Precarity and possibilities

: provider perspectives and women's lived experience of breastfeeding support in Northern Ireland

Abstract

Breastfeeding support is an evidence-based intervention from trained professional and lay providers which can increase rates of breastfeeding duration and exclusivity. However, increases in rates are not always evident and women are not uniformly satisfied with support received. This thesis, comprised of three studies, aimed to explore breastfeeding support in Northern Irish settings where breastfeeding rates remain low despite high levels of accreditation of maternity services with evidence-based strategies to promote and support breastfeeding.

First, a systematic review of qualitative evidence synthesised literature on the experiences of breastfeeding and breastfeeding support which influence trained provider practice. Next, a descriptive qualitative study explored the provider perspective of influential factors in support provision through interviews with twenty-four participants from a range of roles including midwives and trained breastfeeding peer supporters. Data were analysed using a thematic framework analysis and a Bourdieusian lens was used to interpret study findings. Finally, a hermeneutic phenomenological study was undertaken of women’s lived experience of breastfeeding support with ten breastfeeding women interviewed, and findings were illuminated by tenets of Heideggerian philosophy.

The thematic synthesis of literature demonstrated that providers develop a philosophy of breastfeeding support grounded in both personal and professional  experiences, and the growth and expression of that philosophy can be facilitated or hindered by the support setting. Next, findings from the framework analysis indicated that influential factors in support provision were mediated by personal and social understandings of breastfeeding, which influenced the ability to provide effective support, with some providers reporting precarity in service provision. Last, the hermeneutic phenomenology revealed an insight into women’s lived experience where breastfeeding support is understood as technological.

Breastfeeding support provision is precarious in a society where most people do not have a social understanding of breastfeeding. A lack of familiarity with breastfeeding in society facilitates misinterpretation of infant behaviour, causing fear about breastfeeding. However, when women are supported to breastfeed and experience a familiarity with the entirety of the breastfeeding experience as both technological and human within the support encounter, confidence grows, and possibilities open for women to breastfeed in their own way. Support therefore requires the provider to balance a woman-centred and technological approach to optimise proficient meaningful support encounters for women. Increasing the value and social understanding of breastfeeding within support services can mitigate against precarity in quality support provision, and open creative possibilities for women’s breastfeeding relationships with their infants in contemporary society where the world is viewed technologically.

Thesis is embargoed until 31 December 2024.