1.1- Experiences of unmet educational expectations in shaping breastfeeding decisions and self-efficacy.

This subtheme addresses how the idealized portrayal of breastfeeding, often lacking in discussions around potential challenges, can lead to feelings of unpreparedness and disillusionment among mothers. Some postnatal mothers shared that while the educational content was informative, they felt it didn’t encompass the “holistic” preparation they anticipated for a supportive breastfeeding experience. They described how “inadequate knowledge” about common breastfeeding challenges left them with “unmet expectations,” which they associated with a reduced sense of confidence in their ability to breastfeed and feelings of uncertainty about continuing;

“Well, when I faced difficulties in the first few weeks, I was a bit discouraged. I remember the class focusing so much on how natural and beneficial it is, which it is, but I wasn’t fully ready for the hurdles. It made me question my ability to continue breastfeeding and whether I was doing everything right” (MG01).

The postnatal mothers described the initial postnatal period as "quite stressful," associating the stress with the divergence between the class teachings and their actual experiences. For instance, one postnatal mother noted, "I had set my expectations based on what was taught in the class," emphasizing that the unanticipated challenges “shook her confidence” and led her to "question" her ability to breastfeed;

“To be honest, it made the first few weeks quite stressful. I had set my expectations based on what was taught in the class, so facing these unanticipated challenges made me question my ability to breastfeed. It definitely impacted my confidence and made me reconsider my decision to continue breastfeeding at times” (MCM04).

Postnatal mothers pointed out that while the classes emphasized the “naturalness and benefits” of breastfeeding, they inadequately prepared them for the "storm" they faced. This lack of preparedness contributed to “discouragement and self-doubt,” particularly regarding their confidence in overcoming these challenges and their perceived preparedness to breastfeed;

“Well, now that you mention it, I might’ve been a bit naive. The class was all sunshine, but nothing could’ve braced me for the storm that was coming. Soreness, the bab not latching right off–it was a far cry from natural at the start. It knocked me sideways, so it did. Doubts crept in, wondering if I was cut out for this” (Mother L02).

Some of the postnatal mother’s narrative further underscores this sentiment, with one of the postnatal mothers expressing feelings of being "left at sea" regarding the practical challenges of breastfeeding, such as “insufficient milk production and painful nipples.” She felt that the classes barely addressed these “common issues,” leaving her feeling "let down" and unprepared for the reality of breastfeeding. Some of the postnatal mothers with previous childbirth experiences shared their expectations for the class to explore specific obstacles and provide “actionable guidance,” particularly for women with “previous unsuccessful breastfeeding experience” who are going through childbirth again;

"I was hoping, or maybe hoping, the class would touch base on some challenges and tips specifically for mothers like meself, who’ve done it before, faced challenges and might be facing different issues the second time” (MR01).

1.2 -Psychological responses to unexpected challenges following an idealized portrayal of breastfeeding.

This subtheme delves into the emotional and psychological responses of encountering unforeseen breastfeeding challenges among postnatal mothers due to the idealized information on breastfeeding presented in the classes. Most of the postnatal mothers noted a profound “sense of overwhelm, frustration, upset, and anxiety” upon encountering difficulties with breastfeeding that were not anticipated based on their prenatal breastfeeding educational preparation;

" After the baby came, I was all at loss. The breastfeeding wasn’t going as smoothly as I’d hoped, and I felt overwhelmed. I remembered the class and how it all seemed so positive there, but the reality was a lot different. It was frustrating, and I felt anxious because I wasn’t prepared for the problems I was facing" (ML04).

The postnatal mothers expressed a psychological burden of feeling “isolated” in their struggles, intensified by the perceived universality of positive breastfeeding experiences promoted during classes. The mothers illustrated how positive messaging, when not coupled with realistic portrayals of potential challenges, contributed to feelings of “frustration” and “isolation,” especially as new mothers;

"Oh, for sure. When I started having trouble with breastfeeding, all those positive messages from the class made me feel like I was failing. I was frustrated and anxious because I wasn’t prepared for this side of things. It felt like I was the only one struggling, which was isolating” (MR05).

