Factors Associated with the Breastfeeding Aversion Response

Abstract

Background:

The breastfeeding aversion response (BAR) is defined as the compulsion to remove the baby from the breast in response to negative physical sensations experienced during breastfeeding. This phenomenon is characterized by involuntary and overwhelming feelings of disgust that arise during breastfeeding or at various stages of the breastfeeding process.

Objectives:

The aim of the study is to evaluate the frequency of BAR and affecting factors in mothers with breastfeeding experience in Türkiye.

Methods:

The survey was conducted online using the Google Forms® tool, accessible from November 2, 2023, to January 5, 2024. A total of 1,046 mothers with breastfeeding experience were included in the research.

Results:

A total of 9.8% (n = 103) of mothers participating in the study stated that they experienced BAR. Fatigue (23.3%), breastfeeding a toddler (19.4%), and breast pain (18.4%) were the most frequently reported risk factors for BAR. The BAR rate was higher among working mothers (p = 0.037), those lacking spousal support (p = 0.001), mothers diagnosed with postpartum depression (p = 0.009), and those encountering breastfeeding problems (p = 0.007).

Conclusion:

Further research on the factors that trigger BAR, its severity, and what symptoms it may cause may provide guidance on how midwives and nurses working with breastfeeding mothers can support these mothers, how to prevent BAR, and possible treatment options. The findings of our study revealed that BAR is especially affected by psychological processes. For this reason, it is recommended to approach breastfeeding in the postpartum period as a holistic experience that also includes psychological and sociocultural processes rather than solely from a physiological perspective.

Introduction

While research has frequently concentrated on medical and physical challenges that could result in the early cessation of breastfeeding, less attention has been devoted to emotional factors, which are significant reasons affecting breastfeeding.¹ Postpartum mental health problems have become increasingly prevalent in recent years.² Indeed, many mothers report experiencing emotional difficulties during breastfeeding, even in the absence of physical breastfeeding problems. This may occasionally involve intense embodied emotional feelings such as irritation, aggression, or disgust toward the breastfed baby. This experience is often referred to as breastfeeding aversion response (BAR) or agitation.³ There is little research on BAR, which is defined by women as a feeling of disgust during breastfeeding and causes them to have negative feelings toward their desire to breastfeed.^2,4,5

The BAR is defined as the compulsion to remove the baby from the breast in response to negative physical sensations experienced during breastfeeding. This phenomenon is characterized by involuntary and overwhelming feelings of disgust that arise during breastfeeding or at various stages of the breastfeeding process,² or it may be a novel experience for women who have previously undergone a problem-free breastfeeding process.⁶ The literature on BAR is quite limited. This experience was first reported in nonacademic breastfeeding literature in 2003. Anecdotes gathered from online support groups, created by women who have experienced BAR, have contributed to the formation of international literature on the topic.⁷

Although it has been shown that problems such as breastfeeding during pregnancy, tandem breastfeeding, breastfeeding during menstruation, lack of social support, postpartum psychological problems, traumatic pregnancy, and negative birth experience increase the reaction to avoid breastfeeding, the literature on this subject is not clear enough.^2,4,5,7 In addition, the BAR, which is characterized by symptoms such as anger, agitation, tingling of the skin, and a desire to stop breastfeeding, is often confused with dysphoric milk ejection reflex (D-MER).⁸ D-MER occurs just before milk letdown and involves a negative emotional reaction to the milk ejection reflex, with symptoms appearing only during the initial moments of breastfeeding. It is known that BAR symptoms continue throughout breastfeeding.⁹

In Türkiye, it has been observed that some question threads about BAR have been initiated on social media platforms predominantly frequented by women; however, no scientific information or literature has been found on this subject. The aim of this research is to investigate the situation of mothers who experience BAR in Türkiye and to identify the factors influencing this phenomenon.

Methods

The aim of the study is to evaluate the frequency of BAR and affecting factors in mothers with breastfeeding experience in Türkiye.

