Friday September 19 2014
Breast may be best, but it isn't always easy
"Mothers are made to feel 'marginalised and ashamed' when they breastfeed in public, according to an international study," the Mail Online reports. But the same study found mothers who bottlefeed also feel subject to criticism.
The study used discussion groups and interviews to explore the thoughts, feelings and experiences – as well as perceived barriers and facilitators – of feeding infants among a small sample of mothers in north-west England.
A common theme was the shame felt by both mothers who breastfeed and bottlefeed their babies. For example, some breastfeeding mothers discussed concerns about how they are viewed by others when exposing their bodies in public, while conversely women who bottlefeed their baby often feel frowned upon for not breastfeeding.
This was a small study involving just 63 women in one region of England, so we cannot assume its findings are representative of other, larger populations. But it does provide a useful insight into how, for some women, breastfeeding has become an emotional minefield. It suggests there is an important psychological, not just physical, aspect to breastfeeding.
The researchers conclude that health professionals need to find effective methods of providing support to combat feelings of shame in mothers who either breast or bottlefeed.
Where did the story come from?
The study was carried out by researchers from the University of Central Lancashire in England, the Georg Eckert Institute for International Textbook Research in Germany, and Dalarna University in Sweden.
Funding was provided by the North Lancashire Primary Care Trust.
It was published in the peer-reviewed medical journal Maternal and Child Nutrition on an open-access basis, so it can be read online for free.
The Mail Online is generally representative of this research, making it clear these findings are from only 63 women.
However, the headline and general tone of its article mainly focuses on the shame that may be felt on breastfeeding in public. The experience of women who do not breastfeed is largely ignored.
What kind of research was this?
This was a qualitative study that aimed to review women's experiences, thoughts and feelings related to feeding their baby. Qualitative research uses methods such as interviews, observations and discussion groups to understand people's views and feelings, and what motivates them.
The researchers state that emotions such as guilt and blame are often reported among mothers who do not breastfeed, while those who do breastfeed can sometimes feel fear and humiliation when feeding in public places.
In this study, a sample of breastfeeding women and those who did not breastfeed (taken from two primary care trusts in north-west England) took part in discussion groups and individual interviews to explore their experiences, opinions and perceptions of feeding their baby.
What did the research involve?
This study reflects information as part of a wider UNICEF UK Baby Friendly Initiative community project in two community health facilities in north-west England.
A total of 63 women were recruited from various mother and baby groups or clinics (such as baby massage, mother and baby groups, and breastfeeding groups). The researchers report they took care to include women representative of low to high socioeconomic status by recruiting them from a range of different backgrounds.
The mothers' average age was 30 years, most were white British, and most were married or cohabiting and had one or two children. Their infants were mostly aged between 4 and 24 weeks, though 11 infants were aged 6 to 12 months, and 10 were over the age of 1.
Of the women recruited, 28 were breastfeeding, 11 were formula feeding, 7 were mixed feeding through breast and formula, and the remainder were feeding a combination of complementary foods with either breast or formula.
Thirty-three of the women took part in 7 discussion groups (focus groups), and 30 women received individual interviews in their homes, though 2 sets of women were interviewed in pairs.
In both settings, women were asked a range of questions designed to explore the women's current infant feeding status, intentions and motivations behind the feeding pattern, and barriers and facilitators to support. For example, among other questions, the researchers asked:
- Why did you choose to breastfeed or formula feed your baby?
- What information did you receive in regard to infant feeding (antenatally and postnatally)?
- Did any professionals discuss (or provide demonstrations) on infant feeding (breastfeeding or formula feeding)?
The interviews and focus groups took between 25 and 80 minutes to complete, and were digitally recorded and transcribed in full.
What were the basic results?
The researchers explain how many of the women's discussions about their infant feeding experience involved feelings of shame, frequently indicating a sense of feeling out of control and a dependence on others because of insufficient information and a lack of appropriate infant feeding support.
They also say that when a mother's infant feeding method was not as she (or others) intended, this could lead to further feelings of incompetence, inadequacy and inferiority.
The researchers discuss the concept of how both bottle and breastfeeding can both be a source of "offence" to others in different ways.
They also discuss how some of the discussions revealed how women sometimes held ideals and expectations of being a "good" mother. Some women felt anxious, fearful and dependent as a result of various influences: the experience of birth, being overwhelmed by new motherhood and not feeling prepared, cultural influences, and infant feeding.
These feelings were particularly common among first-time mothers, who often weren't aware of what support they would need until faced with the realities of motherhood. Many referred to how they felt expected or under pressure to breastfeed, a pressure transmitted by cultural messages as well as health professionals. Women were said to often experience this as an additional burden of the already bewildering state of new motherhood.
When exploring the social context of any feelings of shame that were experienced by breastfeeding women, a common theme that emerged was related to exposing their breasts in public and concerns about what people thought, or being stared at or frowned upon.
Similar feelings of shame and judgement were reported by women who don't breastfeed their babies, such as people judging them for not breastfeeding. Some women also reported feeling a lack of confidence or difficulties in asking professionals for support about feeding.
How did the researchers interpret the results?
The researchers say how their paper "highlights how breastfeeding and non-breastfeeding women may experience judgement and condemnation in interactions with health professionals as well as within community contexts, leading to feelings of failure, inadequacy and isolation".
They say there is a "need for strategies and support that address personal, cultural, ideological and structural constraints of infant feeding".
This informative study explores the attitudes and experiences surrounding infant feeding, as well as the perceived barriers and ways this could be changed, looking at a sample of mothers in north-west England.
A common theme revealed by mothers related to public and professional perceptions and expectations around infant feeding practices. Both breastfeeding and non-breastfeeding women discussed a sense of shame around their feeding practice for different reasons.
For example, some breastfeeding women discussed concerns about how they are viewed by others when exposing their bodies in public, while conversely women who bottlefeed their baby can feel frowned upon for not breastfeeding. Another common theme discussed by mothers related to feelings of difficulties in accessing support.
This study has provided new insights into the factors that may induce shame in new mothers. Qualitative research of this nature aims to give a detailed exploration of people's views and experiences, and all data and quotes were carefully collected and analysed.
But because of the depth of the analysis, the sample size in these studies tends to be quite small. This study therefore reflects the experiences of only 63 women in one region of England. With only four mothers from minority ethnic groups, it is not known how representative these experiences are of other cultural groups.
Women should never feel ashamed of breastfeeding in public. If other people take issue with it, it is their problem, not yours.
On the other hand, women who find it just too difficult to breastfeed, or can't for other reasons, should also not feel ashamed or guilty.
While breastfeeding does bring proven health benefits to a baby, having a happy and confident mother is probably as, if not more, important.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.