The postnatal mothers illustrated the emotional turmoil they experienced when the reality of breastfeeding challenges differed from the expectations set by the information they received during breastfeeding classes. They expressed a feeling of “loss” and “anxiety,” emotions rooted in the stark contrast between the anticipation of a “beautiful, natural experience” and the unforeseen difficulties encountered;

“It was tough, really tough. I was all set for this beautiful, natural experience, but then, when we hit snags, I felt so lost and anxious. The sense of failure was overwhelming. If the class had been more upfront about the potential difficulties and how common they are, maybe I’d have been kinder to myself when things didn’t go as planned” (MC03).

Most of the postnatal mothers talked about the lack of discussion regarding the mental and emotional obstacles of breastfeeding, such as “postpartum depression.” The mothers expressed their emotional struggles. They believe that “additional guidance and assistance” could have supported their experience with emotional struggles;

Well, it left me feeling quite anxious, you know? I wondered if I’d be able to handle it, especially as a new mom, or if I was the only one struggling. It’s like I was set up to expect this beautiful, natural thing, but then hit with the reality that it’s not always a walk in the park. It made me question whether I was ready or capable, which was frustrating” (MG05).

The majority of the post-natal mothers voiced their expectations for “more support” and “understanding” in navigating the emotional landscape of breastfeeding. They sought discussions that addressed the “frustrations and doubts” inherent in the breastfeeding journey, particularly when not aligned with planned expectations. They yearned for a “personal touch” and reassurance to affirm their feelings were “normal.” The mothers noted that psychological well-being is as crucial as physical preparation for breastfeeding;

“Well, I suppose I was looking’ for more support and understanding, like talking’ about the frustrations and doubts a mother might have, especially if things don’t go as planned. A personal touch, you know? A bit of reassurance that what I was feeling’ was normal. The classes were very clinical, which is good in a way, but it didn’t quite hit the mark for me” (ML01).

Healthcare professionals acknowledged the gap in prenatal breastfeeding education. While reflecting on changes brought about by the pandemic in breastfeeding support, they emphasized the importance of emotional support in the breastfeeding journey and the need to balance practical guidance with emotional and psychological support;

“You know, that’s a very valid point, and it’s something we’ve taken to heart. Historically, our focus may have been more on the physical aspects of breastfeeding, perhaps at the expense of the equally important emotional and psychological support. Breastfeeding is not just a physical act; it’s a deeply emotional journey. With the pandemic forcing us to move our classes online, we’ve realized that we might have missed out on offering that crucial personal connection and emotional support” (GC02).

As narrated by some of the lactation consultants, the transition to online breastfeeding support adds another layer to this complex issue, describing the online environment as sometimes feeling “Impersonal.” In their opinion, this intensifies the sense of isolation and anxiety among mothers. They also acknowledged the challenges posed by the transition to online classes—“Reduced engagement, limited hands-on learning, technological barriers, limited interaction”—and reinforced their commitment to adapting their practices as a positive step towards better addressing the mothers’ needs;

“The shift online was both a blessing and a bit of a curse, to be honest. On one hand, it allowed us to keep providing essential information and support at a crucial time. But on the other, it’s harder to replicate the warmth and personal connection of face-to-face interactions. The nuances of comfort and understanding can sometimes get lost in translation over a screen. It’s something we’re keenly aware of and looking to improve upon” (RC03).

The lactation consultants emphasized the importance of “balancing” prenatal breastfeeding educational content to include both the positive aspects of breastfeeding and realistic portrayals of challenges. Moreover, they noted the need for emotional support mechanisms, particularly in the digital landscape, to bridge the gap between “expectation and reality.” Reflecting on the transition from face-to-face to online support, the lactation consultants underscored the necessity of innovative approaches to replicate the warmth and immediacy of face-to-face interactions, including using more interactive online tools;

“The shift online was necessary, given the circumstances, but it’s had its challenges, no doubt about it. While it’s enabled us to continue providing critical information and support, the online format can sometimes feel impersonal. The physical cues and the immediate comfort you can offer in person are harder to replicate online. This can make it more difficult for mothers to express their concerns and for us to provide the nuanced support they need. We recognize this gap and are exploring ways to make our online sessions more interactive and supportive to better address these emotional aspects” (LC03).

