Lomax Helen 2013 . Troubled talk and tal
CHAPTER EIGHT
Troubled talk and talk about troubles:
moral cultures of infant feeding in
professional, policy and parenting
discourses
Helen Lomax
Introduction
This chapter examines the ways in which policy agendas and contemporary
notions of the ‘good mother’ frame infant feeding practices, rendering them a
site of moral and interactional trouble. Drawing on analysis of mothers’ talk with
midwives during the irst days of motherhood, the chapter explores the ways in
which breastfeeding confers a positive maternal identity, while choosing not to do
so is associated with a deicit identity against which mothers struggle to present
themselves as good parents. The chapter suggests that mothers’ interactions with
professionals are important places for exploring the ways in which ‘ordinary’ family
practices may be troubled by professional and policy agendas that may conlict
with women’s embodied experiences and cultural beliefs about what constitutes a
healthy, well-fed baby. A focus on these encounters makes visible the rich texture
of maternal labour and its complex and troubling relationship with policy.
Infant feeding: a troubled policy terrain?
Despite widely reported health beneits and a national and international policy
agenda to increase the uptake and duration of breastfeeding, the UK has one of
the lowest breastfeeding rates in the developed world (WHO, 2003; Bolling et
al, 2007; DH, 2007; ONS, 2007). While both the Department of Health and the
World Health Organization recommend that mothers breastfeed exclusively for
the irst six months, most do not, and by six months of age, only 2% of infants
are wholly breastfed and 75% receive no breast milk at all (Bolling et al, 2007;
ONS, 2007; Hoddinott et al, 2008). However, while formula-feeding might
be considered ‘normal’ in statistical terms, survey and interview-based research
suggests that, for many, it is experienced as ‘non-normative’ and troubling.While
the majority of mothers report their intentions to breastfeed, a signiicant number
express regret at stopping breastfeeding earlier than they had anticipated and feel
97
Family troubles?
stigmatised for their decisions not to breastfeed or to stop breastfeeding (Dykes,
2005; Hoddinott et al, 2008), indicating a troubling gap between mothers’
expectations and experiences.
A useful perspective on this issue is ofered by Lee’s suggestion that mothers’
breastfeeding troubles are symptomatic of a wider political agenda and the
intensiication of parenting, such that matters that were once the private concerns
of families are increasingly contested and problematised (Knaak, 2005; Lee and
Bristow, 2009; Lee et al, 2010). As Lee and others argue, the construction of
breastfeeding in UK policy as the only reasonable maternal choice relects the
currency of the idea that parents themselves present a signiicant risk to their
children’s health and a means by which mothers are increasingly measured and
measure themselves (Blum, 2000; Murphy, 1999; Marshall et al, 2007; Kukla, 2008;
Knaak, 2010; Lee et al, 2010). However, while this analysis ofers an important
critique of UK public policy, in empirical terms, its restriction to an examination
of policy documents and survey and interview data is such that it ofers limited
insight into mothers’ lived experiences at this time.
Of further relevance are the tensions suggested by policy and guidance,
which tasks midwives, the primary providers of care during this period, with
both working to a woman-centred agenda and also promoting and supporting
breastfeeding (Page and McCandlish, 2006; Leap, 2009). This may be illustrated
with reference to the Royal College of Midwives’ (2004, p 1) breastfeeding
position statement, which airms midwives’ requirement to ‘promote informed
choice and support women in their chosen method of infant feeding’, and in the
National Institute for Clinical Excellence (NICE, 2006) guidance in which the
importance of information, advice and support for breastfeeding is prioritised
alongside an emphasis on woman- and baby-centred care that recognises ‘the
views, beliefs and values of the woman, her partner and her family’. However,
despite wider feminist interest in mothers’‘complicated relationship with medical
institutions and spaces’ (Kukla, 2008, p 69), the ways in which these policy priorities
are mobilised in practice has been little researched.
Methods and analysis
This chapter addresses this deicit in the literature in order to examine the ways
in which mothers and midwives talk about and practically manage infant feeding
at the level of service delivery. Drawing on researcher-generated videotapes of
midwives’ routine visits to mothers (Lomax, 2005, 2011), the analysis considers
the ways in which policy priorities are ‘talked into being’ (Heritage, 1984) and
the implications for women’s moral identities. For brevity, the analysis focuses on
three visits to three mothers: ‘Megan’, who is successfully breastfeeding her irst
baby;‘Emily’, who is experiencing diiculties breastfeeding her second baby; and
‘Chloe’, a irst-time mother who is formula-feeding her daughter. Data, which was
transcribed and analysed using a modiied form of conversation analysis (c.a.) and
discursive analysis (d.a.) (Reynolds and Taylor, 2005; Wooitt, 2005; Heath et al,
98
Troubled talk and talk about troubles
2010), is presented in the form of transcribed sequences in order to make visible
the ways in which dominant and residual narratives (eg about what constitutes
appropriate mothering) are deployed and resisted.
