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A content analysis of mother's negative experiences post-weaning

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Title:
A content analysis of mother's negative experiences post-weaning
Creator:
Schmidli, Brittany N. ( author )
Place of Publication:
Denver, Colo.
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University of Colorado Denver
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English
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1 electronic file (105 pages) : ;

Thesis/Dissertation Information

Degree:
Master's ( Master of arts)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
School of Education and Human Development, CU Denver
Degree Disciplines:
Education and human development

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Subjects / Keywords:
Breastfeeding ( lcsh )
Breastfeeding ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Review:
This thesis is a qualitative content analysis of women's experiences with breastfeeding cessation. This study uses attachment theory as a framework for understanding the data collected for analysis. Data for this research was collected from blogs online from search engines Google, Yahoo, and Bing. Blogs for analysis are accounts posted by women who have had negative experiences such as depressive symptoms, with breastfeeding cessation. The purpose of this study was to understand the lived experience for many women that may also include negative experiences during breastfeeding cessation.
Bibliography:
Includes bibliographical references.
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System requirements: Adobe Reader.
Statement of Responsibility:
by Brittany N. Schmidli.

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University of Colorado Denver
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Auraria Library
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
on10069 ( NOTIS )
1006905039 ( OCLC )
on1006905039
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LD1193.E35 2017m S35 ( lcc )

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Full Text
A CONTENT ANALYSIS OF MOTHERS NEGATIVE EXPERIENCES
POST-WEANING
by
BRITTANY N. SCHMIDLI B.S., University of Colorado Denver, 2013
A thesis submitted to the Faculty of the Graduate School of the University of Colorado in partial fulfillment of the requirements for the degree of Master of Arts
Education and Human Development
2017


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2017
BRITTANY N. SCHMIDLI
ALL RIGHTS RESERVED


Ill
This thesis for the Master of Arts degree by Brittany N. Schmidli has been approved for the Education and Human Development Program by
Troyann Gentile, Chair Cynthia Grant Shruti Poulsen
Date: July 29, 2017


iv
Schmidli, Brittany N. (MA, Education and Human Development Program)
A Content-Analysis of Mothers Negative Experiences Post-Weaning Thesis directed by Professor Troyann Gentile
ABSTRACT
This thesis is a qualitative content analysis of womens experiences with breastfeeding cessation. This study uses attachment theory as a framework for understanding the data collected for analysis. Data for this research was collected from blogs online from search engines Google, Yahoo, and Bing. Blogs for analysis are accounts posted by women who have had negative experiences such as depressive symptoms, with breastfeeding cessation. The purpose of this study was to understand the lived experience for many women that may also include negative experiences during breastfeeding cessation.
The form and content of this abstract are approved. I recommend its publication.
Approved: Troyann Gentile


V
DEDICATION
This thesis is dedicated to my parents, Kenneth and Vicky, and my Grandmother Linda. My parents and grandmother have encouraged me to seek out knowledge and to question the things that I do not understand. These individuals have taught me the value of sharing what I know, my time with others, and teaching me to be a better person. I would not be where I am today without the support and love of my family. I am eternally grateful for their belief in me.


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ACKNOWLEDGMENTS
I would like to acknowledge the many individuals who assisted me in completing my thesis. Writing this thesis was a team effort and I owe a special thanks to all those who gave their time in finishing this project; I would not have accomplished this without them.
Thank you to Dr. Gentile who chaired and guided the process of my thesis development. I appreciate all your assistance, knowledge, and time contributed to this project. I appreciate your questioning and challenging my learning throughout the thesis process, allowing me to learn while writing. Thank you Dr. Gentile.
Thank you to Dr. Grant for all the time and guidance you have provided throughout this process. I am perpetually appreciative of the advice, knowledge, and faith in my abilities. Thank you Dr. Grant.
Thank you Dr. Poulsen for your support and suggestions for revisions. Your recommendations helped to make this thesis one that I feel I can be proud of. I appreciate your time and opinions. Thank you Dr. Poulsen.
Thank you to friends that have supported me and encouraged me throughout the process. Having their support pushed me to finish this project even through the difficult times.
Thank you to my family Kenneth, Vicky, and Linda. You have supported me and encouraged me throughout my entire life, and you've helped out especially during the process of writing this thesis. By continually expressing your faith in me by saying you can do this and we are so proud of you, look how far you have already come! I am tremendously grateful to have these individuals in my life and their support. Thank you mom, dad, and grandma.


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Writing this thesis was a team effort; a special thank you to all who stuck with me throughout the process.


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TABLE OF CONTENTS
CHAPTER
I. INTRODUCTION........................................................1
Research Purpose...................................................3
Research Question..................................................4
Attachment Theory..................................................5
Attachment Theory & Negative Experiences with Weaning..............8
II. REVIEW 01 THE LITERATURE...........................................11
Societal Expectations of Breastfeeding Women......................11
Benefits of Breastfeeding.........................................13
Breastfeeding Expectations and Difficulties.......................14
Breastfeeding Cessation...........................................16
Postpartum Depression.............................................19
Motivation to Continue Breastfeeding..............................21
Role of Oxytocin..................................................22
Online Support for Women..........................................23
Summary...........................................................25
III. METHODOLOGY........................................................26
Research Method ..................................................26
Data Collection...................................................27
Sampling..........................................................28
Ethical Considerations............................................32
Data Coding & Analysis
32


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Coding Procedures.......................................................39
Trustworthiness & Credibility...........................................44
Assumptions.............................................................46
Summary.................................................................46
IV. FINDINGS..................................................................47
Findings................................................................48
Feeling Inadequate...............................................49
Going a Bit Nuts...............................................53
Shared Experience................................................62
Loss of Attachment...............................................66
V. Discussion................................................................71
Research Question.......................................................71
Discussion..............................................................72
Limitations.............................................................80
Strengths...............................................................81
Implications............................................................82
Future Research Considerations..........................................84
Conclusion..............................................................86
REFERENCES
87


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LIST OF TABLES
TABLE
1. A Priori Codes..............................................34
2. Themes and Coding Categories................................37
3. Blogs and Comments..........................................41


XI
LIST OF FIGURES
FIGURE
1. Coding Procedures...........................................42
2. Analysis of Themes..........................................49




CHAPTER I
INTRODUCTION
Many women place pressures on themselves as new mothers. This pressure appears to come from society and culture sending messages that make some mothers feel inadequate if they are unable to live up to societal standards (Kestler-Peleg, Shamir-Dardikman, Hermoni, Ginzburg, 2015). One of the messages that women receive is the idea that breast is best. This idea came from the National Breastfeeding Awareness Campaign from 2004 to 2006, which stated Youd never take risks before your baby is born, Why start after? (Wolf,
2007, p.595) The claim that breastfeeding is the best option was based on inconsistent research (Wolf, 2007). This message portrayed breastfeeding as a matter of danger versus safety; neglecting women in the population who choose to bottle-feed or are unable to breastfeed (Wolf, 2007).
Breastfeeding is not an option for all women, yet this is not a message that is well disseminated in society. Some women have both physical and emotional difficulty with breastfeeding that makes it nearly impossible for them to breastfeed (Shakespeare, Blake, & Garcia, 2004), therefore, making it difficult to live up to societal expectations. The divergence between cultural expectations of mothers and the reality of nursing can be emotionally complex for mothers.
Negative societal views held by society of women who do not breastfeed not only occur in the U.S. but also in different cultures such as the United Kingdom (UK). These views are evident from a study at the University of Nottingham, which explored womens feeding intentions for their child. Data for this study came from a longitudinal qualitative study on womens child feeding methods and choices (Murphy, 1999). The practice of health


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professionals and policy in the UK is insistent on breastfeeding, disseminating the message of superiority in breastfeeding. Women who do not breastfeed are informed that they are endangering their moral status (Murphy, 1999). Within this population the mother is considered selfish by placing her needs, preferences, and convenience above her babys wellbeing.
Messages in the United States and the United Kingdom illustrate mothers who do not breastfeed their baby as endangering their child (Murphy, 1999; Wolf, 2007) could be the reason for a greater percentage of women breastfeeding their children in the United States. While there is a percentage of women that have difficulty with breastfeeding and that discontinue, 76.5% of women in the United States breastfeed for the recommended six months (Centers for Disease and Control Prevention, 2013). However, some of these women have emotional difficulties in weaning. Weaning is defined as final breastfeeding cessation or the steady introduction of food other than breast milk into the childs diet (Pediatrics & Child Health, 2004).
Mezzacappa (1997) found post-weaning mothers displayed worse mood, more stress, and more psychological symptoms in comparison to their breastfeeding counterparts. Although there is limited formal research on the post-weaning experience, women have informally provided a wealth of information related to poor mood and increased stress on blogs on the Internet sharing their lived experiences of emotional difficulties post-weaning. Blogs are informational discussions, personal journals, and diaries updated frequently and published on the World Wide Web to disseminate to a wide public audience (Byrd, 2016).
The literature review will address the focus of prior research on the importance of breastfeeding and the role of postpartum depression as a determinant to cease breastfeeding.


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However, research seems to neglect the negative effects that coincide with weaning (Dias & Figueiredo, 2015; Yimyam & Hanpa, 2014; Colen & Ramey, 2014). It would be advantageous for practitioners to understand the negative experiences of women who have suffered from negative experiences post-weaning. It is advantageous for practitioners to understand the complexity of post-weaning negative experiences, including all emotional and physical difficulties.
New mothers can also benefit from a knowledge of these negative experiences. Knowledge allows the mothers to prepare for the possibility of negative experiences, making it feel manageable. Mothers may also benefit by depathologizing negative experiences. Culture and society appear to expect mothers to be consistently happy. This idea may be particularly harmful for vulnerable populations, such as new mothers navigating the stressors of motherhood. Drawing awareness to mothers negative experiences may assist in decreasing mental health stigma, allowing mothers to seek help and share their experience.
Research Purpose
The purpose of this study is to understand the negative experience of post-weaning among mothers who blog their life world online. Life world is a qualitative term used to describe an individuals inner world of an experience (Johnson & Christenson, 2014). This research is grounded in the theoretical constructs of attachment theory, with emphasis on the mother-child attachment (Spelman, 2013; Spock, 1987; McLeod, 2009). This research utilizes an attachment theory perspective to understand the influence of the mother-child attachment on the negative experiences a number of women have with weaning.
There is a bond created between mother and child through breastfeeding that fosters greater maternal sensitivity (Britton, Britton, & Gronwaldt, 2006). This sensitivity suggests a


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link between attachment security and breastfeeding as the mother has a higher sensitivity towards the childs needs (Britton et al., 2006). Cinar, Kose, & Altinkaynak (2015) found that maternal attachment was positively affected by breastfeeding and the mothers sense of motherhood. Based on the positive attachment facilitated by breastfeeding, this research looked to understand how attachment and maternal perception contribute to the negative experiences that some women have with breastfeeding cessation, with the loss of that intimate act that facilitates bonding.
Qualitative data gathered from the Internet provided rich information of women suffering from negative experiences post-weaning. The objective of this study is to create awareness of these struggles during breastfeeding cessation. Prior to initiating this research, I had conversations with health care providers about negative experiences during breastfeeding cessation; these conversations led to my interest in this topic. Health care providers recognized there are mothers that have emotional difficulty with breastfeeding cessation; however, these difficulties are often thought to be due to hormone fluctuations. These conversations suggested negative experiences during breastfeeding cessation were a result of hormone changes during weaning. These statements seem to neglect the complexity of the breastfeeding cessation experience, appearing to disregard the varying physical and emotional responses of mothers. This research was intended to understand the many contributing factors that are influencing mothers negative experiences with breastfeeding cessation.
Research Question
The following research question guided this investigation:
What is the negative experience of post-weaning among mothers who post on blogs?


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The research question emerged from my interactions with mothers who had difficulty in weaning and health care providers. My personal perspective is formed by social location factors, these socioeconomic factors impact how I viewed my research. These factors include being a white, middle-class, young female. Personally, knowing a mother who had a negative experience sparked my interest to learn more about this topic. Watching a mother who experienced emotional difficulty while weaning influenced my desire to help mothers. As I observed her experience negatively impacting relationships in her life, I was compelled to understand the struggle that other mothers have encountered. Based on a lack of research I hoped to draw attention to these experiences to improve support for these mothers. I focused on understanding the complexity of the negative experiences that mothers suffer from after breastfeeding cessation. This research develops a deeper understanding of ways to assist this population and to share this knowledge with other practitioners who work with these mothers.
The primary focus of this inquiry was to examine the negative experience of weaning through qualitative analysis of stories and comments left on publicly available web blogs. This research was intended to understand to what extant themes of attachment theory were present in the negative experiences of post-weaning among women who blog their life world online.
Attachment Theory
This study utilized elements of attachment theory from theorists Donald Winnicott, John Bowlby, and Mary Ainsworth to understand the negative experiences reported on online blogs by post-weaning mothers. For the purpose of this study, attachment theory is the framework to understand the relationship between the mother and child and the negative


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experiences related to breastfeeding and weaning. This includes the attachment experience between the mother and child. This study uses attachment theory as the lens for which to explore attachment concepts to the mothers phenomenological experience.
Winnicotts Attachment Theory
Winnicotts attachment theory originated in the 1950s; the basis of this theory revolved around a facilitating environment created by the mother with support of others in her life (Spock, 1987; Straker, 2010). Within Winicotts theory, the mother identifies in the baby and the baby identifies in his/her mother at the initial stage of life. The relationship is created through holding Winnicott defined holding as all acts around child care (Spock, 1987). Holding includes the intimate contact between the mother and child during breastfeeding, which is considered the initiation of the human relationship. Holding sets the model of the childs relation to objects within the world and thus, the beginning of object-relating. This holding references the relationship between mother and child.
During the time in which the baby identifies in the mother and the mother in the baby, Winnicott calls this absolute dependence at the beginning of life (Spelman, 2013, p. 13). Within this stage of dependence there is no boundary between mother and child, this space comes at a later point in development after the childs experiences create a construction of boundary and ego. The creation of this space is a result of a good enough environment (Spelman, 2013, p. 14). This environment is created through the responsibility and care of the mother and through the process of holding (Spock, 1987; Spelman, 2013).
Winnicott believes the task of breastfeeding, a key factor of holding, is not a skill that can be taught by doctors and nurses but rather an ability that comes naturally; he described this as she acts naturally, naturally (Spock, 1987, p. 7). Winnicott also believed that the