2.1-Incorporating interactive elements into virtual classes (e.g., Q&A sessions, feedback sessions, breakout rooms).

This sub-theme focuses on the perspectives of postnatal mothers and healthcare professionals on integrating interactive features into virtual learning environments. Most post-natal mothers expressed a desire for formalized feedback mechanisms to share their thoughts on the classes anonymously. They described the lack of such mechanisms as a “missed opportunity” for educators to improve the class experience; “To be honest with ye, there wasn’t any formal way for us to give feedback after the class.” The mothers equally highlighted the importance of anonymous feedback mechanisms to improve course content delivery and enhance the learning experience;

“My biggest suggestion would be to introduce a simple, anonymous way for us mums to give feedback on each class whether it’s through an online form or a suggestion box kind of thing, just something that lets us voice our thoughts without worry. And then, of course, for that feedback to be taken on board and used to make the classes even better” (ML04).

Healthcare professionals also recognize the importance of creating a supportive and responsive educational environment. They expressed “openness to innovations” such as anonymous feedback mechanisms, which could inform adjustments to better meet mothers’ needs;

“We always aim to create an environment where mothers feel supported and heard. The idea of an anonymous feedback mechanism hadn’t crossed our minds, but it’s certainly something we should consider. It would give us a chance to learn what’s working well and where we might need to make adjustments. It’s all about making sure the mums and their families have the best possible experience and support” (GC02).

Considering the uniqueness of the mother’s needs, most postnatal mothers strongly preferred “personalized guidance” through one-on-one sessions or smaller group discussions. They suggested that smaller, more personal discussion groups or one-on-one sessions would help address “unique questions and concerns.” They felt such formats could better support “specific concerns” compared to larger class settings;

“Ok, let’s look at it this way, some mothers might prefer face-to-face interactions or need more in-depth support that’s better provided in person. So, while over-the-phone consultations are beneficial, a combination of options, including in-person and small-group sessions, could better address the diverse needs of all mothers. I mean we still had to go in to the hospital to see our doctors so…” (MR01).

The healthcare professionals also acknowledged the importance of creating a supportive and personalized educational environment for expectant mothers. They discussed the potential benefits and the value of personalized guidance. However, they noted the challenges imposed by COVID-19 restrictions that have led to adjustments, such as moving sessions online or enlarging class sizes. They expressed how this move from in-person classes to virtual platforms has limited the ability to offer personalized interaction and support and shared the desire to improve in this area. They also underscored the importance of more intimate support structures and the inclusion of real-life stories and practical advice to make the classes more relevant and reassuring for mothers;

“Well, that’s the thing. Personalized guidance is something we value a lot, but with the Covid restrictions and all, we’ve had to hold back on how much of that we can offer. It’s been tough, not being able to provide the one-on-one support we know is so beneficial. We’ve had to move a lot of our sessions online or make them larger, which isn’t ideal. It’s a challenge, for sure, but we’re hoping to get back to more of that personal touch when we can” (CC03).

The postnatal mothers critiqued the classes for their “passive nature,” preferring more active forms of engagement; “I was just sitting there watching a screen without much chance to get involved.” Although the mothers said the classes were informative, they also expressed frustration with the lack of interactive opportunities, indicating a clear preference for a more engaged and participatory learning environment;

“The class had great information, don’t get me wrong, but it was mostly just watching and listening. I would’ve loved more opportunities to engage directly, maybe through discussions or practical exercises that could’ve made it feel more personal and less like just watching a webinar” (MG02).

Some postnatal mothers acknowledged efforts to incorporate interactivity through polls and quizzes. However, they felt the interactive elements did not provide the engaging learning experiences necessary to support their breastfeeding journeys. They noted the need for advanced interactive tools, such as “breakout rooms,” for discussions and one-on-one interactions with lactation consultants/midwives. They described these tools as essential for making their learning experience more “immersive” and “interactive.”