A focus on the ‘architecture of talk’ (Heritage, 1984), which encompasses the
ways in which turns at talk are allocated – whether they proceed smoothly or
dysluently, or display agreement or resistance – enables an exploration of the ways
in which particular maternal identities are discursively constructed. Drawing on
these examples, the analysis explores the ways in which mothers’ infant feeding
choices are discursively sanctioned and how this is made visible through the
absence or presence of ‘trouble’.This includes the ways in which breastfeeding is
acknowledged to present both practical and corporeal challenges for mothers (talk
is about troubles), but, more particularly, the ways in which midwives’ questions
and mothers’ responses generate accounts that are universally positioned vis-a-vis
a discourse of ‘breast is best’ (through which talk is troubled).Accordingly, mothers
who do not breastfeed or who are contemplating stopping can be seen do a great
deal of rhetorical work to present their decisions as legitimate in order to defend
against the implicit allegation of a less than ideal ‘choice’. As the chapter explores,
the degree to which mothers acknowledge or rebuke this charge is apparent in
the ways in which talk is visibly dysluent or ‘troubled’.
Breast is best? A morally sanctioned maternal identity
The idea that breastfeeding confers a particular identity as a ‘good mother’ is
immediately evident in the midwife’s opening remarks in Megan’s consultation
(reproduced in Figure 8.11).
Analysis of this sequence suggests unequivocal support for the mother’s
decision to breastfeed. The midwife’s repeated use of positive and enthusiastic
descriptions of the baby as ‘look[ing] so happy’ (line 5) and the mother herself as
‘a wonderful breastfeeder’ (line 11) convey the appropriateness of Megan’s choice
and its association with a positive maternal identity. However, the midwife’s
construction of the mother as ‘doing so brilliantly’ is not entirely unproblematic,
Megan’s question ‘how do you know if he’s actually taking anything in?’ (lines
3–4) articulates a familiar concern that it is not possible to measure the amount a
breastfed baby consumes.The midwife’s response, which includes the assessment
that Megan is ‘doing brilliantly’, implies that she is succeeding at something that
is potentially quite diicult in a way that also sidesteps Megan’s concerns. As a
strategy, its limitations may be deduced by the re-emergence of Megan’s unease
moments later (line 17: ‘is it normally – are there normally problems?’). Of
signiicance, too, are the ways in which Megan phrases her unease, foregrounding
it as connected to her own inexperience in ways that moderate its threat to the
midwife’s construction of untroubled breastfeeding. In this way, Megan’s talk
acknowledges the dominance of a rhetoric in which breastfeeding is constructed
as natural and uncomplicated, while also making visible the midwife’s rights within
the asymmetrical order of interaction to deine it as such.
99
Family troubles?
Figure 8.1: Megan: a sanctioned identity
1
2
M
3
4
5
C
M
6
7
8
9
10
11
12
13
14
15
16
17
18
C
M
C
M
C
M
C
I don’t like to (.) ur: interrupt you when you are
feeding so beautifully
(2.3)
I was just-I don’t-how do you know if he’s actually
taking anything (in) (.)
well he certainly looks as if he is he looks so happy
(0.9)
u↑m (.) he’s getting collostrum of course at the
[
um:
moment (.) you haven’t got gallons
there of course but I mean you know
it does look like it ahahah
you’re going to be a wonderful breastfeeder
I mean you’re you’re doing so brilliantly
is this ↑really your first baby
um::
I can’t believe it ahaha (0.8) how
did you get to be so good! ahah
((smiling)) is it normally-are there
normally problems?
Breastfeeding as troubling: a deficit maternal identity?
The theme of glossed and silenced troubles is continued in Emily’s encounter
with her midwife (see Figure 8.2), which begins with Emily’s vivid description
of leaking breasts (lines 71–77), a fractious and unhappy baby (lines 3–5) and her
eforts to manage these diiculties, including her decision to supplement with
formula milk (line 5).
Emily’s talk presents her experiences as practically diicult but herself as
a morally active mother. Analysis of the ways in which her talk is organised
reveals the ways in which she robustly constructs her decision to formula-feed
as predicated not on ‘choice’ – which might engender a charge of self-interest
– but as the desperate last resort for a baby that ‘wouldn’t settle’ and ‘was gettin’
in a state’. Moreover, her explanation that formula was only ofered after she
had breastfed positions her action as a supplement ofered by a mother who is
ordinarily committed to breastfeeding, in ways that defend against the ‘moral
danger’ associated with formula-feeding (Murphy, 1999).The midwife’s response
‘That’s a shame’ (quietly delivered and accompanied with mild laughter) displays
and makes visible that this is indeed a less than ideal practice.
