Experience of Primiparous Mothers on Exclusive Breastfeeding in Oman

Study Design and Setting

A qualitative design was adopted to explore primiparous mothers’ perspectives, beliefs, and experiences regarding EBF. Qualitative methods are particularly suited to capturing the complexity of social and cultural contexts and participants’ lived experiences (Creswell & Poth, 2017). The study employed constructivist grounded theory, which aims to generate conceptual understanding grounded in participants’ narratives while acknowledging the co-construction of meaning between researchers and participants (Charmaz, 2014; Glaser & Strauss, 1967). This approach allows for iterative data collection and analysis, enabling concepts and relationships to emerge inductively from the data.

The study was conducted in postnatal clinics within MOH primary healthcare facilities in the North Batinah Governorate (NBG), Oman, one of the most populated regions in the country with extensive maternal and child health services.

Sampling and Participants

Purposive sampling was initially used to recruit participants who met the predefined inclusion criteria. Eligible participants were Omani primiparous mothers who had delivered a healthy singleton infant, were classified as low-risk, and had initiated EBF during their hospital stay.

As data analysis progressed, theoretical sampling was applied to refine emerging categories and explore developing concepts in greater depth, consistent with grounded theory methodology (Fram, 2013; Glaser & Strauss, 1967). Recruitment continued until theoretical saturation was reached, when no new conceptual insights emerged from additional interviews. In total, 35 mothers participated in the study.

Data Collection

Data were collected through semi-structured, in-depth, face-to-face interviews using an interview guide developed based on existing breastfeeding literature and the study objectives. Interviews were conducted in Arabic by trained researchers and lasted approximately 40–60 minutes.

All interviews were audio-recorded with participants’ consent and transcribed verbatim in Arabic. The transcripts were subsequently translated into English to facilitate collaborative analysis among the research team. Field notes were also maintained during and after interviews to capture contextual observations and preliminary analytical insights.

Rigor

The study adhered to Charmaz’s criteria for rigor in constructivist grounded theory, including credibility, resonance, originality, and usefulness (Charmaz, 2014). Reflexivity was maintained throughout the research process, with researchers reflecting on their assumptions and interactions with participants (Charmaz, 2006).

Credibility was enhanced through prolonged engagement with participants’ narratives and systematic coding procedures. Transferability was supported by providing detailed contextual descriptions of the study setting and participants. Confirmability was strengthened by maintaining an audit trail of analytic decisions, memos, and coding development to ensure that findings were grounded in participants’ accounts rather than researchers’ assumptions.

Data Analysis

Data analysis followed the constant comparative method, a key component of grounded theory (Charmaz, 2014; Glaser, 1978; Glaser & Strauss, 1967). The analysis was conducted concurrently with data collection, allowing emerging insights to inform subsequent interviews and guide further exploration of participants’ experiences. Initially, transcripts were examined line by line to identify significant concepts and actions expressed by participants (initial coding). Frequently occurring or conceptually significant codes were then grouped to form preliminary categories during the focused coding stage. Throughout the process, codes and categories were continuously compared across interviews to refine similarities, differences, and relationships within the data, using constant comparison. Analytical memos were also written regularly to document emerging interpretations and conceptual connections between categories.

Qualitative data analysis software was not used in this study. Instead, coding and category development were conducted manually by the research team through repeated reading of transcripts, coding tables, and analytic memo writing. Manual analysis allowed the researchers to remain closely engaged with participants’ narratives and facilitated reflexive interpretation throughout the analytic process.

Categories were generated inductively from the data rather than predetermined. Broader conceptual categories were intentionally retained to capture the overall experiential process of primiparous mothers as they anticipated, initiated, and adapted to exclusive breastfeeding.

Through this iterative and reflective process, categories were progressively refined and integrated to develop an interpretive understanding of primiparous mothers’ experiences with EBF.

Participant Characteristics

A total of 35 primiparous Omani mothers participated in the study (Table 1). Most participants were between 23 and 29 years of age (82.9%), and all were married. The majority were employed (62.9%), while the remaining participants were housewives. Educational attainment varied, ranging from a general diploma to a master’s degree, with 42.9% holding a bachelor’s degree.

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Table 1.

Demographic Data.

Variables	Level	Number	%
Age	23–29 years 30–35 years	29 6	82.9 17.1
Marital Status	Married	35	100
Education Level	General Diploma Diploma Bachelor Master	8 10 15 2	22.8 28.6 42.9 5.7
Occupation Status	Working Housewife	22 13	62.9 37.1

Emergent Grounded Theory

Analysis generated three interrelated categories that explained mothers’ experiences with EBF: Anticipating Breastfeeding, Navigating Support Systems, and Encountering Challenges. These categories interacted dynamically and culminated in the grounded theory Shifting Away from Expectations.

This theoretical explanation illustrates how primiparous mothers initially approached breastfeeding with confidence and positive expectations but gradually experienced a mismatch between expectations and reality as they encountered practical challenges and inconsistent support.

Grounded Theory: Shifting Away From Expectations

The interaction between the three categories—anticipating breastfeeding, navigating support systems, and encountering challenges—led to the development of the grounded theory Shifting Away from Expectations. This theory explains how primiparous mothers entered motherhood with strong cultural and personal expectations that breastfeeding would occur naturally and effortlessly. However, when faced with practical challenges and limited sustained support, many mothers experienced a gradual shift from confidence to frustration and eventual discontinuation of EBF. The theory highlights a process in which initial optimism transitions into disillusionment, as mothers attempt to reconcile their expectations with the realities of breastfeeding in the postpartum period.

