Duration.

There was a wide range of participant breastfeeding durations, with some participants noting they breastfed for less than the recommended period. One participant stated she “heard a lot of women who tried and then after one month, they had to quit because they didn’t have enough milk or had problems” (113, 59). Another participant explained, “Nowadays, more and more young women are not willing to breastfeed for a long time” (112, 58). One participant clarified why she stopped early and noted she “was tired” (119, 42). Another stated she “want[ed] to sleep train [her] baby” (110, 25). Each participant described an individualized experience.

Several participants indicated awareness of the recommended duration for breastfeeding. One participant stated, “Pediatricians say between six and nine months. Normally, mothers start to get some food at the age of six months, and they still breastfeed” (113, 59). Other participants described the pressure to adhere to the known guidelines despite personal difficulties. One participant voiced, “it was super painful every single time… but I still exclusively breastfed for about six months” (116, 33). Additionally, one participant expressed her choice to breastfeed for the full recommended time, conveying, “my first child was breastfed, you’re going to be shocked, until he was two” (113, 59). Many participants noted diverse reactions and experiences with these guidelines.

Alternatively, participants described breastfeeding experiences beyond the recommended duration. When explaining the motivation to continue beyond recommendations, one participant stated, “oh, I still have milk. I don’t want to waste it” (110, 25). Some participants noted the effects of extended breastfeeding, with one participant commenting on her friend’s breastfeeding experience: “[she] breastfe[d] until the baby was four and a half. Come on. Then you create a monster” (101, 37). Another participant noted, “my baby [is] six years [and] still searching to touch my boobs because I was feeding him for about two years” (107, 36). Participants held varying opinions and experiences regarding breastfeeding for longer than the recommended duration.

Breastmilk production.

Experiences with breast milk production strongly influenced participants’ opinions surrounding breastfeeding. Individuals confident they produced sufficient breast milk had more favorable opinions surrounding breastfeeding. One participant detailed her positive experience, “With my kid, no problem with [him] hungry anytime and a lot of milk.” (124, 46). Conversely, one participant mentioned a more negative experience, “my experience left me with the feeling that I didn’t have enough for him” (122, 58). Other participants expressed strong emotional responses stemming from the need to supplement with formula, “we had to resort to the bottle, and that just killed me” (118, 54). Many participants experienced emotional turmoil when they could not produce enough breast milk. Overall, participants’ personal milk production amount led to strong emotional responses and shaped participants’ opinions on breastfeeding.

Breastfeeding challenges.

Many participants noted issues and overwhelming feelings within their personal breastfeeding experiences. Participants expressed a lack of support regarding the onset of their breast milk. One participant explained, “I did not know at first that, but I had a lot of milk. It was just difficult because I needed to do [breastfeeding] all by myself” (110, 25). Another participant echoed these attitudes, stating, “When you leave the hospital, I had masses of milk, and no one told me, and I didn’t think about it, the milk, we were just waiting to feed him” (118, 54). Others described their feelings when faced with breastfeeding issues, one participant admitting, “I felt guilty about it. I felt that I wasn’t ready for my daughter. It was heartbreaking” (119, 42). Another participant stated, “then mastitis came over. I first felt disappointed. I cannot even do this” (113, 59). Additionally, some participants mentioned the exhaustion they felt, with one explaining, “I cannot leave, and I am breastfeeding. I am always exhausted with everything, I am exhausted, I’m not even able to have a shower” (124, 46). Another shared, “[Breastfeeding] was very stressful. I felt like a cow. Like the first three months w[ere] very intense” (120, 55). Participants identified issues with breastfeeding that led to heightened emotions.

Participants also mentioned issues of nipple tenderness and latching pain. One participant described, “I almost quit. I was like this [is] too much, too painful” (115, 38). Another participant explained, “breastfeeding is hard. It’s hard work….It takes a lot of time to get your babies [to] latch properly… for me, it was painful” (119, 42). The same participant also noted, “my nipples were cracked and bleedy and so [my daughter] would suck my blood and she would throw up because of that. Yeah, it hurt me. It was painful for me. It was painful for her” (119, 42). Nipple soreness and latching pain are physical changes many participants identified through their personal experiences with breastfeeding.

