Despite considerable evidence and effort, breastfeeding duration rates in resource-rich countries such as Australia remain below World Health Organization recommendations. The literature on the experience of breastfeeding indicates that women construct and experience breastfeeding differently depending upon their own personal circumstances and the culture within which they live. Breastfeeding has also been described as a deeply personal experience, which can be associated with 'moral' decision-making. The aim of this synthesis was to better understand the social phenomenon of breastfeeding by making the hidden obvious. Using a meta-ethnographic approach, we analysed the findings from 17 qualitative studies exploring women's experience of breastfeeding. Commonly used metaphors, ideas and phrases across the national and international qualitative studies were identified. Two overarching themes emerged. Breastfeeding was described in terms of 'expectation' and 'reality', while the emotional aspects of breastfeeding were expressed in 'connected' or 'disconnected' terms. The prevalence of health professionals and public health discourses in the language women use to describe their experience, and the subsequent impact of this on maternal confidence and self-assessment of breastfeeding are discussed. This synthesis provides insight into some of the subtle ways health professionals can build maternal confidence and improve the experience of early mothering.
The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.
Internationally, women give mixed reports regarding professional support during the early establishment of breastfeeding. Little is known about the components of midwifery language and the support practices, which assist or interfere with the early establishment of breastfeeding. In this study, critical discourse analysis has been used to describe the language and practices used by midwives when supporting breastfeeding women during the first week after birth. Participant observation at two geographically distant Australian health care settings facilitated the collection of 85 observed audio-recorded dyadic interactions between breastfeeding women and midwives during 2008-2009. Additionally, 23 interviews with women post discharge, 11 interviews with midwives and four focus groups (40 midwives) have also been analysed. Analysis revealed three discourses shaping the beliefs and practices of participating midwives. In the dominant discourse, labelled 'Mining for Liquid Gold', midwives held great reverence for breast milk as 'liquid gold' and prioritised breastfeeding as the mechanism for transfer of this superior nutrition. In the second discourse, labelled 'Not Rocket Science', midwives constructed breastfeeding as 'natural' or 'easy' and something which all women could do if sufficiently committed. The least well-represented discourse constructed breastfeeding as a relationship between mother and infant. In this minority discourse, women were considered to be knowledgeable about their needs and those of their infant. The language and practices of midwives in this approach facilitated communication and built confidence. These study findings suggest the need for models of midwifery care, which facilitate relationship building between mother and infant and mother and midwife.
BackgroundBreastfeeding support from health professionals can be effective in influencing a mother’s decision to initiate and maintain breastfeeding. However, health professionals, including nursing students, do not always receive adequate breastfeeding education during their foundational education programme to effectively help mothers. In this paper, we report on a systematic review of the literature that aimed to describe nursing and other health professional students’ knowledge and attitudes towards breastfeeding, and examine educational interventions designed to increase breastfeeding knowledge and attitudes amongst health professional students.MethodsA systematic review of peer reviewed literature was performed. The search for literature was conducted utilising six electronic databases, CINAHL, MEDLINE, ProQuest, PubMed, Scopus, and Cochrane, for studies published in English from January 2000 to March 2017. Studies focused on nursing students’ or other health professional students’ knowledge, attitudes or experiences related to breastfeeding. Intervention studies to improve knowledge and attitudes, were also included. All papers were reviewed using the relevant Critical Appraisal Skills Programme (CASP) checklist.ResultsFourteen studies were included in the review. This review indicates that in some settings, health professional students demonstrated mid-range scores on breastfeeding attitudes, and their knowledge of breastfeeding was limited, particularly in relation to breastfeeding assessment and management. All of the studies that tested a specialised breastfeeding education programme, appeared to increase nursing students’ knowledge overall or aspects of their knowledge related to breastfeeding. Several factors were found to influence breastfeeding knowledge and attitudes, including timing of maternal and child health curriculum component, previous personal breastfeeding experience, gender, cultural practices and government legislation.ConclusionsBased on this review, it appears that nursing curriculum, or specialised programmes that emphasise the importance of breastfeeding initiation, can improve breastfeeding knowledge and attitudes and students’ confidence in helping and guiding breastfeeding mothers.
BackgroundStudies report mixed findings about rates of both exclusive and partial breastfeeding amongst women who are migrants or refugees in high income countries. It is important to understand the beliefs and experiences that impact on migrant and refugee women’s infant feeding decisions in order to appropriately support women to breastfeed in a new country. The aim of this paper is to report the findings of a meta-ethnographic study that explored migrant and refugee women’s experiences and practices related to breastfeeding in a new country.MethodsCINAHL, MEDLINE, PubMed, SCOPUS and the Cochrane Library with Full Text databases were searched for the period January 2000 to May 2012. Out of 2355 papers retrieved 11 met the inclusion criteria. A meta-ethnographic synthesis was undertaken using the analytic strategies and theme synthesis techniques of reciprocal translation and refutational investigation. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.ResultsEight qualitative studies and three studies reporting both qualitative and quantitative data were included and one overarching theme emerged: ‘Breastfeeding in a new country: facing contradictions and conflict’. This theme comprised four sub-themes ‘Mother’s milk is best’; ‘Contradictions and conflict in breastfeeding practices’; ‘Producing breast milk requires energy and good health’; and ‘The dominant role of female relatives’. Migrant women who valued, but did not have access to, traditional postpartum practices, were more likely to cease breastfeeding. Women reported a clash between their individual beliefs and practices and the dominant practices in the new country, and also a tension with family members either in the country of origin or in the new country.ConclusionMigrant women experience tensions in their breastfeeding experience and require support from professionals who can sensitively address their individual needs. Strategies to engage grandmothers in educational opportunities may offer a novel approach to breastfeeding support.
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