Anticipation and Cultural Expectations

Mothers entered breastfeeding influenced by cultural norms that framed it as a natural and expected practice (McGlothen-Bell et al., 2023; Severinsen et al., 2024). Exposure to breastfeeding within extended families shaped their assumption that breastfeeding would occur instinctively. Similar findings have been reported in other cultural contexts, where women often perceive breastfeeding as both a defining aspect of motherhood and a moral responsibility (Debucquet & Adt, 2020; Van Esterik, 2018).

Breastfeeding is also deeply embedded within social and cultural systems, where beliefs, traditions, and family expectations influence how mothers approach infant feeding (Cassidy & El Tom, 2015). In many societies, including those in the Middle East, breastfeeding is strongly associated with maternal identity and moral responsibility, which can intensify the emotional impact when mothers encounter difficulties.

However, when participants encountered unanticipated challenges, these assumptions became sources of stress and disappointment. This underscores the importance of preparing mothers with realistic information about potential difficulties rather than solely emphasizing the “naturalness” of breastfeeding.

The challenges described in this study are consistent with prior Omani research. Al-Marzouqi and collegouse (2020) reported that women entered breastfeeding with strong cultural expectations but soon faced difficulties that tested their resilience. In a similar way, our participants experienced a transition from optimism to challenge, a shift that is captured in the grounded theory Shifting Away from Expectations.

The Role of Family Support

Grandmothers played a pivotal role in sustaining breastfeeding during the early postpartum period by offering practical guidance, reassurance, and cultural wisdom. This aligns with research from Papua New Guinea and Malawi, where extended family support is central to breastfeeding continuation (Chipojola et al., 2020; Maviso et al., 2022). Yet, in the Omani context, this support was often limited to the first 6 weeks, leaving mothers without guidance thereafter. Given the collectivist nature of Omani society, integrating grandmothers into structured breastfeeding education programs could leverage their influence for longer-term support. Spousal support, while emotionally encouraging, was constrained by employment demands. This finding echoes prior studies emphasizing that partner involvement remains underutilized despite its potential to positively influence breastfeeding outcomes (Budiarti & Suja, 2024).

Healthcare Professional Support

Many mothers expressed dissatisfaction with the care and guidance they received from healthcare professionals (HCPs). Reports of inconsistent or minimal support are concerning, as HCPs are expected to provide evidence-based guidance and encouragement. Similar gaps between expectations and experiences have been documented elsewhere, where inconsistent advice and rushed interactions have undermined mothers’ confidence (Al-Marzouqi et al., 2020; Al Rifai et al., 2023; Chesnel et al., 2022; Scott et al., 2023). These findings highlight a critical practice gap in Oman: while HCPs recognize breastfeeding support as part of their role, the quality and consistency of this support require improvement. Nurses and midwives are uniquely positioned to bridge this gap through consistent, empathetic, and culturally sensitive care.

Workplace Barriers and Policy Gaps

Returning to work emerged as a major challenge for participants. Many mothers associated employment with fatigue, lack of time, and early discontinuation of EBF. This reflects international evidence showing that employed mothers are less likely to sustain breastfeeding when workplace policies are unsupportive (Vilar-Compte et al., 2021). In Oman, maternity leave policies and workplace accommodations remain limited, which exacerbates the strain on working mothers. Policy reforms, such as extending maternity leave, providing workplace lactation spaces, and promoting flexible schedules, are urgently needed. Nurses and midwives can play an important advocacy role by raising awareness of these systemic barriers and lobbying for supportive workplace policies. Importantly, the influence of workplace barriers identified in this study aligns with previous Omani research, which highlighted insufficient institutional and policy support as significant obstacles to sustaining exclusive breastfeeding (Al-Marzouqi, 2023). Taken together, these findings illustrate the multifactorial nature of breastfeeding discontinuation and reinforce the need for systemic interventions at family, professional, and workplace levels.

Perceived Insufficient Milk Supply

Perceived low milk production and infant crying were frequently cited as reasons for discontinuing EBF. These concerns have been consistently identified in global studies as major barriers (Rabb et al., 2023; Tracz et al., 2021; Akalpler et al., 2023). Importantly, such perceptions often reflect anxiety and lack of anticipatory guidance rather than actual insufficiency. Preparing women during antenatal visits with realistic expectations about infant feeding patterns and strategies to manage perceived insufficiency could strengthen mothers’ confidence and reduce unnecessary discontinuation.

Theoretical Contribution

The grounded theory developed in this study, Shifting Away from Expectations, offers a conceptual explanation of how primiparous mothers navigate the early breastfeeding journey. Initially, mothers approached breastfeeding with strong cultural expectations that it would occur naturally and effortlessly. However, as practical challenges emerged—including inconsistent professional guidance, perceived milk insufficiency, and workplace pressures—these expectations gradually shifted toward uncertainty and struggle. This conceptual framework highlights breastfeeding not as a single decision but as a dynamic process shaped by personal beliefs, social influences, and structural conditions. By illuminating this transition, the theory contributes to breastfeeding literature by emphasizing the importance of continuous support across the postpartum period rather than focusing solely on breastfeeding initiation.

Limitations

This study was limited to mothers attending MOH facilities in one governorate, which may not reflect experiences in other regions. As a qualitative study, the findings are not generalizable but provide in-depth understanding of first-time mothers’ experiences. Additionally, only mothers’ perspectives were included; the views of healthcare providers and family members were not captured.