Mental Health

Maternal health research

These studies look at the links between breastfeeding and mental well-being in mothers.

Affectionate Touch in the Context of Breastfeeding and Maternal Depression Influences Infant Neurodevelopmental and Temperamental Substrates

This study examines the interactive effects of maternal depression and breastfeeding on mother and infant affectionate touch, as well as infant temperament and cortical maturation patterns across early development. A total of 113 mothers and their infants aged between 1 and 3 months were assessed to determine levels of maternal depressive symptoms, feeding, and temperament. Tonic EEG patterns (asymmetry and left and right activity) were collected, with data analysis showing that EEG activity and mother-infant affectionate touch differed as a function of mood and feeding method. Notably, only infants of depressed mothers that bottle-fed showed right frontal EEG asymmetry and attenuated change in the left frontal region across 3 months. Breastfeeding positively impacted affectionate touch behaviors and was associated with increased left and decreased right frontal EEG activation even for depressed groups, suggesting that breastfeeding and the infant’s positive temperament influence mother-infant affectionate touch patterns and result in neuroprotective outcomes for infants, even those exposed to maternal depression within early development.

Hardin, JS. et al. 2021. Affectionate Touch in the Context of Breastfeeding and Maternal Depression Influences Infant Neurodevelopmental and Temperamental Substrates. Neuropsychobiology 2021;80:158–175. https://doi.org/10.1159/000511604

Self-conscious emotions and breastfeeding support: A focused synthesis of UK qualitative research

Qualitative research on UK breastfeeding support is reviewed in this study in order to explore the role of self-conscious emotions and related appraisals in interactions with professional and peer supporters. Template analysis was applied to 34 studies dated between 2007 and 2020 in order to identify findings relevant to self-conscious emotions including shame, guilt, embarrassment, humiliation and pride. Key findings suggest that women may manage interactions with breastfeeding supporters carefully to minimise uncomfortable self-conscious emotions and maintain a positive mothering identity which can sometimes reduces the effectiveness of support and that breastfeeding supporters need to be emotionally aware and self-conscious so as to positively impact women’s development of a positive mothering identity.

The differential role of practical and emotional support in infant feeding experience in the UK

Within the context of the vulnerability of postpartum mental health, this paper explores how support can prolong breastfeeding and which forms of support help to promote a positive infant feeding experience. Findings indicate that different forms of support have different associations with infant feeding experience, highlighting the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely.

Myers S., Page A. E. and Emmott E. H. 2021The differential role of practical and emotional support in infant feeding experience in the UKPhil. Trans. R. Soc. B3762020003420200034

Testing the buffering hypothesis: Breastfeeding problems, cessation, and social support in the UK.

This study ran a series of Cox models on a sample of 565 UK mothers in order to assess the extent to which social support is successful in ‘buffering’ mothers from the negative impact breastfeeding problems can have on duration. Results indicated that the impact of breastfeeding problems could indeed be mitigated via social support, e.g. help with discomfort issues such as blocked ducts was correlated significantly with reduced cessation. However, support for reported milk insufficiency was associated with an increased hazard of cessation.

Page, A. et al. 2021. Testing the buffering hypothesis: Breastfeeding problems, cessation, and social support in the UK. Medical Research Council, Grant/Award Number: MR/P014216/1. https://doi.org/10.1002/ajhb.23621

Effect of Community-Initiated Kangaroo Mother Care on Postpartum Depressive Symptoms and Stress Among Mothers of Low-Birth-Weight Infants

Evidence from a randomised clinical trial supports kangaroo mother care (KMC) as an intervention to be incorporated into newborn care in low- and middle-income settings, where 1 in 5 women experience postpartum depression. The study revealed that community-initiated KMC may substantially reduce maternal risk of moderate to severe postpartum depressive symptoms, and was shown to impact upon salivary cortisol, which is a biomarker of stress.

Sinha B, Sommerfelt H, Ashorn P, et al. Effect of Community-Initiated Kangaroo Mother Care on Postpartum Depressive Symptoms and Stress Among Mothers of Low-Birth-Weight InfantsA Randomized Clinical TrialJAMA Netw Open. 2021;4(4):e216040. doi:10.1001/jamanetworkopen.2021.604

Parents With PTSD Are More Likely to Struggle With Breastfeeding

This article from Parents explores the author’s experience of breastfeeding while suffering from PTSD and examines the relationship between the Hypothalamic Pituitary Stress (HPA) axis and the Hypothalamic-Pituitary-Prolactin (HPP) axis, and oxytocin’s impact on the HPA’s response to stress.

