Iman E. Sarhan ✉ Dasha Grajfoner ✉ (DOBA Business School, Slovenia)
This study explores a breastfeeding coaching intervention to support working mothers in Egypt. Twenty-eight working mothers with breastfeeding experience were interviewed. Semi-structured interviews were used, and self-efficacy and well-being scores were assessed. Thematic Analysis was used to identify overarching themes leading to three higher-level themes, namely: “Transition into motherhood”, “Going back to work”, and “Benefits to the organization”. Findings show that working mothers need support from direct managers in their workplace, and professional breastfeeding support through coaching. The results are smoother transitions into motherhood and return to work, while successfully continuing with breastfeeding and maintaining their performance and wellbeing.
coaching psychology, self-efficacy, breastfeeding coaching, women at workplace, Egypt
Accepted for publication: 10 July 2024 Published online: 01 August 2024
© the Author(s) Published by Oxford Brookes University
The increasing involvement of women in the workplace, in addition to household chores and domestic responsibilities, puts a lot of stress on mothers (Bussell, 2008; Consolación, Eva-María & María-José, 2016; Kamel, 2016). This affects the psychological well-being of mothers (Gozukara, & Çolakoğlu, 2015; Loeb, Stempel, & Isaksson, 2016), and, thus, influences their performance at work and family satisfaction (Chan et al., 2016). Furthermore, the lack of support can influence a mother's belief in herself and her capabilities (Jama et al., 2017). The situation becomes even more challenging for working mothers, who find it difficult to continue breastfeeding their babies as they originally wanted, due to the challenges they encounter (Dinour & Szaro, 2017). Unfortunately, some mothers may opt to resign from their workplace, which could be detrimental to their career trajectory and is often a loss for their respective organizations (Sharma & Dhir, 2022). Nonetheless, mothers with high self-efficacy, who believe they can manage both work and home experience a good wellbeing state (Bandura, 1994).
Self-efficacy is defined as a set of beliefs people have of their own capabilities and confidence to perform, creating some control over events occurring in their life (Bandura, 1997). One way to improve self-efficacy is by reducing stress and elevating mood especially when encountering challenges (Cherry, 2017), and this can be achieved through coaching (Field, 2010). The support becomes even more effective when it is tailored to the mother's situation and needs (Rollins et al., 2016). Self-efficacy changes over different stages of life making one-on-one coaching serve as an efficient intervention (Bandura, 1994). Breastfeeding coaching increases exclusive breastfeeding duration by up to two months and improves breastfeeding rates of late preterm infants (Jang, 2020; Khan, Kabir, Eneroth, & El Arifeen, 2017). Social network support also goes hand-in hand with coach support and reassurance to promote the mother’s readiness and persistence to continue with her desired goal (Heo & Noh, 2017; Jama et al., 2017; McFadden et al., 2017; Stelter, 2015).
Furthermore, exclusive breastfeeding for the first six months of life, meaning nothing else except mothers’ milk, and the continuation of breastfeeding up to two years is a UNICEF and WHO recommendation (McFadden et al., 2017; WHO, 2023). Given its psychological and physical benefits for both the mother and the baby, breastfeeding further adds to the economic and environmental benefits (McFadden et al., 2019). Unfortunately, working mothers in Egypt encounter their own challenges to breastfeeding, leading to low exclusive breastfeeding rates, despite being fully aware of the benefits (Abou-Elwafa & El-Gilany, 2019). As a result of the challenges, concerns and lifestyle changes mothers encounter during this stressful time, which influence their self-esteem, confidence and well-being (Osman, Chaaya, El Zein, Naassan, & Wick, 2010), they also need support to be able to initiate and continue to breastfeed (Rollins et al., 2016).
