Dykes, Fiona Clare and Williams, Catherine
Falling by the wayside: a phenomenological exploration of perceived breast-milk inadequacy in lactating women.
Objective: to provide insight into the lived experience of breast feeding, in primiparous women.Themain focuswas uponwomen's perceptions related to the adequacy of their breastmilk, for the purpose of exclusively nourishing their babies. Design: a longitudinal, phenomenological study involving in-depth, interactive interviews, conducted at 6,12 and18 weeks following the birth of thewomen's babies. Participants and setting: a convenience sample of ten primiparouswomenwere recruited prior to discharge fromamaternity unit, in the north of England, in1998. Findings: two groupsofparticipants emerged, threewhobecame increasinglyconf|dent and empowered by breast feeding and the remaining sevenwhose conf|dence progressively diminished, with six of themexpressing concern that their breastmilk was inadequate. Fourmajor themes related to the participants'perceptions emerged fromthe analysis: the quest to quantify and visualise breastmilk; anxiety regarding the adequacy of their diet; breast feeding as a challenging journey, withmost feeling that they had `fallen by the wayside' (this related partly to inadequate and con£icting advice given by health professionals); and f|nally, unmet needs for support, nurturing and replenishment in return for `giving out'. Conclusion: perceived breast-milk inadequacy is underpinned by a complex and synergistic interaction between socio-cultural in£uences, feedingmanagement, the baby's behaviour, lactation physiology and thewoman's psychological state. Implications: education ofmidwives andhealthvisitors is requiredin relation to the needs of breast-feedingmotherswithin aWestern industrialised society. Strong social policy is vital in theUK, to initiate socio-cultural changes, whichwould enablewomenwho commence breast feeding to perceive it as an empowering and fulf|lling experience and not one of `falling by the wayside'.