Maxine O'Brien

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

AIMS The 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. DESIGN Retrospective case control. METHODS The 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. RESULTS Women 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. CONCLUSIONS This 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 PRACTICE The 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.

Exploring the Influence of Psychological Factors on Breastfeeding Duration, Phase 1: Perceptions of Mothers and Clinicians

Breastfeeding duration rates in Australia are low, prompting a search for modifiable factors capable of increasing the duration of breastfeeding. In this study, participants were asked which psychological factors they believed influence breastfeeding duration. Participants included 3 groups of mothers who had breastfed for varied lengths of time (n = 17), and 1 group of breastfeeding clinicians (n = 4). The nominal group technique was employed, involving a structured group meeting progressing through several steps. Analyses included collation of individual and group responses, group comparisons, and a thematic analysis of group discussions. Forty-five psychological factors thought to influence the duration of breastfeeding were identified. Factors considered most important included the mothers priorities and mothering self-efficacy, faith in breast milk, adaptability, stress, and breastfeeding self-efficacy. In addition to informing the design of phase 2 of this study, these results add to our knowledge of this emerging research area. J Hum Lact. 25(1):55-63.

Identifying Predictors of the Reasons Women Give for Choosing to Breastfeed

The aims of this article are to outline the reasons Australian women give for initiating breastfeeding, identify unique predictors for these reasons, and use principal components factor analysis to determine factors that influence a womans decision to breastfeed. Data were collected as part of a large longitudinal study investigating the breastfeeding behaviors and supports of women in Southern Queensland, Australia. The most common reason women (N = 562) gave for deciding to breastfeed was breast milk is better for my baby (95.5%). Reasons related to the mother such as breastfeeding is more convenient (84.3%) were also popular. Four significant components—mother-related reasons, health effects for the infant, moral and family influences, and advice from others—were determined after principal components factor analysis. As well as health benefits for the infant, convenience and other reasons related to the mother appear to be important factors in an Australian womans decision to breastfeed. J Hum Lact. 23(4):338-344. Los objetivos de este artículo son delinear las razones que las mujeres dan para iniciar la lactancia materna, identificar pronósticos únicos de estas razones y el uso de análisis de componentes principales para determinar los factores que influencian a las mujeres en la decisión de amamantar. Se tomaron datos como parte de un estudio extenso longitudinal para investigar el comportamiento y apoyo a la lactancia materna en mujeres del sur de Queensland, Australia. La razón mas comúnmente mencionada para decidir amamantar de 562 mujeres amamantando durante el estudio fue que la leche materna es lo mejor para mi bebe (95.5%), a pesar de que las razones relacionadas con la madre como que amamantar es mas conveniente (84.3%) fue la mas popular. Cuatro componentes significativos: razones relacionadas con la madre, efectos en la salud del bebe, moral e influencias familiares y consejos de otros fueron determinadas después del análisis de componentes principales. Tanto los beneficios en la salud del bebe como conveniencia y otras razones relacionadas con la madre parecen ser factores importante que la mujer considera en la decisión de amamantar.

Necessity breeds innovation: GPs help prevent an emergency department closure.

In January 2006 the Maryborough Base Hospital in Queensland faced imminent closure of its emergency department (ED) due to a shortage of senior medical staff. At the same time patient confidence in Queensland Health was low. During consultation forums, the community had made it clear that their priority was to maintain emergency services in Maryborough. In search of a solution, the Fraser Coast District Health Service asked Maryborough general practitioners to work in the Maryborough Hospital ED and/or in the internal medicine ward as Visiting Medical Officers. While this represented a solution to the problem, there was much to be considered before such a plan could be put into place.