How are babies fed? A pilot study exploring primary school children's perceptions of infant feeding.

BACKGROUND: Breastfeeding is the optimal feeding method for human infants. In the United Kingdom some women do not initiate breastfeeding, and many commence formula milk feeding after a brief period of breastfeeding. Infant feeding perceptions may develop early in life, and this research aimed to explore infant feeding awareness among primary school children as a first step toward informing appropriate health education interventions. METHOD: Fifty-six children aged 5/6, 7/8, and 10/11 years were recruited from three schools in southern England. Children were shown a series of drawings, and were read a story about a hungry newborn baby. A creative method, "draw, write and tell," was developed for this research. Children were asked to finish the story, showing how they thought the baby might be fed. They were given the opportunity to verbally interpret their work. A constant comparison method was used to analyze the data. RESULTS: Children were aware of formula milk, breastfeeding, and solid foods. Formula milk feeding was referred to more frequently than breastfeeding. Some children combined feeding methods. Children appeared to have gained their awareness in various settings. CONCLUSIONS: Children have a range of perceptions around infant feeding. They appear receptive to new ideas on the subject while of primary school age. An opportunity for education in primary schools arises to present breastfeeding to children as a normal way to feed a baby, but it is vital that education is evidence based and any interventions are evaluated.

Calling, permission, and fulfillment: the interembodied experience of breastfeeding.

Drawing on examples from in-depth interviews with 49 women, in this article we aim to open up a discursive space for women and health professionals to begin to explore the phenomenon of the interembodied experience of breastfeeding. Although acknowledging that social dimensions partially constitute the lived body, we further the view that the lived body's understanding is embedded in contexts far more complex than those that can be represented by language. We argue that women's narratives of their breastfeeding experience contained instances of the body "understanding" its emotional task at a prelogical, preverbal level. We identified three central, iterative dimensions of the phenomenon­calling, permission, and fulfillment­that occurred prereflexively in the protected space provided by the mother, a space that was easily disrupted by unsupportive postnatal practices. We offer this eidetic understanding and conceptual framework and suggest that it provides new (less damaging) subject positions and ways of behaving.

Commercialisation and commodification of breastfeeding: video diaries by first-time mothers.

BACKGROUND: Many of aspects of our lives became increasingly commercialised in post-modern society. Although breastfeeding is perhaps a late comer to this process in recent years, it too has seen significant commercialisation facilitated by social media and our obsession with celebrity culture. This paper explores how the commercialisation and commodification of breastfeeding impacts mothers' experiences of breastfeeding. METHODS: In a qualitative study, five mothers in the United Kingdom recorded their real-time breastfeeding experiences in video diaries. Using a multi-modal method of analysis, incorporating both visual and audio data, a thematic approach was applied. FINDINGS: Women preparing for breastfeeding are exposed to increasing commercialisation. When things do not go to plan, women are even more exposed to commercial solutions. The impact of online marketing strategies fuelled their need for paraphernalia so that their dependence on such items became important aspects of their parenting and breastfeeding experiences. CONCLUSIONS: The audio-visual data demonstrated the extent to which "essential" paraphernalia was used, offering new insights into how advertising influenced mothers' need for specialist equipment and services. Observing mothers in their video diaries, provided valuable insights into their parenting styles and how this affected their breastfeeding experience.

Parental distress around supplementing breastfed babies using nasogastric tubes on the post-natal ward: a theme from an ethnographic study.

There is abundant evidence of the benefits of breastfeeding. In the UK, supplementation in hospital has consistently been shown to be associated with shortened duration of breastfeeding. This paper reports on a subset of the data from an ethnographic study that explored the expectations, beliefs and experiences of mothers and health professionals concerning supplementation, using a variety of methods, of breastfed babies in an English maternity unit in 2002. This paper aims to describe the expectations, beliefs and experiences of mothers and health professionals concerning supplementation by nasogastric (NG) tube on the post-natal ward. Participant observation was carried out on day and night shifts and at weekends over 9 months. Mothers, midwives, neonatal nurses, health care assistants and senior paediatricians were interviewed. Categories and themes were generated. The researchers' constructs of 'the essential method', when the tube was the method needed for medical reasons, and 'the chosen method', when other methods of oral feeding should have been possible, emerged. The latter included time pressures and the avoidance of any form of oral activity that might perhaps make return to the breast more difficult. The data concerning the use of NG tubes for supplementation yielded the specific theme of parental distress. In the absence of evidence that supplementation by NG tube on the post-natal ward is associated with greater breastfeeding success than other methods, the use of the tube to avoid any form of 'oral confusion' should be discontinued. Its use primarily to save time should not be considered acceptable.

