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

"Painful, yet Beautiful, Moments": Pathways Through Infant Feeding and Dynamic Conceptions of Breastfeeding Success

What is breastfeeding "success"? In this article, we challenge the traditional biomedical definition, instead centering visions of success described by breastfeeding mothers themselves. Using semi-structured interviews, quantitative surveys, and written narratives of 38 first-time mothers in the United States, we describe five common pathways through the first-year postpartum, a taxonomic distinction far more complex than a success-failure dichotomy: sustained breastfeeding, exclusive pumping, combination feeding, rapid weaning, and grinding back to exclusivity. We also explore the myriad ways in which mothers define and experience breastfeeding success, and in the process uncover the ways that cultural narratives-especially intensive mothering-color those experiences. Finally, we discuss how these experiences are shaped by infant feeding pathway. In doing so, we discover nuance that has gone unexplored in the breastfeeding literature. These findings have implications for supporting, promoting, and protecting breastfeeding in the United States and other high-income countries.

Caught on the Fringes of Life: Mothers' Lived Experiences of Initial Breastfeeding Complications

Becoming a parent changes one's life, and existential questions arise. Time and being oscillate between joy and powerlessness, vulnerability, and self-confidence, between harmony and unpreparedness. Breastfeeding, one of the first skills new mothers try to master, can be joyful and painful. The aim of this study was to develop a deeper understanding of the phenomenon of initial breastfeeding complications as they are lived and experienced by mothers and how these mothers can be supported. Twelve mothers were interviewed, and a phenomenological lifeworld approach was used. Nourishing an infant and having initial breastfeeding complications can be understood by the essence and its constituents. Expectations are fulfilled, and expectations come to naught when complications are experienced such as wavering between powerlessness and joy and finding solutions through resistance. The results suggest that lifeworld-led caring may lead to deepened acknowledgment and the possibility for mothers to feel supported in their extreme situations.

Vulnerability in birth: A negative capability

AIM

This article explores the literature on women's expectations for birth, the sociocultural context from which these expectations originate and their impact on the interpretation of birth experience.

BACKGROUND

Childbirth is associated with specific expectations from women with the potential for dissatisfaction if these expectations are not met.

DESIGN

This paper presents a systematic analysis of the concept of vulnerability in childbirth.

FINDINGS

A framework was extracted from the literature that linked the themes of a discourse of control, construction of inadequacy and shame of exposure to explain the sociocultural origin of dominant childbirth expectations in the literature. The experience of vulnerability unique to the birthing event is suggested as exposing the woman to this underlying contextual framework and impacting the interpretation of her birth.

CONCLUSION

This synthesis has exposed the transient experience of vulnerability during birth as a significant contributor to the birthing woman's interpretation of the birth and her place within it.

RELEVANCE TO CLINICAL PRACTICE

An explanatory framework is offered to clinicians that could increase their awareness of sociocultural and historical factors impacting a woman's expectations for birth. Appreciation of the woman's vulnerability in birth, exposing her to the influence of this framework, can assist clinicians to facilitate a quality birth experience for women. Furthermore, supporting women and midwives to accept this experience of birth vulnerability as a "negative capability," can facilitate an empowering birth experience.

Toward Understanding How Social Factors Shaped a Behavioral Intervention on Healthier Infant Formula-Feeding

As part of a process evaluation, we explored in semi-structured interviews the experiences of 19 mothers who had taken part in a trial to reduce infant formula-milk intake and promote healthy weight gain, and reflections of three facilitators who delivered the intervention and control group protocols. Mothers appreciated the nonjudgmental support provided during the trial, after experiencing stigma and receiving limited advice on how, how much, and how often formula-milk should be given. The information mothers had previously found, printed on formula-milk tins, or provided by family, friends, and health professionals was often perceived as contradictory; the trial guidance also conflicted with social norms relating infant health positively with weight gain. For those recruited into the trial with older infants, who had already exceeded the recommendations, reducing formula-milk amounts was difficult. The findings highlight the difficulties of addressing a highly stigmatized, complex social practice with an individual, behavioral intervention approach.

