Women's bodies undergo many physical changes during pregnancy that may take them further away from their ideal body shape (Grogan, 2008), and some of these changes will carry over into the postpartum period. Most women adapt positively to the changes that occur during pregnancy, and some authors have suggested that pregnancy protects women from body concerns (Rocco et al, 2005; Skouteris et al, 2005; Clark et al, 2009). However, the postpartum period has been identified by many researchers as a time of augmented body dissatisfaction (Stein and Fairburn, 1996; Rallis et al, 2007; Clark et al, 2009).
One group of postpartum women who have been identified as having higher levels of body satisfaction are those who are currently breastfeeding (Welsh and Hoffman, 2009). It has been suggested that breastfeeding may provide a defence against the negative impact of pressure for slenderness. One study that looked for a relationship between body image, feeding decisions and attachment, found that women who breastfed had a more positive pre-pregnancy body image than those who were bottle-feeding (Huang et al, 2004).
Welsh and Hoffman (2009) concluded that the role of breastfeeding should be investigated more extensively. Not only does breastfeeding appear to be advantageous to a new mother's wellbeing but it also has many advantages for a newborn including: fewer infections, lower rates of obesity and a lower chance of developing eczema (NHS, 2012), although these advantages have been challenged recently (Colen and Ramey, 2014).
In a previous study, we found that postpartum women did not seem to internalise the media-imposed ‘thin ideal’ as expected, and that women felt sympathy for celebrities who were under pressure to look slender shortly after childbirth (Fern et al, 2012). Eight of the 10 participants in that study were currently breastfeeding, which raises the issue of whether these results could be able to be transferred to other postpartum women. This current study set out to expand on the previous findings to understand the impact that feeding choice has on women's body image and was designed to investigate any differences between the participant groups. Using email interviews analysed through inductive thematic analysis, this research addressed the question of whether women who have experienced breastfeeding present more positive accounts of their bodies than women who have bottle-fed.
Method
Participants
Forty women aged 20–42 years who had given birth within the last 3 years were interviewed. No other exclusion criteria were applied. Fourteen participants were currently breastfeeding, 14 had stopped breastfeeding and 12 were bottle-feeding their child and had done so since birth. Participants’ body image pre-pregnancy was classified by the researchers based on responses during interviews. These were classified as positive, negative, or neutral. Due to interviewing through the medium of email, a wider demographic of participants was reached and enabled greater transferability (Hewson et al, 1996). Initially a total of 20 women were sought to aim for data saturation (Cresswell, 1998; Cresswell, 2002); however due to the level of interest in the research, more women were interviewed.
Materials/apparatus
A series of 14 open-ended questions and two closed questions were used in order to answer the research question. Examples included: ‘Have you seen a change in your attitude towards your body over pregnancy or the postpartum time period?’ (closed), ‘Do you compare your body to others around you?’ (closed) and ‘How do you feel when you look at celebrities who have recently given birth?’ (open). An information sheet was designed to inform women about the purposes of the study and to gain informed consent.
Ethical approval
Ethical approval was granted by the University ethics committee.
Procedure
The women were recruited using snowball sampling via poster adverts on several social networking pages. If someone expressed interest in the study they were asked to contact the researcher via email as detailed on the poster. All further contact with the participants was by email. Email interviewing has many advantages, such as reduction in data distortion due to the invisibility of the researcher (Paccagnella, 1997), and allowing participants to share intimate experiences while maintaining both distance and personal space (Turkle, 1995; Whitty and Gavin, 2001). However, due to the nature of an interview by email, the reality of participants’ experiences (Shipman, 1992) cultural norms, jokes and irony (Macdonald and Tipton, 1993) can be easily misinterpreted and therefore responses must be treated with caution. The participants were sent information regarding the research, and consent, and were asked to reply if they had any further questions or were happy to participate. The questions were then sent in sets of three. If responses were short, participants were asked to expand on their experiences. The process was continued until all 16 questions had been asked. The participants were then thanked, the debriefing information was sent and they were reminded that they could contact the researcher at any time if they had any further questions or worries. Anonymity of data was ensured, and data were password protected. Participants’ full transcripts were copied and pasted into a separate Microsoft Word document and then emailed back to them and they were given a week for any changes (such as deletions) to be made.
Data analysis
All data were analysed using inductive thematic analysis, focusing on identifiable themes and patterns of living and/or behaviour (Constas, 1992). The first author familiarised herself with the data, searched for regularities in the text, and coded these and combined them with data that were relevant to each code. Once the codes were combined, potential themes were identified. Themes were identified by ‘bringing together components or fragments of ideas or experiences, which often are meaningless when viewed alone’ (Leininger, 1985: 60). The other two authors then read the transcripts and all authors discussed each theme. Once complete agreement was reached, a final thematic structure was produced and quotes selected to support each theme. Themes that emerged from the participants’ stories were pieced together, defined, and named to form a picture of their experience. The analysis then shaped a story line which is presented below.
