Bakgrund: Det naturligaste sättet att ge näring åt ett nyfött barn är genom att amma, vilket inte alltid är enkelt och problemfritt. I Sverige föds ungefär 7000 barn per år som behöver vård på neonatalavdelningar. När ett barn är fött för tidigt kan amning dessutom vara förenat med ytterligare svårigheter. Problematiken som kan uppstå kan bero på att det för tidigt födda barnet är omoget och därför inte har samma förutsättningar som fullgångna barn har för att amma. Mödrar på neonatalavdelningar kan samtidigt uppleva en stress och oro över den nya situationen med att ha fått ett för tidigt fött barn. Vårdpersonal har en viktig roll i att ge det amningsstöd som krävs för att främja amning bland för tidigt födda barn. Syfte: Syftet med studien var att belysa mödrars upplevelser av amningsstöd på neonatalavdelningar. Metod: En intervjustudie med kvalitativ ansats utfördes. Elva intervjuer genomfördes och materialet analyserades med inspiration av Burnards analysmetod för kvalitativa intervjuer.Resultat: Mödrarnas upplevelser av amningsstöd resulterade i fyra kategorier: bemötande, vägledning, kompetens och tillgänglighet, med två tillhörande underkategorier vardera.Slutsats: Mödrarna upplevde att endast ett fåtal av personalgruppen kunde ge amningsstöd. Amningsstöd handlade om både kunskap och erfarenhet, men även om upplevelsen kring samspelet mellan personalen och modern. Samspelet handlade till stor del om personalens bemötande och tillgänglighet. Helheten var betydelsefull för upplevelsen av amningsstöd. / Background: The most natural way to nourish a newborn baby is by breastfeeding, which is not always easy and trouble-free. Each year about 7000 children who need care in neonatal departments are born in Sweden. When a baby is born prematurely breastfeeding may be associated with additional difficulties. The difficulty that may arise may be the premature baby’s immaturity and therefore the conditions are not the same as a full-term baby’s capacity to breastfeed. At the same time, mothers in neonatal departments experience stress and anxiety about the new situation of having a premature baby. Nursing staff have an important role in providing the breastfeeding support needed, to promote breastfeeding among premature babies.Aim: The aim of the study was to highlight mothers’ experiences of breastfeeding support in neonatal departments.Method: An interview study with a qualitative approach has been performed. Eleven interviews where completed and then analyzed with inspiration of Burnards method of analyzing qualitative interviews.Results: The mothers' experiences of breastfeeding support resulted in four categories: encounter, guidance, competence and availability, with two matching subcategories each.Conclusion: The mothers felt that only a few of the nursing staff could provide breastfeeding support. Breastfeeding support was about knowledge and experience, but also about the experience of the interaction between the staff and the mother. The interaction was largely about the staff's encounter and availability. The entirety was important for the experience of breastfeeding support.

Magister Scientiae (Nutrition Management) - MSc(NM) / Despite evidence-based proof on the benefits of breastfeeding, little progress has been made globally to improve breastfeeding rates (The Lancet, 2016), including in South Africa. Despite many attempts to improve breastfeeding rates worldwide, women are still choosing to stop breastfeeding or avoid it due to various factors (The Lancet, 2016). Aim: To explore the factors influencing the exclusive breastfeeding rate within the first 14 weeks postpartum with mothers in the Khayelitsha Eastern Substructure.

