Methods: This mixed-methods study was part of a longitudinal project (“Neuroendocrine Pathophysiology in Postpartum Depression and Lactation Failure” ). We recruited a purposive sample of 20 women (10 with antenatal depression and 10 without) from the convenience sample of 50 women with intent to breastfeed recruited for the larger study. In-depth interviews were completed postpartum (10-12 weeks), including survey data on mood, support, stress, and breastfeeding self-efficacy and qualitative data on perceptions of breastfeeding and PND, stressors, social support, resources, and breastfeeding experiences, goals, and success. Interviews were digitally recorded and transcribed verbatim. Transcripts were checked for accuracy. Data was managed using NVivo7. Qualitative data analysis followed a predetermined and emergent theme iterative approach. Two coders analyzed 20% of transcripts and developed codebooks through consensus. Intercoder reliability was regularly conducted. Emergent codes were incorporated into codebooks. Reports were produced for coding categories. Patterns and themes were derived through consensus. Expert consultants informed codebook development/interpretation of findings. Analysts reviewed transcripts for contradictory findings and data triangulation. Multiple coders increased reliability and validity.
Results: Several prominent themes emerged. Antenatal breastfeeding expectations were closely tied to expectations postpartum. Mothers with a prior pregnancy or realistic information about breastfeeding reported more positive breastfeeding emotions. Primiparous women who received little or unrealistic information reported more negative breastfeeding emotions. Mothers with adequate social support felt more confident in their breastfeeding and parenting and were able to navigate difficulties more easily than mothers without adequate support. Mothers had a variety of breastfeeding difficulties. However, most reported enjoying breastfeeding. Performance insecurity was another theme, although this occurred less among women with previous pregnancies and more realistic breastfeeding expectations. Help-seeking and social support were associated with perceptions of breastfeeding success. Women sought help with difficulties, but many felt shame if they were unable to breastfeed easily. Help-seeking behavior increased mothers' feelings of success. Many wanted more information antenatally. Lactation consultants and obstetricians were perceived as helpful resources. Family members and new mothers' groups were seen as important supports. Mothers felt breastfeeding support groups could address many challenges including technical difficulties, appropriate expectations, and support. Mothers with PND appeared less resilient in coping with breastfeeding challenges.
Implications: Findings fill a gap by examining women's perceptions of breastfeeding success and PND. Mothers readily perceived a need for realistic information and support involving breastfeeding across the perinatal period. Mothers with PPD experienced more difficulty with breastfeeding. Implementation of breastfeeding support groups could help address expectations, provide normalizing experiences, provide information, and enhance social support, thereby facilitating positive breastfeeding and postpartum experiences for new mothers