Being a ‘good mother’: Managing breastfeeding and merging identities
Introduction
The benefits of breastfeeding for both the health of the baby and the breastfeeding mother are well established (e.g. Fewtrell, 2004; Howie, Forsyth, Ogston, Clark, & du V Florey, 1990; Kramer et al., 2001; Labbok, 2001; Rosenblatt & Thomas, 1993; Wilson et al., 1998) and the most recent expert guidance promotes exclusive breastfeeding for 6 months and continuing to give breastmilk at least up to age two (World Health Organisation, 2003). Within medicalised expert discourse, breastfeeding has assumed the status of moral imperative, inseparable from the conception of ‘good mothering’ (Carter, 1995; Murphy, 1999). The act of breastfeeding is not simply about meeting the nutritional needs of babies; it is also imbued with social, emotional, sexual and cultural meaning for mothers, for ‘significant others’ and for those within the wider social and cultural milieu (Maher, 1992; Vincent, 1999). Infant feeding practices and knowledge and beliefs about breastfeeding vary across countries, cultures, socio-economic position, as well as between individuals (Maher, 1992; Palmer, 1993; Van Esterik, 1989). Moreover, expert opinion has differed across countries and changed over time as have women's feeding practices, reflecting inter alia interpretations of evidence, social and economic constraints of industrial and post-industrial societies and the changing role of women (Henschel & Inch, 1996; Palmer, 1993). In the UK although around 70% of women start to breastfeed only 28% are exclusively breastfeeding their babies after 2 months (Hamlyn, 2002), a pattern that has been largely sustained for the last 20 years. This is in contrast to the situation in some other countries; for example Norway where 99% of women start to breastfeed and 85% are still breastfeeding, 44% exclusively, at 4 months (Lande et al., 2003), in part attributed to more favourable governmental policies around maternity leave and child care (Yngve & Sjöström, 2001).
The reasons why many women who start to breastfeed do not persist for long are likely to be both multidimensional and interactive; technical or skills related (Minchen, 1998; Renfrew, Fisher, & Arms, 2000), social and cultural (Maher, 1992; Phoenix et al., 1991), and reflect the changing patterns of women's participation in the labour market (Kosmala-Anderson & Wallace, 2006).
Being a mother, and indeed breastfeeding, do not occur within a social or historical vacuum (see for example Arnup, 1990; Blum, 2000). Social networks provide women with a framework within which to make sense of their experiences and therefore provoke feelings of responsibility that are culturally located (Miller, 2005). Social constructions of ‘good’, ‘bad or ‘normal’ mothers are usually implicit but the ‘moral minefield’ can affect the initial decision to breastfeed (Murphy, 1999, p. 205) and the continuing process of infant feeding (Murphy, Parker, & Phipps, 1998). Women encounter considerable contradictions in relation to infant feeding; although it has been argued that there is a normative imperative to breastfeed as the healthy option for babies (Murphy (1999), Murphy (2000)), it is also clear that breastfeeding women are rarely seen in the UK and other western countries where rates are low (Hamlyn, 2002; Nicoll, Thayaparan, Newell, & Rundall, 2002). This means that new mothers may lack embodied knowledge of breastfeeding (Hoddinott & Pill, 1999) which may have contributed to loss of confidence in women's bodies (Dykes, 2005) and this is further complicated by media representations of the breast as sexual (Henderson, 1999; Henderson, Kitzinger, & Green, 2000; McConville, 1994). Recognition of such tensions and contradictions facing women as they try to make sense of the relationship between their changing sense of self and their baby, whilst simultaneously maintaining a positive self-image, is an important starting point in understanding women's responses to breastfeeding and the kind of support they might find helpful.
In this paper, we explore breastfeeding in the context of everyday living with a new baby and we consider how it is valued and managed within the wider context of becoming and being a mother and the shift in identity, which that implies. We then draw out the policy and practice implications of our findings.
Section snippets
The study
This qualitative study included observation of 158 encounters between women who had chosen to breastfeed and health professionals (midwives and health visitors) in the community setting, followed by in-depth interviews with women (22) and their health professionals (18). In this paper we draw on observational data and interviews with women to focus on an in-depth understanding of the wider breastfeeding experience for women. Full ethics committee approval was obtained for the study. In the
Factors shaping the decision to breastfeed
All of the women in this study had breastfed their baby from the outset. For most of them, their intention took explicit shape during the later stage of pregnancy.
I hadn’t really thought about it early in my pregnancy, it was when I went to antenatal classes that I made my mind up… I decided from that point that I wanted to certainly give it a go. (Katie M2.4)
Consistent with other studies (e.g. Dykes, 2005; Murphy, 2000; Schmied & Lupton 2001); most women provided as explanation for their
Discussion
This exploration of women's experiences provides insight into the ways their responses to breastfeeding are informed by diverse social, emotional and practical concerns. We suggest that the conception of breastfeeding as synonymous with good mothering is more contested than has previously been presented (e.g. Carter, 1995; Murphy (1999), Murphy (2000), Murphy (2004)). Indeed, for many women in this study, their decision to breastfeed was portrayed as counter to normative practice within their
Acknowledgements
This study was supported by a Department of Health Fellowship Award. We would like to thank the breastfeeding women, midwives and health visitors who made the research possible, also Karl Atkin for helpful comments on earlier drafts of this article and the anonymous reviewers for their helpful comments.
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