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mother instinctively knows what the child needs when the child needs it. The mothers attentiveness to the childs needs and all acts of holding, including breastfeeding, occurs as communication between the mother and the child. Winnicott described the mothers experience of breastfeeding as a sense of achievement, and a newfound understanding of her physiology and anatomy (Spock, 1987).
Bowlbys Attachment Theory
Bowlbys attachment theory originating in the 1980s, characterizing attachment as a parent responding sensitively and appropriately to the childs needs (McLeod, 2009). Bowlby believed that attachment is adaptive and increases the childs chance of survival. According to Bowlby, a child will begin with forming one primary attachment (monotropy), which becomes a secure base for the child to explore the world. This relationship will later be a prototype for social relationships.
Bowlby also suggested an internal working model that defined how the child perceives the world (McLeod, 2007). The caregivers behavior towards the child creates the childs working model of themselves resulting in either secure, avoidant, or resistant attachments. Secure attachment is defined by positivity and love, avoidant is defined as rejection and being unloved, while resistant is defined as anger and confusion (McLeod, 2007). Additionally, when a child has a secure attachment to the caregiver, the child will express distress in the absence of their secure base (McLeod, 2007; Bretherton, 1992). The separation distress during the caregivers absence progresses in three stages: protest, despair, and detachment (McLeod, 2007). Protest is behavior that evidences the childs attempts to keep the parent from leaving, crying, protesting, and clinging on to their parent. Despair is


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defined as the child seeming calm, withdrawn, and uninterested. Detachment is when the child begins to engage with others but rejects the caregiver once they return.
Ainsworths Attachment Theory
Ainsworths work with attachment theory in the 1970s also provided new ways of understanding the mother and child relationship (McLeod, 2009). Ainsworth suggested the concept of an attachment figure (i.e. the mother) as a secure base allowing the child to explore the world (Bretherton, 1992). A securely attached relationship to the childs caregiver is evidenced by little crying, appearing content, and the ability to explore when the mother is present. According to Ainsworth, there is a correlation between secure attachment and maternal sensitivity. This concept was supported by a study that showed that breastfeeding lasted longer when the mother received positive messages from the child during feedings (Wojnar, 2004), The more irritable the mother perceived the baby during feedings the less likely she was to continue breastfeeding past six weeks. Additionally, Ainsworth explained that a mothers enjoyment with breastfeeding related to the childs security (Bretherton, 1992).
Attachment Theory and Negative Experiences with Weaning
By understanding the relationship between the mother and child and the attachment formed through breastfeeding, this research further articulates the role of attachment in weaning for the purpose of this study. Based on this purpose Winnicotts attachment theory is the foundation of this study with a focus of analysis on the good enough mother and her attachment to the child.
Mothers report that the shared experience of breastfeeding with their child is an enjoyable experience and emotionally beneficial (Else-Quest, Hyde, & Clark, 2003).


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Research has shown that mothers may have a stronger bond in the early postpartum months due to breastfeeding (Else-Quest, Hyde, & Clark, 2003). Based on the bond within the first months of the childs life created through the act of breastfeeding, it is possible that breastfeeding cessation may also create feelings of loss of that attachment for mothers.
Mothers may also have negative experiences with breastfeeding cessation connected to feelings of inadequacy. As mothers strive to be good enough mothers, to provide the best care for their child, the reality of not meeting this standard may come with negative emotional consequences, such as guilt (Ratnapalan & Batty, 2009). The feeling of guilt and inadequacy in not meeting the standard of care for a child that is encouraged as a basis for healthy attachment, may contribute to the negative experiences related to breastfeeding cessation.
Winnicott also expressed the importance of the mother having support from others in being successful in creating a good enough environment for the child (Spock, 1987; Spelman, 2013, p.14). In a society where mothers may have difficulty finding support to achieve breastfeeding goals, a lack of support may exacerbate feelings of inadequacy and guilt with breastfeeding cessation. Mercer (2004) supported this idea explaining that environmental support, and support from the family in particular, is the leading factor in the positive effects of the mother-child attachment.
One study found that longer duration of breastfeeding was positively correlated with maternal sensitive responsiveness and greater attachment security (Tharner et al., 2012). Securely attached children seek proximity to their caregiver and are comforted by the contact (Tharner et al., 2012). Based on breastfeeding mothers having higher rates of sensitive responsiveness and the child having greater attachment security when breastfed, mothers that


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observe their child as being distressed during weaning may have a more negative experience with breastfeeding cessation.
Given that a bond is created between mother and child through the act of breastfeeding, there is a possibility that negative experiences with weaning may be related to attachment. This study strives to understand how attachment may influence the negative experiences experienced by women during breastfeeding cessation.


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CHAPTER II
REVIEW OF LITERATURE
New mothers are bombarded with information and standards for motherhood that they are expected to live up to. This chapter covers information and messages women receive as well as the information that they do not receive. These messages create unrealistic ideals of what breastfeeding is like, making the reality that much more difficult to deal with. This difficult reality includes the unpleasant experience that some mothers face during breastfeeding cessation.
Numerous topics are addressed in depth to promote understanding in the phenomenon of negative experiences after breastfeeding cessation based on current literature. This literature review included topics on societal expectations, benefits of breastfeeding, difficulties in breastfeeding, breastfeeding cessation, medical research on the topic, and how women support each other online.
Societal Expectations for Breastfeeding Mothers
Societal expectations for breastfeeding mothers may play an important role in understanding mothers feelings of guilt and failure related to early weaning. Kestler-Peleg, Shamir-Dardikman, Hermoni, Ginzburg (2015) identified breastfeeding as the gold standard (p. 25) of nutrition and a picture of optimal mothering. This standard may put a lot of pressure on mothers to breastfeed. Women in one study equated being a good mother with successful breastfeeding and perceiving their baby as happy (Marshall, Godfrey, & Renfrew, 2007). Perception of successful breastfeeding and the perception of being a good mother also had implications on the mothers confidence. In relation to Winnicotts attachment theory of a good enough mother, the mother adapts to the needs of the baby allowing the child to have


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a sense of control until the child begins to transition to autonomy (Straker, 2010). This is completed through holding, including breastfeeding. When the holding environment is not sufficient (good enough mothering) the child is believed to develop a false self as a result of adaptation to failures (Straker, 2010).
Maternal expectations are demanding. Many believe that children are primarily the responsibility of the mother, that the mother must be child-centric and live up to the ideal good enough mother (Hays, 1996, as cited in Kestler-Peleg et al., 2015; Straker, 2010). These societal messages can become conflicting for mothers as they strive for personal identity but are expected by society to give up all their needs for the child (Liss, Schiffrin, Mackintosh, Miles-McLean, &Erchull, 2013; Kestler-Peleg et al., 2015).
In a study examining motivation to breastfeed, the researchers found the decision to breastfeed may be an attempt for mothers to reach the gold standard (Kestler- Peleg et al., 2015, p.25) and driven by the fear of failing as determined by the terms of societal ideas and expectations. Furthermore, breastfeeding motivated by maternal self-perception was connected to negative factors of maternal well-being. Factors include negative affect and postpartum depression (Kestler-Peleg et al., 2015). In an era where women who do not breastfeed are perceived as failing in their maternal role, endangering their children, and as not good mothers (p.24), it is important for professionals to be sensitive to these messages and burdens on mothers (Marshall et al., 2007; Kestler-Peleg et al., 2015).
Cultural expectations are imperative to consider in relation to breastfeeding. One study conducted with 24 new mothers in Hong Kong who had discontinued breastfeeding within the first month of birth, explained the Chinese tradition that mandates the mother-in-law play a dominant role while the new mother rests and recovers through a tradition called


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doing the month (Pilsbury, 1978; Tarrant, Dodgson, & Wu, 2014). During this time, new mothers are expected to comply with their mother-in-laws recommendations and requests (Tarrant, Dodgson, & Choi, 2004; Tarrant et al., 2014). Mothers who experienced difficulties with breastfeeding while doing the month were pressured by their mother-in-law to switch to bottle-feeding (Tarrant et al., 2004; Tarrant et al., 2014). Some of the women from this study explained that they had feelings of sadness and depression after cessation, as they had wanted to continue to breastfeed (Tarrant et al., 2014). This example highlights the importance of a practitioners need to understand a womans cultural background and traditions in terms of her motivations to either wean or not wean, and the potential subsequent negative experience post-weaning.
These studies and examples outline the extreme pressure that mothers feel from society and culture. These messages from society and culture are supported by the research in the many benefits of breastfeeding to both mothers and children.
Benefits of Breastfeeding
The benefits of breastfeeding are well established and identified in medical literature (Britton, McCormick, Renfrew, Wade, & King, 2007). Benefits to the child include a reduced risk of respiratory, gastrointestinal, ear, and urinary tract infections, as well as a reduced risk of obesity, type I diabetes, and allergic diseases such as eczema and wheezing (World Health Organization, 2003; Darwent & Kempenaar, 2014). Interestingly, in another study, children who were bottle-fed fared better in terms of parental attachment, behavioral compliance, and scholastic competence (Colen & Ramey, 2014). Despite the Colen &
Ramey (2014) findings on how a child may benefit from bottle-feeding there seems to be far more research on the benefits of breastfeeding.


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Breastfeeding also benefits the mother. Women who breastfeed have a lower risk of ovarian and breast cancer, and are less likely to suffer from postmenopausal hip fractures (Ip, Chung, Raman, Chew, Magula, Devine, Trikalinos, & Lau, 2007; Darwent & Kempenaar, 2014). Based on the benefits of breastfeeding to both mother and child, breastfeeding is recommended by The World Health Organization the first six months after birth (World Health Organization, 2001; Darwent & Kempenaar, 2014).
Aside from the health benefits of breastfeeding, there is evidence breastfeeding impacts self-efficacy and a sense of motherhood (Cinar, Kose, &Altinkaynak, 2015). Breastfeeding self-efficacy is defined as the mothers believed ability to breastfeed her child (Oliver-Roig, dAnglade-Gonzalez, Garcia-Garcia, Silva-Tubio, Richart-Martinez, & Dennis, 2012). Breastfeeding self-efficacy influences a positive maternal perception. Additionally, there is a positive correlation between maternal attachment and breastfeeding, with attachment beginning during the last month of pregnancy and months following delivery (Cinar et al., 2015).
Apart from the many health benefits of breastfeeding there are physical and emotional obstacles mothers face that are vastly different than expected. The next section discusses these expectations and difficulties in depth.
Breastfeeding Expectations and Difficulties
Breastfeeding can be both physically and emotionally challenging for new mothers (Kelleher, 2006). Some women report mastitis (breast infection), generalized pain, soreness, discomfort, engorgement, nipple pain, raw breasts, cracked and bleeding nipples, blisters and uterine contractions. Other physical symptoms of breastfeeding include bodily sensations that are related to sucking, leaking, and latching. In a qualitative study of 52 women that explored


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pain and discomfort with breastfeeding, the researchers found that the lack of anticipation for these difficulties exacerbated the pain and discomfort (Kelleher, 2006). Common themes in the research literature related to breastfeeding difficulties include surprise of the extent and duration of discomfort and pain, and a range of pain from mild to severe (at times temporary to other times unbearable) (Kelleher, 2006). Murray and Cooper (1997) noted that the breastfeeding experience impacts the relationship between mother and baby. Some women reported feeling hesitant to continue breastfeeding at times due to the physical challenges (Kelleher, 2006). In another study women expressed concern of sufficient milk supply for the child (Marshall et al., 2007). The inability to measure the amount of milk produced by the mother and being received by the baby, was a source of distress for some mothers.
Aside from the physical pain and discomfort, some women suffer from emotional difficulties during breastfeeding. It is commonly reported that breastfeeding is more difficult than originally expected. As a result of the unanticipated challenges, some women describe a belief that they were being a bad mom due to breastfeeding difficulties and/or weaning (Murphy, 1999; Shakespeare et al., 2004, p. 252). Women who had difficulties described feelings of guilt; particularly women who were depressed (Shakespeare et al., 2004). Shakespeare et al. (2004) found women attributed their distress and depression to breastfeeding difficulties, whether they discontinued breastfeeding or not. Furthermore, various women felt emotionally distressed based on their struggle and lack of expectation for breastfeeding challenges. Women reported feeling physically exhausted, that breastfeeding was a difficult skill to learn, time consuming and painful all realizations that were vastly different from expectations (Kelleher, 2006; Shakespeare et al., 2004).


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Early weaning the weeks following birth leads to feelings of regret for some mothers. Bolling, Grant, Hamlyn, & Thornton (2007) reported 90% of women reported they wished they would have breastfed longer. Alder and Cox (1983) determined that women who breastfed exclusively for 12 weeks were more likely to report dysphoric symptoms. These conditions highlight the challenges that some mothers experience while breastfeeding and the lack of preparation for both the emotional and physical difficulties. In some cases, these difficulties resulted in early cessation of breastfeeding.
Breastfeeding Cessation
The decision to discontinue breastfeeding is influenced by a multitude of factors. One factor is a natural progression of breastfeeding cessation over time based on the mothers decision to wean or having reached breastfeeding goals. Other factors include the presence of postpartum Depression (PPD), difficulties with breastfeeding, disrupted lactation, mothers negative interactions with professionals, and baby-led weaning (Shakespeare et al., 2004; Tarrant et al., 2014).
According to Steube, Horton, Chetwynd, Watkins, Grewen, & Meltzer-Brody (2014), one in eight women experience early undesired weaning associated with the physiological difficulties of breastfeeding. Depression during pregnancy has also shown to predict shorter breastfeeding duration (Dias & Figueiredo, 2015). Steube et al. (2014) found that higher levels of disrupted lactation occurred with young, unmarried, nonprofessional women with no college education. Disrupted lactation was defined as difficulties with latch, pain, and milk supply. Bolling, Grant, Hamlyn, & Thornton (2007) conducted a study with participants from England, Scotland, Wales and Northern Ireland found that women 30 years or older


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from professional occupations with high educational levels were the most prevalent breast feeders in the sample.
A common theme throughout a few studies (Hoddinott & Pill, 1999; Bolling et al, 2007; Steube et al., 2014) showed that women who are younger, lack support, are of a lower socioeconomic status, and less educated discontinue breastfeeding early. Older women who are well educated and partnered are more likely to choose to breastfeed and continue to breastfeed (Vogel, Hutchinson, & Mitchell, 1999; Steube et al., 2014; Evers, Doran, & Schellenberg, 1997; Wojnar, 2004).
Women who sought professional help with breastfeeding difficulties had differing experiences. Some women reported having positive experiences with health professionals, while others expressed it was emotionally charged and negative (Shakespeare et al., 2004 pp. 256). One woman stated that her midwife became angry because she discontinued breastfeeding; she explained, I couldnt, it just, it was impossible with him (Shakespeare et al., 2004, p. 256). Women experiencing problems with breastfeeding had received conflicting messages and inadequate support from health care professionals (Marshall et al., 2007).
Based on these accounts it is important to identify that breastfeeding cessation is not always within the mothers control. Inability to continue breastfeeding may be a result of personal, familial and social factors (Colen & Ramey, 2014). One example is returning to work.
A major obstacle mothers face in terms of breastfeeding is returning to work. Mothers experience difficulties occupying the identity of both worker and mother, especially when the mother works outside of the home (Yimyam & Hanpa, 2014). Burdens experienced by breastfeeding mothers in the workplace include (Yimyam & Hanpa, 2014, pp. 721):
Lack of education on managing breastfeeding and employment


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Lack of awareness on benefits and accommodations of breastfeeding in the workplace
Lack of workplace privacy
Lack of child care facilities, breast pumps, and breast milk storage
Lack of job-flexibility
Lack of mother-friendly policies that support breastfeeding However, the above stated support and policies are not feasible in most cases for breastfeeding mothers who return to work.
Aside from the difficulties in determining whether continuing breastfeeding is feasible, the process of breastfeeding cessation can be formidable for many mothers. Women have reported an increase in symptoms of panic anxiety, depression, psychoses, mania, and obsessions in relation to weaning (Mezzacappa, Nelson, & Bagiella, 2000). Mezzacappa, Nelson, & Bagiella (2000) examined maternal health and breastfeeding practices and found that breastfeeding mothers reported lower perceived stress and less dysphoric symptoms. A possible explanation for these findings is the unfavorable consequences of weaning on maternal health. Mezzacappa (1997) reported that mothers who discontinued breastfeeding reported worse mood, more stress, and more psychological symptoms, in comparison to mothers who either never breastfed or were currently breastfeeding. Psychological symptoms included being easily annoyed or irritated, crying spells, uncontrollable outbursts of anger, fears of places or events, suicidal ideation, overeating, depressed mood, tension and anxiety, low appetite, low energy, loss of interest or enjoyment, loss of sexual drive or function, & obsessive thoughts (Mezzacappa, 1997).


