Full leng h a icle
Expe ience o b eas eeding du ing hospi aliza ion a e bi h: a
quali a i e s udy
C is ina Nie o
a,b
, Pa icia Lopez-Mases
a
, Ra ael Vila-Candel
a,c
, Es he Laza o
a,*
a
Valencian In e na ional Uni e si y. Calle Pin o So olla 21. 46002, Valencia, Spain
b
Ins i u o de la Muje , Hospi al Clínico San Ca los, IdISSC, Mad id, Spain
c
La Ribe a P ima y Heal h Depa men . FISABIO. C a Co be a, Km 1. 46600, Alzi a, Spain
ARTICLE INFO
Keywo ds:
B eas eeding
Expe ience
Mo he s
Quali a i e
Phenomenological app oach
ABSTRACT
Aim: Hospi al admission a e childbi h is a c ucial pe iod o es ablishing b eas eeding. The aim o his s udy is
o explo e mo he s’ expe iences ega ding eeding hei child en du ing he i s 48 h o hospi al admission.
Design: A quali a i e s udy design was used.
Me hodology: A phenomenological app oach was employed h ough hema ic analysis, conduc ed ia in e iews
wi h 14 pos pa um, aged 25–41 wi h di e se pa i ies and cul u al backg ounds, women du ing hei hospi al
admission.
Resul s: Common ac o s we e iden i ied among mo he s, such as he in luence o heal h p o essionals on hei
pe cep ions and eelings abou b eas eeding. Ma e nal o igin and cul u e we e ound o in luence how mo he s
app oach in an eeding. Family suppo could be bo h posi i e and nega i e, and i s absence could lead o he
ea ly abandonmen o b eas eeding. Feelings o guil and shame we e epo ed by pa icipan s, especially when
hey did no mee socie al expec a ions ega ding b eas eeding. Conclusion: B eas eeding is in luenced by
social and cul u al ac o s as well as he quali y o p o essional suppo . Ex e nal opinions and a lack o suppo
can hinde i s success ul es ablishmen . New mo he s ace physical (pain, a igue, body changes) and emo ional
challenges, including he shame and guil associa ed wi h he s anda ds o being a “good mo he .”
Impac : In a wo ld whe e mo he hood is o en idealized, insu icien suppo can exace ba e ma e nal insecu i y.
This highligh s he need o an app oach whe e he humaniza ion o ca e akes p ecedence o e a s ic ly
biomedical model.
Pa ien o Public Con ibu ion: The indings a e based on in e iews conduc ed wi h mo he s.
In oduc ion
B eas eeding (BF) plays a majo ole in pa en ing because b eas
milk has e ol ed in o a ood ha is ully adap ed o he changing needs
o in an s a di e en s ages o de elopmen . Thus, he Wo ld Heal h
O ganiza ion (WHO), he Uni ed Na ions Child en’s Fund (UNICEF), he
Ame ican Academy o Family Physicians (AAFP) and he Ame ican
Academy o Pedia ics (AAP)[22,36] ecommend exclusi e b eas eed-
ing (EBF) o in an s un il 6 mon hs o age, along wi h adequa e com-
plemen a y eeding un il a leas 24 mon hs o age. These
ecommenda ions a e due o he heal h bene i s obse ed bo h in he
sho and long e m o he BF dyad [34]. The e o e, i is no so
impo an o alk abou he bene i s, bu a he ha he al e a ion o his
physiological p ocess is associa ed wi h ad e se ou comes o bo h he
child and he mo he . The 48-hou hospi al-based app oach is pa icu-
la ly ele an compa ed o o he key b eas eeding miles ones (e.g., a 6
weeks o 3 mon hs) because i ep esen s a c i ical window o es ab-
lishing b eas eeding success, p o iding immedia e suppo , add essing
ea ly challenges, and ein o cing ma e nal con idence when guidance is
mos needed.
In mo he s who choose o b eas eed, a la e esump ion o
mens ua ion is obse ed in he sho e m and, he e o e, a g ea e
spacing be ween p egnancies and a as e loss o he ex a weigh ac-
qui ed du ing p egnancy [17]. On he o he hand, a e iew s udy s a es
ha his weigh loss could no be ela ed EBF, since he e a e many
associa ed ac o s [23]. Among he long- e m ou comes in mo he s, BF is
* Co esponding au ho .
E-mail add esses: [email p o ec ed] (C. Nie o), [email p o ec ed] (R. Vila-Candel), es he .laza op@p o esso .
uni e sidad iu.com (E. Laza o).
Con en s lis s a ailable a ScienceDi ec
Eu opean Jou nal o Obs e ics & Gynecology and
Rep oduc i e Biology
jou nal homepage: www.jou nals.else ie .com/eu opean-jou nal-o -obs e ics-and-gynecology-and-
ep oduc i e-biology
h ps://doi.o g/10.1016/j.ejog b.2025.114786
Recei ed 17 June 2025; Recei ed in e ised o m 17 Oc obe 2025; Accep ed 20 Oc obe 2025
Eu opean Jou nal o Obs e ics and Gynecology 316 (2026) 114786
A ailable online 23 Oc obe 2025
0301-2115/© 2025 Else ie B.V. All igh s a e ese ed, including hose o ex and da a mining, AI aining, and simila echnologies.
associa ed wi h a lowe isk o p emenopausal b eas cance ,[12,34]
o a ian cance [31,34], lowe a e ial hype ension [11,27] and ype II
melli us diabe es, especially in women wi hou a his o y o ges a ional
diabe es.
In child en, b eas eeding is associa ed wi h a lowe isk o in ec ious
mo bidi y in he sho e m, especially gas oin es inal in ec ions and
acu e o i is media [2,17,34]. A lowe isk o dea h om in ec ious causes
is also obse ed in child en who a e b eas ed, and his isk is lowe he
highe he pe cen age o b eas milk in he die . As long- e m esul s in
child en, i was ound ha BF ac s as a p o ec i e ac o agains obesi y
and is ela ed o lowe mean a e ial p essu e and o al choles e ol le els
in adul hood. Likewise, BF seems o ha e a p o ec i e e ec agains
epilepsy, an e ec ha inc eases acco ding o he du a ion o BF. This
da a is especially no iceable when he e is EBF. BF o a leas 4 mon hs
(wi h be e ou comes i con inued un il a leas 6 mon hs) is associa ed
wi h imp o ed lung pa ame e s [9], o ced i al capaci y, expi a o y
olume in he i s second, and peak expi a o y low a 10 yea s o age
[24]. A dec eased isk o acu e lymphoblas ic leukemia has also been
obse ed [16].
Di e en s udies indica e ha , among he p edisposing ac o s o
encou age he ini ia ion and main enance o b eas eeding, he e is he
educa ional suppo o heal h p o essionals, as well as hospi al p ac ices
a he beginning o li e ha encou age and p o ec BF. Howe e , when
he expe ience o mo he s ega ding he eeding o hei in an is s udied
in dep h, o he in luences a e disco e ed in he choices hey make. Thus,
i is obse ed ha he g ea e he cul u al oo s o he mo he , he mo e
he social no ms o he cul u e in luence ma e nal decisions [6]. Thus,
he e a e e hnic g oups wi h a g ea e p edisposi ion o eed hei chil-
d en h ough BF [18]. Women o en epo eeling p essu ed by amily
and iends o eed hei child en acco ding o hei p e e ences [29].
Howe e , he amily is also o en a sou ce o suppo o women [15].
Family in luence is posi i e i he amily membe s belie e ha b eas
milk is good, necessa y, and p o ec s agains disease. Also, i he e is a
his o y o success ul BF in he amily [35].
On he o he hand, he in luence o heal hca e pe sonnel is clea , bu
i does no always achie e he desi ed objec i e. I is impo an o bea in
mind ha he educa ional suppo o heal hca e p o essionals is highly
in luenced by hei p e ious expe iences and belie s [28]. In addi ion,
hei a i ude will ma k he mo he s’ esponse, as hey can acili a e he
emo ional p ocess o women by alida ing hei mo he hood. These
a i udes will acili a e adap a ion o he di icul ies o BF o , on he
o he hand, hey can unde mine ma e nal con idence by os e ing eel-
ings o shame, guil o humilia ion [19].
The impac o heal hca e suppo on ma e nal sel -e icacy mus be
aken in o accoun . Mo he s who eel li le emo ional suppo du ing he
i s days a e bi h, due o he hea y wo kloads o heal hca e p o-
essionals, epo dec eased sel -e icacy and eelings o low wo h,
which dis anced hem om hei goal o BF hei child en. In con as ,
mo he s wi h adequa e p o essional suppo , despi e he di icul ies, do
no su e a dec ease in con idence in hei abili y [32].
