A positive deviance inquiry on communicative acts and behaviors that enable working mothers to breastfeed

The benefits of breastfeeding have been well documented for both mother and child. Breastfeeding provides optimal nutrition for an infant and includes decreased risk for numerous diseases and illnesses. However, there is evidence that when mothers return back to work from maternity leave, they often stop breastfeeding. The present research project utilizes the Positive Deviance approach to find working mothers who have successfully breastfed their children exclusively for six months and to determine what enables these mothers to continue to breastfeed past one year of birth while working full time. The purpose is to understand why some working mothers, who face resistance and odds, succeed in effectively breastfeeding while most others do not. Working mothers who continued to breastfeed past one year were found using snowball sampling through a local El Paso charter of an international organization, Mothers of Preschoolers (MOPS). MOPS is a support group for mothers with children under the age of five. Mothers were also found after attending a meeting for the Bi-National Breastfeeding Coalition. For a mother to be considered a Positive Deviant (PD), she will have to meet the following criteria: located in El Paso, TX, working full-time, must have exclusively breastfed for six months and introduced solid foods at six months while continuing to breastfeed for one year or beyond, and to have done so in the face of resistance from one or more friends, family or colleagues. After the PD mothers were identified, in-depth interviews were conducted to help understand what enables the working mother to breastfeed past one year. The identified communicative acts were both intrapersonal and interpersonal in nature. Temporally, these communicative acts occurred for the working mothers, before the child was born, immediately after the child was born and in preparing to return to work. Before the child was born, the working mothers who were positive deviants made an active decision to breastfeed. These PD mothers would discuss their decisions with their partner and they would both come up with a “game plan” on how to make it work. In fact, a mutual decision was reached that baby formula will not be in the picture. Lastly, the PD mothers would purchase a breast pump before the birth of the child. After the birth of their child, the PD mothers regularly sought the advice of lactation consultants to learn how to nurse properly. Many even called the lactation consultant after being discharged from the hospital. Mothers also learned their child’s feeding routines and cues, charting the feeding schedule, including carefully noting, which breast the child nursed from and for what duration. Mothers also figured out ways to deal with painful breasts and cracked nipples with over-the-counter products and holistic remedies. Some PD mothers worked out a night schedule with their husbands enabling them to bottle-feed the child breast milk that was pumped in advance. This allowed them to get at least three days of adequate sleep during the week. In their preparation to return to work, most of the PD mothers were aware of their legal rights to pump milk in the workplace. Also, the PD mothers would build up a stock of pumped breast milk before returning to work. At work, the PD mothers used creative strategies to use the breast pump, and at home train caregivers on how to properly handle and administer breast milk to their child. The mothers would remind caregivers on a daily basis that her child was breastfed. If the child was under the care of a relative, the mother would go over how to properly administer breast milk through a bottle. PD mothers also nursed their child before leaving the house in the morning and soon after on arrival from work. The PD mothers clearly demonstrated the important role of communication in the various stages of breastfeeding their children. Whether it was with their spouse to gain support, or seek the advice of a lactation consultant, or train caregivers, the PD mothers employed communication as a strategic tool to engender effective breastfeeding outcomes