"It Doesn't Have to Be All or Nothing": How Individuals Who Use Infant Formula Understand the Breastfeeding Master Narrative.

Despite clinical recommendations, only 24.9% of infants in the United States are exclusively breastfed at 6 months of age, and women who use formula report facing stigma and feeling like a failure. Individual experiences are often influenced by master narratives such as "breast is best," and stories can reveal how the discourse may manifest unintended effects, potentially eliciting guilt and shame, which are known to result in negative maternal mental outcomes, including depression and anxiety. The purpose of this research was to use a narrative framework to analyze the stories of women who used formula and determine how they interpreted the master narrative of "breast is best." We conducted interviews with 20 women who had used formula within the first 6 months after giving birth and had an infant no older than 12 months at the time of the interview. Qualitative analysis revealed that women integrated "breast is best" into their stories, and that the master narrative influenced conceptions of themselves as mothers including the bonded mother, the good mother, the shameful mother, and, ultimately, the multitudinous mother. Participants who used formula within the first six months desired that messaging about breastfeeding, particularly in online spaces, move away from all-or-nothing framing and instead show the diversity of infant feeding experiences. It is important to consider how breastfeeding discourse evolves online, considering the unintended effect of stigma, its impact on mental health, and the potential for individuals interacting in these spaces to curate more nuanced narrative messaging about breastfeeding to improve maternal and infant health.

Narrative Sense-Making During COVID-19: Using Stories to Understand Birth in a Global Pandemic.

Women who gave birth in the spring and summer of 2020 contended with a host of challenging factors. In addition to facing pregnancy, labor, and delivery during an emerging global pandemic, women grappled with health care restrictions that altered their birth experience. To explore how women made sense of their birth during COVID-19, we analyzed written narratives from 71 women who gave birth in the United States from March to July 2020. Based on tenets of communicated narrative sense-making, the themes that emerged from our data suggest that women framed the role of the pandemic as either completely overshadowing their birth experience or as an inconvenience. Women also wrote about threats to their agency as patients, mothers, and caregivers, as well as the evolving emotional toll of the pandemic that often prompted feelings of fear and sadness, along with self-identified anxiety and depression. We discuss these findings in light of the literature on birth stories as essential sites of narrative sense-making for women and their families.

Expectancy violations and boundary management when giving birth during a pandemic: implications for supporting women.

BACKGROUND: Few life events are as profound as the birth of a child. Yet for those who gave birth during the COVID-19 pandemic, the birth experience and the care of their newborn child were altered in significant ways. METHOD: In this study, we examined the stories of women who gave birth during the COVID-19 pandemic using expectations violations theory and communication privacy management theory. RESULTS: Based on focus group interviews with 65 women from 19 states across the U.S., we found that policies imposed by institutions and visitation rules negotiated by women were prominent in women's birth stories. Policies that affect territorial access to mothers and babies shaped communication to manage health and safety, resulted in intense emotional responses, and affected relationships with women's partners and families. CONCLUSIONS: Our findings offer practical implications for both health care systems and health care providers. Systems must communicate proactively to offer compassionate patient care, and physicians should offer guidance to help new parents manage visitors.

"There's no time limit on grief:" Women's perspectives on a novel reproductive grief screening tool.

Objective: Women who have experienced reproductive loss (i.e., miscarriage, stillbirth, abortion) evaluated the usefulness of a novel screening tool, Reproductive Grief Screen (RGS), to identify patients struggling with ongoing, complicated grief. Methods: This mixed-methods study involved U.S. women who had experienced reproductive loss. Online data collection resulted in 27 interviews and 282 surveys completed. Perceptions of and preferences about RGS were thematically analyzed. Chi square analyses assessed relationships between demographics and tool preferences. Results: RGS validated women's experiences with grief after reproductive loss. Women noted their providers may be unaware of their loss(es). Participants requested periodic screening using RGS beginning shortly after a loss (or during new patient intake) and occurring regularly (e.g., annually). Overall, women preferred completing RGS online before an appointment, though preferences varied by demographics (i.e., age, time since loss). Participants want providers to compassionately discuss RGS results with them and offer appropriate resources. Conclusion: The RGS can help identify largely ignored grief after reproductive loss. Innovation: Findings from group and individual interviews and a survey of women who have coped with reproductive loss suggest that use of a brief RGS tool could reshape clinical practice to aid women who might be facing complicated grief. Moreover, women expressed clear preferences for how to implement use of the RGS in clinical contexts.

"I'm Not Comfortable With COVID, But ": Dilemmas and Decision-Making to Mitigate Risks Among Mothers Who Gave Birth During the COVID-19 Pandemic.

