Breastfeeding and Bonding: A Surprising Role of Breastfeeding Difficulties

Abstract

Aims:

To explore the role of breastfeeding difficulties in bonding.

Background:

Studies published to date yielded varying results regarding the relationship between breastfeeding and bonding. In qualitative studies, mothers often describe breastfeeding as a bonding experience and regard breastfeeding difficulties as challenging. Only one quantitative study explored the impact of breastfeeding difficulties on bonding.

Methods:

A cross-sectional method was used and a self-report questionnaire was administered to a convenience sample of mothers with infants aged 0–6 months.

Results:

We found that having problem-free breastfeeding versus breastfeeding associated with breastfeeding difficulties led to a difference in bonding quality. Experiencing any breastfeeding difficulties was associated with bonding impairment (p = 0.000, r = 0.174), especially in cases of breast engorgement (p = 0.016, r = 0.094), a nonlatching baby (p = 0.000, r = 0.179), perceived low milk supply (p = 0.004, r = 0.112), and fussing at the breast (p = 0.000, r = 0.215). We also found a difference in bonding impairment between exclusively breastfeeding and exclusively bottle-feeding mothers (p = 0.001), but only when taking into account breastfeeding difficulties.

Conclusions:

Breastfeeding is a complex interaction that can be associated with mother–infant bonding in various ways. We found that breastfeeding difficulties were linked to bonding impairment, whereas exclusive breastfeeding without the presence of breastfeeding difficulties was not. Strategies to help achieve exclusive breastfeeding and prevent and resolve breastfeeding difficulties may help mothers fulfill the bonding potential with their infant.

Introduction

Exclusive breastfeeding for the first 6 months of the infants life is recommended by the World Health Organization, with breastfeeding continuing to until 2 years and beyond along with introducing complementary food.¹

Exclusive breastfeeding was shown to be the physiological way of meeting the nutritional needs of infants from birth to 6 months by many studies.^2,3 Yet research dedicated to psychological importance of breastfeeding is sparse. Some authors found a positive link between breastfeeding and mother–infant attachment,⁴ while others failed to prove that this link existed.⁵ To date, studies about breastfeeding vary in methodology,⁶ which seems to be less adequate in psychological than in medical research.

Most studies do not specify whether the infant is breastfed directly from the breast or human milk fed, although it is being recognized by some authors that breastfeeding directly from the breast and feeding human milk from a bottle are two behaviorally different activities.⁵

Another problem is the absence of recording reasons for mothers' bottle feeding human milk. While some mothers may have social reasons (the mother going back to work, thus having to pump human milk and have the child fed by a carer), they might affect the relationship and psychological well-being and might be a source of distress, like a variety of breastfeeding problems.⁷

In her dissertation, Jardine⁸ found that 73% of pumping mothers were exclusively pumping because of breastfeeding problems, not by choice. The qualitative part of her research showed that the problems ranged from the infants' inability to latch on to the breast to excessive crying while breastfeeding, which made the mothers feel rejected. This can arguably influence bonding with their children, although they would normally be categorized as “exclusively breastfeeding.” Therefore, for research purposes, combining mothers who are breastfeeding directly from the breast without any problems and mothers who are exclusively pumping and feeding pumped human milk due to breastfeeding issues (or breastfeed despite severe difficulties) into the same category in studies related to mother–infant bonding might ultimately be producing varying results and/or difficulty interpreting the research.

To date, there is little research regarding the link between breastfeeding difficulties and mother–infant bonding. We were only able to find one study⁹ that examined directly how breastfeeding difficulties may affect mother–infant bonding. The authors of the study found that breastfeeding difficulties predicted reduced bonding and that this effect persisted beyond the effect of postpartum depression on bonding which was well established.^10,11

Despite a lack of research on mother–infant bonding and its link to breastfeeding difficulties there is research suggesting that these two areas may be connected. It is widely recognized that breastfeeding cessation may lead to postpartum depression¹² and that they may have shared neuroendocrine mechanisms.¹³ Some authors concluded that besides breastfeeding cessation, breastfeeding difficulties could also predict postpartum depression.¹⁴ Postpartum depression is in turn connected to mother–infant bonding.¹⁰ Breastfeeding difficulties, postpartum depression, and postpartum bonding disorders therefore seem to be connected.