'Scrutinised, judged and sabotaged': A qualitative video diary study of first-time breastfeeding mothers.

OBJECTIVE: To explore how support impacted on mothers' breastfeeding experiences in the first few weeks following birth. DESIGN: A qualitative approach explored real-time experiences of breastfeeding captured by five first-time mothers in the South of England on camcorder as video diaries. A multi-dimensional approach involving thematic analysis ensured both the audio and visual elements of the data were analysed. FINDINGS: Mothers felt 'under surveillance' by the biomedical approach to support from the healthcare team. At best mothers felt reassured that they were 'on the right track'. When mothers felt their breastfeeding was constantly being examined, criticised and threatened they felt 'scrutinised, judged and sabotaged'. When they found it difficult to access healthcare support, or they avoided it altogether to circumvent further scrutiny, they felt 'abandoned and alone'. KEY CONCLUSIONS: Collecting audio-visual data in real-time adds fresh insights into how support impacts mothers' experiences of breastfeeding. The biomedical approach to support for breastfeeding is not effective. Scrutinising, judging and/or sabotaging mothers' attempts to breastfeed can have long-lasting effects on maternal emotional wellbeing. IMPLICATIONS FOR PRACTICE: Breastfeeding support might be improved by adopting a more social model of care. Future research needs to explore how relationship-based support can be provided by the health service.

The therapeutic role of video diaries: A qualitative study involving breastfeeding mothers.

BACKGROUND: Despite breastfeeding providing maximum health benefits to mother and baby, many women in the United Kingdom do not breastfeed, or do so briefly. PURPOSE: Using tenets of ethnography, this study aimed to explore the everyday experiences of first time breastfeeding mothers in the early weeks following birth. METHODS: Using a camcorder, five mothers in the United Kingdom captured their real-time experiences in a video diary, until they perceived their infant feeding was established. Using a multidimensional approach to analysis, we examined how five mothers interacted with the camcorder as they shared their emotions, feelings, thoughts and actions in real-time. FINDINGS: Mothers recorded 294 video clips, total recording time exceeded 43h. This paper focuses on one theme, the therapeutic role of the camcorder in qualitative research. Four subthemes are discussed highlighting the therapeutic impact of talking to the camcorder: personifying the camcorder; using the camcorder as a confidante; a sounding board; and a mirror and motivator. CONCLUSION: Frequent opportunities to relieve tension by talking to "someone" without interruption, judgement or advice can be therapeutic. Further research needs to explore how the video diary method can be integrated into standard postnatal care to provide benefits for a wider population.

Women's responses to nausea and vomiting in pregnancy.

OBJECTIVE: To explore women's experiences of nausea and vomiting in pregnancy. DESIGN: secondary (thematic) analysis of data collected by narrative interviews for two wider studies about antenatal screening and about pregnancy for the DIPEx website (www.dipex.org). PARTICIPANTS AND SETTING: A maximum variation sample was recruited throughout the UK. Data from the 73 women interviewed have been analysed. Interviews took place between October 2003 and December 2004, mostly in the home. FINDINGS: sickness is considered a typical and almost inevitable feature of pregnancy. Against this backdrop, a new framework for understanding women's responses to nausea and vomiting in pregnancy, and the meanings they attach to it, is suggested: nausea and vomiting as something to be expected, survived, resisted, resented, and acknowledged by others. KEY CONCLUSIONS: The concepts of loss of self and biographical disruption from the field of chronic illness seem to resonate with the women's experiences, and may perhaps be extended to transient as well as chronic health conditions. People's experiences of their bodies in health as well as illness need to be more widely studied. IMPLICATIONS FOR PRACTICE: Many women would appreciate greater acknowledgement of the distress nausea and vomiting in pregnancy causes them, information about remedies and strategies other women have found helpful, and reassurance. Expressions of empathy by health-care professionals are frequently lacking and particularly desired.

The theory of agency and breastfeeding.

