Breastfeeding: An Emotional Instinct

Introduction

The success of a promotion usually lies in understanding the audience emotionally and then implementing affective actions suited to the target. On that basis, one of the most common limitations of campaigns to promote breastfeeding is that they overlook the importance of emotions for the breastfeeding adoption process in mothers. In that respect, the proposed objective of this research is to start from an understanding of the role played by emotions in the breastfeeding adoption behavior. In order to achieve the desired objective, this work is structured in five parts: (1) a review of literature, (2) subjects and methods (study design, measuring instruments, and statistical analysis), (3) results, (4) discussion, and (5) conclusion.

Review of the Literature

The literature on maternal breastfeeding has highlighted the existence of a classic or educational model,^1–3 in which the adoption of breastfeeding is seen as a rational decision based on assimilated knowledge about health and well-being and does not seem to reflect in the best possible fashion what the mother really feels and experiences. This is because a model with preconceived ideas about how to breastfeed has been developed that does not actually analyze the breastfeeding adoption process and therefore fails to establish how mothers actually breastfeed. It could be said that the theory and practice of breastfeeding differ because of excessive doctrinal orientation, ⁴ and no effort has been put into developing an emotional model to explain breastfeeding responses so far. Be that as it may, and from the perspective of the scientific discipline of health social marketing, one of the most common limitations of campaigns to promote breastfeeding is that they do not start from an understanding of the breastfeeding adoption process in mothers.^5–8

More specifically, maternal breastfeeding behavior—or experience of breastfeeding—is expressed in two fundamental ways: (1) the quantitative, related to the volume of performance of the breastfeeding task, ⁹ and (2) the qualitative, referring to the behaviors that lead to improving that performance, for example, by watching what one eats and assuming the most suitable position for breastfeeding. ¹⁰ Thus, and following up on what has been stated above, this work points out that the breastfeeding adoption process involves an experience that is much more emotional than cognitive.^11,12 On that basis, apart from the usual cognitive variables mentioned in the literature regarding knowledge about health^13,14 and knowledge about breastfeeding,^15,16 the importance of an affective variable should also be recognized: this variable can be called breastfeeding emotions.

That is because of the mother's affective support and emotional ties with her infant, as well as nutritional aspects constituting the primary motive for breastfeeding ¹³ and also for deciding not to bottle feed. ¹⁷ Similarly, apart from the obvious reason of physical inability, emotions are the variables that function as inhibitors of the breastfeeding response. ¹³ Thus, on the basis of the fundamental role that emotions and feelings play within the breastfeeding adoption process, the following hypothesis is proposed: \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} \begin{align*}({\rm H}1) \ & \hbox{Breastfeeding behavior is more emotional} \\\quad\quad & \hbox{than cognitive}.\end{align*} \end{document}

Most scientific works have studied the affective variables independently of the cognitive variables. Thus, there is a clear and significant separation between the social science of breastfeeding, whose object of research is cognition,^13,14 and the research works that address emotions. ¹⁸ More specifically, this lack of coordination in the cognitive and affective study of breastfeeding is due to the fact that there is a certain separation between what mothers know and what they feel about breastfeeding. In effect, the literature indicates a set of emotional reactions that are logically more consistent with the physical process of enlightenment than with sociocultural norms and techniques. ¹⁹ For example, there is a clear feeling of bonding between a mother and her child,^18,20–22 as well as postnatal sadness or depression, which appears for hormonal reasons. ²³ On that basis, the second research hypothesis states that: \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} \begin{align*} ({\rm H}2) \ & \hbox{The cognitive and emotional processes are}\\\qquad & \hbox{relatively separate and independent responses}.\end{align*} \end{document}

Subjects and Methods

Results

The findings reveal that there is a very strong association between emotions and breastfeeding behaviors (Table 4). To be more specific, five out of those nine emotions are related to breastfeeding behaviors, in that mothers display more interest in eating healthily—in order to do their best in terms of breastfeeding—if they are prouder of and more confident about breastfeeding, develop more empathy and bond with their babies, and are happier. By contrast, the emotion of disgust is negatively related to breastfeeding in the sense that there is less disgust if mothers are concerned about their diets. In addition, and referring to the correlation analysis between breastfeeding behavior and the cognitive variables about breastfeeding, there are no significant associations (Table 4). To be more specific, when mothers breastfeed they display neither knowledge about breastfeeding nor knowledge of health. Therefore, it can said that breastfeeding behavior is more related to emotions than to cognition, and Hypothesis 1, which states that “the conduct of breastfeeding is more emotional than cognitive,” is confirmed.

In addition, as Table 5 shows, there are only three associations between emotions and cognitions (16.6% of potential associations). More precisely, it has been shown that the possession of information about health favors confidence and pride in the mother. However, a greater level of knowledge about how to breastfeed hinders the appearance of feelings of pride. Therefore, this leads to the conclusion that the mental systems of information and emotional processing that give rise to breastfeeding are relatively independent. On the basis of the above, Hypothesis 2, which states that “the cognitive and emotional processes are relatively separate and independent responses,” is confirmed.

Discussion

In fact, this thesis about the importance of the affective component is supported by institutional assertions and certain scientific bases. In that respect, some prestigious associations^29,30 consider breastfeeding to be beneficial not only to the baby's health but also to the emotional well-being of the family unit as a whole. Moreover, various scientific research works have identified an emotional component in the breastfeeding environment. For example, it has been shown that the feeling that the father is involved facilitates the mother's breastfeeding behavior, ³¹ as well as the infant's expressive temperament, ³² the mother's perception of the treatment in the maternal care unit, ³³ and, of course, the mother's postnatal emotional status. ³⁴ In addition, and specifically regarding the mother, some works show that breastfeeding in itself is basically an emotional phenomenon that occurs in the mother ¹⁵ because it is inherent to motherhood and the affective bond that develops between the mother and child.^20,35 This bonding begins physically from the start of pregnancy since it has been shown that breastfeeding is favored if the mother has a strong feeling of support and bonding with the fetus. ²¹

In addition, it is important to demonstrate the complexity of the emotional character of breastfeeding. In fact, breastfeeding arouses in the mother a great variety of emotions that may be somewhat contradictory. For example, although the mother may feel stronger ties, harmony, and intimacy with her baby, she also experiences some loss of identity, autonomy, and control over her life. ²⁵ According to that study, that affective dichotomy leads to emotional tension and conflict. More specifically, the many dimensions mentioned in the literature on breastfeeding refer to feelings that include guilt for not being able to breastfeed, ¹¹ shame for breastfeeding in public, ²⁶ joy or pleasure of the intimacy that stems from bonds with the infant, ²² sadness and guilt associated with weaning, ¹⁷ and pride for feeding the baby healthily. ²⁵ Another aspect that should be added is the complexity that stems from the condition of sadness and postnatal depression, ²³ where the logical emotion of stress and anxiety about wishing to breastfeed is one of the facets of that emotional decline. ³⁶

This makes it necessary not only to explain that breastfeeding is, above all, an emotional response but also to recognize that mothers follow an inertial—not so rational—pattern in the performance of this desirable behavior. This inertial pattern is defined by various emotions that are often predominant over the traditional cognitive model indicated in the classic literature.

However, although it is true that certain emotions display a clear association with social aspects of the cultural context, there seems to be no link with the variables of knowledge about breastfeeding and health that the literature recognizes as direct determinants of breastfeeding. For example, the father's help and commitment ³¹ and the mother's perception of her treatment by the healthcare personnel are significant variables that facilitate the desired response of breastfeeding, ³³ whereas excessive embarrassment or shame at breastfeeding in public ²⁶ constitute significant inhibitors of the desired behavior. Moreover, as was mentioned previously, because of the effect of the cultural development of a modern female identity, many women feel a certain loss of identity when they meet the inherent demands of breastfeeding ²⁵ and also suffer sadness and anxiety not only if they fail in what they consider their duty and responsibility to feed their infants to the best of their ability,^36,37 but also when they decide to wean them. ¹⁷

Conclusions

The empirical evidence about the predominantly emotional character of breastfeeding has highly significant implications because any promotional approach must be very expressive and emotional. In that respect, knowing that qualitative breastfeeding behavior is more emotionally complex than quantitative breastfeeding behavior, any promotional effort must distinguish two different affective hubs depending on the type of breastfeeding behavior to be reinforced. On the one hand, in motivating mothers to be concerned about their diet and to assume the correct position for breastfeeding (the so-called qualitative breastfeeding behavior), the hub for communication and treatment must comprise pride in doing it correctly, confidence for knowing how to do it, the feeling of building a bond with the baby, and joy at overcoming the challenge of breastfeeding the infant. On the other hand, in increasing the frequency of feeds and the exclusive use of mother's milk rather than formula milk (the so-called quantitative breastfeeding behavior), only joy and pride should be transmitted.

However, in general, it seems logical to propose that the most appropriate treatments are those that avoid stressing the importance of information and emphasize attention on the performance of the desired response, while also favoring affective and emotional persuasion. Finally, a word of advice: perhaps it seems clear that mothers need affective companionship and emotional support much more than explanations about in-depth knowledge and special skills.

However, from a theoretical point of view, once the phenomenon experienced by mothers has been configured, the incontrovertible fact is that, if breastfeeding is understood in its broadest sense, the desired behavior must include the laws of nature, and therefore we must not forget that breastfeeding is less an intellectual event and more an instinctive and emotional response. In fact, not only does the breastfeeding adoption model display a fundamentally emotional character, the system of cognitive processing also functions separately from the affective and emotional system. That evidence stresses the fact that breastfeeding is better compared with a natural physical response rather than the normative dictates of the technical knowledge about how to breastfeed. However, this is not a question of denying that women are assailed by many doubts when it comes to breastfeeding and that those doubts represent a clear demand for information relevant to the task; it is more a question of stressing the natural character and emotional reaction that the practice of feeding their infants from their own bodies entails. In light of the above, it is clear that if this research highlights anything, it is the sometimes forgotten notion that breastfeeding is an instinctive act not only for the baby but also for the mother.

Therefore, future research works should theoretically develop and empirically estimate exclusively emotional models of maternal behavior and so analyze in-depth the precognitive understanding of the breastfeeding adoption process. To achieve this objective and to overcome some limitations of the current research work, it would be necessary to contrast the validity and reliability of these scales with more powerful statistical tools as confirmatory factor analysis. Finally, it has to be pointed out as a shortcoming that the present research work took place in just one hospital belonging to the Spanish public national health system and that these results therefore are not representative of private hospitals, which represent around 15% of total births in Spain.