Breastfeeding difficulties may even be a more significant stressor for mothers than breastfeeding cessation which can sometimes be followed by a sense of relief and closure,¹⁵ particularly when women are not offered adequate breastfeeding help in their situation. Stuebe et al. found that although two-thirds of mothers experiencing breastfeeding difficulties contacted a health care provider, only one in four mothers felt that they received the help they needed.¹⁶ However, if the lactation support providers offer practical help with breastfeeding, mothers can overcome difficulties and breastfeed exclusively¹⁷ which may lead to relief and can help contribute to their breastfeeding self-efficacy¹⁷ which in turn may strengthen the bond with their child.

Qualitative studies regarding mothers' perceptions of breastfeeding difficulties also yield noteworthy results in respect to bonding. Hegney et al.¹⁸ report that about half the mothers viewed breastfeeding as a way of bonding with their babies, and breastfeeding difficulties were perceived as very stressful and emotionally challenging. While mothers that were no longer experiencing difficulties felt connected to their babies when breastfeeding, mothers experiencing difficulties (fussing at the breast) reported feeling rejected by their infant and sometimes even stopped breastfeeding because of the emotional toll it took on them.

In contrast, Lamontagne et al.¹⁹ report that for some mothers, breastfeeding was an important bonding moment, so they continued despite physical difficulties like pain. Notably, breastfeeding difficulties and the attempt to resolve them “took away the charm” of bonding with the baby.¹⁹ Similar conclusions were reached by Whittingham and Mitchell²⁰ who reported that rather than objective breastfeeding difficulties, it was negative breastfeeding experience that negatively influenced mother–infant relationship. They highlighted the importance of breastfeeding support which could help with mother–infant attunement. If the mother overcomes breastfeeding difficulties, she may have a more positive breastfeeding experience overall, while ceasing breastfeeding may leave her feeling that she “could have tried longer.”²¹

Some mothers regret stopping breastfeeding and even attempt relactation after switching to formula feeding. Lommen et al.²¹ examined the reasons for relactation attempts in 10 mothers who ceased breastfeeding prematurely. One of the reasons they provided for trying to relactate was missing the bonding experience with their children when not breastfeeding.²¹ Even if quantitative research is inconclusive when it comes to linking breastfeeding and bonding, in qualitative research and research based on self-reporting, breastfeeding is almost always described as a “bonding experience”^22,23 and a motivator for overcoming breastfeeding difficulties.¹⁸

The goal of this study was to examine if and how problems with breastfeeding might be linked to mother–infant bonding. We consider this study to be a pilot study in a mostly unexplored area. It was not intended to be clinically meaningful but rather exploratory to determine if there were associations that could be tested by more rigorous methods. Based on current research we hypothesize that:

H1: Experiencing breastfeeding difficulties at present positively correlates with mother-infant bonding impairment.

H2: Bottle-feeding mothers have significantly higher bonding impairment with their infant than breastfeeding mothers.

Methods

Research design

We chose a cross-sectional design for our research.

Research sample

The main criterion for participating in the research was to be a mother of an infant aged 1 − 24 weeks at the time of data collection. Other criteria were being over 18 years old and speaking Slovak or Czech. At the time of the research, approximately two-thirds of participants lived in Slovakia and one-third in the Czech Republic.

Data collection

Data collection took place in December 2020. During this period, a questionnaire created using Google Forms was shared through the Facebook social network in groups focusing on motherhood, babywearing, breastfeeding, and selling or buying children's toys and clothes. Participation in the research was voluntary.

Ethical aspect of research

Due to the sensitivity of the research topic, the questionnaire used in this research was submitted to the Ethics Committee of the Comenius University in Bratislava, Slovakia, and received approval on November 30, 2020.

Research methods

A standardized questionnaire was used, and it was aimed at measuring the bonding impairment between mother and the infant from the mother's point of view (Postpartum Bonding Questionnaire [PBQ]). The remaining research questions were created by this author to determine the current feeding method, breastfeeding problems (current and experienced in the past), and some basic information about the mother and baby (see Supplementary Data).

Basic information about the mother and infant

Demographic factors

These included questions regarding the age of the mother and the baby, place of stay, mother's marital status, and relationship satisfaction.