Moreover, mothers tend to resort to formula feeding upon their return to work, indicating that there is a relationship between the early cessation of breastfeeding and a mother’s working status (Dashti, Scott, Edwards, & Al-Sughayer, 2014; Elsayed & Al-Dossary, 2016; Kamel, 2016, Rollins et al., 2016). However, breastfeeding continuation is viable if employers implement breastfeeding support practices and facilities, which is possible by employers (Dinour & Szaro, 2017). Even though working mothers have rights as per the Egyptian Labour Law (2016), they often end up relying on their ability to bargain with their managers for flexible work schedules or longer maternity leave within the legal parameters (Sarhan, 2020). Thus, mothers need sufficient empowerment, and reassurance to seek their rights as well as to start and continue to breastfeed. This can be achieved through breastfeeding coaching to increase self-efficacy, confidence, and facilitate their breastfeeding journey (Jana & Ko, 2021; Jama et al., 2017). Working mothers with breastfed babies and high senses of well-being take less sick leave, feel more satisfied and perform better when the right lactation support programs are in place. Consequently, helping organizations to retain good talent, reduce turnover, and avoid incurring extra costs due to absenteeism (Hicks, Carter, & Sinclair, 2013; Ladge et al., 2018).
Breastfeeding counselling represents a preventative intervention that revolves around supporting mothers and infants to overcome difficulties and problem solve (McFadden et al., 2019). Despite its presence and effectiveness together with Egypt’s lengthy tradition in breastfeeding and mothers’ awareness about its benefits, only 13% of new-borns are exclusively breastfed at 4-5 months (Kamel, 2016). This low Exclusive Breastfeeding rate is putting Egypt in a vulnerable position when it comes to attaining sustainable development goals (SDG) for child and women health (Abul-Fadl, Rizk, Al Adawee, & El Kassar, 2019b). In Egypt, every four in five women work full time (Kamel, 2016). Therefore, for optimum breastfeeding rates, specifically among working mothers, further research is needed with a focus on breastfeeding interventions, particularly for self-efficacy (Al-Nuaimi, Katende, & Arulappan, 2017; Nilsson, Strandberg-Larsen, Knight, Hansen, & Kronborg, 2017).
The main aim of this research is to explore how breastfeeding coaching can enhance mothers’ self-efficacy to continue to breastfeed while in employment and explore the role of the workplace. Research questions will firstly explore how satisfied the mother is with her work and motherhood upon returning to work, secondly, how the mother views breastfeeding coaching, and finally, how breastfeeding coaching might affect mothers’ personal sense of self-efficacy, well-being, rates of absenteeism, and overall satisfaction and performance at work.
This research was conducted using a mixed methods approach (Pole, 2007): semi-structured interviews to bring in-depth insights, standardized questionnaires for self-efficacy and well-being scores, and lastly, a short-tailored questionnaire for socio-demographic and validation questions. Ethical approval for the research was obtained from Herriot Watt University. A convenience sampling technique was used. Participants were members of a mother support group on Facebook and/or researchers’ professional contacts, most of whom had already received lactation support either face to face or online, including but not limited to, breastfeeding coaching.
Breastfeeding coaching was provided as part of the research, and mothers received between seven-ten coaching sessions between birth until weaning, over a period of 12-18 months. The coaching was delivered by the same coach with years of experience in breastfeeding coaching. The coach was aware of breastfeeding coaching importance for mothers, but was not influenced by the study. Mothers received between seven-ten coaching sessions from birth up until weaning, over a period of 12-18 months. The first session was introductory, with the purpose of setting expectations and a focus on the challenges the mother was encountering, giving support and tips as needed. This was succeeded by two follow up sessions during the first eight weeks after the birth. The rest of the sessions were offered as per the mother’s need and request, roughly every eight-ten weeks. The techniques used by the coach were active listening, reflecting back using empathy, confidence building, open ended questions and motivational questions. Added to this was a breathing exercise either at the beginning or the end of every session.
The inclusion criteria were mothers with work experience (pre or post-delivery) in Egypt, 25-45 years old, and who have breastfed or are still breastfeeding. The exclusion criteria were mothers who have never worked, and/or mother or baby with chronic disease or disability. Twenty-eight mothers who live in Cairo and belong to middle and upper-middle socio-economic class, participated in the study. Their demographics are shown in Tables 1and 2 below.
Participants were well informed about the purpose of the study, assured about confidentiality and the anonymity of their identity in the final write-up, and consent was gained before conducting interviews. They were made aware that participation was voluntary, and withdrawal from the study was viable at any point prior to the analysis stage.