Sampling and data collection

Mothers aged 18 years and older, who were either currently breastfeeding or had breastfed within the last 3 years (to avoid recall bias), were eligible for inclusion in the study. The survey was conducted online using the Google Forms® tool, accessible from November 2, 2023, to January 2, 2024. It was shared with administrators of pages dedicated to breastfeeding, motherhood, and baby-related topics on Instagram across Türkiye. In addition, survey links and QR codes were shared through the social media accounts of midwives and nurses who provide information to mothers on topics such as breastfeeding and baby care on the same platforms.

The survey was completed by 1,081 women; however, 16 surveys indicating “No” to the question “Do you have breastfeeding experience?” were excluded from the study. Previous descriptive research on D-MER has found that participants were more likely to experience D-MER during the letdown reflex within the first 1–5 minutes of a feeding session.¹⁰ Mothers who answered the question “During which stage of breastfeeding does BAR occur?” within the first 1–5 minutes of breastfeeding were considered more likely to experience D-MER, and their surveys were excluded from the study. Thus, the analysis was conducted with data from 1,046 participants.

Data collection tool

The survey was created based on previous research on women experiencing BAR.^2,4,5,11 In addition, another tab was added to allow open-ended answers to some questions. Thus, it was aimed to reveal factors that were not addressed in previous studies. The survey includes 33 items.

Sociodemographic characteristics

Data were collected on variables such as age, education level, employment status, and family type.

Results regarding the postpartum period

This section included questions such as whether the participants received a diagnosis of postpartum depression by a physician after childbirth, whether they encountered difficulties in the breastfeeding process with their baby or babies, and assessing the support received from their spouse and family during the breastfeeding journey.

BAR experience

The BAR experience is defined in the survey as the occurrence of negative emotions and feelings while breastfeeding. These emotions may vary from irritation and frustration to anger or disgust. It was defined as “women who experience these feelings during breastfeeding state that they suddenly want to wean their babies from the breast and cannot continue breastfeeding,” and the question “Have you experienced the feeling of BAR while breastfeeding your baby/babies?” was asked. Data were collected on various aspects, including when participants first experienced BAR, at what stage of breastfeeding this situation occurred, whether they had to cease breastfeeding entirely due to this reason, the support they received regarding this issue, and the strategies utilized by those who found solutions to BAR problems in resolving this issue. In addition, different questions were asked about this process for mothers who experienced BAR during menstruation or breastfeeding while pregnant.

Statistical analysis

Data were analyzed using a statistical package program. BAR experience variables were analyzed using descriptive frequencies, means, and standard deviations. The relationship between BAR and some descriptive features was evaluated with chi-square analysis. The text contents of some open-ended questions were shared directly without thematic analysis.

Ethical statement

Ethics committee permission was received for the research from the Non-Interventional Ethics Committee (2023/038). Before participating in the web-based survey, participants were provided with information detailing the purpose of the research. Mothers were then asked to consent to participate by agreeing to a consent form.

Results

Some demographic characteristics of the participants and association with BAR are given in Table 1. The incidence of experiencing BAR was higher among those who lacked spousal support during the postpartum period (p = 0.001), those diagnosed with postpartum depression after any birth (p = 0.009), and those who had breastfeeding problems during the postpartum period (p = 0.007) (Table 2).

Table 1.

