You are on page 1of 10

THEORETICAL STUDIES doi: 10.1111/j.1471-6712.2007.00572.


Shattered expectations: when mothers’ confidence in
breastfeeding is undermined – a metasynthesis

Jette Schilling Larsen RN (Health Visitor), Elisabeth O. C. Hall RN, MScN, PhD (Professor and Chairman NCCS)
and Hanne Aagaard RN, MScN, PhD (Student)
Department of Nursing Science, Institute of Public Health, University of Aarhus, Aarhus, Denmark

Scand J Caring Sci; 2008; 22; 653–661 Foucault’s concept of discourse is used to discuss how
these discourses affect mothers’ confidence in breastfeed-
Shattered expectations: when mothers’ confidence in
ing by giving the right to speak about breastfeeding to
breastfeeding is undermined – a metasynthesis
the breastfeeding experts, by isolating the mothers who
Objectives: Why do mothers give up breastfeeding, even do not breastfeed and by organizing knowledge about
though breastfeeding has great importance to them? This breastfeeding in a certain way.
study examines what has affected mother’s confidence in Conclusions: The individual mother is responsible for the
breastfeeding when she gives up breastfeeding. success of breastfeeding and the discourses are hiding that
Method: A metasynthesis of seven studies on mothers’ general perceptions of breastfeeding undermines the
experiences with breastfeeding was conducted using Noblit mothers’ confidence in breastfeeding and leads to shat-
and Hare’s methodological approach. tered expectations.
Results: The metasynthesis shows that confidence in
breastfeeding is shaped by shattered expectations and is Keywords: breastfeeding, discourse, Foucault, meta-
affected on an immediate level by mothers’ expectations, synthesis, motherhood.
the network and the breastfeeding experts and on a
discourse level by the discourses: breastfeeding as nature, Submitted 21 June 2007, Accepted 29 October 2007
the female body as a machine and the note of caution.

between the official recommendations concerning breast-
feeding and the mothers’ own wish. When mothers give
World Health Organization (WHO) recommends that in- up breastfeeding many feel they have failed as a mother
fants are exclusively breastfed for approximately 6 months and feel guilty not being able to feed the child with breast
(1). Most European countries recommend breastfeeding milk knowing the advantages (2). The starting point of this
because of health benefits for infant and mother. The study was the assumption that the way breastfeeding is
Scandinavian countries have a high rate of breastfeeding; perceived influences mothers who give up breastfeeding
practically all women here start breastfeeding (2, 3). even though breastfeeding is important to them. It is as-
A Danish study has shown that for 91% of the mothers it sumed that breastfeeding is dependent on the context in
has great importance to be able to breastfeed (4). There is which it is practiced: it is socially constructed (5). The
thus accordance between the recommendations and the assumption is based on wondering why leaflets for moth-
mothers’ wish to breastfeed. However, 41% of the Danish ers pictured breastfeeding as something everybody is able
women gave up exclusive breastfeeding before the infant to do naturally (6). Meanwhile, breastfeeding is pictured to
was 4 months old (4). This means that more than a third of health staff as something which has to be learned and
the mothers give up breastfeeding even though it is of something that demands an effort from both the mother
great importance to them. The present study analyses why and her networks (2). As there is sparse research on how to
women give up breastfeeding when there is accordance support mothers who think they are not able to breastfeed
(2), the focus in this study is on what affects mothers’
confidence concerning breastfeeding. The study is based on
Correspondence to: the mothers’ own perspective as described in qualitative
Jette Schilling Larsen, Klintebjerg 23, Skærbæk, 7000 Fredericia, studies. Such studies related to breastfeeding have been
Denmark. conducted over the years but few have synthesized
E-mail: knowledge across multiple studies. Nelson (7), using Noblit 

2008 The Authors. Journal compilation  2008 Nordic College of Caring Science 653

