Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
How did your research into breastfeeding and personality originate?
I'm interested in the factors that are associated with breastfeeding duration, not so much what encourages mums to breastfeed in the first place but how we can support those mums who want to breastfeed to breast feed for longer.
In the UK we've got quite a problem with breastfeeding. The government recommends that all women should breastfeed for six months, exclusively just breast milk, and then for up to a year and beyond. But quite a few women struggle in the UK. About 80% initiate breastfeeding but that drops off really quickly.
By about six weeks only about 50% of women are still breastfeeding. The problem is that most of those who stopped didn't want to stop. It wasn't because it was their own choice that they made, it was because they found it too difficult or they couldn't get the right support. That's what I'm really interested in, is how we can kind of work with that group of women to enable them to breastfeed for longer. We're trying to understand what their problems are.
There's been a lot of research done about how if women are more confident they're more likely to breastfeed, but there's nothing that's been done previously looking at their actual personality. I’d noticed that in other areas such as diet, exercise, and smoking, there were links to personality, so I thought we should look at breastfeeding and personality and see if we can explain it in any way.
What was previously known about how personality can influence the tendency to initiate and continue to breastfeed?
Very, very little. It's understood that women who feel more anxious and worried about breastfeeding and are nervous about whether their baby is getting enough milk or they're feeding too frequently, can struggle with breastfeeding and can stop because formula seems like the easy solution because you can see how much the baby is getting and you know they've had their milk, you can measure it. However that looked more at anxiety specifically in relation to feeding. There was nothing really looking at personality, which looks at anxiety as a general, wider personality trait and then other personality traits in general. It stemmed from that but it was pretty unique in what it looked at.
What exactly did your research involve?
It was part of a wider study looking at the factors associated with breastfeeding: mother's experiences, why they chose to breastfeed, why they stopped, how confident they felt, and then a measurement of their personality type.
602 mothers completed a questionnaire on how long they breastfed and their experiences. Within that I could look at the relationship between, not only personality and breastfeeding, but their experiences as well.
What did your research find? How do you think these results can be explained?
Firstly, personality was linked to breastfeeding. That was the initial finding. Particularly, women who were extroverted, rather than being introverted, were more likely to start breastfeeding and they breastfed for longer. Women who were less anxious were also likely to start.
What I was really interested is not just to say: personality is linked to breastfeeding--because that doesn't really tell us very much and isn’t very helpful in working out how we can give mums more support. What I then started looking at was: what is it about those two personality traits, of introversion and anxiety, that make it so difficult for women to breastfeed? What's going on?
So I looked at the links between their attitudes and thoughts towards breastfeeding, their experience of breastfeeding, any problems they had, any interactions they had with other people, and their social support. I looked at all the factors that are going all around them as that is so important in affecting breastfeeding experience.
What it showed was that, in particular, it seemed that introverted women felt differently and had different experiences than extroverted women. In particular, they didn't like feeding in front of other people. They were very embarrassed or nervous about it. That makes it really difficult to breastfeed because breastfeed babies feed really frequently, so unless you want to sit in the house all day, you're probably going to have to feed them in a cafe somewhere or feed them at somebody else's house. It's very difficult not to feed in front of other people.
Quite possibly, this reluctance or shyness to feed in front of others might be stopping mums breastfeeding because it would be more comfortable for them to use a bottle.
The introverts also felt a lot of pressure from other people to stop breastfeeding. Their mum, or their mother-in-law, or their partner was telling them to stop and they felt a lot of pressure from them. That can happen for lots of reasons. It could be that the father wants to get involved with feeding, or the mother or the mother-in-law wants to do the same thing, maybe they want to take the baby overnight to give the parents a break or to take them out for the day. That's very difficult if you're breastfeeding because you need to be able to feed the baby, unless you can express breastmilk, and not everyone wants to do that or can find it difficult.
The introverts seemed particularly affected by that pressure. Maybe they're a bit shyer and quieter when they don't really want to say, "No," and be so assertive maybe.
With the anxiety link, mums who were more anxious said that they found breastfeeding more difficult and they couldn't seem to get the support that they wanted. Now, I don't really see any kind of physical reason why being anxious would stop you breastfeeding, although very high levels of anxiety and stress might reduce milk supply, but maybe if you're very worried about it, then formula might seem like the solution.
Formula can kind of seem like the answer to any problems some times because, again you can see how much the baby is drinking or someone else can feed the baby which can reduce anxiety about how much milk the baby is getting. It’s not really the answer though as we want, and mums want, to be giving more support to overcome any anxiety and difficulties, not simply saying give them a bottle of formula.
So overall breastfeeding was linked to personality but it was more that personality was linked to the experience of breastfeeding which really affected whether they were able to or not or felt happy or confident doing it.
