Table 3 Summary of the main themes and sub-themes arising from the interviews (n = 29)
Main theme (COMB) | Sub Theme | |
|---|---|---|
Initiating breastfeeding/Initiating formula feeding | ||
Capability | - Physically establishing breastfeeding - Mental toughness | - The very first days are vital as it is so difficult for mothers - Having breastfed before means having more breastfeeding skills to get through the challenges with determination and strength |
Opportunity | - Support and advice - Emotions - Social norms | - Whether the support and advice in hospital is adopted depends upon the individual (inconsistent) and whether nurses are pro-breastfeeding or accept formula feeding - Support from family and friends for choice of feeding mode, previous experience of breastfeeding, choosing to go own way (not influenced by others) - Others in social network are breastfeeding - Negative emotions associated with breastfeeding affect decision to shift to formula |
Motivation | - Desire to breastfeed - Intentions/plans - Beliefs about the consequences (to baby) - Beliefs about the consequences (to mother) - Emotions | - There are benefits to the baby (nutrition and immunity) - Breastfeeding is good for bonding with the baby - It is convenient to breastfeed as no bottles are required - Breastfeeding can be very hard for the mother (e.g., mastitis) - Intentions/plans to breastfeed or formula made during pregnancy or earlier affect decisions about adopted feeding mode - Taking a pragmatic approach to feeding; willingness to use formula if necessary - Negative emotions (e.g., feelings of failure if unable to breastfeed, frustration with nurses, unable to cope with demands of breastfeeding) mean mother is likely to shift to formula feeding - Prior experience affected motivation (positive or negative) |
Prolonging breastfeeding/Replacing breast milk with formula | ||
Capability | - Confidence in ability to continue - Knowledge about benefits to the baby | - Feel confident in knowing how to breastfeed well - Knowledge about health benefits to baby in continuing to breastfeed |
Opportunity | - Work - Social norms | - It is too hard to express breast milk when going back to work - Social judgement and pressure to stop breastfeeding before the child is “too old” |
Motivation | - Plans - Beliefs about benefits for baby - Wanting to do what is best for baby - Convenience/easier | - Plan to breastfeed for a minimum duration - Let the baby decide when he or she wants to stop (self-wean) - Baby has a preference for breastfeeding (does not take a bottle) - Baby’s characteristics affect whether breastfeeding is easy for the mother (e.g., baby pinches, gets teeth) - Breastfeeding is easy, convenient and cheap in comparison to formula |
Best practice formula feeding/Suboptimal formula feeding practices | ||
Capability | - Confidence in ability to formula feed well | - Confidence in ability to formula feed well is high after an initial learning period |
Opportunity | - Advice and support | - There is very little advice available from health professional so information provided on the formula tin is used - Some health professionals are judgemental towards mothers who formula feed and do not provide support - Social norms only influence some mothers |
Motivation | - Motivated to feed well | - Mothers motivated to feed their infant well |
Introducing solids later (at 6 months)/Introducing solids earlier (before 4 months) | ||
Capability | - Knowledge - Confidence | - It is confusing to know when is the best time to introduce solid foods - The baby gives cues and this is the best way to know - Mothers vary in their confidence about knowing when is the right time to introduce solids |
Opportunity | - Advice - Social norms | - There is conflicting and confusing advice about when to introduce solids - Listen to advice but make up own mind about what is best for baby |
Motivation | - Beliefs - Desires | - The 6 month government recommendation is not applicable to me and my baby (it is too broad, should be flexible, not tailored to individual needs) - The baby’s cues are the best indicator of when is the right time to introduce solid foods - Mothers know what is best for their babies - Introducing solids will have the benefit of improving baby’s sleep and alleviate hunger - There is no reason not to introduce solids early |
Introduce healthy first foods/Introduce unhealthy first foods | ||
Capability | - Knowledge - Confidence | - Mother feels that she knows what foods baby should eat in relation to choking hazards, allergies and what is for good digestion - Mother’s confidence in knowledge of what foods to feed baby is affected by experience with solid food feeding, the baby’s weight and happiness, concerns about allergies and choking and whether she received confusing or clear advice - Mothers’ confidence is not necessarily related to her knowledge |
Opportunity | - Advice | - Advice comes from health professionals, friends, family, online and it is inconsistent, confusing and often not practical - Good advice from a health professional is hard to come by - Advice affects mothers’ confidence - Advice online (blogs, Facebook etc.) is very helpful and practical. If mother cannot get good advice from health professionals she looks online - Mothers’ receptiveness to advice is varied with some mothers feeling they did not need advice |
Motivation | - Desires/wants | - Heuristics help inform choice of foods (e.g., homemade food, fresh food, fruits & vegetables, unprocessed foods, no sugar or salt) - Mothers want to feed healthy foods, want to avoid allergenic foods - Want to give baby what s/he wants, take cue from the baby |
Feed to appetite/Use non-nutritive feeding | ||
Capability | - Knowledge - Confidence | - Mother knows how to settle infant without milk/food - Feels confident that settling techniques work - Can accurately read baby’s cues (e.g., hunger or tiredness) |
Opportunity | - Advice | - There is limited advice on settling techniques available to mothers - Advice from health professional is usually provided prior to birth and therefore is not timed with the mother’s need - Mothers seek information from multiple sources (e.g., nurse, family, books.) - There is very little advice available to mothers on how often and how much to feed infants |
Motivation | - Beliefs about the consequences of the behaviour (efficacy) - Beliefs about baby’s needs | - Use whichever techniques work, try various options and see what works (process of deduction) - Feeding to settle works, but tend to use milk as a last resort for settling - There is nothing wrong with feeding to settle - Use the baby’s cues to determine whether to feed, trust the baby’s ability to know when hungry or full - Use a combination of the baby’s cues and the clock to determine whether to feed - Usually try and get the baby to eat/drink a set amount - Mothers usually hadn’t thought about or planned on how they might settle their infant before giving birth |