The imperative for Emily to justify her decision is evident in the embodied
and practical context in which she elaborates her explanation. As the video
and transcript reveal, Emily, who has experienced an extended hospital stay
following her baby’s admission to special care, is struggling to catch up with
100
Troubled talk and talk about troubles
Figure 8.2: Emily: a troubled maternal identity
1
2
3
4
5
M
M
C
6
7
8
9
10
M
C
M
C
11
12
M
C
66
67
68
69
70
71
72
73
74
75
76
77
78
M
C
M
C
M
Are you-you’re putting her on and she’s
going on alright is she?
Yeah she’s going on alright (.) Last night she
wouldn’t settle um and I tried to feed and she
was gettin’ in a state so I did make up a bottle
of SMA
Oh right
Um and I gave her that
*That’s a shame when you have got all that ahaha*
That’s right yeah ((laughter))
But um she was getting frustrated and um
((Mother gets up to let dog in))
yeah
she had fed a lot off me but then um
And you know she might feed every two
hours one day and then she’ll gradually sort
herself out ((inaudible – dog barking))
Because last night I mean – Whistler ((dog))
GO AND LIE DOWN– I
um I mean last night I put towels under
the sheet because I was actually saturated
((inaudible – dog barking))
Um and I thought well it ain’t getting on the
mattress and I thought well if it is going to
be like this I was going to give up you know
like breastfeeding because I can’t you know
Oh no don’t do that!
housework (there are piles of laundry waiting to be sorted, her attention to
which constitutes an ongoing disruption to proceedings), she also has a toddler
and two large dogs, whose noisy presence continually threatens to disrupt the
low of the visit. Physically, she is in considerable discomfort. Her breasts leak, she
has perineal trauma, untreated cystitis and severe bruising to her thigh caused by
the administration of pain relief during labour. However, within the context of
breastfeeding ‘advice’, these diiculties appear themselves insuicient to justify her
decision. They are barely acknowledged by the midwife, who deploys minimal
response tokens (Heritage, 1984) (lines 6: ‘Oh right’; and line 11: ‘yeh’), which
avoid engagement with the emotional content of Emily’s speech. Moreover,
the suggestion that breastfeeding may necessitate feeding every two hours (line
66) ignores the very evident practical diiculties this will entail in this context.
What it does illustrate, however, is the ways in which the imperative to improve
breastfeeding rates may conlict with a policy agenda that seeks to prioritise
woman-centred care.
101
Family troubles?
Formula-feeding: troubling the normal?
This inal sequence considers the ways in which Chloe’s decision to formulafeed is troubled in her encounter with her midwife (see Figure 8.3).The ensuing
talk indicates a wider moral and policy framework within which mothers are
called to account for their decisions in ways that can be seen to trouble ‘normal’
decisions to formula-feed.
Figure 8.3: Chloe: a stigmatised maternal identity
51
M
52
53
C
M
54
55
C
M
56
57
M
C
58
59
60
61
62
M
C
M
C
M
63
64
65
66
C
M
C
M
67
(.)
68
M
Are you feedin’ her?(.2) yourself breastfeeding?
[ ]
no
bottle-feeding yes?
[
]
bottle-feeding yes
right
(1.2)
that’s what you planned to do was it?
yes
[
yeah^
It’s never really appealed to me
^Fair enough^ she’ll survive alright love
/That’s it/ She’s doin’ fine
and what you given’ her SMA? Cow and Gate?
[ ]
oyster *is it oyster?*
Oster-Oster?
yeah
(1.5) ((smiling at baby))
She’s lovely
M
I’ll leave he asleep for a bit …
This is immediately evident in the midwife’s opening question, which assumes
(incorrectly) that Chloe is breastfeeding (line 51:‘Are you feedin’ her?’), generating
an uncomfortable pause and necessitating a clariication (the tag ‘yourself
breastfeeding?’). Further diiculty is generated by Chloe’s negative response,
which, as the c.a. literature elaborates, is ‘dis-preferred’ in the normative order
of conversation. While speakers usually organise questions in ways that solicit
agreement and social cohesion (Hutchby and Wooitt, 1998), talk in this sequence
becomes rapidly dysluent, characterised by non-normative pauses in which the
mother negates to speak, signalling her increased disengagement and discomfort
with this topic (lines 55–56, 66–67 and 67–68). Chloe’s refusals necessitate the
midwife’s additional turns (eg at line 56 ‘that’s what you planned to do was it?’).
