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Table 1 Elements of the teens’ breastfeeding journeys

From: Early breastfeeding experiences of adolescent mothers: a qualitative prospective study

Teen 1 Teen 2 Teen 3 Teen 4 Teen 5
DEMOGRAPHIC CHARACTERISTICS AT BASELINE
14-year old immigrant, 7th grade, expecting her first child. 16-year old, 9th grade, expecting her first child after a previous miscarriage. 17-year old, 12th grade, expecting her first child. 17-year old, 12th grade, expecting her first child. 16-year old, 11th grade, expecting her first child.
DEMOGRAPHIC CHARACTERISTICS AT FOLLOW-UP
At nine weeks postpartum she was in school and not working. She married the father. At eight weeks postpartum she is back in school and working about 40 hours/weeks, after school and on weekends. At four weeks postpartum she is still in the homebound program and will return to school soon. She is not working. At six months postpartum she is in her first semester of college. She is not working. At six weeks postpartum she is out of the school for the summer. She is not working.
FEEDING INTENTION AT BASELINE
She decided to do breastfeeding and bottle feeding for the baby, and intends to breastfeed for six weeks then start formula when she returns to high school. She wants to do both breastfeeding and formula feeding, and she is uncertain about which type of feeding to do the most. She really wants to breastfeed, despite the negative messages that she received about breastfeeding. Should consider formula feeding only if she has to. She plans to breastfeed and pump when she goes to her dad’s home or grandma’s home. She plans to breastfeed as long as she can, and she will pump when someone else is taking care of the baby.
RATIONALE FOR FEEDING INTENTION AT BASELINE
Breastfeeding is best for baby’s health and her relationship with the baby She learned in class that breastfeeding is “excellent thing” Breastfeeding is best for baby Her determination to breastfeed stemmed from an opposition to formula, financial constraints; need for financial independence, her mother’s positive breastfeeding experience, and the encouragement of the TPMP: “I don’t want to go to formula. I don’t want my baby to even know what formula is…Friends I’ve had – like a friend I’ve lived with she had a baby not too long ago. And her baby was going to the hospital every other week, and were like ‘What is wrong with her’. And she’s like ‘Oh, it’s her formula is breaking her out. Oh her formula is messing up her stomach’. She had to change her formula so many times.” Breastfeeding is best for baby
I’m going to breastfeed. When I’m school, then we will do the bottle feeding… when I’m in school the baby need milk. So, I have to do the bottle feeding… I believe breastfeeding is good for baby, make them healthy, and you can also get a relationship with your baby when you breastfeed, I think.” “I was learning in the classes that it’s better milk. They have more – they have less ear infections, um, less breathing problems, you know? More healthy, more routine and stuff like that… I think it’s an excellent thing because the child has better qualities.” That’s one thing that I really wanted to do was breastfeed… it is the best thing for the baby. Even if I won’t be able to breastfeed I maybe still could pump, and then – I just want her to be able to get everything that she needs.” “I don’t even want to be in the state’s system. The only thing I want to be in the state system for is Medicaid…because I can’t pay for Medicaid…My main reason [for breastfeeding] was less money I had to spend. Like I said, I don’t have the funds to get formula milk. . . Two my mom did it…” I plan on breastfeeding as long as I can, but don’t know how long that’s going to be… it’s better for the baby…I mean I’m going to breastfeed no matter what, even if somebody says like I can’t do it. It’s going to make me want to do it even more.”
   At her follow up interview she stated “I mean her [the baby’s] father wanted me to [breastfeed]. So he pushed me to. But then I started finding out like going to the TPMP classes they tell you how much breast milk is good for her.   
BREASTFEEDING PRACTICE
Total human milk for 56 days: breastfed with pumping for 7 days; continued pumping for 51 days; introduced formula during week 6. She started formula the week she started school. At week 7 she was still pumping and using formula; the baby was receiving pumped milk 4x during day and formula 2x at night. (follow-up interview was conducted too early). Total human milk for 4 days; no pumping; introduced formula during week 1 and used cabbage leaves to dry up milk Total human milk for 21 days; breastfed only for 2 days; pumped and breastfed for 10 days; pumped 9 days more; introduced formula in week 2 and was exclusively formula feeding by week 4 Human milk for at least 6 months when follow-up interview was conducted; breastfed exclusively for 42 days with no pumping; started pumping after 42 days and continued both Human milk for 28 days; breastfed only for 3 days when the nurse introduced formula during week 1. She pumped 1-2x per day until week 5.
RATIONALE FOR BREASTFEEDING CESSATION AT FOLLOW-UP
She did not like putting the baby to the breast “It feels funny, it tickles” and she “prefers pumping breast milk with bottle” . She continued to pump and use formula, but she quit pumping during the day because of school: “It is a problem for the school. Like sometime it get really, you know, wet and hurt and there’s no pump at school [the school has a pump but she does not pump there]. Sometimes I have to get all wet and have to cover up so people don’t see. That’s a problem.” She indicated being tired and concerned about keeping up with school work; baby is eating a lot at night. She stated that her “breasts felt like hard rocks”. She stated it was painful when milk comes in. She thought she could not do anything about the pain: “It’s painful…for the breast to get full again. That’s like where they couldn’t do nothing about that.” At day 4 the nurse advised her to put the baby on the bottle since the nurse thought the baby was not getting enough. She stopped breastfeeding “because it’s hard to be honest. She digests so quickly so hunger more, waking up in the middle of the night, too hard for me”. She pumped between feedings using a hand pump, which was a “pain”. “I have to see her and be with her always had to be on top of things all the time”. She also did not want to pump when she went back to school “When I go back to school and I’m still breastfeeding it’s going to be hard also, because I’m still producing milk, because I can’t relieve it how I normally do. Because, then, I would have to pump during lunch. I don’t think I could go for that long. Because when I was breastfeeding I couldn’t go for more than three hours without pumping to relieve. That’s how much would come in. And it was so bad that like my glands under my arms were filled with milk. And it was really like lumpy. And my bra size was like tripled. My bra was double D. I was so happy when my milk dried up.” At 6 months she continued to breastfeed and had not used formula. Was feeding the baby solids at that time. She states that “I breastfeed for three weeks, but he wasn’t gaining enough weight. Because I would get like an ounce every time. So when the nurse come out she made, she put him on a bottle.
     After she started using the bottle, the baby “wouldn’t latch on so I just pumped and mixed”
  1. Notes for Table1:
  2. The follow-up interview for Teen 1 was accidently conducted too early, at week 7, when the mother was still pumping.
  3. The follow-up interview for Teen 4 was conducted at 6 months, to reduce the possibility of loss to follow-up, even though the mother continued to breastfeed.
  4. Teen 5 used the term “breastfeeding” to refer to pumping, which is not an uncommon practice among the teens in this study. We know she was pumping because of the weekly tracking data.