On he o he hand, he biological changes ha p epa e a woman’s
body o BF in luence he body image. These changes in body image can
be pe cei ed nega i ely, making a woman eel uncom o able wi h he
image and wha she shows o o he s, causing eelings o dissa is ac ion
and shame [26]. O he women, on he o he hand, ha e a posi i e
pe cep ion o hese changes, as hey p o ide posi i e ein o cemen o
success ul BF, a eeling o deep connec ion wi h hei child, and a sense
o ul illmen as a woman and mo he [26]. The e may also be conce n
abou he di ec physical e ec s ela ed o he ac o BF: pain, exhaus-
ion, and lack o sleep [30].
Besides, ma e nal emo ions play a key ole in ma e nal decisions
abou in an eeding. When BF is associa ed wi h posi i e emo ions, and
he choice is made by one’s own decision, and no in luenced by social
no ms o he opinion o e e ence pe sons, he ela ionship wi h hei
baby is a he cen e o hei in an eeding decisions. Consequen ly, he
emo ional bond be ween mo he and baby is he main eason o
in ending o b eas eed. These emo ions a e associa ed wi h a longe
du a ion o BF. The gap be ween expec a ions and eali y in ela ion o
BF is obse ed by many s udies [14,15,19]. P ena al educa ional suppo
does no su icien ly p epa e hem o he challenges o he pos pa um
pe iod, especially hose associa ed wi h in an eeding [14]. The eelings
ha mo he s mos equen ly associa e wi h BF include nega i e aspec s
such as guil , shame, and ea o ailu e and posi i e aspec s such as
bonding wi h hei child [14,19].
Gi en he impo ance o his a ea, he p esen wo k aims o explo e
he physical and emo ional expe ience o mo he s in hei ela ionship
wi h he eeding o hei child en du ing 48 h hospi al admission a e
bi h, including eelings, mo i a ions, expec a ions, ela ionships wi h
heal h pe sonnel and amily dynamics ega ding b eas eeding. This
s udy expands on p e ious li e a u e by p o iding a ocused explo a ion
o mo he s’ physical and emo ional expe iences wi h in an eeding
du ing he i s 48 h pos pa um, a c i ical bu o en unde examined
pe iod. Unlike p io esea ch ha p ima ily add esses long- e m
b eas eeding ou comes and in luencing ac o s, his s udy highligh s
he immedia e pos pa um challenges, he ole o heal hca e p o-
essionals, and he emo ional dynamics ha shape ea ly b eas eeding
decisions.
Me hodology
E hical conside a ions
This p ojec has he app o al o he Heal h Resea ch E hics Com-
mi ee o he Hospi al Clínico San Ca lo, whe e he s udy was ca ied ou
(ID 23/780-E). All women who me he inclusion c i e ia we e p o ided
wi h a pa icipan in o ma ion shee and ecei ed a e bal explana ion
o he s udy’s objec i es and p ocedu es om he p ima y esea che . I
was emphasized ha pa icipa ion was olun a y and ha hey could
wi hd aw a any ime wi hou consequence. All pa icipan s p o ided
w i en in o med consen be o e he in e iews commenced. To ensu e
con iden iali y, in e iews we e conduc ed in a p i a e oom, and all
ansc ip s we e anonymized using alphanume ic codes o p o ec he
iden i y o he pa icipan s.
Resea ch design
A quali a i e s udy using a hema ic analysis, aiming o unde s and
and desc ibe in de ail he pe cep ion o b eas eeding (BF) du ing he
i s 48 h o a newbo n’s li e h ough in-dep h in e iews wi h mo he s
who ha e gi en bi h aginally o ia cesa ean sec ion wi hou
complica ions.
Se ing and ele an con ex
This s udy was conduc ed a Hospi al XXXX, a public e ia y hospi al
in Mad id, Spain, be ween Oc obe 7 and Decembe 5, 2023. The hos-
pi al se es a di e se u ban popula ion, e lec ing Spain’s mul icul u al
con ex , wi h a signi ican p opo ion o immig an amilies om La in
Ame ica alongside na i e Spanish esiden s. The ma e ni y wa d p o-
ides s anda d pos pa um ca e, ypically in ol ing a 48-hou hospi al
s ay o uncomplica ed aginal o cesa ean deli e ies, du ing which
b eas eeding ini ia ion is suppo ed by heal hca e p o essionals,
including nu ses and midwi es. This se ing is shaped by Spain’s public
heal hca e sys em, which p omo es b eas eeding in line wi h WHO and
UNICEF guidelines, hough esou ce cons ain s and a ying s a
aining may in luence he quali y o suppo . The immedia e pos -
pa um pe iod was chosen as i ep esen s a c i ical phase o es ab-
lishing b eas eeding, in luenced by hospi al ou ines, p o essional
in e ac ions, and amily p esence, all o which impac ma e nal expe i-
ences in his con ex .
C. Nie o e al.
Eu opean Jou nal o Obs e ics & Gynecology and Rep oduc i e Biology 316 (2026) 114786
2
Sample
To achie e a maximum a ia ion sample, he esea ch eam ac i ely
moni o ed he cha ac e is ics o he ec ui ed pa icipan s. This ensu ed
he inclusion o women wi h di e en pa i y le els ( i s - ime and
expe ienced mo he s), a di e se age ange, and a ious cul u al back-
g ounds o cap u e a wide spec um o pe spec i es on he b eas eeding
expe ience.. The sample size calcula ion ook in o accoun he c i e ion
o in o ma ion sa u a ion.
The inclusion c i e ia we e as ollows: women who ha e been
assis ed a he bi h o hei child a he Hospi al; single bi h; da e o
bi h be ween Oc obe 7 and Decembe 5, 2023. The ollowing exclusion
c i e ia we e applied: clinical complica ions du ing deli e y o cesa ean
sec ion and/o a e bi h; admission o he newbo n du ing he i s 48 h
o li e; admission o he mo he o he In ensi e Ca e Uni du ing he
hospi al s ay; ea ly discha ge wi hin 24 h o bi h; no luen in Spanish;
mo he unde 18 yea s o age; mo he s who do no choose o b eas eed.
Da a collec ion
Sociodemog aphic da a we e collec ed h ough elec onic medical
eco ds. In o ma ion on BF expe iences was ob ained h ough open,
uns uc u ed in e iews, which we e guided by ac i e lis ening. In-
e iews we e conduc ed by a nu se ( emale) wi h expe ience in
women’s heal h and b eas eeding in pa icula . Pa icipan s we e
in i ed o indi idual in e iews a a ime and place con enien o hem,
aking in o accoun he c i e ia o he s udy. Pa icipan s we e asked
abou demog aphic a iables such as age, p o ession and educa ional
le el be o e s a ing he in e iews. These in e iews we e conduc ed
48 h a e bi h and we e eco ded using an audio eco de , and sub-
sequen ly ansc ibed using he O T ansc ibe compu e ool. The ini ial
con ac wi h pa icipan s was made a he ma e nal- e al heal h
consul a ion. Du ing his i s mee ing, he in e iewe , who had no p e-
exis ing ela ionship wi h he women, in oduced he s udy in o de o
es ablish appo . A his consul a ion, he p incipal in es iga o in o-
duced himsel and explained he cha ac e is ics o he s udy. Once he
woman was admi ed o he deli e y oom, she was con ac ed again o
ha e an in o mal con e sa ion. A e deli e y, and once i was e i ied
ha she me he inclusion equi emen s and did no p esen any exclu-
sion equi emen s, she was asked on he i s day o admission i she
wan ed o pa icipa e in he s udy. I he answe was a i ma i e, he
in o med consen documen was gi en and ano he in o mal con e sa-
ion was held.
Da a analysis
A deduc i e con en hema ic analysis was applied in which ca e-
go ies eme ged om he ex [7]. Fo da a analysis, i s ly, he in-
e iews we e ansc ibed om audio eco dings using he O T ansc ibe
compu e ool. Secondly, a gene al eading o he ansc ibed in e iews
was ca ied ou , as well as he o ganiza ion o he in o ma ion and un-
de s anding o he da a. A i e-phase app oach o hema ic analysis was
ollowed, including: amilia izing wi h he da a; gene a ing ini ial codes;
gene a ion o hemes om he codes; e iew o po en ial hemes and
de ini ion o hemes o he inal epo . Ini ially, he p incipal in es i-
ga o e iewed he ansc ip s and he esponses o each ques ion, and
he analysis o he hemes was ca ied ou by wo esea che s wi h
expe ience in quali a i e analysis, h ough a discussion g oup un il
eaching an ag eemen . Da a sa u a ion was de e mined o ha e been
eached a e 14 in e iews, as no new ele an hemes we e iden i ied
du ing he analysis o he inal pa icipan s.
