Interviewee

Dr Jane Grassley, Assistant Professor, College of Nursing, Texas Woman's University, Texas, USA

Article

Grassley, J., Eschiti, V. (2008) Grandmother Breastfeeding Support: What Do Mothers Need and Want?, Birth, 35(4):329-35

Summary

To talk about her study on grandmothers' breastfeeding support for mothers, Dr Jane Grassley talked to Hamish Holewa for IPP-SHR Podcasts. It was found that a grandmother's own infant feeding practices influenced mothers' decisions to initiate and continue breastfeeding. Open encouragement and support from grandmothers assisted a mother's decision to breastfeed and helped protect the mother from ongoing justification of breastfeeding. This was particularly important in cultures that have sanctions against public breastfeeding and unfriendly breastfeeding workplaces. It was also noted that some grandmothers felt that breastfeeding was a barrier to bonding with the grandbaby, including, being able to feed the baby, allowing the baby to stay overnight and concern for the mothers well being. It was also shown that there were numerous myths that persisted in relation to breastfeeding; including: concern that a mother is not making enough milk, that exclusive breastfeeding did not deliver all dietary requirements and that breastfeeding "just did not work anymore". Practical implications suggests including grandmothers in breastfeeding conversations with health professionals, encouraging grandmother's to tell stories about their experiences, and providing additional information to grandmothers.

Transcript

Hamish Holewa: Hi and welcome to IPP-SHR podcasts, I’m Hamish Holewa and today we’re talking with Doctor Jane Grassley, Assistant Professor in the Texas Woman’s University, College of Nursing, Texas, USA. We’re speaking today about her study and article titled: Grandmother breastfeeding support: what do mothers need and want? Published in Birth, and co-authored with others listed on our website. To begin with do you want to tell our listeners what is known about the role of grandparents in breastfeeding support, and what created your interest in this important topic?

Jane Grassley: My interest was created, both, by my clinical practice, as a lactation consultant, and doing my dissertation research. In practice I would encounter grandmothers, who, if the baby was having difficulty latching and beginning breastfeeding, would say, she doesn’t like it. Rather than understanding that sometimes babies didn’t quite know what to do with their tongues when they were trying to latch on. And then for my dissertation research I was studying mother’s experiences of breastfeeding confidence, and, I asked women to tell me their breastfeeding stories, as part of my research, and grandmothers were main characters in women’s stories, and main sources of support for breastfeeding. And there were basically three kinds of grandmothers in this study: there were those who were very supportive of breastfeeding, and these tended to be grandmothers who had breastfed their children; there was the second group of grandmothers who had not breastfed, and had not been breastfed by their mothers, and, their mother’s communicated to them that breastfeeding was not something their family did. And these mums talked about being sent away to breastfeed when they were visiting their families. And, their mother’s seemed to be embarrassed by breastfeeding. And then there was the third group who, women described as, my mother couldn’t help me. These were also grandmothers who had not breastfed, but they didn’t openly oppose breastfeeding and helped and supported in other ways. So, what we know about the role of grandmothers is that their infant feeding practices influenced the mothers’ decisions to initiate and continue breastfeeding. And we also know that being breastfed herself is very predictive of whether or not women will initiate and continue breastfeeding.

Hamish Holewa: And your findings there do highlight the importance of grandmothers valuing breastfeeding and providing loving encouragement; do you want to talk about that a little bit further?

Jane Grassley: Sure; what’s really interesting is that the culture in the United States, as a whole, does not value breastfeeding; we don’t make it easy for women to breastfeed and resume employment. And in public places there are a lot of sanctions, in the United States, about breastfeeding; and what was interesting in the focus group of women, who I talked to, they seemed to spend enormous amounts of energy guarding and protecting their decision to breastfeed their babies, particularly, if the grandmothers - whether it was the maternal or paternal grandmothers - had not breastfed. And what they wanted and needed to hear from grandmothers was good job; I’m so proud of you for giving my grandbaby the best; I really value what you’re doing; I know it’s hard at first, but hang in there. And several mothers talked about how their own mothers, who had not breastfed, would say things like, you were not breastfed and you turned out fine. Are you sure you have enough milk? Or, you need to go to the other room to do that.

Hamish Holewa: Absolutely. And in addition to valuing that breastfeeding practices there, your study also points to mothers’ perceptions of the need for grandmothers to actually acknowledge the barriers with regards to breastfeeding; do you want to elaborate on that?

