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THE LIVED EXPERIENCE of BREASTFEEDING for WOMEN with PERINATAL DEPRESSION by Beth A. Pratt a Dissertation Submitted to the Facul

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THE LIVED EXPERIENCE of BREASTFEEDING for WOMEN with PERINATAL DEPRESSION by Beth A. Pratt a Dissertation Submitted to the Facul THE LIVED EXPERIENCE OF BREASTFEEDING FOR WOMEN WITH PERINATAL DEPRESSION by Beth A. Pratt A Dissertation Submitted to the Faculty of Christine E. Lynn College of Nursing In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Florida Atlantic University Boca Raton, FL August 2017 Copyright by Beth A. Pratt 2017 ii ACKNOWLEDGEMENTS I wish to thank God for carrying me when I least felt able to continue. I wish to thank my family, Luigi, Kirra, Julian, Mom, Dad, and Ana Lucia, for remaining by my side through this process. It has been a long and arduous journey, and I could not have gotten to the other side of it without you all. I also wish to express gratitude to my church family for keeping me in prayer and being my spiritual support. I love you all. I wish to express sincere gratitude to my dissertation committee members, Dr. Joy Longo, Dr. Shirley C. Gordon, and Dr. Nancy Aaron Jones, for continued guidance and support during this dissertation journey. Each of you has gifted me with your knowledge. Thank you, Dr. Longo, for upholding the virtues of confidence, dedication, and patience, which are keys to success. Thank you, Dr. Gordon, for introducing me to the intricacies of qualitative research and encouraging me to grow with the process. Thank you, Dr. Jones, for showing me that truly significant research comes from the passion within oneself. I wish to express heartfelt thanks to the organizations that assisted with recruitment: the Christine E. Lynn College of Nursing, Dr. Lynn Lampert, the Florida Nurses’ Association, Healthy Mothers Healthy Babies of Palm Beach County, and the momsTOmoms online support group. Most of all, I wholeheartedly thank all the amazing warrior mothers who bared their lives to me during the interview process. You are an inspiration to everyone, especially your children. iv ABSTRACT Author: Beth A. Pratt Title: The Lived Experience of Breastfeeding for Women With Perinatal Depression Institution: Florida Atlantic University Dissertation Advisor: Joy Longo, Ph.D., RNC-NIC Degree: Doctor of Philosophy Year: 2017 Exclusive breastfeeding for at least 6 months provides numerous infant and maternal benefits. Yet mothers with risk factors, such as lower education, lower socioeconomic status, younger maternal age, planned cesarean birth, and anxiety and depression, are more likely to stop breastfeeding in the early postpartum period. Few studies have focused on perinatal depression as a risk factor for breastfeeding cessation. To tailor effective interventions, nurses must first understand the lived experience of breastfeeding for mothers at risk for perinatal depression. A descriptive phenomenological study was conducted to elucidate the experience of breastfeeding for mothers with perinatal depression. The study was grounded in Swanson’s middle-range theory of caring. After university Institutional Review Board approval, a purposive sample of 10 women was recruited from various organizations. Participants completed a demographic questionnaire and the Edinburgh Postnatal Depression Scale, and semistructured, audiorecorded face-to-face or telephonic v interviews were conducted. The researcher transcribed the data which was transformed into constituents of the mothers’ lived experience by utilizing Giorgi’s descriptive phenomenological method. Five constituents emerged: choosing selflessness, harboring inadequacy, deliberate persevering, discerning meaning, and cherishing intimacy. The constituents embodied the essence of the mothers’ thoughts and feelings connected to breastfeeding. By daily choosing selflessness, mothers consciously decided to breastfeed despite physical or psychological struggles. They often were harboring inadequacy due to ongoing struggles which led to incessant thoughts of maternal incompetence. Yet they successfully breastfed for at least 2 weeks after birth by deliberate persevering. Through breastfeeding, they were discerning meaning to realize their value as mothers. Finally, they reveled in purposeful moments of togetherness with their babies through cherishing intimacy. The study findings inform recommendations for nursing education, practice, research, and policy. Nursing education must include basic breastfeeding and perinatal mental health knowledge in prelicensure curricula and up-to-date lactation management techniques and perinatal mental health awareness training in continuing education. Practicing maternal-child nurses must provide education and support to mothers about advantages and difficulties of breastfeeding throughout the perinatal period. Future research includes determination of support needs for women with perinatal depression with subsequent development and evaluation of therapeutic actions to promote breastfeeding success. vi THE LIVED EXPERIENCE OF BREASTFEEDING FOR WOMEN WITH PERINATAL DEPRESSION LIST OF TABLES ........................................................................................................... xiii I. INTRODUCTION ........................................................................................................... 1 Phenomenon of Interest ................................................................................................... 3 Background and Significance .......................................................................................... 4 United States Breastfeeding Goals .............................................................................. 4 Breastfeeding Support Interventions ........................................................................... 5 Populations At Risk for Breastfeeding Cessation ........................................................ 6 Perinatal depression. ................................................................................................ 6 Screening for perinatal depression. .......................................................................... 8 Connection to Caring Science ......................................................................................... 9 Assumptions ................................................................................................................ 9 Processes .................................................................................................................... 10 Purpose of the Study ..................................................................................................... 11 Research Questions ....................................................................................................... 12 Researcher’s Perspective Including Conceptual Definitions ........................................ 12 Researcher’s Perspective ........................................................................................... 12 Conceptual Definitions .............................................................................................. 13 Breastfeeding. ........................................................................................................ 13 Breastfeeding duration. .......................................................................................... 13 vii Perinatal depression. .............................................................................................. 14 Summary ....................................................................................................................... 14 II. LITERATURE REVIEW ............................................................................................. 16 Introduction ................................................................................................................... 16 Critical Synthesis of Theoretical and Empirical Foundation ........................................ 16 Breastfeeding and Maternal Health Benefits ............................................................. 16 Factors Affecting Breastfeeding Outcomes ............................................................... 17 Sociodemographic factors. ..................................................................................... 17 Psychological factors. ............................................................................................ 19 Perinatal depression. .............................................................................................. 21 Psychoneuroimmunological effects of breastfeeding. ........................................... 21 Identification of perinatal depression..................................................................... 23 Breastfeeding, Perinatal Depression, and Qualitative Studies ...................................... 27 Discussion of Gap in Knowledge Base and Link to Caring Science ............................ 29 Summary ....................................................................................................................... 31 III. RESEARCH METHODOLOGY................................................................................ 33 Introduction ................................................................................................................... 33 Research Design Including Philosophical Foundations of the Method ........................ 33 Sample, Recruitment, and Setting ................................................................................. 36 Sample ....................................................................................................................... 36 Recruitment ............................................................................................................... 37 Setting
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