Dissertations / Theses on the topic 'Breastfeeding Australia'

Factors influencing breastfeeding initiation and duration in regional Western Australia were examined in this cohort study, with 427 mothers and their infants followed from birth to 12 months. Whilst 98% of mothers initiated breastfeeding after birth, less than 6% were still exclusively breastfeeding at six months. Positive influences on breastfeeding duration included baby-friendly hospital practices, antenatal education and positive attitudes towards breastfeeding, while prepregnancy smoking and overweight were negatively associated with breastfeeding duration.

Funded by the Primary Health Care Initiatives Program. Bibliography: p. 161-170. This thesis examines the public health of breastfeeding from a feminist perspective, based on a qualitative longitudinal study. From reviewing the history of infant feeding, a number of discourses of breastfeeding are identified and their continuing influence on contemporary thinking is discussed.

Fly-in, fly-out employment remains prevalent in Western Australia, however to date, no research has been conducted into the impacts of a FIFO lifestyle on breastfeeding. This study aimed to gain insight from women who were breastfeeding whilst their partners worked a FIFO roster, to better understand their supports, enablers, and barriers to continuing breastfeeding, with an aim to inform future support of families and health professionals in this area.

Exclusive breastfeeding for the first six months is recommended for the significant maternal and infant health benefits it conveys across the lifespan. Australia boasts high breastfeeding initiation rates, however the duration of breastfeeding falls well short of national and global targets. A deeper understanding of mothers’ interactions with breastfeeding supports could assist to further inform how the service of support is currently being received and the meaning it has for individual mother’s breastfeeding success. Narrative Inquiry examined the stories of seven Western Australian women’s lived experiences of support whilst establishing breastfeeding. Data included stories from semi-structured indepth narrative-based interviews, retold narratives and background related to demographic details, family breastfeeding history and pregnancy, birth and general health information. Clandinin and Connelly’s (2000) three-dimensional space structure of temporality, sociality and situation was used to enable an understanding of the relational aspects and the changeable nature of mothers’ breastfeeding support experiences. Thematic data analysis revealed four major themes: Trusting in the ‘natural’, navigating the complexity of the breastfeeding journey, battling others’ assumptions, and finding strength in supportive environments. All mothers found strength in the supportive interactions they experienced from professional, peer and family support, particularly from those whose guidance and assistance reflected the mother’s own personal beliefs about how important breastfeeding was to them. However, many barriers were also encountered, indicating there are still deficits in the support offered to breastfeeding mothers that need addressing. The support experienced could have been improved by more positive societal attitudes and a more knowledgeable, non-judgemental health system that delivered anticipatory, rather than reactive support responses, and recognised individuality, and the importance of self-efficacy and the role of family support in overcoming breastfeeding difficulties.

