Against all odds: a retrospective case‐controlled study of women who experienced extraordinary breastfeeding problems

Abstract

AimsThe study investigated factors empowering women to continue breastfeeding despite experiencing extraordinary difficulties. The study documented the experiences and characteristics of women who continued to breastfeed (continuing cohort) and those who weaned (non-continuing cohort) despite extraordinary difficulties. DesignRetrospective case control. MethodsThe study was undertaken in south-east Queensland, Australia in 2004. Forty women (20 in each cohort) were recruited over six months. Both quantitative (breastfeeding knowledge questionnaire) and qualitative (semi-structured interviews) data were collected. This paper describes the qualitative data. Page 2 of 16 ResultsWomen from both cohorts expressed idealistic expectations about breastfeeding and experienced psychological distress due to their breastfeeding problems. Those who continued breastfeeding used coping strategies and exhibited personal qualities that assisted them to overcome the difficulties experienced. Women who continued to breastfeed were more likely to report relying on a health professional they could trust for support. This latter cohort were also more likely to report having peers with which they shared their experiences. Non-continuing women expressed feelings of guilt and inadequacy following weaning and were more likely to feel isolated. ConclusionsThis study has highlighted the methods women use to deal with breastfeeding problems. It has also revealed modificable factors that can improve breastfeeding duration. Relevance to clinical practiceThe findings indicate that clinicians should:• Provide information which accurately reflects the breastfeeding experience; • Ensure systems are in place so that effective postnatal support for breastfeeding difficulties is available;• Consider screening to ascertain levels of psychological distress, sadness and disillusionment among breastfeeding women; • Design educational interventions with elements of cognitive skills, problem-solving and self-efficacy training to equip women with the skills to overcome any experienced difficulties.

A descriptive qualitative review of the barriers relating to breast‐feeding counselling

“…Bryant et al argued that educational materials reinforce parents' images about breast-feeding. 62 Pictures of beautiful, rich 62 Identify the reasons bottle-feed and motivations could be used to promote breast-feeding 6.5 Bunik et al (2006) 58 Assess barriers to breast-feeding 7 Chopra et al (2002) 44 Assess the impact of Mother-to-Child Transmission programme on infant care practices 5.5 Hegney et al (2008) 55 Investigate factors empowering women to continue breast-feeding despite experiencing extraordinary difficulties 57 Explore the subjective experience of women who initiate breast-feeding but stop within the first 2 weeks 6.5 Neifert et al (1985) 50 Describe cases, where lactation failure was believed to stem from insufficient glandural tissue 5 Raine (2003) 64 Evaluate the effectiveness of a peer-support intervention to promote breast-feeding in a deprived area 6 Raisler (2000) 59 Explore the experiences of low-income nursing mothers within and beyond the health-care system 7 Seidel et al (2000) 69 Experiences and decisions taken around breast-feeding by a peer support group of 13 HIV-positive mothers 7 Tennant et al (2006) 19 Describe health visitors', midwives' and lay breast-feeding counsellors' views of obstacles to breast-feeding 7 † Points from assessment. The criteria are presented in Figure 3.…”

The Maternal Ecology of Breastfeeding: A Life Course Developmental Perspective

“…More specifically, the comparison of two mutually exclusive groups against one another is the most common method of examining the predictors and consequences of breastfeeding trajectories. Examples include contrasts between "persisters" and "nonpersisters" [Hegney, Fallon, & O'Brien, 2008] and "maintainers" and "discontinuers" [Tarrant, Dodgson, & Choi, 2003]. This work has found intraindividual and structural correlates with group membership (examples include confidence, commitment, determination, employment, support networks, etc.).…”

An account of significant events influencing Australian breastfeeding practice over the last 40 years

“…48, p1288 Maternal and/or neonatal pain associated with birth trauma and bruising, nipple pain and trauma, and the belief that there is not enough milk were identified in the literature as three common reasons for discontinuing breastfeeding. 49,50 Evidence of nipple pain and trauma recorded by Gunther as early as 1945 and painful nipple trauma contributing to breastfeeding decline has increased since then. 37,51-54 Persistent nipple pain and trauma inhibits cyclical hormone function slowing the milk ejection (letdown) reflex, while ineffective intra-oral contact diminishes appropriate synchronisation for breast stimulation leading perpetuating women's belief in declining milk volume, confirming the fear of low supply.…”