Jane Grassley: Actually, barriers on two different levels: I defined a barrier as an obstacle that prevents access. And some grandmothers thought breastfeeding is a barrier, for example, to bonding with their grandbabies. One grandmother said: “Ask the mum when she was going to wean the baby,” so that she could feed the baby. The other barrier for grandmothers was that they wanted the baby to come over and spend the night, to take care of the baby themselves, and breastfeeding, they felt breastfeeding is a barrier to being able to do the grandmother things that they really thought they wanted to do. They also felt breastfeeding is a barrier to mothers getting enough sleep, and it was pretty common for grandmothers to tell mothers in the study that they would give the baby a bottle so they could sleep through the night. And then another barrier in the United States is the idea of the sexualised breast. Several women were told by their family members that breastfeeding is nasty, or gross. And then there were a lot of sanctions about breastfeeding in front of family members, even in their own homes. The mothers expressed, in the group that they wished that the grandmothers would be their advocates among family members, ‘cause they really thought that grandmothers could set the tone for breastfeeding in the family. And then the last one is one that didn’t necessarily come out of the study, but I think there’s also an idea that breastfeeding interferes with the autonomy of the mother and the baby. There’s this idea that breastfeeding ties the mother down and she can’t usually leave her baby and go do other things. And then on the other side there’s the idea that breastfeeding makes the baby too dependent on the mother.

Hamish Holewa: Very interesting. Would you like to discuss your findings that explore the myths associated with breastfeeding and current breastfeeding practice and knowledge?

Jane Grassley: Yes; what I have is kind of a list of some of the myths that mums talked about and that I’ve also heard and other situations. A very prevalent one is that breast milk is not sufficient for all the babies needs; and grandmothers would say, I’m really worried about how often the baby wakes up, especially at night. Because for many of these grandmothers, who had not breastfed, they were using their filter of formula, and infants who are given formula sleep longer, they eat less often because the formula is not as easily digested. There’s also a myth that most women can’t make enough milk, that breastfeeding just doesn’t work anymore. There is another myth, that’s pretty prevalent in the United States that, if you breastfeed, your breasts will sag. That’s to do more with aging and pregnancy, than it does with breastfeeding. There’s another myth that babies should be on a schedule from the very beginning. Another one is that babies should sleep through the night as early as possible. Certain foods make your babies fussy. Another one is that, babies should not be feeding every two to three hours, they must not be getting enough milk; your milk looks awfully thin, you must not have enough cream or richness in your milk. These are all myths.

Hamish Holewa: Right.

Jane Grassley: You need to stretch your baby between feedings by giving water. A very popular myth was put cereal in the bottle and the baby will sleep through the night. Mothers encountered a lot of myths related to how long is it long enough to breastfeed. And so a lot were encouraged to begin weaning at six months, even though the American Academy of Pediatrics recommends breastfeeding at least a year, and the World Health Organisation says at least two years. So in relationship to these myths mothers felt that grandmothers needed some current information. They wanted grandmothers to be aware of the American Academy of Pediatrics guildelines for breastfeeding, particularly about exclusive breastfeeding for the first six months. They thought that grandmothers needed to know the benefits of breastfeeding, although, those are fairly well known in the United States. But this can be a really sensitive subject because grandmothers can get defensive about their own feeding decisions. Another area for the information was they thought that grandmothers should know about how breast milk is made, and that it is dependent upon the baby’s needs, so demand feeding is very important, with breastfeeding.

Hamish Holewa: Ok and do you want to talk about the practical implications of your study, including your recommendations for facilitating grandmothers’ support for breastfeeding?

Jane Grassley: I think, first of all, that health care professionals need to involve grandmothers in conversations about breastfeeding. I really think that grandmothers want to be helpful to new mothers and sometimes they don’t know how. And so, I think health care professionals can help them to know how to be helpful in ways that facilitate breastfeeding, rather than undermine it. And I also think that we need to acknowledge and help grandmothers understand that they made the best choice available to them at the time they were having their babies. Because I think sometimes that grandmothers can get defensive about breastfeeding, particularly if they didn’t breastfeed themselves, or if they had a difficult experience themselves, trying to breastfeed. The other thing along that line is I think grandmothers need a place where they can tell their feeding stories. We need to understand that grandmothers bring their own socio-cultural context to being a grandmother. So I think it’s really helpful to value their stories and to understand where they come from. One of the mothers in the study said that she had wished that she had talked, about during pregnancy with her husband’s mother, about what her expectations were, or even have a conversation during pregnancy about breastfeeding. The other thing that I’m doing right now is I’m conducting a study or an intervention for grandmothers called, the grandmothers tea: where grandmothers come for tea and we do interactive activities, address some of the themes that I found in my study: such as, giving them current information, and helping them confront myths and we talk about barriers to breastfeeding; talk about attitudes about breastfeeding in public, or even breastfeeding older children. And my next step though is to possibly try to do something with the information by putting it online for grandmothers, like with a chat room or something like that, and work with an interactive format. And then the last practical idea I’d like to give is to emphasise the importance of giving grandmothers information in culturally appropriate ways. And so in the literature you’ll find some ideas about using traditional songs or stories to teach about breastfeeding, or even using talking circles with grandmothers within a Canadian First Nations Community to talk about ways to support breastfeeding. And actually what was great about this particular project was that breastfeeding rates among younger women really began to rise within that community. It was all because they helped the grandmothers know how to be helpful.

Hamish Holewa: Excellent, and I hope that we’ll hear about that in the future on IPP-SHR Podcasts. Thank you very much for talking with us and sharing those interesting findings.

Jane Grassley: Alrighty.