Some Demographic Characteristics of the Participants and Association with BAR

	With BARn (%)	Without BARn (%)	Totaln (%)	p ^a
Age (n = 1,046)
18–24	8 (7.8)	80 (8.5)	88 (8.4)	0.331
25–30	42 (40.8)	428 (45.4)	470 (44.9)
31–35	38 (36.9)	302 (32.0)	340 (32.5)
36–40	9 (8.7)	107 (11.3)	116 (11.1)
40 ve üzeri	6 (5.8)	26 (2.8)	31 (3.1)
Education levels (n = 1,046)
Primary school	1 (1.0)	10 (1.1)	11 (1.1)	0.720
Secondary school	4 (3.9)	45 (4.8)	49 (4.7)
High school	15 (14.6)	173 (18.3)	188 (18.0)
Undergraduate	81 (78.6)	682 (72.3)	763 (72.9)
Postgraduate	2 (1.9)	33 (3.5)	35 (3.3)
Working status (n = 1,046)
Yes	64 (62.1)	484 (51.3)	548 (52.4)	0.037^b
No	39 (37.9)	459 (48.7)	498 (47.6)	0.037^b
Family type (n = 1,046)
Nuclear family	94 (91.3)	868 (92.0)	962 (92.0)	0.930
Extended family	9 (8.7)	75 (8.0)	84 (8.0)	0.930

Chi-square test.

p < 0.05.

BAR, breastfeeding aversion response.

Table 2.

Some Situations of the Participants During the Postpartum Period and Association with BAR Experience

	With BARn (%)	Without BARn (%)	Totaln (%)	p ^a
Spouse support during the postpartum period (n = 1,046)
Yes	61 (59.2)	699 (74.1)	760 (72.7)	0.001^b
No	42 (40.8)	244 (25.9)	286 (27.3)	0.001^b
Support from family elders during the postpartum period (n = 1,046)
Yes	61 (59.2)	574 (60.9)	635 (60.7)	0.745
No	42 (40.8)	369 (39.1)	411 (39.3)	0.745
Presence of physician-diagnosed postpartum depression after any birth (n = 1,046)
Yes	10 (9.7)	38 (4.0)	48 (4.6)	0.009^b
No	93 (90.3)	905 (96.0)	988 (95.4)	0.009^b
Breastfeeding problems in the postpartum period (n = 1,046)
Yes	74 (71.8)	548 (58.1)	622 (59.5)	0.007^b
No	29 (28.2)	395 (41.9)	424 (40.5)	0.007^b
What problems occurred in breastfeeding?			n (%)
My baby couldn’t latch onto the breast			284 (27.1)
Not enough milk			197 (18.8)
I had sore nipple pain			249 (23.9)
I experienced mastitis			186 (17.8)
Infant had tongue tie			34 (3.3)
I experienced breast refusal			43 (4.1)

Chi-square test.

p < 0.05.

BAR, breastfeeding aversion response.

Table 3.

BAR Frequency and Some Defining Features of the BAR Experience

	n (%)
Feelings of aversion (BAR)
Yes	103 (9.8)
No	943 (90.2)
Definitions associated with BAR
While my baby is breastfeeding, I suddenly feel tingling sensations in my body.	23 (22.3)
I thought about suddenly weaning my baby from the breast.	57 (55.3)
I suddenly wean my baby from the breast because I can’t continue breastfeeding.	41 (39.8)
I experience this feeling more intensely when my baby moves from one breast to the other.	18 (17.5)
It’s an involuntary feeling that I can’t control.	39 (37.9)
While my baby is breastfeeding, I suddenly feel my whole body tightening.	15 (14.6)
I feel my body itching while breastfeeding my baby.	8 (7.8)
It bothers me when my baby touches me.	9 (8.7)
When did BAR first start?
When I felt overwhelmed and exhausted.	24 (23.3)
When I was breastfeeding my toddler.	20 (19.4)
When I started to feel pain in my breasts.	19 (18.4)
When tandem breastfeeding both my toddler and newborn.	10 (9.7)
I felt it randomly, I don’t know.	9 (8.7)
When my period returned.	9 (8.7)
At the beginning of my early postpartum period.	6 (5.8)
When I was pregnant and breastfeeding my toddler.	3 (2.9)
Other	3 (2.9)
Which child had the most BAR experience?
First and only child	64 (62.1)
Oldest child	17 (16.5)
Youngest child	12 (11.7)
All my children I breastfed	10 (9.7)
What time of day is BAR most common?
Evening and night	47 (45.6)
It can happen any time	32 (31.1)
Morning and day	10 (9.7)
All day	14 (13.6)
During which stage of breastfeeding does BAR occur?
When I prepare to breastfeed my baby	16 (15.5)
Throughout breastfeeding	55 (53.4)
When my baby stops breastfeeding	32 (31.1)

BAR, breastfeeding aversion response.