Benefits of breastfeeding.

A majority of participants believed breastfeeding was superior to other alternatives. Several participants explained the benefits of their relationship with their baby: “It’s a nice bonding…I think the children feel really loved” (120, 55) and “breastfeeding is beautiful. There’s a very great connection with [the baby]” (101, 37). Participants also described the health benefits of breastmilk. One participant stated, “just because I had the milk, I gave protection to the small baby” (114, 57), and another affirmed this: “in breastfeeding, you are giving your kids antibodies…the support of the immune system” (124, 46). Overall, participants noted breastfeeding as the preferred option, citing the immune system benefits and stronger parent-child connection.

Individualized experiences.

Participants described individualized feeding regimens to fulfill the needs of each mother and baby. One participant shared, “it really depends on the situation you are in. I think most of the women would do it if they can” (120, 55). Another participant agreed by saying, “I think that whatever is good for them. It’s okay” (109, 42). Several participants similarly believed feeding methods should provide nutrients to the baby in the most comfortable process for the mother and baby. One participant said, “it doesn’t make any less of a mom… It’s okay if even if you’re not breastfeeding. Happy mom, happy baby” (110, 25). Another participant echoed this by saying, “I think a fed baby is a happy baby” (115, 38). Participants expressed breastfeeding is an overwhelming and stressful experience, and ultimately, a mother’s decision to breastfeed is unique to their situation.

Diverse Communities.

While breastfeeding, participants interacted with multiple communities, including but not limited to, healthcare providers, midwives, support groups, other moms, and family. These communities provided both education and support through participants’ breastfeeding processes. Participants expressed varied attitudes toward these communities regarding breastfeeding. Some were positive,

I had a private midwife who came and she told me about breastfeeding lying down, which I never managed to do with my other two, partly because I had so much milk, but she helped me learn how to do that. And it was just the best (104, 32).

While others had a negative experience: “[the nurses] are very rude. They come to you, ‘sponge your boob, come on you have to breastfeed’” (101, 37). Another participant noted, “they wouldn’t help me– I was like, I need help, my child is not coping well” (119, 42). This participant continued, “it was a long process. It wasn’t easy at all, but nobody really helped me in the OBGYN” (119, 42). Communities directly involved with participants’ breastfeeding influenced their perception of their experience.

Diverse breastfeeding education.

In terms of education, participants also had both positive and negative experiences. One participant mentioned YouTube pre-birth courses as “useless,” noting, “you have to teach a woman, to really teach about breastfeeding, about all the problems” (101, 37). Another participant builds on this by mentioning a lack of information, stating, “I found that it’s hard, and information is not volunteered to you here…you have to ask a specific question, and you have to also ask it to the right person” (104, 32). Other participants disagreed and felt ample resources were available to those who wished to utilize them. One mentioned a positive personal experience with a midwife,

It’s awesome. And I feel like there’s a lot of resources for helping with breastfeeding. I remember when I was having trouble with latching… I had a one-on-one with a midwife through the public hospital. All I did was an appointment just to check to make sure that the breastfeeding was going okay. And there were a lot of people who took advantage of that resource (116, 33).

One participant echoed this positive sentiment, stating how the healthcare system has programs to support breastfeeding,

So, they have to encourage women and support women with breastfeeding. I think that the program works, like they got this…certificate. And they got money with it if they convinced women and they show that they’re doing those things, you know, like ‘Yeah, we’re pushing breastfeeding’ (119, 42).

Other participants discussed support groups that aided their efforts with similar programs, “so there is an international league called ‘Leche League,’ so they help women for breastfeeding and so I went to meetings with this league, and I learned things that were very helpful for breastfeeding” (121, 58). Support groups like this one provided both support and education.

Workplace support.

Regarding breastfeeding in the workplace, one participant noted, “it’s totally accepted. It’s totally fine. If you work for a big company, they’ll give you additional breaks for you to breastfeed” (116, 33). Another participant shared, “When I took the bar exam, it took a lot of hours, and this woman there had to leave to go breastfeed, but they just gave her a corner to go pump” (117, 40). Aside from the healthcare and workplace community, participants utilized breastfeeding support from familial and personal connections. One participant described her experiences with her family during breastfeeding,

My mom was here with me. And she had never breastfed herself and she was just helpful in terms of just support, like emotional support. So, I just reached out to cousins, had a lot of cousins with babies and ones that breastfed, so just kind of asked them about it. After I left the hospital, I didn’t talk to any other professionals, no lactation consultants or anybody. So that support was just enough for it all (115, 38).

