Complex decisions : deconstructing best a grounded theory study of infant feeding decisions in the first six weeks post-birth

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Breastfeeding is promoted globally as the optimum method of infant feeding. Despite this, breastfeeding initiation and duration rates differ significantly between and within countries, as well as social and cultural groups. While Australian breastfeeding initiation rates appear high, breastfeeding rates decline quite significantly in the first six weeks. In an effort to implement strategies to increase breastfeeding rates, many research efforts have aimed at identifying factors that predict breastfeeding initiation and duration and/or breastfeeding attrition. These studies have predominantly used quantitative methodologies, and although a number of factors associated with the infant feeding decision have been identified, the mechanisms by which they affect the decision remain unknown. In contrast to quantitative studies, a much smaller amount of qualitative research has explored aspects of the infant feeding experience and has found the experience of breastfeeding to be complex. Rather than simply being an individual act, infant feeding decisions are constructed and practiced within the social milieu in which women live. The purpose of this research was to explore and describe the experiences of women making infant feeding decisions in the first six weeks post-birth. A constructionist grounded theory methodology was used to collect and analyse data. Data were collected through in-depth interviews with thirty-seven women. The women were theoretically sampled in accordance with the principles of grounded theory. In addition to the empirical study, literature focusing on breastfeeding, aspects of the postnatal period and mothering, was used to inform, strengthen and help explain the findings emerging from the empirical data. Four main categories emerged from the data that described what women deemed important to their infant feeding decisions. These categories were 'it's really best to breastfeed', 'it's the unknown', 'its not the only thing going on', and 'everybody's best is different'. The Basic Social Process, which was also the core category, was labelled 'deconstructing best'. The core category 'deconstructing best' linked the categories in a process of decision-making that the women embarked on during this period. It demonstrates the individuality of the experience and provides an explanation as to why trajectories of experience cannot be explicated and predicting outcomes has been unsuccessful. The findings demonstrate that women's infant feeding decisions in the first six weeks post-birth are multifactorial. In contrast to this, hospital policies as well as health professionals' understandings and practices, are generally embedded in the concept that breast is best.
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