This thesis examines infant feeding practices, including knowledge and attitudes towards breastfeeding, factors that influence the duration of breastfeeding, and breastfeeding outcomes in relation to postpartum women’s body image, particularly perceived changes of breast shape in Australian and Japanese women.From previous studies, the number of women who desire to be slim after their childbirth has been increasing in recent years, and it is hypothesised that their concerns about body image may be associated with breastfeeding outcomes. It has been found that the Asian women have more distorted body images than their Caucasian counterparts. Breastfeeding gives many benefits to health of women and child, and the benefits may be greater with longer breastfeeding duration. Nevertheless, the duration of ‘exclusive breastfeeding’ is still less than the recommendations in most countries. There have been only a limited number of studies investigating breastfeeding outcomes related to postpartum women’s body image.This thesis contains two studies. In the first study, a cross-sectional survey was conducted in 2007 at Himeji city, Japan, in order to describe infant feeding practices and to identify factors that are associated with breastfeeding duration. The survey was a self-administered questionnaire included in a letter from the Himeji City Health Department offering free health checks for infants at 18 months of age. The second study was a prospective cohort study with interviews on seven occasions (4, 10, 16, 22, 32, 40, and 52 weeks postpartum) of follow-up over a period of 12 months, the Perth Infant Feeding Study Mark II (PIFS II). This second study was undertaken in two local hospitals in Perth, Australia between 2002 and 2003. While the initial results of the PIFS II have been published elsewhere, variables related to the postpartum women’s body image had not previously been analysed. Both studies used almost the same questions on infant feeding practices and about postpartum women’s body image.Univariate analysis was first employed to describe breastfeeding practices and to assess which factors could be included in the model of breastfeeding duration. These were then incorporated into multivariate analysis to identify the contributing factors of the duration of ‘any breastfeeding’ to six months postpartum. In the second group of analysis, factors related to postpartum women’s body image, their Body Mass Index (BMI) and perceptions of changes in their weight status, body and breast shape were included. These factors were then entered into a multivariate logistics regression analysis with other contributing factors in breastfeeding duration.In the Japanese study, 2,345 women were eligible to participate and 1,623 completed the questionnaire (Response rate: 69.2%). For the final analysis, 1,612 questionnaires were used, due to missing data. The majority (72.8%) of respondents were housewives with mean age 32.2, ranging from 18 to 44. Almost half of them were primiparous (56%) and had annual family income below 4,500,000 Japanese yen (JP¥) (55.5%) (Equivalent value in Australian dollars (AU$), approximately 50000). Low birth weight infants (less than 2500g) were 8.4%, and the great majority of postpartum women (85.0%) had a vaginal delivery. The prevalence of smoking and alcohol during breastfeeding reported by the women were 10.6% and 14.1%, respectively. It was interesting to note that the first feed for 29.8% of the infants was infant formula, followed by glucose (19.5%). By two weeks of age, more than 85% of infants had been introduced to infant formula. Consequently, ‘exclusive breastfeeding’ was not common and ‘any breastfeeding’ was the most common infant feeding method in Japan, with mean duration of 9.1 months (Standard Deviation (SD) = 6.4). The Iowa Infant Feeding Attitudes Scales (IIFAS), reflecting knowledge and attitudes towards infant feeding practices, of the sample was 54.2 (SD = 4.9), a low score, compared with other studies. In this sample, other family members such as husbands and women’s own mothers were less involved in decisions on infant feeding methods.With regard to postpartum women’s body image, 23.9% were in the ‘underweight’ category in their Body Mass Index (BMI) before the first pregnancy and this decreased to 17.8% at 18 months postpartum. The majority perceived some changes in their breast shape, namely ‘lost tension’, ‘changes in size’, and ‘sagging’. While more than half believed that breastfeeding helped to regain their body shape faster than infant formula, the same proportion stated that breastfeeding also made their breast shape ‘drooping’. The Attention to Body Shape Scale (ABS), a measure assessing one’s body image, showed that the Japanese postpartum women were very conscious of their body shape, but this was not a significant factor in relation to breastfeeding outcomes.Results of stepwise logistic regression analysis found four factors that were negatively associated with the duration of ‘any breastfeeding’ to six months of postpartum specifically, working women in non-professional areas (adjusted Odds Ratio (OR) = 0.41, 95% Confidence Interval (CI) = 0.23 to 0.72), experienced in breastfeeding problems (adjusted OR = 0.34, 95% CI = 0.23 to 0.51), smoking by the women during breastfeeding (adjusted OR = 0.32, 95% CI = 0.15 to 0.66), and perceived changes in breast shape (adjusted OR = 0.60, 95% CI = 0.40 to 0.91). In contrast, four factors, the later introduction of infant formula (adjusted OR = 1.07, 95% CI = 1.03 to 1.11), primipara (adjusted OR = 2.26, 95% CI = 1.05 to 4.87), the decision on infant feeding methods before pregnancy (adjusted OR = 2.73, 95% CI = 1.79 to 4.18), alcohol intake during breastfeeding (adjusted OR = 2.00, 95% CI = 1.18 to 3.39) were significantly associated with continuing ‘any breastfeeding’ to six months postpartum.In the Australian study, the Perth Infant Feeding Study Mark II (PIFS II), overall 870 of 1068 postpartum women who were eligible for the study were recruited and asked to complete the baseline questionnaire. In total, 587 completed questionnaire were received, a response rate of 68%. Approximately 30% of respondents were in their 30s, which was the highest proportion by age. The majority were Australian born (73.2%) and were multiparous (63.2%). Only 2.2% of infants were low birth weight and 70% had vaginal deliveries. The highest percentage of annual family income was at the group between 25,000 AU$ and 40,000 AU$ at 31.0%. The smoking rate reported by the women lies between 23% and 39% during the follow-up periods, and the prevalence of alcohol consumption by the women ranged from 40.2% to 48.5%. The majority had made a decision about infant feeding methods either before or early pregnancy (91.8%) and those infants were most often fed breastmilk as their first food while in hospitals (81.2%).Their husbands and own mothers positively supported breastfeeding in the decision making processes. The mean duration of ‘any breastfeeding’ and of introducing infant formula were 23.3 weeks (SD = 19.7) (approximately 5.8 months). The IIFAS also indicated that the Australian women showed positive attitudes towards breastfeeding with the mean score 64.4 (SD=8.3). About 8% of the Perth women were in the ‘underweight’ category (BMI < 18.5) before pregnancy. 51% noticed changes in their breast shape within four weeks of birth and this increased to 60% at 52 weeks postpartum. The most common changes perceived between four and 52 weeks postpartum were ‘sagging’ following ‘changes in size’. The factors that influenced breastfeeding duration in Australia were similar to the Japanese women with the exception of alcohol consumption. A multiple logistic regression showed that the women who had longer breastfeeding duration were more likely to perceive changes of their breast shape at week 52. For a one week increase in the duration of ‘exclusive breastfeeding’ up to six months, the average risk of perceived changes in breast shape at week 52 increased by 3.5% (95% CI = 1.00 to 1.07), by 3.8% (95% CI = 1.01 to 1.07) with ‘any breastfeeding’ duration up to six months, and by 2.9% (95% CI = 1.00 to 1.06) with ‘full breastfeeding’ up to six months, respectively. Moreover, the average risk of perceived changes in breast shape at week 52 increased by 0.8% (95% CI = 1.00 to 1.02), whenever women increase ‘any breastfeeding’ duration up to 12 months with each additional week.Cox logistic regression was also used to explore breastfeeding by type for six months or 12 months given their perceptions of breast shape at four weeks postpartum. However, no significant associations were found after adjustment of the model. The results indicated that the Australian women perceived changes to their body weight and breast shape in the postpartum period, but Japanese women were significantly more conscious about these aspects than their Australian counterparts. The cultural backgrounds of the women affected the associations between body image and breastfeeding outcomes. It is important to acknowledge this factor when providing education programs in breastfeeding.Breastfeeding outcomes were different between studies, particularly with regard to supplemental feeding, family involvement in decisions about infant feeding methods, and opinions on alcohol intake during breastfeeding. In addition, the prevalence of women with ‘underweight’ BMI is different between the two countries. These two studies suggest that cultural beliefs about women’s body image were associated with breastfeeding duration. The Japanese women were more conscious about their body and breast shape, which was significantly associated with breastfeeding duration, compared with their Australian counterparts. Women’s knowledge and attitudes towards breastfeeding reflected this and was at a lower level in Japan than in Australia. Several issues including media exposure, social expectations about women’s body shape and gestational weight control that are potentially related to women’s body image are discussed below.There are some limitations that needed to be considered when interpreting and assessing the applicability of the results. Through these two studies, changes of body weight, breast in shape were not assessed by any objective measure and were based on the participants’ perceptions. In addition, as the first study was cross-sectional and based on self-reported data at 18 months postpartum in Japan, there is a possibility of some recall bias about breastfeeding practices. In the second study, the PIFS II, a limitation was that the sample was recruited from two public hospitals and probably reflected a selection bias towards lower socio-economic status.It is recommended further studies using a cohort method with a large sample size and a qualitative approach be undertaken to enrich and verify the results of the study. These will enable a more accurate estimate of the prevalence of breastfeeding, factors that predict breastfeeding duration and postpartum women’s perceptions of changes in breast shape during breastfeeding. Breastfeeding education programs should be based on accurate studies of maternal knowledge and attitudes towards infant feeding methods, benefits of breastfeeding in the short and long term, and attitudes to body image in postpartum. These education programs need to acknowledge cultural perspectives in breastfeeding and women’s body image. Further improvements in working environments of postpartum women allowing them to continue breastfeeding are also suggested. It is important for public health that relevant interventions should be developed to improve breastfeeding rates and duration, in Australia and Japan.