ideas and concepts used in each study and identification of to explore women’s experiences of breastfeeding in two main areas maternal units in England. Seven studies published from 2001 to 2005 and conducted this study concerns the phenomenon mothers’ confidence by seven research teams from four countries. To understand the experiences of British first-time A data collection literature search was made in April mothers. motherhood. Metaphors were illustrated the experiences of breastfeeding women. A meta. ‘a need for support’ and ‘the journey must end’. ‘becoming a breastfeeding ences in connection with sick or premature infants based mother’. in breastfeeding. Inclusion criteria broaden the understanding of the phenomenon and were: qualitative studies of mothers’ experiences with facilitate implications for practice. The character- breastfeeding. standing of different social groups’ interpretation of pre- itative studies providing a deeper understanding of a and postnatal formal breastfeeding support in health phenomenon through interpretation (8). Table 1 The seven phases of Noblit and Hare’s meta-ethnographic To describe and analyse the conditions of the practice of method breastfeeding. The metaphor. Using narrative data. The author translated breastfeeding and motherhood from 2000 and forward the findings from the synthesized studies into a structure conducted in countries with a western culture and that was dominated by the essential theme ‘an engrossing acknowledging the WHO strategy on nutrition in infants personal journey’ and containing themes and subthemes (1). Cronin (11) conducted a combined focus group 2006 in the databases CINAHL. Larsen et al. mothers who give up mother and child returned home from the maternity ward breastfeeding although breastfeeding is of great importance to them and again 6 months after childbirth.S. family feed- Method ing throughout the generations. Exclusion criteria were: studies of mothers’ experi- such as ‘the embodied reality’. conceived breastfeeding as uncomplicated. focused interviews and guided conversations phrases. but in reality it inclusion and exclusion criteria and selection of studies for the posed a number of different problems. The women initially Delimitation of subject: Literature search to find relevant studies. able to breastfeed. Ireland. the production Interpretation of metaphors and concepts: The main areas were line. Journal compilation  2008 Nordic College of Caring Science . Metasynthesis was the method chosen to investigate what sexualizing infant feeding and fitting feeding around paid affected mothers’ confidence in breastfeeding. Nelson suggests increased sensitivity and individualized breastfeeding plans for mothers. four key-themes were presented: birth and hospitalization. observation. synthesized 15 using the search words breastfeeding. with its notions of demand and efficient supply related and interpreted in relation to each other. Based on the findings.654 J. qualitative breastfeeding studies with the purpose to nursing/nursing attitudes/health visitor. work. spectives on the information. The method consists of seven pha. although they know it is important to be istics of the included studies are described below. Breastfeeding was metasynthesis largely regarded as the woman’s individual responsibility Review of studies on the question: What affects mothers’ and her social duty. infant. confidence in breastfeeding? Identification of metaphors and key Dykes (13) conducted a critical ethnographic study using concepts in individual studies Relation between studies: Drafting of list with key metaphors. ses which have been followed in this study (see Table 1). when Identification of subject: In this study. The support that women motherhood’ as the overall theme. Noblit and Hare services is needed as well as more appreciation of how have described a meta-ethnographic model to combine mothers’ informal support networks affect their use of qualitative studies (9). Dahl (12) interviewed eight Swedish wo- men with a professional career just before childbirth. found for the main areas Graffy and Taylor (14) examined British women’s per- Comparison of interpretation: Compilation of the synthesis. advice and support they separation of the main area ‘perceptions of breastfeeding and received with breastfeeding. support. exposure and expectation. on the assumption that special conditions apply. On the basis of an interview study of 12 British mothers and 12 people in their network Bailey and Pain (10) pre- sented four key themes: dealing with reality. UK and Sweden and with 883 participating The aim of the study was to investigate what affects mothers fulfilled the inclusion criteria and all were in- mothers’ confidence in breastfeeding so they give up cluded in the metasynthesis (see Table 2). Good breastfeeding Presentation of metasynthesis: Communication of the metasynthesis support was described in five components: information  2008 The Authors. formal breastfeeding support. Australia. The authors suggested that a socio-cultural under- synthesis is a systematic comparison of results from qual. motherhood and psychological issues. and Hare’s meta-ethnographic method. PsycINFO and MEDLINE and in-depth interview study. The parts of this main area were wanted was identified on the basis of thematic analysis of related to the other main areas women’s responses to open questions. Sample Contrary to Nelson’s metasynthesis that involved the phenomenon breastfeeding from the mothers’ perspective.

