When the mother receives positive responses from the infant in the breastfeeding relationship, she feels confirmed as capable of caring for the infant. In that moment, she interprets that the infant is doing well, which motivates her to continue breastfeeding.
When he was that sad and I understood that he wanted to eat and I tried that and when it works well then it’s strengthening [for me]. This feeling is beginning to come now // yes, it’s strengthening me. I just feel more confirmed (ID03).
When the mother lacks a positive response, she does not feel confirmed, and that decreases motivation for breastfeeding. She cannot then see that the infant is doing well and she becomes afraid of hurting the infant.
Those feelings when he didn’t take the breast were probably the most important for me stopping. I felt frustrated and powerless. I tried, changed [breastfeeding] positions and tried everything I could and yet it still was not working. It was terrible to feel . . . that the infant wasn’t doing well (ID04).
The mother’s perceptions of the infant guide her breastfeeding decisions and her experience of herself in the breastfeeding relationship. Her own understanding of the infant’s response will determine whether she feels confirmed as a breastfeeding mother or not. When the mother experiences confirmation, this leads to her feeling capable of caring for the infant. The infant then confirms not only the mother’s capability, but his or her own wellbeing. When the mother, on the other hand, does not feel confirmed, she loses faith in herself as a breastfeeding mother. She concludes that the infant is mistreated by breastfeeding and her motivation to continue breastfeeding is lost.
The meaning of the body
The experience of positive responses from the body such as a good milk supply or less painful breasts means confirmation of the body’s capability of breastfeeding. This creates confidence in the body’s breastfeeding ability and leads to continued breastfeeding.
Then when he had gained weight, 500 g in a week, it was quite a relief // But before that, it was hard because for breastfeeding to work out well it was dependent on me and my body. And I didn’t know if there was something wrong with me or if there was enough milk (ID02).
I got confirmation that there actually was milk there, then I was calm (ID06).
When the mother, on the other hand, feels that the body largely generates negative responses, this means a lack of confirmation, which in turn raises doubts over the body’s function. Feeling that one’s own body hurts too much creates both physical and emotional suffering that make breastfeeding actually impossible.
It was terrible . . . I couldn’t have a sweater on, I couldn’t go outside, I had to pull down every blind, it was like a dark prison and then just focusing on breastfeeding that wasn’t working and it did not get any better when I had an infection and an abscess. If there had been any improvement, but there wasn’t. I was terribly depressed (ID08).
But nothing came. Nothing came out of the breasts. It was . . . no . . . nothing (ID01).
The body provides hope or mistrust depending on its responses crucial for the breastfeeding decision. This contributes to a presence or absence of confirmation of the body’s ability to breastfeed. When the body gives positive responses, such as a good milk supply or less painful breasts, it provides hope and confidence in the body’s ability, which becomes a positive sign. A lack of positive signals from the body contributes to a sense of being trapped in the body, making the mother mistrust its function. The feeling that the body desires to be released from suffering arises and the situation is so painful that breastfeeding becomes unbearable.
The meaning of anger
Breastfeeding difficulties may give rise to anger that is directed outwards towards a person or towards the situation in a more or less conscious attempt to find external explanations for the difficulties. Anger can be directed towards, for example, the infant, the health care received, and others’ expectations. This may then be a reason to stop breastfeeding; paradoxically, however, it can also be a motivator to continue.
I felt that . . . I hate this [breastfeeding relationship and the expectations about breastfeeding] . . . then I called my mother . . . and I said I hate to breastfeed, then I had a real breakdown . . . But then she said “Then you shouldn’t breastfeed if you hate it” . . . and then we talked about it for a while and then I felt that I had some strength to continue (ID03).
On the other hand, when the anger results in breastfeeding cessation, it eases mothers’ feelings of responsibility and protects mothers from feelings of extreme failure.
I think that those working on the maternity ward destroyed my breastfeeding // I think they were worthless. Didn’t take any consideration or none of them asked me anything about my wellbeing // It made me so damn angry (ID01).
Anger facilitates handing over responsibility to others. Anger makes it possible to attribute to others the responsibility for difficulties and this protects the mother from bearing all the responsibility herself. The anger can thus be understood as a release related to attempting to find explanations outside of the mother herself. The anger toward others can make her feel both stronger, as protection from self-loathing, or it can drain her inner strength. It is nevertheless how anger is handled and to what it is attributed that determines how such protection works. If the mother has the opportunity to be angry and then the ability to move on, anger can help as a motivating force for continuing breastfeeding. If the mother, on the other hand, is too overwhelmed with anger, the anger and attempts to find explanations outside of herself can paralyze her. The only solution to the risk of feeling defeated is to stop breastfeeding.