Breastfeeding initiation: An in-depth qualitative analysis of the perspectives of women and midwives using Social Cognitive Theory

OBJECTIVE

to explore women's and midwives' expectations, knowledge and experiences of breastfeeding initiation using Social Cognitive Theory.

DESIGN

a qualitative study using focus group discussions and individual interviews. Breastfeeding initiation was defined for this study as a process within the first 48hours after birth. Data were analysed using qualitative inductive analysis then further deductive analysis using Social Cognitive Theory (SCT).

SETTING AND PARTICIPANTS

a purposefully selected sample of primigravid antenatal and postnatal women (n=18) and practising midwives (n=18) from one Health Board area in Scotland.

FINDINGS

attachment of the baby to the breast at birth was hindered by sleepy babies and the busy unfamiliar hospital environment. These resulted in mothers struggling to maintain their motivation to breastfeed and to develop low self-efficacy. Instinctive attachment was rare. Midwives who considered it was normal for babies to be sleepy and unable to attach or feed at birth did not facilitate instinctive baby behaviour. Midwives sometimes experienced lack of autonomy and environmental circumstances that made women centred care difficult. Furthermore caring for high numbers of women, dependent on their help, resulted in reduced self-efficacy for providing effective breastfeeding support.

KEY CONCLUSIONS

interviewing both women and midwives specifically about initiation of breastfeeding has allowed for deeper insights into this critical period and enabled a comparison between the data obtained from mothers and midwives. The findings suggest that instinctive attachment is not an expectation of either mothers or midwives and results in a loss of breastfeeding confidence in both.

IMPLICATIONS FOR PRACTICE

to facilitate initiation there is a need for more research to develop appropriate maternal and midwifery skills, and make changes to the cultural environment in hospitals. Social Cognitive Theory could be used as a framework in both the antenatal and immediate postnatal period to develop strategies and materials to increase women's and midwives' self-efficacy specifically in initiation.

Beyond the latch: A new approach to breastfeeding

Health professionals supporting breastfeeding play an important role in women successfully achieving their breastfeeding goals. Instrumental knowledge has dominated health professionals' breastfeeding education and practice. Because breastfeeding is a contextual and embodied experience, a relational orientation is required to identify effective strategies to support women. A relational inquiry approach to breastfeeding practice offers a practical way to support women to better achieve their breastfeeding goals within the complexities of their own lives. Incorporating a relational inquiry approach to breastfeeding practice may assist health professionals to more effectively respond and engage with women in practice so that women's breastfeeding goals are protected; women's capacity and self-efficacy are promoted; and women feel and experience the support from health professionals that they require to be successful with breastfeeding.

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.

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.

Postnatal Depression

Although breastfeeding has multiple benefits for baby and mother, including maternal mental well-being, many mothers terminate breastfeeding earlier than they desire. We examined two key factors in breastfeeding duration and maternal mental health––breastfeeding efficacy and family–work conflict. Specifically, we examined the moderating role of family–work conflict in the process of breastfeeding efficacy as a predictor of maternal depression by way of duration. In a sample of 61 first-time mothers, we found that breastfeeding duration mediated the relation between prenatal breastfeeding efficacy and depression at 9 months postpartum for working mothers who experienced low levels of family-to-work conflict. That is, for mothers with low family-to-work conflict, higher expected breastfeeding efficacy during pregnancy predicted a longer duration of breastfeeding, which in turn was associated with lower depression at 9 months postpartum. However, for working mothers with high family-to-work conflict, breastfeeding duration did not emerge as an indirect effect on the relation between efficacy and depression. These findings have important implications for a healthy family–work balance to help new mothers adjust when they return to the workforce and as they transition to parenthood.

Maternal experiences of embodied emotional sensations during breast feeding: An Interpretative Phenomenological Analysis

OBJECTIVE

the purpose of this study was to explore mothers׳ experiences of embodied emotional sensations during breast feeding and to understand the meaning and consequences that such experiences may have on mothers' sense of self and the relationships they form with their children.

DESIGN

a qualitative design was applied to this study as it was judged as the most appropriate approach to this novel field of enquiry.

SETTING

the study was conducted in United Kingdom using a sample of mothers drawn from five different countries from Europe, America and Australia.

