Moms' guilt and shame when feeding baby

Research shows when a pregnant parent's infant feeding plans do not meet postpartum reality, they experience guilt and shame. Midwives can help!

Stories of mothers' guilt and shame around infant feeding have been around for ages. There are moms who are ashamed of not being able to offer their breast freely to their child, others who feel guilty about using formula - and some who sense shame and embarrassment with perceived "failings" when dealing with healthcare professionals.

Negative experiences and emotions affect lactation and nursing, and can feed into postpartum depression. This makes it important to understand these parents' emotions, how and when they arise - and steps that can be taken to tailor care for vulnerable mothers.

To discover more about the relationship between guilt, shame and infant feeding, researchers in the UK systematically reviewed international studies from developed countries, including the UK, USA, France, Sweden and Norway. They identified 4 main themes: "underprepared and ineffectively supported", "morality and perceived judgement (breastfeeding)", "frustration with infant feeding care", and "failures, fears and forbidden practice (formula feeding)¹.

Expectations versus reality

The studies reviewed looked into exclusive breastfeeding, combination feeding and exclusive formula feeding. They found that the risk of developing feelings of guilt and shame depended on the parent's expectations during pregnancy. Problems with guilt arose after birth, as they faced their personal infant-feeding reality - and intentions were not met.

Take, for example, a pregnant mother who intended to feed her child exclusively with formula - and another mother who planned to exclusively breastfeed. After birth, the formula-feeding mom had 7 times lower risk of feeling guilt - compared with the mom who had planned to exclusively breastfeed, but ended up using formula exclusively. So it's not surprising to find that moms who initially breastfed exclusively, but had to switch to exclusive formula feeding, also experienced higher levels of guilt.

Being well prepared by healthcare professionals for the realities of breastfeeding appeared to play an important role. During pregnancy, the women in these studies felt that they were not made fully aware of the challenges they could face after birth. Their expectations didn't meet reality - which made them feel shame, guilt and anxiety. As if was their fault, and they were bad mothers.

At the other extreme, having a healthcare professional be too involved was also detrimental to a mother's sense of self. Critical comments about breasts or nipples, and too much nonconsensual physical contact (a healthcare professional holding and squeezing the mother's breast, for example) brought up feelings of shame and embarrassment.

A sense of being judged

There is no denying that exclusive breastfeeding for the first 6 months is the ideal nutrition for newborns. Unfortunately, when mothers ran into problems in their attempts to meet this goal, they felt guilty.

This wasn't just internalized guilt, of not meeting their own expectations - which effects 37.6% of the breastfeeding women in these studies. More than 32% of moms felt that others were judging them negatively for using formula. As one mom said, "There is definitely elements of you're a better mom if you breast feed."

And when breastfeeding didn't go well, some moms pretended everything was ok, so they could avoid being judged as a bad mom by their family and healthcare professionals. This meant not seeking help, and feeling fearful of being seen as a failure.

Then there's the role healthcare professionals play in causing feelings of guilt. The researchers found the 64% of formula-feeding moms felt guilt, caused by healthcare professionals blaming them for breastfeeding problems. Once again, these mothers felt they could not be honest with their healthcare professional.

"Every feed counts"

A mother's wellbeing is essential, if she is going to have a healthy relationship with infant feeding and feel positive about herself. To help breastfeeding moms avoid feelings of guilt and shame, the researchers call for "more realistic, nonjudgmental and mother-centered support." And for moms who must rely on formula, healthcare providers should offer practical information, and emotional support.

When it comes to "breast is best", the researchers recommend shifting the focus to "every feed counts." This way, mothers can feel positive about their individual style of caring for and feeding their infant - and built more confidence in their abilities to be a good mother.

Overweight and obese women often have problems breastfeeding. Some issues are physiological. Others are due to stigmatization. This ranges from a higher frequency of nipple problems, to embarrassment when feeding around others – as well as a lack of support from healthcare professionals.