Information about pregnancy and birth

We inquired about the type of birth, parity, gestational week at birth, complications during pregnancy and birth, and whether it was a singleton or multiple birth.

Psychosocial factors

We inquired about participants' satisfaction with their relationship, whether they have someone to confide in regarding their baby experience, and how they felt about the pregnancy at the beginning.

Postpartum bonding questionnaire

The PBQ is a questionnaire primarily used to assess the mother–child relationship.²⁴ It originally consists of 25 questions regarding the mother's feelings toward the child.

The answers to the questions are provided in the form of a 6-point Likert scale and each answer is subsequently awarded 0 − 5 points. A higher score reflects higher bonding impairment. Based on the factor analysis of the questionnaire, its author presents four factors of disturbed bonding:

1. Impaired bonding, 2. Rejection and anger, 3. Anxiety about care, 4. Risk of abuse. The reliability of the questionnaire is reported to be α = 0.85,²⁵ whereas in our research, we found α = 0.936. The translation of the questionnaire into Slovak was undertaken in cooperation with a professional translator.

The feeding method

As mentioned in the introduction, a consensus has not been reached yet on how to assess and define the feeding method of an infant which causes even more complications in psychological research than in medical studies. We did not find any satisfactory method to assess infant feeding method in the current literature, so we prepared our own definitions for the purpose of this research.

We chose to focus on two factors that we deem essential when studying breastfeeding in psychological research: 1.

The infants' current feeding status (i.e., breastfeeding or bottle feeding), including whether they are getting breast-milk from the breast, from a bottle or both. (“How does your infant get your breastmilk?” and “How does your infant get donor breastmilk or formula?”)

The history of feeding of the infant, that is, whether (and for how long) the baby was exclusively breastfed (“How long was your baby exclusively breastfed?”), whether (and for how long) they were being supplemented (“How long was your baby breastfed while being supplemented?”). We obtained the information on how long the baby was exclusively bottle fed by subtracting the time the baby was exclusively breastfed and/or being breastfed and supplemented from his/her age.

We also inquired whether the baby had been introduced to solids. These questions were pilot tested together with the whole questionnaire to ensure comprehensibility.

Breastfeeding difficulties

We determined breastfeeding difficulties by posing two questions. One regarding the difficulties mothers experienced while breastfeeding this baby overall since birth and the other one to determine if they are experiencing any difficulties with breastfeeding currently. We inquired about eight breastfeeding difficulties: nipple/breast pain during/after breastfeeding, painful breast engorgement, low milk supply, baby refusing to latch from birth, the use of nipple shields, mastitis, breast abscess, and baby fussing at the breast (refusing to latch on or crying at the breast following a period of problem-free breastfeeding). Current breastfeeding difficulties were probed with a yes/no question.

Data analysis

The data were analyzed using IBM SPSS 20.

After describing our sample, we verified the normality of the data using the Shapiro–Wilk test. Since we did not find a normal distribution, we used nonparametric tests, namely Mann–Whitney U test, Kruskal–Wallis H, and Spearman's correlation coefficient.

We used a p-value of 0.05 (95%) as a criterion to accept or reject our hypothesis.

Results

Data characteristics

The questionnaire was filled in by 870 participants. Participants with an infant older than 24 weeks (N = 161) and one duplicate answer were eliminated. We were able to evaluate infant feeding type in 685 (96.6%) cases and classify participants into 9 categories. We excluded the remaining 3.4% (N = 24) of participants; therefore, the final number of participants in our research was N = 685.

Postpartum bonding questionnaire

In our research we work with the whole PBQ as one score, we do not divide it into multiple scales. We also do not have norms established for the Slovak or Czech populations, so we do not have a cutoff score indicating bonding impairment. The PBQ score in our research was M = 15.54, median [Md] = 12, Mode = 9, standard deviation [SD] = 13.57, Min = 0, and Max = 101.

Psychosocial factors

The average age of the mother was 30 years (M = 29.77, Md = 30, Mode = 30) and their infants were 15 weeks old on average (M = 15, Md = 15, Mode = 24). Age of the mother (p = 0.282) or the infant (p = 0.715) did not correlate with mothers' reported bonding. The rest of the psychosocial factors are described in Table 1.

Table 1.

