title: Existential security is a necessary condition for continued breastfeeding despite severe initial difficulties: a lifeworld hermeneutical study.
abstract: BACKGROUND
  The majority of new mothers in Sweden initiate breastfeeding and many experience initial difficulties. This experience is an important cause of early breastfeeding cessation. To increase understanding, there is a need to explore the lived experiences of the decision to continue or cease breastfeeding. The aim of this study is therefore to explain and understand how this decision is influenced by the meaning of severe initial difficulties.
  
  
  METHODS
  A lifeworld hermeneutical approach was used for the study. The study was conducted in Sweden with eight mothers who experienced severe difficulties with initial breastfeeding. All except one were interviewed on two different occasions resulting in fifteen interviews. The interviews were conducted between 2010 and 2013.
  
  
  RESULTS
  Mothers who experience severe difficulties with initial breastfeeding feel both overtaken and violated not only by their own infants and their own bodies but also by their anger, expectations, loneliness and care from health professionals. These feelings of being overtaken and invaded provoke an existential crisis and place mothers at a turning point in which these feelings are compared and put in relation to one another in the negotiation of the decision to continue or cease breastfeeding. This decision thus depends on the possibility of feeling secure with the breastfeeding relationship. If insecurity dominates, this can, in severe cases, create a feeling of fear of breastfeeding that is so great that there is no alternative but to stop breastfeeding.
  
  
  CONCLUSIONS
  Existential security in the breastfeeding relationship seems to be an underlying factor for confidence and therefore a necessary condition for continued breastfeeding when having severe initial breastfeeding difficulties. Unresolved feelings of insecurity may be a serious barrier to further breastfeeding that can result in a fear of breastfeeding. Such fear can force the mother to cease breastfeeding. This study highlights how women are situated in a complex cultural and biological context of breastfeeding that has existential consequences for them. An existential crisis forces mothers into a turning point for the breastfeeding decision. In the existential crisis, mothers' responsibility for the mother-infant relationship guides continuing or ceasing breastfeeding.
authors.affiliation: School of Health Sciences, University of Borås, 501 90 Borås, Sweden ; School of Health and Caring Sciences, Linnaeus University, 351 95 Växjö, Sweden.
authors.forename: Lina
authors.initials: L
authors.lastname: Palmér
authors.affiliation: School of Health Sciences, University of Borås, 501 90 Borås, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Carlsson
authors.affiliation: School of Health and Caring Sciences, Linnaeus University, 351 95 Växjö, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Brunt
authors.affiliation: School of Health Sciences, University of Borås, 501 90 Borås, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Nyström
keywords: Breastfeeding; Caring science; Early breastfeeding cessation; Hermeneutic; Initial breastfeeding difficulties; Lifeworld