The meaning of expectations
When breastfeeding difficulties arise, the mother feels that she is being watched both by herself and others. The expectations become obvious and the mother is ashamed to differ from the expected image. Fear over what others may think generates a need to perform as a happy mother breastfeeding her infant.
It’s that I compared myself with others. Everyone else managed it and this is how it is in general in society. Why can’t I handle it then? It isn’t about jumping 2.4 meters in the high jump // to have severe difficulties isn’t normal . . . , I felt a little strange and worthless. I wanted to breastfeed to prove my ability to do it (ID05).
Such expectations can also mean that breastfeeding is experienced as too great a performance to manage. The gaze from others reinforces the mother’s own sense of being a failure, a feeling of being an unsuccessful mother to her infant.
I have the feeling that others will think that I am bad because I cannot give him what he wants [breastfeeding]. Initially, there are a lot of emotions and I feel forced to try to breastfeed. Otherwise, others will think that I am a bad mother // But I couldn’t manage to handle the expectations and I stopped breastfeeding (ID07).
Feeling others’ gazes functions as a gauge for the breastfeeding decision as well as how the mother sees herself. She thus becomes her own judge; whether breastfeeding is continued or not depends on her strategy in dealing with this dilemma. If a feeling of shame develops upon being unable to fulfill expectations, the need to eliminate this feeling forces the mother to continue breastfeeding. Continuing serves the purpose of demonstrating her ability to other people, and is therefore a driving force in continuing breastfeeding despite difficulties. The shame can, on the other hand, be perceived as so unbearable that the mother feels herself a failure. To escape the judging gaze of others, the mother reformulates and devalues the importance of breastfeeding, which facilitates breastfeeding cessation.
The meaning of loneliness
Breastfeeding difficulties can create feelings of loneliness that risk reinforcing feelings of uselessness and difference from other mothers. In order to escape loneliness, safety is sought in others who can provide support for continued breastfeeding. The connection with others provides a sense of belonging that makes breastfeeding possible.
[My friend] had the same troubles and we talked a lot about that. And then I had some other friends who I talked to on the telephone, they have had troubles too and then I was very much at home alone during that time (ID05).
The reverse is also true. The feeling of loneliness may lead to withdrawal because of a fear of being detected as underperforming, useless, and different. Such fear constitutes a barrier to continued breastfeeding. Instead, the mother searches for contact with others who have stopped breastfeeding and thus breastfeeding can be ceased.
I didn’t talk to [the nurses] about my problems or about how I felt but I kept face // I didn’t want to cry and collapse there and then, instead I went to them to weigh and measure him and then I went back home (ID04).
The fear of being discovered as being different from other new mothers becomes a barrier for breastfeeding and seems to balance against a desire to find someone to contact and create a sense of belonging with. The strength of this fear influences the direction of the search for belonging. The choice is between searching for support from people who represent a possibility for continuing breastfeeding or from people who represent breastfeeding cessation. It seems to be the need for identification with others in similar situations that determines mothers in favor of breastfeeding continuation; otherwise, the difference from other mothers becomes too obvious. If the feeling of loneliness and the fear of being discovered as different become too extensive, the mother cannot bring herself to break out of it and breastfeeding ends with a lasting feeling of being different and unsuccessful.
The meaning of care
When the mother is able to meet professional carers who are trustworthy and extend their care beyond the biological body, a feeling of possibility to overcome breastfeeding difficulties can result. These carers facilitate the development of self-confidence, which eases and reduces thoughts of worthlessness. This is true even if these mothers have experienced non-caring behavior from some of the carers involved.
That lump in my throat or in my chest completely disappeared. Suddenly I became much more alert and all difficult thoughts that I had when I felt myself to be insufficient disappeared. She [the carer] gave me the right feeling or the right attitude for managing it (ID02).
On the other hand, the care can be experienced as non-caring as, for example, intrusive hands-on breastfeeding help, or care that focuses solely on the infant or the body. Such care is degrading in that it objectifies the woman and reduces her to solely an instrumental functionality. Although individual carers may try to disrupt this pattern, it seems to be of no importance for breastfeeding continuance. The feeling of being a worthless object has already been integrated too much in the mother’s self-concept for breastfeeding to continue.