102
Troubled talk and talk about troubles
However, rather than repairing the interaction, this generates further trouble,
obliging Chloe to reveal that breastfeeding ‘never really appealed’. In terms of
a policy and popular discourse in which good mothers are positioned as acting
in the best interests of their children, Chloe’s explanation is fragile at best. It
also generates some diiculty for the midwife, who, in policy terms, is unlikely
to sanction such a ‘choice’ but is also obliged to support the mother’s decisionmaking. The midwife’s discomfort is evident in the way in which she articulates
her response; as a higher pitch utterance that acknowledges the mother’s right to
make this choice (line 60: ‘fair enough’) and the (less than ideal) consequences
for Emily’s daughter (that she will ‘survive’). The mother’s response (line 61: ‘/
That’s it/ She’s doin’ ine’) upgrades the midwife’s appraisal, while it’s production
(rapidly uttered, with an emphasis on ‘ine’) indicates disagreement with the
midwife’s assessment (Pomerantz, 1984).
Discussion and concluding remarks
Analysis of these sequences makes visible the ways in which breastfeeding provides
a morally sanctioned identity for mothers in ways that can be seen to trouble
mothers’‘normal’ infant feeding practices. As the data reveal, mothers experience
breastfeeding as practically and physically diicult, troubles that are exacerbated
by the alignment of breastfeeding with a policy and professional agenda in which
it is positioned as the embodiment of good mothering. Midwives’ construction
of breastfeeding as a positive expression of maternal identity appears to gloss
over mothers’ embodied experiences, such that mothers who are experiencing
problems breastfeeding have diiculty giving voice to their experiences. In contrast,
mothers who choose not to breastfeed struggle to construct a positive maternal
identity and, moreover, are subject to a particular form of surveillance as they
are called to account for their decisions. This analysis suggest that professional–
mother interactions are important places to explore the ways in which ‘ordinary’
family practices are framed and troubled by policy agendas and their mobilisation.
Analysis of the ways in which mothers are discursively positioned and position
themselves in relation to a political and professional hegemony of ‘breast is best’
reveals the ways in which, irrespective of infant feeding ‘choice’, mothers are
acutely attentive to and troubled by a rhetoric of ideal mothering that negates
the complexities of maternal labour.
Note
1
A summary of transcription notation is contained in the Appendix at the end of this
chapter.
103
Family troubles?
References
Blum, L. (2000) At the breast: ideologies of breastfeeding and motherhood in the
contemporary United States, Boston, MA: Beacon Press.
Bolling, K., Grant, K., Hamlyn, B. and Thornton, A. (2007) Infant feeding survey,
United Kingdom: Information Centre, Government Statistical Service.
DH (Department of Health) (2007) Standard 1: promoting health and well-being,
identifying needs and intervening early, national service framework for children young
people and maternity services, London: Crown.
Dykes, F. (2005) ‘“Supply” and “demand”: breastfeeding as labour’, Social Science
and Medicine, vol 60, no 10, pp 2283–93.
Heath, C., Hindmarsh, P. and Luf, P. (2010) Video in qualitative research: analysing
social interaction in everyday life, London: Sage.
Heritage, J. (1984) Garinkel and ethnomethodology, Cambridge: Polity Press.
Hoddinott, D., Tappin, D. and Wright, C.(2008) ‘Breastfeeding’, British Medical
Journal, vol 336, p 881.
Hutchby, I. and Wooitt, R. (1998) Conversation analysis: principles, practices and
applications, Cambridge: Polity Press.
Knaak, S. (2005) ‘Breastfeeding, bottle feeding and Dr Spock: the shifting context
of choice’, Canadian Review of Sociology and Anthropology, vol 42, pp 197–216.
Knaak, S. (2010) ‘Contextualising risk, constructing choice: breasting and good
mothering in risk society’, Health, Risk and Society, vol 12, no 4, pp 345–55.
Kukla, R. (2008) ‘Measuring mothering’, The International Journal of Feminist
Approaches to Bio-ethics, vol 1, no 1, pp 67–90.
Leap, N. (2009) ‘Woman-centred or women-centred care: does it really matter?’,
British Journal of Midwifery, vol 17, no 1, pp 12–16.
Lee, E. and Bristow, J. (2009) ‘Rules for feeding babies’, in S.D. Sclater, F. Ebtehaj,
E. Jackson, E. and M. Richards (eds) Regulating autonomy: sex, reproduction and
family, Oxford: Hart, pp 73–91.
Lee, E., Macvarish, J. and Bristow, J. (2010) ‘Risk, health and parenting culture’,
Health, Risk & Society, vol 12, no 4, pp 293–300.
Lomax, H. (2005) ‘Mothers, midwives and the interactional accomplishment of the
birth story during routine postnatal care’, unpublished PhD thesis, Department
of Sociological Studies, University of Sheield.
Lomax, H. (2011) ‘Visual identities: choreographies of gaze, body movement
and speech in mother–midwife interaction’, in P. Reavey (ed) Visual methods in
psychology: using and interpreting images in qualitative research,Abingdon: Routledge.
Marshall, J., Godfrey, M. and Renfrew, M. (2007) ‘Being a “good mother”:
managing breastfeeding and merging identities’, Social Science and Medicine, vol
65, no 10, pp 2147–59.
