The qualitative study in BMC Pregnancy and Childbirthstresses the need to support women who cannot breastfeed and to educate women on the benefits of contraception for the newborn.
“Women routinely receive breastfeeding and contraceptive counseling throughout their antenatal and postpartum care, but little is published about patients’ priorities, desires, and experiences with this peripartum counseling,” writes the authors.
The study included one-to-one semi-structured interviews with 20 mothers who gave birth at Montefiore Medical Center in the Bronx, a New York borough north of Manhattan and Queens. It is the poorest electoral district in the country. Overall, 90% of women in this study used Medicaid for insurance and 15% were concerned about food safety in the past month.
Interviews were conducted between July and October 2017.
All participants received contraceptive counseling, including long-acting reversible contraception (LARC) postpartum upon admission to the labor and delivery unit by medical providers, as well as advice on breastfeeding when admitted.
80% of women also received advice on postpartum contraception during their antenatal care.
Additionally, all participants had been offered a postplacental intrauterine device (IUD) at admission, and about one-third had received a postplacental IUD.
Interestingly, however, 35% of participants were still undecided about using a contraceptive method after childbirth at the time of the interview.
The interview guide explored the timing and content of contraceptive counseling; breastfeeding goals and expectations; reasons for contraceptive choices; and recommendations for the board.
Three themes emerged from the interviews: new mothers described using contraception as a selfish decision, with no benefit for the newborn; women felt obligated to breastfeed and viewed the inability to breastfeed as a personal failure; and medical providers were considered more trustworthy for breastfeeding information than birth control decisions based on anecdotes from friends or family members.
Many participants did not see contraception as a resource for spacing births, but rather as a way to have sex while avoiding pregnancy. Most women also did not believe that birth control was beneficial for their child. When asked whether they would theoretically prioritize contraception or breastfeeding, almost all women felt that breastfeeding was more important because it directly benefited their children.
The majority of mothers also described feeling immense pressure from their care providers to breastfeed their newborns or formula on demand. When mothers were unable or unwilling to breastfeed, they experienced feelings of guilt and failure.
During formal counseling from health care providers, women reported being told that breastfeeding was the healthiest option for their baby and often cited the reason for choosing to breastfeed.
Many women reported disregarding their family’s recommendations regarding the use of infant formula and instead adopted breastfeeding after learning of its benefits.
“Perhaps the most surprising finding of the study was that participants did not connect breastfeeding and contraceptive advice at all, especially given their particular reactions to the advice,” wrote the authors.
The study findings reinforce the need for the health system to reframe the conversation about birth spacing, with a focus on the health benefits for the newborn and the mother, the authors say.
- MP for Shapiro, Avila K, Levi EE. Breastfeeding counseling and contraception: a qualitative study. BMC Pregnancy Childbirth. Published online February 25, 2022. doi.org/10.1186/s12884-022-04451-2