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Women's experiences of breastfeeding: A narrative review of qualitative studies


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Globally, breastfeeding remains the primary method of infant feeding. Despite the indisputable benefits of breastfeeding, studies have identified both positive and negative aspects of women’s experiences. This article aims to enhance our understanding of these breastfeeding experiences. Methods: Using a narrative review approach, 26 papers using different qualitative approaches were synthesized in order to consider the findings of real-life experiences of breastfeeding women. Selected qualitative studies described women’s experiences of breastfeeding across international regions. This was intended to provide a critical review of the existing evidence and contribute to improving the knowledge of breastfeeding practice. Results: The inclusive studies yielded five main themes. The essence of breastfeeding was described in relation to a symbol of motherhood, feeling connected between the mother and baby, the dilemma of mother’s expectations versus reality of breastfeeding, and mothers’ need for consistent reassurance and support, and lastly social-cultural construct of breastfeeding. Conclusion: The findings identify the wider importance of breastfeeding experience that goes beyond simply providing the baby with nutrition.
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Georgina Afoakwah is a Ph.D. student in midwifery
at the School of Nursing, Midwifery and Social Work,
University of Manchester (UK); Dr Rebecca Smyth is a
Lecturer at the School of Nursing, Midwifery and Social
Work, University of Manchester and Dame Tina Lavender
is a Professor of Midwifery at the School of Nursing,
Midwifery and Social Work, University of Manchester
Womens experiences of breastfeeding:
A narrative review of qualitative studies
By Georgina Afoakwah, Dr Rebecca Smyth and Professor Dame Tina Lavender
Globally, breastfeeding remains the primary method of infant
feeding. Despite the indisputable benefits of breastfeeding,
studies have identified both positive and negative aspects
of women’s experiences. This article aims to enhance our
understanding of these breastfeeding experiences. Methods:
Using a narrative review approach, 26 papers using different
qualitative approaches were synthesized in order to consider
the findings of real-life experiences of breastfeeding women.
Selected qualitative studies described womens experiences
of breastfeeding across international regions. This was
intended to provide a critical review of the existing evidence
and contribute to improving the knowledge of breastfeeding
practice. Results: The inclusive studies yielded five main
themes. The essence of breastfeeding was described in relation
to a symbol of motherhood, feeling connected between the
mother and baby, the dilemma of mothers expectations versus
reality of breastfeeding, and mothers’ need for consistent
reassurance and support, and lastly social-cultural construct
of breastfeeding. Conclusion: The findings identify the wider
importance of breastfeeding experience that goes beyond
simply providing the baby with nutrition.
reastfeeding is an integral aspect of infant survival. It
is well acknowledged for its importance in childhood
growth and development (Kramer and Kakuma 2012;
World Health Organization (WHO) and UNICEF 2003).
Breast milk is considered well balanced and adequate for the
infants need for nourishment (WHO and UNICEF, 2003).
Various guidelines recommend the early introduction of
breastfeeding and its exclusivity for the first six months, after
which time the infant should continue to receive breast milk
in addition to supplementary feeding for one year or more
(Kramer and Kakuma, 2002; WHO and UNICEF, 2003;
American Academy of Pediatrics, 2005). Despite the fact that
the guidelines support practices of exclusive breastfeeding,
variations still exist within the narrative expressions of womens
breastfeeding experiences across different socioeconomic and
cultural environments (Dykes and Williams, 1999; Mozingo et
al, 2000; George, 2005; McFadden, 2006; Tawiah-Agyemang
et al, 2008; Demirtas et al, 2012).
In order to complement previous work on breastfeeding,
a deeper understanding of cumulative interpretations of
womens breastfeeding experiences is needed. This will help
to strengthen the foundation for advocacy and tailored care,
especially in the area of exclusive breastfeeding. As a result,
this review aims to enhance understanding via consideration
of the lived experiences of breastfeeding women.
A narrative approach was adopted for the review. This approach
provides a means for developing both interpretive and narrative
synthesis from the broader perspective of the experiences of
breastfeeding women (Noblit and Hare, 1988). The review
method assists in generating a deeper knowledge of the nature of
breastfeeding, rather than just summarising a number of studies
(Sandelowski et al, 1997). Additionally, it provides insight into
the dynamics underlying the findings of the different approaches
within the framework of qualitative research design (Cronin et
al, 2008). The method allows flexibility in the review process, as
well as the utilisation of the descriptive phrases and metaphors
found within existing studies, to create different perspectives
about the world view (Cronin et al, 2008).
Data review
The data review was conducted between June and September
2012 using the following electronic bibliographical databases:
Medline, CINAHL, PubMed, PsycINFO, Maternal and Infant
Care, Scopus and the World Health Organization (WHO)
library. A manual search was also carried out using other
relevant citations such as in the British Nursing Index and the
International Breastfeeding Journal. The keywords used for the
search were ‘breastfeeding’ or ‘infant feeding’ and ‘womens
experiences or qualitative studies’. Synonyms were used where
appropriate. Papers were included if they presented empirical
qualitative research on breastfeeding experiences and were
published in the English language. No date parameters were set.
