Maternal Guilt and Shame in the Postpartum Infant Feeding Context: A Concept Analysis

Abstract Background: After birth, guilt and shame are differentially experienced by breastfeeding and formula feeding mothers. Despite this, currently utilised guilt and shame definitions lack context specificity, leaving concepts open to misinterpretation. Objective: The current study aimed to develop infant feeding-specific definitions of postpartum guilt and shame. Methods: Study selection involved a three-stage systematic screening process, outlined in Jackson et al (2021). Walker and Avant's (2005, 2019) concept analysis framework was then applied to included articles to identify guilt-specific, shame-specific, and overlapping attributes, antecedents, and consequences. Results: A guilt-specific, shame-specific, and overlapping definition were generated based on exclusive and overlapping antecedents, attributes, and consequences. Guilt and shame belonged to the empirical referent Moral Emotions, which may explain some of the overlapping antecedents, attributes, and consequences identified during analysis. Conclusions: The overlapping definition provides a broad scope for shared characteristics, while specific definitions allow for more in-depth and focused investigations of guilt and shame experiences within an infant feeding context. Utilising context-specific definitions may serve to improve research homogeneity. Shame was found to be uniquely associated with postnatal depression. As such, suggestions are made for future research to further investigate the relationship between shame, infant feeding, and maternal wellbeing outcomes. Implications: Identified antecedents may be used by healthcare professionals to provide additional support to mothers at risk of experiencing guilt and shame, to prevent the occurrence and consequences of these emotions.