BAR frequency and describing the experience of BAR

A total of 9.8% (n = 103) of the mothers participating in the study stated that they experienced BAR. The reactions reported by mothers when experiencing BAR were mostly described as thoughts of suddenly weaning the baby from the breast (55.3%), taking the baby from the breast because they could not breastfeed (39.8%), and experiencing an uncontrollable, involuntary feeling (37.9%). The most common answer to the question “When did BAR first start?” was “when I felt overwhelmed and exhausted” (23.3%). This answer was followed by “I experienced it when I was breastfeeding my toddler” (19.4%) and “I experienced it when I started to feel pain in my breasts” (18.4%). In the study, no mother with three or more children reported experiencing BAR. BAR was most commonly reported by mothers with only one child (62.1%). BAR occurred most frequently in the evening and night (45.6%) (Table 3).

Support systems and individual coping strategies related to BAR

When asked whether they received support regarding BAR, a higher number of individuals were found to have received no support (41.7%) and to not perceive BAR as a problem (36.9%). When asked about their coping strategies for BAR, the top three responses were as follows: “I looked at my phone to distract myself” (54.7%), “I breastfed for short periods of time” (40.7%), and “I engaged in activities to distract myself” (36.0%) (Table 4). In addition, some individual expressions provided by mothers in response to this question include the following: “I practiced patience,” “I believed my baby needed me,” and “I motivated myself by speaking kind words to him.”

Table 4.

Support Systems and Coping Strategies with BAR

	n (%)
Have you had to take a break from breastfeeding for a while because of BAR?
Yes	46 (44.7)
No	57 (55.3)
Have you had to stop breastfeeding completely because of BAR?
Yes	24 (28.2)
No	79 (71.8)
Have you received support regarding BAR?
Yes	22 (21.4)
No	43 (41.7)
I didn’t see this as a problem	38 (36.9)
Did getting support solve your problem?
Yes	8 (7.8)
No	95 (92.2)
Coping strategies with BAR
I looked at my phone to distract myself.	47 (54.7)
I engaged in activities to distract myself.	31 (36.0)
I breastfed for a short time.	35 (40.7)
I reduced breastfeeding during the day.	29 (33.7)
I practiced deep breathing exercises.	25 (29.1)
I remained patient while breastfeeding, despite movements such as biting, pinching, and scratching.	14 (16.3)
I stopped breastfeeding at night.	12 (14.0)
I stopped breastfeeding both my babies at the same time.	2 (2.3)
I ate while breastfeeding.	7 (8.1)
I used vitamin supplements.	0 (0.0)
I wanted someone else to distract me.	2 (2.3)

BAR, breastfeeding aversion response.

Specific considerations for BAR and the reason for onset of BAR

Proportional assessments specific to BAR and the circumstances surrounding its initial occurrence were analyzed, along with differences regarding BAR experienced at the time of onset. In addition, excerpts expressing mothers’ situations from notes they provided in the survey were included.

Pain and BAR

Mothers whose first BAR experience began with feeling pain in their breasts described the pain they experienced as stabbing (53.3%), pain triggered by light touch (40%), itching (26.7%), and nausea (40%). Among mothers who had to interrupt breastfeeding for a while, the majority experienced BAR primarily due to pain (93.3%). One mother who experienced BAR due to pain described it as “it’s like you’re being pulled away, you’re in emptiness.”

Fatigue and BAR

Almost all of the mothers who experienced BAR because they felt overwhelmed and exhausted encountered this situation when their babies were between 0 and 3 months old (94.1%). One mother who experienced BAR due to fatigue expressed this situation as follows: “I was very tired in the first few months, I felt restricted. When someone said, his/her mother wants you, he/she is hungry, it upset me.”