Murphy, E. (1999) ‘“Breast is best”: infant feeding decisions and maternal deviance’,
Sociology of Health & Illness, vol 21 no 2, pp 187–208.
NICE (National Intitute for Clinical Excellence) (2006) ‘Postnatal care: routine
postnatal care of women and their babies’, Clinical Guidelines CG37, July.
104
Troubled talk and talk about troubles
ONS (Oice for National Statistics) (2007) Infant feeding survey 2005, London:
ONS.
Page, L. and McCandlish, R. (2006) The new midwifery: science and sensitivity in
practice, London: Churchill Livingstone.
Pomerantz, A. (1984) ‘Agreeing and disagreeing with assessments: some features
of preferred/dispreferred turn shapes’, in J.M. Atkinson and J. Heritage (eds)
Structures of social action: studies in conversation analysis, Cambridge: Cambridge
University Press.
Reynolds, J. and Taylor, S. (2005) ‘Narrating singleness: life stories and deicit
identities’, Narrative Enquiry, vol 15, no 2, pp197–215.
Royal College of Midwives (2004) ‘Position statement on infant feeding, no. 5’,
RCN.
WHO (World Health Organization) (2003) Global strategy for infant and young
child feeding, Geneva: WHO.
Wooitt, R. (2005) Conversation analysis and discourse analysis: a comparative and
critical introduction, London: Sage.
Appendix
Table A8.1: Transcription notation
Symbol
M
C
[
]
(0.5)
(.)
word
SHOUT
/That’s it/
^Fair enough^
*word*
(word)
wo::rd
word↑
((raises head))
Explanation
Midwife
Mother
Overlap in speakers’ talk
Pause in speech, in this case, of 0.5 seconds
Pause of less than one tenth of a second
Speaker’s stress on a word or phrase
Word or phrase spoken much louder than surrounding text
Word or phrase spoken more rapidly than surrounding text
Word or phrase spoken at higher pitch than surrounding text
Word or phrase spoken more quietly than surrounding text
Transcriber’s uncertainty about what was said
Extension of the sound preceding the colon (the more colons the
longer the sound)
A rise in intonation occurring in the sound preceding the symbol
Contains transcriber’s description
105
Troubled talk and talk about troubles:
moral cultures of infant feeding in
professional, policy and parenting
discourses
Helen Lomax
Introduction
This chapter examines the ways in which policy agendas and contemporary
notions of the ‘good mother’ frame infant feeding practices, rendering them a
site of moral and interactional trouble. Drawing on analysis of mothers’ talk with
midwives during the irst days of motherhood, the chapter explores the ways in
which breastfeeding confers a positive maternal identity, while choosing not to do
so is associated with a deicit identity against which mothers struggle to present
themselves as good parents. The chapter suggests that mothers’ interactions with
professionals are important places for exploring the ways in which ‘ordinary’ family
practices may be troubled by professional and policy agendas that may conlict
with women’s embodied experiences and cultural beliefs about what constitutes a
healthy, well-fed baby. A focus on these encounters makes visible the rich texture
of maternal labour and its complex and troubling relationship with policy.
Infant feeding: a troubled policy terrain?
Despite widely reported health beneits and a national and international policy
agenda to increase the uptake and duration of breastfeeding, the UK has one of
the lowest breastfeeding rates in the developed world (WHO, 2003; Bolling et
al, 2007; DH, 2007; ONS, 2007). While both the Department of Health and the
World Health Organization recommend that mothers breastfeed exclusively for
the irst six months, most do not, and by six months of age, only 2% of infants
are wholly breastfed and 75% receive no breast milk at all (Bolling et al, 2007;
ONS, 2007; Hoddinott et al, 2008). However, while formula-feeding might
be considered ‘normal’ in statistical terms, survey and interview-based research
suggests that, for many, it is experienced as ‘non-normative’ and troubling.While
the majority of mothers report their intentions to breastfeed, a signiicant number
express regret at stopping breastfeeding earlier than they had anticipated and feel
97
Family troubles?
stigmatised for their decisions not to breastfeed or to stop breastfeeding (Dykes,
2005; Hoddinott et al, 2008), indicating a troubling gap between mothers’
expectations and experiences.
A useful perspective on this issue is ofered by Lee’s suggestion that mothers’
breastfeeding troubles are symptomatic of a wider political agenda and the
intensiication of parenting, such that matters that were once the private concerns
of families are increasingly contested and problematised (Knaak, 2005; Lee and
Bristow, 2009; Lee et al, 2010). As Lee and others argue, the construction of
breastfeeding in UK policy as the only reasonable maternal choice relects the
currency of the idea that parents themselves present a signiicant risk to their
children’s health and a means by which mothers are increasingly measured and
measure themselves (Blum, 2000; Murphy, 1999; Marshall et al, 2007; Kukla, 2008;
Knaak, 2010; Lee et al, 2010). However, while this analysis ofers an important
critique of UK public policy, in empirical terms, its restriction to an examination
of policy documents and survey and interview data is such that it ofers limited
insight into mothers’ lived experiences at this time.
