'I thought it would keep them all quiet'. Women's experiences of breastfeeding as illusions of compliance: an interpretive phenomenological study.

AIMS: To explore the experiences of breastfeeding women. BACKGROUND: There is a plethora of data demonstrating that human breast milk provides complete nutrition for human infants. While the rate of initiation of breastfeeding in the United Kingdom has shown a steady increase in the last 25 years, rates of exclusive breastfeeding in the early weeks and months over the same time period have shown only marginal increases. This study was designed to extend current knowledge around breastfeeding experiences, decisions and behaviours. DESIGN: Qualitative, interpretive phenomenological approach. METHODS: Data were collected between July 2009-January 2010 through in-depth interviews with 22 women from a city in the East Midlands where the prevalence of breastfeeding has showed a decreasing trend. Data were collected between 3-6 months after the birth of their youngest baby. FINDINGS: Analysis of data uncovered a key theme: illusions of compliance. The findings revealed that women's breastfeeding behaviours were socially mediated. They adopted a good mother image by conforming to the moral obligation to breastfeed immediately after their babies were born. Those women who struggled to establish breastfeeding tried to hide their difficulties rather than admit that they were not coping. CONCLUSION: This study provides insights into women's infant feeding decisions and behaviours, building on understandings of 'good mothering' in the wider literature. Importantly we highlight some of the previously unknown strategies that women employed to portray themselves as calm, coping and in control when in reality they were struggling and not enjoying breastfeeding.

Practice improvement, breastfeeding duration and health visitors.

The primary purpose of practice improvement is to improve clinical practice through changing the behaviour of healthcare professionals. Breastfeeding is a key public health issue, conferring benefits associated with both infant and maternal health, yet breastfeeding rates in the U.K. and Ireland are among the lowest in Western Europe. In this paper, the ways in which practice improvement can be utilised to enhance both efficiency and effectiveness are described, using a case study of the potential contribution of health visitors to increasing breastfeeding duration in primary care in order to illustrate this in clinical practice.

Nurses', midwives' and health visitors' perceptions of the impact of higher education on professional practice.

AIM: This study examines the perceptions of qualified nurses, midwives and health visitors of the impact of higher education on professional practice. METHODOLOGY: This is a qualitative study using a phenomenological approach. A non-probability convenience sample of 12 qualified nurses, midwives and health visitors who had enrolled upon a Master of Science programme in Professional Practice at a United Kingdom Higher Education Institution in the East Midlands were interviewed using semi-structured interviews, which were audio-taped and analysed using Colaizzi (1978) [Colaizzi, P., 1978. Psychological research as a phenomenologist views it. In: Valle, R., King, M., (Eds.), Existential Phenomenological Alternatives for Psychology. Oxford University Press, New York, pp. 48-71] approach. Approval to undertake this study was received from the University's Research Ethics Committee. RESULTS: Four themes emerged from the interview data. These were personal and professional motivation, workplace constraints, valuing "hands-on" nursing and client contact, and challenging and questioning practice. From the respondents' perspective, there was a strong view that higher education has a positive effect in practice, but a significant number of factors including time and support seemed to inhibit the possible benefits in practice. These are discussed in relation to the findings from similar studies. CONCLUSION: This study has highlighted the need for further research to explore the impact of higher education on client care and service delivery.