OBJECTIVE: In this paper, we apply psychological agency theory to women's interviews of their breastfeeding experiences to understand the role of agency in relation to breastfeeding initiation, maintenance and duration. DESIGN: Qualitative, video interviews were collected from 49 women in the UK from a wide range of ethnic, religious, educational and employment backgrounds about their breastfeeding experiences. We undertook secondary analysis of the data focusing on their accounts of vulnerability and agency. FINDINGS: Women's agency was impacted by a variety of factors including their own vulnerability, knowledge, expectations and experience, the feeding environment and the support of health professionals in sharing decision-making and dealing with uncertainty. CONCLUSION: Health professionals as co-agents with women are well positioned to maintain, enhance or restore women's sense of agency. Breastfeeding goals should be included in women's birth plans. Training related to agency, continuity of care, and staffing and workload management supported by national breastfeeding policies could improve breastfeeding rates and experiences.

'Just a bystander'? Men's place in the process of fetal screening and diagnosis.

Despite increasing research into men's experience of pregnancy and fatherhood, experiences of men whose partner is undergoing fetal screening and diagnosis have been less well-studied. This paper begins to fill a gap in the literature by identifying several potentially conflicting male roles in screening, diagnosis and subsequent decision-making. Drawing on a wider qualitative study in the UK of experiences of antenatal screening, it is suggested men may play inter-linked roles: as parents, bystanders, protectors/supporters, gatherers and guardians of fact, and deciders or enforcers. These may be roles they have chosen, or which are assigned to them intentionally or unintentionally by others (their female partner, health professionals). Men's status and feelings as fathers are sometimes overlooked or suppressed, or may conflict with their other roles, particularly when screening detects possible problems with the baby. The paper concludes by discussing these findings in the context of the wider literature on men and pregnancy.

The cup-versus-bottle debate: a theme from an ethnographic study of the supplementation of breastfed infants in hospital in the United kingdom.

This article reports 1 theme from an ethnographic study that aimed to describe the experiences, expectations, and beliefs of mothers and health care professionals concerning supplementation in a UK maternity unit. Observation was conducted on the postnatal ward and the newborn infant unit, and 30 mothers, 17 midwives, 4 neonatal nurses, 3 health care assistants, 3 senior house officers, and 3 senior pediatricians gave in-depth interviews during a 9-month period in 2002. One of the major themes that emerged was the cup-versus-bottle debate. There were 3 categories strongly linked to this theme: difficulties returning to the breast, ease of use, and necessary skills and knowledge. It appears there is an urgent need to determine which is the best method of giving supplementary feeds, so that full, accurate information can be given to mothers, appropriate policies be devised, and the necessary resources and staff training be provided.

Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study.

BACKGROUND: The long-term effects of pregnancy and lactation on measures of bone mineral in women remain unclear. OBJECTIVE: We studied whether pregnancy or lactation has deleterious long-term effects on bone mineral in healthy women. DESIGN: We measured bone mineral density (BMD; g/cm(2)) in women aged > or = 18 y. Analyses were performed on 3 data sets: study 1, 83 female twin pairs (21 monozygous and 62 dizygous) aged (x +/- SD) 42.2 +/- 15.5 y who were discordant for ever having been pregnant beyond 20 wk; study 2, 498 twin pairs aged 42.3 +/- 15.0 y; and study 3, 1354 individual twins, their siblings, and family members. RESULTS: In study 1, there were no significant within-pair differences in unadjusted BMD or BMD adjusted for age, height, and fat mass at the lumbar spine or total-hip or in total-body bone mineral content (BMC; kg) (paired t tests). In study 2, there was no significant within-pair difference in measures of bone mineral or body composition related to the within-pair difference in number of pregnancies. In study 3, subjects with 1 or 2 (n = 455) and > or = 3 pregnancies (n = 473) had higher adjusted lumbar spine BMD (2.9% and 3.8%, respectively; P = 0.001) and total-body BMC (2.2% and 3.1%; P < 0.001) than did nulliparous women (n = 426). Parous women who breast-fed had higher adjusted total-body BMC (2.6%; P = 0.005), total-hip BMD (3.2%; P = 0.04), and lower fat mass (10.9%; P = 0.01) than did parous non-breast-feeders. CONCLUSION: We found no long-term detrimental effect of pregnancy or breast-feeding on bone mineral measures.

Supplementing breast-fed babies in the UK to protect their mothers from tiredness or distress.