“In a topic as hands-on as breastfeeding, you really need to be able to interact more directly. The polls and quizzes were grand for a start, but they didn’t allow for back-and-forth conversation. There were times I had questions or wanted to hear more about others’ experiences, but the format just didn’t support that kind of interaction. It’s all very well knowing the theory, but breastfeeding is practical, isn’t it?” (MG01).

Most postnatal mothers expressed a preference for a prenatal breastfeeding educational model that transcends traditional didactic approaches, and they talked about the value of “shared experiences.” They noted the importance of hearing other mothers’ experiences, suggesting that real-life stories and practical tips could provide reassurance, a sense of relatability, and a deeper understanding that goes beyond “textbook” information;

“I mean, hearing other mums share their experiences would have provided real-life stories and practical tips that go beyond the textbook information presented in the class. Sometimes, knowing that someone else has faced similar challenges and succeeded can be incredibly reassuring” (MG03).

Further underscoring the importance of participatory learning and shared experience, the mothers suggested that leveraging the collective knowledge and experiences of other mothers in the classes can complement the expertise provided by the professionals, offering a richer, more diverse learning experience that benefits first-time mothers as well as those with prior experience. They noted the importance of giving voice to all participants and recognizing the wealth of knowledge they bring;

“You can imagine sitting down in front of your screen there for nearly two hours listening to someone speak. I think there are other ways to make the classes more interesting. Like watching the videos, I told you about was good, I also think that it would have been more interesting to hear from other moms who had breastfed or had a different point of view. It felt more like a lesson than a workshop where people”.

could talk to each other. I think the class would have been more interesting and easier to understand if there had been a mix of views and experiences” (MR05).

The postnatal mothers also raised concerns about the structured nature of the setup, noting that it discouraged direct questioning and encouraged passive participation through chat boxes. They pointed out the importance of real-time dialogue over indirect communication channels like chat boxes, expressing the need for more fluid, adaptive learning environments that encourage spontaneous interactions and discussions;

“I would say it was more of an informal arrangement, if you know what I mean. We weren’t told not to ask questions directly, but the way the class was set up made it clear that we should ask questions in the chat box. It would have been more interesting if people could talk to each other in real timely. Then again, it was quite a large class with so much to cover all at once. With the way the class was structured it would seem like an interruption to unmute and try to ask a question. I suppose the more convenient thing to do was just to type in the question un the chat box"(MC03).

The healthcare professionals acknowledged the challenges posed by the interactive approach, which aims to provide “real-time support.” They explained that the need for having two consultants—one to teach the class and the other to answer questions in the chat box—supports efficiency. Still, it might feel overwhelming for mothers, especially first-time mothers trying to absorb significant information. Furthermore, they also recognized that although some mothers might find the chat box system convenient for receiving immediate responses, it may not be suitable for everyone. They observed differences in mothers’ comfort levels with technology and noted that busy chat activity could lead to some questions being overlooked;

“Ah, yes, that’s a fair point. We do have two consultants for efficiency, but I see how it can be a bit overwhelming for the mothers listening and having to type in their questions in the chatbox. The idea is to give real-time support. While one of us is talking, the other answers questions so there’s no wait. But I understand it can be distracting, especially for first-time mums who are trying to absorb a lot of information” (LC01).

2.2-Adapting virtual prenatal breastfeeding education to reflect individual preferences through technology.

This subtheme reflects the perspectives of mothers and healthcare professionals on adapting virtual prenatal breastfeeding education to incorporate innovative strategies that empower mothers with the knowledge and confidence to make informed decisions about breastfeeding. The classes were mostly held on virtual platforms, and the mothers described the innovative potential of “leveraging technology” to deliver information and create a more personalized, engaging, and supportive learning environment. The mothers suggested a “forward-thinking approach” to prenatal breastfeeding education that could better support mothers’ breastfeeding decisions by addressing their collective concerns. They also suggested the introduction of “digital platforms” and innovative solutions utilizing “virtual reality scenarios” to simulate hands-on breastfeeding techniques. The mothers proposed “rethinking” the delivery of prenatal breastfeeding education to include tracking learning progress, setting reminders for practicing techniques, and logging their breastfeeding journeys;

“I think it would be beneficial to have some one-on-one sessions available. Even if it’s just a short video call with the lactation consultant to discuss personal concerns or questions. Group sessions are informative, but individual advice could make a big difference. Also, perhaps a virtual buddy system with other expectant mothers to share experiences and support each other” (MG03).