The consumption of alcohol and smoking of cigarettes are both common practices in Australian society. With continued public health efforts exposure to both alcohol and nicotine during pregnancy has diminished, however little is known about exposure to these toxins in the postnatal period and the effect on the breastfed infant. To investigate the pattern of alcohol consumption and cigarette smoking in the postnatal period and the effect on breastfeeding outcomes, a longitudinal study was conducted in two public hospitals with maternity wards in Perth, Australia. Data for the Perth Infant Feeding Study (PIFSII) were collected from 587 mothers between mid-September 2002 and mid-July 2003. While in hospital participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital related and psychosocial factors. Further analysis of alcohol data was undertaken on the 1995 and 2001 National Health Survey (NHS) data sets to provide a national perspective. Alcohol and smoking related data were analysed and described using frequency distributions, means and medians. Univariate logistic regression was used to screen for potentially significant variables for subsequent incorporation in the multivariate analysis. Multivariate logistic regression analysis was employed to determine the effect of alcohol consumption and cigarette smoking on breastfeeding outcomes prenatally, antenatally and postnatally, after adjusting for factors identified in the literature as being associated with breastfeeding initiation and duration. The relationship between smoking status and breastfeeding duration was determined using survival analysis.Analysis of the relationship between breastfeeding duration and the level of postpartum intake was investigated using a Cox hazards model with repeated measures for alcohol consumption. Results showed that: 1. PIFSII. During pregnancy approximately 32% of women stopped drinking alcohol. Thirty five percent of pregnant women continued to consume alcohol during their pregnancy with 82.2% of these women consuming two or fewer standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. 2. NHS. Sixteen point four percent and 1.3% of pregnant women from the 1995 and 2001 NHS, respectively were consuming more than that recommended in ‘Guideline 11’ from the National Health and Medical Research Council of Australia (ie >7 standard drinks/week). 3. NHS. Thirteen percent of lactating mothers from the 1995 NHS and 16.8% from the 2001 NHS were consuming seven or more standard drinks of alcohol in the reference week, thus exceeding the NHMRC recommended level. 4. PIFSII. After 6 months of follow up, women who consumed alcohol at levels of more than two standard drinks per day were almost twice as likely to discontinue breastfeeding earlier than women who drank below these levels (HR 1.9, 95% CI 1.1, 3.0). 5. PIFSII. With regard to smoking, 226 (39%) of mothers reported smoking pre- pregnancy. Mothers who smoked were more likely to have a partner who smoked, to have consumed alcohol prior to pregnancy and less likely to attend antenatal classes.They were also less likely to know how they were going to feed their baby before conception and be more inclined to consider stopping breastfeeding before four months postpartum. 6. PIFSII. Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 weeks versus 11 weeks, 95% CI: 8.3-13.7). This effect remained even after adjustment for age, education, income, father’s smoking status, mother’s country of birth, intended duration of breastfeeding >6 months and birth weight (risk ratio HR 1.59, 95% CI 1.22 to 2.08). 7. PIFSII. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70, 95% CI 1.55 to 8.83; p<0.05). The results of the present study suggest a negative association between drinking alcohol in the postpartum period and breastfeeding outcomes. Similarly, smoking cigarettes before, during and after pregnancy negatively affects breastfeeding. There is a need for guidelines outlining the safe intake of alcohol during lactation and for the cessation of cigarette smoking in the prenatal and antenatal period.

