Original Article

Breast or bottle? Eating disordered childbearing

women and infant-feeding decisions
Helen Stapleton*, Anna Fielder† and Mavis Kirkham‡
*School of Nursing and Midwifery, The University of Sheffield, Bartolomé House, †Jessop Wing Maternity Unit, Sheffield Teaching Hospitals NHS
Foundation Trust, Tree Root Walk, and ‡Centre for Health and Social Care Research, Collegiate Campus, Sheffield Hallam University, Sheffield, UK

Abstract

Debates about infant-feeding methods have intensified in recent years with increasing pressures
on women living in industrialized nations to breastfeed their infants. This paper, based on a
qualitative study of 16 childbearing women with a pre-existing eating disorder living in the north
of England, examines participants’ motivations for, and understandings of, infant-feeding deci-
sions and practices. In this study, a small number of participants reported being ‘desperate’ to
formula feed in order to resume practices underpinning their eating disorder and thereby to
shed the weight accumulated during pregnancy. These participants anticipated an early return
to restrictive eating, heavy exercise regimes and/or bingeing/purging behaviours. Most partici-
pants, however, reported being ‘desperate’ to breastfeed because this implied ‘good’ mothering
and prolonged the time during which they could consume ‘naughty’ treats. Women who opted
to breastfeed generally believed this would accelerate weight loss. This study contributes to
research on the subjective experiences of a particular group of women living with chronic
illnesses and problematic relationships with their bodies. Negotiating individual transitions to
motherhood required participants to confront their own, often longstanding, disrupted eating
patterns and to make important decisions about infant-feeding methods. Findings from this
study raise questions about some of the assumptions underpinning infant-feeding activities and
articulate some of the complexities surrounding these issues. By highlighting ways in which
women may compromise their own well-being by prioritizing their baby’s needs, for example by
persisting with breastfeeding when they were ‘desperate’ to re-engage with their disordered
eating practices, an individualized cost-benefit framing is outlined.

Keywords: qualitative, eating-disorders, infant-feeding decisions, formula feeding, breastfeeding.

Correspondence: Helen Stapleton, School of Nursing and Midwifery, The University of Sheffield, Bartolomé House, Winter Street,
Sheffield S3 7ND, UK. E-mail: h.stapleton@sheffield.ac.uk

106 © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
 Eating disordered mothers and infant-feeding decisions 107

Introduction practices has encouraged a misperception that breast-

feeding, as it is practised by women living in ‘tradi-
It is generally acknowledged, at least in the medical
tional’ societies, can be regarded as an homogenous
and public health literature on the subject, that
event to be exported as an exemplar of good practice
women who breastfeed do so primarily to confer
for Western women (another homogenous category)
health benefits on their babies (Murphy 1999; Hamlyn
to emulate (Maher 1995). This overlooks the fact that
et al. 2002). A desire to lose the weight gained in preg-
countervailing pressures, including lower social class
nancy, and to recover an approximation of pre-
and younger age (Wiggins et al. 2005), and a lack of
pregnancy shape and size, is also known to influence
privacy (Hoddinott & Pill 1999), also influence deci-
women’s decisions, at least in Western cultures (Ryan
sions not to breastfeed.
1998). In this study, concerns about body image, which
Many women make concerted attempts during
tend to be overlooked in the moral hierarchy of moti-
pregnancy to cease, or at least reduce, behaviours
vational factors influencing women’s infant-feeding
considered deleterious to their own health and that
decisions, were significant factors in participants’
of their unborn baby, including those associated with
decisions to both formula feed1 and breastfeed their
disordered eating practices (Lacey & Smith 1987;
infants.
Morgan et al. 1999). Despite these efforts, symptoms
Until fairly recently, the research-driven literature
often recur early in the post-natal period among
on eating disorders has tended to be clinically ori-
eating disordered women who elect not to breast-
ented, employing quantitative methods to classify,
feed (Lewis & Le Grange 1994). Pre-pregnancy atti-
and elaborate, (female) pathology. Indeed, prior to
tudes to body image and weight act as a significant
the early 1980s, gender was either absent altogether
predictor of post-natal discontent (Fairburn & Welch
or was theorized in essentialist terms (Bordo 1993)
1989) and a rapid return to pre-existing disordered
which closes off the possibility of change or variation.
eating practices following childbirth is not uncom-
Within the framework of essentialism ‘a belief in the
mon (Stein & Fairburn 1996; Morgan et al. 1999).
real, true essence of things’ (Fuss 1989, pp. xi–xii) is
There is also some evidence of the actual genesis
endorsed so that variables such as gender, culture and
of an eating disorder around this time (Tiller &
class are either discounted or seen as fixed, solid and
Treasure 1998; Mitchell-Gieleghem et al. 2002).
unchanging. Most importantly insofar as the central
Given the continued ambivalence which surrounds
thesis of this paper is concerned, ‘essentialism is typi-
mothering and the maternal role in contemporary
cally defined in opposition to difference’ (Fuss 1989,
Western societies (Hollway & Featherstone 1997), it
pp. xi–xii) and hence the production of alternative
is perhaps unsurprising that most study participants
meanings and understandings of individual experi-
were generally apprehensive about this transition.
ence is disallowed.
Furthermore, research with pregnant women who do
Following on from critical discourses advanced
not declare an eating disorder reveals that they none-
by feminist scholars on discrete aspects of maternity
theless experience difficulties adapting to their chang-
transitions, debates on infant feeding have become
ing body shapes and sizes during pregnancy and some
more prominent in recent years. Increasing social,
use smoking and dieting as a means of weight control
medical, and more recently political, pressures on
(Abraham et al. 1994). Little is known about the strat-
women in industrialized nations to breastfeed (and
egies pregnant women currently use to maintain their
women’s strategies of avoidance) has tended to polar-
body weight and shape within acceptable (to them)
ize debates on the circumstances underpinning infant
limits although research in New Zealand (Longhurst
feeding (Dykes 2005). A lack of attention to the
2005) and the UK (Earle 1998; Beale 2002) confirms
socio-cultural conditions surrounding infant-feeding
that many pregnant women are very concerned about
1
In accordance with MCN journal policy, the term ‘formula their visual appearance throughout the transition to
feeding’ is used throughout this paper, except where participants motherhood. Lucy Bailey’s (2001) work conceptual-
themselves used the term ‘bottle-feeding’. izes female embodiment explicitly within a maternity

© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
108 H. Stapleton et al.
setting and discusses how first-time mothers’ per-
ceptions of (gendered and classed) self-identity are
shaped by the physicality of pregnancy.
The fashion and media industries are frequently
identified as primarily responsible for the continued
(global) rise in eating disorders among women
because their advertising campaigns emphasize
unachievable ideals of slenderness (Stice et al. 1994;
Groesz et al. 2002). Personal agency has tended not to
figure in these explanations. Social constructionists
have criticized this stance, arguing that interpreta-
tions of the body are neither ahistorical nor acultural,
but are contextually situated (Benveniste et al. 1999).
Furthermore, feminist critiques have highlighted the
role of Biomedicine in the construction and produc-
tion of gendered reproductive identities and norma-
tive constructions of femininity in Western (Moulding
2006) and non-Western (Lee 1999) cultures. Feminist
theorists have thus progressively deconstructed the
eating disordered ‘subject’ and have begun to theo-
rize (her) position in a more discursive manner
(Malson 1998; Saukko 1999).
Childbearing and rearing activities may thus be
viewed as focal points in the life cycle when, in addi-
tion to positive feelings, potentially significant, and
negative, body-related feelings may also be gener-
ated. Our findings support the positioning of the preg-
nant body as a site of potential resistance to the
wholesale objectification and commodification of
females in Western societies (Earle 2003) and for par-
ticipants in this study, pregnancy and breastfeeding
were rare zones of exclusion from normative pre-
occupations with dieting, bingeing, purging and an
obsession with slenderness.
Materials and methods
This was a small, internally funded, qualitative study,2
exploratory and descriptive in design, employing a
feminist (Reinharz 1992) ethnographic approach
(Hammersley & Atkinson 1983) to data generation.
An inductive approach was necessary as little is
known about how women with eating disorders
2
This study was funded by the Department of Midwifery and
Children’s Nursing, University of Sheffield.
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
manage transitions to motherhood. A pilot interview
with one eating disordered mother of two children
preceded the study proper and provided an opportu-
nity to refine the interview guide.
The study itself was undertaken in two phases and
comprised two cohorts of women (n = 16 in total), five
of whom were pregnant at the time of recruitment
while the remaining 11 were already mothers with at
least one child under the age of 2 years. The original
aim of 20 participants (10 pregnant and 10 non-
pregnant) was revised following recruitment difficul-
ties.This was particularly the case for pregnant women,
most of whom were not accessing specialist eating
disorder facilities at the time pregnancy was confirmed
and nor had they necessarily disclosed their eating
disorder to a health professional. Hence, they could
not be specifically targeted and invited to join the
project. Although considerable effort was made to
increase the diversity of the sample by placing posters
and adverts in non-National Health Service (NHS)
environments including community newsletters,
supermarkets, gyms, sports centres and alternative
health clinics, the majority of participants were
recruited through NHS facilities including a specialist
eating disorders service, antenatal clinics and General
Practitioner surgeries. Some women contacted the
researchers directly in response to information they
had read about the study in the public domain, others
responded to information given to them by their
health professionals.
Participants ranged in age from 23 to 44 years and
included first-time mothers and those with more than
one child. All participants were white and from varied
socio-economic backgrounds; all described them-
selves as heterosexual and most were living with male
partners. All participants self-defined as having an
eating disorder; bulimia and restrictive eating were
the most widely reported practices. As the aim of the
research was to report what childbearing women
themselves had to say about their eating disorder, no
attempt was made to assess participants’ according to
established mental health criteria (American Psychi-
atric Association 1994) and nor was any attempt made
to impose a diagnosis on participants. From outward
appearances, all participants were of average size. We
did not succeed in recruiting very thin or very large

