Table 1: Summary of and data extraction from the 15 papers in the meta-synthesis Author, Year and Country Aims Design and Methodology (In-vivo) themes extracted and analysed Hunter and Magill-Cuerden 2014 UK Explore the ways in which a small group of UK adolescent mothers conceptualise their decisions to breastfeed and experience breastfeeding in their communities. n=15 16-20 years old. Qualitative, interviews or focus groups. Postnatal single interviews/FG. Recruited from parenting groups. 1. Stigma of young motherhood has an effect on bf as mothers feared sanctions and tried harder to perform good motherhood 2. Feeding in public is an issue and private as public with an emphasis on the morality of breast exposure. 3. Paucity of support for bf in their social networks. Tension caused to relationships by bf. 4. Need for approval and forming identity as adults, part of bf. Condon et al. 2013 UK To explore teenagers' experiences of the breastfeeding promotion and support delivered by health professionals. n=29 13-18 years old. Qualitative interviews and focus groups of both pregnant and postnatal (up to two years after birth) women. 1. Bf is not normal to the young mothers social group though it is portrayed as normal by professionals. 2. Lack of support for bf beyond the initial few days. 3. Feeding in public was a problem. Nesbitt et al. (2012) Canada To examine the facilitating influences and barriers to initiating, and continuing breastfeeding, as perceived by adolescent mothers in the area. n=16 15-19 years old. Qualitative semi-structured interviewing in the infants first year. Recruited from clinics and centres via respondent led methods (posters). 1. Bf had an impact on social and intimate relationships. 2. Bf risked public breast exposure. 3 Availability of social support effected bf. 4. Physical demands were a reason to stop bf. 5. Knowledge of breastfeeding practice and benefits affected bf. 6. The maternal perceived sense of comfort effected bf.
Noble-Carr and Bell 2012 Australia To gain an understanding of how, when and where younger mothers want and need to receive breastfeeding information and support. n=24 17-25 years old. Qualitative focus groups. Recruited from local services and groups. All three focus groups were postnatal. No ethics sought! 1. Bf is not normal (cultural norm) 2. Mothers influenced by their partners and family. They also used online/social media support. They attached great importance to informal support networks but did not often seek professional advice. 3. Advice and support were generally perceived to be unavailable or misunderstood. They concluded that information needs to be simpler and timely (given in pregnancy then good, consistent support in the postnatal period). 4. Stigma around young motherhood. 5. Many others felt isolated, especially in hospital. Smith et al. 2012 USA To understand the factors that contribute to the breastfeeding decisions and practices of teen mothers n=5 14-17 years old. Qualitative prospective semi-structured interview study. 3 interviews, one antenatal, one after birth and one two weeks after ceasing to use human milk – tracked for this weekly by phone. Recruited from a YWCA teen program. 1. Milk expression extended the duration of receiving human milk. 2. Family influence was important. 3. Bf in public was an issue. 4. HCP's were quick to introduce formula and there were 'mixed messages on bf'. 5. Pain and dislike of the physical experience was an issue. 6. Negotiation of multiple roles and family dependency. 7. The mothers lacked bf knowledge.
because the vast majority of the participants in this study (Brown et al. 2011) had already ceased to breastfeed (the data was collected at 6-24 months after birth) and may be subject to recall bias or because the participants who had successfully breastfed had worked to overcome embarrassment at feeding in public. Further, incidents of dissonance allowed me to identify areas for further research. For example, three UK studies found that women felt let down after discharge from hospital (Condon et al. 2013, Ingram et al. 2008, Spear 2006); because there was little continued support for breastfeeding after the immediate post-partum period. Conversely, six studies, including two of the former (Noble-Carr and Bell 2012, Condon et al. 2013, Ingram et al. 2008, Nelson and Sethi 2005, Dykes et al. 2003) also found that health care professionals (hcps) were often considered to give impractical, conflicting or unhelpful advice and/or that health care professional advice was rarely sought. This suggests that the relationship between a young mother and her health care provider was influenced by more than the services on offer and the health care professional herself. The third step in the production of the meta-synthesis was to examine the themes which were drawn out by the above compare and contrast exercises and to develop new insights by reading across the findings to produce a "synthesis of translation" (Walsh and Downe 2005). Broadly, the findings of the meta-synthesis were grouped into three main categories or overarching themes. The first was the influences of others on breastfeeding; who and what influence the mother and how and when their input is important. The second overarching theme was the physicality of breastfeeding, pain, sleep and physical work. The third overarching theme was the moral and emotional domains of breastfeeding, all of which are discussed in detail below.
