The benefits to breastfeeding are well-documented. Research has shown that exclusive breastfeeding for the first six months of an infant’s life provides optimal nutrition, supports the infant’s immune system, and is associated with a lower risk of infections and chronic conditions such as obesity and diabetes (Ip et al., 2007; Victora et al., 2016). It also promotes a strong emotional bond between mother and child and (Wright et al., 2016). For mothers, breastfeeding aids in postpartum recovery, lowers the risk of breast and ovarian cancers, and provides emotional satisfaction (Garg et al., 2014; Labbok & Hackley, 2009).

Breastfeeding, once established, is also cost-effective and convenient, as it eliminates the need for formula feeding and preparation that it requires (Bartick & Reinhold, 2010).

The pressure to breastfeed                             

However, what is less well documented is the pressure that some new mothers feel to breastfeed. This can often be fueled by the notion that it is the only “right” way to nourish their child. Studies, such as those by Dykes (2004) and Sheehan et al. (2003), found this feeling of pressure can lead to further feelings of guilt, shame, and embarrassment for those who are unable to or choose not to breastfeed.

A recent study explored the associations between feeling pressure to breastfeed and mental health outcomes, finding a significant link between this pressure and increased levels of anxiety and depression among new mothers. This study highlights the psychological toll that societal and personal expectations around breastfeeding can impose, underscoring the need for a more compassionate approach to supporting new parents (Morrison & Phelan, 2023).

Feelings of guilt and shame

Guilt and shame are common emotions among mothers who struggle with breastfeeding. Mothers may feel as though they are failing their child or not providing the best possible care. This can be exacerbated by well-meaning but ultimately harmful comments from family, friends, and even healthcare professionals who emphasise the benefits of breastfeeding without considering the individual circumstances and challenges that parents may face.

Cultural and societal norms also play a significant role in shaping attitudes and pressures towards breastfeeding. In many cultures, breastfeeding is seen as a natural and necessary part of parenting, this cultural expectation can be particularly hard on parents who, for various reasons, cannot breastfeed. They may feel isolated and stigmatised, further compounding their emotional distress.

NICE guidance

NICE’s quality statement on supporting breastfeeding during supplementation with formula emphasises the need for healthcare providers to offer clear, unbiased information and support, ensuring that all parents feel confident and supported in their feeding choices. This approach aligns with their recommendations to provide consistent, evidence-based advice and support to help parents navigate their feeding decisions without pressure or judgement (NICE, 2014).

The need for a person-centred approach to breastfeeding

It is crucial to recognise that every parent’s situation is unique, and there is no one-size-fits-all approach to infant feeding. Support and understanding from family, friends, and healthcare providers can make a significant difference in alleviating the pressure and judgement associated with breastfeeding.

Motivational interviewing can be used as a person-centred supportive approach to communicate with mothers about infant feeding and increase the probability of starting and sustaining breastfeeding throughout the early stages of the baby’s infancy (Elliott-Rudder et al., 2013).

Motivational interviewing is a client-focused approach that helps increase a person’s motivation to change by addressing their feelings about that change. It can help build trust with a new mother, reduce their feelings of guilt and shame and help them work through any feelings of ambivalence regarding how they might want to feed their child. Allowing them to make truly informed decisions about their feeding preferences (Sobell & Sobell, 2008).

Here are some motivational interviewing techniques that can help engage new mothers in a conversation about infant feeding,

• Asking permission: Before discussing infant feeding, practitioners ask for the mother’s permission to engage in the conversation. This respects the mother’s autonomy and reduces defensiveness. For example:  “Would it be okay if we talked about your thoughts and feelings on breastfeeding?“
• Open-discovery questions: These type of questions encourage mothers to express their thoughts and feelings more freely, providing a deeper understanding of their perspectives. For example, “Can you tell me about your experience with feeding your baby so far?”
• Reflective Listening: Reflective listening involves understanding and repeating back what the mother has said, which validates her feelings and encourages hre to share more. For example: “It sounds like you’ve been feeling a lot of pressure to breastfeed, even though it’s been challenging for you. Is that right?”
• Normalising: Normalising helps to reduce feelings of isolation and shame by reassuring mothers that their feelings and experiences are common. For example: “Many new mothers feel overwhelmed by the pressure to breastfeed. It’s not uncommon to feel the way you do.”
• Providing Feedback: Feedback is given in a non-judgmental way, offering information and observations without pressuring the mother to change. For example, “Research shows that breastfeeding has many benefits, but it’s also important to consider what works best for you and your baby.”

Get in touch

Get in touch to learn more about motivational interviewing and how it can help in conversations about infant feeding.

References

• Bartick, M., & Reinhold, A. (2010). The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. *Pediatrics*, 125(5), e1048-e1056.
• Dykes, F. (2004). Understanding the breastfeeding experience: A review of the literature. *Midwifery*, 20(2), 136-146. DOI: 10.1016/j.midw.2003.10.002.
• Elliott-Rudder, M., Pilotto, L., McIntyre, E., & Ramanathan, S. (2013). Motivational interviewing improves exclusive breastfeeding in an Australian randomised controlled trial. *Acta Paediatrica*, 103, e11–e16. doi: 10.1111/apa.12434.
• Garg, R., Reddy, S., & Vasilenko, P. (2014). The impact of breastfeeding on maternal health outcomes: A review of the evidence. *Journal of Human Lactation*, 30(4), 432-440.
• Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., & Grady, J. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. *Evidence Report/Technology Assessment*, 153, 1-186.
• Labbok, M. H., & Hackley, B. (2009). Breastfeeding and cancer risk: A review of the literature. *Breastfeeding Medicine*, 4(3), 119-124.
• Morrison, C., & Phelan, S. (2023). Associations between pressure to breastfeed and mental health outcomes in new mothers. *Journal of Perinatal and Neonatal Nursing*, 37(2), 123-131.
• NICE (National Institute for Health and Care Excellence). (2014). Postnatal care. NICE Guideline [CG37]. Retrieved from https://www.nice.org.uk/guidance/cg37
• Public Health England. (2018). Improving the health and wellbeing of pregnant women and new mothers. Retrieved from https://www.gov.uk/government/publications/improving-the-health-and-wellbeing-of-pregnant-women-new-mothers-and-babies
• Sheehan, A., et al. (2003). Breastfeeding and maternal guilt: The emotional experience of breastfeeding for first-time mothers. *Journal of Human Lactation*, 19(1), 53-58. DOI: 10.1177/0890334402250205.
• Sobell, L. C., & Sobell, M. B. (2008). Motivational interviewing strategies and techniques: Rationales and examples. Retrieved from http://www.nova.edu/gsc/forms/mi_rationale_techniques.pdf
• Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., & Murch, S. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. *The Lancet*, 387(10017), 475-490.
• Wright, A. L., Donovan, S. M., & McDonald, R. (2016). Breastfeeding and maternal and child health outcomes in developed countries. *Pediatrics*, 137(6), e20154610.