Moral work in women's narratives of breastfeeding

The Content and Sources of Breastfeeding Knowledge for New Mothers in the Netherlands

Background:

In the context of decreasing breastfeeding rates and unsuccessful breastfeeding promotion campaigns, a qualitative research project in the Northern part of the Netherlands was initiated.

Objectives:

As part of the overall project, the aim of this study was to explore the content and sources of breastfeeding knowledge among primiparous women. Identifying and categorizing the content and the sources of breastfeeding knowledge could guide professionals such as midwives and maternity nurses as well as others in the women’s surroundings to engage in disseminating knowledge and therefore support women in achieving their breastfeeding goals.

Methods:

We conducted 26 in-depth interviews from the emic perspective with 13 new mothers pre- and postpartum, up to saturation level. Transcripts were analysed applying thematic analysis. As sensitising concepts, the themes identified were divided into two categories: those gained from 'professional' sources and those obtained from 'popular' sources.

Results:

Five knowledge content themes were identified: (1) pros and cons of breastfeeding, (2) how breastfeeding works, (3) individual breastfeeding practice, (4) expressing milk, and (5) formula feeding. ‘Professional’ sources are perceived as more helpful than ‘popular’ sources, whereas ‘intuition’ was inductively identified as an important knowledge source.

Conclusion:

Limited breastfeeding practice exposure, along with the recommendations to breastfeed for six months and perceptions of breastfeeding as ‘natural’ at the same time, generates much pressure in women. Emphasizing all knowledge content in campaigns, addressing a variety of target groups in women’s social environment, and recognizing intuition as an adequate source of knowledge supported by professionals will facilitate women in making informed infant feeding decisions.

"Fear of stopping" vs "wanting to get off the medication": exploring women's experiences of using domperidone as a galactagogue - a qualitative study

Background

Domperidone is the most frequently prescribed medicine used to increase breast milk supply. There is considerable controversy surrounding the use of domperidone in lactation, due to limited evidence about efficacy and concerns about rare but life-threatening side-effects. Despite this, in many high-income settings such as Australia, use of domperidone among breastfeeding mothers appears to be increasing. The aim of this paper was to explore women’s experiences of using domperidone during breastfeeding.

Methods

Semi-structured interviews were conducted in 2019 with 15 women in Australia who reported using domperidone as a galactagogue during breastfeeding. Interviews were recorded, transcribed and analysed thematically.

Results

Women reported a wide variety of practices concerning the timing of initiation of domperidone use, including prophylactic use, as well as the dose and duration of use. Prolonged periods of use and unsupervised dosing were commonly reported, these practices were sometimes associated with a fear of the consequences of stopping, insufficient provision of information about the drug or feeling dismissed by health professionals. Some women indicated that when doctors refused to prescribe domperidone they responded by doctor shopping and seeking anecdotal information about benefits and risks online, leading to unsupervised practices. Women often reported high expectations surrounding the effectiveness of domperidone, and most used the medication in conjunction with food/herbal galactagogues and non-galactagogue support. Positive outcomes following domperidone use included having greater confidence in breastfeeding and pride at achieving breastfeeding goals.

Conclusions

This study identified a variety of practices concerning domperidone use, including potentially unsafe practices, linked in some cases to inconsistent advice from health professionals and a reliance on online, anecdotal information sources. These findings emphasise the urgent need for development of clinical practice guidelines and a greater focus on translating existing evidence concerning domperidone into clinical practice, including clinical support that is tailored to women’s needs.

Self-conscious emotions and breastfeeding support: A focused synthesis of UK qualitative research

Research on women's experiences of infant feeding and related moral discourse suggests that self‐conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re‐examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self‐conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self‐conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self‐conscious emotions, the template also identified thoughts about self‐evaluation, perceptions of judgement and sense of exposure. Self‐conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding ‘support’ could present challenges to mothering identity and hence to emotional well‐being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self‐conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional ‘antennae’ if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self‐conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters.

