The evidence for the benefits of breastfeeding, for both mother and infant, have long been recognised (World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF), 2003). Breastfeeding is associated with physical health benefits to mothers such as protection against breast or ovarian cancer and a reduction in the likelihood of developing type 2 diabetes (Victora et al, 2016). Breastfeeding also has many benefits for infants such as improved immunity, reduced illness and mortality (WHO and UNICEF, 2003), and increased cognitive abilities (Lenehan et al, 2020).
Despite the established benefits of breastfeeding, rates within western societies are low (Bosi et al, 2016). In the UK, breastfeeding rates drop from 68% at birth to less than 50% at 6–8 weeks (Renfrew et al, 2012; Nicholson and Hayward, 2021). Determinants of early cessation of breastfeeding are multifactorial and can include a lack of information provision, poor support from healthcare professionals and family, unaccommodating work environments, public scrutiny, pain during feeding, frequent infant feeding and poor postpartum mental health (Oakley et al, 2014; Spencer et al, 2015; Feenstra et al, 2018; Keevash et al, 2018; Snyder et al, 2018). The growing industry of breastmilk substitutes presents a welcome alternative for struggling mothers in place of improved access to support and information and the promotion of an enabling environment for women who wish to breastfeed (Brady, 2012; Rollins et al, 2016).
In response to the low rates of breastfeeding, the WHO and UNICEF (1991) began the baby-friendly hospital initiative to promote breastfeeding in hospitals. This policy aimed to encourage healthcare professionals to promote breastfeeding through training, policies and practice in hospitals. While the above studies have highlighted the influence of multiple factors on breastfeeding behaviour, there are few studies that have looked at these factors within the UK setting since the introduction of baby-friendly practices. One such study, conducted by the authors, involved a small qualitative study of women's reasons for continuing or ceasing breastfeeding (Keevash et al, 2018). The study identified that even with the existence of baby friendly practices, mothers were still reporting poor support and information provision from healthcare professionals within the UK. However, as a result of the inherent biases associated with small samples, it is unclear if this reflects the experiences of breastfeeding mothers across the UK more generally. Therefore, the aim of the present study was to employ a large-scale mixed-methods approach to investigate factors that influence breastfeeding behaviour within the UK. The focus of this study was specifically on the role of healthcare professionals in promoting and facilitating breastfeeding.
Methods
Participants
The study recruited 1505 participants (aged 18–47 years, mean age=32 years) to take part in an online survey asking about their breastfeeding experiences and the support they received from healthcare professionals. The study advertised for participants through social media. The authors contacted specific online support groups for breastfeeding mothers who agreed to advertise the study.
Inclusion criteria
Participants had to have breastfed an infant within the 5 years preceding the start of data collection (May 2016). Any duration of breastfeeding was included from 1 day through to 4 years postpartum (average (mode) duration=13–24 months) to capture the experiences of both those who were breastfeeding long term and those who had ceased feeding early on. At the time of the survey, 52.2% of participants were still breastfeeding. Participants were recruited from across the UK and some internationally (2.4%). Table 1 shows full participant characteristics.
Table 1. Participant characteristics
| Participant characteristic | Category | Frequency, n=1505 (%) | Participant characteristic | Category | Frequency, n=1505 (%) |
|---|---|---|---|---|---|
| Age (years)* | <18 | 1 | Occupation status (continued) | Unskilled | 50 |
| 18–24 | 48 | Unemployed | 73 | ||
| 31–40 | 286 | Stay-at-home mum | 213 | ||
| 31–40 | 1006 | Place of most recent birth | Southwest England | 330 | |
| 41–45 | 138 | Southeast England | 386 | ||
| >45 | 23 | Northwest England | 217 | ||
| Gender | Female | 1503 | Northeast England | 90 | |
| Non-binary | 2 | Midlands | 188 | ||
| Ethnicity | British (race not specified) | 573 | Scotland | 53 | |
| White British | 717 | Wales | 51 | ||
| Mixed British | 38 | International | 33 | ||
| White European | 59 | Unknown | 157 | ||
| Mixed European | 21 | Number of children | 1 | 817 | |
| Australian | 17 | 2 | 535 | ||
| Canadian | 12 | 3 | 125 | ||
| American | 15 | ≥4 | 28 | ||
| African American | 7 | Breastfeeding duration (months) | <1 week | 28 | |
| Asian | 13 | 1 week–1 month | 52 | ||
| Mixed race (no nationality specified) | 15 | 1–3 | 99 | ||
| African | 12 | 4–6 | 160 | ||
| Prefer not to say | 6 | 7–12 | 437 | ||
| Occupation status | Higher professional | 298 | 13–24 | 502 | |
| Lower professional | 401 | 25–36 | 136 | ||
| Professional white collar | 349 | >36 | 91 | ||
| Professional blue collar | 121 |
Of the entire sample, 30 participants were randomly selected to take part in an interview over the phone to collect further qualitative data for the study.
