Breastfeeding difficulty after caesarean section under regional anaesthesia: A phenomenological study

This study explored the experiences of women with breastfeeding difficulties following a caesarean section under regional anaesthesia. Further, this research aimed to explore the difficulties women experienced initiating and establishing breastfeeding when their babies seemed indifferent or unable to latch to the breast. Caesarean delivery rates have increased progressively in Australia over the last decade creating new challenges for breastfeeding mothers and caregivers. The advantages of breastfeeding to both the mother and baby are well recognised. However, breastfeeding problems are common in the initial postpartum period, particularly with mothers who have had a caesarean section. Despite high breastfeeding initiation rates, duration rates of exclusive breastfeeding continue to fall. An extensive review of the literature revealed that there are a number of factors that lead to difficulties breastfeeding following a caesarean section. These included the effects of caesarean delivery and regional anaesthesia, lack of skin to skin contact, formula supplementation, and inadequate postnatal care on infant behaviour and the initiation, establishment and duration of breastfeeding. However, no qualitative research was identified specifically relating to the lived experience of women having difficulties breastfeeding after caesarean section, identifying a significant gap in the literature. This study explores the lived experience of a group of mothers with breastfeeding difficulties after delivering by caesarean section under regional anaesthesia. The difficulties they were having centred on problems initiating and establishing breastfeeding their babies who seemed indifferent or unable to latch to the breast. Interpretive phenomenology was considered the most relevant approach for this research due to the methodologies ability to produce rich data in order to explore the essence of the lived experience. Purposeful sampling was employed to select eight participants who were interviewed in their homes two to three weeks after birth. Interviews were recorded, transcribed verbatim, and analysed using van Manen’s circular process of hermeneutical writing, underpinned by Heidegger’s hermeneutic V circle of understanding. The hermeneutical circle is a circle of interpretation that moves forward and backward between the parts and the whole. Through this interaction and understanding the data was reflected on and sub themes and themes were identified. Key themes included Unnatural birth, Natural instincts compromised, Helping mothers to mother, and Sabotage and defeat. These themes reflected the mothers’ journey through birth, the baby’s difficulty feeding, postnatal challenges and how the mothers’ felt in response to these challenges. Overall, the data illustrated that the mode of birth can interfere with the normal mechanisms of birth and the intrinsic desire of a baby held skin to skin to effectively latch and suckle. The key findings of the study included the concept that the four themes are bound inextricably together. Unnatural birth causes natural instincts to be compromised. Helping mothers to mother in a sensitive and supportive manner will help those instincts both maternal and infant, to be strengthened. Ensuring only breastmilk is consumed by breastfed infants helps ensure breastfeeding is not compromised and mothers can be assisted in their desire to breastfeed. These findings were further synthesised to create a supportive framework for breastfeeding after caesarean section. Central to this framework is the notion that encouraging and valuing normal birth, supporting the natural instincts of mother and baby and increasing breastfeeding support for mothers who birth by caesarean section is fundamental to midwifery care. These concepts formed the basis of recommendations for changes to midwifery clinical practice that could improve breastfeeding outcomes for women