Striving to be part of the family and important that the family’s everyday life was well-functioning

The main category, ‘Striving to be part of the family and important that the family’s everyday life was well-functioning’, shows that partners in both groups felt it was important to be part of the family and that the family’s everyday life was well-functioning (Fig. 3).

The main category is described through six combined sub-categories, where each sub-category describes a process with opposite poles of partners’ experiences regarding breastfeeding (Fig. 3). IG partners experienced that both parents were involved and cooperated in the breastfeeding process. Guidance from HCPs helped them to feel secure, and sharing the feedings with breastmilk made everyday life easier for the family. CG partners felt excluded and did not feel they received support from HCPs. Sharing the feedings with formula made everyday life easier for the family. Both groups experienced benefits of breastfeeding during the breastfeeding process. Their experience was influenced by the cultural norm.

We are a family, and everyone is involved – feeling excludedWe are a family, and everyone is involved

The IG partners felt both parents were important and that they cooperated in the family. They were pleased when the pregnant women shared the breastfeeding information she received from the midwife. During pregnancy, IG parents talked a lot about breastfeeding and the woman’s previous breastfeeding experiences. IG parents filled in the breastfeeding plan during pregnancy, watched the movies and read the leaflets about breastfeeding: ‘We looked through the brochures; we read them, and we watched the films together and we talked about it’. (Interview IG, Informant 14). After birth, IG partners were often present when the infant was breastfed and viewed it as an enjoyable experience. They stated that both parents were important and that the infant could be satisfied by both parents. IG partners created their own relationship with the infant and had, for example, skin-to-skin contact with the infant between feeds. They bathed the infant or walked with the infant in the stroller without the participation of the mother: ‘I have taken him out in the pram myself and sit with him a lot. It has been great fun. I have been able to be very involved. There is no difference between us’. (Interview IG, Informant 12).

They also described being pleased with their communication and sharing household chores after birth:

‘We have been able to...communicate in a good way...you talk so that you are on the same page all the time. But also that you share the practical because it has to work as well. So we have to pump. But that’s not a disadvantage; it’s just that you have to be a little organised’. (Interview IG, Informant 7).

IG partners valued when the women expressed breastmilk, so that they could feed the infant. They wanted the mother to breastfeed as much as possible but stated that it was up to her to decide whether to breastfeed. Partners in both groups stated that decisions about continued exclusive breastfeeding or introducing bottle feeding with formula were made by both parents.

Feel excluded

CG partners stated they made their own decisions to feed the infant with formula if the mother was not available and the infant cried:

‘She does not like it because she would much rather continue breastfeeding...if she wants to go out for a bike ride in the evening…If he screams. And if he’s hungry and [name] isn’t here, he gets to eat from the bottle’. (Interview CG, Informant 11).

First-time CG partners stated they felt left out during pregnancy, since their lack of knowledge was a barrier to talking about breastfeeding with the pregnant mother. They had confidence in the woman’s knowledge: ‘I’m leaning on my partner; what food will we need to buy in the beginning, or is it just breastfeeding’. (Interview CG, Informant 16).

During pregnancy, family and friends of partners in both groups warned them they might feel excluded after birth, stating it was only the mother who mattered to the infants for a long time. Partners in both groups said that a disadvantage with breastfeeding was that the mother could form a unique bond with the infant, making them feel left out. After birth, both groups articulated feelings of being frustrated, incapable, worthless and jealous: ‘It’s frustrating. I’m standing there with a screaming bundle; it doesn’t matter what I do…it’s the mother’s breast that matters’. (Interview CG, Informant 2).

Some partners wished they could breastfeed. Partners with older children, in both groups, stated they knew this was a transient period.

It is safe to receive guidance from healthcare – we did not receive supportIt is safe to receive guidance from healthcare

IG partners stated that both parents had received fact-based information about breastfeeding during pregnancy. They had gained knowledge through movies and leaflets: ‘I didn’t know why you breastfeed. I learned about the benefits of breastfeeding. That there is so much positive that comes with breastfeeding for the child and for the mother’. (Interview IG, Informant 9).

After birth, IG partners uttered that HCPs respected the breastfeeding plan. They were pleased because HCPs involved both parents in the dialogue on breastfeeding. The HCP asked how the parents experienced breastfeeding, how it worked and about support needs. CHCNs were perceived as non-judgmental and as guides for families to find ways to breastfeed. The CHCN asked about breastfeeding at every visit:

‘We are involved in the discussion there, both me and [name]. We talk very openly there. All three of us. As [name] breastfeeds, so...there has been a standing discussion at every visit, how it works. Every single visit’. (Interview IG Informant 12).

The CHCN assured IG parents that the infant was satisfied and growing because of their care and helped parents to solve breastfeeding problems. IG partners trusted the advice from the CHCN, which implied that they did not read much about breastfeeding. IG partners perceived it as safe to receive guidance from the CHCNs: ‘I think it feels safe to have that guidance, and she has been positive about breastfeeding, our nurse; it has felt good’. (Interview IG, Informant 14).

We did not receive support

CG partners explained that they received no, or very little, information about breastfeeding. They were pleased when the CHCN confirmed that formula was a good alternative to breastfeeding during the first months after birth: ‘I am very happy with our nurse, and we have largely the same opinion; we changed the evening meal at around 8 pm to supplementing with formula’. (Diary CG, Informant 6).

