Understanding Maternal Breastfeeding Confidence: A Gadamerian Hermeneutic Analysis of Women's Stories

Our aim in this Gadamerian hermeneutic study was to understand maternal breastfeeding confidence and its meaning through listening to women's voices describing their experiences within the context of the United States. We asked 13 women, aged 23 to 42 years, who had breastfed a child within the last 2 years to tell us their breastfeeding stories. Women experienced maternal breastfeeding confidence as a dynamic interaction between their expectations, their infant^’s breastfeeding behavior, and sources of support. They described experiences that enhanced or diminished their confidence. Health professionals can use these findings to plan approaches that promote and support maternal breastfeeding confidence.     

‘I just don’t think it’s that natural’: adolescent mothers’ constructions of breastfeeding as deviant

Breastfeeding is recognised globally as the optimal method of infant feeding. For Murphy (1999) its nutritional superiority positions breastfeeding as a moral imperative where mothers who formula-feed are open to charges of maternal deviance and must account for their behaviour. We suggest that this moral superiority of breastfeeding is tenuous for mothers from marginalised contexts and competes with discourses which locate breastfeeding, rather than formula feeding, as maternal deviance. We draw on focus group and interview data from 27 adolescent mothers from socio-economically deprived neighbourhoods in three areas of the UK, and five early years professionals working at a Children’s Centre in the Northeast of England. We argue that breastfeeding is constructed as deviance at three ‘levels’ as (i) a deviation from broad social norms about women’s bodies, (ii) a deviation from local mothering behaviours and (iii) a transgression within micro-level interpersonal and familial relationships. Given this positioning of breastfeeding as deviant, breastfeeding mothers feel obliged to account for their deviance. In making this argument, we extend and rework Murphy’s (1999) framework to encompass diverse experiences of infant feeding. We conclude with reflections on future research directions and potential implications for practice.     

Maternal control of child‐feeding during breast and formula feeding in the first 6 months post‐partum

Background: Mothers who breastfeed use lower levels of control over later child diet. The baby‐led nature of breastfeeding may encourage this low control to develop. Alternatively maternal desire for control may drive breastfeeding duration. The present study explored whether differences in maternal control are present during milk feeding and whether these stem from or drive breastfeeding duration. Methods: Five hundred and two mothers with an infant aged 6–12 months completed a modified retrospective version of the child‐feeding questionnaire adapted to reflect milk feeding during the first 6 months post‐partum. Participants were recruited from mother and baby groups and online parenting forums. Mothers recalled their use of encouraging intake and scheduling feeds in relation to their infant’s intake of milk. Attitudes towards breastfeeding were also measured, including views that breastfeeding is inconvenient, difficult and that formula‐fed infants were more content. Results: Compared to mothers who formula‐fed or ceased breastfeeding within 1 week, mothers who breastfed for at least 6 months recalled a lower use of scheduling and encouraging milk feeds. Mothers who initiated breastfeeding but ceased within 1 week reported lower control compared to exclusive formula feeders. A high level of scheduling feeds was associated with considering that breastfeeding was inconvenient and a greater perceived infant size, whereas encouraging feeds was associated with considering that breastfeeding was difficult, low maternal confidence and a smaller perceived infant size. Conclusions: Maternal desire for control may drive breastfeeding duration. A controlling maternal feeding style may therefore be dispositional and present much earlier than current studies suggest.     

黄石、荆门地区产妇母乳喂养自我效能影响因素分析

目的 探究黄石、荆门地区产后妇女母乳喂养自我效能的现状及影响因素,为改善母乳喂养率提供更多理论依据。方法 对2017年12月—2018年3月在湖北省黄石市、荆门市的三所医院住院分娩的产妇进行问卷调查,获得产妇社会人口特征、孕产相关资料、母乳喂养相关情况。采用多元线性回归分析母乳喂养自我效能的影响因素。结果 共1 023名产妇纳入分析,平均年龄(29.0±5.7)岁。已婚占98.3%,初产占54.0%,大专及以上学历占53.9%。研究对象的母乳喂养自我效能平均得分为(45.5±12.3)分。多元线性回归的结果显示:当前不存在乳腺问题(B=2.08,P=0.036)、有母乳喂养经历(B=3.62,P<0.001)、家人提供母乳喂养指导或经验(B=3.20,P=0.001)、丈夫支持母乳喂养(B=5.87,P=0.001)及产后30 min内有医护母乳喂养帮助(B=3.02,P=0.003)的产妇母乳喂养自我效能得分更高。结论 产后妇女的母乳喂养自我效能可能与其健康状况、母乳喂养经历、社会支持及母乳喂养卫生服务有关。应对产后妇女提供广泛的社会支持,加强母乳喂养卫生服务提供,以提高其母乳喂养的自我效能,促进母乳喂养。     

Breastfeeding in Depressed Mother-Infant Dyads

Depressed versus non-depressed mothers were interviewed on their breastfeeding practices and perceptions of their infants' feeding behavior when their infants were eight-months-old. The depressed mothers less often breastfed, they stopped breastfeeding their infants significantly earlier in infancy and they scored lower on a breastfeeding confidence scale. Independent of maternal depression, mothers who breastfed rather than bottle fed their infants had higher confidence levels and rated their infants as less alert and less irritable during feedings.     

