Objective To describe the use of social media during the antepartum and postpartum periods among first-time African American mothers and their support persons. Design A qualitative critical ethnographic research design within the contexts of Family Life Course Development Theory and Black Feminist Theory. Setting Participants were recruited from community-based, public health, and home visiting programs. Participants A purposive sample was recruited, consisting of 14 pregnant African American women and eight support persons. Methods Pregnant and postpartum African American women and their support persons were interviewed separately during the antepartum and postpartum periods. Data were analyzed thematically. Results Participants frequently used social media for educational and social support and searched the internet for perinatal and parenting information. Most participants reported using at least one mobile application during their pregnancies and after giving birth. Social media were typically accessed through smartphones and/or computers using different websites and applications. While participants gleaned considerable information about infant development from these applications, they had difficulty finding and recalling information about infant feeding. Conclusion Social media are an important vehicle to disseminate infant feeding information; however, they are not currently being used to full potential. Our findings suggest that future interventions geared towards African American mothers and their support persons should include social media approaches. The way individuals gather, receive, and interpret information is dynamic. The increasing popularity and use of social media platforms offers the opportunity to create more innovative, targeted mobile health interventions for infant feeding and breastfeeding promotion.

Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Purpose The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusion Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.

has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version.If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting). Your paper will be maintained in active status for 21 days from the date of this letter. If we have not heard from you by Jul 09, 2019, we will assume you wish to withdraw the manuscript from further consideration. REVIEWER COMMENTS:Reviewer #1:1. Title. The study is about racial disparities in the evaluation and treatment of postpartum pain. Data were obtained from an electronic medical record, but the study is not about "using the electronic medical record" per se. The EMR is not mentioned in the results. Would consider revising the title. Precis.Suggest summarizing what you found rather than writing that you found something.3. Abstract. This is a faithful summary of the manuscript. a. Might include a sentence in the results about the number of women studied (1751), and something about the number of times pain was assessed, as there were > 31K pain scores. b. Line 59. Would define OTE. c. Lines 62-63. Would delete or revise this sentence, because the reader may infer that your study is not novel, e.g. convey that the previous studies were not postpartum women. 4. Introduction. a. Lines 67-68. Higher perinatal morbidity and mortality among fetuses and infants of black women, or higher morbidity and mortality among black women? b. Lines 82-84. This appears to be the objective, but it is not a complete sentence. Minor, but the authors aren't comparing EMR data with other data, so does this merit being part of the study objective? c. Lines 84-87. The authors hypothesized that black women would undergo fewer pain assessments and receive less pain medication. That is fine, but if perhaps the authors (instead) didn't think they were denying women needed pain medication but thought it would be an important question to investigate, could rephrase accordingly. 5. Methods. a. Generally the inclusion and exclusion criteria go in the methods. The Ns are considered results. b. Line 103. What is the Carolina Data Wearhouse? c. Line 118-129. Were the EMR data (pain scores and other variables evaluated) recorded per protocol in a table or other method of data-entry that was readily searchable in aggregate, or did investigators need to sort...