The differential role of practical and emotional support in infant feeding experience in the UK

Social support is a known determinant of breastfeeding behaviour and is generally considered beneficial. However, social support encompasses a myriad of different supportive acts, providing scope for diverse infant feeding outcomes. Given the vulnerability of postpartum mental health, this paper aims to explore both how support prolongs breastfeeding and which forms of support promote the positive experience of all infant feeding. Using survey data collected online from 515 UK mothers with infants aged 0-108 weeks, Cox regression models assessed the relationship between receiving different types of support, support need and breastfeeding duration. Quasi-binomial logistic regression models assessed the relationship between receiving support, infant feeding mode and maternal experience of infant feeding. Rates of negative infant feeding experience indicate the widespread need for support: e.g. 38% of currently, 47% of no longer and 31% of never breastfeeding women found infant feeding stressful. Overall, practical support via infant feeding broadly predicted shorter breastfeeding durations and poorer feeding experience; results in relation to other forms of support were more complex. Our findings indicate different forms of support have different associations with infant feeding experience. They also highlight the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Neurobiological limits and the somatic significance of love: Caregivers' engagements with neuroscience in Scottish parenting programmes

While parents have long received guidance on how to raise children, a relatively new element of this involves explicit references to infant brain development, drawing on brain scans and neuroscientific knowledge. Sometimes called 'brain-based parenting', this has been criticised from within sociological and policy circles alike. However, the engagement of parents themselves with neuroscientific concepts is far less researched. Drawing on 22 interviews with parents/carers of children (mostly aged 0-7) living in Scotland, this article examines how they account for their (non-)use of concepts and understandings relating to neuroscience. Three normative tropes were salient: information about children's processing speed, evidence about deprived Romanian orphans in the 1990s, and ideas relating to whether or not children should 'self-settle' when falling asleep. We interrogate how parents reflexively weigh and judge such understandings and ideas. In some cases, neuroscientific knowledge was enrolled by parents in ways that supported biologically reductionist models of childhood agency. This reductionism commonly had generative effects, enjoining new care practices and producing particular parent and infant subjectivities. Notably, parents do not uncritically adopt or accept (sometimes reductionist) neurobiological and/or psychological knowledge; rather, they reflect on whether and when it is applicable to and relevant for raising their children. Thus, our respondents draw on everyday epistemologies of parenting to negotiate brain-based understandings of infant development and behaviour, and invest meaning in these in ways that cannot be fully anticipated (or appreciated) within straightforward celebrations or critiques of the content of parenting programmes drawing on neuropsychological ideas.

Adherence and the Moral Construction of the Self: A Narrative Analysis of Anticoagulant Medication

In this article, we examine illness narratives to illuminate the discursive work that patients undertake to construct themselves as "good" and adherent. Biographical narrative interviews were undertaken with 17 patients receiving anticoagulation for stroke prevention in atrial fibrillation, from five English hospitals (May 2016-June 2017). Through pluralistic narrative analysis, we highlight the discursive tensions narrators face when sharing accounts of their medicine-taking. They undertake challenging linguistic and performative work to reconcile apparently paradoxical positions. We show how the adherent patient is co-constructed through dialogue at the intersection of discourses including authority of doctors, personal responsibility for health, scarcity of resources, and deservingness. We conclude that the notion of medication adherence places a hidden moral and discursive burden of treatment on patients which they must negotiate when invited into conversations about their medications. This discursive work reveals, constitutes, and upholds medicine-taking as a profoundly moral practice.

'I just don't think it's that natural': adolescent mothers' constructions of breastfeeding as deviant

Breastfeeding is recognised globally as the optimal method of infant feeding. For Murphy (1999) its nutritional superiority positions breastfeeding as a moral imperative where mothers who formula-feed are open to charges of maternal deviance and must account for their behaviour. We suggest that this moral superiority of breastfeeding is tenuous for mothers from marginalised contexts and competes with discourses which locate breastfeeding, rather than formula feeding, as maternal deviance. We draw on focus group and interview data from 27 adolescent mothers from socio-economically deprived neighbourhoods in three areas of the UK, and five early years professionals working at a Children's Centre in the Northeast of England. We argue that breastfeeding is constructed as deviance at three 'levels' as (i) a deviation from broad social norms about women's bodies, (ii) a deviation from local mothering behaviours and (iii) a transgression within micro-level interpersonal and familial relationships. Given this positioning of breastfeeding as deviant, breastfeeding mothers feel obliged to account for their deviance. In making this argument, we extend and rework Murphy's (1999) framework to encompass diverse experiences of infant feeding. We conclude with reflections on future research directions and potential implications for practice.

Commercialisation and commodification of breastfeeding: video diaries by first-time mothers

BACKGROUND

Many of aspects of our lives became increasingly commercialised in post-modern society. Although breastfeeding is perhaps a late comer to this process in recent years, it too has seen significant commercialisation facilitated by social media and our obsession with celebrity culture. This paper explores how the commercialisation and commodification of breastfeeding impacts mothers' experiences of breastfeeding.

METHODS

In a qualitative study, five mothers in the United Kingdom recorded their real-time breastfeeding experiences in video diaries. Using a multi-modal method of analysis, incorporating both visual and audio data, a thematic approach was applied.