Breastfeeding in Depressed Mother-Infant Dyads

Depressed versus non-depressed mothers were interviewed on their breastfeeding practices and perceptions of their infants' feeding behavior when their infants were eight-months-old. The depressed mothers less often breastfed, they stopped breastfeeding their infants significantly earlier in infancy and they scored lower on a breastfeeding confidence scale. Independent of maternal depression, mothers who breastfed rather than bottle fed their infants had higher confidence levels and rated their infants as less alert and less irritable during feedings.     

6个月内婴儿纯母乳喂养现状及影响因素分析

目的 了解深圳市6个月内婴儿纯母乳喂养现状,并分析纯母乳喂养影响因素,为促进纯母乳喂养成功提供科学依据。方法 随机抽取在深圳市3个区妇幼保健院儿保科进行6个月内儿童常规体检的婴儿母亲1 000名进行问卷调查。结果 6个月内纯母乳喂养率为61.2%,非纯母乳喂养主要原因为自述母乳不足(42.01%),通过单因素及多因素分析,学历高、家庭月收入高、胎次多的产妇更少选择纯母乳喂养,有产假、坚持6个月内纯母乳喂养有信心、家人对母乳喂养持支持态度、开奶时间早、有夜间哺乳的产妇更多选择纯母乳喂养。结论 为进一步提高6个月内纯母乳喂养率,医务人员应加强母乳喂养宣教及产后指导,鼓励产妇家属共同参与,增强产妇母乳喂养信心,用工单位提供便利支持母乳喂养,医院落实爱婴医院政策。     

The validity and reliability of maternal recall of breastfeeding practice

In large epidemiologic studies, information on breastfeeding practice is often collected from maternal recall through interviews, but there is concern about the accuracy of the data, especially when mothers are asked to recall their practices from many years earlier. This review examines the validity and reliability of maternal recall of breastfeeding history using 11 studies published between 1966 and 2003 in English with a sample of 10 or more. Validity is the degree to which recall compares with a validation standard or reference, and reliability refers to the degree to which the breastfeeding practices obtained by recall are repeatable over time. The existing studies suggest that maternal recall is a valid and reliable estimate of breastfeeding initiation and duration, especially when the duration of breastfeeding is recalled after a short period (< or = 3 years). Validity and reliability of maternal recall for the age at introduction of food and fluids other than breast milk are less satisfactory. Further and more extensive studies on maternal recall of breastfeeding history and ways to improve such recall are warranted.     

Labor Epidural Anesthesia, Obstetric Factors and Breastfeeding Cessation

Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia’s association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. A pooled analysis using Kaplan–Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within 1 month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95 % confidence interval 1.10, 1.44], p < 0.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01, 1.41], p < 0.04; non-BFH: 1.65 [1.31, 2.08], p < 0.01). A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies.     

Local Landscapes of Breastfeeding: A comparison of breastfeeding amongst mothers in low- and high-income neighborhoods in Bristol,UK

This paper compares experiences of breastfeeding outside the home for women living in low-income and high-income neighborhoods of the same city. Our findings are based on an analysis of 22 interviews with breastfeeding mothers (11 in each of two study areas) undertaken in Bristol, UK in 2017. We extend existing scholarship by showing how experiences of breastfeeding vary not only at the regional level but between local areas of the same city, and outline how our findings can inform policy. We advance literature on maternal bodies by exploring how local “landscapes” of breastfeeding emerge as mothers encounter and negotiate different socio-material landscapes and locally-differentiated norms about “appropriate” maternal embodiment. We argue that these variegated interactions can lead to different orientations to space and forms of spatial practice on the part of breastfeeding mothers, as well as different kinds of maternal identities.     

