Purpose

Intimate partner violence (IPV) during the breastfeeding period endangers women's health and well-being. From a caring science perspective, it may be understood as suffering, potentially reduced through caring. This study aims to describe the meaning of caring, as experienced by women exposed to IPV during the breastfeeding period.

Methods

Nine women with experience of IPV during the breastfeeding period participated in lifeworld interviews, analyzed phenomenologically following the methodological principles of reflective lifeworld research (RLR).

Results

Caring, as experienced by women exposed to IPV during the breastfeeding period, means a potential existential refuge, further described by the constituents: an encounter requiring mutual invitation and trust; an opportunity to rediscover oneself when reflected in another's gaze; being met with insight influences the experience of exposedness; the possibility to get a break from exposedness; and being alleviated from loneliness when confirmed.

Conclusions

For care to be caring in this context it needs to be lifeworld-led and based on insights into the existential situation of breastfeeding women exposed to IPV. Through an encounter of mutual invitation and trust, caring has the potential to be an existential refuge, enabling rest, confirmation, reflection and escape from loneliness.

Purpose

Intimate partner violence is a global health issue with physical, mental, and existential impacts. It affects women throughout their lives, including the breastfeeding period. Gaining an understanding of existential dimensions could potentially inspire individualized, health-oriented care. This study aims to explain and understand women’s lived experience of intimate partner violence during the breastfeeding period.

Methods

A lifeworld hermeneutic approach guided the interpretative analysis of nine lifeworld interviews and forty-nine written lifeworld stories of women exposed to intimate partner violence during breastfeeding.

Results

The interpretations show that intimate partner violence during the breastfeeding period means to breastfeed under attack in an objectified and provocative female body while feeling abandoned and entrapped in an incomprehensible reality. The interpretations are abstracted into a main interpretation: being forced into an existential exile that entails an ambiguous passive-active resistance.

Conclusions

Exposure to intimate partner violence during breastfeeding is a forced existential exile in a vulnerable situation. Women are forced into unauthentic lives, where their whole being is questioned, and active resistance is inhibited by limited freedom. Awareness of the lived experience of IPV during breastfeeding is essential for healthcare professionals to help reduce the suffering and enhance the health and well-being of women exposed to IPV.

Background: One in three women experiences intimate partner violence during her lifetime. Intimate partner violence causes physical, psychological, and sexual harm, jeopardising human rights, global sustainability, and the health and well-being of women and children. Qualitative research on intimate partner violence and breastfeeding is sparse, but both breastfeeding and exposure to intimate partner violence have previously been shown to evoke existential questions. Women experiencing intimate partner violence seem to doubt their ability to breastfeed and have a shorter breastfeeding duration. The aim of the study is to explain and understand women’s lived experience of intimate partner violence manifestations during the breastfeeding period.

Methods: The study employs a lifeworld hermeneutical approach, grounded in caring science and existential philosophy. The data comprises forty-nine written lifeworld stories and nine lifeworld interviews by women with lived experience of intimate partner violence during breastfeeding. Kelly’s feminist theory, ‘The continuum of violence’ underpins the main interpretation.

Results: The seven interpreted themes of intimate partner violence manifestations during breastfeeding show that women are being: accused, devalued, neglected, controlled, opposed, forced to adapt, and punished. The main interpretation suggests that the manifestations form a multidimensional continuum. The manifestations are intertwined and hold different meanings for different women, existing due to patriarchal structures that uphold female oppression and objectification.  The woman-child intimacy and dependency change the intersubjective power balance of the partner relationship, which provokes some partners.

Conclusion: The study shows that the breastfeeding period, intertwined with motherhood and female embodiment, implies a particular vulnerability to intimate partner violence. Carers need to be aware of this to avoid exacerbating the vulnerability.

Potential impact or clinical relevance: The findings are valuable for informing healthcare professionals about how to recognise signs indicating that breastfeeding women under their care may be experiencing intimate partner violence. Highlighting women’s lived experience provides a basis for care improvement. In a Nordic context, the study also encourages reflection on the discourse surrounding equal parenting and partner involvement, given that not all partner relationships are healthy.

Background

One in three women will experience Intimate Partner Violence (IPV). Exposure during breastfeeding endangers women’s and children’s health and wellbeing, negatively affects breastfeeding, and violates human rights and global sustainability goals. Previous qualitative studies have demonstrated that existential aspects are crucial in the separate experience of both IPV and breastfeeding. However, there is a lack of studies examining the meaning of the concurrent experience of these phenomena. An enhanced understanding of the experience of IPV manifestations during the breastfeeding period may inform the provision of care and support for women exposed to IPV. Accordingly, the study aims to explain and understand women’s lived experience of IPV manifestations during the breastfeeding period.