Breastfeeding a toddler and BAR

These mothers were the ones who stopped breastfeeding completely due to BAR the most frequently. Mothers who did not cease breastfeeding completely chose to discontinue breastfeeding at night as a coping method. Some notes written by mothers on this subject include the following: “I never willingly breastfed after my baby reached 20 months. It was very challenging for me. I became weary of breastfeeding.”

Tandem breastfeeding and BAR

In tandem breastfeeding, the BAR was generally associated with the older child. Mothers who experienced BAR because they breastfed both their babies at the same time expressed this situation as follows: “While I was breastfeeding the younger child, I wanted to cut off my breasts when my older child also wanted to breastfeed.”

Menstruation and BAR

All of the mothers who reported that the feeling of BAR begins with menstruation indicated that it occurs at the onset of menstruation. In addition, few mothers who did not initially associate the onset of BAR with menstruation wrote statements indicating that the sensation of BAR increased during menstruation.

Early postpartum period and BAR

The early postpartum period and BAR reaction were not included as options in the survey preferences. However, some mothers mentioned them under the “other” category.

In the notes written by two mothers who experienced BAR during the postpartum period, it was noted that this sensation was only experienced for a short duration in the early stages of postpartum: “I felt it immediately after giving birth, but it was a fleeting sensation, and I didn’t dwell on it.”

Breastfeeding during pregnancy

Two of the mothers who experienced BAR during pregnancy encountered this condition in the second trimester, while the other experienced it in the first trimester.

Life trauma

Two mothers who chose the other option wrote that they experienced BAR during the difficult times they experienced with their spouses (when we had a serious fight with my spouse, I experienced BAR as if I was taking out my anger on my baby) and family elders (the injustices done to me come to mind). The other mother stated that she experienced BAR after the 2023 big earthquake in Türkiye (everything was normal until the earthquake, I experienced these after the earthquake).

Discussion

This research is the first study on the BAR experience in Türkiye. In addition, detailed evaluations of the factors causing BAR were presented for the first time in this study.

BAR frequency and affecting factors

A total of 9.8% of the women participating in this study stated that they experienced BAR. Studies on BAR have different results. In the study conducted by Yate, one of the first studies to examine breastfeeding aversion and agitation (BAA), around 70% of women experienced BAA.¹¹ In a study of 5,511 Australian breastfeeding women, the first to deliberately investigate the lived experience of BAR, the prevalence of BAR was found to be 22.6%.¹² However, there is insufficient evidence to confirm that BAR is a clinical phenomenon. Studies have examined BAR from a biopsychological perspective, made various definitions for BAR, and put forward causes. However, due to the lack of a clear definition and clinical findings, this study established a definition based on probability data, and women were asked whether they had experienced this phenomenon according to that definition. Their responses were then evaluated accordingly. In addition, in our study, mothers whose babies were younger than 36 weeks were included in the study to avoid recall bias. The variation in BAR rates could be attributed to the absence of a limitation on baby age in the studies, as well as the inclusion of all breastfeeding women.

In our study, the BAR rate was higher among working mothers, those lacking spousal support, mothers diagnosed with postpartum depression, and those encountering breastfeeding problems. Research has shown that the risk of discontinuing breastfeeding is higher among mothers who do not have spousal support,¹³ return to work full-time,^14,15 and experience postpartum depression.¹⁶ This study showed that these factors were also associated with BAR.

When did BAR first start?

