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An Exploration of Online Breastfeeding Support 1 AN EXPLORATION OF ONLINE BREASTFEEDING SUPPORT 1 AN EXPLORATION OF ONLINE SOCIAL SUPPORT GROUPS FOR BREASTFEEDING MOTHERS by Amanda Wagg Canterbury Christ Church University Thesis submitted For the Degree of Doctor of Philosophy July 2020 AN EXPLORATION OF ONLINE BREASTFEEDING SUPPORT 2 Acknowledgements I would like to thank my family for supporting me financially, emotionally and for believing in me. I would like to thank Alex Hassett and Margie Callanan for their continued supervision and encouragement, and for challenging me to think differently. I would also like to thank Chloe Griggs, who has been on this journey with me completing her own studies, for her endless encouragement and motivation, and the research team for all their support during the learning sets, you are truly inspirational. I would also like to thank Anglia Ruskin University for part funding my research studies and providing study leave. Lastly, I would like to thank all the mothers that came forward and participated in the interviews, and my friends and colleagues that aided with recruitment and provided a listening ear. AN EXPLORATION OF ONLINE BREASTFEEDING SUPPORT 3 Thesis Summary This thesis provides a portfolio of research that focuses on online social support groups for breastfeeding mothers. The aim of this thesis is to explore how and why online breastfeeding support group are being used, how breastfeeding mothers make sense of and interpret their experiences, and how they perceive the impact on their breastfeeding journey. Acquiring new breastfeeding skills at the same time as being becoming a mother is stressful and experiencing stress may lead some mothers to seek support. Historically people would interact, communicate, and thus seek and receive support from their healthcare provider face-to-face. More recently, this can occur online due to the increasing availability of the internet, home computers, mobile phones, and tablet technologies that provide quick access to others. It is well documented that breastfeeding rates in the UK are some of the lowest in the world, but with professional and peer support a mother is more likely to continue to breastfeed her baby for longer. For these reasons, online support interventions are explored in four original pieces of research, an area of practice only now emerging in the literature. This thesis first examines the use of computer mediated communication in providing patient support. A literature review suggests that online interventions could be both what patients want, and way of delivering support in resource tight environments. This has implications for a range of health support needs and professionals. Secondly, a content analysis documents and describes the posts made to an online breastfeeding support group in the United Kingdom. Mothers are using online groups in their thousands to seek information from people in similar situations and discuss a range of parenting and breastfeeding topics. Thirdly, through Interpretative Phenomenological Analysis, it is highlighted that the online groups have the potential to provide confidence, reassurance, and to normalise breastfeeding. AN EXPLORATION OF ONLINE BREASTFEEDING SUPPORT 4 Online groups provide a sense of community that supports an internal vision of what breastfeeding is like for them. The fourth study presents a case study of one mother’s use of online groups to obtain donor milk for her baby. This final piece of research highlights a tangible support type that was not highlighted in the previous studies, and all four studies highlight the complexities around online support, and infant feeding decisions. Throughout this thesis the term support is critically explored, and the theory of social support and becoming a mother is drawn upon to underpin the research. This thesis offers a definition and model of online breastfeeding support to guide practitioners and further research. Infant feeding policies should include a compulsory social support assessment that incorporates online support, and policies should encourage professionals to have conversations around taboo and stigmatised topics. Those supporting breastfeeding mothers need to be aware of the benefits and risks of online support and be encouraged to promote online support to the mothers with whom they work. AN EXPLORATION OF ONLINE BREASTFEEDING SUPPORT 5 Contents Chapter One: Introducing the research ................................................................................................................. 12 Introduction .......................................................................................................................................................... 12 The Starting Point ............................................................................................................................................ 12 Breastfeeding in the UK ................................................................................................................................... 13 The benefits to breastfeeding ....................................................................................................................... 13 Breastfeeding rates in the UK ...................................................................................................................... 14 A bottle-feeding culture ............................................................................................................................... 15 Disinvestment in breastfeeding support ....................................................................................................... 16 Additional challenges faced by women ....................................................................................................... 17 Defining breastfeeding support ........................................................................................................................ 18 Breastfeeding support in practice ..................................................................................................................... 18 Online breastfeeding support............................................................................................................................ 21 Theoretical Positions ........................................................................................................................................ 23 Social support. ............................................................................................................................................. 23 Community level social support .................................................................................................................. 26 Individual level social support ..................................................................................................................... 27 Chosen theoretical Position .......................................................................................................................... 34 The theory of ‘Becoming a Mother’ ............................................................................................................ 35 Thesis aim ........................................................................................................................................................ 38 Overarching research questions ........................................................................................................................ 38 Guide to the Chapters ....................................................................................................................................... 38 Philosophical Position ...................................................................................................................................... 41 References ............................................................................................................................................................ 44 Appendix A, Initial reflection ............................................................................................................................... 63 Appendix B, Breastfeeding Support Training ...................................................................................................... 65 Appendix C, Initial Bracketing Interview ............................................................................................................. 66 Appendix D, Research Questions ......................................................................................................................... 69 Chapter Two: The use of computer mediated communication in providing patient support: A review of the research literature. ................................................................................................................................................ 70 Abstract................................................................................................................................................................. 70 Introduction .......................................................................................................................................................... 72 Computer mediated communication in healthcare ........................................................................................... 72 Study aims ........................................................................................................................................................ 73 Review process ....................................................................................................................................................
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