title: Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth.
abstract: BACKGROUND
  breast-feeding outcomes are often worse after caesarean section compared to vaginal childbirth.
  
  
  OBJECTIVE
  this study characterises mothers' breast-feeding intentions and their infant feeding experiences after caesarean childbirth.
  
  
  METHODS
  data are from 115 mothers on a postnatal unit in Northeast England during February 2006-March 2009. Interviews were conducted an average of 1.5 days (range 1-6 days) after the women underwent unscheduled or scheduled caesarean.
  
  
  RESULTS
  thematic analysis of the data suggested was mostly considered the 'right thing to do,' preferable, natural, and 'supposedly healthier,' but tiring and painful. Advantages of supplementation involved more satiated infants, feeding ease, and longer sleep bouts. The need for 'thinking about yourself' was part of caesarean recovery. Infrequent feeding was concerning but also enabled maternal rest. Other breast-feeding obstacles were maternal mobility limitations, positioning difficulties, and frustration at the need for assistance. Participants were confused about nocturnal infant wakings, leading many to determine that they had insufficient milk. Mothers were surprised that sub-clinically poor infant condition was common following caesarean section. Some breast-feeding difficulty stemmed from 'mucus' expulsion that had to occur before the infants could be 'interested' in feeding. Women who cited motivations for breast feeding that included benefit to themselves were more likely to exclusively breast feed on the postnatal unit after their caesareans than those who reported infant-only motivations.
  
  
  CONCLUSIONS
  for the majority of mothers, breast feeding after a caesarean is affected by interrelated and compounding difficulties. Provision of more relational breast-feeding information may enable families to better anticipate early feeding experiences after caesarean section childbirth.
authors.affiliation: Center for Developmental Science, Carolina Global Breastfeeding Institute, University of North Carolina at Chapel Hill, 100 East Franklin Street, Suite 200, Campus Box 8115, Chapel Hill, NC 27599, United States. Electronic address: kristin.tully@unc.edu.
authors.forename: Kristin P
authors.initials: KP
authors.lastname: Tully
authors.affiliation: Department of Anthropology, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, United Kingdom.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Ball
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D002585:Cesarean Section; D036861:Delivery, Obstetric; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D008880:Midwifery; D011247:Pregnancy; D020377:Self Efficacy; D055815:Young Adult
keywords: Breast feeding; Caesarean section; Infant feeding; Mothers