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Women consistently receive the message that breast is best and that they are endangering their moral status by not breastfeeding (Murphy, 1999; Wolf, 2007). Many women are not prepared for the possibility of the child rejecting breastfeeding or discontinuing breastfeeding (Unity Point Clinic, 2015). Women may not be fully prepared for a child to lose interest in breastfeeding, especially when the child has been successfully breastfeeding for a period of time (Unity Point Clinic, 2015). There is the possibility of women internalizing this experience, resulting in mothers blaming themselves or feeling rejected.
Often children discontinue breastfeeding through the method baby-led weaning (BLW). Baby-led weaning is defined as introducing handheld food into the childs diet in which the child feeds themselves (Beal, 2016). This method may lead some children to prefer handheld foods with varying tastes. In some cases, the child may desire the corresponding independence in self-feeding practices. Rapley, Forste, Cameron, Brown, & Wright (2015) explained BLW allows the child to choose and control food intake. This process can begin around 6-months of age when the child can begin to feed themselves (Rapley et al., 2015). BLW may lead mothers to have complex emotional experiences related to the child no longer solely relying on the mother for feeding.
Postpartum Depression
Most of the current research related to breastfeeding cessation focuses on links between breastfeeding and postpartum depression (PPD). This research consists of the association between PPD and breastfeeding cessation and difficulties with breastfeeding resulting in emotional distress (Shakespeare et al., 2004; Kelleher, 2006). Approximately one in seven mothers experience PPD; half of the women diagnosed with PPD are experiencing


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their first episode of depression (American Psychological Association, 2015). Based on the known prevalence of PPD, it is understandable why this topic is well researched.
Postpartum depression (PPD) is a well-known condition that affects a significant percentage of women after the birth of a child. Within the DSM 5 (2013) postpartum depression is referred to as peripartum depression based on the statistic that 50% of postpartum major depressive episodes begin during pregnancy (American Psychological Association, 2013). The specifier for peripartum depression requires onset of mood symptoms arising during pregnancy or within the four weeks following delivery (American Psychological Association, 2013, p.186). Based on the prevalence of using the term postpartum depression within the current research, I refer to peripartum depression as PPD within this study. While the scope of this project goes beyond the time criteria for a diagnosis of PPD, it is important to understand the experience of PPD and depression in relation to breastfeeding. Thirteen percent of women will experience PPD within the first 12 weeks after childbirth and 19.2% within the first year of a childs birth (Gaynes, Gavin, Meltzer-Brody, Lohr, Swinson, Gartlehner, Brody, & Miller, 2005).
PPD does not only affect the mother but also has detrimental effects on both the child and partner. Don & Mickelson (2012) determined that maternal PPD may change patterns of supportive interactions between partners resulting in lower relationship satisfaction and support during the transition to parenthood, leading to paternal and/or partner PPD. The presence of PPD may lead to decreased social support for the mother during breastfeeding. Cinar et al. (2015) found that social support is extremely important in breastfeeding success (success defined as breastfeeding sufficiency). This finding is supported by Winnicotts attachment theory, which claims that attachment is aided by the supports available to the


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mother (Spock, 1987). Furthermore, PPD can have an effect on the mother-child relationship (American Psychological Association, 2015; Wojnar, 2004; Dennis & McQueen, 2009). However, there is a gap in the research on understanding the emotional ramifications of weaning on the mother, based on the attachment she had created with the child through breastfeeding.
PPD, returning to work, babies-led weaning, and difficulties with breastfeeding are all factors that impact breastfeeding duration. Yet, some mothers continue to breastfeed beyond the recommended six months.
Motivation to Continue Breastfeeding
To further understand breastfeeding behaviors, it is important to recognize mothers motivations to continue breastfeeding beyond the recommended six-month time period. Myers & Siegel (1985) examined womens motivation to continue breastfeeding through the lens of the opponent-process theory. The study found that women reported positive feelings while nursing and dysphoric symptoms just before the next scheduled feeding. In terms of weaning, some of the women exhibited dysphoric symptoms when they deviated from their routine nursing schedule. However, less distress was reported when the mothers gradually weaned their child. This study highlighted a pleasant experience for some women during breastfeeding and dysphoric states during and/or after breastfeeding cessation.
Secondary to the positive emotions experienced by some mothers during breastfeeding, there may be motivation to continue breastfeeding based on attachment. Maternal self-efficacy has shown to be affected by breastfeeding and facilitation of attachment between mother and child (Cinar et al., 2015). According to attachment theory, breastfeeding creates a feeling of success for the mother. This avenue of attachment and


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accompanied feelings of achievement may be lost with some mothers, which would create difficulties during weaning. Wilkinson & Scherl (2006) found that breastfeeding positively affects attachment between mother and child, with women reporting significantly higher levels of secure attachment in comparison to their bottle-feeding counterparts. Similarly, secure attachment style is associated with greater psychological health and maternal wellbeing. Wilkinson & Scherl (2006) also found that a secure attachment may serve as a protective factor for adjusting to the demands of motherhood.
Role of Oxytocin
It is relevant for practitioners to understand the role of hormones within the body in order to relate breastfeeding and negative experiences with weaning. Oxytocin plays an important role in buffering maternal stress (Cox, Stuebe, Pearson, Grewen, Rubinow, Meltzer-Brody, 2015). Oxytocin is a neuropeptide hormone that is critical for breastfeeding physiology, as it helps to facilitate attachment between mother and child through dopamine pathways (Pedersen, Caldwell, Walker, Ayers, & Mason 1994; Pedersen, 1997; Cox et al., 2015). The effects of oxytocin have been described as similar to antidepressant medication; individuals with major depression are known to have lower levels of oxytocin (Mezzacappa & Katkin, 2002).
In previous research, there has been an association between differing oxytocin responses that correlate with symptoms of depression and anxiety, as well as a possible indicator of PPD with irregularity in oxytocin (Cox et al., 2015; Stuebe, Grewen, & Meltzer-Brody, 2013). Similarly, Zelkowitz et al. (2014) determined that oxytocin may prevent high stress women from developing depressive symptoms, and that oxytocin release in the mother may support sensitive interactions between mother and child. Thus, medical research


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appears to indicate that breastfeeding may be a buffer to external stressors when normal levels of oxytocin are present.
Women who breastfed their children have been found to have a lower cortisol response and heart rate in relation to social stressors (Cox et al., 2015). Oxytocin may play a critical role in lowering heart rate, blood pressure, and depressive symptoms (Cox et al., 2015; Light, Smith, Johns, Brownley, Hofheimer, & Amico, 2000).
Aside from hormonal implications for symptoms of anxiety and depression post-weaning, there are also evolutionary implications of bottle-feeding and postpartum depression. Gallup, Pipitone, Carrone & Leadholm (2010) suggested that at a biological level, the absence or cessation of breastfeeding unknowingly simulates child loss. This hypothesis originates in human evolutionary history in which breastfeeding cessation or absence of breastfeeding was a result of miscarriage, loss, or death of child. Authors of this article suggest that the feelings of child loss, grief and depression, simulated at a physiological level may have a role in PPD in terms of breastfeeding cessation.
While examining oxytocin levels is outside of the scope of this project, it is important to understand the role of hormones in both breastfeeding and weaning. Based on current medical research and the emotional effects of breastfeeding cessation and lower oxytocin, it is clear that women need support for these tough experiences. A source of support for many women and a guiding factor in data collection for this study, are groups of women who support each other online.
Online Support Groups for Women
The Internet can provide a safe place for women to discuss their health concerns online and to gather health related information. Chung (2014) explained that Internet support


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groups, social media, blogs, health-related social networking sites are all potential resources for health information online. There is a breadth of research that focuses on support for women online suffering from breast cancer, sexual dysfunction, and postpartum depression (PPD). Online support is a valuable resource to women.
Anderson (2013) explained that interpersonal communication and support impact how individuals experience illness. Thoits (1986) explained that social support is more effective when support comes from someone who has faced or is facing similar stressors. A qualitative content analysis focusing on the social support received from online discussion of postpartum depression groups found that women experienced encouragement, empathy, and acceptance (Evans, Donelle, & Hume-Loveland, 2012). Evans et al. (2012) expressed the hope women received about their PPD experiences; including an understanding that the experience was finite and that there is light at the end of the tunnel (p. 407).
Chung (2014) found individuals who participated in online support groups were motivated to find information, to learn more about their health condition, to locate information about treatment, and to seek advice from others based on their experiences. Another primary motivator for participation in online support groups was to support others.
Social support can provide assistance to change the meaning of a situation and mediate emotional reactions; these forms of coping can help to eliminate feelings of anxiety and depression (Thoit, 1986). For individuals suffering from symptoms of PPD, participants of an online support group received support through: affection, empathy, informational support, reassurance, emotional support, honesty, advice, hope, and validation (Evans et al., 2012).


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Blogs offer a place for women to support each other and share their experiences online. Blogs provide women a wealth of information, advice, and support about their current health conditions. It is imperative to understand how blogs may assist women to cope with weaning. Based on the understanding of the social support women receive online practitioners can begin to grasp new ways of helping women who are suffering from negative experiences post-weaning and the concerns they express online.
Summary
A review of the literature on breastfeeding cessation has traditionally focused on the role of postpartum depression in a mothers decision to wean. Literature highlights the societal, medical, and internalized pressure placed on women to breastfeed their children based on the known benefits for both the child and mother. A gap was evident in the available research concerning the complex negative emotions women experience when weaning their children. This gap led to curiosity and the question that is the basis for this study: What is the negative emotional experiences of post-weaning among mothers who blog their life world online?
This study explored the online testimonials and experiences of women weaning, utilizing an attachment theory perspective and framework. The next chapter focuses on the methodology used for this investigation.


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CHAPTER III METHODOLOGY
The qualitative method of investigation for this study was content analysis. The scope of the sample included online blogs posted by women online detailing their experience with breastfeeding cessation. Johnson & Christensen (2014) propose a descriptive research approach to create an accurate picture or illustration of the phenomenon being studied. A qualitative method of analysis was chosen to understand how women describe their negative experiences and to find patterns, processes, commonalities, and differences (Morse & Richards, 2002).
Research Method
Qualitative content analysis was the primary methodology for this investigation. The qualitative content analysis approach allows a researcher to go beyond the quantitative approach of counting word frequency, and permits a researcher to understand an individuals social reality (Zhang & Wildemuth, 2009). This is a reflection of the overall purpose of this research. Qualitative content analysis gave me the opportunity to draw attention to womens experiential realities and to give voice to their lived experiences expressed in rich descriptions of feelings and experiences that accompany breastfeeding cessation. Content analysis is defined as an analysis of textual material to make inferences about the data (Weber, 1990). This provides a way for researchers to reduce textual material into relevant and manageable data. The aim is to take a broad amount of data and to decrease the data into concrete concepts and categories that illustrate the phenomenon (Elo & Kyngas, 2008).
Illustration of the phenomenon was accomplished through the analysis and coding of transcripts found online that concentrated on the negative experiences of breastfeeding


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cessation. The transcripts were blogs that detailed accounts of mothers negative experiences with breastfeeding cessation. Blogs are defined as updated personal journals or diaries that are found online (Byrd, 2016). Blogs are a medium to reach a global audience. The data for this research was limited to blogs, as blogs can be a source for women to share their experiences online candidly and a forum to receive support from other women with similar experiences. Blogs and comments made on threads within the blogs can be a source of a substantial amount of information on a lived phenomenon. Phenomenology is the research design of describing individual experiences (Johnson & Christenson, 2014). This design allowed for multiple perspectives on the unique experience of breastfeeding cessation. Aside from unique perspectives, the focus was to find the commonality of negative experiences with breastfeeding cessation. Phenomenology fits this research question by allowing me to obtain a view of the participants life worlds and to understand the participants personal meaning from their lived experiences (Johnson & Christensen, 2014, pp. 444).
Data Collection
The primary strategy of data collection was through three Internet search engines: Google, Yahoo, and Bing. Blogs offer an extensive amount of data that allows for anonymity (Hookway, 2008). Anonymity provides an outlet of sharing personal material while staying hidden from view (Hookway, 2008, pp. 93). Blogs are publicly available for wide readership; therefore, the data is not subject to typical human subject research review and approval. With interviews, the researcher has to build a rapport with the individual sharing their personal experiences, and the researcher is relying on the participants willingness to candidly share their thoughts and experiences. With online blogs and staying out of view, a


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blogger has the means to share intimate details in an unselfconscious manner (Hookway, 2008).
Blogs for this qualitative study were located using key word search terms: blogs about breastfeeding cessation, breastfeeding cessation causing depression blogs, postpartum after weaning blogs, blogs about quitting breastfeeding sadness, breastfeeding cessation sadness, impact of breastfeeding cessation, post-breastfeeding blogs, and experiences after breastfeeding. Key search terms related to attachment experiences included: mother child bond with breastfeeding cessation, breastfeeding attachment, and mother child attachment with breastfeeding cessation. Unfortunately, key search terms related to attachment did not provide any results that met the criteria for analysis.
Search terms were selected to focus on the experience of mothers during and after weaning. Understanding how the bond created between mother and child initiated during breastfeeding (Spock, 1987) impacts the mothers experience after cessation. Terms addressing breastfeeding cessation and weaning narrowed the search to those particular life world experiences. A search of popular blogs addressing the topic of interest led to key search terms for the Internet search. Key search terms were chosen to incorporate how individuals in the public were believed to look up the topic of negative experiences postbreastfeeding.
Sampling
This study focused on primary source blogs and comments made on these blogs by women who self-reported a negative experience with breastfeeding cessation. Primary source is defined as the author being a direct witness or directly involved in the event (Johnson & Christensen, 2014). Based on the narrow scope of this study non-random sampling


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techniques were used for finding text data sources online. Sampling techniques include convenience sampling, purposive sampling, and snowball sampling.
Convenience Sampling
Convenience sampling was used via key search terms with three primary search engines: Google, Yahoo, and Bing, that were easily accessible in the public domain. This sampling technique is to conveniently select (Johnson & Christensen, 2014, p. 263) blogs that are currently available online.
Primary source blogs successfully located during convenience sampling were found using search terms: blogs about breastfeeding cessation, breastfeeding cessation causing depression blogs, postpartum after weaning blogs, blogs about quitting breastfeeding sadness, breastfeeding cessation sadness, impact of breastfeeding cessation, post-breastfeeding blogs, and experiences after breastfeeding. I was unable to find blogs that met the sample inclusion criteria using search terms stopping breastfeeding, breastfeeding weaning, breastfeeding cessation, mother child bond with breastfeeding cessation, breastfeeding attachment, and mother child attachment with breastfeeding cessation.
Purposive Sampling
Next, purposive sampling was used to determine what blogs to include as relevant data. Since my research question focused on negative experiences associated with breastfeeding cessation, purposive sampling was appropriate to locate posts made by women who experienced negative symptoms post-weaning while excluding posts focused on positive experiences. Exclusion of positive experiences occurred to draw attention to the purpose of the study to describe the difficult experience women have with weaning. This is where I utilized purposive sampling; I decisively concluded which blogs were used as data.