Further reinforcing the need for an innovative prenatal breastfeeding educational approach, the mothers emphasized the value of “personalized learning paths” tailored to individual concerns and learning styles, as determined by a “pre-class survey.” Postnatal mothers equally described the concept of a pre-class survey: “The pre-class survey I imagined would be a detailed questionnaire sent to participants before the class starts. It would ask about their current breastfeeding knowledge, specific concerns, learning preferences, and emotional state regarding breastfeeding.” They suggested that this approach would shift away from one-size-fits-all education towards more “adaptive models” that address the specific needs of each mother. For example, offering more resources and simulations focused on latching for those feeling anxious about it;

“I think personalized learning paths could make a big difference. Based on a pre-class survey about our concerns and learning styles, the class could offer tailored content. For instance, if a mother is particularly anxious about latching, she would receive more resources and simulations focused on that. Also, integrating a virtual support group feature where you can instantly connect with other mothers or a consultant for live advice could provide immediate reassurance and a sense of community” (MG04).

On the other hand, healthcare professionals acknowledged the need to enhance educational tools, mainly through online demonstrations focusing on crucial techniques like latching. They noted the multifaceted nature of learning, suggesting a blend of digital innovation with the irreplaceable value of direct human interaction;

“I would say that technology is ever-evolving, and yes, we do hope for enhancements that could provide a more “hands-on” virtual experience in the future. Even at that, the human aspect, the emotional and physical support that comes from being in the same room, might always be a missing piece in online education and support” (LC01).

The healthcare professionals also suggested adopting a "hybrid model” that combines online education with face-to-face sessions: “We’re looking into combining both online and face-to-face classes that combine online education with face-to-face sessions.” They noted that this approach would allow for personal interaction and hands-on practice, which can be reassuring for expectant mothers. Healthcare professionals described the hybrid model as a valuable solution to combine the strengths of both digital and traditional educational methods;

“A hybrid model could offer the best of both worlds. While online classes provide convenience and accessibility, adding face-to-face sessions could foster a deeper connection and allow for real-time feedback. We’re exploring options for small, in-person workshops that comply with safety guidelines, where mothers can practice techniques and ask questions in a supportive setting” (LC03).

The collective viewpoint of the healthcare professionals indicated that this approach assumes a level of digital literacy and access that may not be universal, posing potential barriers to inclusivity. They noted the challenge of seamlessly integrating these modalities to ensure that each complements the other without increasing disparities in access or engagement;

“We’re aware that not everyone has the same access to technology or feels comfortable in online settings. I personally think that the best way to address this is to offer resources in various formats and ensure our in-person sessions are small and welcoming. This way, we hope to reach as many mothers as possible without creating disparities in access or engagement” (LC01).

3.1- Standardization and coordination of guidance for enhanced clarity.

This sub-theme focuses on the perspectives of postnatal mothers and healthcare professionals on the standardization and quality of prenatal breastfeeding education in Ireland. It reflects the need for consistency and accuracy in the information delivered to expectant mothers and considers the potential role of prenatal classes in shaping breastfeeding decisions. This theme also examines the variability in competence among healthcare professionals, which can affect the quality and helpfulness of breastfeeding education for mothers. Most of the postnatal mothers expressed frustration with the lack of consistency in advice, noting that the confusion they felt was a matter of logistical inconvenience and a significant emotional burden, leading to “self-doubt” and a diminished sense of “self-efficacy;”

"But then, you’d get a bit of advice from one professional, and something quite different from another. It was confusing, to be honest. It threw me for a loop, it did. Here I was, trying to do the best for my wee one, and the mixed messages were stressing me out"(ML05).