Design and procedure
Participants were invited to complete a short online survey asking questions about their breastfeeding experiences, the difficulties they had experienced with breastfeeding and the support they received from healthcare professionals. A predominantly qualitative approach was adopted to allow participants to answer freely about their experiences. A series of Likert scales (ranging 1–5, with 1 being ‘very negative’ and 5 being ‘very positive’) were also used to provide quantitative ratings of participant experiences, including how positive their breastfeeding experience and the support received from healthcare professionals had been and the information provided to them to support breastfeeding behaviour. The survey questions were designed by the research team and piloted with 13 women prior to the start of data collection.
Of those who self-selected that they were willing to take part in an interview, 30 participants were randomly selected for telephone interview conducted by the first author to gain greater detail about breastfeeding experiences. The duration of interviews ranged from 30 minutes to 1 hour. The interviewer asked participants a series of questions about the decision to breastfeed, their birthing experience and their experiences of breastfeeding during the early days and weeks, as well as about the experiences of support from family and healthcare professionals.
Data analysis
Stage 1
The data from the online questionnaire were analysed using a mixed-methods approach where quantitative questions were analysed using descriptive statistics and the qualitative sections were analysed using content analysis. Data were analysed separately and then combined using a triangulation approach (Hanson et al, 2005). Analysis began with reading the data repeatedly to gain a complex understanding of the responses (Tesch, 1990) and writing exploratory comments. Reponses were read again to derive codes within the data that capture key thoughts and concepts (Miles and Huberman, 1994). These codes were numerically counted across the survey responses (Neuendorf, 2018) and organised into related categories and meaningful clusters (Patton, 2002), which identified the master themes. A validation analysis of the codes was conducted by another member of the project team. Further validity checks took place through integration with the responses to the interview questions.
Stage 2
The interview data were analysed using a mixed thematic approach using deductive and inductive methods, as described by Braun and Clarke (2006). An initial deductive framework was applied to the data to identify pre-constructed themes based on the content analysis conducted from the questionnaires. A further inductive analysis was applied to the data, to look for any new themes that had not formed part of the original analysis. This triangulation process led to a restructuring of the data collected in stage one. Validity checks were performed on the data by other members of the research team and member checking was used, with 92 participants responding to the analysis and confirming that it represented their responses to the interviews and/or questionnaires.
Ethical considerations
The study received university ethics approval (reference number: 14/15-371). Standard procedures for ethics were followed including informed consent, right to withdraw and appropriate debriefing. Data were collected using a participant code that was self-generated to ensure participant anonymity throughout.
Results
The survey data revealed factors relating to respondents' breastfeeding experiences and the difficulties experienced with their breastfeeding journey.
Breastfeeding experience
Using data taken from Likert scales, 1317 (87.5%) respondents in the survey rated their breastfeeding experience as being positive or very positive (Figure 1). A further 111 (7.4%) rated their experience as negative or very negative. Most participants (97.8%) had planned to breastfeed prior to birth, with most intending to feed for up to 6 (30.1%) or 12 months (24.5%).
Feeding difficulties
Results from the survey found that 87.2% of respondents experienced difficulties during breastfeeding, with the most common difficulty being feeding complications (74.1%). These did not necessarily lead to cessation. Other feeding difficulties are outlined in Table 2.
Table 2. Types of breastfeeding difficulties
| Type of difficulty | Number of participants |
|---|---|
| Feeding complications | 1115 |
| Poor latching | 525 |
| Nipple trauma | 376 |
| Pain | 322 |
| Mastitis/abscess/cyst | 301 |
| Paediatric health issues | 546 |
| Tongue tie | 308 |
| Failure to thrive reflux | 145 |
| Reflux | 51 |
| Maternal mental health | 75 |
| Sleep deprivation | 32 |
| Anxiety or depression | 23 |
Note: Table gives most commonly reported difficulty, participants may have cited more than one complication
Data from the interviews and free-text responses within the questionnaire identified factors that influence breastfeeding behaviour across four main themes: attitudes to and knowledge of breastfeeding, evidence-based support and information, birthing experience and maternal mental health. Each of these themes are highlighted with related subthemes in Figure 2.
