Childbirth Trauma and Its Effect on Breastfeeding

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Title

The title of the article is incomplete; it tells the reader the key phenomenon covered in the article i.e. childbirth trauma and its effect on breastfeeding. According to Polit and Beck (2006) a good qualitative research article title should describe the phenomenon and a group or community. However, this study does not specify the study population. Thus, the title is not complete as information about study population is lacking.

Abstract

The article summarizes the study’s background, aim, methods, results, and conclusion. An abstract should describe, in concise terms, the various aspects covered in the article (Polit& Beck, 2006). From the abstract, the reader gets an idea of the study’s purpose and content areas, the study design, results obtained (major themes) and conclusions. The abstract also maintains the characteristics of the study subjects and the data analysis approach used. The abstract identifies the key words contained in the body of the article but does not define them.

Introduction

Statement of the Problem

In the article, the problem statement is clearly and easily identifiable by the reader. Many organizations have implemented interventions to overcome “barriers to successful breastfeeding, but not one of these interventions addresses the impact of traumatic childbirth on breastfeeding” (Beck & Watson, 2008, p.231). Moreover, the problem statement is unambiguous; it explicitly describes the problem (traumatic childbirth) and its impact on breastfeeding.

Persuasive argument for study

The problem statement is also persuasive; using evidence from relevant studies, the authors convincingly argue that traumatic childbirth is a “potential risk factor for delayed lactogenesis” (Beck & Watson, 2008, p. 228). The statement seems persuasive.

Significance to nursing

The problem has significance in nursing; support by nurse midwives can decrease birth trauma, hence address the barriers to breastfeeding. Knowledge on the impact of birth trauma on breastfeeding based on subjective information obtained from mothers has significance to nursing. It will help nurses to give an effective and holistic care to mothers experiencing delayed lactogenesis due to traumatic childbirth.

The researchers also show a clear connection between paradigms and research problem. The authors describe traumatic childbirth (problem) in a broad way and give different birthing practices that cause trauma. The broad description of the term “traumatic childbirth” in this article ensures that the research problem matches with the model (Garrard, 2011). Also, the study’s phenomenological research method matched with the research problem; the researchers collected and analyzed written statements collected from the participants and then identified main themes that described the subjects’ experiences (Beck & Watson). The themes represented the participants’ views on the research problem.

Research Question

In the study, the research question is clear: “What is the essence of women’s breast-feeding experiences after a traumatic childbirth?” (Beck & Watson, 2008, p.233) In this research question, the various aspects of the research problem are explicit and consistent with the study’s conceptual framework. The researchers set out a clear and focused conceptual framework on the risk factors of birth trauma and how this impacts breastfeeding. They derive the research question from this conceptual framework.

Literature Review

Adequacy of summary of existing body of knowledge

The authors included enough sources in the literature review section. They included 15 major articles (peer-reviewed) and one report with relevant content on the topic. Primary sources are important sources of information for research (Rolfe, 2006); they are reliable, original and have a small time gap. The researchers summarized key concepts and theories from the literature review.Based on past studies, the researchers define birth trauma, describe global perspectives and risk factors for birth trauma and discuss birthing practices that affect breastfeeding.

Justification for the study

The researchers identify gaps in literature that needs to be explored.. Also, by describing the various concepts and theories, they refine and clarify the study’s perspective. According to Polit and Beck (2006, p.122) a good literature review should clearly and concisely analyze earlier studies on the topic and connect it to the present research. They state that past studies mainly focus on physiological measures associated with breastfeeding. This forms the basis for conducting this study. The researchers state that a gap in the literature exists and thus “this qualitative study examined the mother’s descriptions of how their traumatic childbirth affected their breastfeeding” (Beck & Watson, 2008, p.229). They explore this perspective to gain new insights into this topic.

