Document Type


Date of Degree

Fall 2015

Degree Name

PhD (Doctor of Philosophy)

Degree In

Community and Behavioral Health

First Advisor

Ashida, Sato

First Committee Member

Campo, Michelle

Second Committee Member

Buch, Elana

Third Committee Member

Colaizy, Tarah

Fourth Committee Member

Mulder, Pamela


Exclusive breastfeeding for at least six months and continued breastfeeding for the first year or two is promoted as the preferred method for feeding infants. In the United States, about 79% of infants are ever breastfed and less than 27% are breastfed through the first year (Centers for Disease Control and Prevention, 2014b). The purpose of this study was to understand the role of breastfeeding experiences and underlying factors that may facilitate the maintenance of breastfeeding one’s first child as well as the re-engagement in breastfeeding with one's second child. This dissertation includes two quantitative studies using secondary data and one qualitative study involving data specifically collected for this study.

The quantitative studies used data from the Infant Feeding Practices Study II and the Year 6 Follow Up surveys. Findings indicate barriers in the early breastfeeding experience (pain, trouble with milk supply, and trouble with the baby’s suck or latch) are associated with less time spent in breastfeeding maintenance among first-time mothers and experiencing trouble with the first baby’s suck or latch is associated with non-initiation with one's second child. Conversely, as levels of perceived breastfeeding self-efficacy, opinion about the best way to feed a baby, and belief about breast milk increased, or became more pro-breastfeeding over time, time spent in breastfeeding maintenance among first-time mothers also increased. Those with a high level of response efficacy were also more likely to initiate breastfeeding with a second child.

In the qualitative study, 28 first-time mothers who recently stopped breastfeeding and live in Iowa participated in semi-structured interviews. The objectives of this third study were to understand and describe first-time mothers’ experiences of infant feeding throughout the entire breastfeeding maintenance period, and explore how contextual factors may act as facilitators or barriers to breastfeeding maintenance by identifying common turning points. Turning points were defined as events or periods in time perceived as personally significant, that promoted a change, maintenance, or where a new meaning associated with the experience was acquired. Findings include seven turning points (breastfeeding problems, overcoming the unknown, recurring stressors, learning how to live life with the new baby, re-entering social roles, special occasions, and letting go) that were usually associated with stressful situations. The availability of intrapersonal (e.g., individual determination) and interpersonal (e.g., social support from others) coping resources at these turning points facilitated breastfeeding maintenance.

The first study is significant in the longitudinal consideration of both experiences and changes in intrapersonal and interpersonal factors and how these changes relate to breastfeeding maintenance. The second study is significant with the focus on multiparous mothers and the effect of previous breastfeeding thoughts and experiences on breastfeeding initiation with a second child. The third study is unique in the identification of breastfeeding turning points that may lead to identifying opportune times and strategies for maintenance interventions. Findings from these studies have implications for intervention planning and future research. The synthesis of findings across the three studies suggests the early breastfeeding period is paramount to breastfeeding maintenance, along with the role of one’s social environment, particularly the perceived availability of social support to meet mothers' needs. Finally, findings from this dissertation can be used to improve social support provision and multi-level interventions targeting mothers’ most salient needs at the most opportune times.


Breastfeeding, Maintenance, Social support, Stressors, Turning points


xv, 162 pages


Includes bibliographical references (pages 149-162).


Copyright © 2015 Ellen Jennifer Schafer