Of further relevance are the tensions suggested by policy and guidance,
which tasks midwives, the primary providers of care during this period, with
both working to a woman-centred agenda and also promoting and supporting
breastfeeding (Page and McCandlish, 2006; Leap, 2009). This may be illustrated
with reference to the Royal College of Midwives’ (2004, p 1) breastfeeding
position statement, which airms midwives’ requirement to ‘promote informed
choice and support women in their chosen method of infant feeding’, and in the
National Institute for Clinical Excellence (NICE, 2006) guidance in which the
importance of information, advice and support for breastfeeding is prioritised
alongside an emphasis on woman- and baby-centred care that recognises ‘the
views, beliefs and values of the woman, her partner and her family’. However,
despite wider feminist interest in mothers’‘complicated relationship with medical
institutions and spaces’ (Kukla, 2008, p 69), the ways in which these policy priorities
are mobilised in practice has been little researched.
Methods and analysis
This chapter addresses this deicit in the literature in order to examine the ways
in which mothers and midwives talk about and practically manage infant feeding
at the level of service delivery. Drawing on researcher-generated videotapes of
midwives’ routine visits to mothers (Lomax, 2005, 2011), the analysis considers
the ways in which policy priorities are ‘talked into being’ (Heritage, 1984) and
the implications for women’s moral identities. For brevity, the analysis focuses on
three visits to three mothers: ‘Megan’, who is successfully breastfeeding her irst
baby;‘Emily’, who is experiencing diiculties breastfeeding her second baby; and
‘Chloe’, a irst-time mother who is formula-feeding her daughter. Data, which was
transcribed and analysed using a modiied form of conversation analysis (c.a.) and
discursive analysis (d.a.) (Reynolds and Taylor, 2005; Wooitt, 2005; Heath et al,
98
Troubled talk and talk about troubles
2010), is presented in the form of transcribed sequences in order to make visible
the ways in which dominant and residual narratives (eg about what constitutes
appropriate mothering) are deployed and resisted.
A focus on the ‘architecture of talk’ (Heritage, 1984), which encompasses the
ways in which turns at talk are allocated – whether they proceed smoothly or
dysluently, or display agreement or resistance – enables an exploration of the ways
in which particular maternal identities are discursively constructed. Drawing on
these examples, the analysis explores the ways in which mothers’ infant feeding
choices are discursively sanctioned and how this is made visible through the
absence or presence of ‘trouble’.This includes the ways in which breastfeeding is
acknowledged to present both practical and corporeal challenges for mothers (talk
is about troubles), but, more particularly, the ways in which midwives’ questions
and mothers’ responses generate accounts that are universally positioned vis-a-vis
a discourse of ‘breast is best’ (through which talk is troubled).Accordingly, mothers
who do not breastfeed or who are contemplating stopping can be seen do a great
deal of rhetorical work to present their decisions as legitimate in order to defend
against the implicit allegation of a less than ideal ‘choice’. As the chapter explores,
the degree to which mothers acknowledge or rebuke this charge is apparent in
the ways in which talk is visibly dysluent or ‘troubled’.
Breast is best? A morally sanctioned maternal identity
The idea that breastfeeding confers a particular identity as a ‘good mother’ is
immediately evident in the midwife’s opening remarks in Megan’s consultation
(reproduced in Figure 8.11).
Analysis of this sequence suggests unequivocal support for the mother’s
decision to breastfeed. The midwife’s repeated use of positive and enthusiastic
descriptions of the baby as ‘look[ing] so happy’ (line 5) and the mother herself as
‘a wonderful breastfeeder’ (line 11) convey the appropriateness of Megan’s choice
and its association with a positive maternal identity. However, the midwife’s
construction of the mother as ‘doing so brilliantly’ is not entirely unproblematic,
Megan’s question ‘how do you know if he’s actually taking anything in?’ (lines
3–4) articulates a familiar concern that it is not possible to measure the amount a
breastfed baby consumes.The midwife’s response, which includes the assessment
that Megan is ‘doing brilliantly’, implies that she is succeeding at something that
is potentially quite diicult in a way that also sidesteps Megan’s concerns. As a
strategy, its limitations may be deduced by the re-emergence of Megan’s unease
moments later (line 17: ‘is it normally – are there normally problems?’). Of
signiicance, too, are the ways in which Megan phrases her unease, foregrounding
it as connected to her own inexperience in ways that moderate its threat to the
midwife’s construction of untroubled breastfeeding. In this way, Megan’s talk
acknowledges the dominance of a rhetoric in which breastfeeding is constructed
as natural and uncomplicated, while also making visible the midwife’s rights within
the asymmetrical order of interaction to deine it as such.
