7.3 Factors contributing to the core problem
7.3.1.2 Ambiguity of information and attitudes
In general, women expect that the recognised medical experts such as doctors, midwives, and lactation consultants will be able to diagnose their breastfeeding problem and instigate appropriate interventions. Mothers are prepared to play their part by working hard, developing their skills, and doing whatever is recommended to fix the problem. They come to realise, however, with some disbelief, that this is neither a straightforward process nor always an achievable outcome. Women describe feeling frustrated, angry, and let down because, while breastfeeding is actively promoted; the answers about how to achieve it are not necessarily available89. Karen (mother) laments, “I just want someone to say, “This is why [it’s not working], but no one can do that” (M 11/04). In another situation, Wendy (mother), who has a clear medical diagnosis of nipple thrush90, a well-known breastfeeding problem, still cannot find a treatment that works. She states,
“I’m going, “there must be something else you can give me, you’re a doctor”. They just had no idea” (M 09/09). In addition to not being able to access clear and effective diagnoses and treatment strategies, women frequently report receiving conflicting professional advice, which causes further disappointment and confusion.
She [lactation consultant] came many times and she actually said “Look I think her throat condition is causing her feeding problem”, and then the paediatrician over- ruled that. I was so confused. I mean I had put my faith in him, entirely, and he just actually just didn’t know that there could be a connection between the condition and breastfeeding (Kylie, M 07/04).
When mothers receive advice that is unhelpful or incompatible with their needs; it poses a problem for osteopaths, who must determine the best way to deal with the situation. Most osteopaths acknowledge that breastfeeding is not their speciality and are cautious about their recommendations. Typically, they gather information about the type, quality and reliability of advice given to mothers and a comprehensive account of interventions that have been tried and their outcomes. Such an evaluation is necessary before deciding what advice, if any, they will give and how to best deliver it. The typical response from women, who have tried unsuccessfully to overcome their breastfeeding problem, is to feel initially frustrated, then overwhelmed. The data demonstrates significant negative emotional consequences for mothers as a result of receiving what is perceived as inconsistent, insensitive, or unhelpful professional support; a similar finding from other
89 Ambiguity of information and attitudes links closely to the contextual determinant, Health care as a commodity and its sub theme of shopping around. See chapter 6.2.3.
90 Thrush is a lay term for infection with candida. See Chapter 5.2.1, Table 4, for a clinical definition.
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studies of women’s early postpartum and breastfeeding experiences (Binns & Scott, 2002;
Graffy & Taylor, 2005; James, 2004; Locklin & Naber, 1993).
Mothers in this study, who are highly motivated to breastfeed, come to realise, over time, that if they want to continue to breastfeed, they must assume greater responsibility for finding a solution. This is a significant burden as it involves sorting through a plethora of information and making decisions about the trustworthiness and accuracy of the source and whether to try a particular intervention.
There’s so much conflicting information out there though. You really have to trawl through a lot to try and find different things that actually seem like they might work;
that there is enough of the same thing to say, “Ok that’s good, we’ll try that”
(Wendy, M 09/10).
When one resource fails to meet their needs, women tend to consider alternate forms of assistance on the basis of past experiences and personal preferences. Some mothers, for example, seek lay information from outside their immediate social network and standard medically based resources; the most common being the internet and hearsay from other mothers. Marie (mother), for example, places more faith in learning from other mothers’
experiences, preferring to seek advice from internet sites that were, “not from doctors, but with information more from mothers ‘nutting’ out what was wrong with their babies” (M 04/03).
When mothers move away from professionally based breastfeeding support toward wider social and family support they can continue to face uncertainty when exposed to others’
diverse breastfeeding opinions91. Typically, they report feeling caught in the middle of disparate attitudes toward breastfeeding. One example of conflicting breastfeeding views relates to mothers’ feelings about breastfeeding in public places.
I don’t know [what] I’d say to someone if they came up to me and said, “You shouldn’t be doing that [breastfeeding] in public”. I just don’t want to put myself in that situation … especially older people are really funny about it. They want you to breastfeed; that’s the ultimate thing; but then they’re really funny about it if you do it in public (Sally, M 12/11).