women. Having commenced their disordered eating
career in adolescence, all participants could be classed
as chronic sufferers and all but one had sought, and
received, medical treatment, including psychotherapy
and prescribed medication.
Ethical approval was obtained and project informa-
tion sheets were made available to all participants.
Written consent to participate in the study and to
audio-record interview(s) was obtained from all par-
ticipants; women recruited to the longitudinal phase of
the research re-consented prior to each episode of data
collection.The first author (H.S.), who has a midwifery
background but has not been in clinical practice for
some years, interviewed all participants by prior
arrangement in their own homes. Interviews typically
lasted between 90–120 min. An interview guide was
drafted and subsequently modified in light of emer-
gent themes. Prior to follow-up interviews with the
longitudinal cohort of women, the interviewer read
individual transcripts in order to probe issues raised in
the previous interview. All respondents were asked to
provide baseline demographic details including age,
relationship status, number of children, a brief history
of the eating disorder and any treatment received.First
interviews with pregnant women typically focused on
experiences of pregnancy and the maternity services.
Subsequent interviews explored participants’ ongoing
relationships with their changing bodies, experiences
of childbirth/transitions to motherhood and the
current status of their eating disorder. Interviews with
non-pregnant women investigated their experiences
of motherhood and the impact of this transition on
their eating disorder. Interviews were transcribed ver-
batim and subsequently verified as a legitimate record
by the first author (H.S.). Anonymized quotes from
interview transcripts are presented here to illustrate
key theoretical points.
The pregnant cohort of women (n = 5) provided an
important longitudinal element which enabled the
researchers to map their ongoing experiences of pre-
gnancy and early motherhood. They consented to
in-depth interviews on four separate occasions: twice
during pregnancy (around 24 and 36 weeks) and twice
within the first few months following birth. Interviews
were undertaken at these points in the childbearing/
rearing trajectory in order to capture women’s reac-
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
Eating disordered mothers and infant-feeding decisions 109
tions to changes in their weight, shape and body
image, and their infant-feeding intentions and actual
practices. Established mothers (n = 11) participated in
a one-off, in-depth, interview which focused on their
(sometimes multiple) experiences of child bearing
and rearing, and the effect of these events on the
overall trajectory of their eating disorder.
The analysis of interview transcripts was preceded
by an examination of the relevant literature.
Although interviews followed on after this stage of
research activity and hence theoretical discussion
partly preceded analysis, it was nonetheless grounded
in the narratives of women’s everyday lives and their
experiences of living with a chronic, disabling, stigma-
tized but largely invisible, condition (Moss & Dyck
2002; Broussard 2005).
The empirical data and the theoretical material thus
worked together, informing the process of analysis in a
continuous cycle. In this way, the data elaborated key
theoretical concepts such as the role of power and
(self)control. The authors collectively analysed a
random selection of transcripts (n = 6) to identify, and
agree, key themes. Following this process, a framing
code was devised and subsequently modified by the
first author in light of newly emerging material.
Changes to the framing code were subsequently
agreed among all authors before new themes were
added.
Results
Infant-feeding decisions:
is formula feeding all right?
In defying normative understandings of ‘good’ parent-
ing, women who opt to formula feed risk being con-
structed as morally suspect and deviant mothers who
wantonly disregard their mothering responsibilities
(Murphy 1999). Hence, infant-feeding decisions may
be regarded as a ‘highly accountable matter’ (Murphy
1999, p. 205) because decisions are weighted with sig-
nificant ‘moral baggage’ (Murphy 1999, p. 205) and set
against broader ideologies and conceptualizations of
‘appropriate’ parenting. Regardless of the method of
infant feeding eventually chosen then, women may
expect their decisions to be challenged in both lay and
110 H. Stapleton et al.
professional arenas. Breastfeeding tends to be widely
promulgated as the morally superior choice despite the
fact that less than 50% of UK mothers are still breast-
feeding 6 weeks following birth and only just over 20%
are doing so at 6 months (Department of Health 2002).
What is more, despite considerable investment in
breastfeeding initiatives, these figures have remained
largely unchanged over the past decade.Although well
informed about the benefits of breastfeeding, some
study participants were unwilling to consider this
option because they were ‘desperate’ to resume
purging and strenuous exercise regimes in order to
lose the weight they had gained in pregnancy. These
women believed that a swift return to such practices
would effect a more rapid weight loss than they could
hope to achieve by breastfeeding.
In common with many women who live with
socially constructed limitations of a disabling condi-
tion (Moss & Dyck 2002), participants in this study
were very knowledgeable about their own capacity
and their own limitations. The small number of
women who opted to formula feed their babies from
birth made this choice knowing that breastfeeding
was the preferred option insofar as promoting
infant health and well-being was concerned. The
re-emergence of symptoms associated with their
eating disorder, however, worked against them
making this choice. Most participants believed that
frequent cycles of bingeing and purging were incom-
patible with the production of good quality milk, in
sufficient amounts, to satisfy the baby and hence
breastfeeding was discounted as a possible feeding
option. Such women could thus be described as
making an ‘ethically informed’ choice (Edwards
2004) which was grounded in a profound concern for
the baby’s well-being but which competed with a
more urgent need to protect their own (mental)
health.
A number of participants, who were of the opinion
that they had no option but to formula feed, reported
being reprimanded because their choice of feeding
method did not accord with the prescribed norms of
contemporary midwifery practice:
I couldn’t breastfeed. I just couldn’t. I was desperate to get rid
of the weight. I just wanted some reassurance from the mid-
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
wives that bottle-feeding was all right but all they did was tell
me off for not breastfeeding. (Margaret, age 26, two children)
I know that yes, of course they’ve (midwives) got to
encourage you to breastfeed, but they’ve also got to
acknowledge that sometimes you just can’t. I couldn’t. I
couldn’t bear eating proper food anymore. (Susan, age 42,
four children)
Formula feeding mothers wanted reassurance from
midwives that formula milk would not compromise
their baby’s development but most failed to receive
the encouragement they sought. This is perhaps
unsurprising in societies where mothers who formula
feed tend to be associated with ‘failure’ and report
feeling unsupported and very much ‘like second class
citizens’ (Battersby 2006, p. 202). This is not to suggest
that breastfeeding does not suffer from something of
an ‘image’ problem, especially among adolescents and
disadvantaged women who lack role models and a
cultural tradition. For eating disordered women who
are already exceedingly image-conscious, but who
generally project a negative body image, it is sug-
gested that the prospect of breastfeeding may stimu-
late uncomfortable, and unmanageable, feelings
about identity and experience.
Contemporary midwives are in a difficult position
with regard to advising childbearing women about
infant feeding. On the one hand, they must strive to be
‘with’ women (and the ‘bad’ choices they make) but
on the other hand, they ‘are caught up in the disciplin-
ary technologies to which they contribute’ (Murphy
2003, p. 458) and, as such, must vigorously promote
breastfeeding (Royal College of Midwives 2004).
Within this contested territory, the preferences of
individual childbearing women may be easily over-
looked as midwives struggle to be facilitators, rather
than quiet coercers (Foucault 1991) of choice. The
following participant was comforted when she finally
encountered a midwife who provided her with much-
needed support in the form of a personal story:
One midwife was really nice. She said ‘Don’t be so stupid –
my mother never (breast) fed me and I’ve got two degrees’.
But the others tried to pressure. [. . .] All you want is that
reassuring voice telling you it will be all right. (Wendy, age
28, one child)