FINDINGS

Women preparing for breastfeeding are exposed to increasing commercialisation. When things do not go to plan, women are even more exposed to commercial solutions. The impact of online marketing strategies fuelled their need for paraphernalia so that their dependence on such items became important aspects of their parenting and breastfeeding experiences.

CONCLUSIONS

The audio-visual data demonstrated the extent to which "essential" paraphernalia was used, offering new insights into how advertising influenced mothers' need for specialist equipment and services. Observing mothers in their video diaries, provided valuable insights into their parenting styles and how this affected their breastfeeding experience.

Made to Feel Like Less of a Woman: The Experience of Stigma for Mothers Who Do Not Breastfeed

Background: Breastfeeding has become the recognized standard for good parenting, with social costs for not breastfeeding, but not every mother wants to or is able to breastfeed. Objectives: This study investigated social and personal costs with no breastfeeding. Materials and Methods: An in-depth survey was conducted with 250 mothers with infants who were not breastfeeding. Situated in the Framework Integrating Normative Influences on Stigma model for stigma, the study analyzed internalized stigma and perception of stigma from others, maternal feelings of warmth for the infant, and hiding formula use. Results: Mothers who chose not to breastfeed reported little personal or public stigma. In comparison, mothers who were unable to breastfeed experienced relatively more internalized stigma and perceived that other people saw them as failures. Mothers who experienced more internalized and perceived social network stigma were likely to hide use of infant formula from others and had lower feelings of warmth for their infants. Knowledge about formula use and availability of support resulted in less stigma and more warmth for the infant. Conclusions: These results suggest that public responses causing a mother to feel guilty for using infant formula result in negative feelings of self-worth and dysfunctional maternal behaviors.

Breastfeeding woman or lactating object? A critical philosophical discussion on the influence of Cartesian dualism on breastfeeding in the neonatal intensive care unit

AIM

This discursive paper aims to bring to the foreground the ongoing influence of Cartesian dualism and other important contextual complexities on breastfeeding in the neonatal intensive care unit (NICU).

BACKGROUND

Breastfeeding is widely supported as the optimal form of nutrition for the first 6 months of life and beyond. Amidst a myriad of contextual factors, current breastfeeding rates are below globally targeted goals. For premature and/or critically ill infants, the importance of receiving breast milk is often encouraged based on its immunological and nutritive benefits as opposed to the entirety of the breastfeeding interaction, underscoring the influence of dualism in the NICU.

DESIGN

The impact of Cartesian dualism and other sociocultural underpinnings of breastfeeding focused within the NICU environment are illustrated through a critical, philosophical discussion.

METHODS

Relevant historical context is provided followed by an overview of the realities of contemporary breastfeeding. These are presented as a frame of reference for the NICU breastfeeding experiences currently encountered by many mothers of preterm and critically ill neonates, further illustrated using a clinical exemplar as well as the author's own observations from neonatal nursing practice.

RELEVANCE TO CLINICAL PRACTICE

Shifting away from a dualistic approach requires rethinking breastfeeding support interactions between NICU nurses and mothers. To address the disembodied and often mechanistic approach to care inherent in the dominant Western medical model, a relational approach to breastfeeding support in the NICU is suggested and discussed.

CONCLUSION

Future research from a more critical lens is needed to examine the complex dynamics involved when nurses and mothers are negotiating decisions and processes related to infant feeding. In focusing on the relational dimensions of the breastfeeding experience, nurses can resist the dualistic influence and dominant discourses impacting infant feeding and motherhood in the 21st century.

What Do Women Lose if They Are Prevented From Meeting Their Breastfeeding Goals?

This article explores the complex issue of breastfeeding and maternal mental health. Many women stop breastfeeding before they are ready, often leading to feelings of anxiety, guilt, and anger. Critics of breastfeeding promotion blame breastfeeding advocates for this impact, claiming that if the focus were merely on feeding the baby, with all methods equally valued and supported, maternal mental health would be protected. Established health impacts of infant feeding aside, this argument fails to account for the importance of maternal breastfeeding goals, or the physical and emotional rewards breastfeeding can bring. Although some women will take comfort in the message that what matters most is that the baby is fed, others view such suggestions as a lack of recognition of their wishes and the loss that they feel, exacerbating their grief and frustration. The purpose of this article is to highlight the importance of recognizing and valuing women’s individual breastfeeding goals, and not dismissing or invalidating their experience if they do not meet these by telling them that they do not matter. To move forward, we must recognize the impact of all infant feeding experiences, consider the impact of public messaging, and work to support more women to meet their goals.

