An interpretive phenomenological analysis of the experiences of mothers who continue to breastfeed despite facing difficulties

BACKGROUND

Breastfeeding offers many health benefits to mother and infant.

PROBLEM

Breastfeeding difficulties are common and are linked with postnatal distress.

AIM

To explore the lived experiences of breastfeeding continuation despite facing difficulties.

METHODS

Qualitative semi-structured interviews were conducted with eight women who had experienced breastfeeding difficulties yet continued breastfeeding. Interviews were analysed using Interpretative Phenomenological Analysis (IPA).

FINDINGS

The first superordinate theme, 'Radical acceptance of the imperfect' included sub-themes of: 'Taking it day-by-day', 'Breastfeeding takes a community', and, 'Finding what works for you'. The second superordinate theme, 'Determination and persistence' included sub-themes of: 'Adopting a headstrong attitude' and 'Transient challenges versus lifelong achievement'.

DISCUSSION

Participants found radical acceptance of breastfeeding as an imperfect, variable process which enabled them to sustain breastfeeding despite challenges. Participants proactively drew on social and personal resources to navigate guidance and to find solutions which worked for their individual circumstances. Finally, open-mindedness, optimism, self-compassion, and being headstrong and determined were all personal qualities which facilitated breastfeeding during exceptionally difficult moments on their breastfeeding journey.

CONCLUSION

Recommendations are made for healthcare professionals: to provide emotional counselling during routine care (with an aim to instil breastfeeding self-efficacy) and to encourage breastfeeding advocacy among fathers and the maternal social support network (with an aim to further scaffold successful breastfeeding). Recommendations are also made for mothers: to develop and refine maternal confidence, patience, flexibility, self-compassion, and trust.

What makes a good mother? Two decades of research reflecting social norms of motherhood

Over the past two decades, scholars have investigated a multitude of different aspects of motherhood. This article provides a scoping review of research published from 2001 to 2021, covering 115 Social Science Citation Index-referenced papers from WEIRD countries, with the aim of reconstructing social norms around motherhood and mothers' responses to them. The analysis is theoretically based on normological and praxeological concepts. The findings reveal five contemporary norms of motherhood that reflect both stability and increasing differentiation, and are related to five types of mothers: the norms of being attentive to the child (present mother), of securing the child's successful development (future-oriented mother), of integrating employment into mothering (working mother), of being in control (public mother), and of being contented (happy mother). Relying on an intersectional lens, we analyze mothers' heterogeneous responses to these norms of motherhood, and examine how neoliberal demands build on and perpetuate inequalities.

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.

Guilt, shame, and postpartum infant feeding outcomes: A systematic review

Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: 'underprepared and ineffectively supported', 'morality and perceived judgement' (breastfeeding), 'frustration with infant feeding care' and 'failures, fears and forbidden practice' (formula feeding). Both guilt and shame were associated with self-perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.

The “good” epidural: Women’s use of epidurals in relation to dominant discourses on “natural” birth

Childbirth is widely recognized to be among the most painful of experiences, and the most common and effective pain relief for birthing women is known to be the use of epidural analgesia. The increase in the use of epidural analgesia for birthing women has been described by some critics as a by-product of the medicalized model of birth, although there remains a notable dearth of research regarding women’s experiences of epidurals. The present paper seeks to address this research gap by examining how first-time mothers in Iceland discuss their intentions concerning pain relief during birth, along with how they construct childbirth-related pain and the use of epidural analgesia in the context of a midwife-led model of care and an institutionalized preference for “natural” birth. The findings demonstrate that, despite initial intentions, most of the women end up having an epidural, and most describe their epidurals as both wonderful and immensely helpful. The dominant narrative about “natural” childbirth being preferable is not fully refuted by this. Instead, the women either align themselves with the ideology of the capable and knowing body or resist and contest this narrative by constructing their birthing bodies as open to, and in need of, assistance.