PARTICIPANTS

the sample consisted of 11 mothers who reported experiencing or having experienced negative embodied emotional sensations associated with breast feeding in the past five years.

MEASUREMENTS

semi-structured interviews were conducted with the mothers and interviews were transcribed to enable the process of data analysis. Interpretative Phenomenological Analysis (IPA; Smith et al., 2009a, 2009b) was chosen as a method of data analysis, enabling in depth understanding and interpretation of the meaning of mothers' experiences. IPA was chosen due to its idiographic commitment and particular interest in sense-making, phenomenology and hermeneutics.

FINDINGS

three themes were generated reflecting the multifaceted nature of breast feeding experiences (i) 'Breast feeding: An unexpected trigger of intense embodied emotional sensations incongruent with view of self', (ii) 'Fulfilling maternal expectations and maintaining closeness with the child', (iii) 'Making sense of embodied emotional sensations essential to acceptance and coping'.

CONCLUSIONS

breast feeding has the potential to trigger a range of conflicting cognitions and emotions in mothers that may impact on how mothers view themselves and relate to their children.

IMPLICATIONS FOR PRACTICE

increasing awareness about emotional breast feeding experiences and recognising the multifaceted, individual nature of difficulties around breast feeding enables professionals to offer mothers person-centred care and avoid making clinical decisions and recommendations based on inaccurate knowledge.

Breastfeeding mothers' experiences: the ghost in the machine

We critically review qualitative research studies conducted from 2000 to 2012 exploring Western mothers' breastfeeding experiences. We used the search criteria "breastfeeding," "qualitative," and "experiences" to retrieve 74 qualitative research studies, which were reduced to 28 when the terms "existential'' and "research'' were applied. We found that the impact of technology and the pervasive worldwide marketing of infant formula devalued breastfeeding mothers' narratives in a number of ways. Women's bodies were viewed as machine-like objects and the breast was seen as a disembodied object. Dominated by technological narrative, women's bodies were considered unpredictable and hormonal, needing to be managed by health care professionals. This means the disseminating breastfeeding discourse needs to be reinterpreted for practical use. We found that some of the researchers utilized narrative informed by phenomenological philosophy that appears to edge closer to understanding mothers' experiences in a more profound way than nonphenomenological research. However, we need to be mindful of the transparency of terms in replacing one form of technological narrative with another.

Using Goffman's theories of social interaction to reflect first-time mothers' experiences with the social norms of infant feeding

Infant feeding, particularly breastfeeding, is an important public health issue because early feeding methods have been shown to influence health throughout childhood. We investigated how social norms influence first-time mothers' decisions around feeding methods. We conducted two in-depth interviews with 11 first-time mothers, the first 3 weeks after birth and the second 3 months following birth. We analyzed interview data using a third-level, thematic analysis, using Goffman's theories of social interaction to guide our analysis. Our results highlighted several issues surrounding breastfeeding in modern society. We propose that nursing mothers are conscious of adhering to social norms of being a good mother, but must also cope with societal views about presenting normal appearances when they need to feed their babies in public.

Strategies to support breastfeeding: a review

BACKGROUND

Mothers need to be given support, confidence and encouragement to successful breastfeeding. The importance of breastfeeding support has been addressed in numerous studies. However, reviews to explore strategies to support breastfeeding are sparse.

AIM

The study aims to explore strategies to support breastfeeding. It was also aimed to reveal how the international papers compare with the Turkish situation.

METHODS

Searches of CINAHL, PubMed, ScienceDirect, Scopus, Web of Science databases, Cochrane databases, Turkish health databases were conducted for data collection. The search was limited to articles published between the years 1995 and 2011, focusing on the strategies related to the support received by mothers. Two experts independently read and analysed 38 articles.

FINDINGS

Thirty-eight papers were included in this review. The findings identified strategies to support breastfeeding. These include collaboration with community and family members; confidence building; appropriate ratio of staffing levels; development of communication skills; and 'closing the gap' in inequalities in health.

CONCLUSION

Mothers benefit from strategies that encourage breastfeeding, with guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs.