A Descriptive Qualitative Study of Breastfeeding Challenges, Enablers and Confidence Among Women With Hypertensive Disorders of Pregnancy

Background: Individuals with hypertensive disorders of pregnancy are at a significantly increased risk for chronic hypertension and premature cardiovascular disease. Although breastfeeding may have cardiovascular benefits, those with hypertensive disorders of pregnancy tend to have lower rates of breastfeeding initiation, duration, and exclusivity. A deeper understanding of their breastfeeding experiences is necessary to inform effective interventions that support lactation. Research Aim: This study aimed to explore breastfeeding challenges, enablers, and factors influencing breastfeeding confidence among individuals with hypertensive disorders of pregnancy. Method: This study employs a descriptive, qualitative approach. Semi-structured telephone interviews were conducted between 2 and 8 months postpartum with a convenience sub-sample of 18 individuals enrolled in a pilot randomized controlled trial of a breastfeeding support intervention in Quebec, Canada. The interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis. Data were coded and grouped under three categories related to the main interview questions (breastfeeding challenges, enablers, and factors influencing breastfeeding confidence). Results: Perinatal complications, struggles with milk supply, high rates of formula supplementation, and lack of consistent or skilled breastfeeding support challenged early breastfeeding experiences. Breastfeeding enablers included hands-on support with feedings, accessible breastfeeding information and support, and being determined to breastfeed. Discouragement to breastfeed from family or health professionals diminished breastfeeding confidence whereas learning from the breastfeeding experiences of others and positive reinforcement for breastfeeding efforts helped build breastfeeding confidence. Conclusions: Skilled, proactive lactation support targeting breastfeeding confidence may help optimize breastfeeding outcomes among individuals with hypertensive disorders of pregnancy, potentially mitigating their longer-term cardiovascular risks.