Article
Garner, C., McKenzie, S., Devine, C., Thornburg, L., & Rasmussen, K. (2016). Obese women experience multiple challenges with breastfeeding that are either unique or exacerbated by their obesity: discoveries from a longitudinal, qualitative study. Maternal & Child Nutrition , 13 (3), e12344. doi: 10.1111/mcn.12344
Background Information
According to the authors, poor breastfeeding in obese women raises serious issues due to the growing number of obese women in the U.S. and the relationship between breastfeeding and the health of the mother and the infant. Similarly, the authors note that obese women face significant barriers that are less understood or addressed. Obese women are exposed to barriers to breastfeeding and therefore, the researchers were determined to explore the perception that obese women have concerning their breastfeeding experience. The understanding of such experiences and perceptions was done by comparing normal weight groups using a longitudinal approach. The study therefore aimed at identifying the experiences and barriers common to obese women.
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Review of Literature
The researchers of this study conducted an in-depth review of the previous studies on the subject that helped them build their case for this research. The researchers looked at maternal weight, breastfeeding outcomes, body mass index in pregnant women, early breastfeeding cessation, obesity, and social factors. Some of the authors who contributed to the literature review of the study include Weiss et al, 2004, Amir & Donath 2007, Rasmussen2007; Wojcicki2011, Baker et al. 2007, Mok et al. 2008; Hauff et al.2014, Kugyelkaet al. 2004; Liu et al. 2010, Oddy et al.2006, Sebire et al. 2001, (Amir & Donath 2007, Flegal et al. 2012, Dieterich et al.2013, Dewey et al. 2003, Hilson et al. 2004, Nommsen-Rivers et al. 2010, Chapman et al. 2013 and Garner et al. 2014. The different authors used in the literature review section gave useful insight into the topic under study and helped the researchers to identify a gap that needs to be explored.
Methodology
This is a qualitative research that uses a descriptive approach. The researchers recruited pregnant women who were interested in breastfeeding using fliers and brochures. The sample was selected from upstate New York. The researchers also used chain referrals to get the appropriate sample for the study. The material for recruiting the sample identified the criteria for one to assume the role of a subject. The advertisement was targeted to pregnant women who have different body sizes in order to understand the experiences of breastfeeding mothers in the society. Interested women had to contact the researcher and then completed a screening questionnaire through the phone in order to obtain demographic information. Eligibility for the study was either obese or normal weigh. The researchers excluded women who were separated from the infant after they developed complications during delivery. All participants had to consent to the research before they could be enrolled. The researchers stopped enrolling more women once the data became saturated. The researchers conducted semi-structured interviews with the samples. The interviews were done during pregnancy, six weeks and after three months including an optional phone call after six months. The interview was conducted between February 2013 and August 2014 with each woman having completed two to five interviews. The interviewees selected a place of their choice where the interviews were conducted. The researchers developed the questions from previous studies and tested interview guides using similar women to those who were recruited. The researchers used participant directed interviews even though they had interview guides.
Data Analysis
Interview recordings and field notes were analyzed by four researchers who employed predetermined codes. The recordings were transcribed, de-identified and later on the accuracy was determined. The researchers used an iterative analysis of the transcripts where ATLAS.ti 7 software was used. The four researchers used content analysis using predetermined and emergent codes. The authors developed the predetermined codes using results from past studies. The four met weekly in order to discuss the differences that appeared between the two research subsets and agree on the best approach to analyzing the data. The researchers identified themes that emerged in the study and categorized them into subthemes.
Conclusion
According to the study, obese women are susceptible to breastfeeding challenges compared to the normal weight women. Despite the similarity in the challenges faced by all women, the obese experienced enhanced challenges. Such women were also less confident about breastfeeding plans and had unique challenges like health issues and flat nipples. The conclusion by the researcher makes sense to a clinician given that it is critical to understand the difference experienced by women of normal weight and those who are obese.
Article 2
Morrison, M., Collins, C., Lowe, J., & Giglia, R. (2015). Factors associated with early cessation of breastfeeding in women with gestational diabetes mellitus. Women and Birth , 28 (2), 143-147. doi: 10.1016/j.wombi.2014.12.002
Background Information
The authors of this study were determined to establish the factors that are related to early breastfeeding cessation in women who have recently reported gestational diabetes mellitus. According to the researchers, there is inadequate information about breastfeeding in women with the condition. The statement perfect.ly makes sense and the authors clearly described the problem appropriately for the reader to understand. The researchers note that many studies have been conducted to determine the benefits of breastfeeding to the infant and the mother. They have for example identified the reduction of maternal chronic diseases in the future.
Review of Literature
The researchers identify two studies by Gunderson et al., 2010 that reported positive effects of breastfeeding by women who have the condition. The studies were conducted for 20 years where 704 women participated. However, according to the authors, there is limited evidence that is currently available. It is for this reason that the researchers support the argument that breastfeeding can be used to reduce maternal chronic diseases in women who have previously reported the condition.
