Four superordinate themes were identified in this study namely: Being in the Whirlwind, Being with Others, Reimagining Motherhood and Embodiment. This article focuses on Being with Others. The title of this superordinate theme comes from Heidegger’s concept that individuals experience themselves in a world with and through other people, and that their self-understanding is interwoven with the self-understandings of others [43]. As participants experienced the phenomenon of primary low milk supply, they had to engage with HCPs, IBCLCs, voluntary supporters and partners. The interactions that participants had with these various others shaped how they viewed and experienced themselves, and how they derived meaning from being a mother with primary low milk supply. There were four subthemes of Being with Others and these were Disconnected Encounters, Perceiving Judgement from Others, Being in a Safe Space and Having a Savior.

Disconnected encounters

This subtheme considers how participants experienced a lack of meaningful connection in encounters with people providing professional and voluntary breastfeeding support, and how these encounters resulted in them feeling that they were not being heard.

While in hospital, most participants felt that the focus of midwives was their baby’s latch and that concerns they expressed about milk supply were dismissed. As a result, participants felt vulnerable and unseen, and had the impression that staff were not attuned to how important breastfeeding was to them:

I didn’t really have any support in the hospital…the midwives would just take a quick glance and say “the latch is fine”…[Caroline].

I tried to express colostrum….I didn’t know what I was doing, the midwife tried to show me but she was really busy….I brought what I had to the nurses, they were just…“that’s nothing, that’s no good to him”… [Sinead].

Recalling these encounters evoked sadness and anger for participants. Megan became quite distressed when she recalled an interaction she had with a paediatrician after it was discovered that her baby was not gaining weight:

…he said, I’ll never forget it “oh she must have been starving” and that just [voice breaks, crying], that hurt me so much…I interpreted that as him saying I was trying to starve my baby [sobbing, deeply upset].

Some participants were also unhappy about how Healthcare Professionals (HCPs) and International Board Certified Lactation Consultants (IBCLCs) communicated information about primary low milk supply and IGT to them. Being told these conditions are rare or uncommon made them feel alone and marginalised:

I asked her if it was common and she said “maybe I have one every couple of years”…It just made me feel more alone…it would be helpful if they had more compassion and knew a bit more about it. [Sinead]

Another aspect of breastfeeding support in hospital that some participants mentioned was unwelcome hands-on support from midwives. At a time when participants were vulnerable and anxious, this insensitive care increased their anxiety:

…she is one of those people who tries to get her hands in, it was such an invasion of my personal space, I felt violated by her, she was so uncaring. [angry tone of voice]. [Megan]

Participants described very unsatisfactory interactions with PHNs. Kate regarded her PHN’s attitude as not only unreasonable and unhelpful, but a threat to her sense of agency:

The PHN got so annoyed with me for going to an IBCLC…she was being a huge pain, and I was like…“look I am just doing what I can to get the support I need”…it’s my choice who I go to… [annoyed and exasperated]. I was so frustrated, it was such a head-wreck…all added stress. [Kate]

Ruth also had a deeply upsetting experience with her PHN which left her feeling objectified and humiliated. She described a meeting with the PHN her in her local health centre and became very upset as she recounted what was said to her:

I was just a new mom…not used to feeding in front of strangers… she looked at me and said “you have a very large gap between your breasts”, direct like that and kind of cold which automatically just made me feel like a freak….I said I was feeding her all the time,…and she said “well that is because she is starving”… [Ruth].

There was clearly a lack of empathetic connection between Ruth and the PHN, and an apparent lack of awareness on the part of the PHN of Ruth’s vulnerability. Furthermore, Ruth interpreted the comment that her baby was “starving” as an implication she was negligent as a mother.

One of the difficulties participants perceived in breastfeeding support groups was the attitude that there is no such thing as low milk supply. Amy describes her reaction to comments in a Facebook group and Orla recounts her experience of attending a La Leche League group:

…someone commented about low supply and most of the comments were “there’s no such thing, you just latch your baby and your supply will build up and don’t believe anyone saying you have low supply.” It made me angry. [Amy]

I was talking to La Leche League and the ladies were just telling me “just put him on the boob, don’t worry, the milk will come in, don’t give him formula at all…” [Orla].

Like other participants, Amy and Orla appeared to be very attuned to others’ opinions about low milk supply and angry that their concerns were dismissed. They internalised the message to keep breastfeeding as dismissive and undermining.