The same participant built on this further by explaining her experience of reaching out to personal maternal connections: “you’re reaching out to every woman who’s breastfe[d], and you say, ‘What was your experience? Is this normal?'” (115, 38). Overall, participants chose to utilize various communities through breastfeeding. Each community uniquely aided or failed to provide education and support to each participant.

Breastfeeding in public.

Participants described various factors involved in public breastfeeding concerning privacy and cultural norms. When asked whether there are private spaces to breastfeed in public, one participant stated, “I don’t think there are locations designated for breastfeeding, but I would say that I usually try to find more private places, even if I was in a public space maybe not going in the middle of kids playing” (121, 51). Another participant echoed this sentiment, explaining, “there’s little places you can go for breastfeeding.” (115, 38). Some participants indicated they felt comfortable breastfeeding among others. One participant noted, “I felt comfortable breastfeeding with other Italian moms around because I’ve seen them do it, and they seemed very relaxed about it” (104, 32). Other participants agreed; “I never felt that people were looking at me in a bad way because I was breastfeeding” (121, 51) and “you can do it everywhere” (102, 32). One participant noted a differing personal opinion, stating, “it was not taboo at my time, but I really didn’t feel very comfortable, so I breastfed particularly in place that was private and not exposed” (122, 56) and “maybe I don’t want to see you breastfeeding your child, you know?” (122, 56). Generally, participants exhibited a wide range of opinions and viewpoints on the culture of public breastfeeding.

Taboos regarding covering.

Participants expressed various feelings about covering while breastfeeding in public. One participant noted society expects covering, stating, “[in the] Catholic religion….everything must be hidden” (112, 58). Another participant reiterated the importance of covering in specific places, explaining, “really you don’t [breastfeed] in a church or in a special place” (114, 57) but also stated, “if you are in the garden, you don’t have to cover” (114, 57). One participant voiced her belief that the culture around covering is changing as she explained, “Sometimes they cover themselves, but I think it’s something that they did maybe 20 30 years ago. Now, our generations don’t do that anymore” (123, 29). Many participants expressed different views on covering.

Societal pressures.

Many participants expressed public opinion and culture within the community puts pressure on mothers to breastfeed. One participant said, “I felt bad because in this culture, they feel this stereotype that if you don’t breastfeed, you are not a good mother” (102, 32). Participants voiced community opinions towards breastfeeding placed pressure and judgment on a mother’s feeding abilities, with one participant stating,

Yeah, it was a really brutal experience for me… I felt like it was my fault because they were judging me. Like ‘you’re not maternal enough’. ‘You’re not giving your daughter enough attention and enough warmth and enough love to, you know, survive’. I was feeling like shit. I remember I cried every time and constantly. And they wouldn’t let me sleep. That’s one thing that I found (119, 42).

Additionally, participants expressed their community places pressure on the need for women to breastfeed, so much so that mothers may change their desired feeding practices to meet cultural standards. One participant stated, “Not everybody is meant to do it. I had friends who really didn’t want to do it but felt pressured” (101, 37). Participants identified the public’s opinion towards breastfeeding may pressure a mother to breastfeed. Furthermore, women may face negative public opinions by not conforming to these cultural standards.

Formula.

Formula is a common alternative many participants mentioned using either as a supplement to breastfeeding or as a replacement entirely. Participants discussed the differences between breastfeeding and formula. One participant mentioned the only significant difference was antibodies given through breastfeeding, “that is what is different from the formula, not in terms of nutrition, but just in terms of the support of the immune system” (124, 46). However, some participants considered breastfeeding and formula as interchangeable. One mentioned, “I think formula and breastfeeding are equally important, and I think that regardless of how the baby is fed…. there’s not one that’s better than the other” (115, 38). While acknowledging the differences between formula and breastfeeding, most participants still had positive experiences with formula.