Methodology
The researchers used a prospective cohort study (SWIFT study) in order to obtain evidence on the relationship between breastfeeding and type two diabetes. They used a cross-sectional online survey where women aged 18 years and above were involved. The participants were diagnosed with the condition in 2010 and their names could be accessed in the National Diabetes Service Scheme. The researchers contacted the participants who were free to consent to the study. The researchers also obtained approvals from the ethics committee and Diabetes Australia Ltd. They used data from 15817 participants in the database to determine whether they were similar to those who did not consent or participate in the research. Online questionnaires were administered to the participants where data was collected from one and a half to two and a half years after birth. 59 closed questions were used to obtain general information from the participants. the researchers obtained open and fixed choice responses.
Data Analysis
The study employed univariate and chi-square analysis where categorical variables that are related to the cessation of breastfeeding before three months were determined. Variables that are statistically significant at P<=0.05 and continuous variables like age SEIFA and body mass index were used in multiple regression analysis. The researchers also conducted stepwise and backward elimination to determine whether a similar list of significant variables was obtainable. Similarly, they conducted likelihood ratio tests to determine the significance of the effect of the regression model.
Conclusion
According to the researchers, women with gestation diabetes had many factors that influenced their decision to stop breastfeeding at an early stage. The identified issues are similar to those based in other breastfeeding studies that deal with the general population. The factors, however, are likely to be critical to the group. The conclusion makes sense to the clinician as they give an insight into what affects breastfeeding cessation in women with the condition.
A2. & B2. Researcher’s Conclusion
The researchers in the first article concluded that obese women are prone to breastfeeding challenges compared to women of normal weight. The background information in the study supports the conclusion made by the researchers by introducing the concept and the statement of the problem. The review of the literature further enhances the conclusion given that previous studies have discussed the issue under investigation and therefore, the researchers identified a gap that needed to be filled and they went ahead to study the issue. The methodology gives a clear indication of how the researchers went ahead with the study to obtain information that could be used to draw the conclusion. The data analysis section highlighted the approaches used by the researchers to generate meaning from the data in order to draw the conclusion. The researchers examined the possible reasons and drew the strong comparison from the study and therefore the conclusion is appropriate for the study. The second article also concluded that despite having similar factors that affect breastfeeding cessation, women with diabetes face more challenges and their condition is critical compared to healthy women.
A3. B3. Protection and Consideration
The researchers in the two studies considered issues like objectivity, confidentially, honesty and integrity. Similarly, the researchers considered issues like the study design and approval from relevant authorities and the participants. Their analysis of the data was also appropriate. The researchers have also recognized the contribution of other studies towards knowledge building and enabled them to identify gaps in the current study. Other issues that they should consider include conflict of interest and redundant publications.
A4. & B4. Strengths and Limitation
The sample size selected by the researchers was adequate for the study. Similarly, the sample provided adequate information that helped in drawing a conclusion. The researchers in the first article collected as much information as possible until the point of saturation were reached. The researchers allowed the participants to drive the interview process which allowed them to feel confident and to give as much information as possible. The samples were selected from pregnant women who were willing to take part in the study. All pregnant women had an opportunity to be selected but it is only those who were willing to participate that were engaged. The researchers also obtained additional information through mobile phone interviews which were used to determine whether the subject meets the desired criteria. The second study involved women with diabetes type two whose data was obtained from the national database. The sample size was more than adequate and the researcher compared normal women with those who have the condition to determine any differences. According to the researchers, the two studies can be very useful to the clinicians and practitioners as the design future interventions aimed at helping the obese women to overcome the challenges that they currently face.
A5. & B5 Evidence Application
The results from the two studies can be used to inform practitioners on the challenges faced by obese women and those that suffered from chronic conditions like diabetes. The two shows that even though all women faced challenges, the two groups are likely to be affected more due to their current situations. Similarly, the studies give an insight into the real-life experiences under which normal pregnant and obese or those with diabetes undergo during breastfeeding. Similarly, the studies identify different intervention areas that nursing professionals and other practitioners can engage in order to address some of the challenges faced by women.
References
Garner, C., McKenzie, S., Devine, C., Thornburg, L., & Rasmussen, K. (2016). Obese women experience multiple challenges with breastfeeding that are either unique or exacerbated by their obesity: discoveries from a longitudinal, qualitative study. Maternal & Child Nutrition , 13 (3), e12344. doi: 10.1111/mcn.12344
Morrison, M., Collins, C., Lowe, J., & Giglia, R. (2015). Factors associated with early cessation of breastfeeding in women with gestational diabetes mellitus. Women And Birth , 28 (2), 143-147. doi: 10.1016/j.wombi.2014.12.002