Rigo o he s udy
Acco ding o Lincoln and Guba [20] he ollowing c i e ia we e
applied o ensu e he quali y and igo o he analysis o he in e iews:
a) C edibili y. Fo his pu pose, a su icien numbe o in e iews will be
ca ied ou o ob ain all possible in o ma ion, un il da a sa u a ion is
achie ed; b) T ans e abili y. To acili a e ans e abili y, a de ailed
desc ip ion o he con ex in which he esea ch is ca ied ou will be
made, as well as he sociodemog aphic desc ip ion o he pa icipan s; c)
Dependency. In o de o he esea ch o be eplicable, an exhaus i e
desc ip ion o he p ocess ollowed in he de elopmen o he esea ch
will be made, especially, he da a analysis; d) Con i ma ion. Fo his
pu pose, he comple e ansc ibed in e iews o he pa icipan s can be
eques ed, as well as he analy ical memos p epa ed; e) Au hen ici y.
The esea ch will se e o imp o e he ca e o mo he s and child en
du ing hei admission a e bi h; ) Jus ice. Fo his pu pose, women
om mino i y and/o ulne able g oups will be included.
Resul s
Sociodemog aphic esul s
The sample consis ed o 14 women who had gi en bi h o hei child
in a public hospi al in he las 48 h and who chose o b eas eed
(Table 1). The a e age age was 30 yea s old, 57.1 % o pa icipan s we e
Spanish, 35.7 % do no wo k unemployed, 50 % do no ha e mo e
child en we e p imipa ous. O he o al, 57.1 % had no mal deli e y and
64.2 % do no p esen pain.
Below a e he di e en hemes ha eme ged du ing he in e iews
conduc ed, as well as a de ailed desc ip ion o hem.
Educa ional suppo o heal hca e p o essionals
The pe cep ion o educa ional assis ance p o ided by heal h p o-
essionals shows no able dispa i ies linked o amily pa icula i ies and
social en i onmen . In he case o hose mo he s wi h p e ious b eas -
eeding expe iences, i is obse ed ha he expec a ions o hese mo he s
a e no me , in ela ion o he aining acqui ed by heal h p o essionals
o hei guidance ega ding b eas eeding. No ably, hese women
epea edly emphasize ha ing ecei ed con adic o y in o ma ion om
di e en heal h p o essionals. This causes a dec ease in hei con idence
ega ding b eas eeding, as well as he sphe es o hei pos pa um
expe ience. Likewise, hey pe cei ed he in o ma ion p o ided as
inapp op ia e o inco ec . Howe e , mo he s wi hou p e ious aining
in b eas eeding and mainly o La in Ame ican o igin, ind g a i ude o
all he in o ma ion ecei ed om heal h p o essionals.
“… he nu se who came clea ly lacked p ope aining and wasn’ e y
help ul. Pe haps someone mo e specialized in b eas eeding would ha e
been mo e help ul and would ha e been mo e app ecia ed.”
In all cases whe e p ena al p epa a ion was ca ied ou , b eas eed-
ing aining was conside ed bene icial and use ul in many aspec s.
Howe e , many mo he s exp essed ha i would ha e been app op ia e
and bene icial o ha e mo e knowledge abou he expe ience ha
mo he s ha e du ing he pos pa um pe iod. Being able o unde s and
how he eco e y p ocess de elops in he pos pa um pe iod, and
especially, wha he i s s ages o b eas eeding a e like, could dispel
many doub s and allow mo he s o p epa e o he p ocess.
Rela ionship be ween heal h p o essionals and mo he s
The ela ionship be ween heal hca e p o essionals and mo he s is
cha ac e ized by se e al dynamics ha in luence women’s pe cep ion o
he ca e ecei ed du ing he pos pa um p ocess. Fi s , he lack o ime
on he pa o heal hca e pe sonnel is a signi ican ba ie ha impac s
he quali y o in e ac ion and he ime hey can dedica e o suppo ing
mo he s in he ini ia ion o b eas eeding. This ime de ici , o en e i-
denced in b ie and hu ied consul a ions, can hinde he abili y o
p o essionals o comp ehensi ely add ess he needs and conce ns o
mo he s. Fu he mo e, disag eemen wi h he in o ma ion p o ided by
C. Nie o e al.
Eu opean Jou nal o Obs e ics & Gynecology and Rep oduc i e Biology 316 (2026) 114786
3
heal hca e p o essionals cons i u es ano he ele an elemen in his
ela ionship. The disc epancy o pe spec i es gene a es unce ain y and
dec eases mo he s’ con idence in he ecommenda ions ecei ed. Like-
wise, he lack o conside a ion o cul u al o ideological cha ac e is ics
in he planning o ca e adds a laye o complexi y o he ela ionship,
since mo he s may pe cei e ca e as insensi i e o hei alues and cul-
u al con ex . Women who cul u ally pe o m ca e ha is cha ac e is ic
o hei social g oup a e o en subjec o co ec ion and lack o unde -
s anding. The eeling o being e alua ed du ing in e ac ions wi h
heal hca e pe sonnel adds an emo ional dimension, gene a ing anxie y,
eelings o inadequacy, and a ec ing he quali y o communica ion.
“ Well… some imes some nu ses o assis an s—I don’ know how o
di e en ia e hem a lo —make you eel a li le silly. I ’s ue ha I’ e
asked a lo o ques ions, and I’m su e I’ e also called a lo , bu o en I
don’ know i she’s hung y o wha ’s going on, because I pu he o my
b eas and she doesn’ ea , o she ea s bu keeps c ying. You ha e a lo o
doub s and you don’ know wha o do. You eel bad, and you hink
someone can help you, bu hey don’ . I don’ know, maybe hey don’
know ei he . Then, each one ells you di e en hings.”
Finally, unasse i e communica ion by heal hca e p o essionals
ep esen s a challenge. Clea and espec ul in e ac ion is essen ial o
es ablish a suppo i e en i onmen . Lack o asse i eness can lead o
con usion and misunde s anding, nega i ely a ec ing he expe ience o
mo he s du ing his c ucial pos pa um pe iod. On he o he hand, some
mo he s epo excessi e p essu e placed on hose who choose no o
exclusi ely b eas eed. In his si ua ion, nega i e judgmen is made by
some p o essionals, making i di icul o exp ess p e e ences and
doub s.
“They make you eel bad. He e oo, e e y ime I’ e asked o milk, hey
don’ like i . I don’ wan hem o scold me, o look a me as i I’ e done
e e y hing w ong. I don’ know why hey can judge you; i ’s no igh o
hem o do ha . I ’s no igh .”
Ex e nal in luences on he ini ia ion and de elopmen o b eas eeding
Ex e nal in luences a ec ing he ini ia ion and de elopmen o
b eas eeding e eal complex dynamics ha shape mo he s’ expe ience
du ing his c ucial pe iod. The exp ession o g ea e us in people
ou side he heal h ca e s a highligh s he impo ance o social and
amily suppo ne wo ks in b eas eeding decision-making. Howe e ,
his is some imes due o he ac ha , in many cases, heal h ca e
pe sonnel do no achie e adequa e us o es ablish adequa e and use ul
communica ion. This p e e ence o ad ice om close indi iduals may
sugges a signi ican deg ee o in e pe sonal in luence in he o ma ion
o b eas eeding a i udes and p ac ices ha a e some imes based on
my hs o e oneous knowledge. Likewise, seeking suppo om heal h
ca e p o essionals ou side he Na ional Heal h Sys em and om suppo
g oups unde lines he di e si y o sou ces o which mo he s u n o
guidance. The willingness o explo e op ions beyond adi ional heal h
ca e s uc u es sugges s an adap i e s a egy on he pa o mo he s o
ob ain a mo e comple e and pe sonalized pe spec i e, ying o
compensa e o he eeling o lack o suppo and lack o in o ma ion.
“I ha e help. My pa ne and my mo he a e a g ea suppo o me. I can
coun on hem o e e y hing. Tha ’s a poin in my a o , clea ly.”
“B eas eeding is e y heal hy, bu i is no designed o he mo he o
wo k a he same ime.”
“I ’s exhaus ing all he ime, wi h no sleep a all. My amily helps me.
Being alone on hose days when e e y hing hu s and you can’ sleep
would be wo se.”
Iden i ying he bene i o suppo g oups as a posi i e in luence
highligh s he impo ance o pee in e ac ion and alida ion o sha ed
expe iences. Pa icipa ion in hese g oups no only p o ides aluable
in o ma ion, bu also c ea es a space conduci e o he exp ession o
emo ions and he cons uc ion o emo ional connec ions, hus con ib-
u ing o he s eng hening o social suppo du ing he b eas eeding
p ocess. Toge he , hese ex e nal in luences ou line a landscape in which
b eas eeding decision-making and de elopmen a e in insically in e -
wined wi h he social and communi y ab ic su ounding mo he s.