To understand the kind of support mothers receive, how they perceive breastfeeding coaching, a mixed methods approach was used, first using semi-structured interviews. There were five main sections, each had lead questions to be asked in case participants did not give enough information. In addition, the General Self Efficacy scale (GSE) (Schwarzer & Jerusalem, 1995) was used to measure the degree of the mother's positive self-beliefs which help her deal with challenges. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS, 2006) was used to measure mothers’ well-being. Also, socio-demographic questions included mother’s education, age, income, and occupation. Yet, given the “social transformations” that took place and reluctance to openly report income (El-Gilany, El-Wehady, & El-Wasif, 2012), more questions were added, to reflect the socio-economic status; related to travel, children’s education, accommodation, and social club’s membership. Links for GSE and WEMWBS questionnaires were sent to participants and scores were received prior to their interview.
During the interview, the researcher’s role was more of a facilitator, aiming to explore and understand the mother’s story and experience by active listening, empathizing, gently probing, and reflecting back to make sure the mother was understood correctly. Most of the interviews lasted between 45-65 minutes. After the interview, the tailored-questionnaire link was sent to the participant to answer independently.
Data was analysed after transcribing from Arabic to English. The questionnaires’ scores and responses were inserted in an Excel sheet, describing the sample, identifying self-efficacy and well-being. Well-being scores have been disregarded based on participants feedback “not feeling well due to the Covid pandemic situation, having to manage both work and kids e-learning from home.” Codes were identified and extracted using thematic analysis (Clarke & Braun, 2017). This was followed by integrating overlapping codes and identifying higher-level themes, which were adjusted as needed and reviewed against transcripts to make sure they reflect the essence of the data. Though a theoretical framework was applied to identify codes, still the researcher was open to unexpected patterns relevant to the research topic. In the final write-up, quotes from the transcripts were added to enhance the research findings.
Using thematic analysis three themes emerged. Participants described what motherhood means to them and their feelings towards themselves, their capabilities, and their social support system; reinforcing how it influenced their “Transition into motherhood” (theme 1). Breastfeeding formed most of this transition. A few months later, mothers encountered another transition related to work as they realised the barriers. So, “Going back to work” (theme 2) includes influences on the continuation of breastfeeding, mothers’ self-efficacy, and satisfaction with work and motherhood. Lastly, while reporting what support means to them and the kind of support they need from their respective organization, they highlighted the benefits of breastfeeding coaching and the support they received: “Benefits to the organization” (theme 3).
Theme 1 - Transition into motherhood: Participants described becoming a mother as a major transition with a drastic lifestyle change – i.e., having a person that needs full attention and breastfeeding around the clock. They reported that breastfeeding coaching enhanced their mental wellbeing, allowing them to better understand their needs, and, in consequence, satisfy them.
Sub-theme 1: Prenatal awareness and education: Participants emphasized the importance of mothers getting support to set realistic expectations and knowing that life will change “..otherwise you will not understand the GPS of your upcoming 3-4 years, .. you're stuck” (P10). They reported lack of prenatal awareness “I went to the doctor before the delivery... Nobody gave me any tips” (P3). Also, participants reported that breastfeeding coaching helped them set their expectations and goals. “It's more of shifting my mindset…” (P23), “… I should know... I cannot spend an hour in the bathroom ... go to the hairdresser anytime” (P4). “I had this belief that my role is to breastfeed exclusively for the 1st six month, everything else became unimportant, my work was still a priority because I didn’t let go of it.” (P2).
Sub-theme 2: Post-natal support and coaching: Although participants reported the need for prenatal education, they stressed the importance of breastfeeding coaching right after the delivery. “I want to know what to do” (P12); and throughout the breastfeeding duration to “...make the balance between... work, home, breastfeeding and other kids…” (P3). “Encouraging moms to breastfeed and for longer periods... not just... as a responsibility … enjoy this blessing.” (P1)
Moreover, those who received one-on-one breastfeeding coaching reported that it helped them achieve their goals, even those with lower self-efficacy scores. “It’s okay, you will be exhausted for a while, but you will get used to it” (P10). Participants perceived breastfeeding coaching to help mothers find solutions for problems, a work-life balance, “elevating energy levels” (P7), “reduce the sense of guilt” (P1), “feel validated” (P9) “guidance… it's just like a CHEAT SHEET” (P4). Added to the mental wellbeing of the mother: “I needed someone to tell me its fine…accept me” (P3), “..overcome my challenges … more psychological.” (P23)
Furthermore, most participants suggested that breastfeeding coaching should be available for mothers and fathers starting the third trimester, intensively during the first few weeks until breastfeeding has been established then whenever the mother needs it. However, it should be offered consistently for working mothers, especially due to conflicting opinions and pressure from the community: “If someone did not show you the value of what you are doing, you can easily give up” (P8).
