Breastfeeding mothers' perceptions of insufficient milk supply

Background
Insufficient milk supply is commonly cited as a reason for discontinuation of breastfeeding worldwide. Understanding the myriad of factors that shape breastfeeding women’s perceptions of supply is essential for midwives to enable them to offer appropriate support.
Aim
To explore in-depth the issues that contribute to breastfeeding women’s perceptions of insufficient milk supply.
Method
Insufficient milk was a major theme within two research studies conducted in the north of England. Data from both studies were analysed thematically to enable comparison across cases highlighting variation and linkages within related concepts. Study 1 included data from interviews with 22 women who had chosen to breastfeed, 18 health professionals and observation of 158 clinical interactions collected in 2000 - 2002. Conducted in 2008, study two comprised interviews and focus group discussions with 14 grandmothers who had migrated from Bangladesh to the UK, 23 women of Bangladeshi origin who had breastfed in the UK, and 28 health practitioners.
Ethical issues
Full ethical approval was gained for both studies.
Key findings
The idea that they may not have enough milk for their baby was a critical issue for women particularly in the early days of their breastfeeding experience; this was often related to supplementation with formula feeds and could mean women stopped breastfeeding. Women’s perceptions of insufficient milk were complex and shaped by a myriad of explicit and implicit factors. These included: wider societal norms, social interaction with family and friends and health professionals, and women’s confidence and self-identity. The way midwives supported women to ‘know’ their baby was taking sufficient milk, the emotional work involved and the language used will be explored.
Implications
Recommendations will be made to enable midwives to better support breastfeeding women who are concerned they do not have enough milk to feed their baby.