Conceptual Framework

Description of Key Concepts

The researchers give definition for each concept identified in the study. They describe birth trauma, traumatic symptoms and risk factors associated with childbirth, and birthing practices that cause trauma. The epistemological tradition employed is clear. The researchers use phenomenology, which is right for examining life experiences and how they affect the participants (Polit& Beck, 2006). This approach enabled the researchers to describe the relationship between traumatic birth and unsuccessful breastfeeding.

Method

Protection of Human Rights

Institutional review boards (IRBs) approve projects involving human subjects. The study involved an “internet sample consisting of 52 mothers” (Beck & Watson, 2008, p. 230) who had experienced physical or emotional trauma or both during childbirth. The researchers selected eligible subjects based on specific inclusion criteria. The project gained the approval of the university’s IRB before commencement. This protected the participants’ rights or welfare particularly the right to privacy (confidentiality) and anonymity. There is no mention of whether or not the project gained approval from an external entity to assess its procedures and methodologies.

Minimum risk/ Maximum benefit

For a project to gain IRB’s approval its benefits must outweigh the risks. The researchers first informed the participants of the study via a post on Trauma and Birth Stress (TABS) website, and before seeking an informed consent (a story on childbirth experience). Through informed consent, the researchers were able to decreased emotional risks. Furthermore, the communications between the researcher and the participants was also confidential to avoid psychological risks associated with their birth trauma. The study’s design had many benefits to the participants; it helped them understand how the traumatic birth experience may impede breastfeeding. Its purpose was to give support to mothers who experienced traumatic childbirth and educate the public on post-traumatic stress disorder caused by childbirth trauma (Beck & Watson, 2008, p. 228). Thus; the study’s benefits outweighed the risks.

Research Design and Tradition

The research tradition of phenomenology is consistent with the data collection (semi-structured interviews) and data analysis (qualitative data analysis) methods used. This tradition examines people’s experiences for common themes that can describe shared experiences (Polit& Beck, 2006). Qualitative data analysis helps create themes that describe the participants’ subjective experiences. The researchers allowed adequate time for data collection.The researchers used Trauma and Birth Stress (TABS) website to collect data from participants for 11months, with an average of 13,264 mails (responses) per month. This duration was enough to meet saturation and rigor.

Evidence of evolvement of design in field

There is no evidence that the design unfolded during data collection. The categories and themes emerged during the qualitative data analysis, so the researchers could not capitalize on their knowledge on the topic. The researchers made enough contacts with the participants. After sending their stories via email, the researchers sent “follow-up emails to the participants to seek for clarification or ask for more details” (Beck & Watson, 2008, p. 235). Thus, the researchers made adequate contacts with participants, which ensured scientific rigor.

Sample and Setting

Adequacy of description of population and setting

The researchers adequately described the sample (52 mothers), characteristics of the participants and the setting. They tabulate the obstetrics and demographic characteristics of the participants, which provides a clear picture of the scope of the study.

The approach used to recruit participants was right. The researchers first sought IRB’s permission and then posted a recruitment notice on TABS website. Responses (emails) served as informed consent. Thus, the study met the ethical considerations before it started (Polit, & Beck, 2006, p. 85). Moreover, the participants had the right to withdraw at any point in the study or continue with the study.

The researchers used purposive sampling method. The researcher recruited the participants from one specific group (mothers who experienced traumatic childbirth). Thus, the sampling method used was the best method possible as all participants had to belong to this group (Polit& Beck, 2006). Qualitative research requires a convenient sample (not necessarily large) to gain new information on a given phenomenon (Crisp, &Taylor, 2005). Thus, the sample of 52 gave enough information on the topic.

Adequacy of sample size, data saturation

The sample of 52 was enough to meet data saturation. The researchers state that “this number exceeded what was necessary to meet the saturation of data” (Beck & Watson, 2008, p. 234). Also, the researchers allowed enough time for data collection (11 months), which ensured data saturation.