Lastly, a couple of participants, despite of their high self-efficacy scores (34 & 38), stopped breastfeeding before six months due to misleading information from their paediatrician, and felt bad and guilty. Both reported that if they knew breastfeeding coaching existed, it would have helped them continue breastfeeding for longer. Also, participants requested that breastfeeding coaching should not be offered by paediatricians, even though paediatricians and breastfeeding coaches are meant to complement one another “… a doctor doesn’t have the capacity to go into emotions & feelings. However, it’s important that the coach … refers to a doctor, when needed” (P3).
Sub-theme 3: Coaching for experienced mothers: While most of the participants found that it was easier with the second child, due to the experience gained, “… it was much easier. It taught me to appreciate motherhood even more ... appreciate the first child” (P1). Yet, some were not sure of their capabilities as mothers “With my second… I had my doubts breastfeeding her” (P23), it was more psychological. “My worries … to manage the two or not?!” (P8), “I was confused …” (P5). Accordingly, participants reported that even if they have been through the experience before, breastfeeding coaching is needed for problem solving and overcoming their fear and worry. Also, they mentioned that their capacity and tolerance change over time, hence, the need for support and reassurance.
Nonetheless, participants reported that they encounter numerous challenges when it comes to breastfeeding, affecting their confidence and leaving them with self-doubts especially with the belief that breastfeeding should come naturally. Accordingly, mothers who received breastfeeding coaching reported how it impacted their confidence and self-efficacy positively (even pre-natal), allowing them to achieve, both, their motherhood work goals (post-natal).
Theme 2: Going back to work: Participants reported the need to work for various reasons, as indicated in the Figure 1, the first three reasons being to “feel accomplished”, “have own income…”, followed by “grow and develop”.
Other reasons were: “it’s me time, even if I am working... I am talking adult language, seeing different people” (P24), also, it encourages mother to look after themselves and their appearance. Yet, participants expressed that mothers need support to transition back to work after maternity, especially that they struggle to maintain their performance without straining themselves. Besides the challenges they encounter, as elicited by participants, have to do with problem solving, self-efficacy, and effective communication with different stakeholders. Mothers need to reach their own balance, which participants believe is achievable with tailored support through coaching.
Sub-theme 1: Attitudes towards mothers: Participants reported that the perception towards mothers changes after delivery, putting them on the “mommy track” upon their return to work or even as soon as they get pregnant, which clearly reflects on promotions and salary, hindering career progression:
There was even a debate on whether I should or not as a concept of applying... I could choose to take a short maternity, but the perception was... I am joking how come you are going on maternity and you are applying for a promotion and a new career. (P7)
I was highly regarded even by the Board of Directors and the Chairman but... when I got pregnant, they transferred me from the marketing... to the risk department. And... downgraded me from... head of marketing to risk manager. (P23)
One participant said: “I had to hide my kids at work” (P21). This was to be discrete to avoid being labelled, which was quite tough and heart breaking for her. Others mentioned having to stay late hours daily to finish work and prove themselves. And without having a solid support system at home “I would have never done it. No way!”(P8). Some participants ended up resigning which was devastating “I was the first doctor to resign from university!! I had to quit at the end!!” (P3).
Furthermore, some participants reported that even if a mother is not functioning 100% like she used to prior to having a baby, the workplace should be understanding and accepting that it is a temporary phase and give her credit based on her history:
It's a professional relationship, but... it needs to be Humane... this consideration and support. …will be a valuable asset, given her experience and knowledge of the company… understanding and finding an arrangement that would suit her needs and… enable her to perform at work… be satisfied… having enough time for her child... (P23)
Participants suggested that new mothers’ needs should be respected and accepted “I hated the most... at work... they used to make fun of me that I'm a cow and it's time to put the milk in the bottle...” (P1). Added to the office boy inquiring about the milk when they come to store it in the fridge, which embarrassed mothers. All this impacts mothers’ confidence, self-efficacy and stress levels. That said, participants reported the need for a breastfeeding coach to help them vent out their negative emotions, feel validated, reassured, and find ways to cope with such barriers, which positively influences their self-efficacy.
