Associate Professor Athena Sheehan

Barclay, L., Svensson, J.L., Heads, J., Worgan, R., Schmied, V. & Sheehan, A. 2000, Breastfeeding and You: Antenatal Breastfeeding Education, Commonwealth Dept. of Health & Aged Care, Australia.

Sheehan, A. & Schmied, V. 2011, 'The Imperative to Breastfeed: An Australian Perspective' in Pranee Liamputtong (ed), Infant Feeding Practices: a Cross-Cultural Perspective, Springer, London, pp. 55-76.
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In this chapter, the authors argue that in Australia there is a well-constructed cultural imperative to breastfeed. The message of 'breast is best' is powerful and has been transmitted through public health and professional discourses and increasingly within the broader social and cultural context influencing the personal decisions and experiences of women.

Sheehan, A., Schmied, V. & cooke, m. 2006, '3.3 Australian women's stories of their baby-feeding decision in pregnancy' in Sara Wickham (ed), Midwifery Best Practice Volume 4, Elsevier, Spain, pp. 79-86.
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To describe the baby-feeding decisions of a group of Australian women prior to birth.

Barclay, L., Longman, J., Schmied, V., Sheehan, A., Rolfe, M., Burns, E. & Fenwick, J.H. 2012, 'Commentary - The professionalising of breastfeeding - Where are we a decade on?', BMC Health Services Research, vol. InPress.
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This paper is an empirically informed opinion piece revisiting an argument published in Midwifery 10 years ago, that the increasing professionalisation of breastfeeding was not supporting women in Australia in sustaining breastfeeding.

Barclay, L., Longman, J., Schmied, V., Sheehan, A., Rolfe, M., Burns, E. & Fenwick, J.H. 2012, 'The professionalising of breastfeeding - Where are we a decade on?', Midwifery, vol. 28, no. 3, pp. 281-290.
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This paper is an empirically informed opinion piece revisiting an argument published in Midwifery 10 years ago, that the increasing professionalisation of breastfeeding was not supporting women in Australia in sustaining breastfeeding.

Burns, E., Schmied, V., Fenwick, J.H. & Sheehan, A. 2012, 'Liquid gold from the milk bar: Constructions of breastmilk and breastfeeding women in the language and practices of midwives', Social Science & Medicine, vol. 75, no. 10, pp. 1737-1745.
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Midwives are the main health professional group providing support and assistance to women during the early establishment of breastfeeding. In published accounts of early breastfeeding experiences women report high levels of dissatisfaction with health professional support.

Burns, E., Fenwick, J.H., Sheehan, A. & Schmied, V. 2012, 'Mining for liquid gold: midwifery language and practices associated with early breastfeeding support', Maternal And Child Nutrition, vol. INPRESS.
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Internationally, women give mixed reports regarding professional support during the early establishment of breastfeeding. Little is known about the components of midwifery language and the support practices, which assist or interfere with the early establishment of breastfeeding.

Burns, E., Fenwick, J.H., Schmied, V. & Sheehan, A. 2012, 'Reflexivity in midwifery research: The insider/outsider debate', Midwifery, vol. 28, pp. 52-60.
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Objective: to explore the challenges of conducting an observational study of postnatal interactions, between midwives and women, when the researcher was a midwife observing in familiar midwifery settings. Background: participant observation conducted by researchers who are themselves midwives raises questions regarding the influence of `identity+ and `insider+ knowledge on the conduct of such projects. The insider/outsider status of researchers has been explored in other disciplines, yet this is an area which is underdeveloped in the midwifery literature where few attempts have been made to subject this issue to sustained analysis. Design: a qualitative study (investigating the provision of breast-feeding support in the first week after birth) provided the opportunity for reflexive exploration of the tensions faced by midwife researchers. Setting: two maternity units in New South Wales, Australia. Participants: participants included 40 midwives and 78 breast-feeding women. Findings: possessing `insider+ midwifery knowledge was advantageous in the `getting in+ and `fitting in+ phases of this research study however unanticipated role ambiguity, and moral and ethical challenges, arose as a result of this `insider+ knowledge and status. Prolonged periods of observation challenged the midwife researcher+s preconceived ideas and early decisions about the advantages and disadvantages of being an `insider+ or an `outsider+ in the research setting. Key conclusions: reflexive analysis of insider/outsider experiences revealed the middle ground which participant observers tend to navigate. Whilst professional insider knowledge and status offered many advantages, especially at the first study setting, some of the inherent embodied, and socially constructed features of the `midwife+ observer role, were unanticipated. Cultural competence, in these observational study settings, translated into role ambiguity, and at times, culturally entrenched role expectation .

Schmied, V., Beake, S., Sheehan, A., McCourt, C. & Dykes, F. 2011, 'Women's Perceptions and Experiences of Breastfeeding Support: A Metasynthesis', Birth: issues in perinatal care, vol. 38, no. 1, pp. 49-60.
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Both peer and professional support have been identified as important to the success of breastfeeding. The aim of this metasynthesis was to examine women's perceptions and experiences of breastfeeding support, either professional or peer, to illuminate the components of support that they deemed supportive.

