This qualitative study was undertaken to investigatewomen’s experiences in the early postpartum period andto examine and compare responses through the lens of afeminist scholar. It was the interviewees’ responses to thebreastfeeding experience (in the early postpartum period)that led the author to more closely scrutinize and reportthis aspect of her study. The subjects consisted of asubset of the 60 breastfeeding women who participatedin interviews at approximately 5 weeks postpartum. Theinterviews were conducted between 2000 and 2002. Mostof the participants had vaginal births in hospitals in eitherToronto, Ontario, Canada, or near Boston, Massachu-setts, in the United States. A few had planned home-births. The women represent a variety of ethnicities andsocioeconomic backgrounds and averaged 31 years ofage. Interpreters were used with non-English speakingsubjects. Sixty-two percent of subjects were primiparas.Ninety percent of women were still breastfeeding whenthe interviews were conducted.

Semi-structured, in-depth interviews, averaging about65 minutes in length, were tape recorded and latertranscribed. The author developed memos from emergentthemes and then later generated codes to analyze find-ings. This particular analysis discusses four main find-ings related to expressions of pain and discomfort.

The primary finding was that women were surprisedby “extent, intensity, and duration of discomfort andpain” associated with breastfeeding. Another finding wasthat women described their pain anywhere from “mild andtemporary” to “severe and unbearable.” Many womenexpressed that pain associated with breastfeeding interferedwith their relationship with their infants and affected theirdecisions to continue or terminate breastfeeding. Finally,women’s responses to their breastfeeding pain wereaffected, either positively or negatively, by assistancereceived from healthcare providers. Emergent themesincluded “no one tells you,” “sore as hell,” “scared of thepain,” “really intimidating,” and the decision to “pack itin or cope.”

For many women, the breastfeeding experience isaccompanied by minor and temporary discomforts in thefew weeks after birth, and these are quickly overshad-owed by the intensity of the bonding relationship thatdevelops between mothers and infants. However, asKelleher demonstrates, this is not the case for all women;in fact, some experiences are immensely physicallychallenging and debilitating. Some women interpretthese experiences as personal failures, which detractsfrom their abilities to care for their families and them-selves. Kelleher suggested that one reason women’sperceptions of pain in the early postpartum period may berelated to the increasing use of epidural anesthesia duringlabor—hence women do not anticipate pain in thepostpartum period; labor is over! Breastfeeding assis-tance by health care providers (mostly nurses and/orlactation consultants; there are no specific references to

midwives) was perceived as either integral to breastfeed-ing success or physically intimidating and counterpro-ductive; in particular, many women objected to havingtheir breasts and nipples handled by strangers to demon-strate correct latch technique.

Midwives need to be familiar with this body ofliterature about women’s negative experiences withbreastfeeding (Kelleher cites several other authors whohave shown similar results) so that women can be givenaccurate information about breastfeeding ahead of time.Counseling can include anticipatory guidance aboutmanaging pain issues after discharge. Access to lactationconsultants, support groups, and phone numbers to callwhen problems occur may help extend breastfeedingperiods. Current literature advocating breastfeeding canbe reviewed to assure that balanced and realistic infor-mation is given. For mothers who decide to quit breast-feeding, a complete assessment of their reasons why mayprovide insight that could prove helpful for future expe-riences.

LONGER BREASTFEEDING MAY REDUCE INCIDENCE OF TYPE2 DIABETES IN YOUNG AND MIDDLE-AGED WOMENStuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB.Duration of lactation and incidence of type 2 diabetes. JAMA2005;294:2601–10.

Reviewed by: Sharon Bond, CNM, MSN.

This is a cohort of two groups from the Nurses’ HealthStudy examining more than 6000 women with type 2diabetes, who were followed between 1986 and 2002. Theresults show that women who breastfed reduced their risk ofdeveloping diabetes in relation to duration of lactation, evenwhen controlling for other risk factors, such as body massindex, family history, and gestational diabetes. The authorsstated that mechanisms of action could be related to therelationship between lactation and postpartum weight lossand/or by improving glucose homeostasis. Given the epi-demic of obesity and the subsequent development of type 2diabetes in the United States, this is a critically importantpaper that provides data supporting the additional healthbenefits of breastfeeding.

INFANTS WITH COLIC AT RISK FOR SHORTER DURATION OFBREASTFEEDINGHoward CR, Lanphear N, Lanphear BP, Eberly S, Lawrence RA.Parental responses to infant crying and colic: The effect onbreastfeeding duration. Breastfeed Med 2006;1:146 –55.

Reviewed by: Sharon Bond, CNM, MSN.

Infant colic is reported in 8% to 40% of infants,irrespective of feeding method. The purpose of thiswell-written, tightly-designed clinical trial was toinvestigate the effects of pacifiers on duration ofbreastfeeding within the context of examining how

e68 Volume 52, No. 6, November/December 2007

mothers comfort crying infants. Seven hundred moth-er– baby pairs (healthy infants, term newborns) werefollowed for 12 months. Sessions were conductedone-on-one with mothers to give basic education onseveral methods (excluding bottles and pacifiers) use-ful for calming fussy babies, followed by eight inter-views during the postpartum year. The results showedthat using breastfeeding to comfort crying infants is a

strong predictor of overall duration of breastfeeding.However, mothers with colicky infants are apt to nursefor less time overall, perhaps, as authors surmised,because breastfeeding may have been less satisfyingfor mothers. The authors suggest that improved under-standing and interpretation of normal infant cryingbehaviors may help extend breastfeeding duration tothe recommended 6 months and longer.

Journal of Midwifery & Women’s Health • www.jmwh.org e69