7.3 Factors contributing to the core problem
7.3.1.1 Self-doubt and difficult babies
One of the common questions that women in the current study raise relates to whether the problem lies primarily with them or their babies. Osteopaths face a similar dilemma when determining the relative causes of complex breastfeeding difficulties. The problem for them in this instance, however, lies more with exploring the issue of, “to what extent is it the baby or the mother?”, and with awareness of mothers’ psychological vulnerability to avoid intensifying negative thoughts and feelings of self-doubt.
Generally, mothers understand that breastfeeding involves specific positioning skills and the need to work with the baby in order to establish an effective lactation cycle. Doubts relate to a mother’s confidence in her skills and biological capabilities and in relation to the baby’s feeding actions and behaviours. In addition, mothers who are seeking help for breastfeeding difficulties from others must be able to articulate their concerns, which is challenging if a mother is unsure about what is happening. When trying to draw out this information, osteopaths must do so in an efficient but sensitive manner. First-time parents, in particular, face many new challenges. Approximately half the women in the study are first-time mothers. These mothers, new to breastfeeding, readily seek affirmation from health professionals that they are breastfeeding correctly.
I actually got a lactation consultant to come and see me just after I got home, um and just to, she goes ‘Well what’s your problem’? Well not really [a problem], I’m trying to make sure I’m doing everything OK (Dianne, M05/05).
Despite generally being proactive in seeking professional assurance, some mothers remain concerned about their ability to meet their babies’ nutritional requirements. They express uncertainty in their biological capabilities with regard to sufficient quality and quantity of breast milk, which is exacerbated by an inability to exactly measure a breastfed baby’s milk intake. This finding is similarly commonly reported in the literature88. Some
88 See Chapter 2.5.1.2.
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authors propose that a generalised social mistrust of breastfeeding on the basis of its less visible and innate regulatory processes, has currently arisen, in part, because it does not fit with the specific, controlled, and more highly valued scientific approach (Fiona Dykes, 2005; Thomas, 2006). The different experiences of two first-time mothers whose babies were not gaining weight at a satisfactory rate illustrate different dimensions of the way women’s self-doubt can be expressed. Here, Narelle is concerned her baby is not getting enough milk and Dianne doubts the quality of her milk.
At the hospital, it was all about weight gain, how much volume we should be pumping into him; when you go onto the breast it’s hard to know how much he’s getting … I couldn’t get him on the other side [breast] and he was fussing around and it was all so new and I didn’t want to kind of starve him, I guess, is what was going on in my head (Narelle M13/08).
He stopped feeding on my left breast. And oh, not completely stop but he just did not want to, and I didn’t know if I was producing ‘funny milk’ or what was happening (Dianne M 05/02).
Not only first-time mothers, however, face uncertainty and self-doubt. For those who already have children, the new baby brings a unique set of circumstances, and drawing on past experiences does not necessarily help. At times, mothers are frustrated by the inconsistency between breastfeeding experiences with different babies, particularly as they want all their children to receive the same benefits of breastfeeding. In some cases, mothers are better prepared for difficulties if they are similar to previous experiences with an older child; however the data demonstrates a wide range of breastfeeding problems with various levels of complexity experienced by each dyad. Tania (mother), for example, who breastfed three older siblings, is frustrated by a new and confounding problem of breast refusal with her fourth baby.
Yeah I kept trying him on it [the right breast] and he’d always [refuse]; we’d always encounter the same problems, until I just said, “that’s it, and I’m not [going to keep trying]”. You know, I ended up in tears of frustration because of; [I] just couldn’t feed him on that side! (Tania M 01/08).
Typically, babies with breastfeeding difficulties, are described as fussy and irritable, which is often interpreted as a sign of hunger. However, mothers can attribute this behaviour to other causes such as the baby’s personality. For example, Wendy (mother) describes her daughter as “an opinionated baby and she tells us what she likes and what she doesn’t
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like and she just didn’t want to be lying down [to breastfeed]” (M 09/07). Catherine (mother) states that, when attempting to breastfeed, “if she’s [baby] not got the attitude to try it, then there’s no point hurting myself” (Catherine, M 02/06). Although Wendy and Catherine believe their babies are expressing preferences that relate to individual personality traits, they are attempting to make sense of their situations. Breastfeeding problems are particularly confounding, as with Tania before, when women cannot understand why their babies behave the way they do. Mothers describe a wide variety of individual infant behaviours that they desperately want to understand.
Somewhere between week four and week six, he was feeding beautifully and then all of a sudden, it was like this little switch of “Why are you yanking off [the breast]
all the time?” We had weeks of screaming incessantly and Bill [father] was back at work at that time and we were always in the corridors going, you know, fed, changed, can’t understand, we don’t know what else is going on (Sonia M 06/03).
Struggling to breastfeed satisfactorily represents a dynamic and often complex, unpredictable situation. Once a particular problem is sorted, another one can arise as circumstances change and the reasons remain obscure. While mothers typically feel frustrated by their babies’ behaviours, osteopaths take a more objective analytical perspective. Babies’ behaviours provide diagnostic clues to explain the cause of, or factors that contribute to, breastfeeding difficulties. One common example, cited in the data, relates to babies’ asymmetrical postures or uneven movement patterns that are made visible by their reluctance to turn the head in a particular direction or their inability to open the mouth wide. Physical motion restrictions are thought to impede babies’
neuromotor skills and make feeding at the breast tiring, difficult, or uncomfortable. Based on their professional knowledge, osteopaths postulate that the changing nature of breastfeeding difficulties and babies’ behaviours can be attributed, in part, to the consequences of unresolved physical dysfunctions that become more obvious at different stages of a baby’s development.
As mothers in the current study face uncertainty in regard to understanding the underlying cause of their breastfeeding difficulties, the problem is confounded by difficulty in accessing comprehensive answers. Breastfeeding information and support is typically perceived as complicated, confusing and even contradictory, which adds to, rather than ameliorates, their ongoing struggle to breastfeed satisfactorily.
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