Psychosocial, Demographic, Pregnancy, and Birth Factors in Relation to Bonding

	M	Md	Min	Max	%	P	r
Place of stay
Slovak Republic	14.8	11	0	101	65.1	0.006 ^a	0.121^*
Czech Republic	17.1	13	0	83	31.7		0.121^*
Other	15.4	10	3	90	3.2
Marital status
Married	15.6	12	0	101	68.2	0.935^a
In a relationship	15.2	12	0	75	29.9
Single	16.5	11	3	88	1.9
Parity
Secundipara	13.9	11	0	74	37.4	0.003 ^a	0.109^*
Primipara	17.2	13	0	101	53.7		0.109^*	0.125^*
Tripara and multipara	12.3	9	1	40	8.9			0.125^*
Reaction to pregnancy
Unplanned and positive	13.6	11	0	70	19.7	0.000 ^a	0.356^**
Unplanned and negative	26.9	24	4	90	5		0.356^**	0.195^**
Planned and positive	15.3	12	0	101	75.3			0.195^**
Complicated pregnancy
Yes	19.5	12.5	0	101	16.9	0.015 ^b	0.093^*
No	14.7	11	0	90	83.1	0.015 ^b	0.093^*
Infant health issues after birth
Yes	20.8	16	0	74	2.9	0.089^b
No	15.3	12	0	101	97.1	0.089^b
Delivery
Preterm	17.8	15	0	63	7.1	0.140^a
Term	15.2	11	0	101	85.8
Late term	17.5	12	1	66	7
Multiple birth
Yes	22	15	4	74	1.3	0.179^b
No	15.5	12	0	101	98.7	0.179^b
Delivery mode
Vaginal instrumental	17.3	13	3	54	3	0.053^a
Vaginal	14.8	12	0	83	73.3		0.115^*
Emergency c-section	19.6	15	0	101	13.7		0.115^*
Planned c-section	14.8	9	1	54	10

The bold values signify that the value is significant, e.g. < 0.05.

Values represent scores for PBQ: M, mean; Md, median; Min, minimum; Max, maximum.

r, Pearson's r.

Kruskal–Wallis H test significance to find out the differences between groups in bonding.

Mann–Whitney U test significance to find out the differences between groups in bonding.

p-value < 0.05.

p-value < 0.01.

PBQ, Postpartum Bonding Questionnaire.

Infant feeding

Based on the questions regarding infant feeding, we created eight feeding categories, which covered 96.6% (N = 684) of mothers. We list the categories in Table 2.

Table 2.

The Number of Participants in Each of the Feeding Categories

Feeding type	N	%
1. Exclusive breastfeeding (or supplementing for less than a week) since coming home (ExBF1)	353	51.5
2. Exclusive breastfeeding at present, but supplementing for more than a week (ExBF2)	41	6
3. Supplementing with formula or food at present (BFwFF)	115	16.8
4. Exclusive formula feeding at the present, but breastfeeding for more than a week (ExFF1)	108	15.8
5. Exclusive formula feeding since coming home (ExFF2)	26	3.8
6. Exclusive human milk feeding from the bottle (ExHM)	6	0.9
7. Bottle feeding breast milk and formula (Combo HMF)	14	2
8. Breastfeeding and bottle-feeding human milk (ExHMplusBF)	22	3.2

In our research sample 394 women (55.5%) were exclusively breastfeeding, 137 women (20%) were breastfeeding and supplementing with formula or pumped breast milk from a bottle or food, 20 infants (2.8%) were exclusively breast milk fed from a bottle (but not breastfed at all), and 134 infants (19.6%) exclusively received formula from a bottle.

Breastfeeding difficulties

Breastfeeding difficulties were very common in our research sample, with 90.4% of women stating that they have experienced breastfeeding difficulties with their infants. Approximately 2/3 (34%) of them were struggling with at least one breastfeeding difficulty at the time of our research.

The most prevalent breastfeeding difficulty in our sample was nipple/breast pain, which was experienced by 65.7% of women. Another common issue was painful breast engorgement experienced by 45% of our sample, followed by fussing at the breast (40.7%), perceived low milk supply (35.2%), nonlatching baby (29.2%), mastitis (20.4%), and nipple shield use (20.1%). The least common complication was breast abscess with only 2% of the women in our sample having experienced it.

Breastfeeding difficulties and bonding impairment

Our first hypothesis related to the link between currently experienced breastfeeding difficulties and bonding impairment.