Ma e nal mo i a ion
Ma e nal mo i a ion o b eas eed is shaped by a numbe o ac o s
ha e lec he complexi y o his p ocess. Fi s , he pe cep ion ha
b eas eeding c ea es a meaning ul bond wi h he child eme ges as a
cen al mo i a o . This sugges s ha he emo ional connec ion and sense
o in imacy esul ing om b eas eeding con ibu e subs an ially o
mo he s’ decision o op o his p ac ice. The gene a ion o happiness in
he mo he as a esul o b eas eeding is ano he in luen ial elemen in
ma e nal mo i a ion. This posi i e emo ional connec ion ein o ces he
indi idual expe ience o mo he hood, con ibu ing o a sense o pe sonal
ul illmen and sa is ac ion. The pe cep ion o b eas eeding as a simple
and cheape op ion compa ed o o mula eeding also plays an in lu-
en ial ole in amilies wi h ewe economic esou ces. The simplici y and
a o dabili y o b eas eeding a e conside ed p ac ical ad an ages ha
may in luence mo he s’ choice. Howe e , i is no ewo hy ha consid-
e a ion o he bene i s o he mo he ’s heal h is no pe cei ed as a
de e mining ac o in mo i a ion.
“And I’m e y happy. B eas eeding is impo an . I ’s impo an o
b eas eed o babies. I makes hem heal hy.
“ I ’s he mos app op ia e way o eed a baby, he one ha educes many
heal h isks. E e ywhe e, hey ell you i ’s he igh hing o do o he
child’s sake.”
“… when my oldes son was bo n, e e y hing was ela i ely easy…. I
ound i easy and com o able”
Table 1
Sociodemog aphic da a and obs e ic his o y.
SUBJECT AGE NATIONALITY JOB PREVIOUS CHILDREN TYPE OF BIRTH PAIN
1s 38 ITALIAN YES YES −2 EUTOTICEUTOTIC NO
2nd 28 HONDURAS YES NO EUTOTIC NO
3 d 39 SPANISH YES NO INSTRUMENTAL YES
4 h 39 SPANISH NO YES −2 INSTRUMENTAL NO
5 h 26 BOLIVIA NO YES – 1 EUTOTIC NO
6 h 25 BOLIVIA YES NO CESAREA YES
7 h 27 BOLIVIA YES NO INSTRUMENTAL YES
8 h 20 SPANISH NO NO INSTRUMENTAL YES
9 h 31 SPANISH NO YES −1 INSTRUMENTAL YES
10 h 41 SPANISH YES YES – 3 EUTOTIC NO
11 h 19 HONDURAS NO NO EUTOTIC NO
12 h 26 SPANISH YES YES −1 EUTOTIC NO
13 h 29 SPANISH YES NO EUTOTIC NO
14 h 32 SPANISH YES YES −3 EUTOTIC NO
C. Nie o e al.
Eu opean Jou nal o Obs e ics & Gynecology and Rep oduc i e Biology 316 (2026) 114786
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Social and cul u al in luence
Social and cul u al in luences on he expe ience o BF a e a ich and
mul i ace ed dimension ha shapes mo he s’ a i udes and beha io s
du ing his p ocess. Fi s , he pe cep ion ha he needs o child en come
i s e lec s an ing ained cul u al no m ha places he well-being o
child en as he highes p io i y.
This pe spec i e d i es mo he s o iew b eas eeding as a p ac ice in
line wi h op imal child ca e, he eby posi i ely in luencing hei de-
cisions. The impo ance o being a good mo he is highligh ed as a
cen al elemen in social and cul u al in luence. Pe cei ed p essu e o
mee social and cul u al expec a ions o mo he hood may in luence he
choice o b eas eeding as a key componen o ma e nal iden i y. The
pe cep ion o a mo al obliga ion o p o ide he bes o child en e-
in o ces his commi men , sugges ing ha mo he s in e nalize cul u al
no ms ha dic a e maximum dedica ion o pa en ing.
“Besides, e e yone in my amily and my husband’s has been b eas ed.“
“I ha e o e eal mysel o people I don’ know. The i s ew mon hs a e
spen being home wi h he baby.”
The shame associa ed wi h exposing he body du ing b eas eeding
and he obliga ion o co e up while b eas eeding indica es he cul u al
p essu e ha dic a es no ms o modes y and p i acy. These elemen s
e eal how social no ms can a ec mo he s’ expe ience du ing b eas -
eeding, gene a ing emo ional and logis ical complexi ies. Views abou
ma e nal die cons i u e ano he cul u al dimension ha in luences
b eas eeding p ac ices. Cul u ally embedded pe cep ions ega ding
wha is conside ed heal hy and app op ia e o he b eas eeding mo he
can a ec he die a y choices and, consequen ly, he quali y o he
b eas milk.
P e ious b eas eeding his o y
The iden i ying cha ac e is ics ela ed o he p e ious b eas eeding
his o y e eal a c ucial in luence on he de elopmen and cu en ex-
pe iences o mo he s du ing he b eas eeding p ocess. Fi s , i is
obse ed ha he p e ious b eas eeding his o y exe s a no able in lu-
ence on he con igu a ion o cu en b eas eeding. P e ious expe i-
ences, whe he posi i e o nega i e, a e de e minan s ha shape
mo he s’ a i udes and expec a ions owa ds b eas eeding in he p e-
sen . Clea ly, success ul b eas eeding is a p o ec i e ac o in he
de elopmen o b eas eeding. Tandem b eas eeding, cha ac e ized by
he simul aneous b eas eeding o a newbo n and an olde sibling, s ands
ou as a dynamic ha acili a es he success ul ini ia ion o b eas eeding
o he newbo n. In cases whe e andem b eas eeding occu s, i is
common o ecei e nega i e messages abou his p ac ice om amily,
e e ence pe sons o heal h p o essionals. This inding sugges s ha he
cumula i e expe ience o p e ious b eas eeding can p o ide bene icial
esou ces and skills in he ini ia ion o b eas eeding wi h a new child.
Likewise, he p esence o p e ious success ul b eas eeding is a posi i e
ac o ha in luences he cu en b eas eeding p ocess. These p e ious
success ul expe iences can gi e mo he s con idence and compe ence,
hus con ibu ing o he success ul de elopmen o cu en b eas eed-
ing. Howe e , when di icul ies and complica ions a e encoun e ed in
he b eas eeding his o y, i is a ba ie o he de elopmen o cu en
b eas eeding.
“ B eas eeding ou i s child wen poo ly, and in he end, we couldn’
make i wo k. Bu he o he wo we e b eas ed.”
“Well, I al eady ha e wo o he child en ha I ha e b eas ed.”
“I can’ complain; b eas eeding my o he wo child en was qui e
com o able. So, I eel p e y con iden ….”
Ma e nal eelings in ela ion o he de elopmen o b eas eeding
Ma e nal eelings in ela ion o he de elopmen o b eas eeding
e eal a ich and complex ange o emo ions ha signi ican ly impac
he expe ience o mo he s du ing his pe iod. The expe ience o eelings
o guil o de o ing excessi e ime o b eas eeding and, consequen ly,
neglec ing o he child en, cons i u es an emo ional dimension ha e-
lec s he challenges and ensions ha can a ise in he managemen o
ime and ma e nal ca e. This in e nal con lic be ween a ending o he
needs o newbo ns and olde child en can gene a e a hos o complex
emo ions. Likewise, he eeling o guil o he pe cep ion o lack o
success in b eas eeding mani es s i sel in a ious ways, bu i is usually
an in ense and long-las ing eeling. The s a emen o a mo he abou he
eeling o guil , which she main ains yea s a e he ailu e o b eas -
eeding he i s child, s ands ou .
The insecu i y ela ed o he ea o no doing i well, o no ha ing
enough milk, o ha b eas eeding may cause heal h p oblems o he
newbo n highligh s he emo ional bu den ha can accompany his
p ocess, which is combined wi h he emo ional si ua ion ela ed o
pos pa um ho monal changes.
“Bu I’m ying. E e y hing hu s, and I can’ sleep. I need o es . I can’
ake i anymo e. I seems like e e y hing I do is bad o he baby.”
“Be ween he s i ches, he nipples, and no sleeping, I don’ hink I’ e e e
el his bad.. I would be nice o know. I would be nice o know a lo o
hings.”
“Ti ed, b eas eeding is e y di icul a i s . Ve y bo ing o mo he s.
You can’ do any hing else.”
Iden i ying b eas eeding success as an indica o o being a good
mo he unde lines how mo he s link hei b eas eeding achie emen s
o hei sel -concep as pa en s. Howe e , i also highligh s he need o
main ain an op imis ic ou look, as an emo ional s a egy o cope wi h
he challenges and p essu es associa ed wi h b eas eeding. P ide in
e o e eals a posi i e dimension in which mo he s ecognize and
alue hei commi men o b eas eeding, e en in he mids o di i-
cul ies, especially once di icul ies and di icul imes a e o e come. The
desi e o ha e ime o hemsel es and o p o ide he bes o hei
child en e lec s pe sonal aspi a ions and he desi ed balance be ween
sel -ca e and amily ca e. Insecu i y caused by lack o expe ience,
absence o ela ionships wi h women who ha e b eas ed, and lack o
knowledge unde lines he impo ance o ex e nal ac o s in building
ma e nal con idence in ela ion o b eas eeding. Today, i is a e o
mo he s o ha e had con ac wi h o he mo he s, p io o he bi h o
hei own child. In cases whe e his has occu ed, mo he s say hey us
mo e in he lea ning acqui ed om ha expe ience han in he lea ning
ecei ed om heal h se ices. These elemen s e eal he emo ional and
psychological complexi y ha d i es he expe ience o b eas eeding,
highligh ing he need o comp ehensi e suppo o add ess hese
emo ional aspec s.