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Blog text was included that covered the relevant topic and were from primary blogs, links to other blogs, and comment threads. This is discussed further in the third step of snowball sampling. Blogs picked for data were in English to avoid any translation errors. The information posted in blogs came from the individual that had lived the experience to avoid secondary interpretations. Lastly, there was no minimum word count for sections of data that was included in this study due to the expressive nature of blogs. Blog entries and comments used were determined based on the relevance to the research question and defined physically based on their natural boundaries with a stated expression or experience (Stemler, 2001).
Original data consisted of 14 blogs and 59 comments found on the Internet. Five blogs and one comment were excluded due to the authors being a secondary source. Secondary sources were excluded, as the blog did not reflect a mothers personal experience with weaning. One comment was excluded for not focusing on breastfeeding cessation. Five blogs and two comments were eliminated while first reading the transcripts and highlighting all relevant information on negative experiences with breastfeeding cessation. The remaining nine blogs and 57 comments were included in the first unit of analysis. For analysis, I used each blog in its entirety for coding. All comments that met the inclusion criteria of this study were also coded. These comments were all found in the comment section that followed each blog.
Snowball Sampling
The third step in this sampling strategy was snowball sampling. From the primary source blogs found from the three search engines, other potential sources were located through links found in threads and comments. Snowball sampling was employed for linked posts through comments made on other blogs online that were relevant to the topic and detailed a personal


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account. For example, blog 4 was located from a link in blog 3 that was excluded from the analysis as it was written by a secondary source. Blog 3 was found from Google using the key search term breastfeeding cessation causing depression blogs, and blog 5 was found through a link from blog 4.
Inclusion and Exclusion of Blogs
The terminology of posts and blogs are used interchangeably throughout this study to refer to the text data. Posts include comments made on the blog; these comments are by individuals other than the original author. Comments of interest included self-reports of similar experiences, links to other similar blogs, and the original authors comments to a post that provided further information about the experience.
Sample Inclusion Criteria:
Blogs in English to ensure no translation errors
Posts discussing breastfeeding cessation or weaning
Posts by the primary source (i.e. mothers) to avoid translations from secondary sources
Posts discussing negative experiences associated with weaning, as the purpose of the study is to draw attention to these experiences
Posts made in any English-speaking country to acquire a cultural perspective on womens experiences
Sample Exclusion Criteria:
Posts written or translated from another language
Posts created by a secondary source, author who did not experience a negative breastfeeding experience (e.g. husbands, sisters, mothers, etc....)


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Posts that did not discuss breastfeeding cessation and weaning
Posts that did not discuss negative experiences
Ethical Considerations
A method of storing data securely and privately was not necessary for this study since the information is available in a web based public domain. Archived blogs and comments are publicly accessible and searchable on the Internet. I did not include any identifiable information or screen names in this research to maintain anonymity of the blog authors. In order to protect the womens identity and to eliminate any potential risk, the women blog authors were not contacted at any point during this study. This research only utilized publicly available information. The information was cut and copied directly from the original source to a master word file that was coded.
My lack of experience with breastfeeding was another ethical consideration in this study. Never having experienced the struggles and rewards of being a mother personally made it difficult to completely understand a mothers experience of the mother-child bond. This impacted how I analyzed the data. To address this limitation, I utilized what I know about attachment theory from my education and clinical experiences/training in internship. I also focused on the emotional and physical symptoms that I could relate to such as sadness, anxiety, panic, headaches, exhaustion, etc.
Data Coding and Analysis
Saturation ensures that no new or relevant information transpires, yet it still leaves a small enough sample to conduct a deep analysis of the data (Johnson & Christensen, 2014). I coded data until I reached a point of saturation in which emerging themes became evident with no new themes appearing.


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A priori Codes
Johnson & Christensen (2014) define a priori codes as codes that have been identified before coding the data. Due to the literature review and use of attachment theory as a guide for this research a list of codes were created to guide the initial content analysis. To determine whether attachment theory influenced womens negative experiences, a priori codes were used that were relevant to the research on attachment theory. Utilizing attachment codes allowed me to understand the presence of attachment experiences, and how these concepts may have been present during the blogged lifeworld of breastfeeding cessation. Attachment codes were created utilizing an attachment theory perspective by applying concepts from Winnicott, Bowlby and Ainsworth and attachment based research. Attachment codes include: feelings of inadequacy, loss of attachment, support, & perception of the childs adjustment as negative. In-depth descriptions of what each code entails are found in Table 1. Based on the inductive nature of this research, additional grounded codes emerged from examination of the data (Johnson & Christensen, 2014). These a posteriori codes were developed after the grounded and a priori codes had been organized.


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A priori Codes
Code Theoretical Rational Subcategories
Feeling Inadequate As mothers strive to be good enough mothers, to provide the best care for their child, reality of not meeting this standard may come with negative emotional consequences, such as guilt and inadequacy (Ratnapalan & Batty, 2009). Maternal self-efficacy has shown to be affected by breastfeeding and facilitation of attachment between mother and child (Cinar et al., 2015). Feelings of being unable to provide for their baby Feelings of being perceived as a bad mother Perceived lack of self-efficacy Feelings of guilt and inadequacy
Lack of Support Winnicott expressed the importance of the mother having support from others in being successful in creating a good enough environment for the child (Spock, 1987; Spelman, 2013, p. 14). Mercer (2004) supported this idea explaining that environmental support (support from the family in particular), is the leading factor in the positive effects of the mother and child attachment. Lack of Support networks Unavailable family and friends Lack of available Resources
Loss of Attachment Mothers and their children create a strong bond through the act of breastfeeding (Else-Quest, Hyde, & Clark, 2003). Based on this attachment weaning may create feelings of loss of that attachment. Sensitivity to childs needs Relationship between mother and child Feeling the child does not need the mother anymore


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Table 1 contd
Perception of the Childs Adjustment as Negative
Based on breastfeeding mothers having higher rates of sensitive responsiveness and the child having greater attachment security when breastfed (Thamer et al., 2012), mothers that observe their child as being distressed during weaning may have a more negative experience with breastfeeding cessation.
Child showing distress
Separation anxiety
Directed Content Analysis
A directed content analysis approach (Hsieh & Shannon, 2005), was used based on current research on breastfeeding and attachment. Previous research on breastfeeding and attachment offered many coding categories that were identified prior to data collection: these were the a priori codes. Grounded codes emerged from the analysis of text data. A priori codes that emerged from the literature review and attachment theory included: feelings of inadequacy, lack of support, loss of attachment, and perception of the childs adjustment as negative.
To avoid bias of missing relevant information by relying solely on initial codes (Hsieh & Shannon, 2005), I analyzed the data by first reading the transcripts and highlighted all relevant information on negative experiences with breastfeeding. Hsieh & Shannon (2005) suggest coding all highlighted passages using the initial coding scheme formulated from prior research.
A directed content analysis was used while coding the first nine blogs and 57 comments. During analysis, I read through each blog and subsequent comments searching for a single a priori code at a time. The first unit of analysis was coded four times; each time I


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focused on coding the data for one a priori code, which is consistent with directed content analysis.
Inductive Content Analysis
Johnson & Christensen (2014) explain inductive content analysis as a bottom-up approach. The bottom-up approach begins with observations of the data and ends with determining general patterns. Based on the limited research at this time, on the topic of negative experiences with post-breastfeeding cessation, I used an inductive approach for this research. Inductive content analysis is when categories emerge from the data (Elo & Kyngas, 2008). This was achieved through open coding; therefore, potential codes were noted while reading the data. In this study, the data observed were online blogs. During coding, I utilized multiple techniques delineated by Gibbs & Taylor.
Gibbs & Taylor (2005) provide easy to understand definitions for coding techniques used in qualitative research. Gibbs & Taylor (2005) define word repetition as common words used in the data and words that are repeated that may indicate an emotion. Events are defined as things people have done, and are often told in a story. States refers to general conditions people experience. Key-words-in-context is defined as key terms and phrases that occur in the context of a sentence. Searching for missing information is defined by an idea of what is not stated or done, which is often expected. Metaphors and analogies are defined by the individuals core beliefs and may indicate how the individual feels. Meanings were defined as the significance or meaning the person labels the feeling or event (Gibbs & Taylor, 2005). Interim Analysis
Interim analysis was used to create a deeper understanding of the phenomenon being studied (Johnson & Christensen, 2014). To do this I recursively collected and analyzed data


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to strengthen my qualitative research. To create a deeper understanding of the phenomenon of negative experiences with weaning I collected data, analyzed the data, then collected additional data for analysis. This cyclical process of collecting and analyzing data strengthened this study and refined the conclusions drawn from the data (Johnson & Christensen, 2014).
I found two additional blogs to ensure I had met the point of saturation. The two additional blogs were coded using the same procedures as the first unit of analysis. Saturation was met during analysis of the additional two blogs (with no comments) as no new themes emerged from the data. Once the final two blogs were coded, I went through the entire set of data of 11 blogs and 57 comments to ensure coding consistency. Sixty-six different mothers wrote the 11 blogs and 57 comments. An outline of coding categories for each theme that emerged and the coding techniques used is available in Table 2.
Themes & Coding Categories
Themes Coding Categories Coding Technique Representative Examples
Feeling Inadequate Less of a mum & Bad mother word repetition failure, incapable, inadequate
searching for missing information Expressed feelings of being helpless or unable to handle life circumstances. I was a bad mother-I didnt know if I was making the right decisions.
Going a bit nuts Emotional Difficulty word repetition sadness, anxiety, depression, irritable, overwhelmed


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Table 2 contd
states Latent content of the state being described. Being hit by a fog
key-words-in- context Key phrases that displayed tasks feeling overwhelming. Overwhelming tasks I felt broken afterward
Physical Symptoms word repetition headaches, nausea, PMS, hormone, exhaustion
Lack of Awareness word repetition unexpected, surprised, didnt understand, having no idea
searching for missing information I havent heard people talk about depression related to weaning
events Stories of visiting medical professionals
Loss of Attachment Loss of Attachment word repetition grief, loss, missing
meaning Expressed meaning of losing mothering role through weaning
Parallel Process searching for missing information The childs distress was seemingly painful for many mothers and their children. It was heartbreaking when I would deny her something she had been used to her entire life and she would be distraught


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Table 2 contd
events Stories of mothers expressing their emotional reaction as comparable to the childs. Hes sad and grumpy.... Im sad and grumpy
Shared Experience Feeling Alone meaning Mothers expressing being alone in experience. People dont understand or cant relate
word repetition I am glad I am not alone, I am glad it is not just me
Sudden Onset of Symptoms word repetition suddenly, all of a sudden, out of nowhere, boom
Coding Procedures in Qualitative Content Analysis
Zhang & Wildemuth (2009) offer an eight-step procedure for content analysis to support valid and reliable inferences, and that I used for this study:
Step 1: Preparing the data
Step 2: Define the unit of analysis
Step 3: Develop categories and coding scheme
Step 4: Test coding scheme on a sample text
Step 5: Code all the text
Step 6: Assess coding consistency
Step 7: Draw conclusions from coded data
Step 8: Report methods and findings


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Preparing the Data
In the first step preparing the data, transcripts of the data were created for analysis. This included data reduction, which was the selecting, focusing, simplifying, abstracting, and transforming the data into transcripts (Miles & Huberman, 1994). This data reduction process included the use of purposive sampling by discriminating content in the blogs to be included in the analysis based on the phenomenon of interest of this study.
During purposive sampling, I highlighted data to determine which blogs would be included in this study. Once the data were narrowed down from 14 blogs and 59 comments to nine blogs and 57 comments the data were uploaded to Dedoose version 7.5.9. Dedoose is a web-based application used for analyzing qualitative data such as text, audio, and video data (Dedoose version 7.5.9). Many previous researchers have used Dedoose for data analysis. Examples include analyses of data from semi-structured interviews focusing on quality of life (Kyte, Ives, Draper, Keeley, & Calvert, 2013), online social networking for HIV education and prevention (Young & Jaganath, 2013), and a study focused on the use of mobile devices by caregivers (Radesky, Kistin, Zuckerman, Nitzberg, Gross, Kaplan-Sanoff, Augustyn, & Silverstein, 2014).
Define the Unit of Analysis
Zhang & Wildemuth (2009) characterize the unit of analysis as a unit of text to be categorized during analysis. For this study, individual themes were the unit of analysis, which included word/s, sentence/s, and paragraphs. The first unit of analysis consisted of nine blogs and 57 comments. An additional two blogs were added to the unit of analysis during the interim analysis. Both units of analysis included the entire blog and succeeding comments. Table 3 outlines the blogs included in this analysis, the number of comments on


each blog, the date the blog was posted, and names that I use to refer to each blog. The two blogs that were added during interim analysis are bolded in Table 3.
Blogs & Comments
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Blog# # Comments Date of Original Source Blog Descriptive Name
Blog 1 11 No Date Extreme exhaustion
Blog 2 28 2/20/2012 Falling apart
Blog 3 2 7/8/2014 Fog that hit me
Blog 4 4 7/23/2014 Postpartum after weaning
Blog 5 0 5/29/2015 Weaning before planned
Blog 6 0 No Date My Baby is gone
Blog7 5 3/2014 I cant stop crying
Blog 8 4 No Date Quitting breastfeeding
Blog 9 3 2/5/2014 I feel guilty
Blog 10 0 7/25/2013 Extreme sadness
Blog 11 0 No Date I wasnt expecting it
Developing Categories and Coding Schemes
Developing categories and coding schemes came from the data, previous related research, and attachment theory. Elements of attachment theory guided various a priori, grounded codes, and categories for the analysis. When dealing with a priori coding, the categories are established prior to the analysis based upon some theory (Stemler, 2001, p.
2). Attachment theory a priori codes included: feeling inadequate, loss of attachment, and codes that exhibit the mother feeling no longer needed. An additional 13-grounded codes emerged in the data through the inductive content analysis. A coding manual was created and