We tested this hypothesis by including only mothers, who were feeding their children any human milk at the time of our research (either by breast or bottle, e.g., groups 1 − 3 and 7 − 9). We found that women who reported they were having breastfeeding difficulties (N = 219, M = 17.8, Md = 14, SD = 14) were more likely to have impaired bonding (U = 27029.5, Z = −5.103, p = 0.000, r = 0.217) than those who didn't report having breastfeeding difficulties (N = 332, M = 13.4, Md = 10, SD = 12.7).

We also explored how individual breastfeeding difficulties might be linked to bonding. In this analysis, we only included mothers that at least attempted breastfeeding and excluded those who were bottle feeding formula from birth (N = 26). The results of these analyses are presented in Table 3. We also wanted to know if the number of breastfeeding difficulties experienced currently or in the past correlated with bonding impairment. In this analysis we only included the four problems that were significantly linked to bonding impairment (breast engorgement, nonlatching infant, low milk supply, and infant fussing at the breast). The result of a Spearman correlation showed that the higher the number of these problems experienced, the higher the bonding impairment (p = 0.000, r_s = 0.253).

Table 3.

Breastfeeding Difficulties and Their Link to Bonding Impairment

Breastfeeding difficulty	M	Md	SD	N	U	Z	p	r
Nipple/breast pain
Yes	15.5	12	13	440	46,710	−0.639	0.523	—
No	15.7	11	14.7
Breast engorgement
Yes	16.4	12	13.5	301	48023.5	−2.407	0.016	0.094
No	14.8	11	13.6
Low milk supply
Yes	16.8	14	13.6	221	41762.5	−2.878	0.004	0.112
No	14.9	11	13.5
Nonlatching baby
Yes	18.6	15	14.6	187	34,011	−4.597	0.000	0.179
No	14.4	11	13
Nipple shield use
Yes	17.2	13	16.3	126	31726.5	−0.965	0.335	—
No	15.2	11	12.9
Mastitis
Yes	16	12	13.3	135	33,690	−0.852	0.394	—
No	15.4	12	13.7
Breast abscess
Yes	17.8	12	14.1	12	3,412	−0.720	0.472	—
No	15.5	12	13.6
Fussing at the breast
Yes	18.1	15	14	275	39,539	−5.507	0.000	0.215
No	13.8	10	13

The bold values signify that the value is significant, e.g. < 0.05.

M, mean; Md, median and SD, standard deviation are for PBQ scores.

U, Mann–Whitney U; Z, standardized score; r, Pearson's r.

PBQ, Postpartum Bonding Questionnaire.

Type of feeding and bonding impairment

Due to the size of the feeding groups we decided to only include the first five groups in testing for our second hypothesis. We found a significant difference in bonding impairment among these groups [H(4) = 17,879, p = 0.001] using Kruskal–Wallis H test. However, when looking at in-between group differences, we found a significant difference only between groups ExBF1 and ExBF2 (p = 0.015). Descriptive data are listed in Table 4. We also decided to explore the relationship between bonding impairment and feeding type when only including mothers who did not report currently having breastfeeding difficulties. We found that when only looking at mothers without breastfeeding difficulties, there was a significant difference among the groups [H(4) = 20,328, p = 0.000], but apart from the difference between groups ExBF1 and ExBF2 (p = 0.024), there was a difference in bonding impairment between groups ExBF1 and ExFF1 (p = 0.001). This difference did not occur when we included all mothers in this analysis.

Table 4.

The Association Between the Type of Feeding and Bonding Impairment

Mothers experiencing BF difficulties included					Mother experiencing BF difficulties excluded
Group	N	M	Md	SD	Group	N	M	Md	SD
ExBF1^a	403	14.2	10	12.8	ExBF1^a	259	12.2	9	11.1
ExBF2^a	54	17.4	15	10.7	ExBF2^a	36	16.8	15	11.8
BFwFF^a	52	17.6	14.5	14	BFwFF^a	16	14.2	11.5	11
ExFF1^a	108	17.5	13	14.5	ExFF1^a	98	17.6	12.5	14.7
ExFF2^a	26	14.9	12.5	13.4	ExFF2^a	21	14.1	10	14

Explanations for these abbreviations are listed in Table 2.

