THE MOTHER’S LIVED EXPERIENCE OF BREASTFEEDING IN THE FIRST 4 WEEKS POSTPARTUM: A HEIDEGGERIAN HERMENEUTIC PHENOMENOLOGICAL ANALYSIS Stacy Ann Rosales Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Doctor of Philosophy in the School of Nursing, Indiana University April 2021 Accepted by the Graduate Faculty of Indiana University, in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Doctoral Committee ______________________________________ Deborah Stiffler, PhD, RN, CNM, Chair ______________________________________ Jennifer J. Bute, PhD February 25, 2021 ______________________________________ Carol Shieh, DNSc, MPH, RNC-OB, FAAN ______________________________________ Linda S. Wallace, EdD, MSN, RN, NEA-BC, CNE ii © 2021 Stacy Ann Rosales iii DEDICATION I would like to dedicate this dissertation first and foremost to my husband, Charles, and my children, Alexandra and Charlie. The three of you have supported me throughout the many ups and downs of this extremely long journey. Thank you and I love you! Alex and Charlie, my hope is that in some way this will be an inspiration to you. I also would like to thank my mom, Stephanie, and dad, Mark, for instilling in me the importance of a college education and a strong work ethic. Both of you have contributed to my success in different ways due to your unique experiences throughout life. Finally, this dissertation is dedicated to all first generation college students. You too can succeed at whatever level of college degree you set your mind too. Seek professors and others who understand the uniqueness of being the first person in your family to go to college. Let them help you navigate the college or university system so you can be successful and achieve your goal. iv ACKNOWLEDGEMENT I would like to express my deepest appreciation to my committee, Dr. Deborah Stiffler, Dr. Jennifer Bute, Dr. Carol Shieh, and Dr. Linda Wallace. Dr. Stiffler, I am extremely grateful for your willingness to be the chair of my committee. I am thankful for the numerous hours you spent reading my dissertation and providing feedback. Your expertise, encouragement, and patience throughout the duration of my dissertation was exactly what I needed to be successful. Dr. Bute, you were instrumental in providing me with a better understanding of health communication through working with you during my independent study, as well as the advanced health communication course. I enjoyed learning about a field I previously had limited knowledge about. Dr. Shieh, thank you for the many years you have invested into my PhD education. You have provided me with valuable advice on everything from narrowing my topic to writing the dissertation itself. I’m glad you were a part of the finished product! Dr. Wallace, you have held many roles in my life: Professor, colleague, friend, and research advisor. I have been blessed to have you alongside me throughout my many years in academia as a graduate student and faculty. I am truly grateful for the many ways you have invested in me as a person. v Stacy Ann Rosales THE MOTHER’S LIVED EXPERIENCE OF BREASTFEEDING IN THE FIRST 4 WEEKS POSTPARTUM: A HEIDEGGERIAN HERMENEUTIC PHENOMENOLOGICAL ANALYSIS The benefits of breastfeeding are widely known and documented, yet breastfeeding rates at six months have remained well below desired levels. In order to fully understand the breastfeeding experience in the early postpartum period and all the intricacies involved, researchers need to provide mothers with the opportunity to talk about their experiences during the time when there are the most difficulties and when they are most likely to discontinue, the first four weeks postpartum. The purpose of this study was to more fully understand, in their own words, the experiences of mothers who began breastfeeding their infant after birth and may or may not have been breasting at four weeks postpartum. A single research question guided this study: What are the lived experiences of breastfeeding mothers during the first four weeks postpartum? Eight mothers who delivered in the past four to six weeks were interviewed. Data were analyzed using a Heideggerian hermeneutic phenomenological approach. This method was chosen because it allowed the researcher to conduct interviews and explore the lived experience of breastfeeding mothers and to uncover the concealed meaning within the phenomena. This methodology provided a richness that might not be possible through description alone. The narratives shared by the mothers demonstrated that initiating breastfeeding and sustaining it in the early postpartum period was a complex process. Each mother’s breastfeeding experience was unique to her but also similar to someone else’s. The vi overall constitutive pattern of Getting the Hang of It was selected and consisted of four themes and nine subthemes. The four themes included: Physical Experiences, Emotional Complexities, Infant Involvement in Breastfeeding Process, and Support. These themes and their subsequent subthemes provide insight into the complexities experienced by mothers in order to acquire the skills they needed to breastfeed their infants. Breastfeeding mothers, who have had favorable and unfavorable experiences, are willing to share a wealth of information. Health professionals should encourage mothers to talk about their experiences and listen to what they are saying. Through listening they can provide mothers with the resources and support needed to meet their breastfeeding goals. Deborah Stiffler, PhD, RN, CNM, Chair vii TABLE OF CONTENTS List of Tables ..................................................................................................................... xi List of Figures ................................................................................................................... xii List of Abbreviations ....................................................................................................... xiii Chapter 1: Introduction ........................................................................................................1 Background and Significance ........................................................................................1 Problem Statement .........................................................................................................8 Purpose Statement ..........................................................................................................9 Research Question .........................................................................................................9 Summary ........................................................................................................................9 Chapter 2: Review of Literature ........................................................................................11 Literature Search Strategies ........................................................................................11 Breastfeeding Defined .................................................................................................11 Breastfeeding Benefits .................................................................................................14 Infant ......................................................................................................................14 Maternal .................................................................................................................16 Breastfeeding Duration ................................................................................................17 Breastfeeding Barriers .................................................................................................18 Knowledge .............................................................................................................19 Social Norms and Psychosocial Factors ................................................................20 Support ...................................................................................................................21 Embarrassment .......................................................................................................22 Lactation Problems ................................................................................................23 viii Employment and Childcare....................................................................................25 Health Services ......................................................................................................26 Media and Marketing Practices .............................................................................28 Summary ......................................................................................................................29 Chapter 3: Methods ............................................................................................................30 Research Design and Method .....................................................................................30 Methodology ................................................................................................................30 Historical and Philosophical Perspectives of Phenomenology ....................................31 The Hermeneutic Interview .........................................................................................34 Pseudonyms ...........................................................................................................35 Participants