Results
Proportionally, fewer (3/14) women who were currently breastfeeding were negative about their body pre-pregnancy than the groups who had stopped breastfeeding (6/14) or who were bottle-feeding (7/12). Three key themes were established from the thematic analysis: attitude transition, celebrity comparisons and emotional reactions to celebrity mothers. Quotes are used below to indicate examples of accounts within each theme, and are identified by pseudonyms provided by the women themselves, details of months postpartum and the women's ages.
Attitude transition
Most participants’ attitudes towards their bodies had changed as a result of pregnancy. Seven participants who were bottle-feeding, nine who were currently breastfeeding and nine former breastfeeders made distinctions between their attitude pre-pregnancy, during pregnancy and post-pregnancy. (B/F refers to women who are currently breastfeeding, F-B/F refers to women who have had experience of breastfeeding, and F/F refers to women who used formula).
Emily, 22, who bottle-fed her child talked about the change in her attitude towards her body and ‘wishing’ she had the body she had pre-pregnancy.
‘Most of the time I just wish I could be the way I used to be and hate some parts of my body.’ (Emily, 22, 19 months postpartum, F-F)
| Group No. | Pseudonym | Age | Months postpartum | Living area | No. children | Body image prior to conception | Motivation for feeding choice |
|---|---|---|---|---|---|---|---|
| 1 | AJH | 26 | 7 | Cheshire | 1 | Positive | Always wanted to |
| Andrea | 33 | 3 | Lancashire | 1 | Positive | Health benefits | |
| Cherry Granola | 25 | 14 | Cornwall | 1 | Positive | Research, benefits | |
| Jenny | 34 | 11 | North East | 2 | Neutral | Research, mother breastfed | |
| Jodie | 26 | 29 | West Midlands | 1 | Neutral | Natural | |
| Kadam B | 31 | 21 | Cheshire | 2 | Positive | Benefits, family breastfed | |
| Katie | 26 | 2.75 | Scotland | 1 | Positive | Situational | |
| Lotto | 31 | 2 | Cheshire | 1 | Positive | Health benefits | |
| Louise Cottrill | 36 | 16 | Cheshire | 2 | Neutral | Seemed norm | |
| Petunia | 38 | 3 | South East | 1 | Positive | Natural | |
| Rosalind | 37 | 17 | North East | 2 | Negative | Natural | |
| Ruby | 24 | 17 | North East | 1 | Negative | Health benefits | |
| Francais | 33 | 18 | Staffordshire | 1 | Positive | What breasts for | |
| Sarah | 21 | 13 | North East | 1 | Negative | Mother breastfed | |
| 2 | Angelica Bean | 32 | 36 | Wales | 1 | Negative | Research |
| Briony | 34 | 6.5 | North East Wales | 1 | Negative | Health benefits | |
| Claire | 21 | 25 | Staffordshire | 1 | Positive | Natural, money saving | |
| Essa | 31 | 19 | Wales | 1 | Positive | Family breastfed | |
| Georgia Yates | 31 | 18 | Cheshire | 1 | Negative | Health benefits | |
| Iris | 30 | 17 | Cheshire | 1 | Negative | Health benefits | |
| Jane Frost | 32 | 16 | Staffordshire | 1 | Negative | Family pressure | |
| Mac's Mummy | 33 | 12 | Chester | 1 | Neutral | Health benefits | |
| Mummy Ando | 29 | 26 | Cheshire | 1 | Neutral | Natural | |
| Serena | 42 | 31 | Cheshire | 1 | Neutral | Research | |
| Sophia | 28 | 19 | East Yorkshire | 2 | Positive | Experience with first child | |
| Stormkings | 34 | 29 | Lancashire | 1 | Negative | Health benefits | |
| Poppy | 33 | 30 | Shropshire | 1 | Positive | Natural, money saving | |
| Emily Woods | 36 | 7 | Cheshire | 1 | Positive | Health benefits | |
| 3 | Cerys | 24 | 10.5 | Staffordshire | 1 | Negative | Too ill |
| Claire Smith | 22 | 30 | Staffordshire | 1 | Positive | Medical condition | |
| Emily | 22 | 19 | Staffordshire | 1 | Negative | - | |
| Katy Cooper | 23 | 15 | Wood Lane | 1 | Negative | No confidence | |
| Miss M | 26 | 20 | North Wales | 1 | Negative | Schedule, partner's help | |
| Mummy M | 22 | 8.5 | Cheshire | 1 | Negative | Situational | |
| Sarah | 21 | 12 | Staffordshire | 2 | Neutral | Did not breastfeed first child | |
| Sophie | 21 | 18 | Staffordshire | 1 | Positive | Pain post-delivery | |
| Tabbie | 29 | 20 | Staffordshire | 3 | Positive | Baby too hungry | |
| Tay | 20 | 14 | Staffordshire | 1 | Positive | Felt uncomfortable | |
| Trudie | 21 | 20 | Staffordshire | 1 | Negative | Too painful | |
| Fearne | 27 | 17 | Staffordshire | 1 | Negative | Public embarrassment |
Group 1=women who are currently breastfeeding, group 2=women who have had experience of breastfeeding, group 3=women who used formula
However, Serena (who has now stopped breastfeeding her child) talked about her body very differently:
‘My body is more precious and important in its ability to carry and nurture a baby than how I look in terms of body image.’ (Serena, 42, 31 months postpartum, F-B/F)
Kadam B said:
‘Seeing it go through the changes pregnancy brings has made me appreciate it more and the amazing things it can do.’ (Kadam B, 31, 21 months postpartum, B/F)
Eleven participants from the currently breastfeeding and 10 from the former-breast-feeding group were more appreciative of their bodies after pregnancy than participants from the bottle-feeding group and could see it more functionally. Participants who had bottle-fed their child were less inclined to see their body in this way and were more negative about their postpartum bodies, as can be seen in the quote from Emily above; in fact only two participants from the bottle-feeding group were positive about their post-pregnancy bodies. Whether their attitude had changed positively or negatively, for most participants a change in their attitude towards their body was evident.