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Family troubles?
Figure 8.1: Megan: a sanctioned identity
1
2
M
3
4
5
C
M
6
7
8
9
10
11
12
13
14
15
16
17
18
C
M
C
M
C
M
C
I don’t like to (.) ur: interrupt you when you are
feeding so beautifully
(2.3)
I was just-I don’t-how do you know if he’s actually
taking anything (in) (.)
well he certainly looks as if he is he looks so happy
(0.9)
u↑m (.) he’s getting collostrum of course at the
[
um:
moment (.) you haven’t got gallons
there of course but I mean you know
it does look like it ahahah
you’re going to be a wonderful breastfeeder
I mean you’re you’re doing so brilliantly
is this ↑really your first baby
um::
I can’t believe it ahaha (0.8) how
did you get to be so good! ahah
((smiling)) is it normally-are there
normally problems?
Breastfeeding as troubling: a deficit maternal identity?
The theme of glossed and silenced troubles is continued in Emily’s encounter
with her midwife (see Figure 8.2), which begins with Emily’s vivid description
of leaking breasts (lines 71–77), a fractious and unhappy baby (lines 3–5) and her
eforts to manage these diiculties, including her decision to supplement with
formula milk (line 5).
Emily’s talk presents her experiences as practically diicult but herself as
a morally active mother. Analysis of the ways in which her talk is organised
reveals the ways in which she robustly constructs her decision to formula-feed
as predicated not on ‘choice’ – which might engender a charge of self-interest
– but as the desperate last resort for a baby that ‘wouldn’t settle’ and ‘was gettin’
in a state’. Moreover, her explanation that formula was only ofered after she
had breastfed positions her action as a supplement ofered by a mother who is
ordinarily committed to breastfeeding, in ways that defend against the ‘moral
danger’ associated with formula-feeding (Murphy, 1999).The midwife’s response
‘That’s a shame’ (quietly delivered and accompanied with mild laughter) displays
and makes visible that this is indeed a less than ideal practice.
The imperative for Emily to justify her decision is evident in the embodied
and practical context in which she elaborates her explanation. As the video
and transcript reveal, Emily, who has experienced an extended hospital stay
following her baby’s admission to special care, is struggling to catch up with
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Troubled talk and talk about troubles
Figure 8.2: Emily: a troubled maternal identity
1
2
3
4
5
M
M
C
6
7
8
9
10
M
C
M
C
11
12
M
C
66
67
68
69
70
71
72
73
74
75
76
77
78
M
C
M
C
M
Are you-you’re putting her on and she’s
going on alright is she?
Yeah she’s going on alright (.) Last night she
wouldn’t settle um and I tried to feed and she
was gettin’ in a state so I did make up a bottle
of SMA
Oh right
Um and I gave her that
*That’s a shame when you have got all that ahaha*
That’s right yeah ((laughter))
But um she was getting frustrated and um
((Mother gets up to let dog in))
yeah
she had fed a lot off me but then um
And you know she might feed every two
hours one day and then she’ll gradually sort
herself out ((inaudible – dog barking))
Because last night I mean – Whistler ((dog))
GO AND LIE DOWN– I
um I mean last night I put towels under
the sheet because I was actually saturated
((inaudible – dog barking))
Um and I thought well it ain’t getting on the
mattress and I thought well if it is going to
be like this I was going to give up you know
like breastfeeding because I can’t you know
Oh no don’t do that!
housework (there are piles of laundry waiting to be sorted, her attention to
which constitutes an ongoing disruption to proceedings), she also has a toddler
and two large dogs, whose noisy presence continually threatens to disrupt the
low of the visit. Physically, she is in considerable discomfort. Her breasts leak, she
has perineal trauma, untreated cystitis and severe bruising to her thigh caused by
the administration of pain relief during labour. However, within the context of
breastfeeding ‘advice’, these diiculties appear themselves insuicient to justify her
decision. They are barely acknowledged by the midwife, who deploys minimal
response tokens (Heritage, 1984) (lines 6: ‘Oh right’; and line 11: ‘yeh’), which
avoid engagement with the emotional content of Emily’s speech. Moreover,
the suggestion that breastfeeding may necessitate feeding every two hours (line
66) ignores the very evident practical diiculties this will entail in this context.
What it does illustrate, however, is the ways in which the imperative to improve
breastfeeding rates may conlict with a policy agenda that seeks to prioritise
woman-centred care.
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Family troubles?
Formula-feeding: troubling the normal?
This inal sequence considers the ways in which Chloe’s decision to formulafeed is troubled in her encounter with her midwife (see Figure 8.3).The ensuing
talk indicates a wider moral and policy framework within which mothers are
called to account for their decisions in ways that can be seen to trouble ‘normal’
decisions to formula-feed.