M, mean; Md, median; SD, standard deviation.

Discussion

The mean score of PBQ and its SD in our sample is higher than in some previous studies (M = 8.2–10.46, SD = 4.67–7.43 in Moehler et al.²⁶; M = 9.75, SD = 7.05 in Nolvi et al.²⁷), but there are also studies with similar mean scores (M = 13.3, SD = 13.78 in Radoš et al.²⁸; M = 14.4, SD = 8.4 in Edhborg et al.²⁹). The reasons for this may be rooted in the structure of our sample and in cultural differences between countries where the research took place. However, we do not assume that this affected our results.

In accordance with Roth et al.⁹ we found that bonding impairment is linked to breastfeeding difficulties, although we did not find this link to be present with all breastfeeding difficulties. The difference between these two groups of problems in terms of their impact on mother–infant bonding might be explained by how they are subjectively perceived. Although postpartum breastfeeding difficulties involving pain and other health problems were previously found to be connected to poorer maternal mood,³⁰ nipple pain, breast abscess, or mastitis were not found to be connected to bonding in our research. In the case of a breast abscess, this could be partly due to a small percentage of mothers with abscess in our study sample.

The difficulties found to be linked to mother–infant bonding impairment were low milk supply, fussing at the breast, nonlatching baby, and breast engorgement, some of which were also previously found to be reasons for premature breastfeeding cessation.³¹ When an infant is refusing to latch and/or is fussy at the breast, it can cause breast engorgement and later lead to a low milk supply, so these problems may be interconnected. All these breastfeeding difficulties might imply that the infant cries more in general which is a known risk factor for bonding.³² Mothers may feel less competent in calming and soothing their infants and may feel rejected when infants refuse to breastfeed.⁸

Our results show that experiencing any breastfeeding problem at the time of our research was significantly connected with bonding impairment. This supports our first hypothesis and as mentioned earlier also supports the idea that simply inquiring about feeding status might not be sufficient in discovering how the type of feeding is linked to maternal bonding. This is further supported by the results connected with our second hypothesis. These suggest that when comparing mothers and their bonding impairment in relation to their feeding status and not taking breastfeeding difficulties into account, no differences in bonding would be found between breastfeeding mothers and mothers bottle feeding formula. On the contrary, on the discounting of mothers with current breastfeeding difficulties from this analysis, the difference in bonding impairment became significant. This may explain the confusion appearing in studies on breastfeeding and bonding published to date—not controlling for or taking into account breastfeeding difficulties may explain why some researchers have found breastfeeding to be connected to bonding³³ and some have not.^5,34

Because of our study design, we cannot determine how bonding and breastfeeding difficulties affect each other in terms of causality. Nevertheless, for the purpose of future studies, it could be hypothesized that because biologically, breastfeeding is a physiological way of infant feeding desired by most mothers,² it can influence mother–infant bonding positively through oxytocin release³⁵ or by mediating mothers stress responses in the postpartum period.³⁶ However, when encountering breastfeeding difficulties, breastfeeding can become a stressor for mothers, especially if they wished to breastfeed and did not even consider formula feeding as an option.^2,37 They usually turn to health professionals for help with breastfeeding but do not always receive the help needed,¹⁶ and the only option offered is switching to formula feeding.² While this may be an acceptable solution for some mothers,² ceasing breastfeeding sooner than the mother expected or desired because of difficulties was linked to postpartum depression,¹⁴ a known risk factor for bonding.¹⁰ Although logical, these connections remain hypothetical and are yet to be explored by future research.

From our results, it is apparent that breastfeeding mothers that currently do not have any breastfeeding difficulties have the best bonding experience with their infants, but the results do not suggest that when encountering breastfeeding difficulties, the appropriate solution would be switching to formula feeding, as it also appears to be a risk factor for bonding impairment. The solution we propose is for the mothers to receive adequate and practical help with breastfeeding provided by lactation support providers that would help them resolve their breastfeeding difficulties. More research (preferably longitudinal) is required to see which practices provide a long-term solution to specific breastfeeding difficulties, especially when it comes to a nonlatching infant or infant fussy at the breast. The timing of these interventions might also be of significance, and longitudinal research can bring more light to the correct window of opportunity to best help mothers with breastfeeding in their time of need.

