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Support to breastfeeding women
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

Breastfeeding has important health benefits for mothers and infants in high- and low-income countries. For that reason, the World Health Organization (WHO) recommends exclusive breastfeeding for six months and partial breastfeeding for two years or longer. During pregnancy, a majority of women state that they intend to breastfeed, but they often stop earlier than they want because they face many barriers. Thus, it is important that women get the opportunity to breastfeed as long as they want. 

The overall aim of this thesis was to explore women’s perceptions of what assisted them in breastfeeding and their advice to healthcare professionals regarding breastfeeding support. An additional aim was to evaluate a breastfeeding support programme based on the Ten Steps to Successful Breastfeeding and the WHO’s recommendations on breastfeeding. 

In Paper I, an exploratory qualitative design was used based on the critical incident technique. The main finding was that supporting women to continue breastfeeding is both complex and multifaceted. 

In Paper II, an exploratory qualitative design illuminated that Swedish women advised healthcare professionals to provide up-to-date and evidence-based breastfeeding support in a sensitive and individualised manner to help the mothers to reach their breastfeeding goals. 

In Paper III, a breastfeeding training programme was evaluated using a pre-post design. The programme improved midwives’ and child healthcare nurses’ self-efficacy to provide evidence-based support in line with the Ten Steps to Successful Breastfeeding and the WHO’s recommendations on breastfeeding. 

Paper IV used an exploratory, longitudinal and qualitative design. Specifically, the study showed that partners who participated in the breastfeeding support programme and received structured support felt that both parents were important. They felt involved and that the family cooperated in the breastfeeding process. 

In conclusion, it is crucial to understand families’ perceptions and experiences of breastfeeding when supporting women to breastfeed. Midwives and child healthcare nurses have important roles to play by providing structured breastfeeding support during the breastfeeding process. The whole family must be targeted to decrease the partner’s feelings of being excluded. Both parents must be involved in a reflective dialogue, where healthcare professionals explain how breastfeeding works and how the partner can be involved without bottle-feeding the infant. 

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2023. , p. 104
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1988
Keywords [en]
Breast Feeding, Counselling, Education, Family Support, Health Person-nel, Implementation Science, Infant, Interpersonal Relations, Self-Efficacy, Social Support, Parent-Child Relations, Quality of Health Care, Qualitative Research
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-514578ISBN: 978-91-513-1941-4 (print)OAI: oai:DiVA.org:uu-514578DiVA, id: diva2:1805879
Public defence
2023-12-08, Pandion, Centrum för klinisk forskning i Sörmland, Odlarvägen 8, Mälarsjukhuset, Eskilstuna, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2023-11-17 Created: 2023-10-18 Last updated: 2023-11-17
List of papers
1. Australian, Irish and Swedish women's perceptions of what assisted them to breastfeed for six months: exploratory design using critical incident technique
Open this publication in new window or tab >>Australian, Irish and Swedish women's perceptions of what assisted them to breastfeed for six months: exploratory design using critical incident technique
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2016 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 16, article id 1067Article in journal (Refereed) Published
Abstract [en]

Background

Breastfeeding initiation rates in some developed countries are high (98 % in Sweden and 96 % in Australia) whereas in others, they are not as favourable (46 % to 55 % in Ireland). Although the World Health Organization recommends exclusively breastfeeding for six months, 15 % of Australian women, 11 % of Swedish women and less than 7 % of Irish women achieve this goal. Awareness of what women in different countries perceive as essential breastfeeding support is a gap in our knowledge.

Methods

Our aim was to explore Australian, Irish and Swedish women's perceptions of what assisted them to continue breastfeeding for six months. An exploratory design using critical incident techniques was used. Recruitment occurred through advertisements in local newspapers and on social networking platforms. Initial sampling was purposive, followed by snowball sampling. Telephone interviews were conducted with 64 Irish, 139 Swedish and 153 Australian women who responded to one question "what has assisted you to continue breastfeeding for at least six months?" Content analysis was conducted and common categories determined to allow comparison of frequencies and priority ranking.

