The midwives aren't allowed to tell you": perceived infant feeding policy restrictions in a formula feeding culture - the Feeding Your Baby Study

Briege M Lagan, Andrew Symon, Janet Dalzell, Heather Whitford

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


Objective: To explore the expectations and experiences of postnatal mothers in relation to infant feeding, and to identify how care could be improved.Design: This study used a qualitative, exploratory, descriptive design. Data were collected through one to one in-depth semi-structured interviews and focus groups.Setting: Tayside area of Eastern Scotland. Participants: Seven focus group interviews (n=38 participants) and 40 semi-structured one-to-one interviews with mothers with a range of infant feeding experiences i.e. exclusively breast fed; started breastfeeding but changed to formula before 16 weeks; exclusively formula fed; or who concurrently breast and formula fed their baby.Findings: A principal theme of ‘Mixed and missing messages’ emerged, incorporating ‘Conflicting advice’, ‘Information gaps’ and ‘Pressure to breastfeed’ with a secondary theme of ‘Emotional costs’. Several problems were identified with how women were given information, how infant feeding discussions were held, and the type of support available after the baby is born. Key Conclusions: There was a strong perception that some midwives are not ‘allowed’ to discuss or provide information on formula feeding, and the women reported feeling pressurised to breastfeed. Current interpretation of guidance from the UNICEF UK Baby Friendly Initiative may be restricting antenatal discussions about infant feeding. The combination of this partial preparation antenatally and postnatal support that was often inconsistent seems to incur a counter-productive emotional cost. Implications for Practice: At strategic, policy and practice levels the infant feeding message needs to change to encourage a more woman-centred focus including discussions about the realities of all types of infant feeding. It is important that health providers continue to promote and support breastfeeding; and that effective services are provided to women who wish to breastfeed to help them to do so. However provision of information about all aspects of feeding is needed as well as support for women who do not wish to breastfeed.
Original languageEnglish
Pages (from-to)1-1
Publication statusPublished (in print/issue) - 2013

Bibliographical note

Reference text: Ahluwalia I.B., Morrow B., Hsia J., 2005. Why do women stop breastfeeding? Findings from the pregnancy risk assessment and monitoring system. Pediatrics 116, 1408-1412.

Andrew N., Harvey K., 2009. Infant feeding choices: experience, self-identity and lifestyle. Maternal & Child Nutrition 7, 48–60.

Bailey C., Pain, R.H., Aarvoid, J.E., 2004. A ‘give it a go’ breastfeeding culture and early cessation among low-income mothers. Midwifery 20, 240-250.

Barbour R (2008) Introducing Qualitative Research. Sage: London.

Bick D., MacArthur C., Lancashire R.J., 1998. What influences the uptake and early cessation of breast feeding? Midwifery 14, 242–247.

Brodribb W., Fallow T., Jackson C., 2010. Attitudes to infant feeding decision-making-- a mixed-methods study of Australian medical students and GP registrars. Breastfeeding Review 18, 5-13.

Burns E., Schmied V., Sheehan A., Fenwick J., 2010. A meta-ethnographic synthesis of women’s experience of breastfeeding. Maternal & Child Nutrition 6, 201-219.

Burns E., Schmied V., Fenwick J., Sheehan A., 2012. Liquid gold from the milk bar: Constructions of breastmilk and breastfeeding women in the language and practice of midwives. Social Science & Medicine 75, 1737-1745.

Cairney, P.A., Alder, E.M., Barbour R.S., 2006. Support for infant feeding: mothers perceptions. British Journal of Midwifery 14, 694-701.

DaMota, K., Banuelos, J., Goldbronn, J., Vera-Beccera, L.E., Heinig, M.J., 2012. Maternal request for in-hospital supplementation of healthy breastfed infants among low-income women. Journal of Human Lactation 4, 476-482.

Donnan, P.T., Dalzell, J., Symon, A., Rauchhaus, P., Monteith-Hodge, E., Kellett, G., Wyatt, J. C., Whitford, H.M., 2013. Prediction of initiation and cessation of breastfeeding from late pregnancy to 16 weeks: the Feeding Your Baby (FYB) cohort study. BMJ Open 3, e003274

Duijts L., Jaddoe V.W., Hofman A., Moll H.A., 2010. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics 126, e18-e25. doi 10.1542/peds.2008-3256.

Dyson L., Green J.M., Renfrew J.M., McMillan B., Woolridge M., 2010. Factors influencing the infant feeding decision for socioeconomically deprived pregnant teenagers: the moral dimension. Birth 37, 141-149.

European Union, 2008. Protection, promotion and support of breastfeeding in Europe: A blueprint for action (revised). Available at:

Fenwick J., Burns E., Athena S., Schmied V., 2012. We only talk about breast-feeding: A discourse analysis of infant feeding messages in antenatal group-based education. Midwifery [E-pub ahead of print] doi:10.1016/j.midw.2012.02.006.

Forster D. & MacLachlan H. 2010. Women’s views and experiences of breast feeding: positive, negative or just good for the baby? Midwifery 26, 116-125.

Hauck F.R., Thompson J.M.D., Tanabe K.O., Moon R.Y., Vennemann M.M., 2011. Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis. Pediatrics 128, 1-8.

Health and Social Care Information Centre (HSCIC), 2012. Infant Feeding Survey 2010. Available at:

Hoddinott P., Craig L.C.A., Britten J., McInnes R.M., 2012. A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2: e000504. doi: 10.1136/bmjopen-2011-000504

Information and Statistics Division (ISD), NHS Scotland, 2011. Breastfeeding Statistics Financial Year 2010/11 Report. Available at:

Ip S., Chung M., Raman G., Chew P., Magula N., DeVine D. Trikalinos T., Lau J., 2007. Breastfeeding and maternal and infant health outcomes in developed countries. Agency for Healthcare Research and Quality 153, 1-186.