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provided to ensure consistency in coding endeavors. The coding manual included a label for each code, a description, and subcategories of the code.
The developed categories and coding schemes were based on thematic analysis. Thematic analysis is the identification of themes within the data (Johnson & Christensen, 2014). Themes were defined as a word or words denoting an idea that occurs consistently throughout the data (Johnson & Christensen, 2014). Outline of coding procedures utilized throughout the analysis is found in Figure 1.
Coding Procedures
Phenomenological analysis of blogs
What is the negative experience of post-weaning among mothers who post on blogs?
Previous research and attachment theory
Word repetition, metaphors and analogies, searching for missing information, states, events, meaning, key-words-in-context, interaction
Cutting and sorting
Figure 1. Coding Procedure
Test Coding Scheme, Code all the Text, & Assess Coding Consistency
To test my coding theme, a sample was sent to my thesis advisor. This sample included grounded codes that emerged from the data. The grounded codes that emerged were lack of awareness, emotional difficulty, feeling overwhelmed, and feeling alone. An


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additional nine grounded codes emerged through further analysis of the data. My thesis advisor agreed with the emerging codes in the sample. My thesis advisor and a methodologist on my thesis panel checked the example of my coding theme to ensure category definitions were clear and that coding was consistent through all data transcripts. Coding consistency was based on my coding of all text data, as I was the solitary coder for this study.
Coding the text was completed once saturation in coding had been reached. Coding saturation was determined when no new codes emerged from the data. The coding consistency was rechecked once the entire data set had been analyzed to ensure that all text was coded in the same manner. When new codes were added, previous coded texts were analyzed for the presence of new categories.
Draw Conclusions from Coded Data
Once the data set had been coded and rechecked for consistency conclusions were drawn from the coded data. This included constant comparison of the data to compare the mothers experiences of the phenomenon prior to drawing conclusions. I organized the data into categories that were inferred from the coded texts. Once there was a clear understanding of the themes within the data, meaning was derived from the text to understand the relationship between categories, how the themes related to the research question, and how the information was applicable to real world circumstances (Zhang & Wildemuth, 2009).
Report Methods and Findings
The last step in the analysis was drawing conclusions from coded data. I separated codes and analyzed the codes with the assistance of my methodologist to draw conclusions. After separating the coding categories I began to organize data into themes. This process


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included merging codes that were similar. Once similar codes were merged these codes were organized into themes based on the common thread throughout the different codes.
Once the data was organized I reported methods andfindings. This report included a write up of the results of this study and a discussion of how the information is relevant. Additionally, the reported analysis included descriptions and interpretations of the data coding results.
Trustworthiness and Credibility
Trustworthiness and credibility are terms used to refer to the validity and reliability of a qualitative study. Johnson & Christensen (2014) define validity as the accuracy of the inferences and interpretations (p. 676) made within a study. Johnson & Christensen (2014) suggest numerous strategies to increase qualitative research validity. Of these suggestions, pattern matching, reflexivity, highlighting, manifest & latent content, were used in this research.
Pattern Matching
Pattern matching was utilized during cross case analysis; this entailed predicting results that created a pattern that was inspected to determine the degree to which the predicted pattern fit the evident results (Almutairi, Gardner, & McCarthy, 2014). Patterns found from the content analysis were compared to expected patterns from the literature review. Expected patterns found during analysis included feelings of stress, loss of attachment to child and depressed mood.
Reflexivity
Reflexivity is the researchers awareness of her own biases and the impact this will have in the course of the research and interpreting results (Johnson & Christensen, 2014).


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Reflexivity consisted of awareness of my lack of familiarity and experience with breastfeeding cessation. Due to my lack of experience breastfeeding, I tended to focus on the emotional reactions of the mothers who wrote on the blogs. I am better able to relate to emotional reactions and how I would feel based on the emotional states described. This influenced how I perceived the data as well as how I displayed the data. I often asked myself during this process, how would I want my experience described if I were one of these mothers?
Highlighting
A directed content analysis method was employed of reading and highlighting transcripts before coding to increase the trustworthiness of the study (Hsieh & Shannon, 2005). I took this approach in order to categorize facets as self-reports in online public forums of these womens experiences, by initially highlighting data that seemed relevant from my first impression. Once I completed the highlighting, I coded the data with my initial codes and created coding categories for new codes that emerged from the data.
Manifest & Latent Content
To further enhance the trustworthiness and credibility of this study I analyzed both the manifest and latent content of the blogs (Potter & Levine-Donnerstein, 1999). Manifest content refers to the observable surface, the words as they appear in the text. Latent content considered patterns that were observed within the data and the coders interpretations of underlying meanings. While both manifest and latent content were analyzed in answering the research question (Potter & Levine-Donnerstein, 1999).
Manifest content was coded using word repetition, events, and states. The latent content was the interpretation of the underlying meaning from the blogs telling a story for the


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reader; this was accomplished without labeling the emotion, feeling, or thought. Latent content was coded through the coding technique key-words-in-context, searching for missing information, metaphors and analogies, and meaning.
Assumptions
Assumptions in this study were blogs that were used were posted by women who had experienced negative side effects post-weaning and that the accounts were truthful. Since the data was collected from online blogs and bloggers were not contacted at any point throughout this study, I assumed that the stories posted were coming from a primary source, the women who had negative experiences.
The second assumption in this study is that mothers negative experiences would be shared in a public forum. This meant that women were willing to share elements of their private experience in a blog that is open to the public and archived; implicitly indicating womens awareness of the public nature of these forums.
Summary
Chapter three attends to the qualitative methodology that was used for this content analysis of the shared negative experience of breastfeeding cessation. This methodology allowed me to draw themes from the collected data to understand negative experiences with breastfeeding cessation. This chapter covered methods of data collection, sampling, ethical considerations, data coding & analysis, coding procedures, trustworthiness & credibility, and assumptions. The next chapter discusses the findings from the qualitative data analysis.


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CHAPTER IV FINDINGS
Phenomenology guided this content analysis. Phenomenology is a research method used to describe individuals experiences (Johnson & Christenson, 2014). In this phenomenological study blogs were analyzed to explain the unique negative experience of breastfeeding cessation. There were 11 blogs and 57 comments included in this qualitative study. Content analysis was utilized to code and explore mothers negative experiences with breastfeeding cessation. The findings for the analysis are reported here in terms of the four main themes discovered: feeling inadequate, going a bit nuts, shared experience, and loss of attachment. Specific information for each theme is further explained as it pertains to breastfeeding cessation.
Illustrative direct quotes are used throughout the findings to align the mothers experiences with each theme. Blog numbers and blog descriptive names are included with each quote to increase the credibility of findings. Grammatical errors in blog entries were kept consistent to retain authenticity of mothers words/writing.
The blogs included in the sample were displayed with colorful backgrounds and pictures, which made these mothers stories come to life. Mothers included pictures of themselves with their babies, pictures of babies breastfeeding, and serene photos of the outdoors. A number of blogs included links to different websites that would be relevant to mothers. An example of these links was 15 things I would want to tell a new mother and 5 ways to help baby sleep. Some blogs had separate blog posts that addressed other struggles experienced by mothers. An example of blogs embedded on the same page included blogs


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about difficulty with breastfeeding or a mothers experience breastfeeding twins. Blogs consistently appeared to be a supportive outlet for mothers with different difficulties.
When first reading the blogs, I experienced a rush of the emotions the mothers were describing. The mothers created a vivid story of the negative experience during breastfeeding cessation. While I could not relate to the mothering experience, I could relate to the emotional experience. I felt their sadness and anxiety. I felt their guilt and rejection. I felt their confusion and loneliness. I felt their struggle.
Findings
Four main themes found in this study were feeling inadequate, going a bit nuts, shared experience, and loss of attachment. Feeling inadequate addressed the experience of women feeling less like a mother during the process of weaning. Going a bit nuts included codes related to mothers lack of awareness, physical symptoms, and emotional difficulty. The theme shared experience focused on womens comparable experience of feeling alone and sudden onset of negative symptoms. Many mothers felt alone until they had discovered other mothers were having similar experiences. Mothers also shared the experience of sudden onset of symptoms. Loss of attachment addressed the grief that mothers felt from the changing relationship between mother and child as the child became more independent. Loss of attachment also addressed the parallel process observed related to the mothers behavior mimicking the childs behavior during the weaning transition. Main themes found in the data and coding categories found with each theme are outlined in Figure 2.


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Analysis of Themes
Feeling
Inadequate
"Less of a mum" "Bad mother"
"Going a bit nuts"
Lack of awareness Physical symptoms Emotional difficulty
Shared
Experience
Feeling alone Sudden onset of symptoms
Loss of Attachment
Loss of attachment
Parallel process
Figure 2: Analysis of Themes
Feeling Inadequate Bad Mother & Less of a Mum
The theme of feeling inadequate emerged from blog analysis. Mothers expressed they felt helpless or unable to handle their role as a mother without the breastfeeding relationship. The breastfeeding relationship is defined in this study as the relationship between the mother and child facilitated through the act of breastfeeding I think the worse is when she is crying,
I consoled her with the boob, I will have to find other ways to comfort her (Blog 9,1 feel guilty). Mothers reported feeling incapable of providing for their baby without the breastfeeding relationship. A mother who struggled with weaning wrote:
Hearing him cry while I felt so helpless, nothing was helping to calm him down. I felt that darkness wash over me, thinking how awful I am, how everyone would just be better off without me, how they deserved so much more than me (Blog 2, Falling apart).


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Mothers feeling helpless in calming the child down without breastfeeding heightened feelings of inadequacy. Many mothers explained the difficulty of finding new strategies to soothe their child. Another mother commented, Im struggling with weaning. Just an hour ago hearing him cry while I felt so helpless, nothing was helping to calm him down (Blog 2, Falling apart). The mother who wrote Blog 9,1 feel guilty expressed similar feelings:
I have recently stopped feeding my 8-month-old and she has been very fussy and trying to find my boob. She is taking the bottle well and finishing the milk then she wants to feed from me, I feel guilty for some reason.
Many mothers described their feelings of inadequacy and guilt in their mothering role without the breastfeeding relationship to calm the child. Many mothers expressed guilt for taking away the childs preferred method of feeding.
I too weaned gradually and had about a week or twos worth of depression. I know it was exacerbated by my daughters struggles with the weaning: I felt some guilt and ambivalence that added to whatever potent hormonal brew circulated in my veins (Blog 7,1 cant stop crying).
A mother commented on the Blog 2, Falling apart: I am not weaning but am mentally TRYING to... I have a 2.5-year-old that BEGS and CRIES for hubbies and I cant resist her. Another mother had a similar experience with feeling guilty: I started to wean by stopping the night time feedings. It was so hard. She was so sweet, begging me to nurse. I started to feel a little guilty. Mothers appeared to internalize these feelings of inadequacy and guilt creating feelings of being a bad mother.
Mothers feelings of inadequacy and guilt caused mothers to perceive themselves as bad mothers. One mother expressed her feelings of being a bad mother:


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I dont have anyone to talk to cause everyone just says she is a baby like I dont know that. Im starting to not wanna be around her and all I do is yell. I feel like a bad mother because I have no patience with her (Blog 4, Postpartum after weaning). Mothers explicitly identified themselves as a bad mother:
To explain my sadness and worry, I looked at my life and tried to point something out. I convinced myself of these things. I was a bad mother -I didnt know if I was making the right choices about sleep, food, discipline, everything (Blog 2, Falling apart).
Mothers seemed to question their decisions and whether they were capable of being a good enough mother to their child.
Throughout the analysis mothers were found to have comparable experiences with feelings of being less of a mum (Blog 2, Falling apart) without breastfeeding. During weaning mothers redefined their newfound role as a mother without breastfeeding. A mother commented: I cant help but feel guilty like Im ignoring my little boys cry for boob and you do feel like less of a mum (Blog 2, Falling apart). Another mother commented on the same blog wrote: I cant imagine being a mom to my baby girl without nursing being in the picture! Similarly,
I wished my baby had a different mother. He deserved more, I thought. I felt like such a failure: I had always wanted to be a mother. I always had baby fever. I always looked forward to having children. But now that I had a sweet, curious, beautiful baby, I suddenly couldnt handle motherhood (Blog 2, Falling apart).
This mother expressed feeling like a failure and unable to handle motherhood when she was very excited to become a parent. Mothers had comparable experiences where they identified


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being less of a mum during weaning. While feeling like less of a mum was present during analysis, mothers were also faced with feeling inadequate in different areas of their lives.
Feelings of inadequacy were not limited to a womans role as a mother. Mothers expressed feeling inadequate in their roles as a wife, a worker, and as a friend. The words of mothers writing on blogs expressed inability to complete tasks that previously seemed simplistic. The mother who wrote Blog 2, Falling apart explained her feelings of being incapable after abruptly weaning her eight-month-old son: I thought I was just sad because I was lame and going to fail in life. The same mother stated:
The funny thing about depression is that you dont know that its depression. You just think its your actual life-that your career really IS ending, that you really ARE a terrible mother, that your husband really WILL stop loving you, that friends DO think youre boring.
One mother reported similar experiences of feeling inadequate in a multitude of areas in her life:
I am currently weaning my twins and am only pumping 20 ounces a day. I noticed an awful, unsettling depression when I reduced from pumping 30 ounces to 20 ounces. I felt inadequate, like I was not needed, not appreciated and the depression made me not want to be here living my life. I was devastated at my irrational thoughts (Blog 8, Quitting breastfeeding).
Throughout the data women expressed an inability to be effective in their roles as a mother without the breastfeeding relationship. With the end of breastfeeding mothers expressed feeling inadequate, guilty, feeling like failures, and being incapable.


