The moral landscape of infant feeding

In the summer of 2014, I was fortunate to have had a work placement with a one-to-one midwifery service in Greater Manchester. On this placement I shadowed a community midwife on home visits. One day we visited a mother who had been struggling to establish breastfeeding.

This lady was huddled into the nook of her darkened bedroom with her unsettled baby and was sobbing for support. At the time, the only exposure I had had to breastfeeding was through seeing TV advertisements. In said advertisements, mum and baby were smiling and cuddled peacefully amid the backdrop of a pristine white bedroom.

This contrast sparked a question in me: If I had been so unaware of the breastfeeding difficulties that women face after giving birth, I surely couldn't have been the only one? Since then, I have been impassioned to voice the experiences of these women. Flash forward to 2017, by which time this passion had taken the form of a part-time PhD at the University of Liverpool. Here, I then spent five years investigating the moral landscape of infant feeding. This research was conducted in collaboration with Dr Leonardo De Pascalis, Dr Vicky Fallon, and Professor Joanne Harrold. 

Morality and parenting: Two co-occurring experiences

More specifically, my PhD focused on experiences of guilt and shame among cis-female mothers. When synthesising the pre-existing literature base, it was apparent that new mums are frequently exposed to contradictory messages about how 'best' to take care of their baby e.g. when, how, and what foods to wean your baby with, whether co-sleeping benefits outweigh risks, and the benefits of carrying your baby against your chest (called Kangaroo care), to name a few.

Parents and babies are each unique with individual needs and attributes. Because of this, what works 'best' for some families might not work well for others. As a result, people often express opinions online and face-to-face, which counter one another. This makes it confusing for new mums to know how best to proceed. One of the largest topics of contention in the parenting world is that of infant feeding. If a mum thinks that what she is doing is harmful to her baby or is not good enough, this can lead to feelings of guilt and shame. Guilt and shame both come up if you think that you have done something wrong or failed to do something right.

While guilt is tied to the behavioural (in)action e.g. "I shouldn't have given my baby that bottle of formula milk.", shame is more self-deprecating e.g. "I'm not even a real mum, because I can't even feed my baby breastmilk. That's what I'm supposed to do'". Both emotions predict other types of distress, such as anxiety and depression. My research to date has looked at ways that we can better support new mums with feeding and psychological wellbeing. 

Postpartum guilt and shame: Shining a light on infant feeding

In my first study, we found that the more that a mum formula feeds her baby, the more intense the feelings of guilt will be. Official guidance recommends that new mums breastfeed exclusively for the first six months after giving birth. If a mother believes that she is failing by not meeting these recommendations, then this results in feeling guilty.

In an online survey study, we found that shame on the other hand, was not associated with infant feeding method. Rather, women who felt greater pressure to breastfeed, and women who felt less well supported by their healthcare team experienced more intense shame than those who felt better supported.

Some differences were found between how guilt and shame manifested, also. For example, guilt emerged if mothers felt that they had received infant feeding information that was contradicting or overly biased in favour of breastfeeding. On the other hand, shame was present if mums had tried to talk about formula feeding with their healthcare team, but that these bids for conversation were actively silenced.

More recently, my colleagues and I explored factors that helped women to breastfeed when challenges were experienced. For most, breastfeeding is a lot more difficult than they had been led to believe during pregnancy. It's important for conversations about infant feeding to be realistic and solution-focused so that women can better prepare for common challenges.

From interviews with women, we found that being highly determined, goal-orientated, and holding personal motivations for breastfeeding helped to persevere through difficulties in favour of long-term breastfeeding aspirations. Women who had a strong network of supporters, who shared the mother's achievements, also helped to protect breastfeeding continuation.   

How do we find a solution that encourages breastfeeding and supports mums? 

Thinking more broadly about my portfolio of work - there are numerous ways that we can better support women to breastfeed, without expending emotional wellbeing. Firstly, strengthening legal workplace protection for breastfeeding mothers would improve its viability for a lot of UK women. Portraying more breastfeeding role models in the media e.g. advertisements, celebrity magazines, in television and films etc. too, would shift societal attitudes towards a more pro-breastfeeding culture.

Ultimately, giving women balanced information about their infant feeding options would allow for informed choices to be made based on personal circumstances and level of comfort. Doing so may encourage some women to feed their babies with a combination of breastmilk and formula milk, who might otherwise not have considered breastfeeding at all. Finally, for those who choose to formula feed, it is also important for access to information about safe formula milk use to prevent potential feelings of shame.

To conclude, new mothers struggle to navigate contradictory messaging about how to best take care of their babies. Infant feeding is a big topic of contention in the parenting world. Breastfeeding protects against psychological distress and is thus important to protect where possible. Factors are discussed which play a role in protecting breastfeeding continuation. Recommendations are also made so that we may better support new mums with meeting their infant feeding aspirations, while protecting emotional wellbeing.