Sample characteristics
A total of 14 mothers between 24 and 54 years old (mean age: 34 years) were interviewed. At time of the study, the women had been living in Ireland for between three to 18 years (mean duration: nine years). Eight mothers were primiparous, while six had two children (one with twins). Ten had achieved third-level education while four secondary or training school education. Over half of the participants were housewives or had part-time, non-professional jobs; while six were self-employed or had professional jobs. The majority had an annual family income over 30,000 Euro (before tax); three had an annual family income of 15,000-30,000 Euro. All held positive attitudes towards exclusive breastfeeding because they believed that exclusive breastfeeding for four to six months benefited babies, mothers and society.
The results of the thematic analyses are summarized below. The four themes identified were: 1) being strong and getting support-suggestions for new immigrant mothers; 2) creating a supportive workplace-suggestions for employers; 3) addressing cultural differences and promoting breastfeeding in the hospital-suggestions for health care professionals; and 4) promoting societal and policy changes for breastfeeding-suggestions for the government.
Being Strong and Getting Support-Suggestion for New Immigrant Mothers
Breastfeeding is not easy, even among immigrant mothers who managed to exclusively breastfeed their babies. All participants mentioned that strong willpower and persistence were key characteristics for their success in breastfeeding. One mom said, “I was very determined when I decide to do this (breastfeeding), so I think strong determination is very important.” (P1). Another mom said, “it was inconvenient, but when I thought this (breastfeeding) was good for my baby, I would conquer any difficulties.” (P4) Similarly, the other mom said, “first and foremost, you need to be strong, you must stay strong, you can complain, but do not give up. If I think this is the right thing to do, I will do it” (P5). Generally, it was suggested by the study participants that new mothers should believe in themselves and remain positive for breastfeeding.
Many participants also suggested getting support from family members, which was crucial for new moms to initiate and continue breastfeeding. When probed about who provided the most support during breastfeeding, many moms mentioned their parents. One mom said, “I don’t think I can do this (exclusive breastfeeding) without the help of my parents. For example, when my babies cried in the middle of the night, I couldn’t pick them up because I was in the middle of pumping milk. At that time, my mom and dad would come and help taking care of them. If I was all by oneself, I don’t know how I could have done this.” (P3) Besides parents, some moms emphasized the important role of their husband in providing support for breastfeeding. One mom said, “my husband, he is very supportive for me to breastfeed my baby. For example, when I felt embarrassed to breastfed in public, he encouraged me and said it didn’t matter what other people say.” (P1) Some other moms mentioned that their husband was able to adjust the working hours to fit their breastfeeding schedule so they didn’t have to do this alone.
In addition to family support, the participants also suggested new moms to get help from their friends who had breastfeeding experiences. One mother suggested, “as they were experienced, they could understand your difficulties, tolerance the noise from the baby, and provide timely help when necessary.” (P14) When family members were not around to provide support, it might be a good way for inexperienced new moms to reach out to their friends who could offer some practical help and emotional support.
Creating a Supportive Workplace-Suggestions for Employers
Some working mothers suggested employers should find ways to support breastfeeding moms who came back to work following maternity leaves. One mom suggested setting up nurseries within or near the workplace, she said, “the nurseries near my workplace were convenient for me to breastfeed, (so this might be a way to support working moms who wish to continue breastfeeding).” (P13) Besides setting up nurseries, other moms also provided suggestions such as extending the paid maternity leave, creating a private space for breastfeeding moms who need to pump, and providing facilities to store breast milk. Notably, positive attitudes and mutual understanding from the employers and colleagues were also mentioned by some moms as important factors in promoting breastfeeding in workplace. One mom said, “I managed to continue breastfeeding exclusively after returning to work because my colleagues understood my situation well.” (P3) This highlighted the importance of create a breastfeeding-friendly environment at the workplace.
