The Postpartum Period: Using a Series of Mixed-Methods Studies to Investigate Determinants of Infant Feeding and Maternal Emotional Wellbeing Outcomes

This thesis uses an exploratory multi-methods design to investigate the relationship between postpartum guilt, shame, and both practical and emotional infant feeding experiences. Chapter 1 provides a detailed overview of existing literature, as mapped on to a contextual framework of breastfeeding behaviour. Chapter 2 systematically synthesises existing postpartum literature examining the relationship between guilt, shame, and infant feeding outcomes. Chapter 3 generated workable, academic definitions of infant feeding-specific guilt and shame for use in future research endeavours. Chapter 4 provided quantitative evidence to support theoretically proposed relationships between antecedents, attributes, and consequences of infant feeding-specific guilt and shame, which were generated in Chapter 3. Chapter 5 details a study plan and critical analysis to investigate the role of the mother-midwife relationship in determining perinatal emotional and practical infant feeding experiences. Imposed social distancing restrictions on 23 March 2020, to combat concerns regarding the spread and mortality of the novel COVID-19 respiratory infection, resulted in redirected research efforts to explore psychosocial experiences of new motherhood amidst the COVID-19 pandemic. Chapter 6 provides an overview of rapid response literature, mapped on to a contextual framework of biological, psychological, social, and wider societal factors which place perinatal women at greater vulnerability to the impacts of the COVID-19 pandemic, when compared with nulliparous adults. Chapter 7 explores psychological experiences of new motherhood during the COVID-19 pandemic, while Chapter 8 explores postpartum experiences of social and healthcare professional support. First, thesis works show that guilt and shame should be discussed, managed, and treated as distinct emotional experiences, which have potential to influence breastfeeding outcomes and more costly domains of negative affect i.e., postnatal depression and anxiety. Chapter 7 and Chapter 8 identified specific structural, community, and individual level factors which have contributed towards elevated levels of postpartum distress observed during the early phases of national lockdown restrictions in the UK. Although triggers of emotional distress were different in pre-pandemic and pandemic thesis works, overlap existed which highlighted systemic opportunities for improvement. Namely, greater inclusion of partners in perinatal decision making, and improving quality of healthcare professional and social network support were modifiable and dominant intermediaries of practical and emotional infant feeding experience. In all produced works, emotionally and morally valent breastfeeding promotion was found to be counterintuitive to one’s breastfeeding efforts. Thesis works argue that adopting an incremental approach to breastfeeding goal setting and adopting a more morally neutral stance towards breastfeeding promotion would allow mothers greater autonomy and flexibility to work towards more manageable breastfeeding goals. Moving forwards, research efforts should concentrate on recruiting diverse populations of women, to counteract the frequent over recruitment of White, highly educated women from high socioeconomic backgrounds. Additionally, future research should aim to develop and validate a postpartum-specific psychometric measure of guilt and shame, to aid identification and management of sub-clinical emotional states