However, the healthcare professionals addressed the inconsistency issue from a professional perspective: “Inconsistencies can arise due to varying personal experiences and training backgrounds among professionals.” The healthcare professionals acknowledged the diversity in training and experiences as significant contributors to the lack of uniformity in breastfeeding guidance, stressing the need for more precise, more unified guidance and recognizing the confusion and uncertainty that inconsistency can create for mothers;

Yes, I’m aware of this issue. The diversity in training and experiences among healthcare professionals can lead to differences in the breastfeeding advice we give. While we all aim to provide the best guidance, these variations can sometimes confuse mothers. It’s something that should really be worked on (LC01).

The postnatal mothers proffered the solution of a “unified approach” to breastfeeding education, with one stating, “They need to be on the same page. The professionals do. If they could just give consistent advice, it would make a world of difference.” They described this uniformity as a means to address confusion and stress, emphasising that consistency in guidance could positively shape mothers’ breastfeeding experiences. Furthermore, they described how the consequences of inconsistent advice extend beyond individual experiences, fostering a shared sense of confusion among mothers. One mother cited variation in recommendations on how often to feed the baby as a concrete example of the confusing advice that intensified mothers’ feelings of uncertainty;

“One consultant would be saying one thing about how often to feed the baby, and another would have a slightly different take. It was a bit confusing at times. You’re there, trying to learn the best you can for your wee one, and when you get mixed messages, it’s hard to know what’s best” (MC05).

The solution to this issue, as proposed by the healthcare professionals, involves the “standardization” of training across all healthcare professionals involved in prenatal care. Healthcare professionals unanimously indicated that standardization is essential for supporting all professionals, regardless of their role, in being equipped with the knowledge and skills to provide empathetic and supportive breastfeeding education;

“There needs to be a systems approach. The same checklist, same learning outcomes across board. The mother is entitled to get the same standard in all hospitals” (GC03).

The healthcare professionals also recognized the challenges of inconsistent advice for mothers; “Inconsistent advice can certainly throw a spanner in the works. It can confuse the mothers, making them second-guess their choice to breastfeed.” They reflected on a deep understanding of the anxiety and uncertainty that inconsistent guidance can create and emphasized that the overarching goal is to “empower mothers,” not increase their anxiety, while diligently striving to provide consistent and clear advice. A consensus opinion of the mothers reflects a more “coordinated and consistent approach” to breastfeeding education, emphasizing the necessity of clear, unified guidance to support mothers in their breastfeeding journey. Their respective narratives echoed the urgent need for a standardized approach to prenatal breastfeeding guidance, advocating for clarity and accuracy from healthcare professionals;

“I think a more coordinated approach to the information provided would be beneficial. Maybe having a section of the class where they address common misconceptions or differences in advice could help. Also, it would be great if they could provide some resources for further reading, where the information aligns with what was taught in the class” (ML05).

On the other hand, the healthcare professionals pointed out a “systemic” issue affecting the quality of prenatal breastfeeding education, drawing attention to the importance of enhanced communication, coordination, and standardization among healthcare professionals to support the delivery of consistent and evidence-based breastfeeding education;

"Another challenge is ensuring communication and coordination between lactation consultants and midwives. All staff must be on the same page and working together to provide consistent, evidence-based support to mothers" (GC01).

Additionally, the lactation consultant highlighted the importance of regular workshops and seminars and creating a supportive network where professionals can discuss cases and share advice to maintain a “consistent approach” to breastfeeding education. They also emphasised the importance of continuous professional development initiatives to keep healthcare professionals abreast of the latest breastfeeding practices and research, supporting a consistent approach to prenatal breastfeeding education;

“Regular workshops and seminars could also help keep everyone updated on the latest breastfeeding practices and research. Additionally, creating a supportive network where professionals can discuss cases and share advice would help maintain a consistent approach. Again, providing ongoing training and education for lactation consultants and midwives on best practices for supporting breastfeeding mothers is essential. This can help ensure that all staff are current on the latest research and recommendations for breastfeeding support” (CC03).