Sub-theme 2: Logistics and manager’s flexibility: Participants stated that having an understanding and flexible manager is important especially that it has to do with individuals not institutions. P6 mentioned that she was satisfied with her work especially that her manager was “... very understanding, allowed me to go back home during my lunch hour to nurse my baby”. Also, “my boss was supportive about being late to work in the morning” (P4).
Conversely, two participants working in the banking sector, both breastfed for over two years. Unfortunately, one of them ended up resigning despite of having a higher self-efficacy score (37/40) versus (29/40). The main obvious difference was the latter confirming “I had a good relationship with my manger” (P8), while the former feeling “humiliated and disrespected” (P23).
Additionally, participants shared the need for a day-care that is safe, hygienic and equipped to accommodate babies at the workplace. Hence, help them continue breastfeeding and feel less worried and stressed. A couple mentioned that they had a day-care at work but was not well equipped, thus, had to leave their baby with the grandmother; nonetheless, could not sustain that and ended up resigning, especially with the heavy traffic in Egypt and work being far from home. Other participants had to either look for a good nearby day-care or move to their parents’ house to leave the baby with the grandmother. Still, both options required that mothers pump at work to sustain breastfeeding. Pumping was another challenge, leading some to quit breastfeeding sooner than they planned.
Moreover, mothers reported that there was no place designated for pumping, they had to pump in the toilet which was not hygienic nor convenient and sometimes embarrassing. Nonetheless, participants who received breastfeeding coaching, were able to assertively express their needs to their managers and reach a win-win solution. Hence, some were able to work from home two to three days a week, go breastfeed in the middle of the day, or work flexible hours. While, a few participants were able to bring their babies along, in their own offices, however, those were family businesses, so had more flexibility. Even those who had a nursery at work reported that breastfeeding coaching helped them to communicate assertively with their managers to go breastfeed during their breaks. Lastly, some participants wished they had access to breastfeeding coaching to help them figure out their best options.
Sub-theme 3: Policies: Most participants needed more than the three months paid maternity (Figure 2). Despite that the labour law allows them up to two years of unpaid leave, it was subject to the manager’s approval, leaving mothers vulnerable. However, those who had access to breastfeeding coaching were able to figure out what is best for them and communicate assertively with their manager to fulfil their needs:
Breastfeeding needs to take its place, not embarrassing, and something approved at work, .. a mother who is pregnant, she will give birth, meaning she will breastfeed exclusively for six months so it will not be possible to be available before that ..(P2).
Other participants shared that despite having their maternity approved by their manager, they were approached after the first few months to return to work sooner, otherwise, they lose a promotion. One was even asked to resign if she decided not to. Nonetheless, mothers who were determined or had high self-efficacy and a good relationship with their managers managed to reach a mutual agreement and get the maternity duration they needed.
Lastly, most of the participants did not get the one-hour break during the day and instead had to stay beyond the working hours as a result of the workload.
Theme 3: Benefits to the organization: Some participants highlighted that breastfeeding coaching helped them achieve their motherhood goals, as a result, they felt satisfied and better focused at work; which in turn reflected on the organizations as described below. Nonetheless, mothers highlighted the importance of the managers and the respective organizational support.
Sub-theme 1: Cutting costs: Participants reported that mothers are more stable and loyal to the organization: Men are like a butterfly... but women... stay for longer. I used to sign the resignations… so every day if I receive ten... two are women... eight are men. Women look for... stakeholders, good manager, comfort zone” (P8).
Hence, it is important to support and retain good talent who know the company and understand the work inside out. Ultimately, this reduces turnover costs, and saves time and money.
Also, participants who exclusively breastfed and continued for a longer period, believe that breastfeeding had a positive impact on their children’s health. “Once or twice a year I would be absent because my kids were sick” (P2). “We had normal frequency of illness... if I needed time off, it would be one day.” (P8) “During those six months of breastfeeding… my baby was never ill.”(P4)
Participants concluded that they are helping the organization save health insurance and absenteeism costs.