Methods

The study adopts a lifeworld hermeneutic approach based on Reflective Lifeworld Research. Data collection was conducted between June 2022 and August 2023. Swedish women with experience of the phenomenon IPV manifestations during the breastfeeding period participated either through written lifeworld stories (forty-nine women) or lifeworld interviews (nine women). Data were analysed interpretatively. The main interpretation was inspired by Liz Kelly’s theory ‘The continuum of violence’.

Results

The results show that women experience IPV manifestations during breastfeeding in terms of being accused, devalued, neglected, controlled, opposed, forced to adapt, and/or punished. The main interpretation suggests that the manifestations are intertwined within a multidimensional continuum where the most frequent IPV manifestations are less commonly recognised as violence. The main interpretation further illustrates that the continuum is dependent on both the subjective lifeworld of the woman and the patriarchal context in which it exists. In relation to the patriarchal context, the breastfeeding intimacy within the mother–child dyad is pivotal to explaining and understanding the phenomenon.

Conclusions

The breastfeeding intimacy within the mother–child dyad seems to change the intersubjective power balance in the partner relationship and provoke partners, making breastfeeding women especially vulnerable to IPV. Knowledge of breastfeeding women’s lived experience of exposure to IPV is central for carers to strengthen their ability to support women’s health and wellbeing.

BREASTFEEDING AND EXPERIENCED EXPOSEDNESS IN PARTNER RELATIONSHIP

Ida Gustafsson RN, RM, Lecturer, PhD-student

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Gunilla Carlsson RN, PhD, Professor

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Katarina Karlsson RN, PhD

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Aleksandra Jarling RN, PhD, Lecturer

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Lina Palmér RN, RM, PhD, Associate Professor, Docent

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Background: About 110 000 children are born in Sweden annually. The vast majority of their mothers wish to breastfeed, and also initiate breastfeeding. An important factor for continued breastfeeding is support, especially from the partner. It is likely that lack of support can lead to perceived vulnerability in the partner relationship. Intimate partner violence (IPV) during pregnancy is in Sweden nearly as common as gestational diabetes and the frequency seems to rise postpartum. IPV is multifaceted and encompasses many types and degrees of violence. In a caring science perspective the experience of vulnerability and/or exposedness in partner relationship during breastfeeding (or breastfeeding desire) risks negatively affecting womens health and well-being, regardless of the reason or degree of exposedness. For care to be caring - that is, support health and well-being - knowledge is needed from the perspective of the exposed women. Previous lifeworld theoretical research has shown that breastfeeding may be experienced as an existential challenge and that exposedness to violence during the childbearing period means a long-lasting embodied experience. In this project, these two phenomena are intertwined into a common phenomenon - Breastfeeding in case of experienced exposedness in a partner relationship.

Aim: The purpose of the PhD-project is to develop in-depth knowledge of existential meanings of breastfeeding in case of experienced exposedness in a partner relationship (Study 1-2), and what it means to be cared for (Study 3), as well as to give care and support in this context (Study 4).

Methods: The project has a reflective lifeworld approach. Data has been collected through lifeworld interviews and written lifeworld stories and will be analyzed using a phenomenological or hermeneutical approach.

Results & Conclusion: The results and conclusions of the first study are expected to be completed in the summer of 2023 and will be presented at the conference.

CLINICAL INTRODUCTION AND EVALUATION OF THE EXISTENTIAL BREASTFEEDING DIFFICULTY SCALE (EXBREASTS) IN THE CONTEXT OF CHILD HEALTH CARE

Ida Gustafsson RN, RM, Lecturer, PhD-student

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Malin Spångby RN, MNSc

Child Health Services, Region Jönköping County, Jönköping, Sweden

Ann Arvidsdal RN, MNSc

Child Health Services, Region Jönköping County, Jönköping, Sweden

Marie Golsäter RN, PhD, Docent

Child Health Services, Region Jönköping County, Jönköping, Sweden

CHILD Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden

Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden

Lina Palmér RN, RM, Associate Professor, Docent

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Background: Breastfeeding, both with and without perceived difficulties, can be experienced as an existential journey. Therefore, care needs to be based on the woman's breastfeeding story and carers need to be prepared to handle the existential questions that may arise. Previous research shows that healthcare professionals struggle with providing individually tailored care. The Existential Breastfeeding Difficulty Scale (ExBreastS) was developed based on lifeworld theoretical research on women's experiences of initiating breastfeeding with or without breastfeeding difficulties and was in this study introduced in child healthcare in a Swedish region. This was done to evaluate its ability to support child healthcare nurses to conduct existentially oriented caring dialogues with the breastfeeding story in focus. 