Boundary Creatures? Employed, Breastfeeding Mothers and ‘Abjection as Practice’

This paper contributes to theory on maternity, embodiment and organizations through advancing a contemporary theory of ‘abjection as practice’ in relation to breastfeeding and employment. Drawing upon the work of Margaret Shildrick and Julia Kristeva, it analyses a qualitative study of netnographic (internet) discussions among employed breastfeeding mothers, observing how lactating bodies are treated as abject within organizations. It proposes that hostile behaviour towards breastfeeding women could be seen as a form of ‘abjection as practice’, displaying a purposeful intent to exclude breast milk production from workplace contexts. In exploring the position of breastfeeding workers, the paper observes how breastfeeding women occupy an uncomfortable space on the borders between health ideals of ‘proper’ mothering and organizational notions of ‘good’ worker. The situation of breastfeeding employees is rendered ambiguous and such uncertainties invoke co-worker antipathy. Co-worker hostility towards breastfeeding colleagues appears validated at work because minimal action is taken to address deliberate utilization of ‘abjection as practice’ towards breastfeeding workers.

Using narrative inquiry to listen to the voices of adolescent mothers in relation to their use of social networking sites (SNS)

AIM

This article presents a discussion highlighting the relevance and strengths of using narrative inquiry to explore experiences of social networking site (SNS) use by adolescent mothers.

BACKGROUND

Narrative inquiry as a method reveals truths about holistic human experience. Knowledge gleaned from personal narratives informs nursing knowledge and clinical practice. This approach gives voice to adolescent mothers in relation to their experiences with SNS as a means of providing social support.

DESIGN

Discussion paper.

DATA SOURCES

This paper draws and reflects on the author's experiences using narrative inquiry and is supported by literature and theory. The following databases were searched: CINAHL, Cochrane Library, Medline, Scopus, ERIC, ProQuest, PsychINFO, Web of Science and Health Collection (Informit). Key terms and Boolean search operators were used to broaden the search criteria. Search terms included: adolescent mother, teenage mother, "social networking sites", online, social media, Facebook, social support, social capital and information. Dates for the search were limited to January 1995-June 2017.

IMPLICATIONS FOR PRACTICE/RESEARCH

Narrative research inherently values the individual "story" of experience. This approach facilitates rapport building and methodological flexibility with an often difficult to engage sample group, adolescents.

CONCLUSION

Narrative inquiry reveals a deep level of insight into social networking site use by adolescent mothers. The flexibility afforded by use of a narrative approach allows for fluidity and reflexivity in the research process.

The Role of Social-Cognitive and Emotional Factors on Exclusive Breastfeeding Duration

BACKGROUND

Previous research has suggested that exclusive breastfeeding is likely to be predicted by social-cognitive variables and fear. However, there is little research assessing the role of regret and self-conscious emotions (e.g., pride and guilt) in promoting exclusive breastfeeding. Research aim: The primary aim of this research was to determine whether social-cognitive variables, fear, regret, and self-conscious emotions predict exclusive breastfeeding duration. The secondary aim of this research was to assess whether these factors predict infant-feeding choice (i.e., exclusively breastfed, combination fed, or generally formula fed).

METHODS

In this nonexperimental one-group self-report survey, 375 mothers rated social-cognitive variables toward breastfeeding (attitude, subjective norm, perceived control, and self-efficacy), their fear toward inadequate nutrition from breastfeeding and breastfeeding damaging their physical appearance, and the extent to which mothers may feel pride toward breastfeeding and negative self-conscious emotions (guilt and shame) and regret for not breastfeeding their infant.

RESULTS

Exclusive breastfeeding duration was positively predicted by self-efficacy, pride, and regret but negatively predicted by the fear toward inadequate nutrition. We also found that in contrast with exclusive breastfeeding, generally formula feeding an infant was associated with lower self-efficacy, pride, and regret but higher subjective norm and fear toward inadequate nutrition through breastfeeding.

CONCLUSION

The authors argue that it is important to consider the role of self-conscious emotions and regret on exclusive breastfeeding.

Improving Breastfeeding Support by Understanding Women's Perspectives and Emotional Experiences of Breastfeeding

Exclusive breastfeeding for at least 6 months is universally acknowledged as the optimal means of infant nutrition. However, current studies show that most women are not following this recommendation. Many studies address the issue of increasing breastfeeding rates, but fewer explore the perspectives and experiences of breastfeeding women. In this article we review the literature and identify common themes in women's breastfeeding experiences. Nurses and other health care providers stand to help or hinder breastfeeding women, and they must be aware of and sensitive to women's personal experiences and perspectives to understand how to best promote and support women in their attempts to meet their breastfeeding goals.