OBJECTIVE: To explore mothers' and healthcare professionals' beliefs, expectations and experiences in relation to supplementation of breast feeding in the postnatal ward and newborn-baby unit. DESIGN AND METHOD: A qualitative study using an ethnographic approach which involved participant observation and interviews. Analysis of the observation data informed who would be approached for interview and interviews also guided further observation work. Categories and themes were generated from the field notes and interviews. SETTING: A maternity unit in the South of England using six methods of supplementary feeding. PARTICIPANTS: 30 mothers, 17 midwives, four neonatal nurses, three paediatricians, three senior house officers and 3 healthcare assistants were interviewed in the postnatal ward and newborn-baby unit over a period of nine months in 2002. FINDINGS: A major theme was the healthcare professionals' desire to protect the mothers from tiredness or distress, although this at times conflicted with their role in promoting breast feeding. The categories 'protecting the mother from guilt', 'making it easy to give up' and 'protecting the mother from distress' were linked to this theme. Sometimes midwives suggested supplementation because they perceived mothers to be tired, sometimes mothers themselves made the request. Thus the researcher constructs of 'midwife led' and 'mother led' supplementation emerged. KEY CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Healthcare professionals need to be aware that they may not be helping mothers in the longer-term when supplementation is used as a quick 'solution' to a mother's tiredness or distress. However, other strategies such as providing emotional support or role modelling 'settling' skills are time consuming and have resource implications for the maternity services.

Postnatal vaginal bleeding problems and General Practice.

OBJECTIVES: to investigate women's experiences of problems with vaginal loss from 28 days to three months postnatally and to describe the treatment and referral patterns for women who consult their GP about such problems during the first three months postnatally. DESIGN: a longitudinal questionnaire study of consecutively delivered postnatal women and a report-card survey of GP consultations by women with problems with postnatal vaginal loss. SETTING: two health districts in the south of England. PARTICIPANTS: women delivering in the two health districts during specified recruitment periods in 1995 and 1996. For the GP study, with her consent, the GP returned an anonymous registration card for each woman presenting. FINDINGS: in the survey of women, 20% (64/325) reported problems with postnatal loss occurring between 28 days and three months after the birth. Around a half of these consulted a GP. The GP study was disappointing in that only 26% (30/115) of practices agreed to take part and 16% (18/115) returned notification cards. Forty-eight women were included from 18 practices. The most common presenting symptoms were excessive bleeding (29/48; 60%) and prolonged bleeding (26/48; 54%). The commonest form of treatment was antibiotics alone (15/48; 31%) but 12 women (25%) were neither treated nor referred. Referral (n=19) was for hospital admission, out-patient appointment or direct referral for an ultrasound scan. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: morbidity related to abnormalities of postnatal vaginal fluid loss (lochia) has been shown to be significant, yet nothing was known about the outcome of related GP consultations during the first three months postnatally. A variety of treatment and referral patterns were revealed, highlighting the need for a systematic review of the literature on the management of secondary postpartum haemorrhage. Health care workers need to be aware of the significant morbidity experienced by postnatal women in relation to their lochial loss.

An evaluation by focus group and survey of a course for Midwifery Ventouse Practitioners.

OBJECTIVE: to evaluate the Midwifery Ventouse Practitioners' (MVPs) Course and the MVPs' perception of its effect on their practice. DESIGN: qualitative and quantitative. PARTICIPANTS: 18 midwives who had completed the MVP course at Bournemouth University 1998-2000. DATA COLLECTION: focus group (n=8) and postal questionnaire (n=18). FINDINGS: important issues were identified by the focus group and informed the development of the questionnaire which achieved a 100% response rate. The mean length of full-time experience as a midwife was 18.6 years (SD 6.8; range 9-33); 11 midwives were based in community maternity units and seven in consultant units. Seventeen of the MVPs had been called to assist 505 women in this capacity; 366 (72%) had an MVP ventouse-assisted birth, 129 (26%) a normal birth and 10 women (2%) needed obstetric assistance. In this regard, there were considerable differences between individual MVPs. The midwives gave high priority to woman-centred values and to the very judicious use of intervention. They felt that the course had increased their confidence in relation to their midwifery practice, in general, and their ability to define fetal position and station, in particular. They reported a high level of confidence when undertaking their first ventouse birth after completing the course. KEY CONCLUSIONS AND IMPLICATIONS: midwives who have undertaken this course do not appear to expand their role to the detriment of normal midwifery, as had been feared. Even highly experienced midwives value increasing their confidence in relation to vaginal and abdominal examination. Ambulance transfer in the second stage of labour was prevented for at least 109 women. A long-term clinical evaluation of the births to which an MVP has been called is needed.

An evaluation of a support group for breast-feeding women in Salisbury, UK.