maternal irresponsibility that arise when their practises do not conform to expert medical recommendations. Journal compilation  2008 Nordic College of Caring Science . self-doubt and three areas were related to three different discourses con- guilt. metaphors were found to describe the areas mothers use to defend themselves against the charges of and the discourses. which led to confusion. effective advice and suggestions. breastfeeding are inseparable as performance and disap- pointments in one area rub off on other areas of the experience of motherhood (15). the first tations of others. The analysis showed four main interviews with mothers. other. Different methods and theories of science within the expectations concerning motherhood will affect the expe- qualitative field were used in the studies. ments affecting mothers’ confidence in breastfeeding (9). acknowl. Ireland Focus group 13 mothers perceptions and experiences In-depth interview Dahl (12) The condition of breastfeeding practice. Mothers’ confidence in breastfeeding 655 Table 2 Included studies and their characteristics References Title Country Method Participants Bailey and Pain Geographies of infant feeding and access to UK Qualitative interview 7 mothers (10) primary healthcare discussion group 5 mothers in discussion group 12 people in network Cronin (11) First-time mothers – identifying their needs. Further. field notes. The expectations of motherhood the studies focused on mothers’ experiences concerning thus affect confidence in breastfeeding. the studies. thus analysis of rience of breastfeeding. tained in the perceptions of breastfeeding and mother- Murphy (16) examined the rhetorical strategies which hood. Three areas concerned the experiences of the discussion groups. To interpret the experiences of the mothers. Six Shattered expectations qualitative interviews were carried out with 36 British mothers before and up to 2 years after birth. the original texts several times to ensure that all details edgement of mothers’ experiences and feelings and reas. questionnaires and areas. Motherhood and about how children ought to be fed. text the maternal process of managing established The metasynthesis translated the findings from studies of breastfeeding and weaning the child from the breast using mothers’ confidence of breastfeeding into the metaphor the grounded theory method with data collected from ‘shattered expectations’. findings rather constituted a chain of argu- Hauck and Irurita (15) explored in an Australian con. were included. The work process was circular returning to positioning. The author The mother’s expectations are shattered when she wants found that mothers’ feeding choices were made in the to breastfeed but is unsuccessful. field notes. advice and support do UK Qualitative analysis of open 720 mothers (14) women want with breastfeeding? questions Hauck and Irurita Incompatible expectations: the dilemma of Australia Interview. No contradictory perceptions were found in surance and encouragement. A common social problem emerged for mothers and one area concerned perceptions of breast- women in management of their breastfeeding when feeding and motherhood. confi- breastfeeding and the results not on the research methods dence in breastfeeding is affected both when expectations  2008 The Authors. When breastfeeding and Data analysis motherhood are experienced as two sides of the same coin. An Sweden Longitudinal interview study 8 mothers interview study of a group of women’s Feminist research tradition conceptions. The metaphor shattered context of a powerful medicalized scientific discourse expectations is thus used in this paper. The areas were related to each personal expectations were found to oppose the expec. 33 mothers (15) breastfeeding mothers questionnaire. discussion 9 fathers group 12 child health nurses Grounded theory Murphy (16) Expertise and forms of knowledge in the UK Longitudinal interview study 36 mothers government of families Foucauldian perspective about breastfeeding and what to expect. Finally. practical help with (see Table 3). expectations and experience of the practice of breastfeeding Dykes (13) ‘Supply’ and ‘demand’: breastfeeding as UK Participant observation 61 mothers labour Focus interview 39 midwives Guided conversations Critical etnographic study Graffy and Taylor What information.