Igoe, K. Parents with PTSD are more likely to struggle with breastfeeding. April 2021. Parents.com.

Development and evaluation of ‘Sleep, Baby & You’—An approach to supporting parental well-being and responsive infant caregiving

This article discusses how disrupted parental sleep, presenting as post-partum fatigue and perceived as problematic infant sleep, is related to increased symptoms of depression and anxiety among new mothers and fathers. Researchers held six initial stakeholder meetings with 15 practitioners and 6 parents with an interest in supporting parent-infant sleep needs, to explore existing service provision and identify gaps. The team sourced sleep-related materials and adapted them into ‘Sleep, Baby & You’, an intervention that could be universally delivered in the UK via NHS antenatal and postnatal practitioners. Upon feedback from parents and practitioners of the new tools, it was found that these materials were a promising tool for promoting parental attitude and behaviour-change.

Ball, H., Taylor, C. et al. 2020. Development and evaluation of ‘Sleep, Baby & You’—An approach to supporting parental well-being and responsive infant caregiving. https://doi.org/10.1371/journal.pone.0237240

Impact of postpartum depression on infant feeding outcomes

This systematic review examining the relationship between postpartum anxiety (PPA) and infant feeding outcomes found that women with symptoms of PPA were less likely to breastfeed exclusively and more likely to terminate breastfeeding earlier. Some evidence also suggests that those experiencing PPA are less likely to initiate breastfeeding and more likely to supplement with formula in the hospital. In those who do breastfeed, PPA reduces self-efficacy, increases breastfeeding difficulties, and may negatively affect breastfeeding behaviors and breast milk composition. Researchers called for increased breastfeeding support for mothers affected by PPA.

Fallon, V, et al (2016), Postpartum Anxiety and Infant-Feeding Outcomes, Journal of Human Lactation, doi: 10.1177/0890334416662241

Impact of Baby Friendly accreditation on breastfeeding rates, cognitive outcomes and maternal mental health

Using data from the UK Millennium Cohort Study, these researchers found that women giving birth in hospitals that participated in the Baby Friendly Initiative (BFI) were up to 15 percentage points more likely to initiate breastfeeding and between 8 and 9 percentage points more likely to breastfeed exclusively at 4 and 8 weeks than comparable mothers giving birth in non-participating hospitals. Mothers from low income families, and with low levels of education, were more responsive to the BFI programme than highly educated mothers in more affluent families.

They then compared the outcomes of children who were breastfed as a result of the BFI program with those of otherwise similar non-breastfed children. They found significant effects of breastfeeding on cognitive outcomes throughout childhood, and in particular between ages 3 and 7. In contrast to the previous literature, researchers found no statistically significant impact of breastfeeding on a number of health outcomes, but saw an improvement in child emotional development and maternal mental health.

Del Bono E, Rabe B. Breastfeeding and child cognitive outcomes: Evidence from a hospital-based breastfeeding support policy. ISER Working Paper Series: 2012-29

Breastfeeding difficulties and postpartum depression

This study found that, among women with breastfeeding difficulties, those who did not report a negative breastfeeding support experience were at a decreased risk of postpartum depression. A negative breastfeeding support experience was found to have a significant effect on the relationship between breastfeeding difficulties and postpartum depression.

They concluded that the quality of breastfeeding support is important not only for breastfeeding promotion but also for maternal mental health. Educating front-line caregivers to ensure that breastfeeding women have positive experiences of support can reduce the risk of postpartum depression.

Chaput, K, et al (2016) Breastfeeding difficulties and supports and risk of postpartum depression in a cohort of women who have given birth in Calgary: a prospective cohort study. CMAJ Open, 10.9778/cmajo.20150009

Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties

This study found that short breastfeeding duration and stopping breastfeeding for physical difficulty and pain were associated with higher depression score.

The authors conclude that understanding women’s specific reasons for stopping breastfeeding is critical in understanding women’s breastfeeding experience and providing emotional support. They also stress the importance of early breastfeeding support.

Brown, A., Rance, J. & Bennett, P. (2015). Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing, DOI: 10.1111/jan.12832

Related research and further reading