Four group interviews were held yielding eleven women ranging in age from 21–43 years (mean 32.0 ± 6.9) with current or previous breastfeeding experience participated. All women had recently delivered and had infants between the age of three and 10 months. Most women already had children, with the following sample distribution; one child (27.3%), two children (36.4%), three children (18.2%). All women had at least a high school diploma with 63.7% of women having an undergraduate or postgraduate degree, 45.5% had full-time or part-time employment, and all women were white and non-Hispanic. Participant demographics are displayed in Table 2. Women reported the following plans for breastfeeding. Ten women planned to breastfeed prior to delivery and all 10 women initiated breastfeeding in the hospital. Over 70% of women planned to breastfeed for at least one year, however, 30% of women only breastfed for 0–3 months, 20% breastfed for 9–12 months, and 40% were still breastfeeding at the time of the group interview (age nine months). Sixty percent of women introduced formula at some point. Forty percent of women did not feel they met the breastfeeding goal they set for themselves. Regarding introducing solids, 22% of women stared at four months, 11% at five months, and 67% at six months. Forty percent of women stated they achieved pre-pregnancy weight. One woman achieved pre-pregnancy weight before three months, one at four months, one at six months, and one after six months.
Table 2
Demographics (n = 11)
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Age (in years, mean, SD)
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32.0, ± 6.9
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Race
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White
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100.0%
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Ethnicity
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Non-Hispanic/Latino
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100.0%
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Education Level
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High School Diploma
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27.3%
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Associates Degree
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9.1%
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Undergraduate Degree
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36.4%
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Postgraduate Degree (masters, PhD)
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27.3%
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Employment Status
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Stay at home to watch children
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45.5%
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Part-time
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27.3%
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Full-time
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27.3%
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Number of Pregnancies
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|
1
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18.2%
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2
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27.3%
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3
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36.4%
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4
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18.2%
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Thematic analysis of group interview data revealed seven overarching themes: (1) inadequate knowledge for caring for self and infant (2) women desired knowledge from a Healthcare Provider (3) feeding decisions were made before pregnancy and preparation took place in the second/third trimesters (4) breastfeeding goals were not met (5) clear guidelines for introducing solids were lacking (6) in those achieving pre-pregnancy weight, their body shape and weight distribution changed (7) and a lack of time and energy make postpartum weight loss hard. Exemplary quotes are described in Table 3.
Table 3
Cross Cutting Statements
1. Women do not have adequate knowledge on feeding and caring for their infants or themselves. Women want practical information, both during pregnancy and during standard well child visits, on how to be a mother, caring for a feeding a new infant and caring for themselves.
2. Women actively seek information from family, friends, internet, and books but would like the information to be obtained from their healthcare provider.
Breastfeeding Statements
3. Women make decisions about infant feeding prior to pregnancy and desire information about breastfeeding during the 2nd or 3rd trimester
“I thought before I was pregnant that I knew how I wanted to feed my baby.”
“The second trimester…In the first trimester I was too busy worried about ya know, getting sick all the time and trying to survive the day and then third trimester I was, you know, laying in bed.”
4. Women set goals to breastfeed for 1 year or longer but do not reach these goals due to the primary barriers of milk supply and latching issues
“My goal was to nurse for a year, and no, I did not meet my goal. Like not even close. It was because of milk supply, just not having enough.”
Introducing Solids Statements
5. Women want clear guidelines on when and how to introduce solids to their infants
“I think there is too much information out there and I kind of get tired of all the people’s opinions.”
Postpartum Weight Loss Statements
6. Some women achieve pre-pregnancy weight but do not feel their bodies are the same. Women are unprepared for this.
“I am back to pre-pregnancy weight, but my clothes still don’t fit right. It’s the worst.”
“Weight wise I was pre-pregnancy, but my clothes no longer fit. That was a shock.”
7. Women face many barriers related to postpartum weight loss but the most important are time and/or energy
“The biggest barriers are time and energy and the desire to do it, and sometimes the resources of, you know, finding things that you want to do with groups and whatever.”
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Theme 1 and 2: Inadequate Knowledge for Caring for Self and Infant; Desired knowledge from a Healthcare Provider
Women do not feel knowledgeable on how to feed their infant or how to generally care for their babies and themselves. They indicated that they wanted resources to help become educated on basic information regarding being a mother, caring for and feeding a new infant, and caring for themselves in the postpartum period. Women wanted this information during pregnancy in addition to receiving education at standard pediatric or postpartum visits. Breastfeeding education was preferable during pregnancy, but they also appreciated anticipatory guidance on introducing solids, maternal health, and postpartum weight loss. Mothers felt introducing solids should be thoroughly reviewed at a standard four-month pediatric visit. Specific information included feeding problems such as constipation or picky eating, appropriate weight gain and growth expectations, allergies, and baby led weaning. Regarding postpartum weight loss, women wanted information on realistic weight loss expectations and the effect of weight loss on milk supply. Women were already seeking out the desired information from a variety of sources including family, friends, the internet, books, etc. However, they preferred this information come from a trusted healthcare professional. Women did not agree on how they would like to receive this information, but several options were discussed including verbal information, printed information, or via technology such as phone, internet, or email.
