Testing the buffering hypothesis: breastfeeding problems, cessation and social support in the UK

Abstract

Objectives: Physical breastfeeding problems can lead women to terminate breastfeeding earlier than planned. In high-income countries, breastfeeding problems have been attributed to the cultural and individual “inexperience” of breastfeeding, ultimately leading to lower breastfeeding rates. Yet, cross-cultural evidence suggests breastfeeding problems still occur in contexts where breastfeeding is common, prolonged and seen publicly. This suggests breastfeeding problems are not unusual and do not necessarily lead to breastfeeding cessation. Having evolved a cooperative childrearing system, what matters for breastfeeding continuation may be the availability of social support during the postnatal period. Here, we test the hypothesis that social support buffers mothers from the negative impact breastfeeding problems have on duration. Methods: We run cox models on a sample of 566 UK mothers who completed a retrospective online survey about infant feeding and social support in 2017-2018. Results: Breastfeeding problems were important predictors of cessation; however, the direction of the effect was dependent on the type of problem. These relationships were also moderated by informational, practical and emotional support from a range of supporters. Helpful support for discomfort issues (blocked ducts, too much milk) significantly reduced the hazard of cessation, as predicted. However, helpful support for reported milk insufficiency increased the hazard of cessation. Conclusions: Experiencing breastfeeding problems is the norm, but its impact may be mitigated via social support. Working from an interdisciplinary approach, our results highlight that a wide range of supporters who provide different types of support have potential to influence maternal breastfeeding experience.

Typologies of postnatal support and breastfeeding at two months in the UK: Response to comments by Harpur & Haddon

“…Why is that? We agree with Harpur & Haddon (2020) that, as reviewed in the introduction of Emmott et al (2020), part of the issue may be the promotion of breastfeeding as "natural" and "easy." This can create unrealistic expectations of breastfeeding, and this mismatch between reality and expectation may mean many women are not prepared for the challenges of breastfeeding (Williamson et al, 2012;Fox et al, 2015;Brown 2016), with negative implications for maternal mental health (Beck, 2002).…”

“…Rather, such information is perhaps better conceptualised as breastfeeding promotion, which is about normalising breastfeeding behaviours rather than supporting mothers per se (Emmott & Mace, 2015). As we outline in our paper, advice and information from professional sources have indeed been described as "unhelpful" by some mothers (Lamontagne, Hamelin and St-Pierre, 2008), including in our own sample (Emmott et al, 2020). Clearly, informational 'support' is not always supportive.…”

“…As acknowledged by Harpur & Haddon (2020), many women report that their experiences of breastfeeding problems (which, conceptually, increase the costs of breastfeeding) lead to breastfeeding cessation. Given their potential importance as a mechanism influencing breastfeeding cessation, we have in fact been working on further analyses exploring the relationship between breastfeeding problems and breastfeeding duration, and how this may be moderated by different types of social support (see Page, Emmott & Myers, 2020 for analysis pre-registration). In our survey, for mothers who reported ever breastfeeding, we asked about any problems they encountered with breastfeeding.…”

Who cares for women with children? Crossing the bridge between disciplines

“…Past government guidance has included recommendations of 'raising awareness of the health benefits of breastfeeding-as well as the risks of not breastfeeding' [10, p. 28]. But the known costs and challenges of breastfeeding [11][12][13] were barely explained, which one might expect to see more of if breastfeeding was framed as an important determinant of maternal wellbeing, not just that of children. While we cannot be certain why maternal wellbeing in its own right is often overlooked in Western populations, Budds, in this issue, outlines how intensive mothering norms that are pervasive in the West coexist with the expectations of maternal sacrifice [14]: amplified by Bowlby and Ainsworth's Attachment Theory, maternal devotion is often assumed to be crucial for optimal child development, and putting their children first over and above their own wellbeing is fundamental to being 'good mothers'.…”