Enligt World Health Organizations rekommendationer bör kvinnor uteslutande amma sina barn under de första sex levnadsmånaderna. Amning medför kortsiktiga och långsiktiga hälsofördelar för både mamman och barnet och innebär miljömässiga och ekonomiska vinster både på individ och samhällsnivå. Trots detta sjunker amningsfrekvensen och det är i skrivande stund bara en tredjedel av världens spädbarn som helammas upp till sex månaders ålder. I Sverige har andelen helammade barn minskat under de senaste 30 åren och frekvensen fortsätter att sjunka. Detta är ett stort folkhälsoproblem där barnmorskan har en central uppgift i sitt arbete att främja och stödja kvinnor till amning.  Syftet var att undersöka vilka faktorer som bidrar till att kvinnor helammar sitt barn. Vald metod var en integrativ litteraturöversikt med en flerstegsprocess framställd av Whittemore och Knafl. Sexton artiklar inkluderades i resultatet, varav åtta kvantitativa, sjukvalitativa och en av mixad metod. All data insamlades via databaserna PubMed och CINAHL under våren 2023. I resultatet sammanställs fem kategorier som svarar på syftet: aktivt stöd från barnmorskan genom hela vårdkedjan, stöd från partner och omgivning, bemötande och motivation, kunskap och evidensbaserad information samt skyddsfaktorer och riskfaktorer till helamning. Slutsatsen var att kvinnor helammar i större utsträckning när de haft ett aktivt stöd från barnmorskan genom hela vårdkedjan. Ett individanpassat stöd med respekt för kvinnans autonomi var viktigt. Motivationen att helamma ökade i de fall barnmorskan uppmuntrade och stärkte kvinnornas upplevelse av självförmåga samt visade tilltro till deras nya roll som ammande mödrar. Att ha en stödjande partner samt att kvinnorna fick adekvat och evidensbaserad information om amning var också avgörande. Inkonsekventa och motsägelsefulla amningsråd minskade förtroendet för vårdgivarna och påverkade amningen negativt. Gemensamma riktlinjer för amningsstöd bör utformas inom vårdverksamheten och varje barnmorska bör hålla sig uppdaterade kring evidensbaserad kunskap om amning. / World Health Organization recommend women to exclusively breastfeed their children until the age of six months. Breastfeeding contributes to short-term and long-term health benefits for both the mother and child and entails environmental and economic gains at an individual and societal level. Despite this, breastfeeding rates are decreasing and currently only one third of the children worldwide are exclusively breastfed up to the age of six months. In Sweden, exclusive breastfeeding has decreased over the last 30 years and continues to do so. This is a major public health problem where midwives play a central role in their work to promote and support women to breastfeed. The aim was to investigate which factors contribute to women exclusively breastfeeding their children. The chosen method was an integrative literature review based on Whittemore and Knafl´s multi-stepprocess. Sixteen articles were included in the results, eight quantitative, seven qualitative and one of mixed method. All data were collected via the databases PubMed and CINAHL in the spring of 2023. The results compiled five categories: active support from the midwife throughout the care-chain, supportive partner and friends, treatment and motivation, knowledge and evidence-based information as well as protective factors and risk factors for exclusive breastfeeding. Women exclusively breastfeed longer when they recieve active support from midwives throughout the entire care-chain. Individuaized care and respect for womens autonomy was important. The motivation to breastfeed increased when the midwife encouraged and strengthened the womans self-efficacy and showed trust in their new role as breastfeeding mothers. Having a supportive partner as well as receiving adequate and evidence-based information about breastfeeding from midwives were also important. Inconsistent breastfeeding advice from care givers negatively affected their motivation. It is important that midwives create common guidelines for support and remain updated on evidence-based breastfeeding knowledge.