武汉市医护工作者母乳喂养现状调查及对策

目的:了解武汉市医护工作者的母乳喂养现状,探讨提高医护工作者母乳喂养率的对策。方法:采用母乳喂养调查问卷对武汉市10家医院445名医护工作者进行抽样调查。结果:对于产后4～6个月内的婴儿,武汉市医护工作者中19.9%采用人工喂养,42.3%采用混合喂养,37.8%采用母乳喂养;哺乳方法掌握情况、喂养信心、营养状况、乳汁分泌量、朋友喂养方式及对自己喂养行为的定位等因素可影响医护工作者母乳喂养的状况。结论:武汉市医护工作者4～6个月内婴儿母乳喂养率较低,情况不容乐观;巩固产前教育,增强母乳喂养信心,加强产妇营养,营造良好的母乳喂养环境有助于提高医护工作者的母乳喂养率。     

Secrets and lies: Breastfeeding and professional paid work

This paper explores the conflict between health advice and organisational practice regarding breastfeeding. It focuses on the group of mothers with the highest rates of both breastfeeding initiation and of continuous employment following maternity leave: specifically, educated mothers in managerial and/or professional occupations. In this context, the paper investigates, through in-depth interviews, the embodied experiences of 20 heterosexual UK mothers, qualified to degree level, who returned to professional employment within 1 year of childbirth. The paper observes that mothers who attempted to combine breastfeeding with paid work did so with difficulty because the material activity of breastfeeding was 'taboo' within the workplace. Thus, the requirement to conform to organisational expectations regarding 'suitable' embodied behaviour contradicted health advice about what was 'best' for infant children. In order to comply with workplace requirements, mothers in the study were obliged either to cease breastfeeding or to conceal breastfeeding activities. In the light of mothers' experiences, the paper suggests that breastfeeding duration rates among professionally employed mothers can only be improved if negative attitudes about maternal bodies and employment are challenged and if employers, as well as mothers, are the focus of health initiatives aimed at promoting breastfeeding.     

中国西部5省农村婴儿纯母乳喂养影响因素分析

目的:了解中国西部农村婴儿的母乳喂养现状,探讨影响4个月内婴儿纯母乳喂养的相关因素。方法:利用"2006年中国十省农村7岁以下儿童体格发育调查"资料,选取西部5省的农村婴儿作为研究对象。结果:西部5省农村婴儿母乳喂养率为71.97%;4个月内纯母乳喂养率为52.02%。单因素分析结果显示,影响婴儿4个月内纯母乳喂养的因素包括婴儿性别、胎数、出生体重、患病情况,父母亲年龄、母亲文化水平和职业、家庭年收入;多因素分析结果显示,双胎、有疾病史、出生体重低、母亲年龄大、母亲文化水平高、家庭年收入高是婴儿4个月内纯母乳喂养的危险因素。结论:中国西部5省农村婴儿4个月内纯母乳喂养率较低,受婴儿自身因素、母亲因素和家庭经济因素的影响,应加强孕期保健服务,积极宣传和普及科学喂养知识,提高母亲母乳喂养意识。     

Influence of Experiences and Perceptions Related to Breastfeeding One’s First Child on Breastfeeding Initiation of Second Child

Introduction Multiparas tend to initiate breastfeeding less than primiparas. While mothers often repeat the feeding method used for their first child with their second child, the way in which experiences and maternal perceptions related to breastfeeding one’s first child may influence breastfeeding initiation with a second child remain underexplored. The objective of this study was to investigate whether physiological or social experiences, and related psychological factors, reported at the end of breastfeeding one’s first child influence breastfeeding initiation with a second child. Methods Data from 174 multiparas who participated in the Infant Feeding Practices Study II, breastfed their first child, and completed the Year 6 Follow Up were analyzed using exact logistic regression. Results Mothers who reported experiencing trouble with the first baby’s suck or latch had lower odds of initiating breastfeeding (OR 0.15, 95% CI 0.04–0.56) than those who did not report this experience, whereas mothers who agreed that breastfed children are less likely to become obese had greater odds of initiating breastfeeding with a second child (OR 11.49, 95% CI 1.56–513.18) than those who did not agree. Discussion Efforts to facilitate breastfeeding initiation among multiparas may consider mothers’ previous experiences and beliefs associated with breastfeeding. Strategies to facilitate initiation may focus on addressing barriers mothers experienced while breastfeeding their first child and increasing awareness about how breastfeeding may prevent childhood obesity. Future research should explore how such approaches may impact breastfeeding outcomes with subsequent children.     