Sub-theme 2: Improved self-efficacy and psychological availability: Participants who did not get the maternity leave they wanted were less satisfied with their motherhood upon returning to work, which left them with guilt feelings towards their babies, making them distracted at work. However, those who received breastfeeding coaching and had longer maternity leave enjoyed a stronger bond with their babies resulting in better communication. Added to higher self-efficacy scores (Table 3), reduced stress, less guilt feelings; hence, more psychological availability at work. Participants who took their babies with them to work did not feel guilty, unlike those who had to leave them elsewhere.
Lastly, participants who were able to achieve their breastfeeding goals felt satisfied and were confident that they can do anything they put their mind to: “I don't think anything is as hard as breastfeeding... so if I am able to breastfeed, I can just do anything else… I definitely know there is a way out” (P6). “I think after breastfeeding I have... the confidence that I... can succeed at anything. I put my mind into...” (P23)
The objective of this research was to explore breastfeeding coaching as an intervention to support working mothers in Egypt. The findings indicated that working mothers in Egypt are exposed to multiple challenges and barriers. Therefore, they need tailored support for their mental health and wellbeing to be able to initiate and continue breastfeeding, and, as a result, be satisfied with and present at work. More so, with the increasing involvement of women in the workplace, there needs to be more focus on self-efficacy and psychological wellbeing, particularly in countries like Egypt. Unfortunately, only 13% of new-borns are exclusively breastfed at 4-5 months, despite Egypt’s strong tradition in breastfeeding and mothers’ awareness of the benefits of breastfeeding (Kamel, 2016). Such low exclusive breastfeeding rate is putting Egypt in a vulnerable position. Accordingly, there is a need for this relatively novel concept of breastfeeding coaching, to be available for working mothers from pregnancy onwards.
Mothers reported encountering numerous challenges moving into motherhood, consistent with the findings of Osman et al. (2010) who highlighted the precedence of misconceptions and cultural influences that negatively influence breastfeeding. Consequently, they doubt themselves and their capabilities (Bandura, 1997). Mothers highlighted the need for pre-natal support for priority setting, discovering their best options, and setting realistic expectations in order to have higher sense of self-efficacy. They also need support post-delivery for reassurance and guidance in solving breastfeeding problems, which is consistent with Rollins et al. (2016) who confirmed that mothers need support to initiate and continue to breastfeed. In the first few weeks after breastfeeding is established, mothers also expressed the need for someone to help them find the balance between motherhood and work.
Additionally, some mothers struggled with receiving misleading information from their paediatrician, which left them with guilt feelings and high levels of stress, consistent with Mostafa et al. (2019). This puts pressure on some mothers to cease breastfeeding sooner than they intended to. Besides, they stated being vulnerable at this stage, in need for someone to listen, empathize, boost their energy levels, and empower them to problem solve. Ultimately, a coach can help them feel validated while boosting their self-efficacy (Bandura, 1994), which reflects on their wellbeing and performance at work, as well as empowering them to involve the right people for support and manage the negative social influence (Field, 2010). Therefore, it is important to integrate lactation support with coaching skills.
The lack of support from managers and the negative perception towards working mothers plays a crucial role. Mothers with high self-efficacy scores who received breastfeeding coaching but felt disrespected or unappreciated at work with no support from their social network, ended up resigning. Conversely, mothers with lower self-efficacy scores and access to breastfeeding coaching reported that they were able to breastfeed and continue to work due to the support they had from their managers and social network. Hence it would be misleading to discount any of the factors. Furthermore, social network support should complement the coach support and encouragement to promote the mother's readiness and persistence to reach her desired goal, consistent with literature (Heo & Noh, 2017, Stelter, 2015). Nonetheless, coaching enhances the mother’s self-efficacy giving her confidence and courage, ultimately, empowering mothers to manage the challenges encountered from their social network, workplace and to look after their own wellbeing. Therefore, breastfeeding coaching is necessary and may fill the gap when any of the supporting factors is missing.
Moreover, participants expressed the need for tailored support, someone to understand their situation and circumstances to be able to help them. Other research indicates that support becomes more effective when it is tailored to the mother's situation and needs (Rollins et al., 2016). Accordingly, support is necessary irrespective of the mother’s previous experience, since challenges change with each child, also, self-efficacy changes over the lifespan (Bandura, 1994). One-on-one breastfeeding coaching is an efficient intervention, both, pre- and post-delivery.