I was extremely vulnerable, and then they tried to help me with an intrusive hands-on approach. I said “yes” to that because I didn’t know how to do it // It felt even more like I couldn’t manage it by myself and instead someone needed to help me. Instead, someone could have been sitting beside me letting me try // It felt like a violation of my own body (ID04).
An instrumental way of giving care undermining mothers’ breastfeeding and seems to be based on the idea that a woman who has just given birth does not have the same need for extra care as for patients who, for example, are being treated for some medical condition. A new mother can nevertheless be exhausted, in healing from surgical procedures, and under the influence of the hormonal transition that occurs when the milk comes in. The major life change may also give rise to existential issues and sometimes even feelings of depression. Being allowed to have the same care needs as for a “real” patient appears to be significant for the mother’s possibility to overcome breastfeeding difficulties; feeling that her feelings are accepted enables the mother to feel that her burdens become lighter because they are shared. If this is possible, she feels confirmed and strengthened in continuing breastfeeding. Yet in the absence of such acceptance, suffering becomes overwhelming, leading to her feeling forced to cease breastfeeding.
Main interpretation - existential security or insecurity determines mothers’ breastfeeding decision
Mothers who initiate breastfeeding with severe difficulties may feel overtaken and violated by the needs and demands from her infant, the extensive pain and/or changes in her body, and her own as well as others’ expectations for her to succeed. Contact with professional carers whom she experiences as too demanding or her own feelings of anger and loneliness may further enhance these feelings of being overtaken and violated. In these cases, the mother knows that she must take responsibility for the mother-infant relationship, especially given its exposure and vulnerability due to initial difficulties.
In such circumstances, the breastfeeding relationship is characterized by insecurity and complexity because of the different aspects of the feelings of being overtaken and violated, feelings that seem to be interwoven. She does not recognize herself as she was prior to giving birth, but is well aware of the advantages of her own milk as the best kind of nourishment. Implicitly, she also seems to understand that the issue of breastfeeding has an existential aspect symbolically linked to the mother-infant relationship. Consequently, she has to take responsibility for both the relationship with the infant and the infant’s nourishment in order to support the development and wellbeing of the infant.
When feelings of being overtaken and violated make her consider her body primarily as a biological tool, separated from the mother-infant relationship, feelings of alienation easily emerge. The intended reciprocal and intimate relationship with the infant becomes the opposite wherein it is difficult to feel closeness. It is when feelings of alienation make the relationship with the infant problematic that she must find a solution. She approaches an important turning point, an existential crisis, wherein it is necessary to decide whether she should continue to breastfeed or not. She negotiates with herself and tries to find a path that is advantageous for herself and her infant. The different aspects of the feelings of being overtaken and violated are weighed against each other and put in relation to the context of her responsibility for the infant’s thriving and the development of her relationship with the infant.
If it is possible to find togetherness with others who, directly or indirectly support breastfeeding, it becomes easier to continue. The capacity of others to make the mother secure in the breastfeeding relationship seems to make it possible for her to reconcile herself with her initial difficulties. Slowly but surely, she begins to feel secure with continued breastfeeding. This security helps her to regain a mutual intimacy with the infant thus enabling closeness.
The mother’s overwhelming feelings of suffering, anger and loneliness lead to a feeling of alienation from the breastfeeding relationship that can encourage her to see the decision to stop breastfeeding as an act of caring responsibility. In this case, the mother experiences herself as excluded from all other mothers who appear to be successful as well as abandoned by the health carers she has encountered, leaving her unable to continue breastfeeding without jeopardizing her closeness to the infant.
The link between feelings of security and the mother’s relationships to other people is clear. Yet it is important to keep in mind that “other people” represent a variety of contexts, such as professional caregivers, family members, friends and not least the infant. Most critical for the sense of security or insecurity is perhaps the new mother’s tendency to look at herself from the outside, imagining others’ perceptions of her and she thus becomes her own toughest critic in the decision to continue or cease breastfeeding. Others’ gazes and her own beliefs about what they see create feelings of either security or insecurity that in turn relate to the development, or not, of the fear of breastfeeding.
It thus seems fair to assume that the decision to continue or cease breastfeeding after having severe initial difficulties depends on whether or not it is possible to feel existential security in the breastfeeding relationship. Maintaining this security can thus be performed in different ways; mothers can, for example, find security through confirmation from others. The reverse is also true. If existential insecurity dominates, mistrust, doubt, frustration, and worry easily follow, and in severe cases this creates a fear of breastfeeding that is so great that there is no alternative but to cease breastfeeding.