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Background In a context with strong rhetorical support for breastfeeding in the health system, yet extremely low rates of breastfeeding after hospital discharge, UK women’s decisions about infant feeding reflect the reality of competing priorities in their lives, including obtaining adequate sleep. Popular wisdom in the UK tightly links breastfeeding and inadequate night-time sleep. Mothers are advised by peers and family to introduce formula or solid foods to infants to promote longer sleep. Objectives The first objective of this study was to investigate women’s understandings of the nature of infant sleep and their perceptions of links between infant feeding method and sleep. The second was to explore how these perceptions influence infant feeding and sleep practices. Underpinning our work is the understanding that infant care choices result from trade-offs by which mothers strive to balance infant- and self-care. Methods We conducted seven focus groups with mothers of infants in two regions of the UK. Verbatim transcripts were thematically coded and emergent themes were identified. Results We found clearly diverging narratives between breastfeeding and formula-feeding mothers. Breastfeeding mothers viewed the fragmentary nature of infant sleep as natural, while mothers who were formula feeding felt this was a problem to be fixed. Conclusions and Practice The strategies used to promote infant and maternal sleep in each group were aligned with their underlying perception of how infant sleep works. Maternal perceptions of the nature of infant sleep and its relation to infant feeding method impact infant care practices in the first year of life.

Background Professional support in pediatric and rehabilitation care environments has been recommended as a means to build youth competence in life skills during their transition to adulthood. Life skills are the essential psychosocial competencies and interpersonal skills needed to manage one’s life. Residential immersive life skills (RILS) programs offer youth with physical disabilities enriched learning environments to acquire these skills. This study explored trajectories of personal growth in life skills and positive psychological outcomes among youth participating in a RILS program and related caregiver perspectives. Method Delivered by a multidisciplinary healthcare team, The Independence Program is an intensive summer program housed in a college residence that provides realistic experiences of living away from home for small groups of youth between 17 and 21 years of age who have congenital and/or acquired physical disabilities. Using a longitudinal case study and qualitative descriptive design, four youth and their parents/guardians participated in semi-structured interviews prior to, and then 1 month, and 3 to 4 months after the program. A conventional content analysis yielded chronological narratives for each youth and caregiver dyad of their experiences, perceptions and outcomes over time. These narratives were further summarized using a ‘line of development’ perspective to describe individual developmental trajectories of personal growth. Results All four of the youth returned from the program with positive reports about the new life skills acquired and new behaviours they engaged in. These positive reports generally continued post-program, albeit with differing trajectories unique to each youth and varying levels of congruence with their caregivers’ readiness to support, accommodate and facilitate these changes. Caregivers differed in their capacity to shift in their parenting role to support consolidation of youth life skill competencies following program participation. Conclusions RILS programs can be transformative. Varied youth trajectories identified significant personal growth through enhanced self-determination, self-efficacy and self-advocacy. Congruence in youth and caregiver perceptions of post-program changes was an important transactional factor. Professional support addressing caregiver needs may be beneficial to facilitate developmentally appropriate shifts in parenting roles. This shift is central to a model of shared management whereby adolescents take on greater responsibility for their own care and life choices.

Abstract The “moral panic” generated by public response to teenage mothering marginalizes the experiences of young women as mothers, with adolescent pregnancy viewed as catastrophic for young women, their families, and society. In this analysis, focused on the experience of a group of teen women from the city of São Paulo, Brazil, the author explores how the integration of a maternal identity, shaped by Brazilian norms of “good motherhood,” with previously existing identities might lead to new aspirations and ambitions for the future or to hopelessness and despair. Visions of the future were shaped by individual women’s structural circumstances and fell into four rough groups. Well-established adult women expressed their maternal identity through personal ambition, revealing confidence in their ability to provide “the best” for their children. Some adolescent mothers were fortunate enough to be buffered by family resources so that optimistic objectives for the future that pre-dated the pregnancy remained fairly attainable and were compatible with a “good mother” identity. For teens from less well-off families, motherhood resulted in a new-found determination to succeed in school and work, in line with ideals of Brazilian “good mothering” that focus on working hard to benefit one’s children. Women from the poorest households could or would not conjure a vision of the future, faced with the overwhelming challenges of their circumstances. The detailed, longitudinal qualitative data analyzed here reveal how the construction of maternal identity and visions of the future among adolescent mothers are shaped by the embodied experience of motherhood and pre-existing structural forces.

While the ability to breast-feed is virtually universal among women, the experience of breast-feeding is particular to each woman and is influenced by her social, economic, and personal circumstances. This paper explores quantitative and experience-focused ethnographic data on the experiences of low-income women from the eastern periphery of the city of Sao Paulo, Brazil, who were breast-feeding for the first time. The prospective, longitudinal data collection method involved repeated in-depth interviews with a group of 65 women, from the end of pregnancy through the first 12 weeks postpartum. Multivariate statistical analyses of the quantitative data revealed that older age, lower interpersonal satisfaction, and unplanned pregnancy shortened the period of exclusive breast-feeding and increased women's likelihood of having begun supplementation by 12 weeks postpartum. Ethnographic data analysis exposed the meanings of breast-feeding and motherhood for women who had experienced unplanned pregnancy and helped to shed light on the dramatic influence of unplanned pregnancy on women's breast-feeding practice. Adapted from the source document.

Surveys of patient satisfaction are widely used for identifying priorities and problems in healthcare reforms. The present study examined satisfaction and confidence of patients in public healthcare in Trinidad and Tobago. Data were gathered by interviewing a random sample (n = 280) of primary healthcare (PHC) patients. Level of patient satisfaction was high but not constant. Results of interviews showed that patients with a higher monthly income (p = 0.032) and patients who most recently used private medical care (p = 0.037) had lower levels of satisfaction with health services. Employment had an effect on satisfaction (p = 0.065), significant among patients who had recently accessed private medical care (p = 0.039). Patients using PHC clinics preferred private care to public care. Confidence in public care decreased with increasing complexity of the medical condition. These preliminary results support continued efforts in health-sector reforms and call for the enhancement of data on satisfaction through more comprehensive qualitative data-collection methods.

Nighttime Breastfeeding: An American Cultural Dilemma by Cecília Tomori. New York: Berghahn, 2015. 312 pp.