), diabetes (25%), and suspected fetal growth restriction (8%). Most respondents (72%) had hoped to labour spontaneously. Major findings included 19% of women not feeling like they had a choice about induction of labour, 26% not feeling adequately informed (or uncertain if informed), 17% not being given alternatives, and 30% not receiving any written information on induction of labour. Qualitative responses highlight a desire of women to be more actively involved in decision-making.ConclusionA substantial minority of women did not feel adequately informed or prepared, and indicated they were not given alternatives to induction. Suggested improvements include for face-to-face discussions to be supplemented with written information, and for shared decision-making interventions, such as the introduction of decision aids and training, to be implemented and evaluated.     

“Not my child to give away”: A qualitative analysis of gestational surrogates’ experiences

Problem/backgroundLimited empirical data are available on the experiences of women who have been a gestational surrogate.QuestionWhat are the experiences of gestational surrogates along the surrogacy pathway?MethodsAn anonymous study-specific cross-sectional survey was used to evaluate participants’ experience of being a surrogate. A total of 184 Canadian women who were recruited from Canadian surrogacy agencies and the Internet completed the online survey; 9446 words were collected from 110 participants who entered comments to one or more questions. The qualitative data were analyzed through thematic analysis.FindingsSeven main themes, and eighteen interrelated sub-themes grouped under the pre-, during, and post-surrogacy stages were identified. Many surrogates viewed surrogacy as a positive experience and as something meaningful and impactful to other people’s lives. Most surrogates had harmonious relationships with their intended parents and maintained on-going contact with the surrogacy family post birth.DiscussionSurrogacy involves deliberate efforts to establish a trustful surrogate-parent partnership through relationship building, boundary negotiation, and management of expectations. The compatibility between surrogate and intended parents, regarding aspects such as communication and pregnancy management styles, was an important contributing factor to a positive experience.ConclusionOur findings provide a deeper understanding of participants’ reasons for and motivation to be a surrogate, the relationship dynamics with their intended parents and the gestated fetus during surrogacy, and their satisfaction on personal and relationship levels post surrogacy. The findings would be useful to mental health professionals in preparing new surrogates for the potential challenges along the surrogacy pathway.     

Cape queer? A case study of Provincetown, Massachusetts

Cape Queer is a case study that details how sexuality intersects with race, gender, and class in the development of the gay and lesbian resort community, Provincetown, Massachusetts. It asks scholars to pay closer attention to the ways in which methodologies and practices utilizing LGBT studies and queer theory can combine rather than separate to interrogate LGBT and queer histories, politics and communities. In the process, it assesses how the global mechanics of capitalism led to the local queering and eventually un-queering of a gentrified, white, gay and lesbian enclave.     

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