Elsevier

Midwifery

Volume 29, Issue 5, May 2013, Pages 425-433
Midwifery

We only talk about breast feeding: A discourse analysis of infant feeding messages in antenatal group-based education

https://doi.org/10.1016/j.midw.2012.02.006Get rights and content

Abstract

Aim

the aim of the study was to examine the dominant discourses that midwives draw on to present information on breast feeding in group-based antenatal education sessions.

Background

breast-feeding initiation rates are high among Australian women however, duration rates are low. Antenatal breast-feeding education is considered a key strategy in promoting breast feeding to childbearing women. The efficacy and effectiveness of such a strategy is equivocal and there is little qualitative work examining group-based antenatal breast-feeding education.

Methods

discourse analysis was used to explore the language and practises of midwives facilitating group antenatal breast-feeding education sessions at two Australian maternity facilities. Nine sessions were observed and tape recorded over a 12 month period. Each session lasted between 60 and 140 mins.

Findings

the analysis revealed four dominate discourses midwives used to promote breast feeding during group-based antenatal education session. The predominant discourses ‘There is only one feeding option’: breast feeding’ and ‘Selling the ‘breast is best’ reflected how midwives used their personal and professional commitment to breast feeding, within supportive and protective policy frameworks, to convince as many pregnant women as possible to commit to breast feeding. Sessions were organised to ensure women and their partners were ‘armed’ with as much information as possible about the value of breastmilk, successful positioning and attachment and practical strategies to deal with early breast-feeding problems. Antenatal commitment to breast feeding was deemed necessary if women were to overcome potential hurdles and maintain a commitment to the supply of breast milk. The latter two discourses, drawn upon to promote the breast-feeding message, presented infants as ‘hard wired’ to breast feed and male partners as ‘protectors’ of breast feeding.

Conclusions

midwives clearly demonstrated a passion and enthusiasm for breast-feeding education. Examining the dominant discourses used by midwives during the antenatal sessions revealed, however, that their language and practices were often limited to convincing women to breast feed rather than engaging with them in conversations that facilitated exploration and discovery of how breast feeding might be experienced within the mother–infant relationship and broader social and cultural context. In addition, there was evidence that global breast-feeding policies, in resource rich countries such as Australia, may influence how midwives talk about breast feeding without them being fully cognisant of the potentially coercive nature of the messages women receive.

Introduction

Antenatal education is considered an important component of antenatal care in Australia with breast feeding identified as one of a number of important topic areas needing coverage (Svensson et al., 2006). While delivery can take a variety of forms, in Australia breast-feeding education is usually a formalised, defined, descriptive and goal-orientated programme with a specific purpose and target audience (Lumbiganon et al., 2007). Informing all childbearing women of the benefits of breast feeding is part of the Baby Friendly Health Initiative (step 3) (WHO and UNICEF, 2009) and as such is considered a key strategy in improving breast-feeding rates (Dyson et al., 2005).

There are a number of studies that have attempted to determine the efficacy of antenatal education programs in improving breast-feeding rates, however, the results have been mixed (Greenwood and Littlejohn, 2002, Foster et al., 2004, Ryser, 2004, Lin et al., 2007). For example, Foster et al. (2004) tested two different antenatal breast-feeding education strategies—one providing practical aspects of breast feeding, the other exploring community attitudes, and found there was no difference in initiation or duration rates. In contrast, others (e.g. Lin et al., 2007, Rosen and Carney, 2008) have been able to show that antenatal breast-feeding education increases breast-feeding duration. More recently, Ford and Miller (2010) established that seeking antenatal education or information was a strong predictor of breast-feeding initiation as well as increased duration rates. There is evidence also that groups' of women who traditionally have lower breast-feeding rates may benefit from antenatal education. Greenwood and Littlejohn (2002) found that a breast-feeding programme delivered to adolescent pregnant women had a positive effect on initiation but not duration rates. Given these results it is perhaps not surprising that a number of systematic reviews of support interventions for breast feeding have concluded that the effect of antenatal group breast-feeding education, on its own, remains unclear (Dyson et al., 2005, Chung et al., 2008, Hannula et al., 2008). Those noted to be most successful however, reflected an interactive rather than didactic approach. Furthermore there is evidence that when antenatal breast-feeding education is combined with structured postnatal support both initiation and duration rates are increased (Chung et al., 2008).

While a number of studies have focused on breast-feeding outcomes, there has been very little qualitative research exploring women's experiences of antenatal breast-feeding education. Craig and Dietsch (2010) used a qualitative approach to explore 10 new mother's perceptions of the usefulness of an antenatal education strategy for initiating breast feeding. Using semi-structured interviews these authors identified four key themes: scientification, expectations, stories and stressors. Findings demonstrated that while antenatal breast-feeding education was beneficial for informing first time mothers about the practical skills required to initiate breast feeding, it did not reduce anxiety or increase confidence to breast feed. This supports the assumption that while antenatal education is likely to increase a woman’s knowledge about breast feeding this does not necessarily translate into breast-feeding success (Stockdale et al., 2011). Other qualitative studies have demonstrated that women feel pressured to breast feed in the in pregnancy (Sheehan et al., 2003). Women report that midwives are ‘pushing breast feeding’ with little consideration of the practical, emotional and relational support necessary to achieve the goal of sustained breast feeding (Mozingo et al., 2000, Hauck et al., 2002, Manhire et al., 2007).

In summary, despite the implementation of antenatal educational programs designed to promote and support sustained breast feeding, the number of Australian women maintaining breast feeding declines rapidly after the first month postpartum (Lumbiganon et al., 2007, Hauck et al., 2011). While negative hospital experiences have been seen as an impediment to optimal breast feeding (Coreil et al., 1995, Dykes, 2006, Sheehan et al., 2010) there is limited work exploring the way in which antenatal breast-feeding information is delivered. Taking a qualitative approach to study the language used by midwives/educators providing antenatal breast-feeding information to groups may reveal where and how improvements can be made.

The aim of this study was to examine the dominant discourses that midwives draw upon to present information on breast feeding in group-based antenatal education sessions.

Section snippets

Methods

This study used discourse analysis to examine the impact of the language and practices of midwives when discussing breast feeding in group-based antenatal education. Ethical permission was sought and granted from both hospital sites and participating universities.

Findings

The analysis revealed four discourses that reflected how midwives used their personal and professional commitment to breast feeding, within supportive and protective policy frameworks, to convince as many pregnant women as possible to commit to breast feeding. Breast feeding was positioned as the ‘best’ and only feeding option with the overarching aim of the group-based sessions being to ensure women and their partners were ‘armed’ with as much information as possible about the superiority and

Discussion

Four dominant discourses were identified in the analysis of the audio recorded breast-feeding education sessions. The take-home messages for women, and their partners, were that breast feeding was the ‘ultimate’ feeding option with multiple benefits; women were well ‘equipped’ to breast feed if they were sufficiently committed; most infants were born ‘knowing’ how to breast feed; and that partners had an important role in ‘protecting’ breast feeding. Overwhelmingly breast feeding was positioned

Conclusion

Discourse analysis of the language and practices adopted by midwives during the antenatal group breast-feeding education sessions revealed a focus on ‘selling’ the breast is best message. Midwives own passion and enthusiasm for ‘teaching’ breast feeding was often framed within institutional policies promoting and supporting breast feeding, resulting in only information pertaining to breast feeding being discussed. The benefits of breast feeding, the need to commit to breast feeding, and

Conflict of interest

None.

Acknowledgement

We wish to thank the midwives and women who so willing participated in this research project. The study was funded by an Australian Research Council Linkage Grant.

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