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Going a Bit Nuts
The theme going a bit nuts emerged from identification of a verbatim quote during content analysis. Mothers negative experiences post-weaning were often unexpected and misunderstood. Throughout the data mothers stated that due to their lack of awareness they believed something was wrong with them mentally and/or medically. Many mothers expressed feelings that reflected thoughts of going a bit nuts. These were the words used by a mother who commented on Blog 7,1 cant stop crying: I also gradually weaned my son last year and experienced pretty severe mood swings and depression. I thought I was going a bit nuts until my sister made the connection between the weaning and my feelings/moods. Going a bit nuts evolved as a prominent theme during analysis. An example of a mother feeling something was medically wrong was from Blog 8, Quitting breastfeeding: I seriously thought something was medically wrong with me! So tired and depressed Various mothers expressed similar feelings of going a bit nuts utilizing phrases like going insane and going crazy. These feelings reflected shared negative experiences as an unpredicted consequence of breastfeeding cessation.
A mother who commented on Blog 4, Postpartum after weaning expressed her thoughts of becoming mentally ill while weaning her daughter at seven months. She reported: It is a hard road though. I thought I was a freak being diagnosed with PPD [postpartum depression] at 7 months. One mother on Blog 2, Falling apart expressed feeling there was something fundamentally wrong. She wrote: I hope it doesnt last too long, and thank you again for opening up and talking about it so women like myself dont feel alone or like something is fundamentally wrong with us all of a sudden. Another mother from the same blog stated: actually today I felt the worse, until today I thought I am mentally ill that


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something serious is going on with me. Throughout the analysis mothers lack of awareness created a phenomenon reflecting a belief that something was wrong with the mother.
Lack of Awareness
The surprising and unanticipated nature of the negative experiences with postbreastfeeding was evident throughout the data. Mothers explained they thought their experience was related to other factors like life circumstances until they come across blogs that outlined similar experiences. The lack of awareness of the negative experience exacerbated feelings of having no control which appeared to create feelings of going a bit nuts. Mothers expressed a lack of knowledge of what they were going through in the midst of their experience during breastfeeding cessation.
I had never heard of anyone else having this problem and hadnt had any trouble when I weaned my older son at 18 months several years ago. I started to refer to it as my post-lactation depression. It was very real and took me very much by surprise (Blog 7, Cant stop crying).
A mother from Blog 2, Falling apart had a similar struggle of being surprised by the experience:
We were on vacation, one day she just STOPPED nursing. No longer interested, too much else to look at, wanted a bottle, and to wander around. Which was fine with me, but I suffered a terrible slide back into deep sadness, and physical decline, it was dreadful, and totally unexpected.
Mothers explained a lack of awareness of the possibility that they would have a negative experience post-breastfeeding. This lack of awareness made mothers experiences feel unexpected and for some, highlighted a related theme of going a bit nuts. Many blog


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writers reported being ill prepared to deal with the feelings and negative thoughts that resulted from weaning. An example of this experience was from a mother who had been slowly weaning her 13-month-old daughter for the past 2-3 months: It is comforting to know that it will most likely pass and I am not going insane (Blog 2, Falling apart). A mother who had a similar experience with negative thoughts (Blog 1, Extreme exhaustion) wrote: This is the only thing that I have found about weaning and being exhausted I thought I was going crazy! Another wrote: Am I crazy? Is this normal? Is this just from a change of hormones? Mothers seemed to define themselves as going a bit nuts versus labeling their lack of awareness of the experience.
Medical professionals who did not have a clear understanding or awareness of the mothers negative experiences appeared to increase some mothers thoughts of something being wrong. A mother from Blog 2, Falling apart was in the process of weaning her twins:
In the last couple days my moodiness had increased and I began having night sweats (which hadnt happened since pregnancy). I was concerned and contacted my doctor. He referred me to urgent care. Urgent care referred me to a behavioral center to be evaluated, which was extreme. I walked into the center and found out it was a place that admitted patients to watch them for 24 to 72 hours. I walked away from the center frustrated. I didnt need to be locked up. I needed to find ways to balance my hormones and stop the depression.
The mother who authored Blog 2, Falling apart wrote about her various experiences with practitioners during weaning:
Depression around weaning seems to be a real gap in medical research and awareness One psychiatrist, whom I called for an appointment, actually said to me,


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Well, I guess anythings possible. I hope that people will become more aware of it, and more research and preventative measures will develop.
This same mother reported seeing a therapist during breastfeeding cessation. She stated her therapist did not realize her negative emotional experience was related to weaning until the mother had figured it out herself. Mothers reported a lack of support and understanding from health care practitioners. Mothers discussed invalidating messages from medical professionals who prescribed antidepressants, rather than normalizing the mothers current state. A mother who weaned her daughter at two months wrote about her encounter with a doctor:
I thought the convenience and predictability of a formula fed baby would relieve some anxiety it was the opposite. I felt lower than ever! Guilt, depression, anxiety!
My doctor prescribed Zoloft and after researching I could not fathom taking this strong drug (Blog 2, Falling apart).
Mothers were turning to medical professionals to understand their experience and receive help. Instead of receiving a better understanding mothers felt they were treated like they had a mental illness and reported that they were prescribed a psychotropic medication. These experiences seemed to reinforce the mothers thoughts that they were going a bit nuts. Mothers struggles during weaning were not limited to their experience with medical professionals; many mothers communicated physical symptoms as well.
Physical Symptoms
Mothers described experiences of physical discomfort and an influx of hormones. The coding category of physical symptoms emerged as part of the theme going a bit nuts. Mothers appeared to be feeling they were going crazy as they attempted to understand


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what was happening to them. Mothers expressed a multitude of different physical symptoms during and after weaning, including physical symptoms that mimicked pregnancy. An example of these symptoms is from a mother who commented on Blog 1, Extreme exhaustion:
I have been done nursing my 12-month-old for 3 weeks now and my engorgement is finally gone and I am so exhausted as I was in the beginning of both my pregnancies. I thought I was preggo, cause I sometimes literally cannot keep my eyes open.
The mother who authored Blog 1, Extreme exhaustion reported a similar experience:
I found one article that stated weaning can mimic early signs of pregnancy, including the tenderness, bloating, emotions and extreme fatigue that early pregnancy causes. Finally, there was something that made me feel less crazy! I was really, really, really tired when I first found out I was pregnant with N. I guess it would make sense that I feel very tired now too.
Mothers faced other uncomfortable physical symptoms during breastfeeding cessation including nausea, dizziness, exhaustion, food aversion, nipple engorgement, and headaches: It is not only the emotional factors. Im fatigued, experiencing headaches soreness in my breasts and I have PMS- type nausea (Blog 8, Quitting breastfeeding). Another wrote: We stopped breastfeeding one month ago. And boom. Depression/anxiety at its finest. Along with dizziness, no energy, or appetite (Blog 2, Falling apart).
Mothers experienced physical discomfort during and after breastfeeding cessation. Mothers expressed an inability to get out of bed and stay awake due to debilitating fatigue
and exhaustion:


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Weaning process for me has been gradual for the past month, and absolute within the past week. My son is now 16 months and I collapsed in fatigue for a 4-hour nap, and I felt like my body was pressing into the bed, and it was difficult to move my body. I have also had waves of nausea, temperature flashes, mood swings, and food aversions (Blog 1, Extreme exhaustion).
Another mother described her shared experience in a comment:
All I want to do is sleep. Feels like Im walking through mud, Im so tired but my heart is pounding out of my chest. Who is this person!!?? Ending up in the ER for a panic attack (Blog 2, Falling apart).
A prominent coding category was women battling physical symptoms. These physical symptoms combined with hormones heightened womens feelings of going a bit nuts.
Some mothers believed they had become addicted to the hormones released during breastfeeding. Based on these thoughts mothers frequently concluded their experience was a result of hormone levels. Many mothers discussed an extreme influx in their hormones during the process of weaning. Mothers on the blogs and comments explained mood swings being related to hormones and mimicking PMS symptoms. One woman described her experience as hormonal hell (Blog 7,1 cant stop crying); another mother stated, the hormonal ride is HUGE (Blog 2, Falling apart).
One mother expressed her difficulty with missing the hormones released during breastfeeding, I wanted to feel that incredible oxytocin boostthat falling in love hormonethat I got from breastfeeding. Without it, I was sad (Blog 10, Extreme sadness). Another mother expressed a similar feeling of loss of the hormones released during breastfeeding: I began to wonder if I was a kind of nursing addictmy brain was suffering


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from the absence of those hormones that are released when you nurse (Blog 11,1 wasnt expecting it). This same mother described her experience of starting to nurse again after a two-week hiatus as fell off the wagon. Mothers expressed feeling addicted to the hormones released during breastfeeding. Mothers experienced difficulty as their bodies were adjusting to the change in hormone levels and experienced confusion as to whether they were physically or psychologically addicted to the hormones.
Emotional Difficulty
Mothers faced emotional difficulties that exacerbated the feelings of going a bit nuts. Common emotional difficulties women experienced included sadness, worry, panic, anxious feelings, feeling overwhelmed, and impatience. A mother who commented on Blog 2, Falling apart illustrated an example of this theme:
My baby is 2.5 and in the last month went to 1-2 sessions [breastfeeding] every day or so, she was at 3-5. I have been in bed, physically ill, anxious all the time, depressed, crying, and a lump of nothing. Dreading light in the morning because I know everyone expects me to get up. Hubs is at his wits end, doing everything because I cant seem to push through.
Another mother who commented on the same blog described her emotional difficulty while weaning her 21-month-old baby. She reported: I thought I would feel better, more sleepy, more energy. But my mood has dropped like a rock. A mother from Blog 7, I cant stop crying discussed similar feelings of worse mood:
For a few weeks after I weaned my son, I felt like I was having a major clinical depression. In fact, just a little while ago I read over something I wrote in a journal around that time, which ended with my screaming (in pencil, all caps, lots of


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exclamation points) I HATE MYSELF, I HATE MY LIFE, I HATE EVERYTHING
Mothers identified a pattern of crying and having difficulty coping with the emotional difficulty that accompanied breastfeeding cessation.
In addition to coping with sadness and tears, mothers also experienced debilitating anxious feelings. One mother reported how her experience was affecting her in Blog 2, Falling apart: I am going through this now as my daughter is eating less and less. I am going through a roller coaster of anxiety and it was really impacting my day and work. Many comments reflected mothers feeling anxious and sad. Mothers wrote they were experiencing intense sadness and anxiety and could not identify reasons for these emotions outside the possibility of resulting from breastfeeding cessation.
One mother stated how she didnt understand her sadness with all the chubby little smiles around. An inability to understand a negative reaction contributed to feelings of going a bit nuts. An example of this came from a mother who started weaning her daughter: I have a great life with a happy healthy almost 2-year-old and wonderful, supportive husband. Honestly, I have everything Ive ever wanted, but for the last week Ive been haunted by a weird anxiety and depression (Blog 2, Falling apart). Another mother (Blog 8, Quitting breastfeeding) reported a similar sadness: Ive just weaned my 19-month-old. I wanted to, I was over breastfeeding and thought I would feel relieved, but instead Ive just been crying. A mother that commented on Blog 1, Extreme exhaustion explained her experience as having crazy sensitive emotions. To better understand her experience, she asked the question Im just wondering how long it took for you to feel normal again, or as normal as toddler moms can feel. Would love to hear about a light at the end of this tunnel.


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Mothers also navigated feelings of being overwhelmed and impatient. These feelings appeared to affect mothers daily lives as they had difficulty with finishing daily tasks. Overwhelmed and impatient feelings seemed to contribute to mothers thoughts of going a bit nuts due to these feelings not being normal. A woman from Blog 3, Fog that hit me slowly began the weaning process by stopping nighttime feedings. At the same time, experienced feeling overwhelmed by daily tasks:
My days become very long, my daily tasks became larger than life. I no longer had patience for my little one. Or for adults in my life either. I felt mostly emotionless, unmotivated, tired, and lazy. I knew that these feelings were not normal for me. I remembered that I normally had much more energy, happiness, and patience with my family. I normally cared if the house was a mess, but now things began to slip.
A mother from Blog 10, Extreme sadness had a similar experience of feeling overwhelmed. This mother had twins who had weaned themselves; she described an experience of losing focus after weaning, which caused feelings of being overwhelmed. A mother who commented on Blog 2, Falling apart communicated a similar experience: Just the other night while putting my older two kids to bed it felt like such an overwhelming task that I felt completely broken afterward. Mothers appeared to be having difficulty completing routine chores and were feeling overwhelmed by tasks that previously felt natural.
Mothers who stopped breastfeeding also described feeling burdened by their daily tasks once their role and structure as a breastfeeding mother ended. Mothers expressed feelings of being depleted after completing tasks that were previously effortless. Feelings of being depleted may have resulted in another important coding category: lack of patience.


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Mothers expressed having no patience and feeling easily irritated without the role of breastfeeding:
I am going through this now she is 20 mos. I started weening at 15 mos. She was good until the summer came and I was home with her and then she started trying to nurse more often and I began to get really irritated and pissed off at everything she did. I dont know if its because I am not used to being home with her or because I never have any down time since she also refuses to take a nap (Blog 2, Falling apart). Another mother had a similar experience with irritability, agitation, and lack of patience. It was sometime around when I started dropping feedings that I felt different. I was sad and I didnt know why. I was irritable and seemed to have less patience than usual (Blog 11,1 wasnt expecting it). Mothers expressed feeling easily irritated and impatient in their lives during and after weaning.
Mothers faced challenges that created feelings of going a bit nuts. Mothers did not understand the reason behind these experiences due to a lack of awareness of negative experiences post-weaning. Based on the lack of awareness, mothers began to develop feelings and thoughts that they were medically or mentally ill. Mothers did not expect various physical symptoms or emotional difficulty. It appeared that mothers rationalized their experience as evidenced by the mother who wrote that she was going a bit nuts, a major theme found in the data. While many women were confused about their experiences, finding blogs online made women realize they were not alone.
Shared Experiences
As is common in a phenomenological analysis, mothers writing on blogs had shared experiences. Mothers had comparable experiences of feeling alone and negative experiences


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occurring suddenly. Many mothers stated they felt alone until they came across blogs outlining a similar negative experience after weaning. Many mothers who blogged were unaware of what was happening to them physically and psychologically while they were weaning. Mothers expressed thoughts that they were alone in their experiences due to a lack of awareness of the negative experiences post-weaning. Mothers searched on the Internet for information to understand their experience. This search led to blogs of others telling their negative story of breastfeeding cessation.
Mothers expressed comfort in knowing they were not alone and that other mothers had comparable experiences. So glad that I am not alone. Your honesty in the post is great, thanks for sharing (Blog 2, Falling apart). Another mother who commented on the same blog reported: Your experience is SO similar to what I am going through at the moment and it is comforting to I am not alone in these feelings. I am so happy I found this too (Blogl, Extreme exhaustion). Im sorry you went through this but Im happy Im not alone (Blog 2, Falling apart). Knowing that other mothers had similar experiences seemed to normalize what they were going through. A mother who commented on Blog 2, Falling apart expressed how reading another mothers story validated her experience: I am so thankful that I wandered onto your wonderful blog. This is tremendously validating!!!!! A mother who commented on Blog 7,1 cant stop crying wrote:
I hope it helps to know that you are not alone and are likely to get past it in a month or two. It made me feel better to read your post and know that other people go through the same thing.
Based on lack of awareness and knowledge about the negative experience of breastfeeding cessation, many mothers wanted to share their stories to shed light on the


