Infant feeding in Eastern Scotland: a longitudinal mixed methods evaluation of antenatal intentions and postnatal satisfaction--the Feeding Your Baby study

Background: breast-feeding initiation rates have improved in Scotland, but exclusive and partial breast-feeding rates fall rapidly for several reasons. We aimed to examine whether antenatal feeding intention was associated with satisfaction with infant feeding method; and to explore the similarities and differences in infant feeding experience of women with different antenatal feeding intention scores.

Method(s): antenatal questionnaire assessment of infant feeding intentions, based on the theory of planned behaviour; two-weekly postnatal follow-up of infant feeding practice by text messaging; final telephone interview to determine reasons for and satisfaction with infant feeding practice.

Results: 355 women in eastern Scotland were recruited antenatally; 292 completed postnatal follow up. Antenatal feeding intentions broadly predicted postnatal practice. The highest satisfaction scores were seen in mothers with no breast-feeding intention who formula fed from birth, and those with high breast-feeding intention who breastfed for more than 8 weeks. The lowest satisfaction scores were seen in those with high intention scores who only managed to breast feed for less than 3 weeks. This suggests that satisfaction with infant feeding is associated with achieving feeding goals, whether artificial milk or breast feeding. Reasons for stopping breast feeding were broadly similar over time (too demanding, pain, latching, perception of amount of milk, lack of professional support, sibling jealousy). Perseverance appeared to mark out those women who managed to breast feed for longer; this was seen across the socio-economic spectrum. Societal and professional pressure to breast feed was commonly experienced.

Conclusions: satisfaction with actual infant feeding practice is associated with antenatal intention; levels are higher for those meeting their goals, whether formula feeding from birth or breast feeding for longer periods. Perceived pressure to breast feed raises questions about informed decision making. Identifying those who will benefit most from targeted infant feeding support is crucial.