Midwives’ reluctance to share ‘positive impact’
stories, based on personal experience and/or profes-
sional observations with their clients has been previ-
ously remarked upon (Kirkham & Stapleton 2001).
The suggestion to formula feed was not infre-
quently proposed by male partners:
From the beginning (partner) wanted me to bottle-feed
because he said then he could take his turn. But I think it was
really that he didn’t trust me to eat properly. I think that was
really the reason. (Maureen, age 38, two children)
He (husband) didn’t want me to breastfeed because he
thought I wasn’t eating enough to feed her (baby) properly.
[. . .] He was on and on about me giving her the bottle. He
even dragged my sister in to try and get her to talk me round.
(Emma, age 31, one child)
I think he thought right, pregnancy’s over and now the
baby’s out I can take over. I can make sure he’s getting the
food he needs. [. . .] That’s why he wanted him (2nd baby) to
have a bottle from the start. (Jill, age 27, two children)
It is beyond the scope of this study to offer cogent
analyses for why male partners might prefer their
babies to be formula fed. A number of participants
reported, however, that those partners who were cog-
nizant of the nature and severity of the eating disorder
(and many were not), and who had contained their
powerlessness to intervene during pregnancy, viewed
the post-natal period as an opportunity for potential
reparation. Some male partners were reported as
being angry when they were unable to exert control
over their partner’s disordered eating and related
practices during pregnancy. Others expressed con-
cerns about the baby’s health and well-being and had
threatened to contact social services with a view to
obtaining custody of the baby if participants resumed
bingeing and purging in the post-natal period. Hence,
it is reasonable to suggest that formula feeding
enabled male partners to wrest control at a point
where the welfare of the baby was no longer the
mother’s exclusive preserve. The rationale advanced
for male partners in this study becoming more
involved in infant-feeding decisions confirms earlier
research which suggests that men’s motivation for
greater involvement is based on altruistic concerns, in
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
Eating disordered mothers and infant-feeding decisions 111
this case for the welfare of the baby rather than a desire
to share the parenting workload (Earle 2000).
Breastfeeding as a strategic
(and ‘selfish’) practice
The majority of participants3 (n = 11) successfully ini-
tiated breastfeeding and a considerable number
(n = 6) breastfed until 6 months, the UK Govern-
ment’s recommended minimum period for exclusive
breastfeeding (Department of Health 2005). All par-
ticipants had ceased breastfeeding by 7 months
except for Louise and Patricia, both of whom contin-
ued beyond 12 months. Participants were motivated
to breastfeed primarily because they believed this
would help them to lose weight and/or resume their
pre-pregnancy body shape more quickly. Women also
breastfed because they reasoned that the caloric
expenditure associated with this activity meant that
they could consume additional food, especially
‘naughty’4 treats such as chocolate and ice cream. This
acted as something of a compensatory mechanism for
purging and vomiting practices which most women
had suspended throughout pregnancy, and which
those who were breastfeeding did not intend resum-
ing until after they had completed the weaning
process.
Breastfeeding was like a calorie muncher. I was burning up
calories so I could eat more. (Emma, age 31, one child)
I think it (breastfeeding) was partly about me behaving self-
ishly. It was knowing that it brought your figure back more
quickly so I kept putting off and off weaning him because I
knew the weight was still dropping off me. (Tina, age 32, one
child)
The ‘selfish’ drive to recover the pre-pregnant
(eating disordered) figure seemed to be at least as
powerful a motivator for women to breastfeed as
3
This includes two participants who hand expressed their breast
milk and fed this to their babies in bottles. Both women stated
they adopted this practice because they were unable to ‘per-
suade’ their babies to feed directly from their breasts.
4
For a discussion on the compartmentalization of food using
descriptors such as ‘good’ and ‘naughty’ (but ‘nice’), see: Murcott
(1993).
112 H. Stapleton et al.
were altruistic desires to privilege the welfare of
the baby. It should be stressed, however, that
breastfeeding is not necessarily synonymous
with maternal weight loss and indeed one pro-
minent researcher in the field reports that ‘there
is surprisingly little evidence that breastfeeding
makes women lose more weight after pregnancy’
(Linne & Rossner 2003, p. 320). Research from
the USA and Sweden suggests that women not infre-
quently report modest weight gains following child-
birth but that such gains coexist on a continuum, with
a few women actually becoming quite obese (Walker
1998; Linne et al. 2002). Despite weight gain being
an important, and perhaps inevitable, aspect of
childbearing, the extent to which women may suffer
actual weight-related distress following this event is
unknown.
Many participants in this study looked on breast-
feeding as a coping strategy which enabled them to
maintain an increased calorie intake:
I was told all the things about why breastfeeding is impor-
tant for the baby but I was doing it because it meant I could
eat [. . .] I allowed myself to eat a lot of naughty things when
I was breastfeeding [. . .] The calories went straight through
me. I could feel it. I was using up so much energy to feed him.
(Louise, age 29, one child)
The freedom to eat in a relatively unrestrained way,
and to retain what they had eaten, was a very new
experience and hence it is perhaps unsurprising that
some participants capitalized on the opportunity to
extend the breastfeeding period for longer than was
initially anticipated.
I ended up breastfeeding till (baby) was over a year old.
One of the things about breastfeeding that I loved was the
fact that I could eat more and still not get fat. That was one
of the things that kept me hooked in. (Louise, age 29, one
child)
Extending breastfeeding for longer than origi-
nally intended, with the concomitant suspension of
some of the more extreme practices associated
with the eating disorder, provided a rare opportunity
for women to experience a relatively stable body
weight and size in the absence of purging and
vomiting.
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
Breastfeeding as a coping strategy
and a delaying tactic
Although breastfeeding did prolong the suspension of
binge-purging behaviours in most participants, this
was not always easy. A significant number of pregnant
women volunteered that they struggled with not
restricting their food intake and/or ceasing to self-
induce vomiting and some admitted that they failed to
completely stop these practices. The following quota-
tions are illustrative:
I kept trying to stop eating, to go on a diet or something, but
I couldn’t really do it with the breastfeeding. When he was
about 5 months old I went through a really bad period where
I didn’t feel like eating and of course that affected my milk
supply quite a bit. (Patricia, age 25, one child)
I didn’t need to make myself sick so often (when breastfeed-
ing) but that wasn’t because I didn’t want to! [Laughs] I had
to fight with myself all the time to control the urge. I thought
breastfeeding would take that urge away but it didn’t. It
eased a bit but I was still vomiting all the time I was breast-
feeding. (Lorraine, age 28, two children)
Some participants drew parallels between preg-
nancy and breastfeeding and self-imposed restrictions
on ‘eating properly’:
I had to eat properly when I was breastfeeding because I had
a baby to think about. The baby needs nutrition. I thought
whatever I eat the baby is going to get it. So I had to eat
properly. Like when I was pregnant I made myself eat prop-
erly. (Maureen, age 38, two children)
As suggested, a significant number of women vol-
unteered that they had been motivated to breastfeed
because they understood that this would effect early,
and substantial, weight loss. Indeed, many women
reported having been told this by midwives and
some were upset when they did not lose the weight
they had gained in pregnancy at the rate they antici-
pated. There appears to have been surprisingly little
research undertaken on the subject of maternal
weight loss during lactation but the results of avail-
able studies have failed to demonstrate any consis-
tent relationship between mode of feeding and
postpartum weight loss (Lawrence & Lawrence