4.1- Socio-cultural and partner dynamics in breastfeeding decisions.

This subtheme highlights the views of postnatal mothers and healthcare professionals on the significant impact of partner involvement in breastfeeding classes. Most postnatal mothers believed that the direct participation of their partners in these classes would have enhanced their partner’s understanding and ability to support the breastfeeding process. They illustrated the perceived value of first-hand knowledge and engagement of partners;

“Yeah, well, my partner was really supportive, but I think it would have helped him to understand the process better and know how he could help me. Plus, he would have been able to ask questions and get more involved in the process” (MR01).

The healthcare professionals’ view on partner involvement complemented the postnatal mother’s perspective. They emphasized the critical need to equip partners with practical skills and knowledge, fostering a more empowered and collaborative approach to breastfeeding support; “Well, partners can be a huge help in many ways… It’s about making decisions together as a team". Moreover, the postnatal mothers express a shared understanding of the challenges associated with breastfeeding, highlighting that while partners are supportive, their lack of knowledge on how to assist practically can be a significant barrier. They asserted the critical need for educating partners not just on the importance of breastfeeding but also on practical ways they can contribute to easing the mother’s burden;

“My partner was supportive, but he didn’t really know how to help me with breastfeeding. My mother and sister both breastfed their children and were helpful with advice, but I felt like they didn’t really understand how challenging it could be for me” (MG03).

Furthermore, the healthcare practitioner’s perspectives reinforced the notion that breastfeeding success is closely linked to a robust support system including partners. They acknowledged breastfeeding is a “team effort" and the importance of involving partners "as much as possible". This aligns with the mothers’ desires for more “inclusive” breastfeeding educational practices. Yet, the lactation consultants also note a “shortfall” in partner attendance, indicating a potential area for improvement in how these classes are structured to encourage partner participation better;

“We’ve found that mothers who are highly motivated and committed to breastfeeding tend to have the most success, regardless of their individual circumstances. We also see higher rates of success among mothers who have a strong support system, whether that’s a partner, family member, or lactation consultant” (LC01).

Both postnatal mothers and healthcare professionals agreed on the significance of the “socio-cultural” insights in breastfeeding education. The postnatal mothers specifically expressed the desire for broader “community support” and recognition of breastfeeding as a “shared responsibility”. They emphasized that societal perceptions and norms play a substantial role in shaping individual breastfeeding experiences. Collaboratively, the healthcare professionals reinforced this idea by demonstrating professional awareness of the socio-cultural factors in shaping breafeeding breastfeeding practices, aiming to “support not just the mammy but the whole family”. This aligns with an assertion by one mother that "breastfeeding isn’t a solitary task, it’s a family affair", speaking to the need for a cultural shift towards more inclusive prenatal breastfeeding educational support for mothers;

“If there were more understanding and support in the community, then breastfeeding mothers might feel less isolated and under pressure. Also, it might help if more people understand that it’s not only the mum’s job to feed and nurture the baby, but it’s also important for partners and family members to take active roles in supporting and participating in this process” (GM03).

4.2-Breastfeeding confidence in relation to societal norms.

This subtheme explores the challenges postnatal mothers face with breastfeeding in public and healthcare professionals’ perspectives on discussing this topic during classes. Despite a perceived shift toward greater societal acceptance, it indicates the absence of explicit discussion in education classes. The postnatal mothers highlighted the lack of specific discussion on “breastfeeding in public” during the classes. Although the mothers noted a "shift towards more acceptance" of public breastfeeding and indicated a changing societal landscape, they emphasized the need for explicit support and guidance to navigate “societal attitudes” towards it in public. They reiterated the need for openness and understanding, pointing to the essential role of societal support in fostering a “breastfeeding-friendly” environment;

“No, the classes didn’t specifically address breastfeeding in public, but I do think it would be helpful for future classes to include information on this topic. I think there’s definitely been a shift towards more acceptance of breastfeeding in public in recent years in this country. I also think it’s very important for people to be more open to and understanding of breastfeeding in public” (MR02).