The consumption of alcohol and smoking of cigarettes are both common practices in Australian society. With continued public health efforts exposure to both alcohol and nicotine during pregnancy has diminished, however little is known about exposure to these toxins in the postnatal period and the effect on the breastfed infant. To investigate the pattern of alcohol consumption and cigarette smoking in the postnatal period and the effect on breastfeeding outcomes, a longitudinal study was conducted in two public hospitals with maternity wards in Perth, Australia. Data for the Perth Infant Feeding Study (PIFSII) were collected from 587 mothers between mid-September 2002 and mid-July 2003. While in hospital participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital related and psychosocial factors. Further analysis of alcohol data was undertaken on the 1995 and 2001 National Health Survey (NHS) data sets to provide a national perspective. Alcohol and smoking related data were analysed and described using frequency distributions, means and medians. Univariate logistic regression was used to screen for potentially significant variables for subsequent incorporation in the multivariate analysis. Multivariate logistic regression analysis was employed to determine the effect of alcohol consumption and cigarette smoking on breastfeeding outcomes prenatally, antenatally and postnatally, after adjusting for factors identified in the literature as being associated with breastfeeding initiation and duration. The relationship between smoking status and breastfeeding duration was determined using survival analysis.
Analysis of the relationship between breastfeeding duration and the level of postpartum intake was investigated using a Cox hazards model with repeated measures for alcohol consumption. Results showed that: 1. PIFSII. During pregnancy approximately 32% of women stopped drinking alcohol. Thirty five percent of pregnant women continued to consume alcohol during their pregnancy with 82.2% of these women consuming two or fewer standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. 2. NHS. Sixteen point four percent and 1.3% of pregnant women from the 1995 and 2001 NHS, respectively were consuming more than that recommended in ‘Guideline 11’ from the National Health and Medical Research Council of Australia (ie >7 standard drinks/week). 3. NHS. Thirteen percent of lactating mothers from the 1995 NHS and 16.8% from the 2001 NHS were consuming seven or more standard drinks of alcohol in the reference week, thus exceeding the NHMRC recommended level. 4. PIFSII. After 6 months of follow up, women who consumed alcohol at levels of more than two standard drinks per day were almost twice as likely to discontinue breastfeeding earlier than women who drank below these levels (HR 1.9, 95% CI 1.1, 3.0). 5. PIFSII. With regard to smoking, 226 (39%) of mothers reported smoking pre- pregnancy. Mothers who smoked were more likely to have a partner who smoked, to have consumed alcohol prior to pregnancy and less likely to attend antenatal classes.
They were also less likely to know how they were going to feed their baby before conception and be more inclined to consider stopping breastfeeding before four months postpartum. 6. PIFSII. Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 weeks versus 11 weeks, 95% CI: 8.3-13.7). This effect remained even after adjustment for age, education, income, father’s smoking status, mother’s country of birth, intended duration of breastfeeding >6 months and birth weight (risk ratio HR 1.59, 95% CI 1.22 to 2.08). 7. PIFSII. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70, 95% CI 1.55 to 8.83; p<0.05). The results of the present study suggest a negative association between drinking alcohol in the postpartum period and breastfeeding outcomes. Similarly, smoking cigarettes before, during and after pregnancy negatively affects breastfeeding. There is a need for guidelines outlining the safe intake of alcohol during lactation and for the cessation of cigarette smoking in the prenatal and antenatal period.

