'Not a one size fits all'- experiences of breastfeeding families who discontinue behavioural sleep interventions.

INTRODUCTION: In Australian inpatient and residential care settings, behavioural infant sleep interventions are provided to families. Behavioural sleep interventions have been associated with high rates of drop-out and low adherence. However, there is a lack of qualitative research exploring: a) the reasons why families disengage from these interventions, and b) how these interventions interact with the breastfeeding relationship. METHODS: This study used Interpretative Phenomenological Analysis to explore the experiences of breastfeeding mothers (n = 10) who had discontinued behavioural sleep interventions in Australian residential or inpatient settings. RESULTS: Five themes were identified: 1) 'It's not a one size fits all' detailed how interventions were experienced as failing to adapt to the unique needs of families; 2) 'Navigating power and agency on the ward' explored maternal loss of agency when interacting with health professionals and making decisions about their infants' care. ; 3) 'A 'slave' to sleep: loss of pleasure and ease in family life', encompassed maternal experiences of fatigue and loss of enjoyment while implementing the intervention; 4) 'Undermining of the breastfeeding relationship', reflected maternal concern about the effects of the intervention on breastfeeding; and 5) 'Escalating distress within the family system', referred to heightened feelings of distress elicited by the intervention. DISCUSSION: Breastfeeding families who discontinue behavioural sleep interventions in residential and inpatient settings, describe heightened distress, fatigue, and disruptions to the breastfeeding relationship. When interventions are delivered inflexibly without supporting the agency or unique needs of families, there is a risk of undermining parenting confidence and wellbeing.