6.2 Defining the study’s contextual determinants
6.2.1 Women’s views and experiences
6.2.1.1 Personal choices and expectations
In general, women in the study articulate a strong desire to do the best job of mothering possible. Within this central ideal, they share a number of common expectations;
however, they also express much individuality. Knowing how mothers expect or desire things to be creates a backdrop for osteopaths to evaluate the various obstacles to assisting women to achieve their breastfeeding goals. Women participants describe a well-organised approach to preparing for motherhood. It begins with pre-birth planning and gathering information from a range of sources, including written, online, discussion with experts, family and friends, and antenatal education classes. From this knowledge base, they develop an ideal or mental image of what to expect and the potential for flexibility and making individual choices. Other studies have similarly reported visualisation as a common strategy used by women to assist their transition to motherhood (Barnard &
Solchany, 2002; Heinicke, 2002). The following exemplar encapsulates much of these ideas concerning how women prepare for motherhood.
For me, even when I fell pregnant, I did a lot of reading and I’m one of those people if I do something, I have to do it right, and mothering is also … and so then when I was pregnant I read up all the books on child development. This [breastfeeding] is what I need to do and so that’s how I found out that …. I had told myself I’m going to have a natural birth, do everything the natural way. I ended up [with] a caesarean, but it was something in my mind was not going to happen (Jenny, M 08/05).
Like Jenny, women’s choices and expectations centre on doing the best mothering job possible, which is, in turn, linked to birth circumstances and breastfeeding; two issues that are often based upon the underlying idea that ‘natural’ is best. The desire for a ‘natural’
approach to childbirth and infant feeding has been reported in the literature as a growing contemporary lifestyle attitude or belief system which sees ‘natural mothering’ as a form of
63 See Chapter 5.2.1. Table 4, for an overview of mothers‘ obstetric histories, breastfeeding difficulties, and clinical problems.
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embodied female knowing (Bobel, 2010, p. 86). In the literature, tension and debate surrounds contemporary attitudes toward childbirth and the provision of appropriate maternity services, which are influenced by two dominant and competing discourses;
namely the biomedical and naturalistic approaches (Walsh, 2010). One pervasive view of the advantages of natural childbirth and breastfeeding is that they represent normality and an acceptance of complexity and uncertainty (Downe & McCourt, 2008) and a shift away from medicalisation, and external control of women’s bodies. This idea is expanded by applying theories of embodiment such that childbirth (Walsh, 2010) and breastfeeding (Ryan, Todres, & Alexander, 2011) are perceived as innate and fulfilling womanly achievements. When giving birth and making decisions about infant feeding, however, women can face unpredictable and ambiguous circumstances. They, and their partners and supporting health care team, must often negotiate a pathway between competing discourses and beliefs, particularly when problems arise and health risks have to be managed (Bryant, Porter, Tracy, & Sullivan, 2007; Turner et al., 2008).
For women in the current study, the term ‘natural’ means a normal vaginal birth without intervention and breastfeeding. For some, the idea of ‘natural mothering’ has a wider conceptual meaning that is not always clearly articulated but lies embedded within their personal and family values and underpins their behaviour at a deeper level.
Well, I was always going to breastfeed; obviously it’s my belief system;
breastfeeding is good and the way that I’ve been educated … and then I was going to be home, so it just seemed like a natural thing to do (Sally, M12/02).
Women participants generally demonstrate a strong commitment to breastfeed. Their motivation is linked to the importance they place on breastfeeding, their high expectations of themselves at a personal level and as new mothers. They give three prime reasons for choosing to breastfeed; the health benefits, convenience, and to enhance mother-baby bonding. Mothers tend to differ in their emphasis on each of these three elements, but in the following exemplar, Nadia (mother) interlinks them seamlessly and follows a course of action that is based upon what feels intuitively right for her.
It would’ve been easy to stop [breastfeeding] but I don’t think; it’s not as convenient in the long term and stuff for his [baby’s] health and for our relationship too; to keep breastfeeding is very nice, it’s comfy (M10/05).