In all, 306 studies were initially identified, of which 240 papers
were excluded (Figure 1). The excluded papers were either
duplicated or utilised a quantitative design. The abstracts of 66
articles were scanned and examined for eligibility, from which
35 studies were excluded. Five papers were also excluded after
reading them in full and evaluating them for credibility and
Databases: Mediline, CINAL, PubMed, PsycInfo, World Health Organization (WHO),
Scopus, and Maternal and Infant Care
Inclusion criteria: Primary research using qualitative methods, reflecting participants’
breastfeeding experiences and published in English
306 potentially relevant
papers initially identified via
the literature search
66 abstracts reviewed in full,
applying inclusion criteria
240 papers excluded
after initial evaluation of
31 papers reviewed in
further detail
26 papers included in the
Five more papers excluded
after Critical Appraisal
Skills Programme
(CASP) approval
35 papers excluded
after full reading of
26 papers included in the literature:
22 from developed countries(UK, USA, Australia, Canada and New Zealand)
Four from developing countries (China, Turkey and Ghana)
Figure 1. Summary of the searches conducted during the data-gathering stage
Table 1 Characteristics of included studies
Author/year/country Methods Participants Aspects of breastfeeding
Bottorff, 1990; Canada Phenomenology, using interviews n=3 women The decision to breastfeed after
birth, learning to breastfeed, the
personal choice of commitment
and the need for encouragement
and support for mothers
Leff et al, 1994; USA Phenomenology/semi-structured
26 Caucasian breastfeeding women
in northern New England. Aged
21–39 years
Mothers’ descriptions of
successful and unsuccessful
Locklin, 1995; USA Grounded theory based on face-to-
face interviews
n=17 educated, low-income Latin
and African-American women,
supported by peer counsellors. Aged
18–37 years
Achieving breastfeeding success
through the support of peer
counsellors and breastfeeding
Dykes and Williams,
1999; UK
Phenomenological, longitudinal
study/in-depth interactive
interviews conducted at 6, 12
and 18 weeks following childbirth
n=10 primiparous Caucasian
women. Aged 21–36 years
Women’s perceptions related to
the adequacy of breast milk
Schmied and Barclay,
1999; Australia
Grounded theory n=25 Australian women. Aged
23–35 years
Maternal embodied experience of
Mozingo et al, 2000;
Phenomenology n=9 women who initiated
breastfeeding but stopped at 2
weeks. Aged 20–32 years
Incompatibility between an
idealised view of self as a ‘good
mother’ and the reality of the
breastfeeding experience
Raisler, 2000; USA Ethnographic study using seven
focus-group discussions
n=42 women recruited from urban
and suburban-rural areas using
mothers who participated in the
women, infants and children (WIC)
programme and supported by
breastfeeding peer counsellors
Maternal breastfeeding
experience, influence related
to health-care systems and
daily living
Schmied and Lupton,
2001; USA
Exploratory study n=25 Australian first-time mothers Mothers’ subjectivity and
embodiment experience
of breastfeeding
Tarrant et al, 2002;
Exploratory, qualitative study as part
of a longitudinal study
n=19 Hong Kong primiparous
mothers at 1-month postpartum
Sociocultural and environmental
influences of breastfeeding
practices, and lactation
management in the immediate
Hauck and Irurita,
2003; Australia
Grounded theory
Individual and group interviews/
postal questionnaire
n=33 Caucasian women
n= 9 partners
n=12 child health nurses
Incompatibilities of mothers
expectations and realities, influences
on mothering, breastfeeding and
weaning practices
congruity using the Critical Appraisal Skills Programme (CASP)
for qualitative studies (Oxman, 2006) and Joanna Briggs Institute
for Evidence Based Nursing—Qualitative Assessment and Review
Instrument (
crit_appraispdf.). The final synthesis included 26 articles detailing
qualitative studies. These studies demonstrated a varied expression
of the breastfeeding experience for primiparous and multiparous
women. Some depicted women who had a successful experience of
breastfeeding, and others referred to those who felt overwhelmed
and unprepared to embark on the journey. The findings represent
aggregated data from a total of 562 participants.
Quality assessment of studies
Detailed, repeated reading was carried out on the 26 studies
included in the final synthesis. The intent was to determine
the congruity within the studies, and their relatedness. The
characteristics of the various studies are represented in Table 1.
The critical appraisal used yes’, no or unclear’. The various
themes were developed by identifying frequently related concepts.