The Nursing Mothers’ Association, founded in 1964, changed its name to the Nursing Mothers’ Association of Australia in 1969 and it has been known as the Australian Breastfeeding Association since 2001. The Association introduced a highly effective program for educating mothers about breastfeeding. Its progressive adult education aimed to assist the mother to function in society, to learn by experience, reflect on that experience and thus attain a high level of critical health literacy in relation to infant nutrition. This thesis investigates how this program operated in the wider context of modern adult education principles. Using a qualitative approach to archival and oral history sources, this thesis identifies the education model devised by the Association and establishes its effectiveness in terms of health literacy in the mother-to-mother education about breastfeeding, in the training of Association counsellors and in the education of the community. It argues that the key to the success of the Association was that the Foundation Members, led by Mary Paton, devised a new model of educating mothers about infant nutrition and particularly breastfeeding: specifically, they simultaneously established a community of learners and a community of practice. The core principles of the Association’s maternal educational model were first, mother-to-mother education; second, valuing the experience of the learner; and third, encouraging a critical view of mothering and breastfeeding. The thesis establishes that the Foundation Members were particularly influenced by Winnicott’s concept of the “good enough” mother, and the identification of the state of late pregnancy and the post-partum period as a time of “primary maternal preoccupation”, when mothers most needed the support of other mothers. They questioned the prevailing views about the “scientific mother” and they were vehemently opposed to the minimalist mothering implicit in the modernist approach to infant nutrition. The Association gave voice to mothers’ intuitive knowledge of a baby’s well-being and provided them with information that was not only correct, but understandable. It used the authentic voice of the Australian mother in its fully researched publications allowing the mother to choose for herself approaches that suited her own circumstances. Regarding knowledge as fluid and ever changing, its publications were constantly under revision. There were the training of the volunteer counsellors to facilitate the maternal education, the dedifferentiation and simplification of the program, a new understanding of how groups can support their members and the development of a new discourse of infant nutrition which have empowered mothers not only to successfully breastfeed, but also to change society’s attitudes to breastfeeding. This education model has successfully fostered mothers’ interactive and critical health literacy in infant nutrition, specifically in the area of breastfeeding, contributing to increased breastfeeding rates, and a wide acceptance of breastfeeding in the Australian community.

This thesis studies infant and young child feeding in Early Childhood Education and Care services in Australia, an environment of increasing importance to the child population. It examines policies and practices highlighting the need for visibility, support and collaboration in infant feeding in the first 1000 days to support ongoing health and development. It uniquely gives voice to experience of assessors as well as educators and families in eliciting strategies for increasing awareness and support for optimal infant and young child feeding practices in Early Childhood Education and Care.