Bakgrund: Att amma sitt barn i minst sex månader efter födseln ses som mest fördelaktigt för barnets hälsa och även ur ett folkhälsoperspektiv. Ändå så är det inte många som faktiskt helammar efter sex månader.  Syfte: Syftet med studien var att undersöka kvinnors upplevelser av amningsstöd av hälso- och sjukvårdspersonal.  Metod: En kvalitativ litteraturöversikt med en integrerad analys enligt Kristensson (2014). Systematisk sökning av litteratur skedde i databaserna CINAHL, PsycInfo och PubMed.  Resultat: I denna studie inkluderades totalt 12 originalstudier publicerade mellan åren 2017- 2021 med totalt 443 kvinnor inkluderade. Ett tema, två kategorier och 10 underkategorier identifierades. Det tema som identifierades var Ammande kvinnors upplevelser av amningsstöd från hälso- och sjukvårdspersonal och de två kategorierna som identifierades var Positiva upplevelser av amningsstöd och Negativa upplevelser av amningsstöd. Resultatet av studien visar att kvinnor generellt uppskattar det stöd de fått om amning av hälso- och sjukvårdspersonal. Dock upplevs stödet som bristande hos majoriteten både under graviditeten och efter barnet är fött.  Slutsats: Kvinnorna beskrev att de hade både positiva och negativa upplevelser av amningsstöd. För att kvinnor ska ha förutsättningar att fortsätta amma behöver de få tillgång till kontinuerligt stöd från hälso- och sjukvården under graviditet samt postpartum. Mer forskning krävs inom svensk hälso- och sjukvård för att kunna implementera nya arbetssätt som främjar amningsstöd. / Background: To breastfeed an infant six months after birth is beneficial for the infant’s health and positive from a public health perspective. Despite several advantages, few mothers breastfeed their child exclusively until the child is six months old.  Aim: The aim was to investigate women’s experiences of breastfeeding support from healthcare professionals.  Methodology: A qualitative literature review with an integrated analysis was performed according to Kristensson (2014). The included literature was obtained from the databases CINAHL, PsycInfo and PubMed.  Results: This study included a total of 12 original studies published between the years 2017- 2021 with a total of 443 women included. One theme, two categories and 10 subcategories were identified. The theme identified was Breastfeeding women's experiences of breastfeeding support from health care professionals and the two categories identified were Positive experiences of breastfeeding support and Negative experiences of breastfeeding support. Women generally appreciate the breastfeeding support they received from healthcare professionals. However, support was perceived as lacking by the majority both during the pregnancy and after the child was born.  Conclusion: The women described that they had both positive and negative experiences of breastfeeding support. To enable women to continue breastfeeding they need continuous support from the healthcare system during pregnancy and postpartum. More research is required within Swedish healthcare to be able to implement new working methods that promote breastfeeding support.

No / There is now a body of research evaluating breastfeeding interventions and exploring mothers' and health professionals' views on effective and ineffective breastfeeding support. However, this literature leaves relatively unexplored a number of questions about how breastfeeding women experience and make sense of their relationships with those trained to provide breastfeeding support. The present study collected qualitative data from 22 breastfeeding first-time mothers in the United Kingdom on their experiences of, and orientation towards, relationships with maternity care professionals and other breastfeeding advisors. The data were obtained from interviews and audio-diaries at two time points during the first 5 weeks post-partum. We discuss a key theme within the data of 'Making use of expertise' and three subthemes that capture the way in which the women's orientation towards those assumed to have breastfeeding expertise varied according to whether the women (1) adopted a position of consulting experts vs. one of deferring to feeding authorities; (2) experienced difficulty interpreting their own and their baby's bodies; and (3) experienced the expertise of health workers as empowering or disempowering. Although sometimes mothers felt empowered by aligning themselves with the scientific approach and 'normalising gaze' of health care professionals, at other times this gaze could be experienced as objectifying and diminishing. The merits and limitations of a person-centred approach to breastfeeding support are discussed in relation to using breastfeeding expertise in an empowering rather than disempowering way. / British Academy. Grant Number: 37524

The Healthy People 2010 Objectives for the population of the United States include the objective for women to sustain breastfeeding at a higher rate than they are currently.The American Academy of Pediatrics (AAP) now recommends that all infants be fed human milk for the first year of life instead of the previously recommended first six months of life. Breastfeeding initiation rates are rising, but breastfeeding duration rates continue to fall. It was hypothesized that the support system of the women may play a role in the duration of breastfeeding. The purpose of this research study was to investigate the support system and breastfeeding rates of mothers during the first six weeks after delivery and to determine if income level had an effect on these systems and rates. Mothers were interviewed during their hospitalization for childbirth regarding their perception of their support system currently in place. A questionnaire was administered regarding support from friends, family members, co-workers, and health care professionals and the responses were quantified. Mothers were contacted weekly to determine if breastfeeding was being sustained and who was the most supportive person to them. At the end of six weeks or when breastfeeding was discontinued, the mothers were interviewed a second time to determine if the support system had changed. The results of this study showed that income level affected the duration of breastfeeding and the mother's perception of her support system. Additionally, the results showed that the evaluation of the support system changed only slightly over time. The results showed preliminary ability of the study tool to predict breastfeeding at six weeks by income.This document was created using Microsoft Word 2003. The statistical package used for data analysis was JMP version 6.