Improving mother-infant interaction during infant feeding: A randomised controlled trial in a low-income community in South Africa

BACKGROUND

Maternal-infant feeding interactions are a primary context for engagement between mothers and their infants, and constitute a unique space in which reciprocity, attunement and maternal sensitivity can be expressed. Increasingly, research demonstrates the importance of the psychological and social nature of the feeding context, and how it may be affected by maternal mental state, feeding skills and sensitivity. As such, feeding interactions may provide useful contexts for observations of maternal sensitivity, reflecting well on day-to-day maternal sensitivity.

AIMS AND OBJECTIVES

This paper is a post hoc examination of the impact of an intervention on maternal sensitivity during a feeding interaction when the infants were 6 months old.

PARTICIPANTS

A total of 449 women consented to participate in the original intervention and were randomly assigned to the intervention or control groups. Mothers and infants were assessed during pregnancy, and then at 2, 6, 12 and 18 months of infant age. At the 6 month follow-up visit, 79% (354 out of 449) of the participants were retained. Post hoc analyses were conducted on the original sample to determine breastfeeding status. Sixty-nine percent of the women completed the feeding observation at the 6 months follow-up visit, of which 47% reported exclusively breastfeeding and 22% reported bottle-feeding.

RESULTS

Results demonstrated that during a feeding interaction, maternal sensitivity was significantly improved among non-breastfeeding mothers who received the intervention. Particularly, maternal responsiveness to infant cues and synchronous interactions was higher among non-breastfeeding intervention mothers compared to control group mothers. The results also show that non-breastfeeding mothers who received the intervention were significantly less intrusive in their interactions with their infants.

CONCLUSION

The intervention had particular beneficial effects for mothers who were not breastfeeding and suggest that the intervention offered a protective effect for non-breastfeeding mothers.

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.

Women's Choice Regarding Breastfeeding and Its Effect on Well-Being

Because of the many known maternal and neonatal health benefits of breastfeeding, there have been significant efforts to encourage exclusive breastfeeding, and many hospitals follow the guidelines of the Baby-Friendly Hospital Initiative. However, even with the right support, many women are unable to exclusively breastfeed, which may make them feel anxious and/or depressed. Psychological pressure to exclusively breastfeed has the potential to contribute to postpartum depression symptoms in new mothers who are unable to achieve their breastfeeding intentions. In this commentary, we focus on the well-being of the mother-infant dyad and argue for further research on maternal stress related to breastfeeding difficulties or pressure and the need to physically and psychologically assess and support women who are unable to breastfeed successfully or exclusively.

Media Presentation of Breastfeeding Beliefs in Newspapers

Despite numerous health benefits for babies and mothers, many women do not either initiate or continue breastfeeding for the recommended duration, and increasing breastfeeding is a national priority. It is important to understand media messages on the topic, given that breastfeeding is influenced by many environmental factors and that perceived norms, social support, and perceptions of difficulties predict breastfeeding. The current study analyzes how media covers (1) breastfeeding in general, (2) public breastfeeding, and (3) extended breastfeeding (past 1 year). Guided by the theory of planned behavior, this study analyzes 318 news articles sampled from 10 of the most commonly read mainstream newspapers from 2008-2013. This sample covers a wide range of topics related to breastfeeding, including health benefits, societal reform efforts, social/human interest stories, parenting choices, and stories about pumped breast milk and formula. The results indicate approving social norms by public health officials and medical professionals about breastfeeding in general. A significantly larger number of articles discussed positive behavioral beliefs associated with breastfeeding rather than negative behavioral beliefs. However, articles more often presented barriers, rather than factors that facilitate breastfeeding. Theoretical and practical implications are discussed.

Infant formula feeding practices and the role of advice and support: an exploratory qualitative study

Background

Infant formula feeding practices are an important consideration for obesity prevention. An infant’s diet is influential on their later risk of developing overweight or obesity, yet very little is known about infant formula feeding practices. It is plausible that certain modifiable practices may put children at higher risk of developing overweight or obesity, for example how much and how often a baby is fed. Understanding how parents use infant formula and what factors may influence this practice is therefore important. Moreover, parents who feed their infants formula have identified a lack of support and access to resources to guide them. Therefore this study aimed to explore parents’ infant formula feeding practices to understand how parents use infant formula and what factors may influence this practice.