"The right help at the right time": Positive constructions of peer and professional support for breastfeeding

Problem or issue

Support during the early establishment phase of breastfeeding is important but women report that health professionals can undermine their confidence with breastfeeding.

What is already known

Breastfeeding support provided in fragmented hospital based models of care predominantly reflect authoritative expert advice-giving which women describe as conflicting and unsupportive. Women show a preference for support from a known midwife, or a peer supporter, or a combination of the two.

What this paper adds

Peer support counsellors and privately practicing midwives approached breastfeeding support in a similar way. They interacted with women as a ‘knowledgeable friend’ and normalised breastfeeding challenges which enhanced women’s confidence with breastfeeding.

Understanding process and context in breastfeeding support interventions: The potential of qualitative research

Considerable effort has been made in recent years to gain a better understanding of the effectiveness of different interventions for supporting breastfeeding. However, research has tended to focus primarily on measuring outcomes and has paid comparatively little attention to the relational, organizational, and wider contextual processes that may impact delivery of an intervention. Supporting a woman with breastfeeding is an interpersonal encounter that may play out differently in different contexts, despite the apparently consistent aims and structure of an intervention. We consider the limitations of randomized controlled trials for building understanding of the ways in which different components of an intervention may impact breastfeeding women and how the messages conveyed through interactions with breastfeeding supporters might be received. We argue that qualitative methods are ideally suited to understanding psychosocial processes within breastfeeding interventions and have been underused. After briefly reviewing qualitative research to date into experiences of receiving and delivering breastfeeding support, we discuss the potential of theoretically informed qualitative methodologies to provide fuller understanding of intervention processes by focusing on three examples: phenomenology, ethnography, and discourse analysis. The paper concludes by noting some of the epistemological differences between the broadly positivist approach of trials and qualitative methodologies, and we suggest there is a need for further dialog as to how researchers might bridge these differences in order to develop a fuller and more holistic understanding of how best to support breastfeeding women.

The theory of agency and breastfeeding

OBJECTIVE

In this paper, we apply psychological agency theory to women's interviews of their breastfeeding experiences to understand the role of agency in relation to breastfeeding initiation, maintenance and duration.

DESIGN

Qualitative, video interviews were collected from 49 women in the UK from a wide range of ethnic, religious, educational and employment backgrounds about their breastfeeding experiences. We undertook secondary analysis of the data focusing on their accounts of vulnerability and agency.

FINDINGS

Women's agency was impacted by a variety of factors including their own vulnerability, knowledge, expectations and experience, the feeding environment and the support of health professionals in sharing decision-making and dealing with uncertainty.

CONCLUSION

Health professionals as co-agents with women are well positioned to maintain, enhance or restore women's sense of agency. Breastfeeding goals should be included in women's birth plans. Training related to agency, continuity of care, and staffing and workload management supported by national breastfeeding policies could improve breastfeeding rates and experiences.

Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the U.S. and the U.K

Recent public health breastfeeding promotion efforts have galvanized media debates about breastfeeding in wealthy, Euro-American settings. A growing body of research demonstrates that while breastfeeding is increasingly viewed as important for health, mothers continue to face significant structural and cultural barriers. Concerns have been raised about the moralizing aspects of breastfeeding promotion and its detrimental effects on those who do not breastfeed. Far less, however, is known about the moral experiences of those who pursue breastfeeding. This study draws together research on breastmilk sharing (2012-2016) and nighttime breastfeeding from the U.S. (2006-2009), and long-term breastfeeding from the U.K. (2008-2009) from three ethnographic projects to address this gap. Comparative analysis of these cases reveals that while breastfeeding is considered ideal infant nutrition, aspects of its practice continue to evoke physical and moral danger, even when these practices are implemented to facilitate breastfeeding. Breastmilk sharing to maintain exclusive breastmilk feeding, nighttime breastfeeding and bedsharing to facilitate breastfeeding, and breastfeeding beyond the accepted duration are considered unnecessary, unhealthy, harmful or even deadly. The sexual connotations of breastfeeding enhance the morally threatening qualities of these practices. The cessation of these "problematic" breastfeeding practices and their replacement with formula-feeding or other foods is viewed as a way to restore the normative social and moral order. Mothers manage the stigmatization of these breastfeeding practices through secrecy and avoidance of health professionals and others who might judge them, often leading to social isolation. Our findings highlight the divide between perceptions of the ideal of breastfeeding and its actual practice and point to the contested moral status of breastfeeding in the U.S. and the U.K. Further comparative ethnographic research is needed to illuminate the lived social and moral experiences of breastfeeding, and inform initiatives to normalize and support its practice without stigmatizing parents who do not breastfeed.

Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment and mental health care planning

Background

Communication and information sharing are considered crucial to recovery‐focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety.

Objective

Using data from our cross‐national mixed‐method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans.

Design

Thematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template.

Findings

Participants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment.

Conclusions

Despite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.

UK women's experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services

BACKGROUND

Whilst 81 % of UK women initiate breastfeeding, there is a steep decline in breastfeeding rates during the early postnatal period, with just 55 % of women breastfeeding at six weeks. 80 % of these women stopped breastfeeding sooner than they intended, with women citing feeding difficulties and lack of adequate support. As part of efforts to increase breastfeeding continuation rates, many public and voluntary organisations offer additional breastfeeding support services, which provide practical support in the early postnatal period and beyond. This paper focuses on the qualitative experiences of UK users of Baby Café services to examine their experiences of breastfeeding and breastfeeding support.

METHODS

The study was based upon in-depth interviews and focus groups with users of eight Baby Café breastfeeding support groups across the UK. Thirty-six interviews and five focus groups were conducted with a total of fifty-one mothers using the service. Interviews and group discussions were analysed using N Vivo software to draw out key themes and discussions.

RESULTS

Whilst each mother's infant feeding journey is unique, reflecting her own personal circumstances and experiences, several themes emerged strongly from the data. Many women felt that they had been given unrealistic expectations of breastfeeding by professionals keen to promote the benefits. This left them feeling unprepared when they encountered pain, problems and relentlessness of early infant feeding, leading to feelings of guilt and inadequacy over their feeding decisions. Mothers valued the combination of expert professional and peer support provided by Baby Café services and emphasised the importance of social support from other mothers in enabling them to continue feeding for as long as they wished.

CONCLUSIONS

The research emphasises the need for realistic rather than idealistic antenatal preparation and the importance of timely and parent-centred breastfeeding support, particularly in the immediate postnatal weeks. The findings suggest that effective social support, combined with reassurance and guidance from skilled practitioners, can help women to overcome difficulties and find confidence in their own abilities to achieve their feeding goals. However, further work is needed to make sure such services are readily accessible to women from all sectors of the community.

'This little piranha': a qualitative analysis of the language used by health professionals and mothers to describe infant behaviour during breastfeeding

Exclusive breastfeeding for the first 6 months of life offers the recommended best start in the life for a newborn baby. Yet, in Australia only a small number of babies receive breast milk exclusively for the first 6 months. Reasons for the introduction of formula milk are multi-factorial including access to appropriate support and the woman's experience of breastfeeding. The language and practices of health professionals can impact upon how a woman feels about breastfeeding and her breastfeeding body. One aspect of breastfeeding support that has had scarce attention in the literature is the language used by health professionals to describe the behaviour of the breastfeeding infant during the early establishment phase of breastfeeding. This paper reveals some of the ways in which midwives, lactation consultants and breastfeeding women describe the newborn baby during the first week after birth. The study was conducted at two maternity units in New South Wales. Interactions between midwives and breastfeeding women were observed and audio recorded on the post-natal ward and in women's homes, in the first week after birth. The transcribed data were analysed using discourse analysis searching for recurring words, themes and metaphors used in descriptions of the breastfeeding baby. Repeated negative references to infant personality and unfavourable interpretations of infant behaviour influenced how women perceived their infant. The findings revealed that positive language and interpretations of infant breastfeeding behaviour emerged from more relationship-based communication.

Artificial milk-feeding women׳s views of their feeding choice in Ireland

OBJECTIVE

despite the well-documented benefits of breast feeding to both mother and child, breast-feeding initiation rates in Ireland are the second lowest in Europe. This study set out to explore the views of women from low socio-economic groups in Ireland on their choice to feed their infants artificial milk, and to elicit factors that may encourage these women to breast feed in the future.

DESIGN

a qualitative descriptive approach was used.

METHODS

data were collected through recorded focus groups and individual interviews, using a semi-structured interview schedule. Data were transcribed verbatim.

SETTING

interviews took place in two regions in the Republic of Ireland, north and south.

PARTICIPANTS

a purposive sample was drawn from the population of 2572 women taking part in the Irish Infant Feeding Study who had never breast fed previously, had intended to, and had, fed this infant artificial milk and who had completed their education before they were 18 years of age. Two focus groups with two women in each were conducted and six women took part in individual interviews.

ANALYSIS

constant comparative analysis was performed to construct the categories and concepts that led to the final themes.