OBJECTIVE: To evaluate a newly set-up breast-feeding support group. SETTING, PARTICIPANTS, DESIGN AND ANALYSIS: Lay 'Bosom Buddies' were trained, and ran a weekly drop-in group with a breast-feeding counsellor and a midwife in a socio-economically disadvantaged housing estate. During the first 31 weeks, 53 breast-feeding women attended and consent was sought to send an anonymous postal questionnaire six weeks after their first attendance. Content analysis and descriptive statistics have been used. FINDINGS: The response rate to the questionnaire was 87% (45/52) with 76% of respondents (34/45) reporting that they were still breast feeding. Only four women had discontinued for the reason for which they had initially attended the group. While the greatest value of the group was considered by the women to relate to its function in supporting breast feeding, 46% (141/305) of the aspects identified by them as being 'good' related to issues of a predominantly psychosocial nature. Of the women sent questionnaires 38% (20/52) came from areas with high or medium unemployment. KEY CONCLUSIONS: This group appears to be highly successful in supporting women to continue to breast feed for at least six weeks following their first attendance. It also appears to provide psycho-social benefits.

Expressionists of the twenty-first century: the commodification and commercialization of expressed breast milk.

Breast milk expression has been promoted as liberating for women and as offering them more choices, but there has been little research on women's experiences of it and even less critical commentary on the consequences of its incorporation into mainstream behavior. Drawing on narratives of women in the United Kingdom about breastfeeding, we explore the increasingly popular practice of expressing and feeding expressed breast milk. We argue that breast milk has become commodified, breastfeeding commercialized and technologized, and the mother-infant relationship disrupted. We suggest that breastfeeding as a process is being undermined by vested interests that portray it as unreliable and reconstruct it in artificial feeding terms, so playing on women's insecurities. The major beneficiaries of expression are fathers who want increased involvement in infant care and commercial enterprises that aim to maximize profits for shareholders.

When baby's chronic illness and disability interfere with breastfeeding: women's emotional adjustment.

OBJECTIVES: to explore the emotional adjustments that women make when their baby's chronic illness or disability threatens breastfeeding. METHODS: qualitative descriptive study and exploratory secondary analysis of narratives from five breastfeeding women in the UK whose babies experienced a chronic condition. FINDINGS: three key themes were discerned: (1) 'Overwhelmed'--feelings of shock and helplessness. Engagement in the practical issues of breastfeeding, relying on others and receiving emotional support from them helped. (2) 'Under acknowledged'--women spoke of not being listened to or taken seriously. Focus on the medical condition de-valued the contribution of breastfeeding. (3) 'Striving for normality'--reframing the situation and readjusting goals and expectations helped adjustment to a 'normal' life. DISCUSSION: varying levels of emotional adjustment were experienced by the women, and a process or path reflected their efforts to cope. Adjustments are discussed in terms of practical issues of coping and biographical disruption, thereby raising awareness of challenging aspects. Breastfeeding provided a sense of control and purpose. Understanding issues around breastfeeding an ill or disabled child can help health-care providers offer more appropriate care to women who wish to breast feed in spite of chronic illness.

Moral work in women's narratives of breastfeeding.

Women's narratives of their breastfeeding experiences are sites of construction and reconstruction of self as they undertake moral work in relation to feeding their baby. We engaged Foucault's 'technologies of the self' and his notion of ethics (the relationship with self) to examine that moral work (individual actions rather than adherence to universal moral codes) in relation to women's subjectivity constructed in interviews with 49 women from the UK. Four categories of moral work were identified: biographical preservation, biographical repair, altruism and political action. We describe each of these and conclude that women's embodied experience and sense of self are disciplined within current, limited, often punishing discourses by undertaking painful moral work in order to maintain or repair their subjective positions. We suggest the development of new subject positions around infant feeding practices.

Achieving normality: the key to status passage to motherhood after a caesarean section.

OBJECTIVE: to explore women's experiences of caesarean section. DESIGN: a qualitative study using a grounded theory approach. Data were collected using unstructured, tape-recorded interviews which took place between 1999 and 2000. SETTING: the South West of England. PARTICIPANTS: twenty-one women who had experienced a caesarean section-either by choice or of necessity-and who were first- or second-time mothers. FINDINGS: four main categories emerged: expectations and reality, being in control, feelings of failure as a woman and feeling different. These all linked to the core category of achieving normality. Women strove to achieve normality after having a caesarean section. If they did not gain this sense of normality, the status passage to motherhood appeared to be more difficult. IMPLICATIONS FOR PRACTICE: it is important for health-care professionals to identify and acknowledge the emotional and physical needs of women who experience a caesarean section. Improving communication and support antenatally and postnatally may have positive benefits for maternal well-being.