Attitudes to and knowledge of breastfeeding
Participants identified that the attitudes of others to breastfeeding influenced their views about considering, initiating and persevering with breastfeeding over time. Participants highlighted that exposure to other mothers breastfeeding, particularly within their own friendship groups or family, increased their likelihood to want to breastfeed themselves. This also increased their likelihood to initiate breastfeeding at birth (Table 3).
Table 3. Theme 1, subtheme and supporting quotes
| Theme | Supporting quotes |
|---|---|
| Attitudes to and knowledge of breastfeeding |
|
| Subtheme: breastfeeding as natural |
|
Respondents talked about how attitudes to breastfeeding in public meant that it was less common to encounter women breastfeeding. It was suggested that this lack of exposure may be, at least in part, responsible for lower rates of initiating breastfeeding and perseverance, as there are less available role models for breastfeeding.
Knowledge of breastfeeding was an important influence in choosing to initiate and continue with breastfeeding. Participants who were more knowledgeable about the health benefits of breastfeeding were more likely to persevere long term. Family and friends' knowledge and attitudes towards breastfeeding influenced the factual knowledge participants felt they had about breastfeeding. Respondents were more likely to persevere with breastfeeding if people around them had identified that some level of pain on initiating breastfeeding was common. Others who had not received such advice were more likely to stop breastfeeding early. This was interesting as some participants stated they had received guidance from healthcare professionals that breastfeeding was not, and should not be, painful. There was an understanding among experienced participants that there was a degree of pain initially, but that this pain was not long lasting and ‘different’ from the pain associated with poor latching.
Breastfeeding as natural
Many respondents discussed that breastfeeding is a natural process and that they therefore expected it to be ‘easy’, with the reality of this often being far removed. Respondents identified that there was often insufficient information provided during antenatal classes about the possible difficulties one may experience when breastfeeding. Participants highlighted a need for more honest information about breastfeeding difficulties (9.3%) and a more accurate portrayal of breastfeeding (8.2%). It was felt that not providing information about the possible problems led to ‘giv[ing] up more easily’ when problems did occur, rather than accepting that these difficulties were common worries for many new mothers.
Many respondents specifically criticised the ‘natural latching’ information provided at some antenatal classes as an unrealistic portrayal of breastfeeding being easier than it actually is. While it was accepted that some babies do naturally latch, it was generally felt that this happens a lot less often than people are led to believe. Participants highlighted the need for information from ‘real mothers’, with an array of both positive and negative experiences to help them feel more prepared.
Evidence-based support and information
Of those in the sample who had experienced feeding difficulties, 53.2% stated that they had to initiate contact to gain support from healthcare professionals, rather than support being routinely available. The most common form of help came from midwives (44.2%), support groups (35.5%) and health visitors (30.1%). Of the overall sample, 14.1% stated that they had experienced difficulties with receiving general guidance and support for breastfeeding. Other issues with support were noted including poor early support (6.7%), understanding baby's feeding needs (75, 5%) and guidance on breastfeeding in public (1.6%).
Overall, 54.4% respondents rated the support they gained from healthcare professionals as somewhat positive or very positive, while 19.1% of participants rated the support they received as somewhat or very negative (Figure 3). It is important to note that even participants who rated their support as very positive or positive reported some negative experiences with staff.
Respondents highlighted that reassurance from healthcare professionals was one of the biggest contributing factors to them continuing to breastfeed. However, there were large variations in the practices of healthcare professionals with encouraging breastfeeding. Some respondents experienced kind, empathetic care from staff who were keen to encourage breastfeeding but in a supportive way. Others identified feeling pressured to breastfeed and made to feel like a failure when they chose not to continue with breastfeeding. These issues related to the specific mental health theme (Table 4).
Table 4. Theme 2, subtheme and supporting quotes
| Theme | Supporting quotes |
|---|---|
| Theme 2: evidence-based support and information |
|
| Subtheme: signposting |
|
| Subtheme: specialist support |
|
| Subtheme: alternative feeding methods |
|
| Subtheme: intervention points |
|
Other participants discussed encounters with healthcare professionals who often advocated formula feeding rather than breastfeeding in situations where support and encouragement may have been enough to enable women to continue breastfeeding. Participants also identified receiving inconsistent advice and information from healthcare professionals (8.1%) regarding how to breastfeeding or options to try if breastfeeding was proving difficult. This inconsistent and often conflicting advice, accompanied by often inconsistent levels of care and support, left participants feeling unsure and unsupported in their breastfeeding journey.