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phenomenon and help other mothers be prepared. They hoped to share their experience to prevent other mothers from feeling alone and to normalize the experience. An example of a mother realizing she was not alone was illustrated in a comment on Blog 2, Falling apart: I have really been struggling this week and even blogged about it myself however nowhere near as eloquently as you have here. Theres me beating myself up again. Its so nice to see Im not alone. Another mother who commented on Blog 2, Falling apart reported: So these postings made me realize that I am not alone and I am not imagining this issue. A mother from Blog 3, Fog that hit me wrote:
Depression and weaning is not something that is well known or talked about much. I am sharing my story here today, because I feel it is something that needs to be known among mothers. If I can help even one mother, I would be so glad!
Mothers expressed gratitude toward other women for publicly sharing their experiences. Many mothers stated they did not have others to talk to about their experience. Mothers explained how reading the blogs helped them know they were not alone and to normalize the negative experience. Different mothers stated: I went through the same thing. Very comforting to hear you are not alone (Blog 2, Falling apart). Thank you for your honesty and Im glad its not just me. This is EXACTLY how I feel right now, so happy Im not the only one experiencing this (Blog 8, Quitting Breastfeeding). Gratitude is shown throughout the comments on the blogs, that many women were relieved to know the experience is normal for many mothers. Reading about other mothers struggles alleviated feelings of something being wrong with the mother.
The second prominent coding category was sudden onset of symptoms. Mothers explained that their unexpected negative experiences transpired very quickly. However, the


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mothers conceptualized the sudden onset differently. Different methods of weaning appeared to influence the intensity of each the mothers experience. Some women did not begin experiencing difficulties until three to four weeks past cessation, while other women stated the negative experiences occurred directly after breastfeeding cessation within a day or two. The complexity of the onset of emotional and physical experiences was intensified by the various methods of weaning. Within the blogs some mothers slowly weaned their child while others weaned abruptly. Some mothers explained they decreased feedings every couple of days, whereas other mothers discontinued breastfeeding cold turkey (Blog 2, Falling apart). Despite the method or timing of cessation, the majority of women wrote of having a similar phenomenon of sudden onset of emotional and physical difficulty following weaning.
Women were desperate to hear from other women how long the negative experience would last. Mothers would ask questions to each other on the blogs to learn how long they should expect the experience to continue and when they would see the light at the end of the tunnel (Blog 1, Extreme exhaustion). However, knowing that others were having a shared experience encouraged the feeling of hope as stated on Blog 2, Falling apart: I started crying reading about how good you feel now. There is hope! Knowing other mothers had similar experiences also created feelings of being in control over the situation: I experienced a pretty awful two months after I weaned my younger son. It subsided without any special treatment and I felt a bit more in control when I realized what was causing it (Blog 7,1 cant stop crying). A mother commented on Blog 2, Falling apart: I am grateful you have shared it and perhaps knowing that Im not going crazy and others have gone through this struggle will help me manage and recover.


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Mothers experienced relief in knowing others shared their negative experiences. Knowing the reason for their experience and that other mothers have been through it alleviated feelings of being alone, encouraged feelings of hope, and made the experience feel more manageable.
Loss of Attachment
Loss of attachment is a key theme of the content analysis based on the a priori code from previous literature and attachment theory. Else-Quest, Hyde, & Clark (2003) stated mothers and children created a strong bond through the act of breastfeeding. Throughout the blogs in this study mothers expressed feelings of grief in ending the intimate attachment behavior of the breastfeeding relationship. Mothers associated grief and loss with the child who was no longer solely dependent on the mother for feeding. Mothers created the meaning that they were losing their mothering role in discontinuing breastfeeding.
Feelings of grief were often unanticipated, as found in the thick rich data on blogs related to this coding category. Some women described looking forward to breastfeeding cessation. Mothers expressed a desire for routine feedings, consistent sleep, and not being the sole source to feed their babies. However, mothers came to find the breastfeeding cessation experience was not everything they were hoping for:
I thought I would be so happy. Just a few months ago I was still pumping 3x a day at work, plus nursing 3 times a day... and now my boobs are mine! I can finally buy new bras! But I am DEVASTATED. I am heartbroken and do not know what to do. I miss cuddling before bed and have tried to a few times and he hates it. Now every time I put him to bed I go lie down and cry 10 minutes or so afterwards. He does not


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want to nurse, runs all the time, and wants independence. My baby is gone (Blog 6, My baby is gone).
Mothers were not prepared for the loss they felt as the child adapted to new feeding methods and became more independent. A mother commented:
Ive just weaned my 19-month-old. I wanted to, I was over breastfeeding and thought I would feel relieved, but instead Ive just been crying instead. My daughter would still have milk if I let her, she still has pretend milk which just means a fully clothed cuddle with her face on my breast! I thought maybe I should start feeding her again, but its also nice to hear that this grief is normal (Blog 8, Quitting breastfeeding). Another mother commented on this same blog about her experience with loss during breastfeeding cessation:
Imagine my surprise when after weaning my 3rd son, I found myself missing the very thing that I never thought I would do. We just celebrated his first birthday. Do I really miss nursing him? Am I emotional because he is growing out of his baby stage?
Is it because I believe that he is my last baby and I will never breastfeed again? What is this change that is happening to me? Is it the shift in hormone levels in my body? My head was filled with questions while my heart continued to ache (Blog 8, Quitting breastfeeding).
Women were faced with accepting their childs new level of independence, especially in cases where weaning was initiated by their child. Throughout the analysis mothers expressed feelings of no longer being needed by the child and feelings of rejection. Mothers expressed difficulty with the loss of the intimate relationship with their breastfeeding child:


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My daughter is 10 mos. And I have weaned her from breast to bottle while pumping nearly 5x a day to not pumping once yet today over the past 7 days. I also feel sad and have bouts of sadness and crying cuz I miss nursing her and feeling that closeness (Blog 1, Extreme exhaustion).
A mother clearly articulated her feelings of rejection when her twins weaned themselves:
Why dont they want me anymore? Please nurse, please! What is this rejection? Was I eating too much garlic? Does my milk taste bad? How am I supposed to protect them from all the germs they are going to come in contact with when they arent protected by the goodness in my breast milk? Where did that incredible feeling I got when nursing go? I want it back! Please nurse, please (Blog 10, Extreme sadness)! This same mother blamed herself for her childrens discontinued breastfeeding. She blamed the breastfeeding cessation on her lack of milk production after she returned to the workplace. Mothers appeared to have similar feelings of loss and rejection. These feelings seemed to be heightened when the child adjusted to bottle-feeding quicker than the mothers anticipated. One mother reported:
It was days away from my sons first birthday and I began to wean him. I took plenty of time and started by just dropping one feeding a day. About three or four days later,
I dropped another one. The transition was very smooth. It was easier to stop breastfeeding my son than I thought it would be. I wasnt expecting that it would be worse for me than him (Blog 11,1 wasnt expecting it).
Similarly, a mother commented:
My son is 6.5 months old & a week ago, I introduced a bottle to wean off my boob. Hes had 3/5 feeds today as bottle instead of boob... its making me really sad. Im


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back at work in May so thought Id start the wind down NOW but thought itd be a slower transition than this- seems the more bottles he has, the easier he is taking them as the days have passed. I doubt Ill have another child. Im finding him growing up really sad daily anyway never mind going through this detachment too (Blog 9,1 feel guilty).
Throughout the blogs mothers expressed feelings of loss of attachment through discontinuation of the breastfeeding relationship. This loss appeared to be heightened when mothers were weaning their last planned child.
Weaning the last planned child emerged as latent content based on the meaning mothers created. Many mothers explained they did not have negative experiences while weaning their first-born children, which made it difficult for mothers to understand what was happening in the midst of their experience. One mother stated: she is my third nursing and I never experienced this before (Blog 2, Falling apart). Mothers knowing that this was their last opportunity to breastfeed appeared to heighten negative emotional experiences during transition. A mother who weaned her last child commented:
I didnt know you could get depression after weaning. My son is my second and last,
I have never suffered any depression. I think because he is my last its harder for me, I decided to wean him cold turkey way and it was really hard for me I cried (Blog 2, Falling apart).
A mother who wrote Blog 7,1 cant stop crying reported: My son still asks to nurse several times a day: he doesnt know he will never nurse again, but I do! So I feel Im holding the
loss for us both.


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Although the loss of attachment, grief, and feelings of rejection appeared in the data as a child weaned and became more independent, this experience was not consistent for mothers. An additional coding category that emerged was a parallel process of separation of attachment between the mother and child. Some mothers appeared to display the same reaction as the child during breastfeeding cessation. Mothers mimicked their childs reaction. Mothers were sensitive to their childs distress and responded with distress. For example:
Just cut the night nursing for the second night in a row... hes sad and grumpy... Im sad and grumpy... and were both going through so many changes since I started teaching again 2 weeks ago. I miss him so much and when I get home hes just a mess and it is breaking my heart (Blog 2, Falling apart).
The mother who wrote Blog 5, Weaning before planned stated: It was heartbreaking when I would deny her something she had been used to her entire life and she would be distraught. The theme of the childs distress was seemingly painful for many mothers and their children. Mothers expressed feelings of loss and rejection during breastfeeding cessation. These feelings made weaning a negative experience for the mothers on these blogs.


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CHAPTER V DISCUSSION
Chapter five focuses on the significance of this qualitative research study on negative experiences post-weaning. This chapter begins with an overall interpretation of womens negative experiences post-weaning based on finding from the content analysis. This interpretation is grounded in the attachment between mother and child created through the behavior of breastfeeding. Interpretations are given based on the current research in the field. Additional topics in the chapter include the limitations of this study, clinical relevance of the research, and implications for future research.
Research Question
This qualitative phenomenological content analysis focused on womens negative experiences post-weaning through an attachment theory perspective. An attachment perspective was used to understand the implications of attachment theory on the negative experiences reported by mothers on blogs. The research question that guided this investigation was:
What is the negative experience of post-weaning among mothers who post on blogs?
The purpose of this study was to understand the complex experience of post-weaning among mothers who blog their life world online. This research is grounded in attachment theory to understand the influence of attachment in comprehending the negative experience pre-and post-weaning. Concepts of attachment consist of the bond created through the breastfeeding relationship and the mothers perceived self-efficacy and sense of motherhood created through breastfeeding. Attachment concepts from previous research included holding, absolute dependence, good enough mother, maternal sensitivity, and the hormone


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oxytocin (Spock, 1987; Spelman, 2013; Bretherton, 1992; Pedersen et al., 1997; Britton et al., 2006). These were the concepts utilized to understand the negative experience post-weaning through an attachment perspective.
Discussion
Four overarching themes were identified in the analysis: feelings of inadequacy, going a bit nuts, shared experience, and loss of attachment. An argument can be made that mothers sense of attachment may influence the negative experiences during breastfeeding cessation. Research has shown mothers create a bond with the child during the intimate act of breastfeeding (Levy & Orlans,2014). The loss of this attachment may impact mothers emotional difficulty and the mothers self-perception.
Data from this study has shown that many of the women shared a common experience of having difficulties during breastfeeding cessation. This analysis suggests these experiences are exceedingly complex, with mothers feeling maladjusted both emotionally and physically. These difficulties may be a result of mothers internalizing the end of the breastfeeding relationship. During this time, the mother is faced with the child developing independence thus creating a substantial change in the mothers life.
This study does not provide concrete quantifiable data about negative experiences with breastfeeding cessation. This study does provide evidence that there appears to be a shared negative experience with breastfeeding cessation. This evidence could be used to draw focus to this topic and facilitate conversations regarding the alleviation of negative experiences post-weaning.


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Feelings of Inadequacy
The first main theme of this study showed mothers felt inadequate in their role as a mother. Many mothers described feeling they were bad mothers (Blog 4, Postpartum after weaning; Blog 2, Falling apart) or like less of a mum (Blog 2, Falling apart) during the transition. These feelings affect the mother-child bond as mothers feel they are inadequate in providing a good enough environment for their child.
Current research shows that mothers experience negative emotional consequences such as guilt, when they do not meet the standard of good enough mothers (Ratnapalan & Batty, 2009). Cinar et al. (2015) found that breastfeeding augments a womans sense of motherhood. Findings from this study show mothers experienced decreased self-efficacy and feelings of inadequacy during breastfeeding cessation. Mothers expressed lower self-efficacy in relation to having difficulty in finding new ways to calm the child down without utilizing breastfeeding. Lower perceived self-efficacy influenced womens feelings of being less of a mum or bad mothers.
Going a Bit Nuts
The second theme was taken verbatim from a mother who reported feeling as if she was going a bit nuts (Blog 7,1 cant stop crying). Several mothers expressed a belief that there was something mentally and/or medically wrong. Throughout the blogs mothers discussed they had no knowledge of their experience until they were in the midst of breastfeeding cessation. Mothers reported that their friends, family members, and doctors were also unaware of the negative experiences with breastfeeding cessation. This lack of awareness may impact the mother-child bond as a mother experiences a decrease in social support during a negative experience with breastfeeding cessation. Previous research on PPD


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has shown PPD has an effect on the supportive interactions between parents, resulting in lower relationship satisfaction and support (Don & Mickelson, 2012). Previous research also indicated the importance of support for the mother in facilitating a positive attachment between the mother and child (Mercer, 2004). Lack of knowledge from support networks appeared to exacerbate mothers beliefs that there was something wrong.
Physical symptoms and emotional difficulty were additional obstacles that created feelings of going a bit nuts. Mothers experienced physical discomfort and a change in hormones. Mothers experienced nausea, dizziness, exhaustion, food aversion, nipple engorgement, and headaches. Some symptoms mimicked pregnancy creating thoughts the mother was pregnant again. Mothers also expressed difficulty with hormones. Mothers expressed missing the oxytocin boost (Blog 10, Extreme sadness) during cessation. Other mothers expressed mood swings due to the change in hormones. Mood swings and emotional difficulty were prominent throughout the blogs. Mothers expressed feeling sadness, worry, panic, anxious feelings, feeling overwhelmed, and impatient. Mothers discussed uncontrollable crying and anxious feelings associated with everyday tasks.
Difficulties with hormones and emotions may be explained through current medical research. Previous research has shown that oxytocin, released during breastfeeding, is a neuropeptide hormone that facilitates attachment between mother and child (Pedersen et al., 1997). Mothers have a decrease in oxytocin and subsequently reported feeling detached from their child during discontinuation of breastfeeding. The decrease in oxytocin appeared to influence mothers relationship to their child, and was associated with mood swings reported by mothers. Utilizing an attachment theory perspective to understand the negative experience


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may indicate mothers experienced feeling loss of attachment based on the decrease in oxytocin during breastfeeding cessation.
Shared Experiences
The third theme was the shared experience that was felt in the blogging space by mothers. Feeling alone in the experience and the sudden onset of the experience affected mothers during breastfeeding cessation. Mothers expressed they felt alone until they came across blogs written by women with comparable experiences. Mothers also expressed the negative experience occurred very quickly. The sudden onset of the negative experience occurred at different times as mothers utilized different methods and timeframes for weaning.
The current lack of research and understanding of negative experiences postbreastfeeding created feelings of being alone or that something was wrong with the mother. The experience of feeling alone reinforced thoughts of inadequacy and not meeting the standard of being a good enough mother. Fortunately, many mothers received online support from other mothers who had similar experiences.
The support and resources provided online for these mothers decreased feelings of loneliness, created a sense of hope, and normalized the breastfeeding cessation experiences. Social support is increasingly effective when an individual who gives the support has faced similar stressors (Thoits, 1986). Women expressed a sense of gratitude on the blogs for knowing they were not alone in their negative experience. Research has shown that individuals receive hope through online support groups (Evans et al., 2012). Mothers from this study stated they felt more control over their experience after having a clear understanding from others; this resulted in hope for the women who were in the midst of their own negative experiences.