Women who feel more confident, happy, and knowledgeable are going to breastfeed a lot more easily. They feel supported. It's when they don't have the support and they get really worried that it seems very difficult. I think it's just the experience really, but personality seemed to be linked to experience.
What impact do you think this research will have on the support and education available to mothers? How do you think support for more introverted and anxious mothers can be improved?
I think it's really important to think about the practical message from these findings that mums who are more introverted or are more anxious really want to breastfeed but they find it a lot more difficult to do than more confident women.
I think support really needs to come antenatally when they're pregnant and then postnatally as well. I think we have antenatal teaching about breastfeeding but often it focuses on: this is how you breastfeed your baby. We tell mums: breastfeeding is really good for your baby. But we don't always think about: how are you going to breastfeed? What challenges might you face? What are you a bit worried about? I think talking to mums in antenatal classes about: what are they worried about; what challenges do you think you might face? And then working with them on strategies to overcome that.
For example, if they're really worried about feeding in public then they can think about ways that they might overcome that, perhaps taking a friend with them or their partner so they don't feel so embarrassed on their own. Asking other mums about where is quite breastfeeding friendly? Where could I go and have a coffee and quite happily feed my baby?
Or maybe it's about wider education for the family so the partner, mother, mother-in-law, or aunt doesn’t suggest, "can we give the baby a bottle?" Instead they try and support the mother in another way, by cooking a dinner or talking the baby out for a walk etc.
Postnatally, I think it's really important the mums get put in touch with the right support as well because there are breastfeeding support services out there. The NHS runs groups and there are charities that run helplines for if a mum has got a question. They also run drop-in clinics and sessions with women who have themselves breastfed.
For example the Association of Breastfeeding Mothers is one of them. They run a helpline and they have peer support groups. It's really important that mums get put in touch with support services, rather than sitting at home and worrying about whether the baby is getting enough milk or thinking, "this hurts, I don’t know what to do,” they go and speak to people who can help them, so they get the support that way.
Do you have plans to study the effect of any other aspects of personality on breastfeeding rates?
I think the important thing at the moment is taking these findings and looking at how we can help mothers with them, so I'm hoping to kind of think about how this can be applied to antenatal teaching or postnatal support. So working in to a kind of intervention or support package that can help mums to get them thinking about breastfeeding and overcoming some of the challenges.
Is it important to study the personalities of the partners of mothers?
I think that dads play a really, really important role in breastfeeding because they are the mum’ first line of support and they can be so influential on them.
I'm just writing at a paper at the moment, actually, looking at father's experiences of breastfeeding. The dads are so important in supporting the mum and their attitude as to whether they want the mum to breastfeed or not is critical because, if they're really supportive, she'll probably feel happier and more confident, and perhaps he can support her by looking after her and cooking dinner or just being there for her if she's feeding in public and feeling a bit embarrassed.
If he doesn't really understand breastfeeding or isn't supportive of it then you can see how she can end up stopping breastfeeding if he says things like, "it is my baby too, I want to give him a bottle." This might pressurize her to bottle feed.
You could easily transfer the same personality traits to dads in that, if they're quite introverted, they might get embarrassed by their partner breastfeeding in public. They might be sitting there thinking, "Oh, what's she doing? I feel embarrassed and awkward about this." Or if they're very anxious, they might be worried that the baby is not getting enough milk, and if the mum's surrounded by somebody who is anxious and worried and a bit embarrassed, then, even if she's not herself, she might be more likely to stop breastfeeding.
Where can readers find more information?
It's in the Journal of the Advanced Nursing: http://onlinelibrary.wiley.com/doi/10.1111/jan.12219/abstract
One of the really key places mums can go is to breastfeeding support groups. The NHS will run them in all areas, but you also have the groups run by charities. They are run by people who have very skilled knowledge about breastfeeding but also peer supporters who are women who have recently breastfed a child themselves so they know what it's like. They have ideas about how you can overcome different challenges.
So if women want to find out more, I recommend they go along to their local breastfeeding support group. They'll welcome pregnant women along; you don't have to have had your baby already. Get in touch with one of the charity helplines, such as the Association of Breastfeeding Mothers. There's also the breastfeeding network. They're all services that women can ring if they've got questions or problems.
About Dr Amy Brown
Dr. Amy Brown is a Senior Lecturer in Public Health and Policy Studies at Swansea University. Her research explores the importance of nutrition during the first year of life upon longer-term child weight and eating patterns.
She is especially interested in the factors that influence whether infants are breast or formula fed and when and how they are introduced to solid foods. In particular her work examines how complex psychological, societal and cultural factors can affect maternal experiences at this time.
Her long-term aim is to develop interventions to support new mothers to feel confident, informed and supported in their choices.