“ In ou case, b eas eeding has been e y com o able, I’d e en say e y
beau i ul. I ’s helped us bond a lo wi h he child en.”
“I would say i gi es me peace. I gi es me a eeling o so much lo e, and so
much happiness.”
“We can’ hold ou child en all day. We ha e o he hings o do. I need o
sleep and es .”
“ I’m lucky a ha ; I’m good a i . Then I eel sad when I ha e o s op,
because he ime spen b eas eeding hem is qui e pleasan . And
com o able.”
Family ela ionships
Family ela ionships play a key ole in he expe ience o b eas -
eeding, and a ious dynamics in luence mo he s’ expe iences du ing
his p ocess. The bene icial in luence o pa ne suppo is a posi i e
ac o ha can s eng hen mo he s’ con idence and emo ional com o
du ing b eas eeding. I is an in aluable aid o mo he s in adap ing o
he new ole. Howe e , when he e is a pa e nal conce n o ensu e ha
he baby does no go hung y, i is an in luence owa ds no op ing o
C. Nie o e al.
Eu opean Jou nal o Obs e ics & Gynecology and Rep oduc i e Biology 316 (2026) 114786
5
exclusi e b eas eeding. When he e is a lack o amily suppo o
b eas eeding, i c ea es a signi ican emo ional challenge o he
mo he , as well as a lack o con idence in he help ha hey can p o ide.
“ My husband jus wan s he kids and me o be okay. And my mom isn’
oo keen on b eas milk.”
“ My mo he didn’ b eas eed us; she says he e’s no milk in he amily.
My sis e didn’ gi e i o he son ei he .”
“Nei he my amily no my iends seem o unde s and wha ’s happening
o me. They hink I wo y mo e han necessa y. And I don’ eel like
a guing o ying o con ince anyone.”
Lack o suppo can gene a e emo ional ensions and make i di icul
o con inue b eas eeding. In addi ion, nega i e opinions o amily and
iends ega ding he de elopmen o b eas eeding add ex e nal p es-
su es ha can a ec he emo ional well-being o mo he s. Suppo om
he ma e nal amily, al hough bene icial, is usually obse ed in amilies
whe e male in ol emen in child ea ing is less. This dynamic may
e lec adi ional a i udes owa d gende oles and hei implica ions
o child ea ing.
Mo he ’s wishes ega ding in an eeding
When mo he s ask o o mula milk, o exp ess hei desi e o choose
ano he way o eeding, hey may eel judged and labelled as bad
mo he s. On se e al occasions, hey ha e said hey lie o heal h p o-
essionals o a oid being ea ed ha way. On he o he hand, hey claim
ha he child en hey know who a e ed wi h mixed o o mula milk a e
also in good heal h, which indica es ha in o ma ion ela ed o he
heal h bene i s o babies is no adequa ely unde s ood.
“I wan o aise my baby, bu I also ha e o hink abou wha ’s bes o
me. I’m no well igh now, so I hink being able o gi e him a bo le will
help make i easie .”
“I’m looking o wa d o ge ing h ough his i s pa , because a i s i
hu s, bu hen when he picks i up and ea s, no, hen I eel happy, because
I’m being ed.”
“B eas eeding is e y impo an o me.”
Lack o p i acy
The cons an p esence o heal hca e p o essionals con inually
en e ing he oom ep esen s an in usion in o he mo he ’s pe sonal
space, a ec ing he sense o p i acy and au onomy. This con inued
si ua ion can gene a e emo ional and physical discom o , a ec ing he
quali y o he b eas eeding expe ience. Added o his is he excessi e
numbe o isi o s du ing admission, which u he agg a a es he lack
o p i acy, c ea ing an en i onmen in which mo he s may eel exposed
and disad an aged in hei a emp o es ablish an in ima e connec ion
wi h he newbo n.
“ I’m con en wi h no ha ing isi o s. I ’s been c azy, hese isi s.. You’ e
a mess, pu ing up wi h people. In you nigh gown, bleeding, you b eas s
swollen and so e, you eel e ible, you daugh e won’ s op c ying,…
wha a ho ible si ua ion.”
Du a ion o b eas eeding
Ma e nal conside a ions ega ding b eas eeding du a ion e lec he
complexi ies and ime conside a ions ha mo he s ace in b eas eeding
p og ess. Doub s abou b eas eeding du a ion poin o he unce ain y
ha some mo he s expe ience abou how long o con inue b eas eeding.
This aspec may be in luenced by a ious ac o s, such as in o ma ion
ecei ed, pe sonal expe ience and cul u al expec a ions, bu also by a
lack o con idence in hei own abili y o con inue b eas eeding o as
long as hey wish. This las eason causes hem o be unable o se a goal
by hei own decision, as hey conside i o depend on ex e nal ac o s.
The desi e o con inue b eas eeding o as long as possible highligh s
a posi i e and commi ed aspi a ion on he pa o mo he s. This desi e
may be linked o he long- e m heal h bene i s o he baby, as well as
he emo ional connec ion ha b eas eeding p o ides. The in en ion o
con inue b eas eeding un il e u ning o wo k indica es planning and
ime managemen in he b eas eeding p ocess. The di icul ies in ol ed
in combining wo k and b eas eeding mus be conside ed, due in pa o
he impossibili y o exp essing milk in many jobs. Reconciling mo he -
hood and ca ee is a challenge o many mo he s.
“ I don’ wan o ha e he baby hanging on my b eas all day. She’s e y
small now and ha ’s ine, bu in a couple o mon hs.”
“ I ied o b eas eed he o he child en as much as possible. I had o gi e
up on wo k; I couldn’ con inue. My mom doesn’ like i , bu wha can I
do? I’d like o he hings..”
“ When I ha e o s a wo king, I can’ keep going; i ’s impossible. Wo k
and child en a e enough.”
Fu u e expec a ions ega ding b eas eeding
Mo he s’ expec a ions o he u u e ega ding b eas eeding e eal
he p ojec ions and conce ns hey ha e abou his p ocess as hey mo e
h ough hei expe ience. The desi e o e u n home wi h hei pa ne
and eo ganize hei li e sugges s he impo ance o he ansi ion om
he hospi al en i onmen o a mo e amilia and com o able en i on-
men . Howe e , his pe spec i e ca ies wi h i he inhe en conce n
abou amily o ganiza ion a e e u ning home. Mo he s an icipa e
logis ical challenges and adjus men s in amily dynamics ha may a ise
in his ansi ion pe iod, highligh ing he need o suppo and adap a-
ion du ing his c i ical phase. These challenges a e especially wo ying
o women who al eady ha e o he child en, and o hose wi hou a
suppo ne wo k. I is also no able o mo he s wi h posi i e p e ious
expe iences wi h b eas eeding, who desc ibe physical and logis ical
complica ions as empo a y, s a ing ha hey usually las only a ew
weeks. This pe spec i e acknowledges he possibili y o acing ini ial
challenges, bu a he same ime sugges s he belie ha wi h ime,
b eas eeding will become smoo he and less complica ed. Ve y
di e en conce ns and expec a ions a e obse ed be ween mo he s wi h
p e ious b eas eeding expe ience and hose acing he p ocess o he
i s ime.
“ So, I hope e e y hing wo ks ou . I ’s some hing I wan . Th oughou my
p egnancy, I’ e been e y clea ha I wan ed o b eas eed. I didn’ expec
i o be so ha d, bu I ha e o keep ying..”
“Tha ’s why I eel p e y con iden ha his b eas eeding is going o go
well. Yes e day she los a li le mo e weigh han usual, bu I’m su e i ’ll
jus be a one- ime hing.”
Adap a ion o he ole o mo he and b eas eeding
The signi ican ca ego y o adap a ion o he mo he ole includes
adap a ion o he b eas eeding p ocess. This pe iod is augh wi h g ea
emo ional and physical complexi ies ha mo he s ace. The i s days
pos pa um a e pe cei ed as di icul , exhaus ing and emo ionally un-
s able, due o he in ense eelings caused by ho monal changes. This
in ense emo ional expe ience can con ibu e o he emo ional ulne a-
bili y o mo he s in his ini ial phase o mo he hood and b eas eeding.