inappropriate advice as Made to feel guilty interpretation particularly unhelpful about risking their and use of babies’ health if they formal did not confirm to breastfeeding advice from medical support experts ‘Governing at a distance’ Perceptions of An image of Official Women conceptualize Relationship between the breastfeeding breastfeeding as breastfeeding breasts as machines state and the individual and natural policy The female body: a Rhetorical strategies motherhood Breastfeeding dysfunctional male Identities as ‘good discourse ‘Breast milk is natural’ mothers’ Natural discourse discourse  2008 The Authors. when some professionals to impact on their Identified conflicting or making decisions? communicate access to. breastfeed breastfeeding one-way from those around to be Beliefs and knowledge which did not prepare from midwives Breastfeeding as nonreciprocal able to meet the Breastfeeding a component them for reality work transmission of demands of life with a of the mothering J. main areas Bailey and Pain (10) Cronin (11) Dahl (12) Dykes (13) Graffy and Taylor (14) Hauck and Irurita (15) Murphy (16) Mothers An image of Pressure to Expectations to Breastfeeding as a Need for time and support Incompatible expectations Realities expectations breastfeeding as natural. if Practical individualized pre. in their Comments and opinions of autonomy and their depended on the practice postnatal care or in other others freedom to manoeuvre support.and postnatal not acceptable support received they gave inaccurate or knowledge formal breastfeeding Mothers Those offering support outdated advice Expert knowledge support health services informal must listen and Are mothers truly informed (technical knowledge) support acknowledge individual of all relevant aspects of The competence of networks have experiences infant feeding. Something that women health to the baby new baby experience just know how to do Supply and demand Unprepared for the Specific expectations and Familial infant feeding ‘realities of breastfeeding’ goals adds effort to meet history intentions To be in control Experience of less confusion. ideas and concepts 656 Studies. they felt they aspects of their life that The impact upon the family could draw on contributed to their Breastfeeding decisions difficulties in sustaining depend on the reactions of breastfeeding the child Breastfeeding A socio-cultural Conflicting Breastfeeding The mechanistic More of the negative Contradictory and confusing Medicalized scientific experts understanding of advice experts notions of supplying comments concerned the debate discourse different social groups’ Breastfeeding were reinforced by way others had related to The issue of guilt Education – persuasion access to and promoted by the language of them rather than the The credibility of health Expert defined practice interpretation of midwives was midwives content of advice or professionals was lost. self-doubt. Larsen et al. Journal compilation  2008 Nordic College of Caring Science . phrases.S. Table 3 List of key metaphors. and guilt with a supportive network The network How women dealt with Conditions for Women identified factors Acknowledgment To preserve mothers’ feeding difficulties breastfeeding around the birth.

11). If the network perceived breastfeeding as Breastfeeding as natural natural. 1). An immediate level was described as mother’s expectations.g. the network and the breastfeeding experts (Fig. had high expectations of what she chine’ and ‘the note of caution’. e. help from breastfeeding experts was not neces- In this discourse breastfeeding was taken for granted and sary. Whether mothers used support from breastfeeding experts depended on the network’s attitude to these ex- perts (10. the network and The network. breastfeeding prob- because there are special expectations of them. Journal compilation  2008 Nordic College of Caring Science . The age of enlightenment’s perception of the male as the human prototype and the female as deviant Figure 1 Shattered expectations on a discourse level and an immediate and potentially defective was behind this discourse (13). The female body was perceived as an isolated unit  2008 The Authors. 15). The in. the female body was conceptualized as a machine and breastfeeding became a supply of breast milk regulated by demand (13). Mothers who had given up breastfeeding did not something that everybody could do right away (12). Breastfeeding experts Mother’s expectations. Breastfeeding became an unquestionable truth. and a discourse level was described as ral it had consequences for the support that the mother breastfeeding as natural. The discourse level: Breastfeeding experts. The discourse on breastfeeding as crucial knowledge on breastfeeding. Dur. lems resulted in feelings of guilt and affected the mother’s cluded studies showed that three implicit perceptions or confidence in her own abilities (15). The discourse hid in many ways Influences that lead to shattered expectations are in. Machines are in danger of The note of breaking down and must be supplemented. level. cluded in the three metaphors: ‘mother’s expectations’. the female body as a machine and received from her network. mothers’ confidence in breastfeeding. mothers did not encounter any natural understanding when it did not feel right to breastfeed (10) and breastfeeding experts put pressure on the mothers to The immediate level: Mother’s expectations make them breastfeed (11). it did not function in all practical aspects (12. Mother’s whether the social and practical conditions of everyday life expectations cover the challenge and role as a new mother. Breastfeeding experts are regarded by the questioned when breastfeeding was considered to be mothers and the network. Breastfeeding problems thus became the informants of the official breastfeeding policy and the latest mother’s problem. repaired and caution controlled. and she encountered no understanding The metasynthesis revealed two levels which can affect (12. The network is the mother’s close surroundings. In this study these discourses are explained accordance. Mothers’ confidence in breastfeeding 657 of breastfeeding are shattered and when expectations of ing pregnancy this was a prominent discourse stating that motherhood are shattered. The network The female body as a machine Breastfeeding experts In this discourse. could manage. for mother and child were compatible with breastfeeding. as: ‘breastfeeding as natural’. When mothers experienced breast- can thus be part of the network but are treated separately feeding as their responsibility alone. The three discourses are discussed in but they found it difficult to demand support because they the following section in relationship to mothers’ expecta. related to breastfeeding are overcome depends on the support from the surroundings (10). The mother was surprised by the workload. breastfeeding was natural. as health professionals who are natural (12). felt out of control. 14). that breastfeeding demanded learning a competency. Mothers needed time and the note of caution. receive enough support (14). Whether problems natural was very strong (13). The mother’s discourses affect the expectations of breastfeeding and expectations of breastfeeding and the reality were not in motherhood. When breastfeeding experts perceived The female body breastfeeding as natural it was taken for granted that wo- Breastfeeding as as a machine men breastfed. so even if there were some understanding from the healthcare system or the com- munity that mothers needed support. the immediate level. The discourse level affected all areas of support to meet the demands of life with an infant (14). It was not ‘the network’ and ‘breastfeeding experts’. (12). ‘the female body as a ma. felt both limited. proud and satisfied when they breastfed tions. When breastfeeding was considered as natu- breastfeeding experts. Therefore. family but rather that the individual woman and her choice were and friends.