Celebrity comparisons
When participants were asked if they made comparisons to celebrity mothers, seven participants from the currently breastfeeding group and eight participants from the former-breastfeeding group reported that celebrities were not appropriate comparison targets:
‘I don't tend to compare myself to celebrities who have given birth as I find the image … is unrealistic to the average mother.’ (Sarah, 21, 13 months postpartum, B/F)
This perception was also shown by Jane Frost:
‘I don't really compare myself to celebrities because they are totally different to me and my life.’ (Jane Frost, 32, 16 months postpartum, F-B/F)
This was compared to just two participants from the bottle-feeding group who felt that celebrities were ‘unrealistic’ and not comparable. In fact, over half of participants from the bottle-feeding group compared their appearance to that of celebrities:
‘Beyonce, she gave birth to her daughter the day before I gave birth to mine and I look at my pictures now and look at hers and hate the fact she is looking like she did before and you wouldn't be able to tell she had a baby.’ (Cerys, 24, 10.5 months postpartum, F/F)
‘I do, mainly thinking that perhaps my body should be back to looking the way it was before getting pregnant.’ (Miss M, 26, 20 months postpartum, F/F)
Comparing herself to celebrities made Miss M, 26, believe that she should be back to her pre-pregnancy figure, creating negative feelings and unrealistic perceptions. For participants who did compare themselves to celebrities, emphasis was paid to the amount of time it had taken them to lose the weight in comparison to themselves. Only four currently breastfeeding participants and five former-breastfeeding participants admitted comparing themselves to celebrities in this way.
Emotional reactions to celebrity mothers
When asked how the women felt when comparing themselves to celebrities a number of differing responses emerged. For five participants from the bottle-feeding group, emotions of jealousy and envy were apparent:
‘I envy the ones who look amazing and I feel very jealous, at times it can make me feel embarrassed if I am looking at pictures with someone else.’ (Miss M, 26, 20 months postpartum, F/F)
Mummy M, 22, felt similar:
‘I do feel a little dissatisfied and critical about my own body, even though I know celebs have an extra helping hand.’ (Mummy M, 22, 8.5 months postpartum, F/F)
For five of the participants in the bottle-feeding group, feelings of jealousy and envy arose when looking at celebrities who have given birth. As Miss M and Mummy M state, looking at celebrities for them causes negative emotions about their own bodies. However, for three participants from the currently breastfeeding group and five from the former-breastfeeding group a different emotion emerged:
‘I actually feel sad for them and their babies.’ (Cherry Granola, 25, 14 months postpartum, B/F)
Cherry Granola, 25, who was currently breastfeeding her child talked about feeling ‘sad’ for celebrities and their children due to added pressures they experience from being in the public eye. Sympathy was also felt by Jane Frost, 32:
‘…maybe feel a bit of sympathy as I'm sure they know that if they didn't lose their baby weight and fast, that they would probably get scrutinised for it.’ (Jane Frost, 32, 16 months postpartum, F-B/F)
Jane Frost, 32, felt sympathy for celebrities due to the pressure that they are under to lose weight gained during pregnancy, in particular for celebrities who did not manage to do so. Similarly for Mac's Mummy, 33:
‘Happy for them having been given the joy of a child, but sad they are under so much pressure when normal people can just enjoy being a mummy.’ (Mac's Mummy, 33, 12 months postpartum, F-B/F)
Mac's Mummy, 33, who had breastfed her child, expressed mixed emotions when talking about celebrities, referring to the positivity of having a child but also the pressure for slenderness linked with fame. Interestingly no participants from the bottle-feeding group felt this way.