The emerging themes represent the experiences of breastfeeding
according to the 26 studies considered in Table 1. Synthesis
of the studies revealed five main themes, which consist of
breastfeeding: a symbol of motherhood; feeling connected;
dilemma of mothersexpectations compared to reality; consistent
reassurance and support; and the sociocultural construct of
breastfeeding. A summary of the findings grouped together the
metaphors and phrases used to describe the motherssubjective
experiences of breastfeeding. Direct quotations were drawn from
the original studies to support each theme. The identified themes
were found to be consistent within most of the articles.
Table 1. Characteristics of included studies (continued)
Author/year/country Methods Participants Aspects of breastfeeding
Dykes, 2005; UK An ethnography study based on
97 observational encounters
between midwives and postnatal
women, 106 focused interviews
with postnatal women and 37
guided conversations with
n=61 postnatal women
n=39 midwives from two maternity
units in the north of England
Postnatal women’s experiences
and the influence of breastfeeding
within the postnatal ward setting
George, 2005; USA Grounded theory based on semi-
structured interviews/field-notes
n=10 primiparous women. Aged
18–35 years
Lack of preparedness for the
postpartum period
Nelson and Sethi,
2005; Canada
Grounded theory n=8 first-time breastfeeding teenage
mothers. Aged 15–19 years
Continuous commitment to
the journey of breastfeeding,
along with the positive
and negative experiences
of breastfeeding
McFadden and Toole,
2006; UK
Exploratory study/focus group
n=35 women, aged 17–40 years in
northeast England
Barriers and attitudes influencing
breastfeeding, incompatible
advice and support from health
Marshall et al, (2007);
Observations and interviews n=22 women
n=18 health professionals
Managing self identity as a
‘good mother’
McBride-Henry et al,
2009; New Zealand
Reflective life-world n=19 breastfeeding women Objectification of the maternal
Tawiah-Agyemang et al,
2008; Ghana
65 semistructured interviews and
eight focus groups
n=52 purposeful selection of
recent mothers, 7 nurses and
midwives from the study hospital,
6 policy-makers and implementers
Barriers and facilitators to early
initiating of breastfeeding
Andrew and Harvey,
2011; UK
In-depth interviews (topic guide with
12 open-ended questions)
n=12 primi- and multiparous women
with infants aged 7–18 weeks
Decisions regarding infant
feeding choices, concerns about
limited independence and self
identities, along with social and
cultural influence
Otoo et al, 2009;
Focus-group study n=35 Ghanaian women aged 19–49,
with one child less than 4 months old
Benefits, incentives and barriers
to exclusive breastfeeding
Sheehan et al, 2009;
Focus group study n=37 women with infants aged
between 1 and 9 weeks using
snowball sampling
Mother’s expectations
and experiences of health
professionalssupport for
infant feeding in the first 6
weeks postnatal
McBride-Henry, 2010;
New Zealand
Interpretive life-world methodology/
n=19 women currently breastfeeding
or who had breastfed within the last
32 months. Aged 20–30 years
Societal influence and its effects
on the interpretation of the
breastfeeding experience
Palmèr et al, 2010;
Reflective life-world study n=2 primiparous women
n=6 multiparous women
Mothers’ experiences of
initiating and managing
Phillips, 2010; USA Phenomenology n=19 primiparous Reflections on everyday
experiences of breastfeeding
Demirtas et al, 2012;
Descriptive, qualitative study based on
in-depth, semi-structured interviews
n=24 women, with infants aged
4–24 months old
The influence of cultural, social
and religious breastfeeding
Ryan et al, 2011;
In-depth interviews n=49 women living in the UK, who
are breastfeeding or had breastfed
within the last 2 years
Maternal interembodied and
interdependence experience of
Hoddinott et al, 2012;
Qualitative serial interviews n=72 women/37 significant others Female and family perspectives
on infant feeding versus the
idealism and realism of health
Breastfeeding: A symbol of motherhood
Breastfeeding is both a biological process and a
sociocultural activity (Bottorff, 1990; Dykes and Williams,
1999; Dykes, 2005). Evidence from the studies shows
breastfeeding as a demonstration of motherhood, which
include nurturing and provision of nourishment (Schmied
and Barclay, 1999; Mozingo et al, 2000; Marshall et al,
2007; McBride-Henry, 2010; Palmèr et al, 2010; Philips,
2010). The ability to manage breastfeeding has been linked
to ‘womanliness’ and good mothering (Bottorff, 1990;
Hauck and Irurita, 2003; Otoo et al, 2009). For instance,
one mother reported: ‘Breastfeeding gave me one link to
a positive mothering side I felt that I was being a good
mother in breastfeeding. It was rewarding, feeling satisfied
within, being happy with your nurturing abilities at that
stage’ (Hauck and Irurita, 2003:66). The idea of mothering
entails a sense of duty for mothers towards the growth and
development of their newborns (Mozingo et al, 2000;
Nelson and Sethi, 2005; McFadden and Toole 2006).
As noted by Dykes (2005), mothers describe themselves
as ‘milk producing machine[s]’ in relation to providing
food for their babies. This enhances their confidence and
positive attitude towards breastfeeding.