Perceiving judgement from others

In social settings, many participants feared judgement from others. They felt different, they were embarrassed about giving infant formula and they felt a need to explain to people why they were not exclusively breastfeeding. This could be interpreted as internalised stigma - an awareness of others’ perception of an ‘undesirable difference’ in them that makes them feel that they are falling short of what they ought to be. Many participants described feeling self-conscious and even ashamed about giving their babies infant formula in social settings and expressed that they felt a need to explain to people why they were not exclusively breastfeeding. They gave the impression that formula-feeding in public undermined their sense of who they were as a mother:

I feel a little bit ashamed with people seeing me formula feed her…And sometimes I over-share, I might say “oh she is combination fed”, I feel like have to say it…. [Ruth]

I always want to tell people about the IGT…then it’s “that’s why I’m not breastfeeding”…it’s just, I’m still a breastfeeding mum even though I’m not breastfeeding, or whatever that is. [Caroline]

Caroline strongly identifies breastfeeding as inseparable from her identity as a mother and craves acknowledgement that she had a difficult time breastfeeding:

I need the opportunity to talk about it or you kind of want it acknowledged… [Caroline is crying].

Megan used an at-breast supplementer and explained how she felt using this in front of other mothers. She portrays herself as vulnerable and self-conscious, unable to understand why her body cannot make enough milk for her baby yet feeling obliged to explain to others why she was feeding this way:

…they weren’t rude about it but they were like “what is that?” [tone and facial expression of disgust]…“and you’re breastfeeding her, and there’s formula and a tube?”, they were trying to be nice about it but it wasn’t something they had ever been exposed to. Having to explain it when I didn’t even know why I had to do it….

Rather than give their babies infant formula in front of other people, some participants chose not to as they did not want people to know they had low milk supply. Donna described attending a breastfeeding support group and leaving when she knew her baby needed extra milk, rather than giving him formula in front of the other mothers:

I couldn’t fully participate in some of the things because I was supplementing…it was totally my perception. It was shame…this is the dirty laundry piece…not wanting people to know or to see that I couldn’t fully feed him. There was always a coffee after the breastfeeding group, and I remember looking at my baby thinking he’s hungry and…I just wasn’t willing to feed him the bottle in front of other people, having emptied both breasts. It sounds totally idiotic…all I should have said was “I have low supply” but in a group of people who had all successfully achieved supply for their children I couldn’t do that.

Donna felt that she was falling short of a level of achievement which she believed all the other mothers at the group had attained. She feared judgement for not exclusively breastfeeding and compared having primary low milk supply to having ‘dirty laundry’ – something to be hidden or ashamed of. The consequence of this internalised feeling of stigma for Donna was isolation from the other mothers.

Some participants recalled experiences of being in a large breastfeeding support group on Facebook. The perceived negative attitudes towards the use of infant formula and scepticism about low milk supply made them feel stigmatised and angry. Both Amy and Sinead subsequently left this group:

I think there’s a lot of hatred for combination feeding in that group because it is seen like “oh you just want a break from breastfeeding” or “you just don’t want to do night feeds” or “you’re just not committed to it.”…it made me angry…. [Amy]

…I feel that there is a sense of being really sceptical of people who say they have low supply and they don’t know what it is to triple feed…and always be obsessing about your supply. [Sinead]

Kate described not being able to breastfeed exclusively as being like denied admission to an ‘exclusive’ club. This analogy is representative of how participants experienced having primary low milk supply. Kate highlighted a common perception that mothers either breastfeed or formula feed, and asserts that she did not fall into either of these categories, rather, she was ‘in-between:’

I hate the word ‘exclusive’ it’s like it’s this exclusive club that I’m not in…it makes it seem like it is all or nothing…but there is lots in-between.

Being in a safe space

This section discusses experiences of peer-support from other mothers with primary low milk supply. Four of the participants were members of a WhatsApp support group for mothers experiencing breastfeeding difficulties called The Purple Hearts group. Most of the women in this group had primary low milk supply. Two of the participants joined a low milk supply support group on Facebook. They reported similar experiences of being in these groups. The one benefit they stressed above all others was that of being understood, and therefore validated:

….they accepted me into the Low Milk Supply group, and…I was so overwhelmed because I was like “this is actually a thing!” [excited tone]…other people have this…I started reading other people’s posts…that was a real changing point for me in my journey. Just like life-changing…. My journey would have been much worse if it hadn’t been for that Facebook group. [Sinead]

…it felt really good to be connected with other women who know this is important to me as a mum. [Fiona]

Being in these groups helped the participants come to terms with having primary low milk supply. The understanding and empathy they described contrasts with the lack of understanding they reported in their interactions with HCPs. Megan became emotional as she elaborated about what it was like to feel that she was in a ‘safe space’ among people who had had similar experiences:

…people who get that grief, who understand the challenges and practicalities of that…there are people who have been through similar things, who’ll say “I’ve tried this”, or people who…can say ”yeah I went through that it was so hard”. For new mums to the group everyone really rallies round and says “you’re doing so well keep going”…it’s just really compassionate people…[starts crying]…it’s just a really safe space. [Megan]

Another aspect of being supported by other women with primary low milk supply was reassurance that they were not on their own:

…hearing different women’s problems and hearing the hardship that they had to go through…gave me a sense of belonging and then knowing that you’re not the only one…you feel listened to. [Orla]