Some of the postnatal mothers who had attempted breastfeeding in public narrated their experience of breastfeeding in public, revealing a series of reactions from onlookers, ranging from indifference to overt staring. They highlight the varied societal responses to breastfeeding and mothers’ challenges in balancing natural motherhood practices with societal perceptions, underscoring the conflict between individual confidence and societal norms;

“Yes, I have breastfed my baby in public before, and people’s reactions were varied. Some people appeared unconcerned, while others just stared. It can be difficult to breastfeed in public, I believe that breastfeeding is a natural and necessary aspect of motherhood, and that women should not be made to feel humiliated or for breastfeeding in public” (CM04).

A typical example of the postnatal mother’s experience with breastfeeding in public is captured in one of the mother’s expressions of her pre-existing determination to breastfeed; “I was set on breastfeeding anyway”. However, she also acknowledged the potential impacts of societal pressure on her decision to breastfeed, which made her feel "already a bit unsure”. She highlighted the importance of more discussions on "real-life experiences of breastfeeding in public" and the need for practical advice beyond the reassurance that "it’s legal,". She suggests that legal knowledge alone is insufficient to build confidence against societal scrutiny;

“I was set on breastfeeding anyway. But I think it might affect some women, especially those already feeling a bit unsure. And even for me, it would have been comforting to have more discussion about the real-life experiences of breastfeeding in public, rather than just the ’you can do it, it’s legal’ part, you know?” (CM04).

The healthcare professionals acknowledged the importance of discussing public breastfeeding in the classes, particularly in the “Irish context”, where a discrepancy exists between high initiation and low continuation rates. They identified “societal challenges” as a significant barrier to sustained breastfeeding;

“I definitely think it’s important to discuss breastfeeding in public in these classes, especially in the Irish context. Ireland has a relatively high breastfeeding initiation rate, but a low rate of breastfeeding continuation, which suggests that many mothers may be facing challenges with breastfeeding in public. By discussing breastfeeding in public and addressing any concerns or fears that mothers may have, we can help to empower them to breastfeed confidently and comfortably in any setting” (RC02).

The postnatal mothers drew the comparison between the support for breastfeeding within their network and the “awkwardness and stigma” associated with breastfeeding in public. They described the internal conflict that mothers may face, torn between the support of their immediate circle and the broader societal pressures, potentially undermining confidence in breastfeeding publicly;

“In me own circle, there’s a fair bit of breastfeeding support. Many of the mums I know, they’ve breastfed their wee ones and they’re all for it. But, there’s also a good few who find it a bit awkward, you know, doing’ it in public or around other people. There’s still a bit of a stigma attached to it, like. Not everyone’s comfortable with it” (RM04).

Considering the acceptance of breastfeeding in public within the Irish context, the healthcare professionals acknowledged the challenges but noted a shift towards greater acceptance, suggesting that "Irish society as a whole is changing and becoming a more accepting place for breastfeeding mothers." However, they expressed an optimistic view of societal evolution, albeit recognizing the current complexities of breastfeeding in public as informed by "both national norms and personal views."

“Breastfeeding in public is a complicated issue, especially here in Ireland. that is affected by both national norms and personal views, but I think that the Irish society as a whole is changing and becoming a more accepting place for breastfeeding mothers” (LC03).

From the healthcare practitioner’s perspective, the lactation consultants acknowledged breastfeeding mothers’ multifaceted challenges, including "lack of support from family and friends, returning to work, and difficulty breastfeeding in public”. Their emphasis on the pressure on mothers to formula feed "due to cultural or societal expectations" aligns with the mothers’ concerns about societal attitudes. The healthcare professionals highlighted their role in "educating and empowering mothers to make informed decisions", advocating for their rights to breastfeed in any setting and overcoming the barriers posed by societal norms;

“One of the most common deterrents to breastfeeding in Ireland is the lack of support for breastfeeding in public places. Although Limerick city is breastfeeding friendly, but we still have a lot to do in this area in form of advocacy and creating awareness, I mean the government can do better because many mothers feel uncomfortable or judged when they try to breastfeed in public, which can lead them to avoid breastfeeding altogether” (LC03)