Results

Categories reflected the individual mother, her inner social network, her outer social network (informal support either face to face or online), and societal support (health professionals, work environment and breastfeeding being regarded as the cultural norm). Categories ranked in the top five across the three countries were 'informal face to face support' and 'maternal determination'. Swedish and Australian women ranked "health professional support" higher (first and third respectively) than Irish women who ranked 'informal online support' as second compared to ninth and tenth for Swedish and Australian women.

Conclusions

The support required to assist breastfeeding women is complex and multi-faceted. Although common international categories were revealed, the ranking of these supportive categories varied. We must recognize how the cultural context of breastfeeding support can vary for women in differing countries and acknowledge the resourcefulness of women who embrace innovations such as social media where face to face formal and informal support are not as accessible.

Keywords
Breastfeeding, Prevalence, International, Social support, Professional support, Self-efficacy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-307546 (URN)10.1186/s12889-016-3740-3 (DOI)000385305900004 ()27724932 (PubMedID)
Available from: 2016-11-17 Created: 2016-11-17 Last updated: 2023-10-18Bibliographically approved
2. Women's advice to healthcare professionals regarding breastfeeding: "offer sensitive individualized breastfeeding support"- an interview study
Open this publication in new window or tab >>Women's advice to healthcare professionals regarding breastfeeding: "offer sensitive individualized breastfeeding support"- an interview study
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2019 (English)In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 14, article id 51Article in journal (Refereed) Published
Abstract [en]

Background

The World Health Organization recommends exclusive breastfeeding for 6 months followed by continued breastfeeding with complementary food up to 2 years of age or beyond. Few women achieve this recommendation in Sweden, and they often stop breastfeeding earlier than they would like. Investigating women's advice to healthcare professionals is important for the provision of optimal breastfeeding support. The aim of this study was to explore women's advice to healthcare professionals regarding support for continuing to breastfeed for at least 6 months.

Methods

This investigation used an exploratory study design, and a purposive sample of women was recruited between 2015 and 2016 through social media platforms. The work is a follow-up of an earlier study exploring women's perceptions of the factors that assisted them in breastfeeding for at least 6 months. Telephone interviews were conducted with 139 Swedish women who reported that they had breastfed for at least 6 months. Women were asked the question, "Do you have any advice that you would like to give to healthcare professionals regarding breastfeeding support?". The data were analysed using content analysis.

Results

The theme, "Professionals need to offer women sensitive, individualized breastfeeding support to promote a positive breastfeeding experience", describes the women's advice based on five categories: 1) providing evidence-based care, 2) preparing expectant parents during pregnancy, 3) creating a respectful and mutual dialogue, 4) offering individual solutions to breastfeeding problems, and 5) offering practical support.

Conclusions

This study highlights the importance of professionals providing evidence-based breastfeeding support in a sensitive and individualized manner. This consideration is an important prerequisite to strengthening women's self-confidence and assisting them in reaching their breastfeeding goals, which may enhance the positive nature of their breastfeeding experience.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Breastfeeding, Healthcare professionals, Support, Women’sadvice
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-400080 (URN)10.1186/s13006-019-0247-4 (DOI)000513520300002 ()31889974 (PubMedID)
Available from: 2019-12-18 Created: 2019-12-18 Last updated: 2023-10-18Bibliographically approved
3. Breastfeeding training improved healthcare professional's self-efficacy to provide evidence-based breastfeeding support: A pre-post intervention study
Open this publication in new window or tab >>Breastfeeding training improved healthcare professional's self-efficacy to provide evidence-based breastfeeding support: A pre-post intervention study
2023 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 125, article id 103794Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe healthcare professional's (HCP's) perceived self-efficacy in their ability to provide breastfeeding support before and after a breastfeeding training program.

DESIGN: Pre-post intervention study.

SETTING: Antenatal care and child healthcare (CHC) centres in Sweden during 2020.

PARTICIPANTS: An intervention group consisting of 39 HCPs (midwives 51.3%, child healthcare nurses 46.2%) completing a questionnaire at baseline and after intervention, and a control group of 34 HCPs (midwives 61.8%, child healthcare nurses 38.2%) completing a questionnaire at baseline.