Young women with breast cancer have been found to experience their disease more negatively and more intensely than their older counterparts. However 'young' is not uniformly defined within the literature. Studies have reported on a wide range of ages considered to be 'young', such as samples simply divided by menopausal status or other researcher-defined parameters. For the purpose of this study, young women with breast cancer were defined as those diagnosed at 40 years of age or younger. The overarching aim of the study was to explore the problems faced by this group of young women using qualitative methodology, guided by constructionist epistemology, and grounded in symbolic interactionism and social constructionism. The study was conducted longitudinally, with data collected three times over a 12-18 month period using one-to-one in-depth semi-structured interviews. Baseline data were collected in the first phase of the study (n=35). A sub-group of participants (n=13) were chosen to be followed twice more approximately six months apart, which made up the next two phases. Themes derived from the literature guided the first phase of the study, data collection and analysis. Data analysis was performed after each data collection phase, with findings informing the next phase/s of the study. Thematic and content analysis were utilized in regards to the analysis of the first phase of the study, providing a framework identifying the most pressing concerns, such as those centred around children and partners, emotional aspects and negative physical consequences of treatment. Interrelationships between these themes were apparent. Findings suggest that the emotional support needs of this group of young women remains a challenge. Basic analytical principles of data reduction, data display and drawing conclusions guided the following phases of the analysis. NUD*IST (N6) software was utilized to help undertake in-depth analysis of all follow-up data. The literature concentrates on infertility as a concern for young women with breast cancer, however the study found that fertility per se was a concern for this group of women. Issues of maintained and regained fertility were reported, i.e., concerns surrounding suitable, safe and reliable contraception, pregnancy and breastfeeding after breast cancer. Over time, perceptions of fertility changed. Decisions related to unplanned pregnancies and breastfeeding were particularly onerous. The study also provided other insights into the participants' lives. Body image is suggested to be of greater concern for younger women with breast cancer than their older counterparts. Perceptions of breast symbolism, societal and personal, were explored, as were perceptions of the external portrayal of their bodies. In addition, the participants reported how their experience of breast cancer differed from that of older women with breast cancer, e.g., to be and dress more sexually. Theories and notions of social constructionism and the social construction of the body helped explain the participants' experiences. The women were acutely aware of the sexual importance society placed on women's breasts. Social norms and expectations and cultural trends, that is the youth and beauty culture, were found to greatly influence the participants' perceptions and hence decisions made. Prosthesis use and breast reconstructive surgery were viewed as normalising efforts undertaken by participants to reduce stigma related to breast loss/disfigurement and to enhance body image. The findings from this study provide a greater understanding of the issues, concerns and experiences of young women with breast cancer and provide information that could be utilized in the redesign of educational/information resources to provide these women with relevant information. Currently available support services may also benefit from these findings as greater understanding of these women's experiences may facilitate and promote the provision of more age-appropriate support for young women with breast cancer diagnosed in the future.