Partners in both groups stated that some HCPs had more positive attitudes towards formula feeding than towards breastfeeding.

First time CG partners were also disappointed because they had not been allowed to visit “the expert” (midwife) during pregnancy. This made them feel left out and made it more difficult for them to find their role. Such feelings caused irritation between parents:

‘It’s sad that, as a father, especially now that it’s Covid, I can’t go to the routine check-ups; I’m not the one who breastfeeds. The mother gets everything. While the father gets a bit like this “uh, you have to grasp at a corner there”...we have managed to get annoyed with each other’. (Interview CG, Informant 15).

Breastfeeding made everyday life easier for the family –formula made everyday life easier for the familyBreastfeeding made everyday life easier for the family

IG partners said it was convenient when both parents could share feedings, since it simplified everyday life. They preferred bottle feeding with breastmilk in the first place, but it could be topped up with formula when the breast milk was not enough:

‘Practically - If there’s a moment when it’s just me at home. We think it’s important that he gets as much breast milk as possible and it’s good that...she has time to pump and that there is...in a bottle’. (Interview IG, Informant 7).

Partners in both groups stated that breastfeeding made everyday life easier. For example, breastfeeding was practical and convenient because food was always available, heated and ready. Partners with earlier experiences of formula feeding perceived that breastfeeding helped parents to sleep better and that co-sleeping with the breastfed infant contributed to improved sleep:

‘I have two children with another partner. There, it was not possible to breastfeed; it was supplementing with formula. I am used to getting up at night and doing it. So, I think it worked great. He wakes up and is nursed and goes back to sleep’. (Interview IG, informant 9).

Formula made everyday life easier for the family

After birth, CG partners with older infants stated they became exhausted because they took responsibility for older siblings, housework, job, finances and housing. They also said they had no one to talk to about their experiences. They said that it was convenient when both parents could share feedings but by bottle feeding with formula, since it simplified everyday life: ‘Supplementing with formula is, of course, a welcome option, to be able to share the feedings’. (Diary CG, Informant 6).

Both groups stated it was a disadvantage that the mother did not have time for anything else except for breastfeeding and that she was unable to do anything without the infant. They saw it as important to relieve the mother during the breastfeeding period and wished they could help her more. During pregnancy, partners worried about whether they would be strong enough to both work and take responsibility for everything, apart from feeding the infant. For example, they were unsure if they would have enough time to eat or sleep.

Breastfeeding has benefits – infants who are not breastfed feel wellBreastfeeding has benefits

IG partners talked about specific benefits and about breastfeeding being less stressful for the mother and infant and that breastfeeding promotes the infant’s attachment:

‘As much antibodies as possible. Before, I probably thought that it was just a matter of supplementing with formula. But it doesn’t feel like that anymore, considering that we have come to understand that breast milk contains a lot more than just energy’. (Interview IG, Informant 9).

Both groups said that breastfeeding provides emotional closeness between the woman and infant and stated that breastfeeding can comfort the infant.

Infants who are not breastfed feel well

Other partners in both groups described that breastfeeding and formula were equally good: ‘There are children who have been separated from their mothers at birth and have grown up eating and drinking and are doing just fine’. (Interview CG, Informant 16).

Breastfeeding works, the infant grows – not all infants find it easy to breastfeedBreastfeeding works, the infant grows

IG partners described being happy when breastfeeding was working 2 months after birth and that the infant received enough breastmilk and grew: ‘I’m happy that my wife wants to breastfeed and that it works’. (Diary IG, Informant 5). One CG partner stated he was happy that his wife did not give up when problems arose, because now breastfeeding finally worked. Other CG partners stated they did not have a breastfeeding plan, but the infant continued to breastfeed because it worked so well.

Not all infants find it easy to breastfeed

During pregnancy, partners in both groups had heard from family and friends that breastfeeding can work, but it could also be very problematic. They had been advised to buy formula before birth. Both groups also experienced problems during the first period after birth, such as painful breastfeeding, the infant not gaining weight or the mother feeling that the infant did not want to breastfeed.

The cultural norm is that women should breastfeed – it is uncomfortable to see someone breastfeedingThe cultural norm is that women should breastfeed

Partners from both groups believed that breastfeeding is the natural way to feed the infant. They disliked the breastfeeding norm and felt that it put pressure on women who did not want to or could not breastfeed. For example, partners stated women did not want to breastfeed because breasts are sexual objects for their partner. Both groups felt that women could experience shame if they were unable to breastfeed and that women put pressure on each other on social media. Partners also mentioned that information early in pregnancy had influenced their understanding about breastfeeding:

‘The perception we had that we should breastfeed fifty/fifty comes from that book where they say “yes, but it’s clear that only breastfeeding is the best”, but because we have clean water in Sweden, you can feel safe with buying and using the others’. (Interview IG, Informant 7).

It is uncomfortable to see someone breastfeeding

During pregnancy, partners in both groups stated breastfeeding was normal; however, they were unsure if it was acceptable to breastfeed in public:

‘It is completely normal to breastfeed. It doesn’t matter where...she is. Because there is nothing strange about it. You know, people say like this, “it’s dirty, it’s going to be naked.” It’s this and that’. (Interview CG, Informant 15).