Breast refusal: an analysis of frequency, onset timing, recovery status, and their interplay with breastfeeding self-efficacy and maternal depression

Abstract

Objectives This cross-sectional study aimed to explore the frequency of breast refusal (BR), associated factors including postpartum depression and breastfeeding self-efficacy, and investigate the recovery status following BR. Methods The survey comprised four sections, to investigate the sociodemographic characteristics of mothers and their babies, Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), the Edinburgh Postnatal Depression Scale (EPDS) of mothers, and features associated with BR. The survey was administered online to those with babies aged 0–24 months. Specific questions related to BR were directed to mothers who experienced it within the first 12 months. Results The study encompassed 651 mothers, with a mean age of 30.5 ± 3.6 years, and revealed that 35.6% experienced BR. The presence or history of BR was associated with monthly household income, nurse-midwife support during the first breastfeeding, nipple shape, co-sleeping practices, mother-in-law’s support in child care, and BSES-SF scores. Notably, mothers facing breastfeeding-related challenges such as engorgement, pressured milk issues, and infants with gas-related concerns, -excluding low milk supply, pacifier or bottle use-, demonstrated higher recovery from BR. Conclusions Some sociodemographic factors, social support, mothers characteristics were associated with the BR. In addition, several challenges were present in BR recovery. Mothers need to be supported in child care and house work to prevent and improve BR and restore breastfeeding. Additinal cohort studies with the possible related factors for BR are necessary to implement targeted interventions to prolong breastfeeding duration.