Alison Bowes and Teresa Meehan
Domokos (1998) 'Negotiating Breast-Feeding: Pakistani
Women, White Women and their Experiences in Hospital
and at Home'
Sociological Research Online, vol. 3, no. 3, <http://www.socresonline.org.uk/3/3/5.html>
To cite articles published in Sociological Research Online, please reference the above information and include paragraph numbers if necessary
Received: 20/2/98 Accepted: 4/9/98 Published: 30/9/98
As a global goal for optimal maternal and child health and nutrition, all women should be enabled to practise exclusive breast-feeding, and all infants should be fed exclusively on breast-milk, from birth to 4-6 months of age (Palmer, 1988: p. 319).
Asian women here gossip and think it's a bad thing to breast- feed. (PW138)
She had preferred to breast-feed, but did not do so, following pressure from her in-laws. A contrasting view was presented by PW105:
I like breast-feeding, because in Pakistan, all ladies give two years. Two years feeding is [a] must. (PW105)
This woman, whose case is referred to later, was a determined breast-feeder.
They are so busy, they don't have the time to sit and help you to do it. They really don't. They are rushed off their feet, and are quite harassed, and I was quite willing to give up....That was just agreed on all sides, just to go for feeds [i. e. bottle-feeding]. (WW248)
And then it turned out it was twins, and I thought I'd still try, but I don't think I was really a hundred per cent behind it. (WW248)
She gave up very quickly.
No-one asked me what I wanted. (WW209)
All I needed was a bit of encouragement, which I didn't get. (WW253).
They didn't take the time to sit with you. (PW134)
From day one, I thought I would breast-feed, but when I went into the hospital, and I wasn't getting much help, I just thought stuff it....I didn't even know how to start myself, and the nurse showed me once, but after that I still couldn't do it....and I started getting myself depressed and anxious, and I thought 'No. I won't be able to cope'. (PW130)
The hospital staff had, she felt, been too rushed to help her:
It's not a five minute job, you know. I'd rather have somebody spending more time. (PW130)
WW202 had also wanted to breast-feed:
I wanted to breast-feed in the hospital, and I couldn't. I wasn't managing on my own, and the nurses were never there when I wanted to feed the baby. They were always busy with someone else. So [I tried] it myself, and I made a total mess of it. I got [so] I couldn't breast-feed then in the end. (WW202)
I can't say enough about them. They were really great. If they hadn't supported me, I don't think I would have persevered with my breast- feeding. They used to come in and spend hours. You really felt at ease with them. (PW113)
The hospital midwives had helped the baby latch on, and had left the woman a bell to call them if she had problems. Another woman described a similar experience:
I couldn't sit properly because of my stitches. They told me to feed him lying down. So I would lie down, and they'd put him next to me, and then they'd put my buzzer next to me, so if there was a problem, just to call them. ÷ At times, it was sore ÷ but they quite encouraged you to breast-feed, which was good. (PW115)
In these cases, concerted action, in the form of the co-production of breast-feeding support had enabled women to succeed in their aims.
She sat with me every night she was on night shift, and I sat bubbling my heart out, and she sat cuddling me. (WW221)
Everyone was in, manhandling me. (WW238).
I didn't bother, because I was only going to have sore breasts and everything. (PW134)
At the time of interview, she was happily breast-feeding her fourth child (then aged two and a half months). She explained that she had been helped with latching-on in hospital, and felt that this had made all the difference:
If I would have had that kind of support the first time you know, I would have been able to breast-feed all my children. (PW134)
In this case, the role of hospital staff in the negotiation process was especially clear. For her fourth child, her own wishes, the knowledge and the time given by hospital staff had combined to enable her to breast-feed.
They needed the stimulation [of the baby feeding]. These were midwives that are supposed to know things like that. (WW244)
I think it must be different for people that bottle-feed their babies. They [the babies] get taken away [to the nursery on the ward]. But the breast-feeding mothers sometimes feel that they're left to get on with it. (WW263)
I certainly felt it was just ridiculous, the amount of pressure that was put on you to do it.....I don't think [women] should be made to feel somehow or other that you've failed if you can't manage it. (WW201)
WW211 felt that mothers who breast-fed were believed incapable of doing wrong:
I think they have a very naive attitude to mothers that breast- feed, and a very ignorant one to mothers that don't. But that's the government. They are pushing that forward. (WW211)
Thus, hospital practices linked with infant feeding were a topic of live debate for these white, middle-class women, who looked at them in a context wider than their own feeding decisions. The contrast between the views that, on the one hand, bottle- feeding, and on the other hand, breast-feeding, received more support illustrates that breast-feeding was not universally promoted by the hospitals or hospital staff, and that a monolithic view of their approach would be mistaken.