There are several limitations to our research. One of them is using a convenience sample composed of women from various Facebook groups which could have skewed our results. Another limitation is that we haven't inquired which breastfeeding difficulties mothers were experiencing at the time of our research, only whether they were experiencing any type of breastfeeding difficulty. This makes it complicated to determine if specific breastfeeding difficulties have a long-term effect on mother–infant bonding impairment or if their effect is only present while the mother is currently experiencing them. Using only quantitative approach may also be considered a limitation; mothers may perceive their breastfeeding difficulties differently which can in turn influence to what extent their bonding with their infants is impaired.

Conclusions and Further Recommendations

This research may offer a new method of assessing the type of feeding, taking into the account also whether the infant is breastfed directly from the breast or being human milk fed by bottle. Our results also suggest that experiencing breastfeeding difficulties could be connected to bonding impairment, although this does not apply to all breastfeeding difficulties.

Footnotes

Disclosure Statement

No competing financial interests exist.

Funding Information

This work was supported by the Ministry of Education, Youth and Sports of the Czech Republic granted by Palacky University in Olomouc under grant IGA_FF_2022_034. This sponsor had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Supplementary Material

References

World Health Organization. Breastfeeding; 2022. Available from: https://www.who.int/health-topics/breastfeeding#tab=tab_2. [Last accessed: November 22, 2022]

Brown

. What do women lose if they are prevented from meeting their breastfeeding goals?. Clin Lact, 2018; 9(4):200–207.

Victora

, Bahl

, Barros

AJD

, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 2016; 387(10017):475–490.

Hailemeskel

, Kebede

, Fetene

, et al. Mother-infant bonding and its associated factors among mothers in the postpartum period, Northwest Ethiopia, 2021. Front Psychiatry, 2022; 13:893505.

Hairston

, Handelzalts

, Lehman-Inbar

, et al. Mother-infant bonding is not associated with feeding type: A community study sample. BMC Pregnancy Childbirth, 2019; 19(1):125.

Thulier

. A call for clarity in infant breast and bottle-feeding definitions for research. J Obstet Gynecol Neonatal Nurs, 2010; 39(6):627–634.

Johns

, Forster

, Amir

, et al. Prevalence and outcomes of breast milk expressing in women with healthy term infants: A systematic review. BMC Pregnancy Childbirth, 2013; 13(1):212.

Jardine

FM.

Breastfeeding Without Nursing: The Lived Experiences of Exclusive Pumpers. Doctoral dissertation; 2020.

Roth

, Humphreys

, King

, et al. Breastfeeding difficulties predict mothers' bonding with their infants from birth to age six months. Matern Child Health J, 2021; 25(5):777–785.

10.

Dubber

, Reck

, Müller

, et al. Postpartum bonding: The role of perinatal depression, anxiety and maternal–fetal bonding during pregnancy. Arch Womens Ment Health, 2015; 18(2):187–195.

11.

Gilden

, Molenaar

, Smit

, et al. Mother-to-infant bonding in women with postpartum psychosis and severe postpartum depression: A clinical cohort study. J Clin Med, 2020; 9(7):2291.

12.

Assarian

, Moravveji

, Ghaffarian

, et al. The association of postpartum maternal mental health with breastfeeding status of mothers: A case-control study. Iran Red Crescent Med J, 2014; 16(3):e14839.

13.

Stuebe

, Grewen

, Pedersen

, et al. Failed lactation and perinatal depression: Common problems with shared neuroendocrine mechanisms?. J Womens Health (Larchmt), 2012; 21(3):264–272.

14.

Brown

, Rance

, Bennett

. Understanding the relationship between breastfeeding and postnatal depression: The role of pain and physical difficulties. J Adv Nurs, 2016; 72(2):273–282.

15.

Larsen

, Kronborg

. When breastfeeding is unsuccessful—Mothers' experiences after giving up breastfeeding. Scand J Caring Sci, 2013; 27(4):848–856.

16.

Stuebe

, Horton

, Chetwynd

, et al. Prevalence and risk factors for early, undesired weaning attributed to lactation dysfunction. J Womens Health (Larchmt), 2014; 23(5):404–412.

17.

Chrzan-Dętkoś

, Walczak-Kozłowska

, Pietkiewicz

, et al. Improvement of the breastfeeding self-efficacy and postpartum mental health after lactation consultations—Observational study. Midwifery, 2021; 94:102905.