Methods

Using an explorative qualitative design, data were collected using semi-structured telephone interviews and analysed using a pragmatic inductive approach to thematic analysis.

Results

A total of 24 mothers from across Australia were interviewed. Mothers are influenced by a number of factors in relation to their infant formula feeding practice. These factors include information on the formula tin and marketing from formula manufacturers, particularly in relation to choosing the type of formula. Their formula feeding practices are also influenced by their interpretation of infant cues, and the amount of formula in the bottle. Many mothers would like more information to aid their practices but barriers exist to accessing health professional advice and support, so mothers may rely on informal sources. Some women reported that the social environment surrounding infant feeding wherein breastfeeding is promoted as the best option leads a feeling of stigma when formula feeding.

Conclusions

Additional support for parents’ feeding their infants with formula is necessary. Health professionals and policy around infant formula use should include how formula information may be provided to parents who use formula in ways that do not undermine breastfeeding promotion. Further observational research should seek to understand the interaction between advice, interpretation of cues and the amount formula fed to infants.

Electronic supplementary material

The online version of this article (10.1186/s12887-017-0977-7) contains supplementary material, which is available to authorized users.

The emotional and practical experiences of formula-feeding mothers

The majority of infant-feeding research is focused on identifying mother's reasons for the cessation of breastfeeding. The experience of mothers who choose to use formula is largely overlooked in quantitative designs. This study aimed to describe the emotional and practical experiences of mothers who formula feed in any quantity, and examine whether these experiences would vary among different cohorts of formula-feeding mothers according to prenatal feeding intention and postnatal feeding method. A total of 890 mothers of infants up to 26 weeks of age, who were currently formula feeding in any quantity, were recruited through relevant international social media sites via advertisements providing a link to an online survey. Predictors of emotional experiences included guilt, stigma, satisfaction, and defense as a result of their infant feeding choices. Practical predictor variables included support received from health professionals, respect displayed by their everyday environment, and main sources of infant feeding information. Descriptive findings from the overall sample highlighted a worryingly high percentage of mother's experienced negative emotions as a result of their decision to use formula. Multinomial logit models revealed that negative emotions such as guilt, dissatisfaction, and stigma were directly associated with feeding intention and method. The evidence suggests that the current approach to infant-feeding promotion and support may be paradoxically related to significant issues with emotional well-being. These findings support criticisms of how infant-feeding recommendations are framed by health care professionals and policy makers, and highlight a need to address formula feeding in a more balanced, woman-centered manner.

“Living for others”: Narrating agency in the context of failed marriages and singleness in urban Sri Lanka

Marriage is a cultural imperative in Sri Lanka and is constructed as the principal source of personal fulfilment for women. This paper critically examines through two case studies – a never-married woman and a woman in a “failed” marriage – how women from older generations narrate their life histories using culturally coherent repertoires. By deconstructing the subject positions of the “long-suffering wife”, the “devoted mother”, and the “selfless woman”, I reveal the spaces for manoeuvre these women create to experience well-being and exercise agency outside of the culture’s “hegemonic narrative” of successful marriage and maternity. Using the life history narratives I challenge the tendency to imagine older women’s lives as more constrained and illustrate the ways in which equivocal narratives about independence and self-sacrifice, about freedom and suffering simultaneously conceal agency while allowing non-normative ways of being.

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.