Figure 8.3: Chloe: a stigmatised maternal identity
51
M
52
53
C
M
54
55
C
M
56
57
M
C
58
59
60
61
62
M
C
M
C
M
63
64
65
66
C
M
C
M
67
(.)
68
M
Are you feedin’ her?(.2) yourself breastfeeding?
[ ]
no
bottle-feeding yes?
[
]
bottle-feeding yes
right
(1.2)
that’s what you planned to do was it?
yes
[
yeah^
It’s never really appealed to me
^Fair enough^ she’ll survive alright love
/That’s it/ She’s doin’ fine
and what you given’ her SMA? Cow and Gate?
[ ]
oyster *is it oyster?*
Oster-Oster?
yeah
(1.5) ((smiling at baby))
She’s lovely
M
I’ll leave he asleep for a bit …
This is immediately evident in the midwife’s opening question, which assumes
(incorrectly) that Chloe is breastfeeding (line 51:‘Are you feedin’ her?’), generating
an uncomfortable pause and necessitating a clariication (the tag ‘yourself
breastfeeding?’). Further diiculty is generated by Chloe’s negative response,
which, as the c.a. literature elaborates, is ‘dis-preferred’ in the normative order
of conversation. While speakers usually organise questions in ways that solicit
agreement and social cohesion (Hutchby and Wooitt, 1998), talk in this sequence
becomes rapidly dysluent, characterised by non-normative pauses in which the
mother negates to speak, signalling her increased disengagement and discomfort
with this topic (lines 55–56, 66–67 and 67–68). Chloe’s refusals necessitate the
midwife’s additional turns (eg at line 56 ‘that’s what you planned to do was it?’).
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Troubled talk and talk about troubles
However, rather than repairing the interaction, this generates further trouble,
obliging Chloe to reveal that breastfeeding ‘never really appealed’. In terms of
a policy and popular discourse in which good mothers are positioned as acting
in the best interests of their children, Chloe’s explanation is fragile at best. It
also generates some diiculty for the midwife, who, in policy terms, is unlikely
to sanction such a ‘choice’ but is also obliged to support the mother’s decisionmaking. The midwife’s discomfort is evident in the way in which she articulates
her response; as a higher pitch utterance that acknowledges the mother’s right to
make this choice (line 60: ‘fair enough’) and the (less than ideal) consequences
for Emily’s daughter (that she will ‘survive’). The mother’s response (line 61: ‘/
That’s it/ She’s doin’ ine’) upgrades the midwife’s appraisal, while it’s production
(rapidly uttered, with an emphasis on ‘ine’) indicates disagreement with the
midwife’s assessment (Pomerantz, 1984).
Discussion and concluding remarks
Analysis of these sequences makes visible the ways in which breastfeeding provides
a morally sanctioned identity for mothers in ways that can be seen to trouble
mothers’‘normal’ infant feeding practices. As the data reveal, mothers experience
breastfeeding as practically and physically diicult, troubles that are exacerbated
by the alignment of breastfeeding with a policy and professional agenda in which
it is positioned as the embodiment of good mothering. Midwives’ construction
of breastfeeding as a positive expression of maternal identity appears to gloss
over mothers’ embodied experiences, such that mothers who are experiencing
problems breastfeeding have diiculty giving voice to their experiences. In contrast,
mothers who choose not to breastfeed struggle to construct a positive maternal
identity and, moreover, are subject to a particular form of surveillance as they
are called to account for their decisions. This analysis suggest that professional–
mother interactions are important places to explore the ways in which ‘ordinary’
family practices are framed and troubled by policy agendas and their mobilisation.
Analysis of the ways in which mothers are discursively positioned and position
themselves in relation to a political and professional hegemony of ‘breast is best’
reveals the ways in which, irrespective of infant feeding ‘choice’, mothers are
acutely attentive to and troubled by a rhetoric of ideal mothering that negates
the complexities of maternal labour.
Note
1
A summary of transcription notation is contained in the Appendix at the end of this
chapter.
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Family troubles?
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Appendix
Table A8.1: Transcription notation
Symbol
M
C
[
]
(0.5)
(.)
word
SHOUT
/That’s it/
^Fair enough^
*word*
(word)
wo::rd
word↑
((raises head))
Explanation
Midwife
Mother
Overlap in speakers’ talk
Pause in speech, in this case, of 0.5 seconds
Pause of less than one tenth of a second
Speaker’s stress on a word or phrase
Word or phrase spoken much louder than surrounding text
Word or phrase spoken more rapidly than surrounding text
Word or phrase spoken at higher pitch than surrounding text
Word or phrase spoken more quietly than surrounding text
Transcriber’s uncertainty about what was said
Extension of the sound preceding the colon (the more colons the
longer the sound)
A rise in intonation occurring in the sound preceding the symbol
Contains transcriber’s description
105