Introduction: Breastfeeding offers the substance exposed mother and child potential short and long-term health benefits, with breast milk shown to alleviate the severity of Neonatal Abstinence Syndrome. Substance dependent women, however, have limited success establishing breastfeeding with physical, psychological and institutional factors cited as barriers. This study aimed to develop and test the feasibility of an evidence informed and theory based intervention to support continued breastfeeding for this group. Methods: The research was a two-phase feasibility study. Phase 1 informed intervention development using a mixed methodology approach which included (a) a comprehensive systematic literature review of breastfeeding support for women from disadvantaged groups (b) expert advisory group recommendations and (c) ‘think aloud’ verbal protocols with opioid dependent women. Phase 2 underpinned the evidence with the theoretical constructs of behaviour change, prior to testing the acceptability and implementation fidelity of the intervention in a feasibility study with an embedded small-scale randomised controlled trial. Results: Phase 1 identified the barriers to breastfeeding continuation as low maternal self-efficacy; neonatal feeding difficulties associated with withdrawal and unsupportive healthcare practices. Evidence and theory synthesis resulted in an integrated breastfeeding support model founded on practical, informational, psychological, person-centred and environmental components. Phase 2 demonstrated that the intervention was feasible to implement and acceptable to participants. The randomised controlled trial reported higher rates of continued breastfeeding and a greater level of maternal confidence in breastfeeding ability in the intervention group compared to the control group. Breastfed infants were less likely to require pharmacological management and had corresponding shorter durations of hospitalisation than formula fed infants. Conclusion: The research provided an original contribution to the development of a complex healthcare intervention which is meaningful to both existing research and clinical practice. The findings highlighted the potential of the intervention to support breastfeeding for the substance exposed mother and baby, which has wide ranging implications for the improved health and social equalities of this group.

Bakgrund: Tidigare forskning har rapporterat att amning är associerat med flera hälsofördelar för barnet såväl som modern. Trots det är amningsfrekvensen i Sverige sjunkande. En viktig faktor för en fungerande amning är ett gott amningsstöd. I Sverige förmedlas det stödet företrädesvis av barnhälsovårdssjuksköterskor.Syfte: Syftet med studien är att belysa barnhälsovårdssjuksköterskans erfarenheterav att ge amningsstöd.Metod: Studien är av kvalitativ design med en datainsamling som genomfördes via semistrukturerade intervjuer med tio barnhälsovårdssjuksköterskor. Data analyserades med metoden för kvalitativ innehållsanalys.Resultat: Analysen resulterade i två huvudkategorier som belyser barnhälsovårdssjuksköterskans erfarenheter av att ge amningsstöd: Att främja amningsstödet och Att utmanas vid amningsstöd, med tillhörande sju underkategorier.Konklusion: Ökad kunskap om amning resulterade i större engagemang för ett gott amningsstöd. Amningen främjades av ett individualiserat amningsstöd. Det var av vikt att barnhälsovårdssjuksköterskan anpassade stödet utifrån ammande mödrars erfarenheter av amning. Barnets behov och familjens förväntningar om amning togs även i beaktande. Trots erfarenheter om ett amningsfrämjande arbete utmanades amningsstödet bland annat av bröstmjölksersättning och strävan efter en jämställd relation. / Background: Previous research has reported that breastfeeding is associated with several health benefits for the child as well as the mother. Despite that, the breastfeeding rate in Sweden is declining. An important factor for a functioning breastfeeding is breastfeeding support. In Sweden, that support is preferably provided by nurses in child health care.Purpose: The purpose of the study is to illustrate the child health nurse's experiences of providing breastfeeding support.Method: The study is of a qualitative design with a data collection that was carried out via semi-structured interviews with ten child health nurses. Data were analyzed using the method of qualitative content analysis.Results: The analysis resulted in two main categories that highlight the child health nurse's experiences of providing breastfeeding support: Promoting breastfeeding support and Being challenged by breastfeeding support, with associated seven subcategories.Conclusion: Increased knowledge about breastfeeding resulted in greater commitment to good breastfeeding support. Breastfeeding was promoted by an individualized breastfeeding support. It was important that the child health nurse adapted the support based on breastfeeding mothers' experiences with breastfeeding. The child's needs and the family's expectations about breastfeeding were also taken into consideration. Despite experiences with breastfeeding promotion work, breastfeeding support was challenged, among other things, by breast milk substitutes and the pursuit of an equal relationship.