Differences in the emotional and practical experiences of exclusively breastfeeding and combination feeding mothers

The majority of research examining the barriers to breastfeeding focuses on the physical challenges faced by mothers rather than the risks of encountering negative emotional and practical feeding experiences. We aimed to quantify the emotional and practical experiences of the overall sample of breastfeeding mothers and identify the differences in the emotional and practical experiences of exclusively breastfeeding mothers and combination feeding mothers, by feeding type and intention. Eight hundred forty-five mothers with infants up to 26 weeks of age and who had initiated breastfeeding were recruited through relevant social media via advertisements providing a link to an online survey. Predictors of emotional experiences included guilt, stigma, satisfaction with feeding method, and the need to defend themselves due to infant feeding choices. Practical predictors included perceived support from health professionals, main sources of infant feeding information, and respect from their everyday environment, workplace, and when breastfeeding in public. Current feeding type and prenatal feeding intention. In the overall sample, 15% of the mothers reported feeling guilty, 38% stigmatized, and 55% felt the need to defend their feeding choice. Binary logit models revealed that guilt and dissatisfaction were directly associated with feeding type, being higher when supplementing with formula. No associations with feeding intention were identified. This study demonstrates a link between current breastfeeding promotion strategies and the emotional state of breastfeeding mothers who supplement with formula to any extent. To minimize the negative impact on maternal well-being, it is important that future recommendations recognize the challenges that exclusive breastfeeding brings and provide a more balanced and realistic target for mothers.

'That's just what's expected of you … so you do it': mothers discussions around choice and the MMR vaccination

One of the major shifts in the form and experience of contemporary family life has been the increasing insertion of the 'expert' voice into the relationship between parents and children. This paper focuses on an exploration of mothers' engagement with advice around the combined measles, mumps and rubella (MMR) vaccine. Much of the previous literature utilises a 'decision-making' framework, based on 'risk assessment' whereby mothers' decisions are conceptualised as rooted in complex belief systems, and supposes that that by gaining an understanding of these systems, beliefs and behaviour can be modified and uptake improved. However, less attention has been paid to the ways in which mothers negotiate such advice or the ways in which advice is mediated by positionings, practices and relationships. Analysis of data from a focus group with five mothers identified three themes: (i) Sourcing advice and information, (ii) Constructing 'Mother knows best' and (iii) Negotiating agency. Despite the trustworthiness of advice and information being questioned, an awareness of concerns about the MMR, and health professionals being constructed as remote, ultimate conformity to, and compliance with, the 'system' and 'society' were described as determining MMR 'decisions'.

'The midwives aren't allowed to tell you': perceived infant feeding policy restrictions in a formula feeding culture - the Feeding Your Baby Study

OBJECTIVE

to explore the expectations and experiences of postnatal mothers in relation to infant feeding, and to identify how care could be improved.

DESIGN

this study used a qualitative, exploratory, descriptive design. Data were collected through one to one in-depth semi-structured interviews and focus groups.

SETTING

Tayside area of Eastern Scotland.

PARTICIPANTS

seven focus group interviews (n=38 participants) and 40 semi-structured one-to-one interviews with mothers with a range of infant feeding experiences i.e. exclusively breast fed; started breast feeding but changed to formula milk before 16 weeks; exclusively formula fed; or who concurrently breast and formula fed their infant.

FINDINGS

a principal theme of 'Mixed and missing messages' emerged, incorporating 'Conflicting advice', 'Information gaps' and 'Pressure to breast feed' with a secondary theme of 'Emotional costs'. Several problems were identified with how women were given information, how infant feeding discussions were held, and the type of support available after the infant is born.

KEY CONCLUSIONS

there was a strong perception that some midwives are not 'allowed' to discuss or provide information on formula feeding, and the women reported feeling pressurised to breast feed. Current interpretation of guidance from the UNICEF UK Baby Friendly Initiative may be restricting antenatal discussions about infant feeding. The combination of this partial preparation antenatally and postnatal support that was often inconsistent seems to incur a counter-productive emotional cost.

IMPLICATIONS FOR PRACTICE

at strategic, policy and practice levels the infant feeding message needs to change to encourage a more woman-centred focus including discussions about the realities of all types of infant feeding. It is important that health providers continue to promote and support breast feeding; and that effective services are provided to women who wish to breast feed to help them to do so. However provision of information about all aspects of feeding is needed as well as support for women who do not wish to breast feed.