Although breastfeeding is directly associated with
mothering, some women feel overwhelmed by the early
challenges of breastfeeding. Studies identify issues relating
to painful breasts, sore nipples, and a lack of adequate
preparation and support from health professionals (Nelson
and Sethi, 2005; George, 2005). Women who fail to
breastfeed successfully describe their experiences in relation
to being a failure, and feeling ashamed and guilty (Mozingo
et al, 2000; McBride-Henry, 2010). One mother stated ‘I
wanted to feel mothering. And I felt guilty for so long. It
took me a long time to get over feeling guilty because I didnt
breastfeed’ (Mozingo et al, 2000:127).
Feeling connected
Breastfeeding has been acknowledged as relating to more
than just the provision of nourishment to the baby
(Bottorff, 1990; Schmied and Barclay, 1999; Mozingo
et al, 2000; Nelson and Sethi, 2005). Studies identify
both a physical and an emotional connection between the
mother and baby (Schmied and Barclay, 1999; Schmied
and Lupton, 2001; Ryan et al, 2011). Feeling connected
describes how mothers share their own bodies with the
baby (Schmied and Barclay, 1999; Nelson and Sethi,
2005). The experience was described as intimate and
sensual (Schmied and Lupton, 2001), as one mother
explained: ‘Theres such a closeness with the baby and
you relax when youre feeding, you get that hormone.
It just makes you feel motherly’ (Raisler, 2000:258).
Breastfeeding promotes interdependency and physical
bonding between the mother and baby (Schmied and
Barclay, 1999; McFadden and Toole, 2006). Several studies
describe the mothers’ satisfaction and their emphasis
on the closeness derived with their baby as a beautiful
experience (Schmied and Barclay, 1999; McBride-Henry
et al, 2009). One mother described the feeling, the bond
and closeness as being beyond words: ‘I just love every
moment’ (Ryan et al, 2010:734). Breastfeeding success
was viewed as a balance between the mother and her
baby, mutually working together to enjoy moments of
breastfeeding (Palmèr et al, 2010).
In several of the studies considered, mothers physical
attachment to their infants are expressed in both positive
and negative ways (Schmied and Barclay, 1999; Mozingo et
al, 2000; Raisler, 2000). Positive signs include security and
protection of the mother over her baby (Raisler, 2000), and
the babys ability to recognise the mother among other family
members (Schmied and Barclay, 1999), which one mother
described as: ‘My baby is able to make me out among my
friends (Schmied and Barclay, 1999:125). However, others
talked about the distressing feelings relating to their bodies
being out of control and messy (McBride-Henry et al, 2009).
For others, there was a feeling of being engrossed in the
demand of their babiesbreastfeeding needs and a wish for early
separation (Mozingo et al, 2000; Andrew and Harvey, 2011).
Dilemma of mothers’ expectations versus reality
The decision to breastfeed arises from specific goals and
expectations regarding breastfeeding (Mozingo et al, 2000;
Phillips, 2010; Hoddinott et al, 2012). Importantly, women
are motivated by the goodness of breastmilk in relation to
the health of the baby (Marshall et al, 2007). The belief
that breastfeeding is natural, easy and already available is
perceived as the norm (Marshall et al, 2007). This was
described by one mother in the following terms: ‘I just
thought it would come naturally, that it was just something
that everybody did and there was never any rejection I
just expected it to be automatic’ (Mozingo et al, 2000:122).
For most women, the ideal way to breastfeed is something
that is envisaged prior to or during pregnancy (Hauck and
Irurita, 2003; Mozingo et al, 2000; Marshall et al, 2007;
McBride-Henry, 2010). For instance, one mother reported:
‘I had envisioned how easy and wonderful and natural it
would be’ (Mozingo et al, 2000:122).
In contrast to their idealised expectations, most mothers
reported that the reality of breastfeeding was incompatible
with their goals (Mozingo et al, 2000; Hauck and Irurita,
2003; George, 2005; Dykes 2005; McFadden and Toole,
2006; Tawiah-Agyemang et al, 2008; Phillips, 2010). For
instance, one woman stated: ‘I didnt think it [breastfeeding]
would be this difficult, because it looked easy you put
a baby to the breast and it drinks, but it’s not that easy
(Bottorff 1990:204). Mothers’ breastfeeding experiences
within the first 2–6 weeks are described as overwhelming’
and awful’ (Mozingo et al, 2000; Otoo et al, 2009). Studies
identify problems such as positioning, latching and managing
engorged, painful breasts as being common with new mothers
(Mozingo et al, 2000; Hauck and Irurita. 2003; George 2005;
Phillips, 2010). Palmèr et al (2010) identify early discharge
from hospital as a significant issue that limits mothers’
preparation and the professional support they receive with
respect to breastfeeding. Mothers perceive themselves as
being handicapped in their breastfeeding journey due to the
unrealistic and sometimes conflicting information between
health professionals and immediate families (Mozingo et al,
2000; George, 2005).
