Date of Award

1-1-2002

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Nursing and Public Health

Faculty

Faculty of Communications, Health and Science

First Advisor

Associate Professor Lynne Hunt

Second Advisor

Dr Rycki Maltby

Third Advisor

Dr Yvonne Hauck

Abstract

The original contribution of this qualitative study is that it sketches the front-line of the contested domain of infant feeding choices by exploring the under-researched experiences and perceptions of mothers who actively choose to bottle-feed their babies. Twelve bottle-feeding mothers in Western Australia participated in open-ended, in-depth interviews. The interview findings were further explored using participant observations of relevant hospital practices and critical, hermeneutic re-readings of midwifery's professional and policy documents. The thesis argues that bottle-feeding is marginalised by the midwifery profession that currently defines its practices in accordance with policies such as the Baby Friendly Hospital Initiative. Bottle-feeding mothers described experiencing negative, antagonistic encounters with midwives moralising about infant feeding choices, pressuring them to choose breastfeeding, and obstructing rather than supporting their infant feeding choice. The bottle-feeding choice is often marginalised in the literature by the deployment of nebulous concepts about parental emotions, most notably so-called "mother-child bonding". However, the mothers presented an identifiable "bottle-centric" perspective by which they considered bottle-feeding the best choice to support their priorities of overall life-style organisation, avoidance of discomfort and anxiety, and optimal family inter-relationship dynamics. Notably, the bottle-centric perspectives described breastfeeding as a threat to those goals and values. This study also identifies a previously unexplored phenomenon of the mothers' concept of “father bonding" with its symbolic meanings of bottle-feeding for the mother desiring the father's emotional involvement with the baby. A speculative theory of an evolved socio-biologic concept of "Father bonding/bondage" is forwarded. Theoretical dimensions of current health belief models, especially that underlying the BFHI, cannot adequately recognise or service this client group's needs. Bottle-feeding mothers intelligently engage in health decision-making processes when deciding their infant feeding options, considering a broad range of factors to optimise their family relationships. However, the mothers' value systems are diametrically opposed to those of the midwifery profession. Midwifery's approach to limiting information and practical educational demonstrations of bottle-feeding is a key aspect of marginalisation. The mothers strongly criticised bias in antenatal classes, poor support for their own training in bottle-feeding, experiences of learning by making mistakes, and some mothers afforded more credibility to advice from sources outside midwifery. These alarming findings appear to result from WHO/UNICEF anti-marketing principles mistakenly being generalised to educational functions in the BFHI policy. Variations in the mothers' levels of satisfaction with their experiences in hospitals depended upon whether facilities suited or inconvenienced their needs, how efficiently hospital administrative procedures upheld their choice, and staff attitudes towards them. Major differences appeared related less to public or private sector differences and more to how well facilities were oriented towards either bottle~ feeding or breastfeeding. Exemplary support should be provided to both breast- and bottle-feeding client groups but will require a more sophisticated approach. Practical suggestions for developing and disseminating more timely and relevant information and support for bottle-feeding, and suggested research projects to expand the present study's findings are forwarded. The thesis proposes a "Caring Options- Responsive" model of Midwifery services suited to fully informing and respectfully supporting clients in their choice.

Share

 
COinS