There were 20 informants who participated in the in-depth interviews. Nine of them had practiced exclusive breastfeeding of their infants until six months of age, while 11 of them had mixed breastfeeding with feeding using infant formula. The informants’ occupations included doctor, veterinarian, dietician, nurse, teacher, clerk and assistant officer. Their ages ranged from 25 to 37 years, with their youngest children aged between eight months and 2.5 years.
Analysis of the transcripts identified three themes regarding breast milk expression that hindered them from practicing exclusive breastfeeding until six months of their infants’ age. They were as follows: (i) lack of feasibility of expressing breast milk, (ii) negative feelings about expressing breast milk, and (iii) doubts about the safety and hygiene of expressing breast milk.
Lack of feasibility of expressing breast milk
It was common for the informants who had practiced exclusive breastfeeding to express their breast milk regularly at their workplaces. They usually did so twice during their working time, spending about 15 minutes to half an hour for each session. They narrated their experiences as:
“I express my milk two times during office hours, morning and afternoon. I spend half an hour for that.” (IJ, 32 years old, exclusive breastfeeding)
“I do not use the whole one hour break for lunch. I need to balance my time. I use only half an hour to eat and I spent 15 minutes to express my milk.” (NAB, 30 years old, exclusive breastfeeding)
Every day, they brought their own breast pumps and milk containers to their workplace. At the end of their working day, they brought back their expressed breast milk. It was then given to their infants when they reached home or were kept and fed to the infants by the care taker in their absence.
These women had started to express their breast milk since their early postpartum period. One informant mentioned:
“I started to express my milk during confinement period. I know from my reading that it [expressed breast milk] can be kept for one year, so I started to keep it.” (NAS, 29 years old, exclusive breastfeeding)
They did not have much difficulty expressing their breast milk either by using breast pumps or hand expression. However, a few of the exclusive breastfeeding informants did not express their milk, but they went home to give direct breastfeeding during their work. They had the advantage of working near their house. One of them stated:
“I never express my milk. I stay at the nearby quarters, so I always go home at 10am to give breastfeeding.” (RZ, 31 years old, exclusive breastfeeding)
The informants who did not practice exclusive breastfeeding reported they never expressed their milk or did so very infrequently while working. For them, expressing their breast milk was not feasible. It was commonly reported that they did not feel it was worth their while to express their breast milk. They attributed it to their inability to produce enough milk and the pain involved. Moreover, they still needed to mix breast milk with infant formula, because the expressed breast milk was not enough to satisfy their infants’ needs. Some of them mentioned as:
“I feel difficult. I cannot store my milk because I do not have enough milk. When I press my breast, the milk does not come out.” (AMS, 38 years old, non-exclusive breastfeeding)"
“I express my milk but I only get small amount of it. I am afraid that it is not enough for my baby, especially I am tired and stress at work, so I am afraid my breast milk will not come out. That’s why I mix with formula milk.” (NR, 26 years old, non-exclusive breastfeeding)
A lack of facilities at the workplace also caused them to feel that it was not feasible to express their breast milk. The prayer rooms were the most common place used, but the informants did not feel comfortable expressing their breast milk there:
“I express my milk inside the prayer room, and I am not comfortable doing it there.” (NR, 26 years old, non-exclusive breastfeeding)
A few of the informants even expressed their breast milk inside the washroom, for example:
“I express my milk inside the toilet, or sometimes I try to hide and express it here, on this chair, when my partner is not around.” (RK, 27 years old, non-exclusive breastfeeding)
The informants who had practiced exclusive breastfeeding also experienced limitations with the facilities at their workplace. They also commonly used the prayer rooms to express their breast milk, but they did not face much problem with it. They received strong support from their colleagues who were sensitive to their needs. In addition, some of the non-exclusive breastfeeding informants had their own rooms and were able to express their milk comfortably, but they still did not do so. One respondent gave the following reason:
“There are many rooms here and I can choose one to express my milk. But, the problem is, I do not have the milk to express out.”
(AMS, 38 years old, non-exclusive breastfeeding).
