“The nurse said, the baby won’t be having your breast. All the time the baby will be in the hospital he will only be given formula. Since they never explained why he was that color or anything, I thought maybe my milk was no good. That’s why they told me not to give it to him.”
Discussion
Interactions with medical professionals emerged as the most important factor mediating the impact of the maternal experience with neonatal jaundice on breastfeeding. Encouragement or lack of encouragement from health care professionals played a large role in whether women continued to breastfeed after their experience, which agrees with other findings on the influence, both positive and negative, of interactions with medical professionals on breastfeeding.25-28 Maternal understanding of and reaction to information received during jaundice management and their subsequent internalization of their experience also played a key role in mothers’ infant feeding decisions. In contrast with previous studies,14,29 no consistent pattern was seen between breastfeeding continuation and whether infants received blood work only or phototherapy. This difference may be due to our study’s inclusion of multiple settings for phototherapy and differences in the study populations. In addition, earlier studies did not include information on medical professional’s breastfeeding orders.
Limitations
Although the use of qualitative methods allowed in-depth inquiry from the mother’s perspective, it necessitated a small sample limiting generalizability. Generalizability was further limited because the women in the sample were predominately Latina, though study findings were consistent across ethnicities. Data was only collected from the mothers’ point of view, which likely differed from medical professionals’ perceptions. Limiting the sample to mothers who initiated breastfeeding may have excluded mothers who decided not to breastfeed because of a previous jaundice experience. In addition, women whose infants did not develop jaundice because of adequate early breastfeeding support were not interviewed. Careful structuring of the interview guideline and use of experienced ethnographers minimized potential threats to validity through interviewer bias. Regular team meetings to discuss data collection and analysis increased reliability.
Additional research is needed to gain further understanding of mothers’ emotional responses when faced with neonatal conditions like jaundice. While maternal guilt has been acknowledged as a potential problem arising from treatment for neonatal jaundice,4,7,8 no research has focused on the impact of this guilt on breastfeeding. How do responses like guilt influence perceptions of themselves as breastfeeding mothers and their breastfeeding decisions? The possibility that neonatal jaundice and its management may deprive future children of the opportunity to breastfeed should be examined.
Conclusions
Neonatal jaundice affects many newborns and their families. Besides the monetary cost of treatment, our study results indicate that treatment for jaundice is not completely benign; there are health and emotional costs. Medical professionals must weigh the perceived benefits of treatment decisions and feeding orders against the potential costs to the emotional well being of mothers and newly established breastfeeding relationships. To minimize guilt and enhance maternal understanding about this common condition, professionals need to be aware not only of what information is given to mothers, but how mothers receive and interpret this information. Identifying neonatal jaundice with terms such as breastfeeding jaundice and breast milk jaundice may cause maternal concerns that jaundice is a result of their decision to breastfeed. Medical professionals must provide consistent information and ensure that mothers more fully understand the causes of jaundice and how it relates to breastfeeding, as well as breastfeeding instructions during the experience. The neonatal jaundice experience provides an opportunity for medical professionals to encourage breastfeeding mothers and provide specific guidance on how to maintain a successful breastfeeding relationship.
Acknowledgments
Our study was supported by a grant from the Campus Research Board at the University of Illinois. We would like to thank the women who participated in this study and made time to share their stories with us. We would also like to thank Isabel Martinez, MPH, for her assistance with scheduling and data collection, and Nadine Peacock, PhD, Arden Handler, DrPH, and Rebecca Lipton, PhD, for their comments during the development and analysis of this project.