‘As good as chocolate’ and ‘better than ice cream’: how toddler,and older,breastfeeders experience breastfeeding

The breastfeeding experiences of 114 Australian children who were currently breastfeeding were explored via maternal observation and direct questioning of the children. Mothers commonly stated that their child breastfed for comfort and this opinion was validated by observations of when the children breastfed, which was often in the transition to sleep or when the child was upset. Children stated that they liked breastfeeding and that they felt happy, good or nice when they breastfed. Children expressed that they liked the taste of breastmilk and compared the flavour to a wide variety of foods. Conversations with the children revealed that they had learnt significant information about breastfeeding. Breastfeeding role‐play was often involved in this learning and it is proposed that this learning should be valued. This study is the first examination of breastfeeding from the viewpoint of children, who are the actual breastfeeders, and provides insight into their practices and motivations.     

Exploratory survey of fifth-grade elementary students in relation to breastfeeding

The present study assessed the knowledge, perceptions, beliefs, and experiences related to breastfeeding as expressed by 564 fifth-grade students (both boys and girls). A questionnaire was used, containing 25 objective questions. The t test and chi-squared test were used, based on cluster sampling. The students consistently viewed maternal breast milk as the best food for infants, although only 60% would choose exclusive breastfeeding for their own children. Fewer than 20% replied that children could be breastfed until two years of age. Approximately one-fourth believed that infants should begin receiving other foods at 6 months of age, and 80% also believed in the need for tea and water. Other beliefs included: that breast milk is weak or thin; that tea is good for infant colic; that breastfeeding makes the breasts flaccid; that breast size influences the amount of milk; and that breastfeeding should be interrupted as soon as the infant's first teeth appear. They highlighted the importance of the father participating in the breastfeeding process, but 70% said that the father could help by giving the baby a bottle. There is also an evident need for primary schools to promote measures for a more favorable position towards breastfeeding.     

Breast feeding practices among health care professionals in a tertiary care hospital from South India

Personal breastfeeding experiences of health care professionals play a major role in influencing their attitudes and expertise regarding counseling and managing breastfeeding issues in patients. This study was done with an objective of studying the current breastfeeding practices among health care professionals (HP) and their spouses and the factors influencing them. All children < 5 years of age, residing in hospital's residential quarters, were included. A detailed breastfeeding history demographic data were obtained following a semi-structured interview with mothers. Among 81 children included for analysis, in 73 children (90.1%), an initiation of breastfeeding was within 24 hours of birth and in 36 children (44.4%), it was within first hour of life. 43 children (58.1%) were exclusively breast fed for 6 months. Mean duration of EBF was 5.3 months and total duration of breastfeeding was 13.2 months. Gender of HP, gender of the child and socio-economic factors were not found to significantly affect breastfeeding practices among HP.     

Breastfeeding in the industrialized world. Review of the literature

Since the Industrial Revolution there has been an almost continuous decline in breastfeeding in North-America and western Europe. But the last years numerous studies report that breastfeeding is regaining popularity. The social forces responsible for this are a back-to-nature movement, ecological concerns, breastfeeding support groups and a renewed interest by scientists, the health profession and national and international organizations. Many determinants of child feeding behaviour have been analyzed extensively: ethnic and cultural background, socioeconomic and employment status, maternal (age, parity, marital status) and child (sex, birthweight) characteristics, maternal knowledge and attitudes, health care management. Still the relative influence of these factors can only be estimated, partly because of a lack of an accurate methodology. The reasons mentioned with regard to weaning often indicate a lack of confidence intensified by deficiencies in information and support systems. The negative influence of the infant food industry on breastfeeding behaviour cannot be disregarded. Clearly the promotion of breastfeeding in our society is a policy matter, requiring positive action in the field of health education; legislation, research and the reorganization of health services.     

我国城市产妇母乳喂养知识 态度与喂养行为的关联研究

目的了解我国城市产妇母乳喂养的知识、态度,探讨母乳喂养知识、态度与喂养行为的关系。方法通过自填式问卷了解产妇的母乳喂养知识、态度和喂养行为,比较不同社会人口学特征下母乳喂养知识和态度的差异。通过Logistic回归校正社会人口学特征,评价母乳喂养知识、态度对喂养行为的独立影响。结果产妇母乳喂养知识的平均得分为(8.5±1.5)分,母乳喂养组产妇母乳喂养知识的掌握程度普遍优于混合/人工喂养组,进行早期母乳喂养的可能性随母乳喂养知识得分的增加而增加(OR=1.305)。98.1%的产妇愿意坚持母乳喂养,认为自己能坚持6个月以上的占92.4%,母乳喂养的消极态度将影响母乳喂养行为的实现(OR=0.233)。结论母乳喂养知识和态度是影响早期母乳喂养行为的独立因素。加强孕产期母乳喂养知识的宣传教育,增强产妇母乳喂养的信心,将有利于促进母乳喂养行为的实现。