Taylor, C., Gribble, K., Sheehan, A., Schmied, V. & Dykes, F. 2011, 'Staff Perceptions and Experiences of Implementing the Baby Friendly Initiative in Neonatal Intensive Care Units in Australia', Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, vol. 40, no. 1, pp. 25-34.
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To explore the perceptions, understandings, and experiences of maternity service staff toward the World Health Organization/United Nations Children's Fund (WHO/UNICEF) Baby Friendly Hospital Initiative (BFHI) and its implementation in the Neonatal Intensive Care Unit (NICU).

Burns, E., Schmied, V., Sheehan, A. & Fenwick, J.H. 2010, 'A meta-ethnographic synthesis of women's experience of breastfeeding', Maternal And Child Nutrition, vol. 6, no. 3, pp. 201-219.
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Despite considerable evidence and effort, breastfeeding duration rates in resource-rich countries such as Australia remain below World Health Organization recommendations. The literature on the experience of breastfeeding indicates that women construct and experience breastfeeding differently depending upon their own personal circumstances and the culture within which they live. Breastfeeding has also been described as a deeply personal experience, which can be associated with `moral+ decision-making. The aim of this synthesis was to better understand the social phenomenon of breastfeeding by making the hidden obvious. Using a meta-ethnographic approach, we analysed the findings from 17 qualitative studies exploring women's experience of breastfeeding. Commonly used metaphors, ideas and phrases across the national and international qualitative studies were identified. Two overarching themes emerged. Breastfeeding was described in terms of `expectation+ and `reality+, while the emotional aspects of breastfeeding were expressed in `connected+ or `disconnected+ terms. The prevalence of health professionals and public health discourses in the language women use to describe their experience, and the subsequent impact of this on maternal confidence and self-assessment of breastfeeding are discussed. This synthesis provides insight into some of the subtle ways health professionals can build maternal confidence and improve the experience of early mothering.

Sheehan, A., Schmied, V. & Barclay, L. 2010, 'Complex decisions: theorizing women's infant feeding decisions in the first 6 weeks after birth', Journal of Advanced Nursing, vol. 66, no. 2, pp. 371-380.
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This paper is a report of a grounded theory study of woman's infant feeding experiences and decisions in the first 6 weeks after birth. Breastfeeding is considered the optimum method of infant feeding. Studies have identified numerous factors associated with infant feeding decisions. What remains unexplored are the mechanisms by which socio-demographic, biomedical and psychosocial factors influence infant feeding decisions. Research highlights the need for further investigation of the experiences and decision-making processes of both breastfeeding and formula-feeding women. A constructionist grounded theory approach to data collection and analysis was used. Data for this study were collected and analysed between 2003 and 2004. Further data, collected in a previous study in 2000, were theoretically sampled and analysed in 2005. In-depth interviews with 37 women from various socio-demographic areas in New South Wales, Australia provided data. The core category was "deconstructing best'. "Deconstructing best' was the infant feeding decision-making process in the first 6 weeks after birth. The process of "deconstructing best' involved seven phases: planning, expecting, realizing, questioning, getting on with it, defending and qualifying. Four main categories - 'it's really best to breastfeed', 'it's the unknown', 'it's not the only thing going on', and 'everybody's best is different' - comprised the context within which deconstructing best occurred. Woman's infant feeding decisions cannot be viewed in isolation from other post-natal experiences and needs. Infant feeding decisions will only be understood and appropriately supported when they are seen in relation to the circumstances of a woman's life, her immediate sociocultural context and individual experience.

Sheehan, A., Schmied, V. & Barclay, L. 2009, 'Women's experiences of infant feeding support in the first 6 weeks post-birth', Maternal And Child Nutrition, vol. 5, no. 2, pp. 138-150.
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Research suggests women find the first 2 to 6 weeks to be the most difficult time for breastfeeding. It has been identified that women need and seek support with breastfeeding during this time. Support is a difficult concept to define.When discussed by professionals, support for breastfeeding is generally viewed in terms of providing information and educational interventions.There is little understanding of the different elements of breastfeeding support strategies and the mechanisms by which support operates. Further, there is a paucity of qualitative research specifically reporting women's experiences and expectations of professional support.

Cooke, M., Schmied, V. & Sheehan, A. 2007, 'An exploration of the relationship between postnatal distress and maternal role attainment, breast feeding problems and breast feeding cessation in Australia', Midwifery, vol. 23, no. 1, pp. 66-76.
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OBJECTIVES: To explore the relationships between maternal distress, breast feeding cessation, breast feeding problems and breast feeding maternal role attainment. DESIGN: Longitudinal cohort study. SETTING: Three urban hospitals within Sydney, Australia. PARTICIPANTS: 449 women were invited to participate in the study, with an 81% response rate. MEASUREMENT: Self-report questionnaires were used to collect the data in pregnancy (28-36 weeks) and 2 weeks and 3 months after birth. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure postnatal distress, and the Maternal Role Attainment subscale (MRA) of the Maternal Breast Feeding Evaluation Scale (MBFES) was used to measure breast feeding maternal role attainment. FINDINGS: Women with high MRA were less likely to stop breast feeding (even when they had breast feeding problems) than women with low MRA. Antenatal EPDS and anxiety scores were not related to breast feeding cessation or breast feeding problems when analysed alone. As hypothesised, the relationship between breast feeding cessation and postnatal distress (EPDS scores) varied according to MRA level. Women who were categorised as high MRA and no longer breast feeding had higher EPDS scores and were more likely to be categorised as distressed (36%) than women who had low MRA (<12%) or women who had high MRA and continued to breast feed (7%). IMPLICATIONS: There is a complex relationship between maternal identity, stopping breast feeding earlier than desired, and psychological distress. Women with strong beliefs about the importance of breast feeding to their maternal role may benefit from psychological assessment and support should they decide to stop breast feeding earlier.