Nadia has breast attachment problems with her third baby, which causes her considerable nipple discomfort. While bottle feeding offers an easy immediate solution, she maintains a
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longer term perspective, believing that the benefits of persevering with breastfeeding outweigh the alternatives. The message that breast milk and breastfeeding is the healthiest option for baby and mother is frequently articulated by this group of women, and it is a powerful motivator for them to breastfeed. Typically, knowledge concerning the extensive health related advantages of breastfeeding is expressed in the data as a form of pressure, of varying degrees, on mothers to breastfeed, or at least, to ensure their babies receive breast milk64. Women in this study apply personal pressure to live up to their breastfeeding expectations. They might not articulate exactly where this sense of pressure to breastfeed comes from, but it is evident in the data and expressed in emotive ways.
I mean, you sort of do this thing where breast milk’s the best, and she [baby] has to have it, at all costs (Kylie, M07/05).
Personal expectations of breastfeeding range from idealistic to more pragmatic. Each woman has her own perception of breastfeeding and its advantages. A similar finding was reported in another Australian grounded theory study, which explored women’s infant feeding experiences and decisions in the first six weeks after birth (Sheehan et al., 2009).
In this study, women’s infant feeding decisions were made on the basis of individuals
‘deconstructing best’ which means women working out what ‘best’ (infant feeding) means to them given that everybody’s experience is different.
Women in the current study consider, and prioritise, a number of factors when making their infant feeding choices. In general, the practical and nutritional elements of breastfeeding receive a lot of attention. Some view breastfeeding as an expedient way to feed a baby; linked to the notion of ready availability and transportability. The notion of breastfeeding as a convenient option, however, depends on how well breastfeeding works for each dyad. At times, bottle feeding is also seen as convenient and women build a lot of flexibility into how they choose to breastfeed. Variations relate to duration, exclusivity, and complementary feeding with artificial feeding products. For example, a common feeding strategy used by mothers in the study is breast milk feeding65 with a bottle for a number of different reasons. Some mothers, whose babies have attachment and suck problems, want to ensure adequate delivery of breast milk. Others use this method as a temporary measure, either to allow someone else to feed the baby, to feel more comfortable feeding the baby with a bottle in public, or due to nipple pain or damage. An exemplar of an individualized breastfeeding approach follows.
64 The concept of ‘pressure to breastfeed’ is discussed in Section 6.2.1.2 of this chapter.
65 Breast milk feeding is defined in Chapter 1.52.
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For Catherine, who comes from a long family tradition of women with breastfeeding difficulties, breastfeeding means ensuring her baby has breast milk as the healthiest option and also represents a sense of personal achievement. As she experiences initial attachment difficulties, she is more focused on the nutritional value of breast milk than how it is delivered to her baby.
But also the challenge of it [breastfeeding]; just to see whether I could do it or not, because I can be pretty determined when I want to be, but also I’m a bit of a ‘wuss’
[weakling], so I’ll do it in my own time ... Given that I was actually successfully giving her [expressed] milk [from a bottle], I didn’t want to ruin it by breastfeeding as well, at the same time. So from time to time, I would put her on [the breast] and see how it goes, but my main concern was to make sure at least she gets the milk and that I keep going with that (Catherine, M 02/).
Not all mothers enjoy breastfeeding; however all are generally aware that it enhances mother-baby bonding but can find it difficult to articulate what this means, exactly. The concept of bonding tends to be expressed more innately by the intimate way in which dyads interact, particularly by the way they look at each other and touch during breastfeeding. The emotional benefits that dyads attach to breastfeeding tend to emerge from the data in more subtle ways when mothers describe intimate moments during their everyday lives. For example, Sally (mother), who has an older child, describes breastfeeding as a much needed special time together for her and her new baby.
The only time we [mother and baby] really get together by ourselves is in the middle of the night. So it’s actually really quite nice, just to sort of sit there and admire him, and have that little time by ourselves. I think the bonding experience when you breastfeed is just amazing, yes it’s great … they’re so close to you, it’s really lovely. I would have been sad if I couldn’t breastfeed (M 12/12).
Most women participants, who make a choice to breastfeed, expect to be able to do so. In general, they anticipate that breastfeeding will require some effort; they might need some initial assistance, but it is a realistic and achievable goal. This idea fits with the notion of breastfeeding as a combination of natural and learnt processes which is the predominant discourse that underpins contemporary breastfeeding education66. All women, having initiated breastfeeding, regardless of their early breastfeeding choices, demonstrate considerable perseverance with this course of action. Despite encountering difficulties, they refuse to give up on breastfeeding; an attitude that can be understood, in part, on the
66 See Chapter 2.8.1.
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basis of individual factors such as strong personal beliefs. Other influencing factors are now considered.