Mother's difficulties in breastfeeding: a review of qualitative studies

QUESTION: What difficulties lead mothers early abandoning exclusive breastfeeding despite WHO and UNICEF recomanded breastfeeding to at least six months postpartum as best practice for mothers and babies? AIM: This paper reviews the qualitative research literature about difficulties mothers may experience in setting up and maintaining breastfeeding until their babies are six months old. METHOD: An online qualitative literature search was conducted in Pubmed, Embase and CINHAL database. The search strategy included the following keywords: breastfeeding, exclusive breastfeeding, difficulties/problems, qualitative article/research. Studies not exclusively qualitative, meta-synthesis and reviews were excluded. RESULTS: From the 1990-2010 search, in twenty-two articles, four themes emerged about mothers\u2019 difficulties in breastfeeding: \u2022 personal difficulties (demographic, biophysical and psychological factors); \u2022 social difficulties (marital status and income level; coming back to work; social context; social and familiar support; father\u2019s involvement in neonatal care); \u2022 cultural difficulties (presence of a \u201cbreastfeeding culture\u201d; woman\u2019s body perception; maternal or breastfeeding stereotypes); \u2022 healthcare difficulties (organization of health services during pregnancy, birth and the postpartum period; healthcare professional support). CONCLUSION: The duration of exclusive breastfeeding to at least six months postpartum is influenced by many personal, social, cultural factors and by socio-sanitary maternity services. It is clear from women\u2019s accounts that all these aspects cannot be reduced to single factors acting in isolation; many of them tend to be experienced in combination. So, only their mutual influence can enlighten women\u2019s experiences during breastfeeding difficulties. Healthcare professionals can use the study findings to better identify mothers who risk early breastfeeding cessation and to better design future professional interventions; social and political institutions can use the review results in order to guarantee social and structural conditions to breastfeeding mothers by reducing those barriers who prevent them to exclusively breastfeeding their babies for the first six months of life