Young women with breast cancer have been found to experience their disease more negatively and more intensely than their older counterparts. However 'young' is not uniformly defined within the literature. Studies have reported on a wide range of ages considered to be 'young', such as samples simply divided by menopausal status or other researcher-defined parameters. For the purpose of this study, young women with breast cancer were defined as those diagnosed at 40 years of age or younger. The overarching aim of the study was to explore the problems faced by this group of young women using qualitative methodology, guided by constructionist epistemology, and grounded in symbolic interactionism and social constructionism. The study was conducted longitudinally, with data collected three times over a 12-18 month period using one-to-one in-depth semi-structured interviews. Baseline data were collected in the first phase of the study (n=35). A sub-group of participants (n=13) were chosen to be followed twice more approximately six months apart, which made up the next two phases. Themes derived from the literature guided the first phase of the study, data collection and analysis. Data analysis was performed after each data collection phase, with findings informing the next phase/s of the study. Thematic and content analysis were utilized in regards to the analysis of the first phase of the study, providing a framework identifying the most pressing concerns, such as those centred around children and partners, emotional aspects and negative physical consequences of treatment. Interrelationships between these themes were apparent. Findings suggest that the emotional support needs of this group of young women remains a challenge. Basic analytical principles of data reduction, data display and drawing conclusions guided the following phases of the analysis. NUD*IST (N6) software was utilized to help undertake in-depth analysis of all follow-up data. The literature concentrates on infertility as a concern for young women with breast cancer, however the study found that fertility per se was a concern for this group of women. Issues of maintained and regained fertility were reported, i.e., concerns surrounding suitable, safe and reliable contraception, pregnancy and breastfeeding after breast cancer. Over time, perceptions of fertility changed. Decisions related to unplanned pregnancies and breastfeeding were particularly onerous. The study also provided other insights into the participants' lives. Body image is suggested to be of greater concern for younger women with breast cancer than their older counterparts. Perceptions of breast symbolism, societal and personal, were explored, as were perceptions of the external portrayal of their bodies. In addition, the participants reported how their experience of breast cancer differed from that of older women with breast cancer, e.g., to be and dress more sexually. Theories and notions of social constructionism and the social construction of the body helped explain the participants' experiences. The women were acutely aware of the sexual importance society placed on women's breasts. Social norms and expectations and cultural trends, that is the youth and beauty culture, were found to greatly influence the participants' perceptions and hence decisions made. Prosthesis use and breast reconstructive surgery were viewed as normalising efforts undertaken by participants to reduce stigma related to breast loss/disfigurement and to enhance body image. The findings from this study provide a greater understanding of the issues, concerns and experiences of young women with breast cancer and provide information that could be utilized in the redesign of educational/information resources to provide these women with relevant information. Currently available support services may also benefit from these findings as greater understanding of these women's experiences may facilitate and promote the provision of more age-appropriate support for young women with breast cancer diagnosed in the future.

The aims of this study were:-identify breast feeding problems mothers have experienced-formulate theories about what could be done to improve breastfeeding outcomes-consider if it is practicable for the health care system to implement these changes-explore what strategies might be developed to improve breastfeeding outcomes beyond the health care system.

Bibliography: leaves 250-267.
xx, 267, [90] leaves : ill., map ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Aims to develop a model to improve breastfeeding in a low socio-economic area through the development of health promotion strategies to create a supportive environment for breastfeeding.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000?

Bibliography: leaves 250-267.
xx, 267, [90] leaves : ill., map ; 30 cm.
Aims to develop a model to improve breastfeeding in a low socio-economic area through the development of health promotion strategies to create a supportive environment for breastfeeding.
Thesis (Ph.D.) -- University of Adelaide, Dept. of Public Health, 2000?

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.
Aim This research aimed to explore the key elements to improve the quality of postnatal care provided to women in a public hospital postnatal ward in Sydney and to attempt to implement a new model of postnatal care. Background Reports, internationally and nationally, indicate that women are least satisfied with hospital-based postnatal care when compared with antenatal, labour and birth care. Many researchers have identified the components of postnatal care that women find most helpful however, there continues to be barriers to develop and test innovative approaches or models of postnatal care within hospital settings. The focus of this project was to try to move the postnatal ward to a culture that is woman and baby centred rather than illness or institution-centred. The development process drew on Practice Development approaches that would enable midwives to facilitate change in the environment and culture of the postnatal ward with a view to improving postnatal care for women and their families. Method A qualitative descriptive study, using a three phased approach, was adopted for this research. Phase one was to identify the issues and concerns by conducting focus groups with staff. Phase two challenged usual practices and explored new ways of providing care in the postnatal ward. This phase incorporated working with the staff utilising Practice Development approaches. The third phase explored with key stakeholders the outcomes and issues of phase two including the barriers and limitations to enable midwives to implement a new model of postnatal care. Findings There were a number of barriers for change to occur including the current system of maternity care provided to women. This has also been reported by others over the past few decades. Within an acute care hospital environment, the midwives struggled to provide quality midwifery care with a philosophy of care counter to that which had been imbedded over many years. Midwives were caught up managing the day to day issues and most were unable to reflect on the care women received or to have the time to contemplate changes. Challenging the usual rituals and routines with the midwives generated some attainable changes that included providing women with more information about what to expect following birth and updated policies for healthy women and babies. The policies reflect the latest evidence and a more woman and baby centred approach to a daily assessment. This research also explored ways for midwives to be able to spend more time with women, and included challenging the everyday non-midwifery tasks undertaken by midwives working within the hospital system. These non-midwifery tasks included managing administration, security, catering and domestic duties. Barriers towards providing a more woman and baby centred way of providing postnatal care included the need for further professional development of the midwives and more professional support. There was also a need for role modelling of womancentred approaches to care and the development of a different way of providing care that included midwifery continuity of care. Conclusion Maternity services in hospitals have been subsumed into the general wards often governed by sickness priorities and it is acknowledged changing to a more womancentred approach was challenging. Without support from leaders, the change towards a woman-centred approach may not happen within the constraints of the medicalised model. Implications for Practice My research found a number of implications for others planning improved postnatal care for women in an acute care setting. Key elements included the need for midwives to have a clear articulation of their vision for the ward. Change may not happen if midwives do not believe the benefits of providing individualised care that meets the needs of the women. For this to be realistic and achievable, strong visionary leadership is key to moving the ward vision forward and implementing a new model of care. The timing for change in this setting is critical. It is unreasonable to implement change with midwives during a period of restructure. This can have a negative impact on successful change by threatening the midwives personal sense of control. In summary, this research found that effective leadership, adopting a shared vision, providing high support and high challenge were all important elements to support moving towards a more woman-centred care approach. Threatening the midwives sense of control over their professional world was also found to be an important factor when attempting to bring about change and will be discussed in this thesis.