Consistent support and reassurance
Support for mothers is expressed as crucial to their success
at all levels of breastfeeding (Bottorf, 1990; Locklin, 1995;
Dykes 2005; Andrew and Harvey, 2011; Sheehan et al,
2009). For instance, mothers valued support based on
practical guidance, encouragement and the reassurance of
doing it right’ (Sheehan et al, 2009:142). Mothers reported
a sense of abandonment and frustration at the inconsistent
information received in relation to their efforts to initiate and
continue breastfeeding (Mozingo et al, 2000; George, 2005).
Both primiparous and multiparous mothers expressed a desire
for constant reassurance in a gentle and empathetic manner,
to help them achieve their breastfeeding goals (Mozingo
et al, 2000; Schmied and Lupton, 2001; Sheehan et al,
2009). There is thus a need for health professionals to spend
quality time and share information on techniques, as well as
providing practical solutions to breastfeeding problems (Leff
et al, 1994; Raisler, 2000; Hauck and Irurita, 2003).
Active support for mothers is given in various forms.
Mothers within the traditional setting reported that they
received support from their immediate families, as well as
religious leaders and friends, while peer counsellors and
breastfeeding advisors provided support for mothers within
industrialised communities. Across the studies, support
from health professionals was described using terms such
as ‘rushed’, ‘routine’, ‘judgmental’, somebody who grabbed
the mother’s breast’, ‘insensitive’ and ‘inconsistent advice’
(Bottorff, 1990; Raisler, 2000; Hauck and Irurita, 2003;
Dykes, 2005; Phillips, 2010).
Sociocultural construct of breastfeeding
Although breastfeeding is a natural act, it is also argued as a
social behaviour (Schmied and Lupton, 2001; Tarrant et al,
2002; McBride-Henry, 2010; Andrew and Harvey, 2011;
Demirtas et al, 2012). The social construct of breastfeeding
was central to a womans interpretation and experience of
breastfeeding (Tarrant et al, 2002; Tawiah-Agyemang et al,
2008; McBride-Henry, 2010). Sociocultural influences on
breastfeeding are viewed as complex and diverse (Tarrant
et al, 2002; Tawiah-Agyemang et al, 2008; Demirtas et al,
2012). In the studies considered, the maternal immediate
family and friends were predominantly cited as sources of
advice and support (Andrew and Harvey, 2011). Factors such
as social, cultural and religious activities were identified to
impact on decision making, support and the management
of breastfeeding (Tarrant et al, 2002; McBride-Henry, 2010;
Dermatis et al, 2011). Tawiah-Agyemang et al (2008) also note
the influence of Traditional Birth Attendants (TBAs) and the
performance of rituals for new mothers which delay initiating
breastfeeding early. Women felt the need to breastfeed if they
were breastfed themselves, and the infant was likely to be
introduced to formula feeds if the mother was not breastfed
(Bottorff ,1990; Mozingo et al, 2000; Dykes 2005).
The womens experiences in relation to public breastfeeding
emerged as a barrier to successful breastfeeding. Women
repeatedly expressed the inconvenience and disapproval in
the presence of others. For instance, a woman narrated:
‘I was made aware of their disapproval through critical
facial expressions being directed toward me(McBride-Henry,
2010:771). Similarly, Bottorff (1990) noted that, breastfeeding
challenges a mother’s position in relation to the world, and
thus, acceptance is extremely beneficial. Dykes (2005) further
described ‘sexuality issues’, relating to maternal feeling for
exposing their breasts in public settings. Breastfeeding women
in both industrialised and low socioeconomic communities
face this as a challenge and find breastfeeding outside the home
difficult. Studies therefore recognised the need for support and
building infrastructures that ensure privacy to enable mothers
to breastfeed in public settings.
The cumulative review provides insight into womens various
experiences of breastfeeding. The findings reveal that the
essence of breastfeeding goes beyond simply providing the
baby with nutrition. Significant to womens experiences of
breastfeeding are a blend of biological, social and cultural
activities that shape their breastfeeding journey. Mothering
involves the provision of nourishment and security for the
infant, as well as bonding. Women consistently conceptualised
their breastfeeding experience as an essential element of
good’ mothering, which transforms a womans identity and
role within motherhood, compared to mothers who use
formula feeding. However, there is a sense of shame and guilt
as mothers failed to achieve their breastfeeding goals.
Breastfeeding was revealed to be not just a physical
activity, but an inextricable matter of the body, soul and
mind. Mothers who have a positive attitude towards
breastfeeding expressed a sense of wellbeing and a feeling
of being connected to their baby. Hoddinott et al (2012)
argue that mothers who rush, breastfeed on schedule and
introduced complementary feeds early often find it harder
to experience the ‘breastfeeding magic’. Mothers who have
been unsuccessful in breastfeeding described negative feelings
about their experiences, which often influence subsequent
breastfeeding. WHO (2010) recommends early skin-to-skin
contact and rooming-in with the mother, which facilitates
bonding and effective breastfeeding. Mothers are encouraged
to enjoy communicating with the baby during breastfeeding
and taking time to allow the baby to breastfeed.