Hearing other women’s stories appeared to give participants greater insight into their own experience of having primary low milk supply and a realisation of how much effort they had invested in breastfeeding. Being in the groups served to hold up a mirror to them and helped them develop a greater sense of self and a stronger motherhood self-identity – an identity which had previously been shattered by having primary low milk supply:

…when you talk to all of those women…you realise we do 500 percent more than the women whose baby latches ok. [Orla]

…being able to give advice to other mums kind of made me realise how far we have come. I remember one of the women…her baby was maybe five weeks and she just looked so sad, it was like looking in a mirror… and I could just relate so much, she looked exhausted and so sad and frustrated and…it made me realise we have come a long way.. [Fiona]

Kate and Donna spoke about being supported by other mothers with primary low milk supply. Their reflections echoed the comments of the participants who were in online groups, in that they gained insight and self-acceptance through seeing their experiences mirrored in the experiences of others. These encounters seemed to represent a significant shift in how they understood and perceived themselves:

…she was kind of like me, she really wanted to make breastfeeding work and she did the best she could…she was like “look, you have to know that just because you have low supply it doesn’t make you any less of a mom”. She was really supportive. She had gone through something similar. [Kate]

I kind of feel an affiliation with her because she had the low supply as well. [Donna]

Having a saviour

Participants identified two main sources of invaluable help and support as they struggled with the challenges of breastfeeding with primary low milk supply, their IBCLCs and their partners. They credited IBCLCs with providing skilled and empathetic support that helped them continue breastfeeding and come to terms with having primary low milk supply. Participants also described how their partners gave them practical help and emotional support.

Caroline described her HSE community IBCLC as an ‘absolute lifesaver’, and Kate credited her private practice IBCLC with being the ‘saviour’ of her breastfeeding relationship:

….she was fantastic and was my main support for the remainder of my breastfeeding journey…she an absolute lifesaver, I wouldn’t have breastfed for as long without her… [Caroline].

My lactation consultant was the savior of our breastfeeding relationship. [Kate]

Participants stressed the importance of the empathy and emotional support that they received from their IBCLCs, giving the impression that it was as important as the practical support to continue breastfeeding:

It would have been a very different journey if I hadn’t had someone who understood completely and was empathetic. She didn’t just support me with breastfeeding, she supported me emotionally at times as well. And that was so important. No one else had any knowledge about it, apart from my lactation consultant. [Amy]

Another aspect of the support IBCLCs provided to participants was helping them to understand the embodied nature of breastfeeding, that it is more than a means of providing milk, and that having primary low milk supply can be experienced as a loss:

She put into words, what I didn’t realise I felt, you know like not being able to breastfeed fully…can be viewed as a loss. And that breastfeeding is about so much more than feeding your baby, and that it’s a connection, it’s bonding. But I didn’t know that. [Ruth]

The participants stressed how much they valued being listened to by their IBCLCs. This and being emotionally supported are in stark contrast to participants’ earlier experiences in maternity settings of feeling unseen and unsupported:

….that felt like the first time someone was really listening to what we were saying… I felt supported. [Megan]

The participants’ partners also played an important role in providing support. At a practical level, they helped with preparing bottles and minding the baby while participants rested or pumped:

I have the most supportive husband on the planet. He was flat out running and getting me bottles and like sterilizing things, and washing bottles… [Kate].

….he would put her in the sling and work away in his office and she’d be asleep on him, and that was my chance to have a rest or whatever. That was absolutely fundamental, it is not possible to do this without somebody. [Caroline]

The participants credited their partners with giving them encouragement when they were finding breastfeeding difficult and with being a source of ongoing emotional support. When Ruth spoke about her partner, she described him as a steadying and calm presence, who encouraged her to just do what she could without pressuring or discouraging her. She said he helped her to rationalise things and to see her situation more objectively, while also understanding that breastfeeding mattered to her:

….he admired the effort that went into it and never pushed me to keep going,…he would say “just give her what you can” and would help me to rationalise things and just to realise that he was there for me. [Ruth]

The participants also reflected on the role their partners played in helping them to appreciate how much effort they had put into breastfeeding, giving them a clearer perspective on their experience of having primary low milk supply:

He knew how much it meant to me, and he tried to reassure me that I was doing a good job no matter how much I got or if I took a break, but like, “look at everything you are giving to him, look at how well he’s doing.” [Amy]

Kate became emotional when she talked about how her partner supported her and how he had so much faith in her. She gave the impression that he was a calm and wise presence throughout her breastfeeding journey, who had an unconditional belief in Kate’s ability to care for her baby, despite Kate’s own misgivings:

I’m going to cry now thinking about how well my husband supported me, not that I could ever love him more. It has made us so much stronger. He was never like “oh maybe you should switch to formula”, he was always supportive of what I wanted to do and…he knew that somewhere deep inside I knew what she needed. [Kate]