Joubish M.F., Kharram, M.A., Ahmed, A., Fatima, S.T., Haider, K., 2011. Paradigms and characteristics of a good qualitative research. World Applied Science Journal 12, 2082-2087.

Knaak S.J. 2006. The problem with breastfeeding discourse. Canadian Journal of Public Health 97, 412-414.

Kramer M.S., Kakuma R., 2004. The optimal duration of exclusive breastfeeding: a systematic review. Advances in Experimental Medicine and Biology 554, 57-63.

Laksham R., Ogilvie D., Ong K.K. 2009. Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies. Archive of Diseases in Childhood 94, 596-601.

Lee E., 2007. Health, morality, and infant feeding: British mothers’ experiences of formula milk use in the early weeks. Sociology of Health & Illness 29, 1075-1090.

Leung A.K., Sauve R.S., 2005. Breast is best for babies. Journal of the National Medical Association 97, 1010-1019.

Martell L.K., 2003. Postpartum women’s perceptions of the hospital environment. Journal of Obstetric, Gynecologic and Neonatal Nursing 32, 478-485.

McInnes R.J., Chambers J., 2008. Supporting breastfeeding mothers: qualitative synthesis. Journal of Advanced Nursing 62, 407-427.

Nelson, A.M., 2006. A metasynthesis of qualitative breastfeeding studies. Journal of Midwifery & Women’s Health 51, e13-e20.

National Institute for Clinical Excellence (NICE), 2008. Antenatal Care: routine care for the healthy pregnant woman. NICE: London.

Ogbuanu C.A., Probst J., Laditka S.B., Liu J., Baek J.D., Glover S. 2009. Reasons why women do not initiate breastfeeding: A southeastern state study. Women’s Health Issues 19, 268-278.

QSR International Pty Ltd, 2012. Introducing NVivo 10. Available at:

Razurel C., Bruchon-Schweitzer M., Dupanloup A., Irion O., Epiney M., 2011. Stressful events, social support and coping strategies of primiparous women during the postpartum period: a qualitative study. Midwifery 27, 237-242.

Renfrew M., Dyson L., Wallace L., D’Souza L., McCormick F., Spiby H., 2005. The effectiveness of public health interventions to promote the duration of
breastfeeding. National Institute of Clinical Excellence: London.

Redshaw M., Henderson J., 2012. Learning the hard way: expectations and experiences of infant feeding support. Birth 39, 21-29.

Renfrew M., Pokhrel S., Quigley M., McCormick F., Dodds R., Duffy S., Trueman P., Williams A., 2012. Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. UNICEF: UK.

Ritchie J., Lewis J., 2003. Qualitative Research Practice. Sage: London.

Royal College of Midwives (RCM), 2004. Position Statement No 5: Infant feeding. RCM: London.

Rudman A., Waldenstrom U., 2007. Critical views on postpartum care expressed by new mothers. BMC Health Services Research 7, 178.

Schmied V., Barclay L., 1999. Connection and pleasure, disruption and distress: Women’s experiences of breastfeeding. Journal of Human Lactation 15, 325-334.

Schmied V., Cooke M., Gutwein R., Steinlein E., Homer C., 2009. An evaluation of strategies to improve the quality and content of hospital-based postnatal care in a metropolitan Australian hospital. Journal of Clinical Nursing 18, 1850-1861.

Schmied V., Beake S., Sheehan A., McCourt C., Dykes F., 2011. Women’s perceptions and experiences of breastfeeding support: A metasynthesis. Birth 38, 49-60.

Scottish Government, 2007. Better Health, Better Care. The Scottish Government: Edinburgh.

Scottish Government, 2011a. Improving Maternal and Infant Nutrition: A Framework for Action. Available at:

Scottish Government, 2011b. A Refreshed Framework for Maternity Care in Scotland. Available at:

Sheehan A., Schmied V., Cooke M., 2003. Australian women’s stories of their baby-feeding decisions in pregnancy. Midwifery 19, 259-266.

Stewart-Knox B., Gardiner K., Wright M., 2003. What is the problem with breast-feeding? A qualitative analysis of infant feeding perceptions. Journal of Human Nutrition and Dietetics 16, 265-273.

Symon A., Whitford H., Dalzell J., 2012. Infant feeding in Eastern Scotland: A longitudinal mixed methods evaluation of antenatal intentions and postnatal satisfaction—The Feeding Your Baby study. Midwifery [E-pub ahead of print] doi:10.1016/j.midw.2012.06.017.

UNICEF, 2010. The Baby Friendly Initiative. Available at:

UNICEF, 2012. Guide to the Baby Friendly Standards. Available at:

Williams K., Donaghue N., Kurz T., 2013. “Giving guilt the flick”?: an investigation of mothers’ talk about guilt in relation to infant feeding. Psychology of Women Quarterly 37, 97-112.

Wolf J., 2011. Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood. NYU Press, New York

World Health Organization (WHO), 1981. International Code of Marketing of Breast-milk Substitutes Available at:

World Health Organization (WHO), 2003. Global strategy for infant and young child feeding. Available at:

World Health Organization (WHO), 2012. World Health Statistics 2012. Available at:


  • Breastfeeding
  • Formula feeding
  • Informed consent
  • Policy


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