Although narrative reviews focus on capturing a broader
perspective on a given topic, in this review it is possible that
other relevant citations may have been missed that might
have influenced the conclusions of the review. For instance,
breastfeeding and HIV transmission as well as the experiences
of breastfeeding mothersin the neonatal intensive care unit
(NICU). Another limitation is the fact that the findings
cannot be generalised, except to provide insight into the
reality of breastfeeding.
This paper provides insight into the experiences of
breastfeeding women which is relevant to professional practice
and helping mothers to reflect on their own experiences.
About 90 percent of the studies considered were conducted
in Western, industrialised countries, and aimed to depict the
issues shaping womens breastfeeding experiences in order to
help improve the quality of breastfeeding. However, Africa
and most developing countries have recorded limited narrative
studies that explore womens daily experiences of breastfeeding.
Despite the production of a UNICEF (2012) database report
showing an increasing percentage in breastfeeding rates in
most African regions, the meaning of breastfeeding is taken
for granted. The two studies conducted in Ghana used a
qualitative methodology that identifies the broad reasons and
factors influencing Ghanaian womens breastfeeding practices
(Tawiah-Agyemang et al, 2008; Otoo et al, 2009). Future
research should employ qualitative in-depth interviews and
a longitudinal approach to provide insight into the unique
experiences of breastfeeding women in Ghana.
Aspects of womens breastfeeding experience were consistent
using the themes identified during the review process.
The findings of the review identify the wider importance
of breastfeeding experience, which goes beyond simply
providing the baby with nutrition. Variations in the mothers
narratives of their breastfeeding experiences portray the reality
of breastfeeding. The findings of this study are important in
helping to incorporate the actual experiences of mothers
into professional care giving and support strategies aimed at
enhancing effective breastfeeding. AJM
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Key Points
Breastfeeding is considered a symbol of motherhood, which is
significant in enhancing mothers’ decisions to breastfeed and
their devotion to it
The sensual feeling and beauty of the mother–baby connection
promotes bonding, closeness, protection and mutual interaction,
which is important to breastfeeding women
Breastfeeding mothers need to be taught realistic and
practical techniques to enhance their confidence in managing
breastfeeding problems
Provision of sensitive and tailored care is needed to assist
mothers to breastfeed effectively
... Breastfeeding arrangements are rarely researched in contexts with longer statutory leave periods, such as the UK (Gatrell 2007), denoting societal norms of appropriateness of breastfeeding duration. Apart from regulation, we have seen that small firms are particularly sensitive to local cultural context (Carlier et al. 2012) and, as breastfeeding is a socio-cultural construct (Afoakwah et al. 2013;Turner and Norwood 2013), it is important to understand whether and how women can negotiate mutual adjustments for breastfeeding in diverse cultural settings. The paucity of research on breastfeeding at work in the management and organizations literature is likely to be related to masculine ideas about workers and objection to leaky maternal bodies in the workplace (Gatrell 2007). ...
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This paper provides a transdisciplinary critical review of the literature on maternity management in small and medium-sized enterprises (SMEs), embedded within the wider literatures on maternity in the workplace. The key objectives are to describe what is known about the relations that shape maternity management in smaller workplaces and to identify research directions to enhance this knowledge. The review is guided by theory of organizational gendering and small business management, conceptualizing adaptions to maternity as a process of mutual adjustment and dynamic capability within smaller firms’ informally negotiated order, resource endowments and wider labour and product/service markets. A context-sensitive lens is also applied. The review highlights the complex range of processes involved in SME maternity management and identifies major research gaps in relation to pregnancy, maternity leave and the return to work (family-friendly working and breastfeeding) in these contexts. This blind spot is surprising, as SMEs employ the majority of women worldwide. A detailed agenda for future research is outlined, building on the gaps identified by the review and founded on renewed theoretical direction.
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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, organisational 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 randomised 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 under-used. 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 qualitative methodologies and the broadly positivist approach of trials, and we suggest there is a need for further dialogue 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.