It influenced the mothers’ confidence in breastfeeding if Mothers expect breastfeeding experts to be carriers of the there were considerable differences in advice from the medical discourse and communicators of the most recent surroundings and the experts (15). the atti- Breastfeeding experts. The breastfeeding experts talked about breastfeeding as delivering milk and focused on timing. and information on breastfeeding is medical field. This quote individualized knowledge from reality in relation to the illustrates that mothers received much advice from the individual child rather than knowledge acquired from network but lacked recognition and appreciation of their books (7. mothering…People find it unusual to be getting praise for Mothers preferred advice from experts based on practical something that is expected of you’ (15. breastfeeding experts were expected to be Secondly. Journal compilation  2008 Nordic College of Caring Science . mothers’ expectation of clear answers as contradictory and Mothers expected clear answers on what was right and outdated information is given.S. do it. a discourse that is setting from many sources – family. ‘We do not give enough credit to mothers for caution from the experts thus had little importance (14). Mothers became insecure and confused when sured and weighed. Whether mothers can apply the knowledge depends on several factors. fessionals’ competence to communicate the knowledge chine and performance related to breastfeeding was mea. Foucault’s notions of nicated by healthcare staff. Being the providers of the official tude of the network to the breastfeeding experts is decisive breastfeeding policy and the most recent knowledge on for mothers’ use of the breastfeeding experts’ knowledge. healthcare staff. communication of knowledge on breastfeeding. friends and healthcare staff was confusing (14). p. friends. Foucault states that we are Mother’s expectations. a confusing and contradic- wrong. the female body as a machine and how children were supposed to be fed. breastfeeding courses’ influence on the breastfeeding experts and their was experienced as more complex than the medical dis. isolation because of breastfeeding discourse. Discourse influence on mothers’ confidence Breastfeeding experts. media and books and thus discourse are used to describe how discourses affect influenced the mother’s belief and consequently her mothers’ confidence in breastfeeding. After the delivery. It is problematic for the mothers were caught in a confusing and contradictory mothers when breastfeeding experts as carriers of the  2008 The Authors. The purpose of the study was to investigate what affects duration and amount. Mother’s belief in breastfeeding came subject to a knowledge regime. 15). needed (16). 67). both supporting The right to speak about breastfeeding and critical. Knowledge of breastfeeding was commu. the network and the In this discourse. cussed in accordance with the concept of discourse described by Foucault (17). mothers’ choices about breastfeeding breastfeeding experts and a discourse level interpreted as were seen in a natural and medical science perspective on breastfeeding as natural. debate on the best way to breastfeed (15). Mothers felt guilty the note of caution. norms and rules expressed by experts were not in accor- dance with the reality they faced (12) and the note of The network. First. as a reflection of their maternal ability. untouched by individual consciousness and social rela. The result of the metasynthesis was that mothers’ confidence in breastfeeding is affected at two levels: an immediate The note of caution level with mother’s expectations. metasynthesis of seven qualitative studies was made. Diverging and inappropriate advice cussion concerns three issues: the right to speak about from family. The question tions. often got contradictory and outdated information from the healthcare staff (11. breastfeeding. However. mothers’ confidence in breastfeeding so they give up feeding caused problems. This was intensified when breast. knowledge on breastfeeding. and it made the mothers even breastfeeding even though it is important to them. they were made responsible To explain how the discourse level influences the for the nutrition if they did not follow advice given by immediate level the results of the metasynthesis are dis- medical experts (16). The network. mothers became insecure (13). effort (15).658 J. The dis- course suggested (16). the breastfeeding experts do not live up to the the carriers of the medical discourse on breastfeeding. There was doubt about the pro- Mother’s expectations. In the following paragraphs. media limits to what we can say and do and how we can say and and books (15). Mothers were vulnerable to opinions of their breastfeeding and perceived comments. risking their infants’ health. as a consequence of new research in the tory debate is ongoing. 16). and the truth about breastfeeding. breastfeeding. new aspects of breastfeeding emerged and provided in an unacceptable manner. Larsen et al. A more insecure (13). When the body was seen as a ma. Focus is on the dis- expectations to breastfeed. Women were not perceived as individuals but as was if mothers were informed of all relevant issues as they bodies when they breastfed (12).

