M E Edwards1, R G Jepson2, R J McInnes3. 1. Centre for Public Health and Population Health Research, Faculty of Health Sciences and Sport, Pathfoot Building, University of Stirling, Scotland FK9 4LA, UK. Electronic address: mee23@btinternet.com. 2. Scottish Collaboration for Public Health Research and Policy (SCPHRP), 20 West Richmond Street, Edinburgh, Scotland EH8 9DX, UK. Electronic address: ruth.jepson@ed.ac.uk. 3. School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, EH11 4BN Scotland, UK. Electronic address: r.mcinnes@napier.ac.uk.
Abstract
OBJECTIVE: to explore women's and midwives' expectations, knowledge and experiences of breastfeeding initiation using Social Cognitive Theory. DESIGN: a qualitative study using focus group discussions and individual interviews. Breastfeeding initiation was defined for this study as a process within the first 48hours after birth. Data were analysed using qualitative inductive analysis then further deductive analysis using Social Cognitive Theory (SCT). SETTING AND PARTICIPANTS: a purposefully selected sample of primigravid antenatal and postnatal women (n=18) and practising midwives (n=18) from one Health Board area in Scotland. FINDINGS: attachment of the baby to the breast at birth was hindered by sleepy babies and the busy unfamiliar hospital environment. These resulted in mothers struggling to maintain their motivation to breastfeed and to develop low self-efficacy. Instinctive attachment was rare. Midwives who considered it was normal for babies to be sleepy and unable to attach or feed at birth did not facilitate instinctive baby behaviour. Midwives sometimes experienced lack of autonomy and environmental circumstances that made women centred care difficult. Furthermore caring for high numbers of women, dependent on their help, resulted in reduced self-efficacy for providing effective breastfeeding support. KEY CONCLUSIONS: interviewing both women and midwives specifically about initiation of breastfeeding has allowed for deeper insights into this critical period and enabled a comparison between the data obtained from mothers and midwives. The findings suggest that instinctive attachment is not an expectation of either mothers or midwives and results in a loss of breastfeeding confidence in both. IMPLICATIONS FOR PRACTICE: to facilitate initiation there is a need for more research to develop appropriate maternal and midwifery skills, and make changes to the cultural environment in hospitals. Social Cognitive Theory could be used as a framework in both the antenatal and immediate postnatal period to develop strategies and materials to increase women's and midwives' self-efficacy specifically in initiation.
OBJECTIVE: to explore women's and midwives' expectations, knowledge and experiences of breastfeeding initiation using Social Cognitive Theory. DESIGN: a qualitative study using focus group discussions and individual interviews. Breastfeeding initiation was defined for this study as a process within the first 48hours after birth. Data were analysed using qualitative inductive analysis then further deductive analysis using Social Cognitive Theory (SCT). SETTING AND PARTICIPANTS: a purposefully selected sample of primigravid antenatal and postnatal women (n=18) and practising midwives (n=18) from one Health Board area in Scotland. FINDINGS: attachment of the baby to the breast at birth was hindered by sleepy babies and the busy unfamiliar hospital environment. These resulted in mothers struggling to maintain their motivation to breastfeed and to develop low self-efficacy. Instinctive attachment was rare. Midwives who considered it was normal for babies to be sleepy and unable to attach or feed at birth did not facilitate instinctive baby behaviour. Midwives sometimes experienced lack of autonomy and environmental circumstances that made women centred care difficult. Furthermore caring for high numbers of women, dependent on their help, resulted in reduced self-efficacy for providing effective breastfeeding support. KEY CONCLUSIONS: interviewing both women and midwives specifically about initiation of breastfeeding has allowed for deeper insights into this critical period and enabled a comparison between the data obtained from mothers and midwives. The findings suggest that instinctive attachment is not an expectation of either mothers or midwives and results in a loss of breastfeeding confidence in both. IMPLICATIONS FOR PRACTICE: to facilitate initiation there is a need for more research to develop appropriate maternal and midwifery skills, and make changes to the cultural environment in hospitals. Social Cognitive Theory could be used as a framework in both the antenatal and immediate postnatal period to develop strategies and materials to increase women's and midwives' self-efficacy specifically in initiation.
Authors: Jeni Hebert-Beirne; Deepa R Camenga; Aimee S James; Sonya S Brady; Diane K Newman; Kathryn L Burgio; Lisa Kane Low; Cecilia T Hardacker; Sheila Gahagan; Beverly Rosa Williams Journal: Qual Health Res Date: 2021-02
Authors: Elisabeth A Stelson; Laura Kulkacek; Rosemary Frasso; Moriah Hall; James P Guevara Journal: Breastfeed Med Date: 2021-05-19 Impact factor: 2.335