Discussion
The findings suggest that women who had experience of breastfeeding viewed their bodies more functionally than women who bottle-fed their babies. They also had more appreciation for their bodies and the process that they had gone through to give them a child, whereas women who had bottle-fed their child tended to be more negative about their own bodies. It is important to note that participants who were currently breastfeeding were least negative about their body pre-pregnancy and six participants who formula-fed their child did so due to situational factors that prevented them from breastfeeding (e.g. too ill, lactating problems, and medical conditions). Although all participants implied that they had some degree of body dissatisfaction, women who had experience of breastfeeding implied that they were more appreciative of their body, which appeared to allow them to accept the changes that had occurred through pregnancy. Women who had bottle-fed their child had more negative attitudes towards their bodies, which replicates previous findings (McCarthy, 1998). These findings add to the current debate around breastfeeding suggesting that women who breastfeed may be more likely to see their bodies as ‘operational’ as opposed to ‘aesthetic’ compared with women who have bottle-fed their child, and this effect appears to persist even after breastfeeding has ceased.
Some authors have suggested that Western media presents unrealistic expectations of new mothers by focusing on body perfection (Earle, 2003; Douglas and Michaels, 2005). Participants from the currently breastfeeding and former-breastfeeding group felt that media representations of new mothers were ‘unrealistic’ and ‘non-comparable’. Research has also suggested that women feel sympathy for celebrities and the pressure that they are under from the media (Fern et al, 2012) and this was supported by the current research. Participants felt sympathy for celebrities and also implied that they felt sad for them and their babies. What is of particular interest is that participants who felt sympathy for celebrities had experience of breastfeeding, whereas women who bottle-fed who did not report feeling such sympathy. The majority of the women recruited by Fern et al (2012) were also currently breastfeeding suggesting that breastfeeding provides a buffer and somewhat moderates the impact of the media on mothers’ views of their own body.
For the majority of women who experienced breastfeeding, acceptance, appreciation and a functional view of the body was found. A number of explanations could be provided for this. According to Wood-Barcalow et al (2010), body appreciation includes four features of positive body image: being attentive to the body's needs, being favourable towards the body in spite of perceived imperfections, protection of the body by the dismissal of unrealistic media ideals and taking care of the body by engaging in healthy behaviours. Body appreciation is thought to predict numerous indicators of psychological wellbeing (e.g. life satisfaction, self-esteem, proactive coping, and optimism) and is a complex concept that indicates more than just low levels of negative body image (Avalos and Tylka, 2006). Women who had experience of breastfeeding tended to be more appreciative of their bodies which may have influenced their body perceptions. Another explanation is that breastfeeding women may view the body more functionally. In a study by Rubin (2006) pregnant women put their baby's and their own health above aesthetics. Body satisfaction during pregnancy was thought to come from a perception of increased body functionality. A positive view of the body has also been linked with physical competence (Greenleaf et al, 2009) and greater body appreciation has been linked with a focus on body function (Avalos and Tylka, 2006). Additionally, research has shown that the functional body is evaluated more favourably than the aesthetic body (Franzoi, 1995), with fewer negative evaluations made when the body is viewed more functionally (Gusella et al, 2004). This may explain why women who have experience of breastfeeding are less concerned about the appearance of their body compared to women who bottle-fed their children, who appeared to view their bodies more aesthetically (and negatively).
Limitations
As the study used email interviewing, responses from participants were relatively short which restricted the level of information obtained by the researcher; however, even for the close-ended questions participants did elaborate and provide more than simply yes/no responses. In future, researchers who conduct interviews via email might consider sending questions individually to allow participants more time to spend on each question, which may increase the level of information gained.
Future research
It would be beneficial to conduct the current study with a larger sample of women, possibly incorporating a quantitative measure such as the Embodied Image Scale (Abbott and Barber, 2010) to gain more objective measures of body function related to body image, e.g. aesthetics vs functionality. Comparing women who have experience of breastfeeding and bottle-feeding on this kind of measure would determine the generalisability of the current findings.
Conclusions
Aspects of the body that are functional (of practical significance) rather than aesthetic may be of particular significance to women who have given birth due to bodily changes that arise during pregnancy and postpartum. If viewing the body more functionally encourages women to appreciate their bodies, then prenatal workshops for expectant mothers that encourage focus on the importance of health and wellbeing and the function of the body over and above aesthetics may be beneficial in improving their body image post-pregnancy. Furthermore, media literacy training, where women are taught how to critique media imagery around bodies, especially in relation to pressure to look slender soon after pregnancy, are likely to be helpful in promoting positive body image and wellbeing postpartum.