"I Just Want to Do Everything Right:" Primiparous Women's Accounts of Early Breastfeeding via an App-Based Diary

Introduction: Our objective was to describe the early breastfeeding experience of primiparous women. Methods: Healthy, primiparous women intending to exclusively breastfeed downloaded a commercial infant feeding mobile application (app) during their postpartum hospitalization. Women free-texted breastfeeding thoughts and experiences through 8 weeks postpartum in the app's diary. Diary content was qualitatively coded. Results: Thirty-five participants completed diaries and were included in analyses. The overarching theme was Seeking sustainability and validation. Mothers felt overwhelmed, anxious, and frustrated with the intensity and unpredictability of breastfeeding and inconsistent professional breastfeeding support. The ability to exclusively breastfeed was seen as a bellwether of maternal competence. Breastfeeding progress was primarily measured through external feedback (e.g., weight checks) and managed through strict adherence to provider feeding plans. As breastfeeding problems and intensity abated, women exhibited optimism and assumed greater independence in feeding decisions. Discussion: The primiparous breastfeeding experience is fraught with internally imposed and externally reinforced pressure to produce and persevere despite inadequate breastfeeding support infrastructure.