Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3 months postpartum: a prospective cohort study

Abstract

Background The rate of exclusive breastfeeding at 3 months postpartum is only 50% in Japan. In order to increase this rate, we aimed to examine modifiable factors related to exclusive breastfeeding at 3 months postpartum by focusing on breastfeeding-related and psychosocial variables at 1 month postpartum. Methods This prospective cohort study was conducted at a secondary medical care center in Osaka, Japan from February 2017 to October 2018. Demographic variables, infant feeding modality, breastfeeding-related variables, and psychosocial variables were obtained using questionnaires at 1 month postpartum. Daytime salivary cortisol levels before and after breastfeeding at 1 month postpartum were measured as a biological marker for stress responses associated with breastfeeding. Each infant’s feeding modality was re-assessed at 3 months postpartum. Multiple logistic regression analyses were performed to examine factors affecting exclusive breastfeeding at 3 months postpartum. Results Of the 104 participants, 61 reported exclusive breastfeeding at 3 months postpartum. The following factors were significantly associated with exclusive breastfeeding at 3 months postpartum: multiparity (adjusted odds ratio, 95% confidence interval: 11.13, 2.08–59.59), having a university degree (5.25, 1.04–26.53), no plan to return to work by 6 months postpartum (0.02, 0.00–0.46), and exclusive breastfeeding (42.84, 6.05–303.52), lower cortisol level after breastfeeding (0.00, 0.00–0.02), and higher breastfeeding self-efficacy scale score (1.07, 1.00–1.14) at 1 month postpartum. In parity-specific analyses, exclusive breastfeeding (25.33, 4.75–134.98) and lower cortisol level after breastfeeding (0.00, 0.00–0.21) at 1 month postpartum in primiparous women, and lower cortisol level after breastfeeding (0.00, 0.00–0.94), higher breastfeeding self-efficacy score (1.18, 1.05–1.32), and absence of breast complications (0.09, 0.01–0.82) at 1 month postpartum in multiparous women were associated with exclusive breastfeeding at 3 months postpartum. Conclusions Stress levels after breastfeeding, breastfeeding self-efficacy, and the presence of breast complications could be modifiable factors associated with subsequent exclusive breastfeeding. Further research is needed to examine whether approaches to reducing breastfeeding-related stress, improving breastfeeding self-efficacy, and preventing breast complications during lactation are effective to increase exclusive breastfeeding practices.

Association between exclusive breastfeeding and postpartum post-traumatic stress disorder

“…In the present study, exclusive breastfeeding within 42 days after childbirth was associated with a reduced risk of postpartum PTSD, which may be mediated through the regulation of stress biomarkers such as cortisol [ 27 – 29 ]. One study has shown that women with PTSD had very high levels of cortisol in the postpartum period [ 30 ], raising the possibility that postpartum PTSD might be linked to the dysregulation of cortisol. Another study has found that lower cortisol levels after breastfeeding were associated with exclusive breastfeeding practices [ 31 ].…”

Breastfeeding Experience During COVID-19 Pandemic in Indonesia: Strengthening and Weakening Elements

“…Physiological discomfort can also trigger the mother to discontinue breastfeeding ( 32 – 33 ). According to the findings of this study, breastfeeding mothers face challenges such as nipple pain, nausea, vomiting and dizziness.…”

“…The pain felt when the baby sucks the milk causes stress in the mother. This condition is due to increased cortisol, which plays an essential role in stress ( 33 , 35 ).…”

“…This stressor reduced her milk supply. One of the factors that predicts the success of exclusive breastfeeding is social support and one of the most critical social supports comes from the husbands of breastfeeding mothers ( 33 ).…”

Opinions of midwives regarding the introduction of breast ultrasound in mothers’ breast care

“…However, mothers often have to resort to artificial milk, without fulfilling their wishes to breastfeed. Mothers who breastfeed are more likely to continue breastfeeding despite being provided with breast support (Shiraishi et al, 2020). This support is provided mainly by midwives in Japan; their breast care method involves the use of hands only.…”