INTERVENTION: A breastfeeding training program in line with the Ten Steps to Successful Breastfeeding and WHO recommendations about breastfeeding.

MEASUREMENTS AND FINDINGS: The 11-item Breastfeeding Support Confidence Scale (BSCS) measures HCP's self-efficacy regarding providing breastfeeding support in line with Ten Steps to Successful Breastfeeding and WHO recommendations. The intervention group experienced a significantly increased self-efficacy from pre-intervention to post-intervention for 8 of the 11 BSCS items, with the overall BSCS index score increasing from 36.87 to 39.56 points (p = 0.001). The index score in the intervention group at follow-up was significantly higher than the corresponding score in the control group at baseline (p = 0.025). The intervention group had significantly higher scores at follow-up than the control group at baseline on the questions: "I'm sure that I can help mothers continue to breastfeed even if the infant doesn't follow the growth curve" (p = 0.026) and "I'm sure that I can help mothers continue to breastfeed when the breastfeeding is painful" (p = 0.048).

KEY CONCLUSIONS: The breastfeeding training program improved HCP' self-efficacy to provide evidence-based support to breastfeeding mothers.

IMPLICATIONS FOR PRACTICE: This training program is well suited to implement in clinical practice and follows the Ten Steps to Successful Breastfeeding.

TRIAL REGISTRATION: ACTRN12623000648628.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Breastfeeding, Healthcare professionals, Intervention study, Self-efficacy, Support, Training
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-513106 (URN)10.1016/j.midw.2023.103794 (DOI)001071312900001 ()37660540 (PubMedID)
Available from: 2023-10-03 Created: 2023-10-03 Last updated: 2023-10-18Bibliographically approved
4. Partners’ Experiences of Breastfeeding: A Qualitative Evaluation of an Intervention
Open this publication in new window or tab >>Partners’ Experiences of Breastfeeding: A Qualitative Evaluation of an Intervention
(English)Article in journal (Refereed) Submitted
Abstract [en]

Background

The World Health Organization states that women and their families need breastfeeding support from the healthcare system. However, knowledge about the most effective way to involve the partner in breastfeeding is lacking. A qualitative evaluation can provide insight and knowledge about the partner’s experiences towards a breastfeeding support intervention and thus contribute to how forthcoming breastfeeding support policies are designed. The aim of this study was to explore partners’ experiences regarding breastfeeding.

Methods

An exploratory, longitudinal and qualitative design was used. Partners in an intervention group (IG) and control group (CG) participated in interviews or wrote diaries during pregnancy and two months after birth. The intervention was performed in line with the Ten Steps to Successful Breastfeeding. Partners in the IG were part of a structured breastfeeding support programme. An individual breastfeeding plan was established in cooperation with the parents-to-be during pregnancy, and the plan was followed up at the child healthcare centre. A purposive sample was recruited from March to December 2021. Interviews and diary entries from 16 Swedish partners (8 IG and 8 CG) were analysed by content analysis, in accordance with the COREQ guidelines.

Results

Partners’ experiences can be summarised under the main category of ‘Striving to be part of the family and important that the family’s everyday life was well-functioning’. IG partners experienced that both parents were involved and cooperated in the breastfeeding process and that guidance from healthcare professionals (HCPs) helped them to feel secure. CG partners experienced feeling excluded and not receiving support from HCPs.

Conclusion

Both parents need to be targeted in breastfeeding support policies to meet the support needs. Midwives at antenatal care and child healthcare nurses at the child healthcare centre have important roles to play in providing structured breastfeeding support and a breastfeeding plan. Both IG and CG partners strived to become a part of the infant’s life and to make family life work. Midwives should involve both parents in a reflective dialogue on how the partner can be involved, apart from just feeding the infant.

Keywords
Breastfeeding, Experiences, Infant, Intervention, Partner, Qualitative methods, Support
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-514575 (URN)
Available from: 2023-10-18 Created: 2023-10-18 Last updated: 2023-10-27

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