Another discounting factor to highlight was the amount of logistics mothers had to deal with to continue breastfeeding while working, such as pumping or finding a place to leave the children, or the distance commuted. Hence, mothers resort to formula feeding upon their return to work, indicating there is a relationship between the early cessation of breastfeeding and the mother working status (Dashti, Scott, Edwards, & Al-Sughayer, 2014; Elsayed & Al-Dossary, 2016; Kamel, 2016, Rollins et al., 2016). Therefore, mothers demand nurseries in the workplace, having the option of working remotely, part-time or even flexible hours, which may be achieved through breastfeeding coaching using problem solving techniques. This is viable and important especially that when mothers receive the right support, they feel more satisfied, and can perform better at work (Dinour & Szaro, 2017). Besides, with the right support in place, most women can multitask. Hence, retaining good talent will reap enormous benefits for the workplace, especially if the mother has proven track record with their respective organization or elsewhere. Even more, the Covid pandemic has created opportunities for remote working and flexible hours.
Additionally, mothers reported that breastfeeding has positively impacted their children’s health as well as their own, (UNICEF, n.d.), allowing them to be more physically and psychologically available at work, consequently, cutting down on absenteeism and healthcare costs, (Hicks et al.,2013; McFadden et al.,2019). Mothers reported that the support, flexibility, and appreciation from their managers contributes to their satisfaction and self-belief, consistent with Ladge et al (2018). Also, support and words of encouragement could possibly increase self-efficacy (Bandura, 1997). More so, mothers who breastfed exclusively reported that succeeding to breastfeed reassures them that they can succeed in anything else, which in turn reflects on performance at work, problem solving and possibly resilience.
In conclusion, despite the presence of breastfeeding counselling as a preventative intervention to support mothers and infants to overcome breastfeeding difficulties and problem solve (McFadden et al., 2019). Offering breastfeeding coaching as an intervention shall benefit organizations, as well as the broader governmental agenda in attaining SDGs for women and child health, which is currently a challenge (Abul-Fadl et al., 2019b). Breastfeeding coaching assists the mother to transition smoothly into motherhood, and provides support for mothers to transition back to work while continuing to breastfeed for improved wellbeing and self-efficacy.
As with any research, there is the subjectivity factor (Mann, 2016; Pannucci, & Wilkins, 2010). Conducting the interviews during lockdown, participants were not in a good wellbeing state. However, all participants have had previous breastfeeding experience, at least with one child, prior to the start of the pandemic, hence, reducing the impact of their wellbeing on the data. This data has been collected from mothers living in Cairo (urban), working within certain sectors, within the middle and upper-middle socio-economic class; hence, further research is needed to investigate the transferability of findings to different segments of the society. Moreover, there is room for research to investigate the workplace perspective and how it compares to mothers’ perspectives. Lastly, some participants expressed the need for coaching to support mothers beyond breastfeeding or mothers who could not breastfeed for whatsoever, which would be interesting to study.
This research indicates that there is a need for breastfeeding coaching to increase working mothers’ self-efficacy, thus, empower them to initiate and continue to breastfeed, which in turn will reflect on their work performance and satisfaction. Also, coaching will help mothers feel validated, and able to understand their needs, hence, able to communicate assertively with their social network including colleagues and managers in the workplace. Eventually, this will support mothers to problem solve better and discover ways to balance between home, motherhood, and work, which will reflect positively on their mental health and wellbeing.
In addition, breastfeeding coaching should be offered to mothers pre-delivery of baby for setting expectations, priorities and boosting self-efficacy. While post-delivery to provide practical support for mothers with breastfeeding challenges, look after their mental wellbeing, elevate energy levels, and help them attain their own balance. Consequently, this will help mothers breastfeed for longer durations as well as enhance their performance and presence at work. Ultimately, organizations would retain experienced talent, while reducing the rates of absenteeism and turnover, saving them valuable time, and money.
Iman E. Sarhan, MSc. is an Organizational Psychologist. She specializes in supporting and empowering leaders manage transitions effectively, build and maintain healthy relationships/boundaries, with a focus on mental health & wellbeing.
Dr Dasha Grajfoner is a Chartered Coaching Psychologists (BPS) and Director of Centre for Business at DOBA Business School, Slovenia and past Chair of the Division of Coaching Psychology (BPS).