Data Collection

Data collection method

The researchers used an appropriate method to gather data. The email responses (semi-structured interviews) and the duration (11 months) ensured enough duration for data collection. The authors only used this method; thus, the study did not involve triangulation. According to Polit and Beck (2006), triangulation enhances the validity and credibility of a study. This study only employed one method (email interviews) to gather data.

The researchers did not use any specific questions; they relied on stories about the participants’ breastfeeding experiences submitted via email. The researchers answered all questions that respondents raised. The researchers noted that an audit trail of the responses would help later follow-ups for further suggestions from the participants. They recorded the responses in a validated decision trail.

The researchers used a decision trail to collect an in-depth and detailed data from the participants. Of the 52 stories emailed by participants, 249 distinct statements were received, which generated eight main themes (Beck & Watson, 2008, p. 234). The sample size, which was enough for a qualitative study, ensured a rich and detailed data.

Procedures

Appropriateness and description of data collection and recordings

In this article, the authors describe data collection and recording methods very well. The phenomenological approach allowed the “discovery of the essence of the women’s breastfeeding experiences after a traumatic childbirth” (Beck & Watson, 2008, p. 235). This approach appears convenient in this qualitative study.

The first author and second author participated directly in data collection and analysis. They are professionals with adequate training and experience in data collection. Also, the methods section of the article mentions the second author as the one who co-founded TABS. According to Polit and Beck (2006), qualitative research is prone to bias; to minimize bias triangulation methods are important. The failure to use triangulation methods in this study increased researcher bias.

Enhancement of Trustworthiness

Strategies to enhance trustworthiness and integrity of the study

The trustworthiness of the data collected was inadequate. Rolfe (2004) defines trustworthiness as the dependability and credibility of a study, which researchers achieve through triangulation. In this study, there was no use of triangulation methods; triangulation enhances data integrity and trustworthiness by minimizing bias.

Appropriateness of methods to enhance trustworthiness

As mentioned above, the researchers did not use triangulation; they only used one method (email interviews) to collect data. Triangulation methods enhance trustworthiness. In the study, the authors document the methods employed to collect data as well as the decision trail. They recorded the email responses (interviews), which are thus conformable. However, since the interviews did not involve audio-taping, the responses are not adoptable.

Reflexivity

The data collection involved female researchers to gather response via email from mothers who experienced traumatic childbirth. Thus, there is a reflexivity; the possibility that the mothers (participants) identified with the female researcher and felt free to express their experiences as opposed to using a male researcher to collect data. Also, the detailed and elaborate description of data (responses) supports transferability. The authors provide a detailed description of the responses and even include them in the analysis. They describe the methods used to categorize the data into the eight themes.

Results

Data Analysis

Data analysis refers to the process of collecting, summarizing, comparing and grouping data into categories (Crisp, & Taylor, 2005). In this study, the data analysis and management are described in detail and are consistent with qualitative data analysis.

Compatibility of data analysis and research tradition

The authors organized the data into categories to generate eight themes that describe the participants’ childbirth experiences (Beck & Watson, 2008). This approach is consistent with the research tradition, phenomenology, which entails the collection of data (lived experiences), organizing them into categories and identifying common themes. In this study, the qualitative data analysis summarized the data into categories. The authors identified eight themes that described the participants’ experiences. This approach is consistent with phenomenology tradition used in the study.

Presence of bias in analytical procedures

The authors used a validated method (Colaizzi’s (1978) method) for data analysis. This helped to decrease bias. Additionally, the phenomenological approach helped to avoid bias by organizing data into categories.

Findings

Summary of findings with use of excerpts and supportive information

The authors summarized the findings and provided good excerpts to define and explain the meaning of their findings. In any study, the findings relate to the identified themes, with excerpts to support the findings (Polit& Beck, 2006). The authors’ use of excerpts from the participants’ emails helps to support the major themes.