Additionally, many participants thought having an alternative to breastfeeding and the pump was important. One participant positively mentioned this, “no! We are not meant to do this. If I don’t care to pump, then if I don’t feel happy in breastfeeding. Formula!” (101, 37). Some participants detailed using formula to supplement breastfeeding. One participant explained the possibility of using a formula to supplement the lack of milk production, stating, “But if you cannot produce, like, if it is not enough for your baby, powdered milk, it’s okay” (110, 25). Another participant mentioned feeling more secure as a result of using formula,

In the evening, I was giving him formula also because it help him to sleep better and I was feeling more secure because you didn’t know… you never know how much milk from a human. So, formula then you know (101, 37).

Another participant said, “all of my friends supplement.” (116, 33). Supplementation through formula was a common topic among participants.

Some participants used formula out of necessity. One participant shared, “I really wanted to breastfeed, but unfortunately, after one month, I introduced artificial milk because I didn’t have much milk” (102, 32). Another participant explained, “obviously, [my daughter] needed milk, I wasn’t giving her much, and she wasn’t putting on weight” (118, 54). One participant used formula because her baby struggled to latch,

I didn’t… it was very hard because I have big breasts, and she was so little toward the beginning. And she couldn’t, like, she was latching, and then letting go, latching, and letting go. And she wasn’t eating. So she was screaming the whole time. And we were very stressed about that. So we just switch to formula very fast (123, 29).

Formula is commonly used as both a supplement and an alternative to breastfeeding for a variety of reasons.

Breast pumps.

In terms of acquiring breast pumps, many participants purchased them. One participant stated, “I had a breast pump… I bought it before my son was born” (121, 51). Another participant described an option to rent but explained she felt uncomfortable renting, “I wouldn’t feel comfortable in that. That’s really personal. I think they cannot give you just the machine, they give you everything” (124, 46). One participant who was lent a pump noted, “I actually borrowed it from another mum from Florence expat mom’s group, she lent it to me. But I did look at other options before that. I looked at buying one” (104, 32). The decision whether to rent or purchase a pump is personal, so some participants were more comfortable using a breast pump than others.

Several participants described success with their pumps, “my pump was very useful” (121, 51). Another noted, “I had to grab the pump. And I was working, and after three hours, your boobs are exploding. It’s stressful if a woman has to go back to work” (101, 37). One participant described pumping out of necessity, stating, “I had to sleep on a one-hour cycle like every three hours and then just to be able to pump milk for her and to bring it down to her” (105, 42). While another participant pumped for convenience, explaining, “I would pump into a bottle sometimes for a night feed for her dad, but other than that, I’ve just breastfed” (115, 38). Several participants described positive experiences with pumping.

Some participants disliked their pumps because of pain or a lack of milk production. One participant noted, “I tried this pump because I said, ‘Probably I have too much milk.’ But no, it was not something that I liked” (113, 59). While another participant noted the pain that came with pumping, “they had to manually pump me. It was the most painful thing I’ve ever been through except for birth. So painful... I have tiny boobs, so it was really, really painful” (116, 33). Another participant discussed how pumping did not work for her, stating, “in the next few weeks, we tried, I tried to do things like pump, stuff like that to build up my milk, but it didn’t work, so we had to switch” (118, 54). Each participant had a different experience; some could breastfeed without pumping, but others found it helpful.

Milk banks.

Milk banks are an alternative to breastfeeding that still allows mothers to feed their children with breast milk, in case they cannot breastfeed their child. Many participants used milk banks to donate or acquire breast milk for their children. One participant explained her excess of milk led her to donate, “I had a lot of milk. So, I give my milk to the milk bank” (114, 57). Another participant shared a similar experience,

I would say that actually, I was also able to donate some of my milk because I had a lot. So, there’s this milk bank here because we have the pediatric hospital that is really, really big here. So actually, you can donate for people that [are] not able to (124, 46).

Other participants needed milk for their children, which they received from milk banks. One shared, “luckily, the hospital had a milk bank, so he would get milk from other mothers” (118, 54). Overall, milk banks seem to be a reliable source for obtaining and donating breast milk.