Advising women to breastfeed exclusively for six months may be "unhelpful" and far too idealistic, suggests a qualitative study of new mothers, their partners, and close relatives, published in the online journal BMJ Open.
Exclusive breastfeeding for six months is known to confer considerable health benefits for mother and baby, and many governments around the world endorse the World Health Organization recommendations to do so.
But more realistic, incremental, and achievable goals should be set instead, particularly in countries that have struggled to meet targets to boost breastfeeding rates, which include the UK and the US say the authors.
They base their conclusions on 220 face to face interviews with 36 women, all but one of whom planned to breastfeed their babies, plus 26 partners, eight mothers, one sister and two healthcare professionals.
These were carried out at roughly four week intervals in a bid to find out participants' views on infant feeding from the last month of pregnancy until six months after birth, and what impact feeding practice had on the wider family.
The principal theme to emerge was the mismatch between the represented ideal of six months of exclusive breastfeeding; timely and appropriate support from partner, family, and fully trained healthcare professionals, and the reality experienced.
One woman said: "I think a reality check actually would be good, because they [healthcare professionals] make it sound so easy." Another said that breastfeeding was promoted "as a lovely bonding experience," which made her feel guilty, because that's not what she had.
And another woman commented: "It all seems to be 'don't ever do anything that would interfere with breastfeeding,' it's all got to be very purist, which is fine, but it just doesn't fit in with the rest of your life-.I think people just give up because it's too difficult."
Partners particularly expressed frustration that antenatal information on breastfeeding did not prepare them for the reality of it. And some parents said they felt "pressured" to breastfeed, and found an all or nothing approach to breastfeeding unhelpful.
Many women said they wanted a greater focus on the emotional issues, with opportunities for partners to be involved in these discussions, rather than purely on the technicalities of breastfeeding.
"Pivotal points" when babies change their crying, feeding, or sleep patterns are common during the first six months, say the authors, and parents believed that changing the mode of feeding was one of the few ways in which they could restore the wellbeing of their child, themselves, and other family members.
The authors make several recommendations, including providing opportunities for "realistic, interactive discussions with appropriately skilled healthcare providers and peers before and after birth"; a shift to feeding care after birth: and a proactive rather than reactive approach.
More attention should be paid to realistic "rather than idealistic goals," they say, and suggest that healthcare professionals ditch the "checklist approach" in favour of a family centred narrative approach, and acknowledge that there are many ways to feed a baby safely.
"Almost two decades ago, there was a debate around idealism in health promotion which questioned the transformation of health into political value," write the authors.
"We would argue that it is time to revisit this debate for infant feeding, if we are to design and deliver successful interventions to improve infant feeding outcomes and subsequent health outcomes of future generations."
Editor in Chief of BMJ Open, Dr Trish Groves, comments: "Any research or other article that seems to be "anti-breast feeding" is, rightly, highly controversial. This study is not, however, against breast feeding: far from it.
"We hope that parents, and anyone supporting mothers with breast feeding, will read the full paper. It provides first person accounts of how families actually feed their babies and how they feel about it, and the researchers have discussed their findings sensitively and in great depth."
AI tools improve maternity care outcomes for women