In addi ion, he misma ch be ween expec a ions and eali y abou
b eas eeding cons i u es a common challenge. The e o e, he di e ence
be ween expec a ions and eali y cons i u es one o he main p oblems
in achie ing adap a ion o he new ole. Mo he s may ace su p ises and
us a ions when he eali y o b eas eeding does no ma ch hei
p e ious expec a ions, gene a ing eelings o unce ain y and
adap a ion.
C. Nie o e al.
Eu opean Jou nal o Obs e ics & Gynecology and Rep oduc i e Biology 316 (2026) 114786
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“ I don’ eel as sca ed as I did wi h my i s baby, bu I guess you always
ha e ea .”
“I hink he h ee o us—my pa ne , he kid, and I—will be be e o a
home. I don’ see mysel alone wi h all his. I don’ eel s ong enough.”
“I jus wan o do i igh . I’m happy wi h him. Bu he e’s a lo going on.
I’m no eeling well a all, and hen e e y hing is so complica ed. I wan o
es and no ha e o lis en o e e yone all he ime.”
Pos pa um eco e y, which encompasses bo h physical and
emo ional aspec s, highligh s he social and cul u al p essu es ha can
con ibu e o eelings o exhaus ion and s ess. Finally, he p esence o
new amily models highligh s he di e si y and e olu ion o amily
s uc u es, which can in luence he pe cep ion and execu ion o he
mo he ’s ole and b eas eeding. These new models equi e new ways o
assessing and suppo ing he pos pa um pe iod and b eas eeding.
Feelings and hough s abou body changes
Feelings and hough s abou bodily changes e eal he complex ex-
pe iences ha mo he s ha e in ela ion o he ans o ma ion o hei
bodies du ing p egnancy and b eas eeding. I is di icul o econcile he
image o mo he and he image o woman, wi h he aes he ic implica-
ions ha his has. The eeling o no ecognizing one’s own body is a
p ominen emo ional phenomenon since i implies a ejec ion o he
changes ha ha e occu ed. These physical changes can ha e a p o ound
impac on he pe cep ion o body iden i y. This eeling can be linked o
signi ican al e a ions in body appea ance and unc ion du ing he
p ocess o p egnancy and b eas eeding.
“These days you don’ e en know how o d ess, e e y hing eels w ong.
You body eels wei d, igh ? You belly won’ go down, you b eas s ge
bigge and sag, you body swells, you bleed, and he s i ches make you eel
like pa o you body isn’ you s. I ’s wei d. I ’s he ha des hing o me.”
Weigh loss is p esen ed as a majo conce n, closely ela ed o cu en
beau y s anda ds. I e lec s he complexi y o adjus ing o he new de-
mands o he mo he ing ole and b eas eeding, combined wi h main-
aining one’s o me emale sel . The exhaus ing expe ience o
b eas eeding highligh s he physical and emo ional demands ha his
p ac ice can place on mo he s, unde lining he need o suppo and sel -
ca e. He e again lies he impo ance o ha ing a suppo ne wo k.
Weigh loss can gene a e a mix o emo ions, ei he as a posi i e ou come
o as a sou ce o anxie y in ela ion o heal h and well-being.
“ No long ago, I wo e beau i ul d esses o go o pa ies. E e y hing
changes so much. My s omach, my b eas s, my legs. I don’ ecognize
mysel .”
Pos pa um eco e y add esses bo h physical and emo ional aspec s,
highligh ing he impo ance o a comp ehensi e p ocess o es o a ion
and adap a ion o changes, all o his closely ela ed o he adap a ion o
he new ma e nal ole. Conce ns abou body modi ica ions due o
p egnancy and b eas eeding e lec he conce ns mo he s may ha e
abou how hese expe iences will pe manen ly a ec hei body, and
hei u u e sel es. This ea may be ela ed o social and cul u al
p essu es a ound beau y s anda ds and sel -accep ance.
E ec s o pain
Pain and nipple inju y a e physical aspec s ha can signi ican ly
a ec he com o and con inui y o b eas eeding. These ad e se e ec s
can be caused by a ious easons: inadequa e sucking by he baby,
p oblems wi h posi ion o inco ec la ching, among o he ac o s,
gene a ing discom o and di icul ies, as well as insecu i y in he
de elopmen o b eas eeding. The p esence o nipple pain can in luence
he pe cep ion and gene al expe ience o b eas eeding o mo he s, and
is a common cause o ejec ion owa ds con inuing b eas eeding o he
baby. In addi ion, i is highligh ed ha labo pain can ha e addi ional
implica ions, as i can make he ini ia ion o b eas eeding e en mo e
complica ed. Pain associa ed wi h childbi h can a ec he emo ional
and physical disposi ion o he mo he , impac ing he abili y o es ablish
and main ain success ul b eas eeding, as i p e en s he mo he om
acqui ing adequa e pos u es a he ime o b eas eeding. This aspec
unde lines he in e connec ion be ween pe ina al e en s and b eas -
eeding, highligh ing he impo ance o a comp ehensi e app oach ha
add esses bo h physical pain and he associa ed emo ional ami ica ions.
“ Wi h all he pain, i ’s o u e. I hu s so much. I pu on he c eam hey
old me o, and i doesn’ do any hing. Now he’s la ching on wo se, i ’s
ge ing ha de and ha de o him. I’m eally looking o wa d o b eas -
eeding him. I didn’ hink he’d ha e such a bad ime. I’m ha ing a e ible
ime. I’m going o keep going, bu I’m ha ing a e ible ime.”
“When he la ches on o he b eas ha hu s he mos , you hold on,
whe he i hu s a lo o a li le, and you hold on. The u h is, e en hough
he c acks seem small, hey hu like skin is coming o . When you know
he’s going o la ch on o he b eas ha hu s he mos and you hea him
c y, you ge a li le ne ous. I ’s be e no o hink abou i .”
“My nipples a e aw, hey hu when I showe , i hu s o ge d essed, and
when he baby ea s, i ’s ho ible. They say she ea s well, bu i kills me.
Now, my b eas s ha e ha dened, and hey hu e en mo e.”
Discussion
B eas eeding is globally ecognized as a undamen al p ac ice o
he heal h and well-being o bo h mo he s and child en, suppo ed by
in e na ional o ganiza ions such as WHO and UNICEF. Howe e , i s
implemen a ion aces mul iple challenges ela ed o biological, cul u al,
emo ional, and social ac o s. In his con ex , he immedia e pos pa um
pe iod becomes a c i ical window o es ablishing b eas eeding, whe e
he hospi al en i onmen and in e ac ions wi h heal hca e p o essionals
play a decisi e ole. This s udy p o ides an essen ial quali a i e
pe spec i e o unde s and mo he s’ expe iences du ing he i s 48 h
a e bi h, iden i ying ba ie s and oppo uni ies o enhance suppo
du ing his key pe iod.
A e analyzing he in e iews, hey con i m much o he li e a u e
on he opic consul ed. E en hough s udies a e ca ied ou in di e en
coun ies wi h di e en cul u es, much o he expe ience o b eas -
eeding is simila . Rega ding social and cul u al in luence, wo di e en
b anches mus be es ablished. On he one hand, we ind he g ea in-
luence p oduced by he cus oms and belie s o he g oup, which is
especially seen in hose women wi h deep cul u al oo s [6]. The e is a
high pe cen age o women om Sou h Ame ica among he popula ion
e alua ed (45.2 %; among hese mo he s, hose who had a g ea e
oo ing wi h hei e e ence cul u e, he in luence o belie s om hei
cul u e o o igin was g ea e . In mos o hese women, he e is an
impo an cul u al and social his o y o b eas eeding he child en o he
amily. Howe e , in hose women in whom he e is less connec ion wi h
hei cul u e o o igin, i is mo e common o ind he need o mo e
educa ional suppo due o lack o e e ences.
On he o he hand, being suppo ed by deep cul u al belie s c ea es a
ba ie in communica ion wi h heal h p o essionals, and he e o e i is
mo e complica ed o change my hs o misconcep ions. As a g ea
ad an age, he e is a g ea e p edisposi ion o choose b eas milk as a
newbo n’s die , when he e is a his o y o b eas eeding among he
e e ence people [18] and, e en mo e so, i wha he woman has
obse ed a e success ul b eas eeding in he en i onmen [35].
As ano he b anch o social and cul u al in luence, he in luence o
belie s abou he di icul y o a mo he o de elop success ul b eas -
eeding, which a e e y common in ou Wes e n cul u e, mus also be
conside ed. These ideas and my hs abou b eas eeding make i easie o
abandon o choose ano he ype o eeding [35]. Suppo is gene a ed o
abandon b eas eeding, con a y o heal h educa ion messages. Like-
wise, in mo he s wi h adi ional belie s, and in some cases ela ed o
belonging o eligious g oups, he exposu e o he emale body du ing
C. Nie o e al.
Eu opean Jou nal o Obs e ics & Gynecology and Rep oduc i e Biology 316 (2026) 114786
7
b eas eeding is conside ed some hing nega i e o indecen [19],
al hough a change in he pa adigm is obse ed, especially in Eu opean
women, whe e i is no only no conside ed a nega i e ac o , bu a igh .
