The impact of the maternal experience with a jaundiced newborn on the breastfeeding relationship

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Original Research

The impact of the maternal experience with a jaundiced newborn on the breastfeeding relationship

J Fam Pract. 2002 May;51(5):1-1

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References

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All correspondence should be addressed to Sharla K. Willis, DrPH, The Ohio State University, School of Public Health, B-209 Starling-Loving Hall, 320 West 10th Avenue, Columbus, OH 43210-1240. E-mail: willis.181@osu.edu.

To submit a letter to the editor on this topic, click here: jfp@fammed.uc.edu

Analysis

Interviews were carefully read by all investigators for themes, and codes were developed to represent these themes.^18,22,23 A code book defining each code and listing inclusion and exclusion criteria was developed, and one investigator (S.K.W.) applied codes to the interviews using ATLAS/ti qualitative data analysis software (Scientific Software Development, Berlin, Germany). Intracoder and intercoder (with P.R.H.) agreement were determined to assure consistency of code definitions. Codes with a low level of agreement were redefined and reapplied. Coded text was retrieved and emerging themes analyzed in relation to other themes and variables. Focus was placed on comparing and contrasting women’s experiences to elicit what in the maternal experience with neonatal jaundice influenced infant feeding decisions. We also focused on women’s understanding of the information they received and the relationship between jaundice and breastfeeding.

Results

Of 69 eligible mothers, 11 declined to participate, and 13 could not be reached or scheduled for an interview. Forty-five mothers were interviewed between October 1997 and April 1998 at 2.5 to 14.5 weeks postpartum (mean = 6 weeks). Investigators attempted to hold 2 focus groups with unsuccessful show rates. Individual interviews were conducted with the 2 women who attended these sessions and analyzed with the other interviews. The 24 nonparticipants had similar demographic characteristics to women in the study.

Participants represented a range of sociodemographic and jaundice management characteristics Table 2. Mothers were predominately Latinas of Mexican descent, with a mean age of 27 years (range = 16-38 years). Women born outside the United States had lived in the US from 1 to 25 years (mean = 7 years). More than three quarters of the women lived with the father of the baby. Peak bilirubin levels of all infants ranged from 10.3 to 23.5 mg/dL; 4 infants had peak levels of >20 mg/dL and 7 had peak levels of <12 mg/dL. Thirty-nine infants experienced jaundice within the first 6 days of life, with the majority having nonhemolytic jaundice. Eight infants had breast milk jaundice with peak bilirubin levels occurring between 1 and 2 weeks of age. More than half of the multiparous women had experienced jaundice with a previous infant (n = 14) and three fourths had breastfed a previous child (n = 19).

Though each woman’s experience was unique, a pattern emerged from the women’s discussions that described a process by which their experiences affected the breastfeeding relationship. This process centered on mothers’ interactions with medical professionals during jaundice management and their internalization of the experience.

Jaundice management

Half the women described how their experiences with neonatal jaundice had directly influenced their breastfeeding decisions, positively or negatively, primarily discussing this impact in terms of the breastfeeding instructions they received. Table 3 illustrates the clear pattern seen between a maternal report of breastfeeding orders received from medical professionals and a woman’s feeding status at 2 weeks postpartum, directly after the jaundice experience. Breastfeeding orders were categorized as: continue, conflicting, supplement, suspend, and none. Regardless of parity, women’s interactions with medical professionals related to breastfeeding orders and the level of encouragement they received had the strongest influence on whether women continued to breastfeed.

Mothers exclusively breastfeeding after their experience discussed the encouragement they received from medical staff. Mothers told to continue to breastfeed felt encouraged to breastfeed frequently to help the jaundice go away. All continued to breastfeed for at least 3 weeks, none quit because of their infant’s jaundice. Mothers who returned to exclusive breastfeeding after being told to temporarily suspend breastfeeding or to supplement with formula described being encouraged not to quit breastfeeding and were reassured that their milk was good.

“Right away I wanted to stop breastfeeding, especially if it is me causing him to get that. And they were like, ‘No, no. We’re not telling you to stop. It’s good that you are breastfeeding him.’”

Women exclusively formula feeding because of their experience with jaundice shared 2 separate reasons for not resuming. The first related to not wanting to “take anymore chances” with their infant receiving insufficient milk.

“At the time she was in the hospital they told me to stop breastfeeding her. They wanted to formula feed her. They just said that they think she wasn’t getting enough. They said since they can’t measure how much she drinks that they don’t know how much she is drinking. So I decided, well, I’ll just continue formula feeding her.”

The second related to physical difficulty in reestablishing lactation.

“I breastfed my other three children. … That’s why I tried more to see if he’d latch on, but he didn’t. … Since the beginning, I had the idea that I was only going to breastfeed him, but no.”