The concept of shame and how understanding this might enhance support for breastfeeding mothers

The purpose of this paper is to explore the usefulness of the concept of shame and the literature on shame management for understanding the experiences of women who struggle to establish breastfeeding. In particular we consider what this literature might suggest with regard to good practice when supporting breastfeeding mothers, illustrating our discussion with data from two previous empirical studies.
There is increasing evidence from qualitative explorations of women’s experiences of breastfeeding that, for some mothers, breastfeeding can be a psychologically uncomfortable or even distressing experience. This seems particularly likely where there are difficulties establishing successful feeding which are counter to a mother’s previous expectations and where she may then feel she is positioned by discourses of ‘good’ or ‘natural’ mothering as failing both as a mother and a woman (e.g. Williamson et al., 2012).
Previous discussions of the potential for breastfeeding promotion to cause distress for women who do not breastfeed or who struggle to do so have tended to assume that the problem is guilt. In response to this a frequently made point has been the importance of recognising that apparent ‘failures’ to breastfeed are not best understood as the mother’s omission or ‘choice’ but instead as a consequence of the many barriers to breastfeeding in Western societies. Thus the possibility is created for breastfeeding advocacy to target the many ways in which breastfeeding is made difficult for women, rather than blaming mothers. However, as Taylor and Wallace (2012) point out, women’s emotional responses may be more complex than has sometimes been assumed and for many mothers who struggle with breastfeeding or turn to formula milk, shame may be as much if not more of an issue than guilt. As such the identity work which mothers engage in to make sense of not breastfeeding (e.g. Marshall, Godfrey & Renfrew, 2007) can perhaps be viewed as a form of shame avoidance.
There have been several attempts to distinguish shame from guilt, and we draw on Gilbert’s (2003) work as one of the most comprehensive models which usefully highlights the differing experience of relations with others when we feel guilty or ashamed. Guilt suggests a relatively powerful position where we are able to hurt another by our actions or omissions and we may then be motivated to make reparation. However, shame can be a much more destructive emotion and therefore difficult to manage. When we are ashamed we experience ourselves as inferior or flawed before a more powerful critical ‘other’, whether this is an actual person we perceive as devaluing us or a sense of a generalised ‘other’ in front of whom we are inadequate and lesser. With shame the focus is on a sense of a damaged and unable self, rather than on specific actions. Therefore an example of shame would be a mother whose distress about feeding difficulties arises from the possibility to her that these difficulties mean she is fundamentally flawed or inadequate as a mother, and possibly exposed as such before critical others. This is a rather different emotional experience from a sense of guilt towards her baby for providing less than optimal nutrition, though the two are not mutually exclusive.
We discuss some of the ways in which shame and the avoidance of shame may challenge a mother’s relationships with others, including her developing attachment with the baby and her interactions with breastfeeding supporters. Drawing on literature on shame management and some of our own research data, we suggest a number of ways in which healthcare practitioners may be able to help women to manage or repair feelings of shame. For example, Brown’s (2006) research on women’s experiences of shame in a range of contexts suggests that establishing relationships with breastfeeding women which validate both their experiences and emerging identities as mothers is important for providing a space in which it is safe to acknowledge, examine and contextualise often unspoken and taboo feelings of shame. In this way, the research on shame management supports recent proposals for breastfeeding support to adopt a more person-centred focus (e.g. Hall Moran et al., 2006).
Finally, in reviewing the usefulness of a focus on shame, we reflect briefly on the irony that the most visible examples of breastfeeding in public may paradoxically be viewed as shameful acts. This underscores the difficulties that women may face within contemporary Western societies in resisting shame in relation to breastfeeding.