Department of Social and Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Breastfeed Med. 2021 Oct;16(10):790-798. doi: 10.1089/bfm.2020.0251. Epub 2021 May 19.
Postpartum depression (PPD) is one of the most common birthing complications, and studies negatively associate PPD with breastfeeding initiation and continuation. However, little is known about either the breastfeeding experience of mothers with PPD or what resources mothers need for sustained breastfeeding from their perspectives. This study aimed to identify the antecedents, barriers, and facilitators to breastfeeding for mothers with PPD, understand the relationship between self-efficacy and emergent themes, and generate suggestions to inform supportive interventions. Birth mothers who screened positive for PPD and reported breastfeeding were recruited to participate in semistructured interviews. Interviews were transcribed verbatim, and inter-coder discrepancies from double coding were resolved through consensus. Thematic analysis was facilitated using immersion-crystallization methods. Participants identified five antecedent themes that encourage initiation (professional support, infant health, mother's health, cost-effectiveness, and faith), four facilitator themes for sustained breastfeeding (infant connection, decreased stress, personal attributes, and logistical strategies), and seven barrier themes (physical pain, infant nutrition, negative feelings, latching difficulties, medical conditions, public breastfeeding, and sleep). Participants' suggestions fell into three primary themes: supportive services, managing expectations, and respecting self-determination. Antecedent and facilitator themes did not overlap, indicating that factors encouraging breastfeeding initiation differ from sustaining factors. Participant suggestions, barriers, and facilitators did not largely differ from mothers PPD in other qualitative studies. Therefore, interventions should tailor support to specific breastfeeding phase and may not need to be markedly different for mothers with PPD, in addition to depression management.
产后抑郁症（PPD）是最常见的分娩并发症之一，研究表明 PPD 与母乳喂养的开始和持续呈负相关。然而，人们对患有 PPD 的母亲的母乳喂养体验或从她们的角度来看，母亲需要哪些资源来持续母乳喂养知之甚少。本研究旨在确定患有 PPD 的母亲进行母乳喂养的前因、障碍和促进因素，了解自我效能感与新兴主题之间的关系，并提出建议以告知支持性干预措施。
筛选出患有 PPD 且报告母乳喂养的产妇母亲被招募参加半结构化访谈。访谈逐字转录，通过共识解决双重编码的编目差异。使用沉浸式结晶方法促进主题分析。
参与者确定了五个鼓励开始母乳喂养的前因主题（专业支持、婴儿健康、母亲健康、成本效益、和信仰），四个促进持续母乳喂养的促进因素主题（婴儿联系、减少压力、个人特质、和后勤策略），以及七个障碍主题（身体疼痛、婴儿营养、负面情绪、衔乳困难、医疗状况、公共哺乳、和睡眠）。参与者的建议分为三个主要主题：支持服务、管理期望和尊重自我决定。
前因和促进因素主题没有重叠，这表明鼓励母乳喂养开始的因素与维持因素不同。参与者的建议、障碍和促进因素与其他定性研究中的 PPD 母亲并没有太大差异。因此，干预措施应根据特定的母乳喂养阶段调整支持，除了抑郁管理外，对于患有 PPD 的母亲来说，可能不需要有很大的不同。