a specific view and a specific feeding experts who have the right to speak about function is imposed on the individual mother before she is breastfeeding (17). As mothers and the network regard it as the mother’s per. Mothers do not experience the coun- divide. The discourses decide who has the right in breastfeeding are in other words isolated and looked to say something about breastfeeding. Mothers take on the blame and see new research appear constantly exacerbates the confusion it as a defeat when breastfeeding is unsuccessful as both and catches the mothers in a self-contradictory debate. parts of the medical discourse to be excluded in practice  2008 The Authors. (2). Journal compilation  2008 Nordic College of Caring Science . the mothers and not the social or practical Consequently. The fact that new aspects of breastfeeding and duration and amount. Experts make mothers inse. it is the breast. what can be seen and docu- discourse on breastfeeding as breastfeeding experts have to mented is acknowledged as the truth about breastfeeding fulfil public health objectives (18). p. This can be illustrated by the following quote: other aspects of practical experience-based knowledge are ‘‘Women when at their most vulnerable are made to pushed into the background (17). Knowledge of natural and the mothers’ responsibility and it makes breastfeeding is organized in a way where only one mode mothers feel guilty. ferent discourses overlap (17). feeding experts acquire from the literature. seems to be a clear and undisputed attitude to breast- courses imply that mothers do not get the right support. and they make a specific female body as a machine isolate mothers unsuccessful in type of knowledge on breastfeeding the preferred and breastfeeding and regard them as second class mothers dominant. ability. they are practical knowledge they receive the knowledge breast- made to feel like second class citizens (failures)’’ (15. If they can’t. and they overlap and cause company of breastfeeding mothers. Moreover. On the the mother take the blame and lose confidence in her contrary. The guilt caused by unsuccessful breastfeeding is turned who expect breastfeeding to be natural and something inward and mothers lose confidence in breastfeeding. the ability to superior to other knowledge types and the knowledge on breastfeed is taken for granted and this puts pressure on breastfeeding valuable to make breastfeeding successful in the mothers. there discourses so to speak undermine the mothers confidence are discourses such as breastfeeding as natural and the in breastfeeding and thus exclude them from the good female body as a machine. they are isolated and find it difficult to learned and demands an effort. This explains why what feeding depends on support from the network. This way of talking and writing about breastfeeding is the result of a shift in knowledge perception on children and childcare from the middle of the 18th century (19). the dis. A specific position. breastfeeding is perceived as able to acknowledge or know anything (17). confidence in their ability to breastfeed. The discourses new mothers face. of the experts do not conform to the complex reality that mothers unable to breastfeed are isolated. Thus. it is considered natural that mothers breastfeed. In this way work. they might isolate down on. Society also When knowledge of breastfeeding experts is determined perceives breastfeeding experts as carriers of the medical by the medical discourse. reality. Isolation because of the breastfeeding discourses The natural science way of organizing knowledge was When breastfeeding is perceived as natural. three discourses uncovered by the metasyn- understanding. she gets confused. and they the dominant discourse (17). Breastfeeding is the mother’s responsibility practice disappeared (19). In the medical discourse alone and she risks exclusion from the good company of breastfeeding experts are directed to view matters that can mothers who breastfeed when she is unable to make it be seen. feeding by the experts becomes unclear to the mothers. Besides the medical discourse. To mother to live up to the advice of breastfeeding experts fulfil society’s and the mothers’ objective that more infants to ensure the health of the child. Instead of having the time and feeding was pictured as natural in leaflets for mothers but support from the networks that the mothers need in their to health staff was pictured as something that has to be new maternal role. 71). the discourse also imposes the responsibility on the sonal responsibility to make breastfeeding successful. measured and classified as the truth. reject and isolate when mothers do not live up to selling from breastfeeding experts as adequate. This study started out wondering why breast- with defective bodies. the mothers are under pressure and encounter little In sum. As overcoming problems related to breast. The discourses breastfeeding as natural and the mothers who do not breastfeed. the mechanisms of the discourses make conditions for the breastfeeding are questioned. doubt their competency and lose of knowledge is recognized. When mothers ask for breastfeed by the ‘establishment’. Mothers who are unsuccessful in different ways. In other words two dif- ask for help. find it difficult to relate the counselling to their everyday cure about their own performance when focusing on time. they do not obtain the recognition and thesis influence the mothers’ confidence in breastfeeding appreciation they deserve. The medical discourse entails that the norms and rules When the female body is perceived as a machine. are breastfed. The every woman can do. Mothers’ confidence in breastfeeding 659 medical discourse do not live up to the expectations of the The truth about breastfeeding discourse namely that mothers risk the health of their child if they do not follow the advice of experts.