Det finns många fördelar med att amma varför amning är förstahandsvalet. Antalet kvinnor som helammar sitt nyfödda barn minskar trots att majoriteten av svenska kvinnor planerar att helamma. WHO rekommenderar att barnet helammas till sex månaders ålder. Trots rekommendationen helammas 44 procent av barnen globalt vid sex månaders ålder. Amning är en del av barnmorskans kompetensområde vilket innebär att de ska främja amning. Barnmorskor har en plikt att genomföra amningsrådgivning till samtliga kvinnor. Många kvinnor upplever initialt amningssvårigheter och för att förhindra tidigt amningsstopp är barnmorskans amningsstöd grundläggande. För att utveckla barnmorskans amningsstöd är det därför viktigt att ta reda på hur kvinnor upplever att det är att ta emot amningsrådgivning. Syftet med studien var att undersöka kvinnors upplevelse av amningsstöd och amningsinformation från barnets födelse till sex månaders ålder. Metoden som valdes var en litteraturöversikt med systematisk metod. Studier med kvalitativ och mixad metod inkluderades och endast kvalitativa data användes i resultatet. Databassökning genomfördes i Pubmed och Cinahl. Därefter kvalitetsgranskades artiklarna och endast de som uppfyllde kvalitetskraven inkluderades i resultatet. Vald data analyserades sedan genom integrerad analys. I resultatet inkluderades femton artiklar. Likheter och skillnader i hur kvinnor upplevde amningsstödet identifierades och utformade subkategorierna: kontinuitet inom vårdkedjan, tid för amningsstöd, praktiskt amningsstöd, betydelsen av bekräftelse och uppmuntran samt information och rådgivning. Utifrån subkategorierna identifierades sedan kategorierna kontinuitet och tillgänglighet samt vårdpersonalens bemötande. Slutsatsen indikerade att kvinnorna hade både positiva och negativa upplevelser av amningsrådgivning. I resultatet framkom faktorer som barnmorskor kan påverka kvinnans amningsupplevelse på egen hand genom sitt bemötande. Vidare urskildes faktorer som barnmorskorna inte kan påverka, såsom barnmorskeutbildningens innehåll och tidsbrist. Resultatet ger en bredare förståelse för vad som behöver utvecklas för att amningsrådgivningen ska förbättras. / There are many benefits to breastfeeding and it is the preferred choice. Despite the majority of the Swedish women intending to exclusively breastfeed, the numbers are decreasing. WHO recommends exclusive breastfeeding until six months, however only 44 percent globally follow through. Midwives are experts in the field of breastfeeding, they should promote and provide efficient support. Many women experience initial difficulties with breastfeeding, and to prevent early disruption of breastfeeding, the midwife's support is essential. Understanding women's perception of breastfeeding advice is key to improving midwives' support. The aim of the study was to examine women's experiences of breastfeeding support and breastfeeding information from birth to six months of age. The method was a literature review using a systematic approach. Studies with qualitative and mixed methods were included, and only qualitative data were used in the results. A database search was conducted in PubMed and Cinahl. The articles were quality-reviewed, and only those meeting the quality criteria were included in the results. The selected data was then analyzed through integrated analysis. The results included fifteen articles. Similarities and differences in how women experienced breastfeeding support were identified and constituted the subcategories: continuity within the healthcare chain, time for breastfeeding support, practical breastfeeding support, the significance of affirmation and encouragement and information and guidance. Based on the subcategories, these categories where formulated: continuity and accessibility, as well as healthcare professionals' approach. The conclusion indicated that women had both positive and negative experiences of breastfeeding advice. The results revealed factors that midwives can independently influence women’s breastfeeding experience with their approach. Furthermore, factors were identified that midwives cannot change on their own, such as the content of midwifery education and time constraints. The results provide a broader understanding of what needs to be developed for breastfeeding advice to improve.