Individuals have faced unprecedented uncertainty and risk surrounding the COVID-19 pandemic, and decision-making dilemmas have been complicated by quickly evolving and often contradictory recommendations for staying healthy. Using tenets of problematic integration theory and risk orders theory, we analyzed interview data from 50 mothers who gave birth during the pandemic to understand how uncertainty and risk perceptions shaped their decision-making about keeping themselves and their infants healthy in the first year after birth. Results describe how some mothers in our sample made sense of their decision-making to prioritize first-order risks to their own and their family's physical health, and other mothers prioritized second-order risks to their relationships and identities. We also discuss the social nature of mitigating risk during the COVID-19 pandemic and the catalysts for shifting risk perceptions. Theoretical and practical implications include improving public health messaging and clinical conversations to enable individuals to effectively manage social and identity needs alongside serious threats to physical health.

Exploring Internal Medicine Interns' Educational Experiences on Opioid Addiction: A Narrative Analysis.

Increased efforts to educate physicians on addiction are crucial based on widespread addiction rates and the ongoing opioid crisis. Physicians in the United States hesitate to adopt medication-assisted treatment (MAT) due to a lack of addiction education. For this study, we used a narrative framework to understand how internal medicine interns (first-year residents) recount their educational experiences on addiction during their medical school education and early residency. In using a sensemaking function, our results revealed four types of narratives: dearth, futility, priority, and impact. We found that the narratives were interrelated and indicated that interns understood addiction as a disease yet felt unprepared to treat it. We also discovered that interns did not fully appreciate the nuances of addiction. Their attempts to engage patients in substance recovery or reduction were often unsuccessful, leaving them feeling disappointed. Interns had mixed feelings when working with addiction-related issues as patients' addiction was rarely ever addressed. Interns also encountered "eye-opening" events leaving them astonished. Thus, shaping their views on the opioid crisis, and by extension, addiction. Increasing medical students' and residents' competency through practical education and training may improve physician comfort and confidence leading to the adoption of opioid addiction treatment such as MAT, potentially reducing the opioid epidemic.

Parents' Communication Work in the Management of Food Allergies.

The National Academies of Sciences, Engineering, and Medicine (NASEM) has identified food allergies as a critical public health issue that significantly affects quality of life for patients and their families. Despite the crisis-level status of food allergies, especially in children, there are currently no curative treatments. As a result, impacted families must learn how to carry the burden of disease management. Using an expanded application of the concept of communication work, this study features data from interviews with 26 parents of food allergic children and explores how parents navigate the nuances of food allergy maintenance while negotiating and preserving valued relationships and identities through everyday talk. Results revealed that parents used communication to legitimate food allergy, balance potential face-threats with identity and relational goals, and coordinate care with spouses. Due to the lack of therapeutic treatment options, we found that parents utilize communication work, which is both demanding and effortful, as a form of disease management.

Qualitative Assessment of Bad News Delivery Practices during Miscarriage Diagnosis.

Miscarriage is one of the most common pregnancy complications health care providers discuss with patients. Previous research suggests that women's distress is compounded by ineffective communication with providers, who are usually not trained to deliver bad news using patient-centered dialogue. The purpose of this study was to use a patient-centered approach to examine women's experiences with and perspectives of communication during a miscarriage to assist in the development of communication training tools for health care providers. During focus groups, 22 women who had experienced miscarriage discussed video-recorded standardized patient-provider interactions and recalled communication during their own miscarriages. Results of a pragmatic iterative analysis of the transcripts suggest training techniques and communication behaviors that should guide education for providers to deliver the diagnosis of and treatment options for early pregnancy loss, such as demonstrating empathy, creating space for processing, checking for understanding, and avoiding medical jargon and emotionally charged language.

Tensions and Contradictions in Interns' Communication about Unexpected Pregnancy Loss.

Early miscarriage is an unexpected pregnancy complication that affects up to 25% of pregnant women. Physicians are often tasked with delivering the bad news of a pregnancy loss to asymptomatic women while also helping them make an informed decision about managing the miscarriage. Assessing the communicative responses, particularly the discursive tensions embedded within providers' speech, offers insight into the (in)effective communication used in the delivery of bad news and the management of a potentially traumatic medical event. We observed and analyzed transcripts from 40 standardized patient encounters using Baxter's relational dialectics theory 2.0. Results indicated that interns invoked two primary distal already-spoken discourses: discourses of medicalization of miscarriage and discourses of rationality and informed consent. We contend that tensions and contradictions could affect how women respond to the news of an impending miscarriage and offer practical implications for communication skills training.

The Influence of Everyday Interpersonal Communication on the Medical Encounter: An Extension of Street's Ecological Model.

Street's ecological model has shaped the research-examining communication during medical encounters for over a decade. Although the model accounts for the variety of contexts that shape the conversations in which patients and health-care providers engage, the model does not adequately address the way that everyday conversations about health carry over into patient-provider interactions. In this essay, we propose an extension of Street's model that adds the context of everyday communication about health as a contributing factor in the medical encounter. We support the need for this extension by discussing research that points to the ways these conversations with our social network influence communication during the medical encounter and propose new areas for research based on this extension.