Breastfeeding Theme 3 and 4: Feeding decisions before pregnancy and preparation in the second/third trimesters; Unmet breastfeeding goals
All 11 participants indicated that they made their feeding decision prior to pregnancy. Ten of the 11 women who participated in the study planned to breastfeed. When asked about this decision, a comment from one mother on the topic was “It’s a funny question because I think it was just always known you should breastfeed your baby. My mom had talked about it, and other friends had done it. You just heard in your head that breastfeeding is best. I liked the idea of bonding and just wanted that relationship with my baby so breastfeeding was on my mind.” Seventy percent of women set breastfeeding goals for up to one year or longer. Despite many women having goals that aligned with breastfeeding recommendations, 40% of the women did not meet their goal for breastfeeding length. One mom indicated that “My plan was to nurse her for a year and I did not meet my goal, and I was not even close. The reason was because I did not have enough milk, and I supplemented her with formula until she was done nursing and then went to formula only.” Milk supply issues was a top stated barrier for not meeting breastfeeding goals. In addition to milk supply issues, women named several other barriers including latching issues (n = 3), maternal health (n = 2), nipple pain (n = 1), and other (n = 2). “Other” reasons included mother being pregnant and an infant milk allergy. To address these barriers, women wanted basic information on breastfeeding, difficulties experienced while breastfeeding and how to handle problems that arise, and where they can find support. Specific breastfeeding information desired included proper use of a nipple shield, guidance for moms who are exclusively pumping, how often to feed their baby, hunger cues versus other reasons the baby may cry, latching techniques, and how to access a lactation consultant. Women also indicated that it is important for mothers to have an understanding that facing barriers is normal and it does not make them a bad mother. One mom stated that “I think it is important for new mothers who have never breastfed to understand it is not easy because it is one of the most difficult things I have ever done, and you really have to be persistent at it.”
Introducing Solids Theme 5: Clear recommendations on introducing solids
The primary message from women regarding introducing solids was that they wanted clear guidelines on when and how to introduce solids. In general, women planned to introduce solids around six months of age. Seventy-two percent of women indicated that a healthcare provider or expert committee recommendations influenced their decision on when to start solids. Despite this, women sought out information on introducing solids from a source other than their provider such as a technological source (i.e., internet, video, etc.), book/article, or friend. When asked if they would utilize a specific manual provided from their doctor, all women indicated that they would like and utilize this. The standard four-month pediatric visit was the favorable time to receive this resource. When asked what barriers the women faced when introducing solids, the most common response was being overwhelmed with information or that their child was not interested in food in general; however, they also cited barriers such as medical problems like eczema and allergies or difficulty getting the child to sit still for a meal. One mom said “I think there is too much information out there and I get tired of other people’s opinions. So I selected my doctor carefully so I can put my trust in him and I won’t have to worry about every little thing I read and every little trend because it’s too overwhelming.” Another mom said “I am frustrated because of his total disregard for food. He will put anything in his mouth besides food. So that was a struggle.” Women indicated wanting practical information for how often to feed their baby and how much to offer, recipes for making baby food, information on picky eating, how to combat constipation, guidelines related to food allergies, and information about appropriate growth and weight gain.
Postpartum Weight Loss Theme 6 and 7: Those that achieve pre-pregnancy weight have a different body shape and weight distribution; Lack of time and energy make postpartum weight loss hard
Many women in this study were able to achieve pre-pregnancy weight, but three women specifically mentioned that their bodies were not the same. Women stated this was not an expectation prior to pregnancy. One woman said “Weight wise I was back to my pre-pregnancy weight, but my clothes no longer fit. That was a shock.” Another said “I am back to pre-pregnancy weight, but my clothes still don’t fit right. It’s the worst.” The women indicated that they wanted to be informed of realistic expectations regarding postpartum weight loss as well as the fact that their bodies may not be the same despite achieving pre-pregnancy weight. Women named several barriers related to postpartum weight loss including hunger related to breastfeeding, milk supply concerns, a lack of ability to exercise, and turning to convenience junk food. However, the most consistent barriers were lack of time and/or energy. One mom stated “The biggest barriers are time and energy and the desire to do it, and sometimes the resources of finding things that you want to do with groups.” Another said “Time for exercise is a barrier. I just can’t seem to fit it in.” Women indicated that they would like support to help overcome these barriers. Examples of information women wanted included time management strategies, support systems, childcare options during exercise, available exercise programs, and practical information on diet and nutrition. Many women commented on being interested in some type of postpartum group and felt that having appropriate support or a community of other mothers would improve their postpartum weight loss experience.