There appear to be many beliefs and traditions surrounding breastfeeding. Analysis of the content of telephone calls to a hotline for support of first-time mothers in Lebanon revealed a number of beliefs and misconceptions that could discourage or hinder successful breastfeeding. Like many other studies, we found the quantity of breast milk that a mother produces to be a common concern and a major source of anxiety. Batal et al noted this to be the primary reason for early introduction of formula in their study on Lebanese women . Researchers cited similar concerns about insufficiency of breast milk as a common reason for early discontinuation of breastfeeding in many different countries including Iran , Turkey [6, 12], Brazil [3, 21], and the United States , among others.
The perception of insufficient breast milk has been attributed to the mother's interpretation of the baby's crying as a sign of hunger . In our population, this concern was related to both the crying of the infant, as well as the resolution of breast engorgement, which was interpreted by the mother as a sign for concern.
Interestingly, we found that family members (particularly the woman's mother) are important sources of discouragement of breastfeeding. This was noted in another study on breastfeeding in first-time mothers when women identified their own mothers, their partners and their partner's mothers as the main sources of discouragement of breastfeeding . In our study population, several women were discouraged from attempting to breastfeed because they were believed to be biologically incapable of breastfeeding. The belief that the tendency to have an insufficient milk supply is inherited from the mother has been noted previously . It is possible that mothers who had not breastfed their daughters may find it particularly difficult to have their own daughters breastfeed successfully, as they believe this may reflect on their own abilities to nurture their infants.
Family support is an important factor in establishing successful breastfeeding and lack of family support may discourage it [1, 21]. Identifying these issues in families may help the clinician address them during antenatal care and support the mother by reassuring female relatives that the capacity to breastfeed depends on the support and advice one receives and not on heredity.
Perceived characteristics of breast milk are another important determinant of breastfeeding duration . The belief that a mother can harm her infant through her breast milk can be an important source of distress for the mother. Many women may abandon breastfeeding because they are afraid of hurting their baby. "Bad" milk, abdominal cramps, medications, and the maternal diet are all viewed as potential sources of harm for the infant.
The belief that abdominal cramps can be transferred from mother to infant through breast milk was surprising to the authors as they had not heard of it before the study and there is no mention of such a belief in the literature. This belief reflects that breastfeeding is not only about transmission of nutrition from mother to child, but also about transmission of physical pain. Given that abdominal cramping postpartum is essentially universal, due to uterine involution, this belief can be a very important barrier to breastfeeding. Understanding that this is a commonly held belief and addressing it before discharge from the hospital may be an important step towards improving a woman's chance of breastfeeding successfully.
Colostrum is seen as harmful in many cultures and discarding it is a common practice [5, 11, 16]. However, we are not aware of such a belief in Lebanese culture and did not see this concept emerge through the telephone calls to the hotline. Other causes of "bad milk" cited in the literature such as sexual intercourse, pregnancy, and working in the sun were not mentioned by our callers [13, 15]. This may have been because the hotline was only available for four months postpartum. Had it been available for longer, these kinds of questions may have emerged.
The concept of the "kabseh" is an example in which breastfeeding relates to other people in society, not only the mother and infant. The belief that the evil eye could harm a mother's milk has been described in the literature . In Egypt, the belief that the entrance of a menstruating woman into the room can harm a mother or baby is referred to as "mushahra" . In Anatolia, not allowing another lactating woman to enter the house is believed to protect the mother and baby from evil forces . The perception of the evil eye presents a barrier to women breastfeeding, because a mother might deny her child the benefits of her breast milk if she fears she has been subjected to the evil eye.
Our findings revealed that women might hold a number of beliefs that discourage them from breastfeeding successfully. Clinicians should attempt to elicit such beliefs and address them during the clinical encounter as a means to reassure mothers and encourage them to continue breastfeeding. Local and international organizations working to encourage breastfeeding, such as La Leche League, should also consider these beliefs when planning their programs.
In this study, the researchers did not specifically set out to investigate beliefs and traditions associated with breastfeeding. Women were not interviewed regarding their beliefs. Concerns that were expressed spontaneously in calls to the hotline were recorded. Therefore, common practices and beliefs would not have been identified if the callers did not specifically ask about them. There may be beliefs that are very common and so widely accepted that women do not question them or ask about them. Further studies that address this issue by asking women about their beliefs and practices could provide valuable information. Randomized trials could test the effectiveness of interventions to reduce maternal anxiety about breast milk quantity and quality.