1999; Walker et al. 2005). A few women stated that
they would have ceased breastfeeding much earlier
in order to resume their binge/purge activities had
they known that weight loss did not automatically
follow from breastfeeding. As is attested by quo-
tations from participants throughout this paper,
however, breastfeeding women often reported diffi-
cultly in balancing pressures to eat ‘healthily’ in
order to produce ‘healthy’ milk, while simulta-
neously denying themselves access to familiar coping
mechanisms, such as restricted eating, bingeing and
purging and/or strenuous exercise.
Breastfeeding as a signifier of good
and competent mothering
Breastfeeding appeared to act as a powerful rein-
forcer of maternal competence and nurturing ability.
It also acted as an external signifier that, despite the
eating disorder, participants were endowed with a
‘good’ maternal body (Stearns 1999) and were there-
fore embodied with the necessary expertise and
capacity for their new role. Breastfeeding, then,
seemed to assuage some of the guilt women carried
throughout pregnancy for their eating disorder to
potentially ‘damage’ the baby.
It wasn’t my instinct to want to breastfeed him but in the end
I did. In some ways it made up for all the damage I thought
I’d done to him because of my eating disorder. (Fiona, age
24, one child)
I’m glad I did (breastfeed). It’s the one thing good I did for
him. (Patricia, age 25, one child)
Breastfeeding was also seen as a ‘fair exchange’,
signifying a degree of reciprocity between the eating
disordered mother and her infant:
When I was breastfeeding it was like well, I’m holding off
bingeing and vomiting and I’m eating well so I’ll make the
milk he needs. He’s eating the calories so I’m not putting on
any weight even though I’m eating way more than I nor-
mally would. So in a way I’d say it was a fair exchange really.
[Laughs] (Carlene, age 36, one child)
From a Foucauldian (Foucault 1991) perspective,
biomedical constructions tend to frame breastfeed-
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
Eating disordered mothers and infant-feeding decisions 113
ing in terms of (milk) production; as a means of sup-
plying the infant with the necessary nutrients to
achieve efficient outputs or developmental ‘mile-
stones’. Such constructions reduce breastfeeding to
an agendered, purely physical, process which empha-
size the more mechanical elements involved in the
transference of milk from mother to infant (Ryan
1998). Advocates of breastfeeding also tend to
emphasize the benefits to either the mother or the
baby but many women in this study stressed the
relational aspect of this activity which some under-
stood as an exchange based on mutual need and
symbiotic association.
There’s that kind of connection [. . .] which is very precious
[. . .] I carried on (breastfeeding) as long as I could not
necessarily because the breast milk was more nutritious [. . .]
but because of the intimacy of that relationship, because of
the bond. [. . .] there’s still a very necessary and vital con-
nection, which we’ve established through the breastfeeding.
(Maureen, age 38, two children)
Unlike some mothers in this study whose motiva-
tions for breastfeeding were driven more by consum-
erist values and a need to be seen as ‘performing’
(Shaw 2004, p. 99) a duty until such time as they could
reclaim their bodies for themselves, participants such
as Maureen valued the pleasurable, sensory and inti-
mate aspects of breastfeeding.
Satisfying the baby
In common with many breastfeeding women, some
participants in this study experienced difficulties with
‘satisfying’ the baby. It is suggested that this is unsur-
prising given women’s own troubled relationship with
satisfying their own needs, especially those which are
food-related. On the occasions women sought advice
from health professionals for such problems, they did
not always find it helpful:
He’d just cry and cry but I couldn’t satisfy him. He didn’t
seem to be getting enough from me. The health visitor told
me to increase my fat intake to see if that would help. I felt
really guilty but I couldn’t do that. I’d put on so much weight
in pregnancy already there was no way I could do that.
(Emma, age 31, one child)
114 H. Stapleton et al.
She (baby) started losing weight and I panicked. The health
visitor came and said ‘Get some Mars bars down you’ –
which of course I wasn’t going to do. But it was just a glitch.
It was just for a week where she didn’t put weight on. I’m
glad I didn’t listen to the health visitor or I’d have been back
into bingeing and vomiting. (Lorraine, age 28, one child)
For various reasons, few women disclosed their
eating disorder to a health professional involved with
their maternity care and it is possible that lack of
knowledge may have hindered professionals in their
desire to offer more appropriate, and individualized,
advice.
Participants reported feeling intensely proud when
their (breastfeeding) efforts resulted in weight gain in
the baby (and continued weight loss in themselves);
such positive feedback reinforced participants’ com-
mitment to continue. Breastfeeding also, of course,
emphasizes the moral certitude inscribing mothering
practices in many contemporary societies.
I remember looking at him growing and thinking that’s
totally down to me. He’s growing totally because of me. I’m
giving him all this nourishment and that’s all he’s getting and
that’s making him grow. It’s very, very powerful feedback. It
makes you feel important, like you’re the main person.
(Carlene, age 36, one child)
The approval thing was a big factor. Everyone was telling me
how well I’d done to keep breastfeeding. All that approval
made me feel really good about myself, and that I was being
a good mother to (baby). I wasn’t thinking negative thoughts
about myself, I was feeling very positive really. (Lorraine, age
28, one child, 18 weeks post-natal)
Positive feedback was especially important for
women whose primary relationship with their own
bodies tended to vacillate between extreme ambiva-
lence and/or self-hatred.
Weaning
Weaning is defined here as the cessation of breast-
feeding. The age at which weaning occurs varies but it
is likely to reflect local cultural norms and the socio-
political environment in which infant-feeding prac-
tices occur. Weaning was widely reported as a difficult
transition and participants were open and eloquent
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
when describing their attachment to continuing
breastfeeding, often for the simple reason that this
delayed the inevitable, but nonetheless frightening,
confrontation with their eating disordered personae.
Delaying the cessation of breastfeeding enabled
women to sustain their belief in their ability to
adequately provide for the needs of their growing
infant; it also provided an extended window of pro-
tection from re-engagement with practices underpin-
ning their eating disorder. That said, no participant
volunteered that they delayed weaning in order to
delay the responsibility they would face for providing
(healthy) foods on a regular basis.
Many participants reported feeling pressured to
wean their babies and such pressures were sometimes
internally generated. As is evidenced by the following
quotation, some participants feared that ceasing to
breastfeed would trigger a swift return to their disor-
dered eating practices:
[Baby] was about 10 months old and I was starting to feel
really bad about it [breastfeeding]. I was feeling almost
guilty. I was starting to wonder whether there was some
unhealthy pattern developing. You know like was I just
breastfeeding because I was so afraid of what would happen
with my eating when I stopped. (Louise, age 29, one child)
It is interesting to consider Louise’s concern that
breastfeeding her 10-month-old baby may be ‘read’ as
indicative of an ‘unhealthy’ (psychologically depen-
dent) pattern developing, when this is compared with
the damaging consequences to her own health in
maintaining her eating disorder. Her statement does,
however, support psychological theorising (Chassler
1997) which suggests that eating disordered women
may suffer greater disturbance in the relationship
they have with themselves and their own physical
bodies than they do with external objects – including
perhaps their own children.
A desire to reclaim the (pre-pregnant) body in
order to resume regimes which had previously been
employed to control and shape the body, was a sig-
nificant motivator for some participants ceasing to
breastfeed:
I wanted my body back and I knew I wouldn’t get it back
until I’d stopped breastfeeding. I knew the minute that I