FINDINGS

these artificial milk-feeding women based their infant feeding decision on many social and experiential factors. The major influences on their decisions were: personal attitudes toward feeding methods, and external influences on infant feeding methods. Attitudes towards other women and feeding future infants reinforced a strong preference towards artificial milk feeding.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

it is apparent that a prevailing culture that is unreceptive to breast feeding and the lack of positive breast-feeding role models, contributed to a strong commitment to artificial milk feeding for these participants. Promotion of breast feeding must take account of the complex contexts in which women make decisions. Advice regarding breast feeding should take account of women׳s feelings and avoid undue pressure, while still promoting the benefits of breast feeding to women and their families.

When 'breast' is no longer 'best': Post-partum constructions of infant-feeding in the hospital

In this paper, we focus on the initial experiences of breastfeeding among mothers to examine the ways that infant-feeding is socially constructed in the hospital. Data comes from 51 in-depth interviews with 17 first-time mothers in Ontario, Canada. Analysis reveals 52 magnified moments that we categorize as Successful, Ultimately Successful and Unsuccessful. For mothers who describe Successful and Ultimately Successful moments, breastfeeding is understood as physiologically natural, and as something they must learn to do. Unsuccessful moments reveal that when health care providers interpret breastfeeding as not working, the breastfeeding discourse frequently shifts to one that incorporates formula as the means to achieve optimal infant health. In other words, in the hospital 'breast is best' holds true when breast 'works', otherwise mothers are often directed to give their babies formula. While formula appears to be compulsory in these moments, it is not typically understood as a "good or best" infant-feeding practice. For mothers in this situation, the shift from breast to formula is experienced as failures or evidence of inadequacy in their mothering. Paradoxically, our results suggest that formula may not, in and of itself, pose a threat to mothers' overall continued practice of breastfeeding. It appears that Successful and Ultimately Successful moments coincide with the current dominant 'breast is best' understanding. Unsuccessful moments, conversely, are insightful because they reveal when and how hospital practices disrupt mothers' understanding of their bodies and their role in providing the 'best' form of infant food. The implications for policy and practice are discussed.

Expressionists of the twenty-first century: the commodification and commercialization of expressed breast milk

Breast milk expression has been promoted as liberating for women and as offering them more choices, but there has been little research on women's experiences of it and even less critical commentary on the consequences of its incorporation into mainstream behavior. Drawing on narratives of women in the United Kingdom about breastfeeding, we explore the increasingly popular practice of expressing and feeding expressed breast milk. We argue that breast milk has become commodified, breastfeeding commercialized and technologized, and the mother-infant relationship disrupted. We suggest that breastfeeding as a process is being undermined by vested interests that portray it as unreliable and reconstruct it in artificial feeding terms, so playing on women's insecurities. The major beneficiaries of expression are fathers who want increased involvement in infant care and commercial enterprises that aim to maximize profits for shareholders.

Significant others, situations and infant feeding behaviour change processes: a serial qualitative interview study

Background

Exclusive breastfeeding until six months followed by the introduction of solids and continued breastfeeding is recommended by the World Health Organisation. The dominant approach to achieving this has been to educate and support women to start and continue breastfeeding rather than understanding behaviour change processes from a broader perspective.

Method

Serial qualitative interviews examined the influences of significant others on women’s feeding behaviour. Thirty-six women and 37 nominated significant others participated in 220 interviews, conducted approximately four weekly from late pregnancy to six months after birth. Responses to summative structured questions at the end of each interview asking about significant influences on feeding decisions were compared and contrasted with formative semi-structured data within and between cases. Analysis focused on pivotal points where behaviour changed from exclusive breastfeeding to introducing formula, stopping breastfeeding or introducing solids. This enabled us to identify processes that decelerate or accelerate behaviour change and understand resolution processes afterwards.

Results

The dominant goal motivating behaviour change was family wellbeing, rather than exclusive breastfeeding. Rather than one type of significant other emerging as the key influence, there was a complex interplay between the self-baby dyad, significant others, situations and personal or vicarious feeding history. Following behaviour change women turned to those most likely to confirm or resolve their decisions and maintain their confidence as mothers.

Conclusions

Applying ecological models of behaviour would enable health service organisation, practice, policy and research to focus on enhancing family efficacy and wellbeing, improving family-centred communication and increasing opportunities for health professionals to be a constructive influence around pivotal points when feeding behaviour changes. A paradigm shift is recommended away from the dominant approach of support and education of individual women towards a more holistic, family-centred narrative approach, whilst acknowledging that breastfeeding is a practical skill that women and babies have to learn.