18.

Hegney

, Fallon

, O'Brien

. Against all odds: A retrospective case-controlled study of women who experienced extraordinary breastfeeding problems. J Clin Nurs, 2008; 17(9):1182–1192.

19.

Lamontagne

, Hamelin

, St-Pierre

. The breastfeeding experience of women with major difficulties who use the services of a breastfeeding clinic: A descriptive study. Int Breastfeed J, 2008; 3(1):17.

20.

Whittingham

, Mitchell

. Birth, breastfeeding, psychological flexibility and self-compassion as predictors of mother–infant emotional availability in a cross-sectional study. Infant Ment Health J, 2021; 42(5):718–730.

21.

Lommen

, Brown

, Hollist

. Experiential perceptions of relactation: A phenomenological study. J Hum Lact, 2015; 31(3):498–503.

22.

Kair

, Flaherman

, Newby

, et al. The experience of breastfeeding the late preterm infant: A qualitative study. Breastfeed Med, 2015; 10(2):102–106.

23.

Giannì

, Lanzani

, Consales

, et al. Exploring the emotional breastfeeding experience of first-time mothers: Implications for healthcare support. Front Pediatr, 2020; 8:199.

24.

Brockington

, Oates

, George

, et al. A Screening Questionnaire for mother-infant bonding disorders. Arch Womens Ment Health, 2001; 3(4):133–140.

25.

Reck

, Klier

, Pabst

, et al. The German version of the Postpartum Bonding Instrument: Psychometric properties and association with postpartum depression. Arch Womens Ment Health, 2006; 9(5):265–271.

26.

Moehler

, Brunner

, Wiebel

, et al. Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding. Arch Womens Ment Health, 2006; 9(5):273–278.

27.

Nolvi

, Karlsson

, Bridgett

, et al. Maternal postnatal psychiatric symptoms and infant temperament affect early mother-infant bonding. Infant Behav Dev, 2016; 43:13–23.

28.

Radoš

, Matijaš

, Anđelinović

, et al. The role of posttraumatic stress and depression symptoms in mother-infant bonding. J Affect Disord, 2020; 268:134–140.

29.

Edhborg

, Nasreen

, Kabir

. Impact of postpartum depressive and anxiety symptoms on mothers' emotional tie to their infants 2–3 months postpartum: A population-based study from rural Bangladesh. Arch Womens Ment Health, 2011; 14(4):307–316.

30.

Cooklin

, Amir

, Nguyen

, et al. Physical health, breastfeeding problems and maternal mood in the early postpartum: A prospective cohort study. Arch Womens Ment Health, 2018; 21(3):365–374.

31.

Brown

CRL

, Dodds

, Legge

, et al. Factors influencing the reasons why mothers stop breastfeeding. Can J Public Health, 2014; 105(3):179–185.

32.

Frankel

, Umemura

, Pfeffer

, et al. Maternal perceptions of infant behavior as a potential indicator of parents or infants in need of additional support and intervention. Front Public Health, 2021; 9:630201.

33.

Kim

, Feldman

, Mayes

, et al. Breastfeeding, brain activation to own infant cry, and maternal sensitivity: Breastfeeding, brain, and maternal sensitivity. J Child Psychol Psychiatry, 2011; 52(8):907–915.

34.

Minamida

, Iseki

, Sakai

, et al. Do postpartum anxiety and breastfeeding self-efficacy and bonding at early postpartum predict postpartum depression and the breastfeeding method?. Infant Ment Health J, 2020; 41(5):1–15.

35.

Feldman

, Weller

, Zagoory-Sharon

, et al. Evidence for a neuroendocrinological foundation of human affiliation: Plasma oxytocin levels across pregnancy and the postpartum period predict mother-infant bonding. Psychol Sci, 2007; 18(11):965–970.

36.

Mezzacappa

, Kelsey

, Katkin

. Breast feeding, bottle feeding, and maternal autonomic responses to stress. J Psychosom Res, 2005; 58(4):351–365.

37.

Brown

, Lee

. An exploration of the attitudes and experiences of mothers in the United Kingdom who chose to breastfeed exclusively for 6 months postpartum. Breastfeed Med, 2011; 6(4):197–204.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB