5.2 Socio-demographic and clinical information
5.2.1 Characteristics of mother and baby participants
Information concerning mothers’ ages, parity, education, and occupation is summarised in Table 3. In general, mother participants were well educated. All reported being employed up until the birth of their first child. One had returned to full-time, and a few, to part-time work after the birth of the baby in the present study. All had given thought to returning to employment at some time in the future.
Women in the study follow the growing trend, in Australia, of having children later in life.
The median age of mothers was 32 years, which is similar to the median age of 30.6 years reported for all mothers for births registered in Australia in 2011 (Australian Bureau of Statistics, 2013) and is consistent with the median age of 31.7 years for women who gave birth in a nuptial relationship in Australia in 2009 (Australian Bureau of Statistics, 2010)}.
Just over half of the women in the study were first-time mothers. The median age for the seven first-time mothers was 36 years, which is significantly higher than the median age of 29 years that has been reported for women’s first birth, during 2005 and 2006 in Victoria (Carolan, Davey, Biro, & Kealy, 2011) and for first-time mothers in 2011, in Australia (Australian Bureau of Statistics, 2013).
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Table 3: Socio-demographic characteristics of mother participants Sample
M Pseudonym Age
(years) Parity Educational
Level56 Occupation
1 Tania 31 4 Year 12 Retail
2 Catherine 34 1 University degree Solicitor
3 Vivienne 30 1 University degree Teacher
4 Marie 30 2 TAFE Personal trainer
5 Dianne 35 1 Year 12 Book keeper
6 Sonia 35 1 University degree Speech pathologist
7 Kylie 32 1 University degree Accountant
8 Jenny 41 3 University degree Home duties
9 Wendy 29 2 TAFE Administration
10 Nadia 32 3 University degree Teacher
11 Karen 40 1 Year 12 Retail
12 Sally 34 2 University degree Nurse, naturopath
13 Narelle 35 1 University degree Teacher
Five mother participants, four of whom were first-time mothers, were aged 35 years and over, which is a commonly accepted parameter for defining older maternal age (Beischer, Mackay, & Colditz, 1997; Gabbe, Niebyl, Galan, Jauniaux, Landon, et al., 2012). In more recent times, research has identified this group of older first-time mothers as being predominantly healthy and of higher socioeconomic and educational status (Carolan, 2005; Carolan et al., 2011). Despite this finding, birth over 35 years continues, however, to be associated with adverse obstetric outcomes (Carolan et al., 2011).
Mothers in the present study follow a similar trend of experiencing complicated births and difficult early post-natal circumstances.
An overview of mother participants’ clinical problems associated with the birth and post- partum events is presented in Table 4. Clinical terminology and participants’ own words are used to describe various problems that effected mothers and babies in different ways and that impacted upon their breastfeeding experiences. Referring to Table 4, it is noteworthy to consider the high rate of complicated births and early clinical problems reported by this group of women. Five of the 13 mothers had caesarean births; two were emergency procedures, and three were elective, following a previous birth of an older sibling by emergency caesarean section. Five women reported a complicated vaginal
56 In Australia, Year 12 represents the final year of compulsory school education. TAFE is an acronym for Tertiary And Further Education.
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delivery, either with a positional obstruction or intervention. Two were relatively uncomplicated but one had a very fast delivery with physical signs of trauma to the baby.
Only one mother had an unassisted vaginal delivery which had gone according to her birth-plan57.
At the time of interview, and while attending the osteopath for treatment, the babies’
ages ranged from three weeks to 28 weeks, with a median age of 12 weeks. This variation in babies’ ages correlates with the range and diversity of breastfeeding problems that are associated with different stages of breastfeeding, such as beginning, establishing, and established breastfeeding. The detail and consequences of these experiences and clinical problems were discussed by mothers and osteopaths throughout the data. For example, osteopaths gathered a detailed obstetric history, looking for connections between mother and baby dyad’s past experiences and presenting problems. Mothers tended to view their breastfeeding difficulties in association with birth and early postpartum events; issues that are discussed in more detail throughout the findings chapters.
57 There has been a growing research interest in exploring the determinants of interventions in labour and birth, such as advancing maternal age (Carolan et al., 2011) and the implications for breastfeeding outcomes (Baxter, 2006; Nissen et al., 1998).
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Table 4: Mother-baby dyads’ obstetric and postpartum histories
Dyad Mother’s age
Baby’s age
Maternal
parity Method of Birth Type of labour & other significant events Clinical Problems - mother and baby 1 31 16 weeks Multipara Instrumental Spontaneous with augmentation, posterior presentation- difficult
& prolonged labour
Breast refusal from one breast only; fussy unsettled behaviour
2 34 8 weeks Primipara Normal Unknown, described as quick and baby engaged early before
labour, ‘nine weeks compressed down there’ (M 02/13). Attachment or suck dysfunction; sore nipples
3 30 6 weeks Primipara Caesarean -
emergency Spontaneous with augmentation, undiagnosed breech position Attachment or suck dysfunction;
concerns about baby’s weight gain
4 30 6weeks Mulitpara Caesarean -
planned
No labour
Osteopath described a history of stressful psychosocial circumstances throughout mother’s pregnancy (O04/09)
Fussy unsettled behaviour; reflux
5 35 7 weeks Primipara Normal Spontaneous, no intervention Breast refusal (short duration); no other
clinical problems 6 35 16 weeks Primipara Caesarean -
emergency
Spontaneous, not progressing.
Baby was “yanked out unexpectedly… I was fairly stressed because I was very against having a Caesar “(M06/02).
Fussy unsettled behaviour; breast refusal
7 32 28 weeks Primipara Normal
Spontaneous with augmentation
“The drip really speed things up, extremely fast ,much more than everyone expected”, (M07/04)
Swallowing difficulty; distressed when feeding; diagnosed with laryngomalacia at 10 weeks
8 41 3 weeks Mulitpara Caesarean -
planned, forceps No labour Attachment or suck dysfunction
9 29 20 weeks Mulitpara Compound
presentation
“When she was born she came out with her head and one arm and the other arm was still inside” (M09/05).
Sore nipples; mastitis; candidiasis; fussy unsettled behaviour
10 32 12 weeks Mulitpara Instrumental Spontaneous, posterior presentation - difficult & prolonged
delivery Attachment or suck dysfunction; sore nipples
11 40 16 weeks Mulitpara Normal Very fast delivery, large baby who was bruised and “shot out like
a cannon” (M11/05). Fussy unsettled behaviour; reflux
12 34 12 weeks Primipara Caesarean -
emergency No labour, mother developed HELLP Syndrome
Breast refusal; fussy unsettled behaviour;
suck dysfunction; sore nipples; mastitis;
concerns about baby’s weight gain
13 35 4 weeks Primipara Instrumental Spontaneous with augmentation- difficult & prolonged labour
Baby in intensive care for 24 hours after birth; suck dysfunction; concerns about baby’s weight gain; mother had a postpartum infection
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Definitions of terms relating to Table 4 (Beischer, 1997).
Method of birth is categorised as normal: unassisted vaginal birth; instrumental: vaginal birth (forceps, vacuum extraction); and caesarean section. Information on the timing of caesarean section is also included and described as emergency (due to maternal or infant distress) or planned.
Type of labour is categorised as spontaneous, spontaneous with augmentation, induced, or no labour (caesarean section before commencement of labour). Induced and augmented labours involve the use of drugs or procedures to speed up labour. Posterior presentation: Back of baby’s head is directed to the back of the maternal pelvis; commonly associated with prolonged or difficult labour.
Clinical problems are categorised as breast refusal, fussy unsettled behaviour, attachment or suck dysfunction, sore nipples, mastitis, and concerns about baby’s weight gain.
Multipara: a woman who has delivered more than one viable infant. Primipara: a woman who has given birth to one viable infant Laryngomalacia: congenital deformity of the epiglottis which usually resolves clinically by 18 months of age.
Reflux (gastroesophageal): back flow of the contents of the stomach Mastitis: inflammatory condition of the breast, usually caused by infection.
Candidasis or thrush: infection caused by a species of Candida.
HELLP Syndrome: severe form of preeclampsia, a hypertensive complication of late pregnancy.
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