Bakgrund: Trots att amning har många fördelar och de flesta mödrar väljer att amma sina barn så sjunker amningsfrekvensen både globalt och i Sverige. Trots WHO ́s rekommendationer så väljer många mödrar att avsluta amningen innan rekommenderad tid. Detta skulle kunna bero på att mödrarna stöter på problem med amningen och inte får den hjälp de behöver för att välja att fortsätta amma. Amningen väljs bort när det finns alternativ som bröstmjölksersättning. BVC-sjuksköterskan har en viktig uppgift då hen blir den första kontakten för mödrarna efter förlossningen. Syfte: Syftet med studien var att belysa mödrars upplevelse av BVC-sjuksköterskans stöd vid amningsproblem. Metod: Studien har en kvalitativ design och datainsamlingen genomfördes via semistrukturerade intervjuer med tio mödrar från olika delar av Sverige. Dataanalysen skedde utifrån en kvalitativ innehållsanalys med en manifest ansats. Resultat: I den dataanalys som gjordes framkom tre huvudkategorier: Önskan om ökat engagemang, Bristande kunskap orsakade minskat förtroende och Uteblivet stöd skapade inre stress.  Konklusion: Studiens resultat har påvisat att BVC-sjuksköterskan spelar en stor roll för mödrar som ammar och har problem med amningen. BVC-sjuksköterskan är den som mödrarna vänder sig till för att få amningsstöd. Det engagemang och intresse som BVC-sjuksköterskan visar har stor betydelse för hur upplevelsen av stödet blir, men även den kunskap om amning som BVC-sjuksköterskan besitter spelar stor roll. Bristande stöd resulterade i att mödrarna tvivlade på sig själva. / Background: Although breastfeeding has many advantages and most mothers choose to breastfeed their children, the breastfeeding rate is declining both globally and in Sweden. Despite the WHO's recommendations, many mothers choose to end breastfeeding earlier. This could be due to the mothers encountering problems with breastfeeding and don’t get the help they need to choose to continue. Breastfeeding is opted out when there are alternatives such as breast milk substitutes. The child-healthcare center (CHC-)nurse has an important task as she becomes the first point of contact for mothers after childbirth. Aim: The aim of the study was to shed light on mothers' experience of the CHC-nurse's support during breastfeeding problems. Method: The study has a qualitative design and the data collection was carried out via semi-structured interviews with ten mothers from different parts of Sweden. The data analysis was based on a qualitative content analysis with a manifest approach. Results: In the data analysis that was carried out, three main categories emerged: The desire for increased commitment, Lack of knowledge caused reduced trust  and Lack of support created internal stress. Conclusion: The results of the study have shown that the CHC-nurse plays a major role for mothers who are breastfeeding and have problems with breastfeeding. The CHC-nurse is the one the mothers turn to for breastfeeding support. The commitment and interest that the CHC-nurse shows is of great importance to how the support is experienced, but also that the knowledge of breastfeeding that the CHC-nurse possesses, is important. The lack of support made the mothers doubt themselves.