This research attempted to identify the causes of and variables associated with early weaning (during the first three months) by breastfeeding women. Prior to 1970, there was a decline in breastfeeding rates, with a gradual increase during the 1970's and 1980's. Since the late 1980's, even with increased knowledge, evidence about the benefits and health promotion activity, rates remain relatively static. Of particular concern is the early postnatal through to three months of age group, where there continues to be a marked drop out of almost 50%. This was a descriptive longitudinal study of 682 primiparous and multiparous mothers and their babies that collected both qualitative and quantitative data via a series of self-administered questionnaires. They were completed at three monthly intervals over a period of up to twelve months. Participants exited the study following weaning or at the baby's first birth.

This study investigated the experiences and post-natal depression rates in women experiencing problems in establishing and maintaining a successful breastfeeding process with their babies. There were two phases in the project. Phase 1 gathered categorical data about this client group, their partner and baby, the breastfeeding problems experienced and screened the women for post-natal depression. Phase 2 involved semi-structured, in-depth interviews with ten of the women involved in Phase 1. The interviews explored women’s physical and emotional experiences of the breastfeeding problem(s); how this/these impacted on their relationship with their baby and partner; sought to elicit and evaluate the professional assistance they have received to remedy the problem(s); examined the amount and quality of family and social support received by the women; and invited participants to provide suggestions as to how other women in the same situation could be assisted. The results obtained found that this sample group had a higher level of PND than found by most previous researchers; that breastfeeding problems had a considerable physical and emotional impact on the women; they supported previous findings that professional, family and social supports are very important to new mothers; and that professional assistance and support to these women could be improved. It is recommended that further investigation is warranted – with a larger and more representative sample - to explore whether breastfeeding problems contribute to the aetiology and exacerbation of post-natal depression.

Research Doctorate - Doctor of Philosophy (PhD)
Based on ethnographic fieldwork undertaken in the maternity unit of an urban Australian public hospital, this thesis explores metaphors derived from material density as major ordering principles in western understandings of the world, and argues that logics of solidity and fluidity underpin lines of contestation in scientific, academic, and biomedical/health discourses. Through an exploration of social and scientific understandings of the human body, the thesis argues that the body as a fluid, dynamic phenomenon is frequently understood, in biomedical culture, through a logic that is inherently ‘solid’. Solid logic is privileged over fluid logic in hospital environments, which has particular consequences for maternity and birthing care. While medicalised birthing has contributed to improvements in maternal and infant safety and well-being across the western world, inappropriately medicalised birth can be both traumatising and iatrogenic. Feminist contestations to the medicalisation of pregnancy and birth, and obstetric resistance to these contestations, can be seen as contestations between epistemologies centered on (more) fluid or (more) solid understandings of the world. Risk management is shown to be reliant on strategies of material and symbolic solidification, often to the detriment of the inherent fluidity of the maternal body. Constructions of individual autonomy rely on the construction of a bounded body that is often in contradiction with experienced biological corporeality. The thesis argues that fluid logic offers space for maternal corporeality, however the individual autonomy required by the western health consumer is only achievable within a framework of solid logic. Ethnographic engagement with pregnant and birthing women, their partners and families, midwives, obstetricians and other hospital professionals allows for an analysis of embodied and discursive beliefs and practices. The rich complexities of technologised birthing are highlighted in explorations of clinical encounters and key decision making moments in birthing and maternity care.