In our study, mothers who reported feeling BAR stated that they first experienced these sensations when they felt tired and exhausted. This experience occurred within the first 3 months after birth for almost all mothers. The postpartum period is a sensitive and stressful time characterized by fatigue, mood changes, and sleep disorders.¹⁷ Due to the physical, emotional, and social changes during the transition to motherhood, mothers may experience negative thoughts regarding issues such as baby care and breastfeeding after giving birth. Research suggests that burnout, which occurs especially due to the physical, emotional, and social changes experienced during the transition to motherhood, causes various problems in mothers. These challenges include difficulty returning to normal life, exacerbation of depression, and early cessation of breastfeeding.^18,19 Fatigue is one of the most commonly cited reasons for stopping breastfeeding early.²⁰ Fatigue can significantly impact emotional health, potentially leading to increased irritability or feelings of being overwhelmed. Mothers may choose to avoid breastfeeding to alleviate these negative feelings. Mothers who reported experiencing BAR due to exhaustion often encountered this situation predominantly in the first months. Similarly, among the mothers in our study who reported experiencing BAR, some mentioned that it occurred only briefly during the postpartum period. This suggests that BAR may be triggered as a component of postpartum depression.

Pain is cited as one of the primary reasons for discontinuing breastfeeding. Breastfeeding pain affects over half of breastfeeding mothers and is often perceived as highly distressing.²¹ In this study, some mothers who experienced BAR associated the onset of this condition with “the period when they began to feel pain in their breasts.” When asked to describe the pain they experienced, some described sensations that did not indicate typical nociceptive pain, such as “itchy,” “nauseous,” or “pain caused by light touch.” These descriptions may suggest that the pain experienced could be attributed to affective feelings of aversion.² However, comprehensive studies are necessary to determine whether there is a cause–effect relationship for this type of pain in certain women who experience BAR. Mothers experiencing severe breastfeeding pain tend to exhibit weaker positive emotional expressions with their babies compared with mothers with no pain or moderate pain.²¹ This may lead to experiencing BAR. On the contrary, mothers who experience BAR may feel pain in their breasts as a result of these experiences.

When breastfeeding overlaps with a new pregnancy, women are faced with the decision of whether to cessation or continue breastfeeding for their toddler. Studies have not shown any adverse effects associated with tandem breastfeeding.²² However, some mothers in this study reported that their experiences with BAR began when they breastfed two children of different ages together. Some tandem breastfeeding mothers may experience reluctance to breastfeed during pregnancy, and this may continue after the new baby arrives. BAR associated with tandem feeding has been explained by a theory suggesting it may be a mammalian instinct to wean the toddler.²³ In the literature, it has been shown that mothers who are tandem breastfeeding experience issues such as breast sharing between babies, breast pain and tenderness, decreased breast milk production, increased nighttime breastfeeding, and related problems such as insomnia, fatigue, and insufficient rest.²⁴ In our study, notes written by a mother who experienced BAR during tandem breastfeeding, such as “I felt disgusted for a while when my baby was born and his brother also wanted to breastfeed,” indicated that these mothers primarily experienced BAR due to psychological factors. This may create a different perspective from the instinct theory put forward for the reason for experiencing BAR in tandem breastfeeding. On the contrary, some of the mothers who breastfed only one child expressed their first BAR experience as “When I was breastfeeding my toddler.” Extended breastfeeding during and beyond infancy may be one of the reasons for the emergence of BAR in some women.^2,12 While the child’s dependence on breast milk decreases with age, mothers may also need physical space and time for themselves as their babies grow.¹¹ During this period, not changing the time the baby spends at the breast may cause tension and disappointment in mothers and increase the incidence of BAR in mothers. In addition, for some mothers, breastfeeding an older child can lead to feelings of embarrassment, isolation, lack of enjoyment in feeding their child,²⁵ and the BAR.

Unlike other studies conducted on BAR, only three mothers in our study stated that they experienced BAR during pregnancy and breastfeeding. When breastfeeding overlaps with a new pregnancy, women are faced with the decision to wean their toddler or continue breastfeeding.²² Breastfeeding during pregnancy in Türkiye is less common due to cultural taboos.²⁶ Therefore, the mothers in our study may have stopped breastfeeding during pregnancy.