the metasynthesis al- mines the mothers’ confidence in breastfeeding and leads lows access to more research results in practice (8. data collection/analysis and  2008 The Authors. phenomenon based on a number of studies. Confidence may be increased by reassurance that thus shown that qualitative research results can be inte. chines that naturally can breastfeed if they only want to. Help The value is theoretical but the metasynthesis likewise must depend on the situation (10) and be provided by lis- offers an opportunity for breastfeeding experts to reflect on tening and acknowledging personal experiences and efforts their practice (20). the network and the breastfeeding approach has thus provided more understanding of the experts causing the mother’s confidence in breastfeeding complex phenomenon of mothers’ confidence in to disappear. an underlying discourse level discourses such as breast- tradictions have been found but instead more nuances of feeding as natural. Journal compilation  2008 Nordic College of Caring Science . The metasynthesis has also shown that the discourses Transferring experiences from a foreign context can be overlap. 21).S. and the texts chosen have fulfilled the aim of the meta- synthesis to give a varied and broader understanding of Use of the metasynthesis approach what influences mothers’ confidence when they are The metasynthesis approach has made it possible to use the unsuccessful in breastfeeding. The metasynthesis standings of a phenomenon (8). The different approaches and methods note of caution more or less covertly influence the mo- have provided a nuanced picture. able to manage the demands of life with an infant (14). enced by the present discourses. it is not unusual to have problems and that you are not grated and can provide a broader understanding of a wrong because you think breastfeeding is difficult (14). when they give up breastfeeding. In this struction embedded in the culture where it is practiced. number of researchers. breastfeeding and motherhood are connected for the On the other hand. It is well know that qualitative research heavily depends on the knowl- Author contributions edge and reflections of the individual researcher or research teams (20. Larsen et al. The breast- metasynthesis is transferable to other western societies. (17). Sweden and Great Britain are equal to the differences works counter to the good intentions about supporting between Denmark and Great Britain indicating that the mothers to breastfeed. feeding experts need to debate how to avoid the note of The choice of studies from this millennium means that caution to claim that all women are milk-producing ma- mothers who have participated in the studies are influ. 15). 21). in this way draw attention to the discourses on breast. Whether these discourses To prevent shattered expectations it is necessary to see have changed in recent years is unknown. RN. breastfeeding. Consequently the messages from breastfeeding ex. a metasynthesis approach risks inte. same result. it explains why mothers feel they have failed grating results with different backgrounds and under. The value of this study is the ability to combine results and Mothers need time and support from their surroundings. No way the individual mother is responsible for the success of contradictions have been found in the results. The metasynthesis ther’s expectations. Applying the metasynthesis model has (14.660 J. the female body as a machine and the the phenomenon. mothers. experts influence the confidence in breastfeeding and on ferent starting points and different methods. it breastfeeding as a competency to be attained and not just a is thus possible that older studies would have provided the natural trait. and is based on the combined knowledge and skills of a perts become unclear and confusing. responsibility when breastfeeding is unsuccessful. to shattered expectations. breastfeeding. Overall. This metasynthesis is states that mothers’ confidence in breastfeeding is influ- based on seven studies from four different countries on enced at two levels. Moreover. This study has shown that breastfeeding in bility therefore is high that cultural differences between western societies is perceived in such a way that it actually e. Health visitor is responsible for research offers a broader understanding of a phenomenon study conception/design. This means that mothers get and assume problematic when breastfeeding is seen as a social con. when they choose so. The metasynthesis has shown how experiences of ten are underlying and hidden to those affected by them. the proba. experiences of breastfeeding and motherhood from an extensive number of mothers. the metasynthesis approach has proved applicable. This again under. tions of the mother. port breastfeeding. the network and the breastfeeding The seven different qualitative research projects had dif. they need to feel they are being taken care of and thus are feeding and motherhood and their possible consequences.g. In retrospect. Comparing the studies has Conclusions made it possible to investigate mechanisms that would otherwise have been difficult to discover as discourses of. A metasynthesis of a series of Jette Schilling Larsen. The mothers in the metasynthesis have provided the Data in a metasynthesis are research publications and following pointers on how breastfeeding experts can sup- the primary value of a metasynthesis is theoretical (20). No con. On an immediate level the expecta- mothers’ experiences of breastfeeding and motherhood.

