Despite the know benefits and recommendations for breastfeeding, women receiving MAT often face challenges. This may be due to misconceptions about the effects of MAT on the infant and the stigma associated with addiction. According to the CDC (2012), rates of breastfeeding initiation among women receiving MAT are approximately 24-46%.7 This rate is low in comparison to an overall national breastfeeding initiation rate of 77%.7 Further, for women receiving MAT who do initiate breastfeeding, more than half discontinue within one week. 5
In general, women make infant feeding decisions based on their perceptions of a woman’s role as a mother, life experiences, and perceptions of societal response and support.8,9,10 While women may view infant feeding as an important part of their mothering role, multi-level, contextual factors influence the way in which women receiving MAT navigate this role. Little research exists to explain how women receiving MAT make infant feeding decisions. Therefore, the purpose of this qualitative pilot study was to explore the contextual factors that influence the infant feeding decisions of women receiving MAT.
Research Questions: How do mothers who are receiving MAT for an OUD make infant feeding decisions?
Methods: This pilot study was part of a larger study focused on the impact of kangaroo mother care on mother-infant dyads impacted by opioid use. Institutional review board approval was obtained prior to the onset of any data collection. Participants received an information sheet and provided verbal consent at enrollment. A qualitative descriptive design was used. Data were collected through semi-structured, individual, audio taped interviews with eight mothers in the early postpartum period (no more than six months post-delivery). All women were receiving MAT for an OUD at the time of the interview. Each woman was interviewed once in a private room in the hospital or the addiction treatment center where they were receiving recovery care. The interviews lasted approximately 30-60 minutes and were transcribed verbatim using a professional transcription service. We used qualitative content analysis to analyze all data.
Findings: Our data analysis revealed three common categories: 1) what I heard about breastfeeding and MAT, 2) who/what influenced my infant feeding decision, and 3) how I made my decision.
Our findings highlight the need for greater support of women who are receiving MAT during the infant feeding decision making process. In the category what I heard about breastfeeding, mothers reported receiving conflicting information regarding their ability to breastfeed while receiving MAT. The women also described the negative attitudes that they felt they received from healthcare providers, family members, and peers surrounding breastfeeding and MAT. One mother stated, “My dad keeps telling me about the methadone going through my milk. He’s real rude about it too. He’s like, I don’t even know why you’re pumping… you’re just going to get the baby hooked.”
Multiple factors contributed to the second category of who/what influenced my infant feeding decision. For most mothers, the knowledge of the benefits of breastfeeding for infants largely influenced their infant feeding choice. Most mothers decided to breastfeed because they wanted to, “…do anything to relieve their infant’s withdrawal symptoms.” Several mothers said that breastfeeding was a way for them to atone for the guilt they felt about their infants’ withdrawal.
“I wasn’t going to breastfeed at first. But I see all the withdrawal symptoms and I feel bad. I feel like I’m helping him and I feel better knowing that he has milk here when I’m at home and I’m not with him. He has milk here that’s going to help him feel better.”
In the last category, how I made my decision, the women reported typical breastfeeding concerns including: the embarrassment of breastfeeding in public, insufficient milk supply, maternal nutrition and health, and pain with breastfeeding. They reported that the benefits of breastfeeding were a strong contributing factor to their decision to breastfeed; however, the mothers felt that the information they received regarding the safety of breastfeeding while receiving MAT influenced their ultimate decision to breastfeed or formula feed. Additionally, the women felt that their love for their infants encouraged them to continue breastfeeding when they wanted to give up.
“But now she’s home, I know what drugs I'm taking and what I'm not so I am feeding her breastmilk. Yeah, because she’s my daughter and she’s home with me now. So, I don’t have to ask nobody anymore. I’m doing the best that I can for her.”
The findings from this study contribute to the body of knowledge surrounding infant feeding decision making in mothers receiving MAT. This knowledge provides a basis for developing and testing effective and sustainable interventions to improve infant feeding outcomes in this population of mothers and infants.