Our study also showed a previously unrecognized aspect of the BAR experience. Three women in this study experienced BAR after psychological traumas, such as family conflicts and natural disasters. Recent or ongoing trauma can affect breastfeeding and suppress both oxytocin and prolactin by activating underlying stress systems associated with depression, anxiety, and post-traumatic stress disorders.²⁷

Comparison of BAR and D-MER

Women in this study experienced BAR throughout the feeding session, while preparing to breastfeed, and after finishing breastfeeding, which contrasts with the D-MER experience. In addition, in this study, while defining the feeling of BAR, women did not agree with the descriptions of “dread” and “hopelessness” from previous research that defined D-MER emotions.

Support and strategies for coping with BAR

Although almost half of the women who experienced BAR had to take a break from breastfeeding and some could not continue breastfeeding, women looked for a way to cope with this situation. Women continued breastfeeding by using various coping strategies that they found useful, such as distracting themselves while breastfeeding, using phone to distract self, setting some limit on breastfeeding, and thinking positively.⁵ For very few of the mothers who reported receiving support during this process, the support they received provided a solve to their problems. One significant reason for this situation is that professionals providing breastfeeding support are often unaware of BAR and cannot identify these differences experienced by mothers. Therefore, more studies are urgently needed on this subject. A detailed anamnesis of the breastfeeding mother, focusing on the symptoms she experiences, when they occur, and how she experiences these feelings can help identify BAR.⁶

The most common coping strategy reported by participants experiencing BAR was doing distractions while breastfeeding, such as watching television or using their phone. Previous research on BAR has also indicated that distraction is a helpful strategy for women to redirect their focus away from negative emotions and continue breastfeeding.^4,5 In the relevant study, it was mentioned that the use of self-distraction to cope with BAR may have a negative impact on the mother–infant bond. However, no significant relationship was found between activities that distract mothers while breastfeeding, such as using their phone, and the quality of mother–infant interactions or bonding during breastfeeding.²⁸

Limitation

BAR is a phenomenon that has not been adequately defined and researched. The term “BAR” has been defined using anecdotes from the limited studies conducted on this subject, and the experiences of women have been questioned within this definition. In addition, since the research is quantitative, it is unknown how women interpret the definition of BAR in their own way. To mitigate recall bias, the study included mothers who breastfed their babies who were younger than 3 years. Mothers who were unable to breastfeed their babies due to BAR, or whose babies were older than 3 years and had experienced BAR, were excluded from the study.

Conclusion

This study investigated the experience of BAR, a previously understudied breastfeeding problem, its risk factors, and its relationship with certain defining characteristics. This study was also the first study to make specific assessments of BAR and its onset time. Fatigue, pain in breasts, breastfeeding a toddler, tandem breastfeeding, early postpartum, breastfeeding during pregnancy, and life trauma were risk factors for BAR. The incidence of BAR was higher among working mothers, those lacking spousal support, individuals diagnosed with postpartum depression, and mothers encountering breastfeeding difficulties. Further research on the factors that trigger BAR, its severity, and what symptoms it may cause may provide guidance on how nurses and midwives working with breastfeeding mothers can support these mothers, how to prevent BAR, and possible treatment options. The findings of our study revealed that BAR is especially affected by psychological processes. For this reason, it is recommended to approach breastfeeding in the postpartum period as a holistic experience that also includes psychological and sociocultural processes rather than solely from a physiological perspective. Family, spouse, or even professional support could not be a solution for mothers regarding BAR. Therefore, greater support and understanding of BAR are needed to support women with this experience to achieve their own personal breastfeeding goals.

Footnotes

Acknowledgment

The author thanks all the mothers who participated in the research and all the women who shared the survey on their Instagram pages.

Author’s Contributions

Study design, data collection, data analysis, and article writing: B.M.S.

Disclosure Statement

The author has no conflict of interest relevant to this article to disclose.

Funding Information

The author declares that this study has received no financial support.

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