Addressing Cultural Differences and Promoting Breastfeeding in the Hospital-Suggestions for Health Care Professionals
In general, participants felt the health care professionals in Irish hospitals and health centers should provide more information about breastfeeding. One mom indicated “in Ireland, people pay less attention to breastfeeding (than in China).” (P14) Similarly, another mom said, “breastfeeding was seldom mentioned in medical advice. Doctors should encourage mothers to breastfeed.” (P1) Some participants suggested that health care professionals should combine breastfeeding knowledge with breastfeeding practice in prenatal education classes for future breastfeeding initiation. “Primipara were taught breastfeeding knowledge, but it’s difficult for them to operate in practice… Practice is needed to assist the understanding of theoretical knowledge.” (P14)
When providing information, most participants suggested that health care professionals should address the language barriers encountered by Chinese immigrant mothers. One mom mentioned, “in fact, there was still a language barrier. When I communicated with a health care professional, there were many professional terminologies which troubled me. So, I think maybe more Chinese nurses and midwives would be better.” (P6). Other participants also indicated language-specific health care professionals should be recruited and trained to provide support and prenatal education for immigrant mothers since many Chinese immigrant mothers in Ireland were the first generation and had difficulties understanding English, especially professional terminologies. In addition, breastfeeding support groups targeting Chinese immigrant mothers to share experiences was also suggested.
Another suggestion for the health care professional was to address the conflicting information received by Chinese immigrant mothers from their country of origin and from Ireland. For example, one mother indicated that treatments of breast milk jaundice by Chinese doctors and Irish doctors were completely different. “My baby had jaundice due to breastfeeding. Chinese doctors advised to stop breastfeeding for one or two weeks, but Irish medical staff advised to increase breastfeeding frequency to promote infant digest[ion] and wet napp[ies].” (P6) Participants suggested health care professional should consider the cultural differences and resolve these confusions on whether they should or should not breastfeed.
Promoting Societal and Policy Changes for Breastfeeding-Suggestions for the government
Most participants suggested the government agencies to increase and enrich breastfeeding publicity by various means. For example, enhancement of publicity at clinics, communities and television advertisements could be possible venues for mothers to understand the benefits of breastfeeding. One mom mentioned, “the government still need to increase the publicity to let more mothers know that breast milk is better than bottles.” (P9) In order to reach the target audiences, many participants suggested that breastfeeding should be publicized in Chinese and in various forms (e.g., brochures, books). “Add some Chinese information on breastfeeding.” (P12). “Publicity can be made through newspapers and television.” (P5). “Publicizing breastfeeding to Chinese immigrants by brochures may be better, because they don’t like to join clubs.” (P6) Regarding the content of breastfeeding promotion materials, participants provide some topics such as emphasizing that breastfeeding is natural, necessary, and worthwhile when compared to formula feeding. “I think you can compare breast milk with formula, and present in a table.” (P9) This may help moms to understand the pros and cons of breastfeeding and formula feeding. Other topics includes providing education on benefits of breastfeeding, correcting breastfeeding misconceptions, and discussing solutions to breastfeeding problems such as for mothers taking medication.
Besides increasing publicity, some participants suggested Irish governmental agencies should amend the laws and regulations to provide more breastfeeding support for Chinese immigrant mothers. One mom suggested providing financial subsidies during maternity leave. “The government could give appropriate subsidies for breastfeeding, such as dozens of Euros a month.” (P11) Others suggested developing new social security policies for Chinese immigrants, such as narrowing the gap of social welfare benefits between Irish and immigrant residents. “As there is a big gap of social welfare between immigrants and Irish, I do hope that Ireland could provide special social welfare policy for immigrants.” (P14) Providing a longer-term Irish visa for Chinese mothers came to Ireland for education-related reasons was also suggested to ensure they could breastfeed for six months in Ireland after birth. A newly arrived mother said, “I attained language class in the second month after delivery for student visa which caused difficulties in exclusive breastfeeding.” (P14)
Another common suggestion was that government agencies should develop policies to urge public places, such as shopping malls, to set up more well-equipped breastfeeding facilities. One mom said “There were many places for nappy changing, but breastfeeding facilities are not enough.” (P5). Some participants further suggested to equip these rooms with seats, water and breast milk heaters to better enhance breastfeeding experiences.