Reconciling motherhood ideology: a classic grounded theory of breastfeeding grief

Breastfeeding grief is a form of complicated and disenfranchised grief which occurs when mothers are unable to achieve their breastfeeding goals; it is characterized by profound sadness and a sense of failure that negatively impact perinatal mental health. The scientific literature consists of very few studies on breastfeeding grief; and a critical gap remains about the primary concern of mothers experiencing breastfeeding grief and how these mothers cope with this concern. This study includes the first substantive grounded theory of breastfeeding grief using a classic grounded theory design. A purposive sample of 46 mothers who are experiencing/have experienced breastfeeding grief completed unstructured virtual individual interviews, and an additional theoretical sample of 19 mothers completed semi-structured individual interviews. Interviews were transcribed verbatim and coded in Quirkos. Data were analyzed using constant comparative analysis, which resulted in the development of a substantive grounded theory. The theory has 3 postulations: 1) the main concern of mothers experiencing breastfeeding is unattained perception of motherhood, 2) the basic psychosocial process used to cope with unattained perception of motherhood is reconciling motherhood ideology, which occurs in 5 stages (responding to disruptions, disavowing reality, grieving, accepting reality, and reframing motherhood ideology), and 3) factors accounting for variation in reconciling motherhood include self-worth, personality, social sentiment/norm, context, and conditions. This theory underscores breastfeeding grief as indeed a perinatal mental health concern, that transcends affective, cognitive, and psychomotor domains. Movement across the stages of reconciling breastfeeding grief is cyclical, not progressive. Therefore, focused psychological interventions to address this concern are urgently warranted.