Here, Sally wants to avoid causing others’ and her own discomfort and embarrassment; a complex issue that has been discussed in other studies (Lavender et al., 2006; Mahon- Daly & Andrews, 2002; Ryan et al., 2011). Public places are not the only environment in
91 See Chapter 6.2.1.2 Advice and Expectations of Significant Others.
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which some women report feeling uncomfortable while breastfeeding. In general, women express a desire for privacy when breastfeeding, for different reasons. Overall, they articulate a need to create an environment conducive to breastfeeding; one that is removed from disruptive elements, where they can simultaneously relax and focus on their baby and the task. In the present study, mothers describe a range of situations that reflect an unfriendly breastfeeding culture in the sense that their efforts to breastfeed are not actively supported by family and friends, or even undermined, in subtle and more obvious ways. For example, a common finding is that family and friends typically adopt an attitude to breastfeeding, encapsulated by Nadia (mother) as, “if it’s [breastfeeding] not working, just put him [baby] on the bottle” (M 10/10). The intent may be well-meaning but the effect is discouraging for a mother determined to breastfeed. As discussed before92, conflicting generational views are thought to contribute to the complexity of issues with which some mothers must contend.
Mother participants, who describe a range of frustrating experiences relating to others’
breastfeeding views, which are incompatible with their own, typically describe reaching a point where they are reluctant to accept advice or assistance from anyone, including perceived ‘experts’, until they have had an opportunity to process it, perhaps test it, and draw their own conclusions. The data highlight numerous possible breastfeeding support strategies, recommended by a variety of sources that mothers have to choose from and which are employed with mixed results. Breastfeeding interventions are, however, generally associated with emotive maternal responses that reflect considerable distress.
Ultimately, women with breastfeeding difficulties make decisions and take action based on their confidence in a proposed strategy, the perceived reliability of the source, and interplay of less readily identifiable intuitive processes. Mothers often use trial and error, employing a range of combinations of strategies that include artificial feeding products such as nipple shields, bottles, and pumps to express milk as well as adjusting timing, positioning and the feeding environment. Infant feeding emerges as a dynamic complicated activity, which involves different strategies in different combinations at different times. Vivienne, a first-time mother, sums this situation up as, “a bit of everything is what’s working for us at the moment” (M03/02).
Osteopathy emerges as one of the strategies that mothers believe might assist; however the initial visit to the osteopath is often associated with considerable uncertainty and anxiety. As noted in the previous chapter93, osteopathy is a relatively unknown or poorly
92 See Chapter 6.2.1.2.
93 See Chapter 6.3.2.2.
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understood health discipline. Different perceptions of osteopathy are expressed throughout the data, which can create uncertainty and some anxiety for mothers, who have mixed levels of understanding of osteopathy for babies according to their knowledge and experience of it. Most women choose more orthodox forms of treatment at first, but finding that they have not helped, move onto other less well-known therapies, such as osteopathy.
The first time [visit to the osteopath] it did [worry me] because I guess I was really unsure, not having had an osteopathic treatment before, I didn’t know if it hurt (Sally, M 12/07).
Mothers weigh up a number of factors before deciding to take their baby to an osteopath.
Some act on the recommendation of one, or a combination of, a health professional, another mother, or friend. Some already have a long history of association with osteopathic treatment, such that it has become an integral part of their general approach to family health; however all participants began this initial association with the same ambiguity about what osteopathic treatment of babies entails.
Those who are generally supportive of osteopathy still hold some concerns regarding its suitability for a baby. This idea is linked to individuals’ perceptions of different types of manual therapy and the perceived risks, particularly for a baby. Babies are considered vulnerable due to the immaturity of their anatomy and physiological systems, and consent and communication difficulties. The expertise of the osteopath in the field of paediatrics becomes another form of uncertainty faced by parents. Mothers who have experienced elements of self-doubt, difficult babies, and ambiguous information and interventions and who are also unfamiliar with osteopathy, typically seek breastfeeding assistance from a paediatric osteopath in an anxious state. At this stage, they are often feeling desperate and overwhelmed.