Adequacy of themes to capture the meaning of data

The authors identified eight themes; three themes facilitated breastfeeding while five hindered successful breastfeeding. These themes together with the excerpts from the participants adequately represent the meaning of data. The authors included excerpts and the eight themes obtained from qualitative data analysis. Thus, they were able to get new insights and meanings relating to childbirth trauma (a phenomenon under study). They created a provocative yet clear picture of the problem under study.

Theoretical Integration

In the article, the authors identify eight themes, which they cluster into two groups or clusters (three facilitated breastfeeding while five hampered breastfeeding). Moreover, the use of excerpts from the participants gives a clear picture of how the themes are interlinked.

Figures and Models

In the article, the authors used a table to illustrate the connection between two themes (theme 7 and 3). They also used a “breastfeeding scale” to group the eight themes into two groups and another figure to illustrate the phenomenological methods used in the data analysis. Moreover, the authors link the themes to the conceptual framework. They state that the two clusters of themes represent a range of possible aspects of birth trauma that can impact mothers’ breastfeeding experiences” (Beck & Watson, 2008, p. 229). Thus, they show a link between these themes and the study’s framework.

Discussion

Interpretation of Findings

In this study, the authors discuss the findings within the right context; that is, traumatic childbirth and breastfeeding among mothers. The title mentions the two pathways, which are the two main findings of the study. Also, in the article, the researchers discuss the researchers’ findings and relate them to earlier researches. Thus, the reader can identify aspects of past studies included in the current and understand the implications of the findings.

Interpretations consistency with limitations

The authors identify three limitations of the study, which are derived from the findings. The authors state that the sampling method had some flaws, which may limit the transferability of the findings (Beck & Watson, 2008). Nevertheless, the limitations of this study relate to the findings of the study.

Implications and Recommendations

The researchers give directions for future research; they recommend a further study of the predictors of poor breastfeeding based on traumatic childbirth experiences and psychometric instruments for assessing PTSD in mothers who have experienced traumatic childbirth (Beck & Watson, 2008). This will expand knowledge on birth trauma and its effects.

Global Issues

Presentation

Overall, this article was written and organized well. It described the methods (data collection and analysis) as well as the study’s findings. This article provides enough details and insights into the experiences of mothers during childbirth and how this affects breastfeeding. As mentioned above, the authors describe in detail the methods and findings and provide detailed information on the topic. The findings are interpreted to vividly allow the reader to have a good insight on the topic.

Researcher Credibility

The authors have good credentials and experience in nursing practice. Beck is a professor while Watson is the founder of TBS. Because of these qualifications, the readers can have confidence in the research findings.

Summary Assessment

Perception of trustworthiness of study

The findings presented in the article seem trustworthy. Nevertheless, the use of one data collection method affects the credibility of the findings. However, the use of validated instruments and analysis procedures enhanced the reliability of this study. I have confidence in the study’s findings and believe that they are truthful.

Implications of the study

The findings of this study have implications in nursing. The researchers established that childbirth trauma does affect breastfeeding among mothers. Thus, nurses and other care professionals should develop strategies (holistic care) to support the mothers overcome PSTD associated with traumatic childbirth to promote breastfeeding.

References

Beck, T., & Watson, S. (2008). Impact of Birth Trauma on Breastfeeding: A Tale of Two Pathways. Nursing Research, 57 (4), 228-236.

Crisp, J. & Taylor, C. (2005). Potter & Perry’s Fundamentals of Nursing, 2^nd Edition. Marrickville: Elsevier.

Garrard, J. (2011). Health sciences literature review made easy: The matrix method (3rd Ed.). Sudbury, MA: Jones & Bartlett.

Polite, D.F., & Beck, C. T. (2012). Nursing research: Generating and Assessing Evidence for Nursing Practice (9th Eqd.). Philadelphia, PA: Lippincott Williams & Wilkins.

Rolfe, G. (2006).Validity, Trustworthiness and Rigor: Quality and the Idea of Qualitative Research.Journal of Advanced Nursing, 53(3), 305-310.

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