title: Maternal perceptions of breastfeeding difficulty after caesarean section with regional anaesthesia: A qualitative study.
abstract: BACKGROUND
  Caesarean delivery rates have increased in Australia over the last decade creating new challenges for breastfeeding mothers and caregivers. The advantages of breastfeeding are well recognised, however breastfeeding problems are common. Review of the literature revealed limited qualitative research relating to the experience of women having difficulties breastfeeding after caesarean section under regional anaesthesia. This study aimed to fill that gap in the literature.
  
  
  METHODS
  Participants were women referred to the hospital Breastfeeding Support Centre with difficulty initiating and establishing breastfeeding. The methodology employed was interpretive phenomenology and purposeful sampling. Data was analysed using van Manen's hermeneutical circular process.
  
  
  RESULTS
  Themes identified included Unnatural birth, Natural instincts compromised, Helping mothers to mother and Sabotage and defeat. These themes elicited ten subthemes which were interpreted and reflected upon to reveal key findings. These findings included the emotional and physical effects of the delivery and anaesthetic, the lack of true skin to skin contact, separation of mother and baby, inconsistent information, inadequate support, unnecessary formula supplementation and feelings of failure.
  
  
  CONCLUSIONS
  Key recommendations included increasing skin to skin contact after caesarean section to support the natural instincts of mother and baby, increasing education on possible effects of surgical delivery on breastfeeding and increasing postnatal breastfeeding support for this group of women. Broader issues of inadequate staffing and a changing postnatal dynamic reflecting increased post-surgical care need further exploration.
authors.affiliation: Mater Research Institute, University of Qld, Brisbane, Australia; School of Nursing and Midwifery, Australian Catholic University, Brisbane, Australia; School of Nursing, Midwifery and Social Work, University of Qld, Brisbane, Australia. Electronic address: m.jchaplin@bigpond.com.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Chaplin
authors.affiliation: School of Health and Wellbeing, University of Southern Qld, Ipswich, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Mater Research Institute, University of Qld, Brisbane, Australia; School of Nursing and Midwifery, Australian Catholic University, Brisbane, Australia; School of Nursing, Midwifery and Social Work, University of Qld, Brisbane, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000523:psychology*; D001315:Australia; D001942:Breast Feeding / Q000523:psychology*; D002585:Cesarean Section / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D036801:Parturition; D010465:Perception; D011247:Pregnancy; D036301:Qualitative Research
keywords: Breastfeeding difficulties; Breastfeeding support; Caesarean section; Interpretive phenomenology; Regional anaesthesia