Communicating to promote informed decisions in the context of early pregnancy loss.

OBJECTIVE: To evaluate residents' ability to engage standardized patients in informed decision making during a pregnancy loss scenario. METHODS: Forty patient encounters between interns and standardized patients were coded to assess informed decision-making practices, exploration of unexpressed concerns, and support provision. RESULTS: Interns engaged in minimum informed decision making but did not address all of the communicative elements necessary for informed decisions, and most elements were only partially addressed. Patients in this study did not receive information about all management options, their concerns were not addressed, and there was limited support communicated for their decision. CONCLUSION: This study offers an initial assessment of a communicative approach to evaluate and improve decision making during early pregnancy loss. A comprehensive approach to making informed decisions must include discussion of all management options, exploration of patient preferences and concerns, and support for the patient's decision. PRACTICE IMPLICATIONS: Physicians could benefit from communication skills training to communicate more effectively with patients to help them make more informed decisions.

Informing or Exploiting? Public Reponses to Giuliana Rancic's Health Narrative.

Popular entertainment journalist Giuliana Rancic has shared her struggles with pregnancy loss, infertility, and breast cancer in an array of public forums. In this study, we analyzed online comments responding to public discourses surrounding Rancic's revelations, including her miscarriage and fertility treatments, her breast cancer diagnosis, and her decision to undergo a double mastectomy. Our goal was to explore how the public framed Rancic's health challenges. Using a narrative lens, we argue that online comments reveal the tensions that celebrities like Rancic must manage as they contend with public scrutiny of their stories. Online commenters in this study framed Rancic's narrative as a privileged vantage point in which she exploited her health struggles for personal and financial gain. Our analysis of these comments also demonstrates how Rancic's narrative exists in concert with other discourses that challenge and disrupt her own account of events. The examination of these mediated discourses has implications for understanding the role of celebrity experiences in personal and public conversations about health.

Surrogate decision makers and proxy ownership: challenges of privacy management in health care decision making.

This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients' private health information while the patient was hospitalized. This research determined that not only are surrogates guardians and thereby co-owners of the patients' private health information, they actually served in a "proxy ownership" role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients' information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient's wishes. Theoretical and practical implications of these challenges are discussed.

Implementation of a journal prototype for pregnant and parenting adolescents.

Teenage pregnancy and childbearing remain pressing public health issues that have garnered attention from public health officials and social services agencies. This paper reports on the initial implementation and formative evaluation of a journaling program used as a means of communicating health information to pregnant and parenting adolescents (young women age 15-19) while also providing participants with a means of self-expression. The journaling prototype was implemented in a community-based agency in the Midwest by Family Support Specialists (FSSs) who made home visits on a monthly basis to assist pregnant and parenting adolescents (n=52) with successful family planning and public health education. A mixed method approach of qualitative (analysis of journals, field notes, and responses of semi-structured interviews with FSSs) and quantitative (questionnaires from pregnant and parenting adolescent respondents) data with purposive sampling was employed to evaluate the implementation of the journaling intervention. Twenty of the 52 study participants were pregnant when the journaling intervention was implemented, while 32 were not pregnant, but recently had a child and were currently parenting. Two core themes emerged from analysis of the data after the implementation of the journals: (1) usefulness of the journal and responsiveness to participants' information needs and (2) functionality challenges. The results offer practical starting points to tailor the implementation of journaling in other contexts. Further, areas for improvement emerged regarding the distribution timeline for the journal and the content of the journal itself. As such, we discuss the lessons learned through this collaborative project and suggest opportunities for future phases of the journal intervention.

Public discourses about teenage pregnancy: disruption, restoration, and ideology.

Two recent incidents in the United States generated a wealth of public discourses about a particular reproductive health issue: adolescent childbearing. As the media, political pundits, and private citizens pondered the meaning of these events, they expressed viewpoints, explanations, and possible solutions in mass-mediated outlets. We examined the discourses communicated in such outlets to understand how public discussion of teenage pregnancy reveals ideological assumptions about reproductive health, ideal family forms, and the expected life course.

Low-income women describe fertility-related expectations: descriptive norms, injunctive norms, and behavior.

Social norms surrounding sexuality, pregnancy, and childbearing may help guide women's health-related behaviors. In this study, we explore low-income women's perceptions of fertility-related norms by allowing women to describe their experiences with normative expectations. Semistructured interviews (n = 30) suggested that women in low-income subject positions articulate descriptive norms that generally correspond with mainstream descriptive norms, identify two major sources of injunctive norms concerning fertility and sexuality- authoritative and peer-oriented-and often align their behaviors according to subgroup expectations communicated in the form of peer-oriented injunctive norms. We discuss these results in light of the extant literature on social norms.