Data from a large-scale national survey of women’s experience of maternity care in England was analysed using qualitative methods in order to gain a better understanding of what is needed in the early days to enable women to initiate and continue breastfeeding. A total of 2,966 women responded to the survey (62.7% response rate). All of those who responded recognised the importance of the topic for them and their babies.

The main themes identified were ‘‘the mismatch between women’s expectations and experiences’’ and ‘‘emotional reactions’’ at this time, ‘‘staff behaviour and attitudes,’’ and ‘‘the organisation of care and facilities.’’ Sub-themes included issues around seeking help, conflicting advice, pressure to breastfeed, the nature of interactions with staff, and a lack of respect for women’s choices, wishes, previous experience, and knowledge.

The authors acknowledge that the women who responded about infant feeding were self-selected and were more likely to be older, with more education, and of white ethnicity than women who did not respond. They often had strong opinions and probably experienced more feeding problems.

They conclude that many women who succeeded felt that they had ‘‘learned the hard way’’ and some of those who did not, felt they were perceived as ‘‘bad mothers’’ and as having in some way ‘‘failed’’ at one of the earliest tasks of motherhood. What women perceived to be staff perceptions affected how they saw themselves and what they took away from their early experience of infant feeding. They emphasised the need for early support, help, and information, and recognised the negative consequences for maternal self-esteem and well-being when breastfeeding ceased.

Redshaw M, Henderson J (2012). Learning the Hard Way: Expectations and Experiences of Infant Feeding Support. BIRTH: 39 (1); 21-29