I hadn't a clue. I just did it. (WW219)
But she was very positive about her experiences of breast-feeding:
I love breast-feeding÷..I learned to just love it. (WW219)
My nipples were so sore, they were cracked. And the midwife and the health visitor said how brave I was, trying to feed. I tried, because I wanted to feed them very much. (PW113)
I said I'd had enough. I was giving up breast-feeding. I was just going to give her bottles because it would be so much easier....And she said how about trying one of these, and she gave me a nipple shield, and that was fine. (WW247)
Another woman had also received what she described as good, no nonsense advice, which had helped alleviate her anxiety about feeding her baby:
She came in 'Oh, you're not eating enough to keep a sparrow, never mind feed your baby' and told me what to do and all that. She was excellent. (WW262)
For some women, health visitor support had been decisive:
I would have given up without her. (WW215)
I would have liked to continue giving breast feeds....I would have liked more advice....Sometimes you don't know what to do....So I just kept quiet, and kept giving him bottles. (PW102)
I would have appreciated someone who knew something about breast-feeding.....I don't know if they [health visitors] go for refresher courses or not, but I think they should. (WW244)
WW210 described being threatened by a health visitor, when she was experiencing breast-feeding problems:
She said 'Well, that's two weeks, and she hasn't made up her birth-weight. It just means we'll have to take the child to care if you're going to persist with this breast-feeding.' I thought that was a terrible thing to say. (WW210)
Another woman was advised to give up breast-feeding when her baby developed a cold. All these women actively and critically resisted the advice given to them.
I lasted ten weeks with both children, then after that, I felt they needed something more than myself. (WW245)
I just felt dreadful after that. I just felt I had absolutely no time whatever on my own÷..I didn't even know if he was getting enough. (WW221)
She had stopped breast-feeding, but felt that, with support, she might not have done so. Several women had been persuaded by others to stop breast-feeding: sometimes, a health professional had advised them to stop, whilst in other cases, families had put pressure on them to do so. For some women, their babies were a cause of stopping breast-feeding: 'greedy babies' (eg. PW113) or babies that 'would not feed' (eg. WW221) were described as influencing decisions. PW161 linked her own feelings and her baby's character:
Six weeks I breast-fed her, but I didn't enjoy it. Apart from that, she wasn't taking it very much, and she was not a very happy child, so I took her off it. (PW161)
2 Currently in the planning process.
3 The research was funded by the Chief Scientist Office, Health Department, the Scottish Office.
4 This paper focuses mainly on the data from the women. A detailed discussion of the health visitor data is published elsewhere (Bowes and Domokos, 1998).
5 Sampling strategies were as follows:
6 It is possible that women who did not discuss infant feeding might have had different experiences from those who did. But the extracted data reveals a range of experiences and strategies. Throughout, we emphasise this range, and avoid quantitative discussion of the more detailed findings.
7 The characteristics of this sub-sample were broadly similar to those of the full sample, ie.the median age of the Pakistani women was 30, and the white women, 33. Pakistani women had a median of three children, and white women, two. Pakistani women were more likely to live in an extended family (27 per cent, as compared with 3per cent), less likely to have a job outside the home (5 per cent, as compared with 38 per cent), and somewhat more likely to have relatives living nearby (85 per cent, as compared with 80 per cent).
8 Breast-feeding is here defined as any attempt to do so.
9 A set of tools for organising data.
10 PW denotes a Pakistani woman, WW a white woman.
11 Chi square = 1.745 (1d.f. p=.186)
12 For Pakistani women, the relationship between socio-economic group and breast-feeding was not significant (Chi-square = 3.407 (5d.f. p=.637)). For white women, breast-feeding was strongly associated with higher socio-economic group (Chi-square = 17.097 (5d.f. p=.004)).
13 These women would require a separate discussion.
14 Later in the paper, we discuss some of the bodily experience of breast-feeding, and suggest that experiences of pain over-ride other bodily considerations.
15 A recent (January 1998) BBC 'Watchdog' campaign about breast-feeding also emphasised women's reports that they had not received the necessary support for breast-feeding whilst in hospital.
16 The Glasgow Women's Health Book (Glasgow Healthy City Project, 1993) states that women are given information about both breast and bottle feeding, and emphasises choice for women.
17 It is worth noting here that reports in the literature suggest that Pakistani women may experience denial of their pain on the basis of exclusionary stereotyping: Bowler (1993: p. 166) reports midwives insisting that Asian women (including Pakistani women) were inclined to 'make a fuss about nothing' during childbirth, ie. to cry out in pain unnecessarily, and Martin (1989: p. 153) makes a comparative point about black women in the U.S.A.
18 After the tenth day, the health visitor takes over from the hospital and community midwives in post-natal care.
19 Echoing the 'normality' of bottle-feeding discussed earlier.
20 Interestingly Blaxter and Paterson (1982: pp. 134 - 135) report that the working class women they interviewed were very keen to start their babies on solid food at a few weeks old, to the consternation of health visitors and clinic doctors.
21 See Bowes and Domokos (1998) for further discussion.
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