Negative feelings about expressing breast milk
The exclusive breastfeeding informants were very determined to give breast milk to their infants even though they were working. They believed that expressing breast milk and giving it to the infants was an important strategy for working women to practice exclusive breastfeeding. They were also proud and happy to express their breast milk. One informant stated as:
“I am confident and I have planned during confinement period to make plenty of milk stock, because I know from my reading that it is not necessary for direct breastfeeding. We can express the milk and give to our baby. I have bought the bottles during pregnancy to store my milk.” (IJ, 32 years old, exclusive breastfeeding).
They were motivated to bring the equipment for breast milk expression wherever they went. If they needed to work away from home and leave their infants, they planned ahead to ensure they have enough stock of expressed breast milk for their infants. Besides, some of them felt that the expressed breast milk could be used when they were tired, especially after coming home from work. During those times, their husbands or someone else could feed their infants with the milk while they took some rest.
One exclusive breastfeeding informant did not express her milk but preferred to go to her infant for direct breastfeeding. She related that it was embarrassing to let her male colleagues see the breast milk, even though she claimed that they understood her motivation and supported her effort in breastfeeding. She mentioned:
“I have problem to keep the milk. I feel embarrassed; there are many male colleagues in my office.” (NM, 30 years old, exclusive breastfeeding)
The non-exclusive breastfeeding informants commonly described that it was difficult, painful and fussy to express and store their breast milk. It started from the method to express their breast milk, the equipment required, the time taken, the storing process and the way to feed the infants with the expressed breast milk. One of them mentioned:
“The process of storing the milk is difficult. It requires many arrangements when we leave the baby with the babysitter. We need to tell her how to prepare it, and yet I am afraid that she will not follow what I told her.” (AMN, 29 years old, non-exclusive breastfeeding)
They even felt disturbed when they had the sensation of breast fullness during working which required them to express the breast milk. Furthermore, it was noted that the non-exclusive breastfeeding informants who expressed their breast milk infrequently in the workplace only did so to release the feeling of breast fullness and discomfort. They did not plan to store it for feeding their infants.
Doubts about the safety and hygiene of expressing breast milk
Safety of the expressed breast milk was commonly doubted by the informants, especially those who did not practice exclusive breastfeeding. The common perception was that the frozen breast milk was not fresh anymore, thus it might be harmful for the infant’s health. Therefore, they shifted to formula feeding while they were at work. One non-exclusive breastfeeding informant also claimed that she expressed her breast milk at her workplace but discarded it. Safety and hygiene of the expressed breast milk was her main concern, as quoted:
“I express my milk but I throw it away. I never keep the milk like what other people do. I am actually not confident whether the milk can be used again after we stored it. I throw it and I give formula milk to my baby at home.” (RK, 27 years old, non-exclusive breastfeeding)
Lack of confidence with the condition of the frozen breast milk was also described by the two exclusive breastfeeding informants who did not express their milk at their workplace. One of them described as:
“I am not confident. I am afraid that the milk is spoilt. So, I prefer to go and breastfeed him directly.” (NM, 30 years old, exclusive breastfeeding)
With regards to the storage of the expressed breast milk, almost all the informants had access to a refrigerator at their workplace. Thus, it could be used by them to store the expressed breast milk. However, unlike those who practiced exclusive breastfeeding, the non-exclusive breastfeeding informants doubted the hygiene of this common refrigerator, as it was used for keeping various things such as food, drink or medicine. They were worried that the expressed breast milk might be contaminated by these things in the refrigerator. One respondent mentioned as:
“The door of the refrigerator was frequently opened by other people and they keep foods and other stuff inside it. I am not confident to keep my milk there.” (NI, 25 years old, non-exclusive breastfeeding).
Our study demonstrates that unlike informants who practiced exclusive breastfeeding, those who did not rarely expressed their breast milk, believing that it was not feasible to do so. They also had negative feelings related to expressing breast milk, and doubted the safety and hygiene of the expressed breast milk. These findings need to be highlighted because breast milk expression is very important for working women, as it allows them to continue breastfeeding their infants, especially exclusive breastfeeding in the first six months.