Likewise, in some social ci cles, he exposu e o he emale body is
conside ed indeco ous and can lead o no main aining exclusi e
b eas eeding, o o gene a ing nega i e eelings ela ed o i . The
nega i e iew o b eas eeding in public can be ound in he mo als o
he mo he , he en i onmen o socie y [19].
The cul u al di e ences obse ed in mo he s’ expe iences align wi h
b oade li e a u e on he impac o mig a ion and accul u a ion on
b eas eeding p ac ices. Resea ch consis en ly shows ha while immi-
g an women o en ha e highe a es o b eas eeding ini ia ion oo ed
in hei cul u al adi ions, hese p ac ices a e ulne able o he p ocess
o accul u a ion [5]. As mo he s adap o he hos coun y’s no m, which
may include highe a es o o mula eeding and a medicalized app oach
o childbi h, hei b eas eeding du a ion and exclusi i y can decline.
Fu he mo e, he mig a ion p ocess i sel o en disman les he adi-
ional social suppo ne wo ks (e.g., g andpa en s, ex ended amily) ha
a e ins umen al in p o iding p ac ical and emo ional b eas eeding
suppo in hei coun ies o o igin [13]. Consequen ly, immig an
mo he s may ind hemsel es isola ed and solely dependen on a
heal hca e sys em ha is no always equipped o p o ide cul u ally
compe en lac a ion suppo . Ou indings unde sco e he need o
heal hca e p o essionals o be awa e o hese dynamics, mo ing beyond
simple ad ice o o e suppo ha acknowledges and espec s he
mo he ’s cul u al backg ound while helping he na iga e he challenges
o b eas eeding in a new sociocul u al en i onmen .
I we look close o he mo he –child dyad ci cle, we ind he in-
luences o he amily and e e ence people. These in luences a e usually
ela ed o p e ious expe iences and pe sis en my hs in hese people
om he closes en i onmen . The in luence ha hese can cause is
closely ela ed o he bond and dependence ha mo he s ha e on his
g oup o indi iduals. Wha is equen ly obse ed is he p essu e om
amily and iends ega ding he me hod o aising he newbo n, espe-
cially ega ding he eeding me hod. This p essu e is ela ed o p e ious
expe iences and exis ing my hs in hose membe s o he mo he ’s closes
ci cle. In a high pe cen age, women epo p essu e om hese membe s
o hei close ci cle, when hey do no coincide in hei expec a ions
[29]. Howe e , e en when ideas abou b eas eeding be ween new
mo he s and hei amily coincide, he amily con inues o be a e e ence
o suppo in pa en ing [15]. When such suppo is impossible due o
dis ance o he g ea gap be ween ideas abou pa en ing, i gene a es a
g ea oid and ins abili y o he mo he .
Mo he s’ expe ience o eeding hei newbo ns di ec ly a ec s hei
emo ional s a e. A wide ange o emo ions a e obse ed: om ea , guil ,
shame o joy and sa is ac ion. Mo he s who do no choose o b eas eed
o who ace di icul ies a he beginning and a e o ced o abandon hei
goal o exclusi e b eas eeding equen ly eel guil y abou no s a ing,
abandoning o ailing o es ablish and main ain b eas eeding [14,19].
Shame, on he o he hand, is mo e ela ed o in e ac ion wi h o he s
( e e ence pe sons o heal h p o essionals) when he e a e di icul ies o
when mo he s a e subjec o e alua ion by o he s.
As a common ac o o many pue pe al women in he i s days
pos pa um, he in luence o heal h p o essionals om di e en pe -
spec i es and wi h di e en esul s s ands ou . The a i ude o heal h
p o essionals in luences he emo ional p ocess ha allows women o
alida e hei mo he hood, in many cases, h ough hei in e en ion in
ma e nal pe o mance in eeding newbo ns [19]. Rega ding he pe -
o mance o heal h p o essionals, he eeling o mo he s ha hese
heal h p o essionals do no ha e adequa e aining is impo an , in
addi ion o no ha ing enough ime o p o ide e ec i e educa ional and
logis ical suppo . Bo h componen s con ibu e o no suppo ing he
de elopmen o b eas eeding in new mo he s and dec ease he eeling
o sel -e icacy expe ienced by mo he s [32]. In gene al, i is obse ed
ha mos mo he s do no eel adequa ely suppo ed by he heal h ca e
ecei ed. And hey eel judged when hei choice is no b eas eeding
[4], o he poin ha hey p e e o lie o heal h p o essionals, so as no o
eel judged. I is iden i ied ha he ca e a he beginning o b eas eeding
is ocused on a biomedical app oach [32] in which mo he s eel ha
heal h p o essionals examine, judge and do no espec he au onomy o
pa ien s. The h ee elemen s o he biomedical model in b eas eeding
ca e gene a e less sel -con idence in he mo he , less e ec i eness in he
ini ia ion o b eas eeding, long- e m e ec s on ma e nal emo ional
well-being and c ea e ba ie s in communica ion. On he o he hand,
and i has no been ound in he consul ed bibliog aphy, hey posi i ely
alue he educa ional suppo ecei ed om p ima y ca e p io o bi h.
Al hough hey also alue he p epa a ion o b eas eeding p io o bi h
as insu icien .
I mus be conside ed ha some imes he e is a g ea dis ance be-
ween he expec a ions c ea ed in ela ion o pa en ing and eali y
[3,14,15,19]. When he e a e posi i e eelings in ela ion o in an
eeding, a eeling o g ea e bonding wi h he child is gene a ed. In his
sense, pe haps due o he ea ly na u e o he s udy in he e olu ion o
b eas eeding, no di icul y has been obse ed in he bond wi h he child
when b eas eeding de elops wi h di icul y [25,33]. This would be an
in e es ing poin o e alua e a he nex le el o he s udy.
Rega ding he bodily changes ela ed o childbi h and b eas eed-
ing, conce n and dissa is ac ion a e mainly obse ed. On he con a y, i
is obse ed ha hese changes c ea e an imagina y dis ance be ween he
woman be o e p egnancy and he woman a e childbi h [26].
The challenges mo he s aced can be analyzed h ough he lens o
social suppo amewo ks, which ca ego ize suppo in o dis inc ypes:
emo ional, in o ma ional, ins umen al, and app aisal [21]. Ou ind-
ings indica e ha while mo he s ecei ed ins umen al suppo , he
p o ision o in o ma ional and emo ional suppo was o en agmen ed
and inconsis en . The con lic ing ad ice desc ibed by pa icipan s
highligh s a c i ical ailu e in p o iding cohe en in o ma ional suppo ,
which is known o inc ease anxie y and unde mine ma e nal con idence
[28]. Mo eo e , he mo he s’ na a i es unde sco e he p o ound
impac o emo ional suppo ; he way ad ice was deli e ed was o en
mo e signi ican han he ad ice i sel . A pe cei ed lack o empa hy o
pa ience om s a ac ed as a signi ican ba ie , whe eas momen s o
genuine encou agemen cons i u ed powe ul ac s o app aisal suppo ,
alida ing he mo he ’s e o s. The e o e, ou s udy sugges s ha o
e ec i e b eas eeding p omo ion in he immedia e pos pa um pe iod,
i is no enough o suppo o be me ely a ailable; i mus be holis ically
in eg a ed. P o essionals should be ained no only o p o ide echnical
help bu also o deli e consis en in o ma ion and sensi i e emo ional
suppo , he eby c ea ing a obus suppo i e en i onmen ha em-
powe s mo he s du ing his ulne able ansi ion.
Ou indings esona e deeply wi h Bandu a’s heo y o sel -e icacy,
which posi s ha an indi idual’s belie in hei capaci y o succeed is a
key de e minan o hei pe o mance [1]. In he con ex o b eas -
eeding, ma e nal sel -e icacy is a powe ul p edic o o ini ia ion and
du a ion, as ex ensi ely documen ed by esea che s like Dennis and
[10]. The expe iences o unce ain y and us a ion epo ed by
mo he s in ou s udy can be in e p e ed as a e lec ion o low ini ial sel -
e icacy, shaped by he ou main sou ces p oposed by Bandu a. The
di icul ies wi h la ching and he pain expe ienced ep esen challenging
’mas e y expe iences’ ha , ins ead o building con idence, unde mined
i in his c i ical ea ly phase. Fu he mo e, he inconsis en ad ice om
p o essionals dep i ed mo he s o posi i e e bal pe suasion, a c ucial
elemen o building con idence. Ou esul s sugges ha he 48-hou
hospi al s ay is a o ma i e pe iod whe e heal hca e p o essionals’ ac-
ions such as p o iding hands-on assis ance o o e ing consis en
encou agemen a e no me ely suppo i e ges u es, bu c i ical in-
e en ions ha di ec ly shape a mo he ’s b eas eeding sel -e icacy.
