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.