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. 2021 Jul;17(3):e13141.
doi: 10.1111/mcn.13141. Epub 2021 Jan 24.

Guilt, shame, and postpartum infant feeding outcomes: A systematic review

Leanne Jackson  1 , Leonardo De Pascalis  1 , Jo Harrold  1 , Victoria Fallon  1
Affiliations

Guilt, shame, and postpartum infant feeding outcomes: A systematic review

Leanne Jackson et al. Matern Child Nutr. 2021 Jul.

Abstract

Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: 'underprepared and ineffectively supported', 'morality and perceived judgement' (breastfeeding), 'frustration with infant feeding care' and 'failures, fears and forbidden practice' (formula feeding). Both guilt and shame were associated with self-perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.

Keywords: breastfeeding; infant feeding; infant formula; maternal mental health; postpartum; systematic review.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA 2009 flow diagram identifying three stage systematic screening process for article inclusion
FIGURE 2
FIGURE 2
Diagrammatic overview of framework synthesis structure
See this image and copyright information in PMC

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