student is responsible for critical revisions for important 11 Cronin C. 2005. Pain R. Oslo. References Acta Universitatis Gothoburgensis. 21 Sandelowski M. Mothers’ confidence in breastfeeding 661 drafting of the manuscript. ernment of families. MScN. Kort og godt om amning. Newbury Park. Geographies of infant feeding and access to PhD is responsible for critical revisions for important primary health-care. RN.  2008 The Authors. Nordisk Forlag A/S. The Anthropology of Breast-Feeding. nursing practice. Res Nurs Health 1997. studies. Døden i barndommen. Birth 2005. København. 6 Jerris T. 32: 210–6. Docherty S. Hall. on the duration of breastfeeding. of breastfeeding mothers. What information. The influence of psychosocial factors 17 Foucault M. 19 Løkke A. 6th edn. 1998. 18 Vallgårda S. Expertise and forms of knowledge in the gov- 1973–2000. Geneva. Elisabeth O. til sundhedspersonale. J Clin Nurs 2003. Berg 1930 og til i dag. Meta-Ethnography: Synthesizing Qualita- tive Studies. Folkesundhed som politik Danmark og Sverige fra 5 Maher V. 25: 977–84. PhD 17. 2003. per- ceptions and experiences. 2001. Journal compilation  2008 Nordic College of Caring Science . Global Strategy for Infant and Young Child Feeding. 15 Hauck Y. MScN. C. Qual Health Res 2007. ‘‘Supply’’ and ‘‘demand’’: breastfeeding as labour. Oxford. Health Care Women Int 2002. Heiberg E. Sage Publications. Talens Forfatning Nietzche genealogien Historien. Aarhus Universitetsforlag. Emden C. 9 Noblit GW. Health Soc Care Community 2001. Hall EOC. 4 Kronborg H. 3rd edn. Komiteen for Sundhed. Pape KP. First-time mothers – identifying their needs. 24: 3 Eide I. CA. Copenhagen. Soc Sci Med 2005. 2003. Ammeundersøkelsen år 62–78. Publishers Limited. Scand J Public Health 2004. Taylor J. Irurita VF. advice and support do 2 Sundhedsstyrelsen. Copenhagen. Komiteen for Copenhagen. 2006. 12 Dahl L. Challenges in approaching metasyn- 7 Nelson AM. A metasynthesis of qualitative breastfeeding thesis research. barn og materutiner ved norsk fødeenheter i perspektiv 16 Murphy E. 10 Bailey C. 2004. Helsing E. 32: 179–86. 1 WHO. Aarhus. Hans Reitzels Forlag. Helsetilsynet. intellectual content. 17: 113–21. J Adv Nurs 1997. 60: 2283–93. 1988. Qualitative meta- 8 Kirkevold M. 1992. 9: 309– intellectual content and Hanne Aagaard RN. Hare RD. 2000. Håndbog i Vellykket Amning – anbefalinger women want with breastfeeding. Væth M. Sociol Rev 2003. WHO. 20 Bondas T. 20: strategy to further the development of nursing science and 365–71. 51: 433–62. Göteborg. 2003. Integrative nursing research – an important synthesis: issues and techniques. 14 Graffy J. 51: e13–20. Amningspraktikens villkor En intervjustudie av en grupp kvinnors föreställningar på och erfarenheter av amning. Sundhedsoplysning. 13 Dykes F. 12: 260–7. Mor. J Midwifery Womens Health 2006. Incompatible expectations: the dilemma soplysning.