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Loss of Attachment
The last theme was the loss of attachment mothers felt with the end of the breastfeeding relationship. Mothers described feelings of grief and loss during the childs transition to different feeding methods. Mothers had difficulty knowing the child no longer solely needed the mother for feeding as the child began a new stage of independence. Current research shows that mothers have a stronger bond in the early postpartum months from breastfeeding (Else-Quest et al., 2003). Mothers from blogs expressed a detachment from their child with the loss of the breastfeeding relationship. This was exacerbated in women who weaned their last planned child, stating they knew they would never experience the attachment behavior of breastfeeding again.
Many mothers created the meaning they were losing their mothering role and being rejected by their child. In some cases, the child did not show signs of having difficulty during the weaning process, thus, enhancing feelings of maternal rejection. These feelings of rejection may be a result of mothers lack of awareness of the possibility of the child losing interest in breastfeeding (Unity Point Clinic, 2015). This experience may be internalized by the mother creating feelings of rejection. These experiences may be a result of baby-led weaning. The child may choose to discontinue breastfeeding when the child can feed themselves, allowing the child to choose and control food intake (Rapley et al., 2015). In other cases, the child showed signs of distress, which mothers seemed to mirror the same reaction. In some instances, both the mother and the child appeared to have painful experiences during weaning. This reaction may be further understood through the attachment theories of John Bowlby and Mary Ainsworth.


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According to Bowlby and Ainsworth the child will form a primary attachment to their caregiver, who becomes their secure base (McLeod, 2009). Ainsworth also suggested a correlation between a secure attachment and maternal sensitivity (Bretherton, 1992). This was evident in the findings showing mothers experiencing difficulty when the child was distressed during the breastfeeding transition. Mothers stated difficulty in finding new ways to calm the child down without breastfeeding, which increased mothers feelings of not being a good enough mother. This sensitivity is also evident as mothers began to mimic the childs distress. Mothers displayed similar signs of distress when the child had a difficult time transitioning off of breastmilk.
The loss of attachment can be further understood from an attachment theory perspective that contributed to a negative emotional experience. Donald Winnicott suggested in the childs initial stage of life a relationship is created between mother and child through holding defined as child care (Spock, 1987). A significant act of holding is the attachment behavior of breastfeeding. Spelman (2013) explained that during this time the baby identifies in the mother and the mother in the baby. Winnicott refers to this as absolute dependence. Based on the findings of this study, the mothers identity is often lost during the process of discontinuing breastfeeding. Throughout the data, women expressed having to redefine their role as a mother without the breastfeeding relationship. Mothers reported feeling less of a mum with the absence of breastfeeding. Winnicott also explained the mothers experience of breastfeeding as a sense of achievement (Spock, 1987). Yet, the women on these blogs were faced with feelings of inadequacy as they discontinued the specific act of holding that facilitated a sense of maternal efficacy. The data from this study showed women


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experiencing, what appeared to be, lower self-efficacy in terms of taking care of their childs needs and hence, a perceived lack of achievement.
Relationship Between Themes
All four themes played significant roles in the lived experience of mothers following breastfeeding cessation. Each theme appeared to influence the other, resulting in overlapping and interconnected themes. For example, there was a relationship between the theme lack of awareness and the theme feeling inadequate. Mothers reported they were unclear what they were going through until they found blogs outlining a similar experience. This lack of knowledge fueled feelings of inadequacy evidenced by mothers stating they believed they were bad mothers. Mothers believed the reason they were having a negative experience was because they were inadequate. Anecdotal evidence shows that feelings of inadequacy may be a result of societal messages implying that mothers are invariably happy, and that negative experiences are not the norm. Based on my own personal experience with social media, society generally displays positive aspects of motherhood omitting adverse experiences. These displays can create the ambiguous perception that motherhood is effortless. An implied argument regarding feelings of inadequacy may impact the mother-child relationship. Mothers lacking confidence in their abilities may experience complications in finding ways to foster the mother-child bond.
Lack of awareness also appeared to impact the theme loss of attachment. Mothers stated their support networks of friends, family, and medical professionals lacked an understanding of what the mothers were going through, which made mothers feel crazy, which in turn impacted the mothers relationships with the child. Research has shown that support for the mother is a primary factor in promoting the mother-child bond (Mercer,


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2004). This suggests the lack of support may have influenced feeling a loss of attachment with the child.
Lack of awareness and knowledge seemed to influence more than just the mothers relationships; it also made mothers feel alone. Mothers described feeling alone due to not knowing others had gone through the same experience when weaning from breastfeeding. Mothers feeling alone may feel stigmatized, feeling they are the only mother going through the experience. Stigma created through societal pressures may hinder mothers from obtaining assistance from practitioners. Feeling alone was also connected to the theme of going a bit nuts. Mothers expressed that knowing other women who had similar experiences had validated their experience and made them realize they were not imagining this issue (Blog 2, Falling apart).
The relationship between hormones and attachment appeared evident through previous medical research. Pedersen et al. (1994) & Cox et al. (2015) found oxytocin released during breastfeeding facilitates bonding between the mother and child. Throughout the blogs mothers expressed missing the oxytocin boost (Blog 10, Extreme sadness). Levy & Orlans (2014) stated breastfeeding is an attachment behavior that is both intimate and soothing for the child through the skin-to-skin contact. Yet, the reduction in oxytocin and lack of skin-to-skin contact through breastfeeding may have influenced mothers grieving the loss of the attachment.
The shared experience of feeling alone is connected to going a bit nuts. As mothers attempted to rationalize their experience, mothers expressed a belief that there was something wrong with them. Feeling something was wrong led to mothers feeling inadequate. Mothers felt inadequate and that they were unable to provide a 'good enough environment for the


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child without breastfeeding. Feelings of inadequacy are related to loss of attachment as mothers were forced to redefine their role as a mother during breastfeeding cessation. Mothers expressed feelings of grief during the transition as they conceptualized the loss of the mothering role. Feeling loss of the mothering role enhanced mothers perceived low self-efficacy and thoughts of being inadequate as a mother. Lack of awareness is connected to all four themes as mothers felt they were alone in their experience and that something was fundamentally wrong with the mother. Results of this study show all four themes influence one another during the period of weaning.
Limitations
The purpose of this study was to highlight the self-reported negative experience of women post-breastfeeding. By drawing attention to these experiences, practitioners may develop a deeper understanding in order to validate women, support women, and to prepare some women for possible difficult experiences after and during weaning. The interpretations and conclusions of this study are limited by various factors.
Data for this study was collected from online blogs; thus, I was only able to derive latent meaning from the written word. Additionally, since none of the women were contacted throughout the study I could not request clarification of what was stated in the blogs or ask additional questions that came up during analysis. Based on these limitations I was unable to elucidate what the expression of emotion means to each participant; I relied on my interpretations of the meanings of posts. The limitation of not contacting the bloggers limits the ability to verify that the self-accounts were not fictitious (Cohen, 2008).
Cohen (2008) explained another potential problem with relying on the written word is that some blogs that are not well written. Errors, poor phrasing, and lengthy irrelevant


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content can make transcripts difficult to examine. Cohen (2008) identified the bias that is presented in blogs due to social endorsement. A bloggers goal is to attract an audience.
Based on this goal, self-accounts written on blogs may be embellished or sensationalized to attract a larger audience.
Other limitations from this study originated from the sampling techniques. Non-random sampling techniques were used to collect data, including convenience sampling, snowball sampling, and purposive sampling. Johnson & Christensen (2014) rationalize the inability to generalize the conclusions to the population using these sampling techniques, based on the unknown likelihood for women to be included in this study.
An additional boundary to this study is capturing the experience of women with Internet access. Personal experiences from women with no access to Internet or opportunity to post on a public forum were unable to be included. Since the primary data source was blogs this sample was also biased by collected information from women who were willing to share their experiences publicly on the Internet. Capturing the experiences of women that are willing to share their experience online creates a bias of personalities of women who are comfortable sharing private experiences publicly. This included the narrow scope of the study focusing on blogs that address negative experiences associated with weaning; this research does not address treatment for these experiences.
Strengths
The focus of the negative experience provides information for practitioners to identify ways to assist women with similar experiences. Practitioners can utilize thematic knowledge in this data to help clients who are having difficult experiences during and after weaning. Understanding these experiences will permit practitioners to assist their clients in


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understanding research about negative experiences with breastfeeding cessation and provide an opportunity to normalize the experience. Women understanding that this is a shared experience may keep themselves from feeling alone and encourage them to reach out for support from others that had the experience. Utilizing blogs for data provided unique perspectives of the experiences from people potentially across the world. Blogs also allow people to share intimate details about their experience while staying hidden from view (Hookway, 2008, pp. 93).
Another strength of this study is the unique nature of drawing attention to the negative experiences during breastfeeding cessation. The focus of this study encourages appropriate care for mothers, allowing individuals to feel they may have a space to express their emotions. Blogs provide mothers a space to be validated in their experiences and to connect to other mothers to strengthen support networks.
Implications
The examination of the negative experiences post-weaning may lead to key factors for practitioners to consider in effectively assisting women following breastfeeding cessation. These factors include preparing women, normalizing the experience, and supporting both the mothers and their support networks.
Women explained breastfeeding cessation did not go as expected. Women had an expectation that breastfeeding cessation would occur smoothly and naturally. Women believed feeding would be easier with a predictable feeding schedule where the mother is not the sole feeder of the child. However, women in this study reported a lack of awareness and understanding about their negative experience. Based on this, it is important for women to know that having a negative experience post-weaning, is possible. Such knowledge provided


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by a professional may help alleviate womens fears that they are completely alone in their experience. Knowing that other women have shared similar experiences will give mothers hope, a light at the end of the tunnel (Blog 1, Extreme exhaustion). The hope is that mothers can be made aware of the potential negative effects during weaning and will be able to mitigate the risk of being caught off guard. Additionally, many mothers expressed feeling more control over the situation after having an understanding of what was happening.
Based on womens lack of awareness of negative experiences during breastfeeding cessation, mothers felt that something was wrong with themthat their experience was not normal. Professionals creating the awareness that having a negative emotional and physical experience post-breastfeeding is possible may help normalize the experience for mothers. An awareness may in turn help prevent mothers from feeling like they are going a bit nuts or that something is fundamentally wrong with them.
Lastly, this research provides a deeper understanding of the frequency of which mothers are experiencing negative effects post-weaning. Based on this understanding practitioners can begin to plan ways to effectively support these women. One potential way to support women with these experiences is through the use of support groups. There are support groups for women navigating the difficulties of starting breastfeeding; based on this research it may be beneficial for mothers to have support groups for navigating the difficulties of discontinuing breastfeeding. Another recommended clinical intervention would be to normalize the experience and have empathy for the difficulty the mother is experiencing.
Additional interventions may include practitioners screening for negative experiences with breastfeeding cessation. For example, PPD is a widely known experience and often


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screened for by practitioners. By increasing attentiveness of this issue, practitioners can begin to screen for negative experiences during breastfeeding cessation. A screener based off of further research could be developed that applies to this particular experience. Frequently screening for negative experiences after birth implies early intervention for struggling mothers.
Finally, practitioners and family members should help mothers understand that what they are going through is not just a hormonal response, but an important psychological transition for both the mother and child as the child becomes more independent.
Professionals must leave space for mothers to grieve that loss. This is exceedingly important in a society that makes it sociably unacceptable for a mother to experience the full range of emotions, both negative and positive. Society sends the message children are primarily the responsibility of the mother, that the mother is to be child-centric (Hays, 1996, as cited in Kestler-Peleg et al., 2015; Straker, 2010). Society expects the mother to give up all her needs for the child (Liss et al., 2015). This idea neglects the mothers experiences and her needs, especially during a transition that affects both the mother and the child. Raising awareness about the potential for negative experiences will assist mothers and healthcare professionals in providing appropriate care and support for breastfeeding mothers, allowing mothers to express their full range of emotions.
Future Research Considerations
Since this research was exploratory in nature, the qualitative data provided an initial understanding of womens negative experiences post-weaning. Further exploration of the topic may provide a deeper understanding and enhance the findings of this study. Additional exploration on negative experiences is increasingly valuable because of culture and society.


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Culture and society in general push the idea that if we are not consistently happy, there is something wrong with us. This is particularly harmful for vulnerable populations such as mothers dealing with pressures of pregnancy, birth, nurturing, and breastfeeding. New mothers may benefit from additional research that depathologizes the negative experiences that accompany breastfeeding cessation. It is possible stigmatization and lack of awareness prevents mothers from seeking help, out of fear. Some mothers may fear being labeled as mentally ill or as an inadequate mother.
Additional research is also needed in various areas to address some of the limitations of this study. A replicated study that extends the research to include a larger sample size, beyond that of non-random sampling would expand the understanding of this topic. Additional studies that utilize interviewing women would create a richer and realistic description of the womens experiences, allowing the research to expand and clarify womens experiences.
Additional research could also enhance the results of this study through a quantitative approach. Future researchers could ask mothers to take inventories, i.e. Beck Depression Inventory, that would further assist professionals in understanding and labeling mothers experiences.
Potential future research questions that may arise as a result of this study could be:
What are risk factors for women who have negative experiences during breastfeeding cessation?
What are potential preventive factors for negative experiences during breastfeeding cessation?
What is the prevalence of negative experiences with breastfeeding cessation?


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The findings of this study draw attention to womens negative experiences during breastfeeding cessation, allowing for practitioners to have a greater understanding of the experience. This gave me a better understanding of the experience of motherhood, including the complexities of breastfeeding cessation. Further exploration could provide deeper knowledge to better understand the experience and ways to assist both the mothers and their child.
Conclusion
This thesis presented the findings of an exploratory study of womens negative experiences post-weaning. The results of this study described the emotionally and physically negative experience during breastfeeding cessation. Analysis revealed that the mother-child bond and the loss of the attachment due to breastfeeding affected these mothers' negative experiences. Women also expressed a lack of awareness of what was happening to them during the experience. Based on these findings, practitioners can develop a broader understanding of this experience and how to assist mothers who are coping with and adjusting to breastfeeding cessation. Findings also suggests future research that could further assist professionals in planning and implementing effective treatment and support for women in the midst of breastfeeding cessation.


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