Professionalisation of a breast-feeding peer support service: issues and experiences of peer supporters

OBJECTIVES

to describe the issues faced by breast-feeding peer supporters as their roles altered from a voluntary to a professionalised role with targets, accountability and more formalised interface with health professionals.

DESIGN

a descriptive qualitative study utilising group and individual semi-structured interviews, with thematic network analysis.

SETTING

19 breast-feeding peer supporters were consulted from one peer support service located in the UK.

FINDINGS

thematic network analysis of the peer supporter data generated a global theme of 'Professionalising Breast-feeding Peer Support'. The three underpinning organising themes (and their associated basic themes): 'visibility and communication', 'guardianship of knowledge' and 'roles and boundaries' revealed the early and transitional tensions and anxieties that peer supporters faced when their role altered from a voluntary position to a formal model of service delivery, particularly within the clinical environment.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

professionalisation of peer support can lead to benefits in terms of providing a standardised and comprehensive service with increased capacity for service provision. However, the transitional difficulties faced by the peer supporters as they moved from a voluntary into a professionalised role included a lack of identity; restricted time to care for new mothers; pressures and anxieties of meeting targets and accountability of case recording and the hostility and gatekeeping practices experienced amongst some of the health professionals. Flexible systems incorporating service-user involvement and needs-led strategies may help to overcome these issues.

“Giving Guilt the Flick”?

Manuals offering advice to new parents on the topic of infant feeding have recently begun to attend to the possible implications of pro-breast-feeding discourses for mothers’ subjective experiences, particularly with respect to guilt. In this article, we present a discursive analysis of focus groups with 35 Australian mothers in which we examine how mothers discuss their infant-feeding practices and their related subjective experiences. We focus on how the mothers draw upon notions of “guilt,” “choice,” and “emotional self-control” to attend to the possibility of moral judgment over their infant-feeding practices. We highlight a construction of choice that dramatically restricts permissible reasons for not breast-feeding one’s infant and a pervasive view that guilt is a natural and appropriate response for “good” mothers who do not breast-feed. We argue that the incorporation of advice to mothers that they should “not feel guilty” is unrealistic in a context in which breast-feeding is so heavily advocated and that, rather than providing relief or comfort, this advice can create an additional burden for mothers who do not breast-feed. Finally, we reflect upon the implications of our findings in relation to the provision of public health information to women making choices around how to feed their infants.

A serial qualitative interview study of infant feeding experiences: idealism meets realism

OBJECTIVE

To investigate the infant feeding experiences of women and their significant others from pregnancy until 6 months after birth to establish what would make a difference.

DESIGN

Qualitative serial interview study.

SETTING

Two health boards in Scotland.

PARTICIPANTS

72 of 541 invited pregnant women volunteered. 220 interviews approximately every 4 weeks with 36 women, 26 partners, eight maternal mothers, one sister and two health professionals took place.

RESULTS

The overarching theme was a clash between overt or covert infant feeding idealism and the reality experienced. This is manifest as pivotal points where families perceive that the only solution that will restore family well-being is to stop breast feeding or introduce solids. Immediate family well-being is the overriding goal rather than theoretical longer term health benefits. Feeding education is perceived as unrealistic, overly technical and rules based which can undermine women's confidence. Unanimously families would prefer the balance to shift away from antenatal theory towards more help immediately after birth and at 3-4 months when solids are being considered. Family-orientated interactive discussions are valued above breastfeeding-centred checklist style encounters.

CONCLUSIONS

Adopting idealistic global policy goals like exclusive breast feeding until 6 months as individual goals for women is unhelpful. More achievable incremental goals are recommended. Using a proactive family-centred narrative approach to feeding care might enable pivotal points to be anticipated and resolved. More attention to the diverse values, meanings and emotions around infant feeding within families could help to reconcile health ideals with reality.

Calling, permission, and fulfillment: the interembodied experience of breastfeeding

Drawing on examples from in-depth interviews with 49 women, in this article we aim to open up a discursive space for women and health professionals to begin to explore the phenomenon of the interembodied experience of breastfeeding. Although acknowledging that social dimensions partially constitute the lived body, we further the view that the lived body's understanding is embedded in contexts far more complex than those that can be represented by language. We argue that women's narratives of their breastfeeding experience contained instances of the body "understanding" its emotional task at a prelogical, preverbal level. We identified three central, iterative dimensions of the phenomenon—calling, permission, and fulfillment—that occurred prereflexively in the protected space provided by the mother, a space that was easily disrupted by unsupportive postnatal practices. We offer this eidetic understanding and conceptual framework and suggest that it provides new (less damaging) subject positions and ways of behaving.