Mining for liquid gold : an analysis of the language and practices of midwives when interacting with women who are establishing breastfeeding

This thesis reports on a qualitative study of midwifery support for women who are breastfeeding during the first week after birth. In Australia, nine out of ten women initiate breastfeeding, yet the average duration of breastfeeding is well below World Health Organization recommendations. Approximately one quarter of women who commence breastfeeding, cease, or introduce supplemental formula, during the first few weeks after birth. This is a time when midwives are available to provide support. However, women report widespread dissatisfaction with midwifery care during the early postnatal period, particularly hospital-based care. The aim of this study was to examine the nature and impact of the language and practices used by midwives when providing breastfeeding support in the early postpartum period. Identification of the facilitative or inhibitive components of support, as well as insight into the impact on women, can lead to improvements in midwifery practice and inform the education and training of midwives. This study is underpinned by a social constructionist epistemology, situating an understanding of reality within a social and cultural frame. A post structuralist approach informed the methodology and discourse analysis has been used to examine the way in which language and discourse shaped the beliefs and practices of participating midwives, and postpartum women, around breastfeeding. Data were collected from midwives and breastfeeding women at two geographically distant maternity units in New South Wales. This study is based around the observation of midwife-woman interactions during the provision of breastfeeding support in hospital, and, to a lesser extent, in home environments, during the first week after birth. In total, 85 breastfeeding interactions between women and midwives were observed, audio recorded and then transcribed verbatim. Additional perspectives were gathered from participants at 34 individual interviews and four focus group discussions. Nine antenatal breastfeeding education sessions were also observed and audio-recorded, to gain an insight into the language used to describe breastfeeding during pregnancy