stopped feeding him I could control my food again and that’s
what I wanted. When I was feeding I needed to eat properly
because he needs the nutrients. (Lorraine, age 28, one child)
Concerns were expressed, however, that weaning
would inevitably be accompanied by personal weight
gain:
I was very conscious about weaning him because I knew he
wasn’t going to be taking out as much from me so of course
I was worried I’d put on weight. But at the same time I was
glad that I wouldn’t have that responsibility any more of
having to feed him and having to eat properly. (Maureen, age
38, two children)
Breastfeeding and weaning may thus be under-
stood as enormously conflicted activities which
required participants to adopt an entirely new regime
of eating (‘healthily’ and ‘regularly’) without recourse
to purging. Many volunteered that this was the first
time in their adult lives that they had accomplished
this goal.
Some participants reported that they waited for a
signal from the baby before they initiated weaning:
I’d rather her [baby] put an end to it than me. It’s quite a big
thing for me to have to do so I’ll wait for her to do it.
(Maureen, age 38, two children)
Given participants’ expressed needs to control the
circumstances underpinning decisions about food and
related matters, it is suggested that the ability to relin-
quish decision-making control to the baby repre-
sented a significant accomplishment. Further research
is needed to establish the impact of such decisions,
including whether the autonomy conferred on the
baby had an enduring, and positive, effect especially
on new mothers.
The majority of women weaned their babies
before returning to work. Leaving the protection of
home and the routine of caring for a new baby con-
fronted women with a new set of dilemmas about
self and body image. Many women, especially those
who were still leaking milk, or who had not lost the
weight they had anticipated, or did not fit their pre-
pregnancy (work) clothes, reported feeling distressed
about the prospect of returning to the work environ-
ment. These feelings appeared to be particularly
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
Eating disordered mothers and infant-feeding decisions 115
pronounced in women working in the retail, fashion,
or leisure industries:
I breastfed [baby] for about six weeks because at that point
I was back at work and I needed to look the part. In my job
(fashion) you’re a size 10 or less no matter what. Whether
you’ve just had one baby or 10 babies you’re never more
than a size 10! [Laughs] (Emma, age 31, one child)
I had to go back to work (as a fitness instructor) when [baby]
was three months old so I had to stop breastfeeding about a
month before that so I could get back in shape. But I was still
terrified I’d start leaking milk or something in the middle of
a class. [Laughs] (Judy, age 34, two children)
Participants who felt pressured to return to work
early in the post-natal period quickly resumed the
customary regulatory activities over body weight and
shape which they had ceased, or at least reduced,
during pregnancy and early lactation.
The prospect of weaning brought into sharp focus a
return to the denying, and restrictive, attitudes embod-
ied in the ascetic practices which had previously sup-
ported women in maintaining their eating disorder.
Impending change prompted an internalized sense of
increased size, or ‘bigness’ even if this was not reflected
in an alteration in actual physical size:
As weaning got closer I was starting to feel big again because
I’d eaten lots of things regularly that I wouldn’t normally let
myself eat unless I was going to vomit. I don’t think I was any
bigger but I felt I was. (Lorraine, age 28, one child)
For the majority of participants, the cessation of
breastfeeding was associated with a resumption of
the practices associated with the eating disorder.
Although a significant number of women reported a
reduction in the intensity of such practices, a few
women reported the opposite:
I was worried about getting fat when I stopped (breastfeed-
ing). I was worried about putting weight on because I wasn’t
burning the calories up. My eating really got worse after I
stopped breastfeeding. For a while it was worse than before
I got pregnant. (Tina, age 32, one child)
Some women reported that they felt pressured to
wean an ‘older’ baby because of externally generated
pressures including social norms which proscribe
116 H. Stapleton et al.

