Feeling the pressure - coping with chaos : breastfeeding at the end of the medical production line.

This study explored the Influences upon women's experiences of breastfeeding within postnatal ward settings. A critical ethnographic approach was adopted in two maternity units in the North of England, with 61 postnatal women and 39 midwives participating. Participant observations of 97 encounters between midwives and mothers, 106 focused interviews with mothers and 37 guided conversations with midwives were conducted. Basic, organising and global themes were constructed utilising thematic networXs analysis. The metaphor of the production line, with its notions of demand and efficient supply against linear time, illustrated the experiences of breastfeeding women. They conceptualised breastfeeding as a 'productive' project yet expressed deep mistrust in the efficacy of their bodies. Their emphasis centred on breast milk as nutrition rather than relationalily and breastfeeding. Women referred to the demanding and unpredictable ways in which their baby breached their temporal and spatial boundaries. They sought strategies to cope with the uncertainty of this embodied experience. Women felt 'subjected' to ideologically pervasive notions that 'breast Is best' and authoritative versions of how 'best to breastfeed'. An atmosphere of surveillance was experienced In relation to the institutional regulation of breastfeeding and through conducting a private and culturally ambiguous activity in a public domain. Women felt dissonant when a 'natural' process was experienced as complicated and challenging. The midwives were also 'productive' yet 'subjected', their work being time pressured, unpredictable and fragmented. In 'supplying' a service under 'demanding' conditions midwives engaged in institutionally orientated rituals and routines, approaching women in disconnected and directive ways. Consequently, breastfeedlng women's individual needs for support were rarely met. Recommendations are made for: a reconsideration of the way In which women's bodies are understood and experienced; a re-conceptuallsation of women's time; reconflguratlon of knowledge about breastfeedlng; re-visioning of relationships; and relocation of the place within which women commence breastfeeding.