Although new mothers describe breastfeeding as a meaningful and fulfilling aspect of caring for their infants, breastfeeding is also a common source of stress and anxiety. A recent study suggests that difficulties with breastfeeding may also impact mothers’ bonding with their infants.  

In this study, researchers followed 121 mothers with newborn infants (age = 23-45 years, mean age = 32.31 ± 4.79 years).  Every month, the participants completed self-assessments of bonding.  At the first postpartum visits, mothers reported on whether they were experiencing any breastfeeding difficulties.  

Breastfeeding difficulties were commonly reported, with 39% of the mothers (n=46) reporting difficulties within the first two months postpartum.  At the first month postpartum, seven mothers (6.0%) were not breastfeeding.  A total of 17 mothers (14.5%) stopped breastfeeding within 3 months postpartum, and a total of 25 mothers (21.4%) stopped breastfeeding within 6 months. 

Women who reported breastfeeding difficulty reported lower bonding than women who did not.  The effect of breastfeeding difficulties on bonding was not explained by depressive symptoms.  The researchers found that, independent of breastfeeding difficulties, women who reported higher depressive symptoms across the first 6 months postpartum also reported lower levels of bonding. Thus, both breastfeeding difficulties and postpartum depression are uniquely important in affecting women’s experiences with bonding during the early postpartum period. In addition, they observed that within-individual decreases in depressive symptoms across the first six months were associated with  improvements in bonding across this period.

How Can We Best Support Those Experiencing Breastfeeding Difficulties?

These findings are consistent with other studies demonstrating a link between breastfeeding difficulties and postpartum depression.  This study underscores the importance of supporting mothers who choose to breastfeed. If we intervene early and support women and their efforts to initiate breastfeeding, we may be able to increase rates and duration of breastfeeding. And helping new mothers to achieve success in this important aspect of mothering may decrease stress and help build a stronger sense of competency, factors which may help to reduce risk for postpartum depression and improve bonding.

Nonetheless, even when excellent support and resources are available, breastfeeding may not be successful, and for most mothers, this is experienced as a loss.  During the postpartum period, when feeding is one of the key aspects of caring for an infant, not being able to breastfeed successfully is a major stressor and a challenge that may make a mother feel incompetent or ineffective in her new role as a mother.  In this setting, mothers feel disappointment, grief, sadness, and often shame.

Given the impact breastfeeding difficulties may have on maternal competence, bonding and vulnerability to depression, we need to broaden our definition of lactation support.  The primacy of exclusive breastfeeding creates a situation where anything short of that ideal feels like a failure.  We need to help mothers to understand that while there are benefits to breastfeeding, it is but one element of mothering a new baby and that there are so many other things that mothers can do to promote bonding.  We have to remind mothers that simply holding, touching, and communicating with their babies can have profound beneficial effects on the baby and the mother.

And finally, we strongly believe that supporting mothers in their efforts to breastfeed also means allowing or advising them to stop breastfeeding when they are having significant or unresolvable difficulties and helping them to feel comfortable with this decision.  Far too often, women feel ashamed and inadequate as mothers when they cannot (or choose not) to breastfeed.  Being a new mom is stressful enough, we don’t have to make it worse.

Ruta Nonacs, MD PhD

Roth MC, Humphreys KL, King LS, Gotlib IH, Robakis TK. Breastfeeding Difficulties Predict Mothers’ Bonding with Their Infants from Birth to Age Six Months.  Matern Child Health J. 2021 Feb 2. 

Read More:

Why we shouldn’t demonize formula feeding (Harvard Health Blog)

I’m An Obstetrician And I Failed At Breast-Feeding (NPR)

Formula feeding is not failure (Washington Post)