breastfeeding children beyond a certain age and/or Breastfeeding an ‘older’ infant in public was
beyond a certain size. perhaps less threatening to Patricia’s sense of self-
identity because this activity was congruent with her
I did find it quite difficult after (baby) was about five months.
role as a mother – as opposed to her objectified, and
People were starting to say ‘Still feeding then?’ [. . .] I stopped
eating disordered, identity as a sexually scripted
(breastfeeding) him at about six months because he felt like
female. Her unconcerned attitude about revealing a
he was getting too big and it didn’t feel right any more. People
part of her physique which, in any other circumstance
kept staring when I was feeding him outside and I just felt
would normally have shamed her, suggests a consid-
more and more uncomfortable. (Patricia, age 25, one child)
erable degree of body confidence. That she is able to
The worst thing was when he got a bit older (nine months) permit her body to engage with her infant in the
and people started to look at you and you know they’re regular production of body fluids which she under-
thinking ‘You breastfeed new-borns, not toddlers’. (Louise, stands to be useful, and of which she feels proud, is
age 29, one child) perhaps in direct contrast to the fluids she ejects from
her body in response to her eating disorder.
Recent guidelines from the World Health Organi-
Some women reported being pressured to wean by
zation and United Nations Children’s Fund currently
male partners:
recommend exclusive breastfeeding for a minimum of
6 months and to continue this practice for at least 2 I didn’t want to stop (breastfeeding). [Partner] kept saying
years while simultaneously offering weaning foods ‘When are you going to stop?’ I think he wanted me to stop
(World Health Organization and UNICEF 2003). because he wanted me back so when [baby] was just over a
Prevalence rates in the UK currently fall well below year old I pushed myself to stop. (Louise, age 29, one child)
these targets, however, with only 21% of women still
Regardless of whether the motivation to wean was
breastfeeding when the baby is 6 months old and only
internally or externally derived, extending the feeding
13% continuing at 9 months (Hamlyn et al. 2002).
period beyond the time originally planned was widely
Although a sustained improvement in breastfeeding
reported. Weaning an ‘older’ baby was generally
initiation has been reported (Hamlyn et al. 2002), offi-
experienced as a more difficult undertaking because
cial statistics confirm that childbearing women in the
participants had become more accustomed to eating
UK remain deeply mistrustful in the efficacy of their
an extensive range of food items, many of which
bodies to nurture and satisfy the food-related
would be outlawed altogether or consumed only
demands of their babies (Dykes 2005).
during bingeing episodes.
Given this backdrop, it is of some concern when
eating disordered women, whose adult corporeal
experience has been so tenuous, report that negative Discussion
attitudes impinged upon their desire to continue
This study identified some new, and significant, influ-
breastfeeding their growing infants. Despite the public
ences on decision-making processes which eating dis-
approbation experienced, however, some women
ordered, childbearing women, employ with respect
reported feeling greatly strengthened by negative
to infant feeding. Women are generally understood
interactions. In the following quotation, Patricia vol-
to involve their male partners in formula feeding in
unteers that criticism would previously have triggered
order to share parental roles and hence move towards
a change in her behaviour but her determination to
a more equitable division of responsibilities. Formula
succeed with breastfeeding deflected any disapproval,
feeding in this context may be understood as ‘a some-
whether this was implied or real.
what covert shift in the sexual division of labour, as
But I didn’t care what anyone else said (about breastfeeding involving the father in parenting, by beginning with its
her toddler in public). And that was a surprise to me because most gratifying aspects’ (Maher 1995, p. 8). The find-
normally I do care very much what people say about me. ings from this study suggest, however, an alternative
[Laughs] (Patricia, age 25, one child) reading of men’s role in this activity.

© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120

Male partners who were aware of their partner’s
eating disordered status were generally reported by
participants as being extremely concerned about the
welfare of the baby and, while there was little they
could do about this during pregnancy, some acted on
their concerns once the baby was born. Insisting on
the baby being formula fed was one strategy adopted
by male partners who understood this to be the only
possible means to guarantee the quality and quantity
of nutritional input.
Breastfeeding was identified as a strategy which
enabled participants to circumvent customary prac-
tices associated with their eating disorder and to
reassign their identities as ‘good’, as opposed to
‘neglectful’, mothers. Breastfeeding, which was widely
construed as positive and beneficial to infant welfare,
permitted women to increase their food intake, par-
ticularly their consumption of previously forbidden
‘naughty’ treats such as ice cream and chocolate.
While formula feeders were not averse to the idea of
breastfeeding, they were unable to countenance the
prospect of a delayed return to the project of reclaim-
ing of their pre-pregnant body. Breastfeeding was
generally believed to be incompatible with the
re-enactment of eating disordered behaviours
because the production of ‘good’ quality milk, in suf-
ficient amounts to nourish a growing baby, could not
be guaranteed. To that end, formula feeding was
viewed as the only alternative solution for a number
of participants.
Although breastfeeders in this study greatly out-
numbered formula feeders, both groups of partici-
pants were very concerned to be seen doing the ‘right’
thing; indeed, rationales advanced for infant-feeding
decisions by all participants revealed a desire to
protect infant well-being. Women who had disclosed
their eating disorder were apprehensive that
knowledge about their (mental health) status might
render them vulnerable to criticism and/or instigate
unwanted surveillance from health and allied profes-
sionals. Some used breastfeeding to deflect possible
censure and to maximize the opportunities for dem-
onstrating ‘good’ mothering. In this sense, breastfeed-
ing may be conceptualized as a ‘performative
accomplishment which the mundane social audiences,
including the actors themselves, come to believe and
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
Eating disordered mothers and infant-feeding decisions 117
to perform in the mode of belief’ (Butler 1999 [1990],
p. 179).
The practice of breastfeeding seemed to afford
eating disordered mothers an opportunity to experi-
ence their body in a very different way. By discovering
resources within themselves which were essential for
the well-being and development of the baby, parti-
cipants were able to construct alternative represen-
tations of themselves. Hence, the maternal body
metamorphosed into a figure of pride and accom-
plishment but one which, nonetheless, retained the
capacity for holding deep-seated and enduring feel-
ings of shame and embarrassment. It is suggested that
breastfeeding demonstrated a particular, and highly
specific, experience of mutuality and interdependency
which enabled women to see themselves not simply as
a ‘fat’ maternal body but as body which was perform-
ing an essential function.
It could be argued, however, that breastfeeding
encouraged women to disassociate from their (eating
disordered) bodies and to foster a belief that the preg-
nant or lactating body was ‘other’ than their own.
Future research is needed to investigate whether
eating disordered mothers who breastfeed develop a
more fluid identity which enables them to embrace
contradictory messages while simultaneously retain-
ing their sense of personal agency.
This study contributes to research on the subjective
experiences of a particular group of women who
acknowledged a chronic,and problematic,relationship
with their bodies. Negotiating the transition to moth-
erhood required study participants to confront their
own, often longstanding, disrupted eating patterns and
to make important decisions about infant-feeding
methods. Women’s solutions to the difficulties they
encountered were creative and idiosyncratic attesting
perhaps to the ‘cross-currents of complex and some-
times contradictory obligations, which mean that
infant-feeding decisions are as much about morality as
they are about nutrition’ (Murphy 1999, p. 206).
Implications for health professionals
The establishment of an agreed pathway of care,
which is properly funded and adequately serviced, is
urgently required to facilitate the appropriate referral
118 H. Stapleton et al.
of women who disclose a history of an eating disorder.
Such a facility would also support midwives and other
health professionals involved with providing care to
childbearing women.
Participants’ who breastfed (rather than bottle fed)
appeared to develop a more fluid identity – at least
during the research period – and this seemed to
enable some women to embrace contradictory health-
promotion messages, while simultaneously retaining a
strong sense of personal agency. Health professionals
need help to recognize this window of opportunity for
eating disordered women to maximize the opportuni-
ties provided by the behavioural changes adopted as a
result of pregnancy and motherhood.
Limitations of the study
The study did not seek to involve health professionals,
women’s partners or other family members and hence
their perspectives, while sometimes alluded to by par-
ticipants, were not available for independent analysis.
As a significant proportion (n = 6) of participants had
never disclosed their eating disorder to their partners,
and an even greater number (n = 9) did not disclose
this aspect of their history to maternity staff, however,
it is difficult to imagine how the views of these groups
might have been accessed.
A second consideration is that the study sample
was recruited primarily through NHS facilities pro-
viding medically orientated treatment for women
with eating disorders. The majority of participants
were currently enrolled in, or were on the waiting list
for, psychotherapeutic programmes including group,
and cognitive behavioral, therapy. Additionally, most
participants had been prescribed antidepressant
and/or antipsychotic medications at different points
in their eating disordered career5 and it is suggested
that prolonged exposure to medical practices may
have shaped their views in particular ways and ren-
dered their responses to interview questions more
uniform than might be expected in a non-medicalized
sample.
5
All participants ceased taking prescribed medication following
confirmation of pregnancy and continued until breastfeeding
was completed.
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd. Maternal and Child Nutrition (2008), 4, pp. 106–120
Acknowledgements
Sincere thanks to the women who participated in this
research, especially for sharing personal, and some-
times deeply unsettling, accounts of their experiences
of living with an eating disorder in the context of
childbearing and mothering. Thanks are also due to
the project advisory group for their advice regarding
discrete aspects of project management and for their
suggestions during the early phases of data analysis.
Finally, the authors thank the reviewers of the original
draft of this paper for their insightful criticisms.
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