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To explore the experiences of breastfeeding women. There is a plethora of data demonstrating that human breast milk provides complete nutrition for human infants. While the rate of initiation of breastfeeding in the United Kingdom has shown a steady increase in the last 25 years, rates of exclusive breastfeeding in the early weeks and months over the same time period have shown only marginal increases. This study was designed to extend current knowledge around breastfeeding experiences, decisions and behaviours. Qualitative, interpretive phenomenological approach. Data were collected between July 2009-January 2010 through in-depth interviews with 22 women from a city in the East Midlands where the prevalence of breastfeeding has showed a decreasing trend. Data were collected between 3-6 months after the birth of their youngest baby. Analysis of data uncovered a key theme: illusions of compliance. The findings revealed that women's breastfeeding behaviours were socially mediated. They adopted a good mother image by conforming to the moral obligation to breastfeed immediately after their babies were born. Those women who struggled to establish breastfeeding tried to hide their difficulties rather than admit that they were not coping. This study provides insights into women's infant feeding decisions and behaviours, building on understandings of 'good mothering' in the wider literature. Importantly we highlight some of the previously unknown strategies that women employed to portray themselves as calm, coping and in control when in reality they were struggling and not enjoying breastfeeding. © 2014 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
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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. Qualitative serial interview study. Two health boards in Scotland. 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. 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. 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.
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To explore why women in Ghana initiate breast-feeding early or late, who gives advice about initiation and what foods or fluids are given to babies when breast-feeding initiation is late. Qualitative data were collected through 52 semistructured interviews with recent mothers, 8 focus group discussions with women of child-bearing age and 13 semistructured interviews with health workers, policy makers and implementers. The major reasons for delaying initiation of breast-feeding were the perception of a lack of breast milk, performing postbirth activities such as bathing, perception that the mother and the baby need rest after birth and the baby not crying for milk. Facilitating factors for early initiation included delivery in a health facility, where the staff encouraged early breast-feeding, and the belief in some ethnic groups that putting the baby to the breast encourages the milk. Policy makers tended to focus on exclusive breast-feeding rather than early initiation. Most activities for the promotion of early initiation of breast-feeding were focused on health facilities with very few community activities. It is important to raise awareness about early initiation of breast-feeding in communities and in the policy arena. Interventions should focus on addressing barriers to early initiation and should include a community component.
This policy statement on breastfeeding replaces the previous policy statement of the American Academy of Pediatrics, reflecting the considerable advances that have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, in the mechanisms underlying these benefits, and in the practice of breastfeeding. This document summarizes the benefits of breastfeeding to the infant, the mother, and the nation, and sets forth principles to guide the pediatrician and other health care providers in the initiation and maintenance of breastfeeding. The policy statement also delineates the various ways in which pediatricians can promote, protect, and support breastfeeding, not only in their individual practices but also in the hospital, medical school, community, and nation.
Although the health benefits of breastfeeding are acknowledged widely, opinions and recommendations are divided on the optimal duration of exclusive breastfeeding. We systematically reviewed available evidence concerning the effects on child health, growth, and development and on maternal health of exclusive breastfeeding for 6 months vs. exclusive breastfeeding for 3–4 months followed by mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) to 6 months. Two independent literature searches were conducted, together comprising the following databases: MEDLINE (as of 1966), Index Medicus (prior to 1966), CINAHL, HealthSTAR, BIOSIS, CAB Abstracts, EMBASE-Medicine, EMBASE-Psychology, Econlit, Index Medicus for the WHO Eastern Mediterranean Region, African Index Medicus, Lilacs (Latin American and Carribean literature), EBM Reviews-Best Evidence, the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trials Register. No language restrictions were imposed. The two searches yielded a total of 2,668 unique citations. Contacts with experts in the field yielded additional published and unpublished studies. Studies were stratified according to study design (controlled trials vs. observational studies) and provenance (developing vs. developed countries). The main outcome measures were weight and length gain, weight-for-age and length-for-age z-scores, head circumference, iron status, gastrointestinal and respiratory infectious morbidity, atopic eczema, asthma, neuromotor development, duration of lactational amenorrhea, and maternal postpartum weight loss. Twenty independent studies meeting the selection criteria were identified by the literature search: 9 from developing countries (2 of which were controlled trials in Honduras) and 11 from developed countries (all observational studies). Neither the trials nor the observational studies suggest that infants who continue to be exclusively breastfed for 6 months show deficits in weight or length gain, although larger sample sizes would be required to rule out modest increases in the risk of undernutrition. The data are conflicting with respect to iron status but suggest that, at least in developing-country settings, where iron stores of newborn infants may be suboptimal, exclusive breastfeeding without iron supplementation through 6 months of age may compromise hematologic status. Based primarily on an observational analysis of a large randomized trial in Belarus, infants who continue exclusive breastfeeding for 6 months or more appear to have a significantly reduced risk of one or more episodes of gastrointestinal tract infection. No significant reduction in risk of atopic eczema, asthma, or other atopic outcomes has been demonstrated in studies from Finland, Australia, and Belarus. Data from the two Honduran trials suggest that exclusive breastfeeding through 6 months of age is associated with delayed resumption of menses and more rapid postpartum weight loss in the mother. Infants who are breastfed exclusively for 6 months experience less morbidity from gastrointestinal tract infection than infants who were mixed breastfed as of 3 or 4 months of age. No deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for 6 months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea and faster postpartum weight loss. Based on the results of this review, the World Health Assembly adopted a resolution to recommend exclusive breastfeeding for 6 months to its member countries. Large randomized trials are recommended in both developed and developing countries to ensure that exclusive breastfeeding for 6 months does not increase the risk of undernutrition (growth faltering), to confirm the health benefits reported thus far, and to investigate other potential effects on health and development, especially over the long term.