Aim: Describe child healthcare nurses’ lived experience of how ExBreastS influences the caring dialogue.

Methods: Lifeworld interviews were conducted with 17 child healthcare nurses about their experience of using ExBreastS to support caring dialogues with breastfeeding women. The interviews were conducted either individually, in pairs or in groups. The material was analyzed through thematic analysis based on descriptive phenomenology.

Results: The results show that ExBreastS contributes to the re-evaluation of the importance of the caring dialogue because the existential significance of breastfeeding is given more space. ExBreastS also makes new perspectives of the breastfeeding story visible for both woman and carer. However, if the instrument itself receives too much of the nurse’s focus, there is a risk that the caring dialogue will be overshadowed.

Conclusions: ExBreastS supports caring dialogues based on the breastfeeding story through its focus on the existential aspects of breastfeeding. However, this requires time, support from the organization and an awareness that caring dialogues can have no manual.

Breastfeeding is experienced as an existential journey, and breastfeeding difficulties put mothers in existentially vulnerable situations. For care to be caring, it must be based on the mother's breastfeeding story. Previous research show that healthcare professionals struggle to perform individualised breastfeeding care. The Existential Breastfeeding Difficulty Scale (ExBreastS) was developed to support an existential focus in caring dialogues and was introduced in child healthcare in Sweden. The aim of this study is to describe child healthcare nurses' lived experience of how the Existential Breastfeeding Difficulty Scale (ExBreastS) influences the caring dialogue. Seventeen child healthcare nurses with experience in using ExBreastS as a basis for caring dialogues with breastfeeding mothers were interviewed, in groups, pairs or individually. The interviews were analysed using a thematic analysis based on descriptive phenomenology. The results show that the caring dialogue becomes re-evaluated when using ExBreastS because existential aspects of breastfeeding is acknowledged. ExBreastS also visualises new perspectives of the mother's breastfeeding experiences. However, the use of ExBreastS also risks overshadowing the caring dialogue when the nurses focus too much on the instrument. The use of ExBreastS supports caring dialogues-and caring care-by highlighting the existential aspects of breastfeeding/breastfeeding difficulties and the uniqueness of every mothers' breastfeeding experience. However, the instrument sometimes evokes a vulnerability in the nurses that calls for support from the care organisation.

In the context of breastfeeding care, models are lacking that can guide caring practice. This article examines the prerequisites for care to be caring, based on research about breastfeeding difficulties. These prerequisites are presented as a theoretical model of caring that demonstrates that a genuine caring relationship, embodied wisdom, and an ability to create a space for dwelling, together with cultural awareness, form the prerequisites for the breastfeeding story to be a hub in caring practice. The model contributes to the development of caring practices that embrace the existentiality of each woman's breastfeeding experiences. 

På sektionen för vård används ofta loggböcker i samband med verksamhetsförlagd utbildning. Tanken med loggböckerna är att studenterna ska få möjlighet att reflektera kring sina upplevelser i klinisk praktik samt stödjas i sammanvävning av teori och praktik. Denna tanke vilar på livsvärldsdidaktisk forskning från sektionen. I vårt arbete som universitetsadjunkter har vi sett att reflektionen i loggböckerna ofta stannar på en ytlig nivå. Studenterna uttrycker också i kursvärderingar att de inte riktigt förstår syftet med uppgiften. Därför ser vi ett behov av att utveckla och teorianknyta loggböckerna, för att bättre stödja studenternas lärandeprocess.

Objective: The aim of this study is to obtain a deeper understanding of midwives’ lived experiences of caring for new mothers with initial breastfeeding difficulties.

Methods: A reflective lifeworld approach was used. Six midwives were recruited from a hospital in western Sweden. Data were collected via individual lifeworld interviews and analysed using phenomenological methods.

Results: The essential meaning can be described as a midwife’s wish to help new mothers reach their breastfeeding goals by trying to interact with them as individual women in unique breastfeeding situations. This wish constitutes a contradiction to the midwife’s own desire to succeed in enabling mothers to breastfeed and the perceived risk of failure as a midwife if the mothers decide not to breastfeed. This is further described by five constituents: striving to provide individualised care, collegial and personal responsibility both enables and prevents care, a struggle to be sufficient, an uphill struggle and mutual joy becomes the motivation to care.

Conclusions: Caring for new mothers with initial breastfeeding difficulties is a balancing act between the midwife’s personal desire to succeed in enabling mothers to breastfeed, the mothers’ wishes, the infants’ needs, the importance of collective collegial competence and the limitations in the health care organisation. This makes the midwife’s efforts to provide individualised care frustrating and demanding as well as motivating.