Exploring women's perceptions of pain when breastfeeding using online forums.

Background: Despite numerous benefits, many mothers stop breastfeeding soon after birth. A common reason for this is the experience of pain or discomfort. One resource which women use to share their breastfeeding challenges and seek support are online forums. This study aimed to collect data from online forums to explore 1) usage of forums as social support for breastfeeding-related pain; 2) experiences of breastfeeding-related pain; 3) perceptions and strategies to deal with breastfeeding-related pain; and 4) the impact of pain on breastfeeding duration.

Methods: Data was gathered through searches of online forums based in the UK and USA: Netmums, What to Expect and Mumsnet using key terms: 'painful breastfeeding' and 'sore breastfeeding'. Data extraction took place in July 2018 and included posts made between 2012 and 2018. Data included 123 posts and 193 replies, analysed using thematic analysis.

Results: The first theme identified was 'variation in types of pain', highlighting the variety of painful experiences and their descriptions. In particular, this theme reveals the large variety of different types of pain women experience at different stages throughout their breastfeeding journey, as well as the different pain characteristic they focus on in the description of their experience (i.e., location, sensory or physical aspects). Secondly, the theme 'perceived causes and explanations for pain' revealed how women interpret pain experiences either due to a recognised condition or behavioural cause. The third theme 'cessation of breastfeeding related to pain' identified. How women experience both physical and psychological struggles (e.g., guilt) related to breastfeeding cessation, with pain being a main factor in considering cessation of breastfeeding. Finally, the theme 'shared experiences and support' identified women's strong need for both practical and emotional support to deal with pain. Many women look for this support through the knowledge exchange offered on the online forums.

Conclusions: Pain was a key reason for breastfeeding cessation, commonly associated with strong feelings of guilt. The online forums provide a unique form of social support for breastfeeding women to find ways to cope with the pain, while highlighting the urgent need for more appropriate antenatal education on realistic expectation surrounding breastfeeding.