Finally, 1.9% of respondents highlighted a need for healthcare professionals to take the time to monitor their breastfeeding to be able to provide specific and tailored advice, and to provide basic physiological checks to rule out problems, such as tongue tie, that may impede feeding. Participants reported that this support was not always forthcoming.
When asked to identify factors that may have improved their breastfeeding journey and increased the likelihood of persevering with breastfeeding, 17.6% of participants wanted better staff training to help provide adequate advice for queries, 13.5%) identified a need for better care in maternity units and 8% wanted better emotional support. The most common types of advice participants were seeking included general advice on feeding (57.5%), latching (21.1%) and positioning (9.5%).
Signposting
Respondents throughout the survey and interviews discussed access to support services. It was felt that while support services were often available, there was a lack of signposting to those services. Participants described having to find their own solutions to feeding difficulties, having to persevere alone, and having to initiate support for themselves (Table 4).
Respondents identified a need for increased access to support, particularly access to support groups (6.4%), specialist care (6.4%) and home support (6.2%). Other respondents highlighted the need for 24/7 access to help as breastfeeding is not a 9–5 activity. Many mentioned the difficulties of attending groups with a young infant, or if they had other older children. It was also highlighted that groups are not regular enough to provide consistent support and some participants did not feel comfortable asking for advice in a group context.
Specialist support
While most respondents highlighted a need for general advice around feeding and reassurance, a significant proportion of participants identified a need for more specialist support (Table 4). Among the sample, many respondents discussed the need to speak with specialists trained in dealing with health conditions or difficulties. For example, participants expressed concerns that allergies in babies were not suitably supported, tongue and lip ties were not being detected early enough and that there was a need for greater support when feeding premature infants.
Alternative feeding methods
When describing difficulties surrounding breastfeeding, many respondents discussed various forms of alternative feeding methods as well as barriers to continuing to solely breastfeed. Many participants felt that healthcare professionals did not provide enough support with combination feeding (combining artificial and breastmilk) as an option. Respondents who had needed to return to work early, those who had experienced traumatic births and those who had experienced maternal or infant ill-health highlighted how combination feeding had been vital in maintaining their breastfeeding journey (Table 4). However, in many instances, participants described a lack of support and a lack of information about how to successfully combination feed from healthcare professionals.
A further interesting finding was a perceived lack of support for expressing. Respondents who had express-fed their babies had done so for a variety of reasons, including premature birth, returning to work or latching difficulties. These participants described receiving limited information or advice from healthcare professionals and, in some instances, no practical support.
Intervention points
Participants within the survey and the interviews highlighted key points in time when intervention from healthcare professionals was crucial. First, participants identified that support from midwives often disappeared too soon after birth before breastfeeding had become established. There was also a general feeling the health visitors were less well-equipped to support breastfeeding than midwives (Table 4). Mental health support was also identified as lacking. Some identified that when experiencing mental health problems, intervention and support from healthcare professionals was either not forthcoming or too slow to be effective. Others expressed a need for greater support at times when they experienced intensive sleep deprivation, a time when participants were at their most vulnerable to developing mental health difficulties either short or longer term.
Mental health
Participants in the survey were asked questions about the impact of breastfeeding upon their mental health. Overall, 46.7% of participants identified a change in their mental health while breastfeeding. The most common change was feeling depressed (22.3%), with 9.5% reporting significant feelings of guilt and 8.4% reporting feelings of anxiety. A total of 4.2% respondents identified that they felt breastfeeding had negatively affected their attachment with their infant (Table 5).
Table 5. Theme 3, subtheme and supporting quotes
| Theme | Supporting quotes |
|---|---|
| Theme 3: mental health |
|
| Subtheme: pressure to breastfeed |
|
| Subtheme: failure to breastfeed |
|
Of the sample, 17.0% reported a positive impact of breastfeeding on their mental health and 66.0% felt that breastfeeding had positively affected their attachment with their infant.
Pressure to breastfeed
Linked to mental health, 37.3% of participants reported feeling pressure to breastfeed (Table 5). This pressure was driven by an internal pressure to breastfeed (46.0%), pressure from healthcare professionals (33.0%) or pressure from family and friends (21.0%). The subtheme was linked to mental health, as participants expressed feeling guilt when they were unable to breastfeed, shame if they contemplated stopping or a sense of disappointment and failure in performing their role as a mother if they did not continue breastfeeding.
Failure to breastfeed
One of the worrying subthemes among participants who struggled to maintain breastfeeding was a sense of failure associated with being unable to do so (Table 5). This feeling of failure often fed into poor mental health and in some instances, a poor ongoing attachment relationship with their child. In some instances, ceasing breastfeeding was necessary for their own mental health.
Birthing experience
Throughout both the interviews and the survey, it was clear that participants' childbirth experience often had an impact on their need for support from healthcare professionals, their breastfeeding success and their mental health. For example, participants who described their births as traumatic in some way often talked about having difficulties initiating breastfeeding. This was often overlooked by staff who, in many instances, advocated formula feeding rather than supporting initiation of breastfeeding. It was felt by some participants that healthcare professionals did not seem to make allowances for the extra difficulties a traumatic birth may present to a person choosing to breastfeed and insufficient resources were provided to support them (Table 6). Furthermore, participants who had experienced traumatic childbirth often reflected feeling like a ‘failure’ and overinvested in breastfeeding as a way of atonement for this failure, often to the detriment of their own mental health.
Table 6. Theme 4, subtheme and supporting quotes
| Theme | Supporting quotes |
|---|---|
| Theme 4: birthing experience | ‘She was really, really sleepy and that kind of in turn affected obviously the breastfeeding attachment and things’ P1 (emergency caesarean section)‘He did have a couple of formula feeds while I was in hospital because the milk wasn't flowing or I couldn't get him latched and he needed to be fed’.P2 (Post-delivery complications)‘They took her off me and put her in transitional care. And then, unbeknownst to me they gave her formula in a syringe. So by the time I had seen her, she'd already had several syringes of formula’. P4 (Post-delivery complications)‘I hadn't managed to give birth…at that point, I felt like I'd failed, so I was adamant that I would feed’ P3‘Very dramatic and and difficult birth…I was then in intensive care with her. The only thing I could actually do to provide for her was to try and express’ P21 |
Discussion
The findings from this study identified a range of challenges experienced by people who breastfeed. Complications with latching, nipple trauma and pain while feeding coincided with limited access to appropriate advice, support and information. This study also highlighted difficulties with mental health during breastfeeding and additional challenges for participants who had undergone a traumatic birth. These factors influenced the likelihood of respondents continuing to breastfeed their infants.
While most of the respondents to the survey continued to breastfeed their babies for at least 12 months, there were others who did not. It was identified that issues associated with poor support were a key factor in influencing early cessation, whereas reassurance from healthcare professionals was one of the biggest contributing factors to continuing breastfeeding. It is important to note that despite the majority continuing to breastfeed longer term, 87.2% of the sample had experienced complications. This identifies a need for continued support during the breastfeeding journey, as outlined in previous literature (Keevash et al, 2018). Support needs arise in the early stages of breastfeeding with more focus needed in hospitals on ensuring women and breastfeeding people are confident and capable of breastfeeding (Wray and Garside, 2018). The need for support is long term, particularly at crucial periods where mental health may be most at risk.
The study also identified that participants required general advice as well as specialist care for their infant when faced with things such as tongue and lip tie, particularly if they are new mothers. Information and advice about the difficulties that can occur when breastfeeding need to be included in antenatal care so that women and breastfeeding people are forewarned and forearmed with the facts, both good and bad, about breastfeeding (Keevash et al, 2018). The difficulties participants were not prepared for were often a contributing factor in the decision to cease breastfeeding earlier than originally intended.
The findings from this study clearly identified that support, particularly around aspects of mental health are still lacking within antenatal, perinatal and postnatal services in the UK, as identified by previous studies (Baptie et al, 2021). Participants talked of experiences of poor mental health that were either left untreated or not addressed appropriately until long after they had been reported. Poor mental health is known to be a contributing factor in early cessation of breastfeeding (Silva et al, 2017) and it is vital that there are appropriate support structures in place to ensure women and breastfeeding people receive the help they need. This is particularly important for women and breastfeeding people who experienced a traumatic birth who may be more susceptible to experience mental health issues postpartum (Baptie et al, 2021). Previous literature has identified that mothers who had experienced a traumatic birth felt it vital to be able to initiate breastfeeding to regain the sense of control lost during the birthing process (Baptie et al, 2021). The current findings support this and while a positive breastfeeding experience can overcome the psychological impact of a traumatic birth, for those who are then unable to breastfeed, the consequences for their ongoing mental health may be particularly negative.