Cooke, M., Sheehan, A. & Schmied, V. 2003, 'A description of the relationship between breastfeeding experiences, breastfeeding satisfaction and meaning in the first 3 months after birth', Journal of Human Lactation, vol. 19, no. 2, pp. 145-156.
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Leap, N., Barclay, L. & Sheehan, A. 2003, 'Results of the Australian Midwifery Action Project Education Survey. Paper 2: Barriers to effective midwifery education as identified by midwifery course coordinators', Australian Midwifery Journal, vol. 16, no. 3, pp. 6-11.
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Leap, N., Barclay, L. & Sheehan, A. 2003, 'Results of the Australian Midwifery Action Project Education Survey. Paper 3: Workforce issues', Australian Midwifery, vol. 16, no. 3, pp. 12-17.
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This paper is the third in a series reporting on the findings of the AMAP Education Survey of the 27 Australian universities providing a program for initial authorisation to practise as a midwife. Workforce issues were identified by this research, such as the potential number of places in courses, attrition rates, and the number of graduates from midwifery education programs who seek and obtain employment in midwifery. The findings pose serious challenges to the development and sustainability of the Australian midwifery workforce.

Sheehan, A., Schmied, V. & Cooke, M. 2003, 'Australian women's stories of their baby-feeding decisions in pregnancy', Midwifery, vol. 19, no. 4, pp. 259-266.
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Sheehan, A., Schmied, V. & cooke, m. 2003, 'Australian women's stories of their baby-feeding decisions in pregnancy', Midwifery, vol. 19, no. 4, pp. 259-266.
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Objective: to describe the baby-feeding decisions of a group of Australian women prior to birth. Design, setting and participants: a qualitative study using face-to-face in depth interviews was undertaken with 29 women. All interviews were audio-tape recorded and transcribed verbatim. Data were analysed using thematic analysis. Findings: the women observed and sought information from a variety of sources as well as exploring their own understandings of themselves and their breasts. Based on this knowledge the women made their antenatal baby-feeding decisions. These baby-feeding decisions grouped into four thematic groups,'assuming I'll breast feed',- 'definitely going to breast feed'; 'playing it by ear' and 'definitely going to bottle feed' Each of these standpoints was associated with, and precipitated a number of behaviours and strategies. Implications: the findings of this research highlight the need for antenatal educators and midwives who provide care in pregnancy to acknowledge a range of experiences and expectations of women and to provide diverse educational opportunities to meet a range of needs. There is a need for further research to identify how midwives can encourage and assist women to explore and challenge their assumptions about breast feeding as they relate to other aspects of their lives

Homer, C.S., Sheehan, A. & Cooke, M. 2002, 'Initial Infant Feeding Decisions and Duration of Breastfeeding in Women from English, Arabic and Chinese-speaking backgrounds in Australia', Breastfeeding Review, vol. 10, no. 2, pp. 27-32.
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Homer, C.S., Davis, G.K., Brodie, P.M., Sheehan, A., Barclay, L., Wills, J. & Chapman, M. 2001, 'Collaboration in Maternity Care: A randomised controlled trial comparing community-based continuity of care with standard hospital care', British Journal of Obsterics and Gynaecology, vol. 108, no. 1, pp. 16-22.
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Schmied, V., Sheehan, A. & Barclay, L. 2001, 'Contemporary Breastfeeding Policy and Practice: Implications for midwives', Midwifery, vol. 17, no. 1, pp. 44-54.
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Sheehan, A. 1999, 'A comparison of two methods of antenatal breast-feeding education', Midwifery, vol. 15, no. 4, pp. 274-282.
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Objective: to compare a woman-centered antenatal breast-feeding programme based on concepts of peer and husband/partner support with a control group, who received antenatal breast-feeding education led by a midwife childbirth educator. Design: longitudinal, quasi-experimental study. Setting: a large private hospital in Sydney.

Fenwick, J.H., Burns, E., Sheehan, A., Schmied, V. 2013, 'We only talk about breastfeeding: A discourse analysis of infant feeding messages in antenatal group-based education', Midwifery, Churchill Livingstone, Edinburgh, UK, pp. 1-9.
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Aim: the aim of the study was to examine the dominant discourses that midwives draw onto present information on breast feeding in group- Based antenatal education sessions.