semi-detached two-bedroom house on a crescent of similar houses all with gardens. The garden is well kept; Alfie later tells me that she enjoys gardening. Alfie called me a few weeks after the baby was born and said that everything had gone well but that she had decided not to try breastfeeding when he was born, and therefore she would like to withdraw from the study. We had a brief chat and she seemed quite happy with her decision to bottle feed him and still very excited to be a mother. She said that she didn't know why she had changed her mind, just that it 'felt right' to bottle-feed him immediately after she gave birth. In our first interview they discussed her expectations of breastfeeding: "Alfie: If I can breastfeed, I'll breastfeed, if I can't then I'll bottle feed. (P: OK!) But I might do both." (Antenatal interview, Alfie, Nannan and Phoebe present). Alfie's Nan-nan echoed this sentiment a little later on: "Nannan: It is a good thing, don't get me wrong, to feed them on the breast if you can, it is a good thing. But if you can't..." (Antenatal interview, Alfie, Nannan and Phoebe present). Alfie withdrew from the study after baby James’ birth, so her subsequent experiences about infant feeding are missing. Jessie and baby Lee Jessie is 18 and this is her first baby. She was studying at college, before she left to have her baby. She hopes to return to college when Lee is a bit older. She was born in Eastern Europe and has lived in the UK since she was nine years old. Her partner lives with her and she tells me he is a very supportive father to their son. Her parents support her a lot, and every time I visited her at least two other members of her family were there. She had her own council flat when she was pregnant, but moved back in with her parents before Lee was born. Her parents live in a deprived area of
participant (Deedee) asked me why I hadn't (her midwife had mentioned that I was there as Deedee had told her about the project). I said that I had not wanted to intrude, and she seemed to think this was reasonable though said that it would have been nice "to see a friendly face". Although I always introduced myself as a researcher, the participants seemed to regard me as a midwife. From general conversations they saw the value in the pragmatic goals of the research, basically that I was finding out what helps mums with breastfeeding, but did not perhaps understand either the research process or the role of academic research in practice development. Prior to beginning fieldwork, I had discussed what I would do with my supervisors, should I be asked questions about midwifery care or motherhood by the participants. We decided that I should refrain from making any clinical recommendations but to listen and try to signpost the participant to the most relevant service (e.g. midwife or GP). In the end, I was actually asked very few questions about infant feeding. The two direct clinical questions I was asked were about infant care in the extended period. This was perhaps because they all had intensive support from their midwives in the early days. I suggested for each of these questions (one about the development of the spine, another about an eye infection at four months) that they call their GP as these symptoms were outside my professional remit in any case. The clinician-researcher dialectic (Kanuha 2000) Some, if not all, of my analysis and interpretations of data are undoubtedly affected by my professional training and experience. Indeed, as in the introduction to this thesis (pg. 9), the topic itself grew out of observations from my practice and personal experience of breastfeeding mothers. This has positives in that the field was familiar to me, undoubtedly helping me to quickly build rapport with the participants. One concern is that the results may be seen "through the lens" (Allen 2004) of midwifery. Through reflection and discussion I tried to separate my 'midwifery' thoughts from that of a health researcher. Perhaps because my initial training was anthropology followed by several years of working in grass-roots research and support, I found this