When a midwi e success ully helps a mo he and baby achie e a pain-
less la ch, she is p o iding a powe ul ica ious and mas e y expe ience
ha can signi ican ly bols e he mo he ’s belie in he own abili y o
con inue b eas eeding a e discha ge [8].
Ou indings e lec he complexi y o b eas eeding, wi h cul u al
C. Nie o e al.
Eu opean Jou nal o Obs e ics & Gynecology and Rep oduc i e Biology 316 (2026) 114786
8
and emo ional nuances epo ed in p e ious s udies, while also high-
ligh ing speci ic c i ical a eas o imp o emen in he hospi al con ex .
In line wi h esea ch conduc ed in o he coun ies, he educa ional
suppo ecei ed by mo he s was ound o be inconsis en , wi h con-
adic o y messages om heal hca e p o essionals unde mining
women’s con idence in hei abili y o b eas eed. Taylo e al. also
iden i ied ha mo he s o en pe cei e an o e ly biomedical app oach in
ca e, leading o eelings o judgmen and diminished au onomy [32].
Fu he mo e, he emo ional expe iences associa ed wi h b eas -
eeding, such as ea o ailu e, guil , and insecu i y, a e common among
he in e iewed mo he s. These emo ions a e deeply in luenced by social
and cul u al no ms, aligning wi h he indings o Leeming e al. [19],
who highligh ed he impac o sel -conscious emo ions on in an eeding
decisions. This aspec unde sco es he need o a mo e humanized
app oach o ca e, cha ac e ized by empa he ic, espec ul, and cul u ally
sensi i e in e ac ions.
A c i ical issue iden i ied was he lack o ime and aining among
heal hca e s a , a ba ie also desc ibed in o he s udies [30].
Add essing his issue could in ol e implemen ing con inuous aining
p og ams o p o essionals, ocusing no only on echnical skills bu also
on communica ion and cul u al compe ence. Addi ionally, ensu ing an
adequa e s a - o-pa ien a io is essen ial o enable meaning ul in-
e ac ions du ing his c ucial pe iod.
Limi a ions
Despi e he e o s made o ensu e he alidi y and eliabili y o his
quali a i e s udy on mo he s’ expe ience o b eas eeding du ing hos-
pi al admission a e bi h, i is impo an o ecognize he limi a ions
ha may ha e in luenced he esul s and he in e p e a ion o he
indings. These limi a ions include he sample size, which consis ed o
14 mo he s who olun a ily pa icipa ed in he in e iews. Al hough
di e si y was sough in he selec ion o pa icipan s, he ela i ely small
sample size p e en s gene aliza ion o he esul s o a b oade popula-
ion o b eas eeding mo he s in simila hospi al se ings. Ha ing ound
e y simila esul s in he consul ed li e a u e, ein o ces he conclusions
eached. In e iewe bias mus also be conside ed, since he in e p e-
a ion o in e iew esponses may ha e been in luenced by he in-
e iewe ’s p ejudices o expec a ions. In his sense, i is impossible o
comple ely elimina e subjec i i y in in e p e a ion. Fu he mo e, his
s udy was conduc ed in a speci ic con ex , which could limi he appli-
cabili y o he indings o o he cul u es o social con ex s, which a e
inc easingly common in ou en i onmen . Mo he s’ pe cep ions and
expe iences o b eas eeding may a y acco ding o cul u al, social and
economic ac o s, which we e no ully add essed in his s udy. Since
la ge di e ences ha e been obse ed depending on ma e nal o igin, i is
conside ed necessa y o del e deepe in o he cul u al in luence on
choices ega ding in an eeding.
Likewise, du ing he da a collec ion pe iod, pa icipan s may ha e
expe ienced ex e nal e en s o si ua ions ha in luenced hei expe i-
ences and pe cep ions abou b eas eeding. These ex e nal ac o s we e
no con olled in he s udy and could ha e a ec ed he esul s in un-
expec ed ways. Finally, he analysis is ocused on i s - ime mo he s,
which leads o assessing a new expe ience ha is jus beginning, which
may c ea e opinions ha a e no se led o based on a deep knowledge o
he p ocess. Fo his eason, i is conside ed necessa y o epea he in-
e iews a e a ew weeks, expanding he s udy o he analysis o he
ma e nal expe ience o b eas eeding a 3 mon hs a e deli e y.
Implica ions o policy and p ac ice
Taking hese limi a ions in o conside a ion, his s udy p o ides a
meaning ul and en iching insigh in o mo he s’ expe iences o b eas -
eeding du ing hospi al admission a e bi h, which may con ibu e o
he de elopmen o mo e e ec i e in e en ions and policies o suppo
b eas eeding mo he s in hospi al se ings. Howe e , cau ion is ad ised
when in e p e ing he esul s and hei applicabili y o o he con ex s.
Following he analysis ca ied ou , he need o del e deepe in o he
e olu ion o he expe iences o hese mo he s is aised, wi h in e iews a
ew mon hs a e he bi h. Howe e , he need o iden i y he in luence
o he mo he s’ cul u al o igin has also been iden i ied, since in an
inc easingly mul icul u al socie y, humanized ca e o mo he and child
equi es unde s anding hei social con ex . In gene al, we could say
ha , in a wo ld whe e mo he hood is idealized, wi h he obliga ion o
all mo he s o do e e y hing well, many mo he s do no ind he suppo
hey need o hei new li e, nei he om heal h p o essionals no in he
amily and social en i onmen .
B eas eeding, as a heal h-p omo ing p ac ice o bo h mo he and
child, is shaped by di e se ac o s ha in e ac du ing he ea ly pos -
pa um pe iod. Educa ional suppo om heal hca e p o essionals
eme ges as a c i ical elemen , ye i is o en hinde ed by ba ie s such as
limi ed ime, inconsis en in o ma ion, and insu icien cul u al sensi-
i i y. These gaps in p o essional ca e exace ba e he challenges mo he s
ace, especially when hei belie s abou in an eeding di e om hose
o hei su ounding en i onmen , leading o communica ion ba ie s
wi h e e ence pe sons.
Ex e nal in luences, such as social suppo and amily opinions,
signi ican ly impac b eas eeding decisions. Suppo i e amily dy-
namics can encou age ini ia ion and con inua ion, while con lic ing
belie s may c ea e addi ional p essu e o doub s o mo he s. Many
women epo expe iencing pain, a igue, and lack o sleep in he ini ial
days, challenges ha a e no adequa ely add essed in hospi al se ings.
The igidi y o hospi al ou ines u he limi s oppo uni ies o mo he s
o adjus o hei new oles.
Las ly, socie al expec a ions a ound he idealized concep o a “good
mo he ” add emo ional s ain. This is pa icula ly ha m ul o women
wi hou p io b eas eeding examples in hei en i onmen , as i mag-
ni ies eelings o insecu i y and inadequacy. Add essing hese issues
equi es a humanized app oach o ca e, os e ing empa hy and ailo ed
suppo o each mo he ’s unique expe ience.
CRediT au ho ship con ibu ion s a emen
C is ina Nie o: W i ing – e iew & edi ing, W i ing – o iginal d a ,
Resou ces, Me hodology, In es iga ion, Fo mal analysis, Da a cu a ion,
Concep ualiza ion. Pa icia Lopez-Mases: W i ing – e iew & edi ing,
Valida ion, Supe ision, Resou ces, Me hodology, In es iga ion,
Concep ualiza ion. Ra ael Vila-Candel: W i ing – e iew & edi ing,
Resou ces. Es he Laza o: W i ing – e iew & edi ing, Valida ion, Su-
pe ision, Resou ces.
Funding
NA.
Decla a ion o compe ing in e es
The au ho s decla e ha hey ha e no known compe ing inancial
in e es s o pe sonal ela ionships ha could ha e appea ed o in luence
he wo k epo ed in his pape .
Re e ences
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Re 1977;84:191–215. h ps://doi.o g/10.1037/0033-295X.84.2.191.
[2] Ba ick MC, Jegie BJ, G een BD, Schwa z EB, Reinhold AG, S uebe AM. Dispa i ies
in B eas eeding: Impac on Ma e nal and Child Heal h Ou comes and Cos s.
J Pedia 2017;181:49–55.e6. h ps://doi.o g/10.1016/j.jpeds.2016.10.028.
[3] Beggs B, Koshy L, Nei e man E. Women’s Pe cep ions and Expe iences o
B eas eeding: a scoping e iew o he li e a u e. BMC Public Heal h 2021;21:2169.
h ps://doi.o g/10.1186/s12889-021-12216-3.
[4] Benoi B, Goldbe g L, Campbell-Yeo M. In an eeding and ma e nal guil : The
applica ion o a eminis phenomenological amewo k o guide clinician p ac ices
C. Nie o e al.
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