On a more positive note, the current findings also identified that while negative breastfeeding experiences could negatively impact on mental health, positive breastfeeding experiences led to positive infant attachment relationships and overall improvements in mental health for those previously experiencing anxiety or depression or acted as a protective factor against developing postnatal depression (Hahn-Holbrook et al, 2013; Borra et al, 2015). The multifaceted relationship between breastfeeding experiences and mental health requires further investigation.
Limitations
The study recruited participants who had given birth and were, or had attempted to, breastfeed their infants after 2012. This timeframe was chosen to ensure data were based on current practice implemented after the WHO baby-friendly UK initiative was reviewed in 2012. However, it is important to note that the baby-friendly initiative has grown over the course of this time period so the responses of the participants may not entirely reflect current practice everywhere in the UK.
The authors recognise that a major limitation in the study is that of socioeconomic and sociocultural factors. The sample collected was large but reflects the needs and opinions of a largely professional, white British audience from higher socioeconomic backgrounds. Additionally, the modal average period of breastfeeding in this study was 13–24 months, which is far greater than the national average, as less than 50% of people still breastfeed at 8 weeks (Nicholson and Hayward, 2021). Therefore, the authors accept that the issues affecting individuals from more deprived areas, those from ethnic minority communities and those who have not breastfed for long, or at all, are not sufficiently represented here.
Implications for practice and policy
The findings from this study emphasise that the success in breastfeeding is not solely a mother's responsibility, instead it is a collective societal responsibility that requires promotion of a supportive environment through healthcare services, social attitudes employment conditions and policymaking. Changes are required to antenatal care to include classes that provide new mothers with accurate information about the difficulties it is possible to experience when breastfeeding. It is recommended that this process should include a peer support element where existing mothers discuss their breastfeeding experiences, both positive and negative. Health visitors should discuss breastfeeding with evidence-based information on antenatal visits to ensure informed decisions over feeding choices, and to arm mothers and families with maximum knowledge, preparation and an awareness of available support.
The respondents expressed a need for more support to build confidence and capability to breastfeed, including longer lengths of stay in hospital to ensure successful breastfeeding prior to venturing home. While this may not always be necessary or desired, it is important that length of stay in hospital is not determined purely by a mother and infant's physical ability to return home, but that their ability to do so with the infant's feeding needs being met are also considered appropriately. This should involve more time being taken to observe women and breastfeeding people. Maternity unit staff need to provide more information to new mothers about the potential complications that can arise when breastfeeding. Based on the findings of this study, the authors recomment that a feeding pack with useful sources of support and information be provided to new mothers along with guidelines on common difficulties to be aware of. Particular attention should be paid to those who have experienced a potentially traumatic birth, with improved training for maternity staff on the potential complications to breastfeeding caused by such births. Maternity units need to provide support that is more intensive, with consideration of referrals to breastfeeding specialists if required.
On discharge, it is important that health visitors have protected visits in the postnatal period to use their skills in assessing potential mental health issues and acknowledge that feeding, either breast or formula, may be impacting on maternal mental health. It is crucial that they support mothers in whichever feeding choice they make, without judgement.
Conclusions
This study has identified a wealth of difficulties experienced by those who are breastfeeding that can influence breastfeeding behaviour. Far from being a ‘natural and easy’ process, breastfeeding can be incredibly challenging, and this unrealistic façade can evoke feelings of inadequacy and guilt in new mothers when faced with feeding difficulties. Despite recommendations to improve rates of breastfeeding across the UK, many ae still cease breastfeeding prior to 1 year and before they originally desired. This report highlights that increased access to, and awareness of, support services, as well as improved information about the potential difficulties with breastfeeding, may increase confidence and thus improve rates of breastfeeding.
Key points
- This study surveyed 1505 people about factors that influenced their breastfeeding experiences, with 30 mothers agreeing to be interviewed.
- A range of feeding complications were identified, including those associated with maternal and pediatric ill health.
- Thematic analysis found that factors influencing breastfeeding included attitudes towards breastfeeding, availability of information, birthing experience and maternal mental health.
- Breastfeeding requires support and information from healthcare professionals to ensure that it is adopted longer term.
CPD reflective questions
- How can midwives ensure accurate information about the difficulties of breastfeeding are provided during the antenatal period without discouraging breastfeeding?
- How can healthcare professionals promote breastfeeding while ensuring that messages are not perceived as judgemental if they struggle?
- How can services be improved to support those who have experienced a traumatic birth and wish to breastfeed?
- What information could professionals provide on combination feeding to support the needs of those who are unable to solely breastfeed long term?
- How can appropriate support services be signposted?