Contemporary medical and public health discourses represent breastfeeding as vital to infant development and the mother-infant bond. Little research from a medical or sociological perspective has sought to investigate the qualitative breastfeeding experiences of women. This article draws on a range of feminist perspectives on the body and subjectivity, together with empirical data from a series of interviews with 25 Australian first-time mothers, to theorise the experience of breastfeeding. These women’s accounts revealed that, although nearly all of them subscribed vehemently to the dominant discourse of ‘breast is best’, the experience of breastfeeding differed markedly among them. Some of the women experienced breastfeeding as a connected, harmonious and intimate relationship between themselves and their baby. For others, however, the breastfeeding relationship between mother and infant was difficult to reconcile with notions of identity that value autonomy, independence and control. We use insights from feminist philosophy on subjectivity and embodiment to explain why the latter response predominated among our interviewees.
This qualitative study asked low income mothers about their experiences of breastfeeding care in the health system and about integrating breastfeeding into their daily lives. Focus group interviews were conducted with urban and rural nursing mothers who participated in the WIC Program and were supported by breastfeeding peer counselors. Mothers said that helpful breastfeeding care providers knew correct information, established supportive personal relationships, referred women to breastfeeding specialists for problems, showed enthusiasm for nursing, and facilitated breastfeeding through concrete actions during the prenatal, intrapartum, and postpartum periods. Unhelpful providers missed opportunities to discuss breastfeeding, gave misinformation, encouraged formula supplementation, provided perfunctory or routine breastfeeding care, and were hard to contact when problems arose. Women valued their breastfeeding peer counselors for responding promptly to distress calls, making home visits, being knowledgeable about breastfeeding, providing hands-on assistance, and acting personal and caring. Incorporating breastfeeding into daily activities was a challenge for many mothers. Ambivalence about the physical bond of nursing, personal modesty, and getting on with life at home, work, or school were identified as important issues. Listening to the thoughts and experiences of low income nursing mothers can help health workers to provide more culturally sensitive, effective breastfeeding care to this population.
To describe the experiences of Turkish women regarding traditional breastfeeding practices. Breastfeeding is a popular practice in Turkey. Nevertheless, the rate of exclusive breastfeeding in the first six months of life is quite low. Merely about 16% of infants aged between 2-3 months are exclusively breastfed, whereas those fed with supplementary foods are 78%. In the light of this data, we argue that traditional breastfeeding practices may be the underlying reason for low rate of breastfeeding. Significant as it is, however, this subject matter has largely been overlooked in the literature in Turkey. A descriptive, qualitative study based on in-depth interviews, with a purposive sample of 24 mothers of four to- 24-month-old babies. The background information of the mothers was obtained from the Mother and Child Health and Family Planning Centre that offers specific services for mothers. Mothers were visited at home and data were gathered through semistructured and in-depth, audio-taped interviews. The collected data were analysed using the content analysis method. Three themes emerged from the participants' descriptions of their breastfeeding experiences: (1) influence of the older family members, (2) influence of social learning and (3) influence of the religion. This study concluded that traditional breastfeeding practices are still prevalent among mothers, regardless of their age and level of education. Breastfeeding behaviour of mothers was mostly shaped by various cultural social and religious influences imposed on them by their family, close social network and religious community. Nurses can encourage mothers for exclusive breastfeeding by means of individual- and social-based training programmes, which they will prepare in view of traditional breastfeeding practices.
In England, 78% of mothers initiate breastfeeding and, in the UK, less than 1% exclusively breastfeed until 6 months, despite World Health Organization (WHO) recommendations to do so. This study investigated women's infant feeding choices using in-depth interviews with 12 mothers of infants aged 7-18 weeks. Using content analysis, four themes emerged: (1) information, knowledge and decision making, (2) physical capability, (3) family and social influences, (4) lifestyle, independence and self-identity. While women were aware of the 'Breast is Best' message, some expressed distrust in this information if they had not been breastfed themselves. Women felt their own infant feeding choice was influenced by the perceived norm among family and friends. Women described how breastfeeding hindered their ability to retain their self-identities beyond motherhood as it limited their independence. Several second-time mothers felt they lacked support from health professionals when breastfeeding their second baby, even if they had previously encountered breastfeeding difficulties. The study indicates that experience of breastfeeding and belief in the health benefits associated with it are important factors for initiation of breastfeeding, while decreased independence and self-identity may influence duration of breastfeeding. Intervention and support schemes should tackle all mothers, not just first-time mothers.
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.