Stress Life Events and Breastfeeding Initiation
by Anne Eglash MD, IBCLC, FABM
We know that certain factors are associated with lower breastfeeding rates such as poverty and less education. Both of these conditions typically create more stress. If we control for factors that we already know lower the rate of breastfeeding including lower income, young age, and race, do prenatal life stresses such as bereavement, trauma, and relationship conflicts still impact breastfeeding initiation?
A research group used 2012-2014 Rhode Island Pregnancy Risk Assessment Monitoring System data that evaluated 3,353 postpartum mothers on exposure to a variety of prenatal stressful life events categorized as either traumatic, emotional, financial, or relationship stress. The mothers were screened for postpartum depression, and were asked if they initiated breastfeeding. The study tried to over-sample for women who had low birth-weight infants, as this can be a marker for higher risk of life stress.
- The odds of breastfeeding were the same for pregnant women with and without financial or relationship stress.
- The type of stress most associated with a lower breastfeeding initiation rate was trauma (i.e. homelessness, going to jail, alcoholic partner).
- In comparing pregnant women with 4 or more stressful life events, those with depression had lower breastfeeding initiation rates compared to women who did not score positive for depression.
- As the number of prenatal stressful life events increased, the rate of breastfeeding initiation decreased.
See the Answer
Of the various barriers to breastfeeding, limited information is available on the relationship between prenatal stress and breastfeeding. This study investigates the association between prenatal stressful life event (SLE) exposure and breastfeeding initiation postpartum.
Materials & Methods:
Using Rhode Island Pregnancy Risk Assessment Monitoring System data from 2012 to 2014, SLE was defined as self-report of prenatal exposure to 14 predefined life events such as job loss or illness. Exposure to SLE was categorized by number and type of events. Multivariable logistic regression was performed to assess the relationship between SLE and breastfeeding initiation. Results accounted for complex survey design and were adjusted for maternal and infant characteristics (age, race, ethnicity, insurance, delivery type, parity, gestational age, birth weight for gestational age, and neonatal intensive care unit admission).
Among 3,353 respondents, 86% reported breastfeeding initiation, 74% reported exposure to ≥1 SLE, and 17% reported exposure to ≥4 SLE. Decreased odds of breastfeeding initiation were associated with prenatal exposure to ≥4 SLE (adjusted odds ratio [aOR] 0.67; 95% confidence interval [CI]: 0.48-0.95), emotional stressors (aOR 0.77; 95% CI: 0.61-0.98), and traumatic stressors (aOR 0.68; 95% CI: 0.50-0.91).
This study underscores the impact of exposure to prenatal SLE on breastfeeding initiation among postpartum women. Findings may assist providers in identifying at-risk women for anticipatory guidance to improve breastfeeding rates.
This research is a good reminder that in our endeavor to teach and encourage pregnant women to make the decision to breastfeed, we must address the stressful life events that may be associated with her decision to not breastfeed. It will likely be more helpful and healing to explore the trauma or stress that she is dealing with and connect her to resources, than to pull out the list of reasons why formula feeding would be harmful to her newborn. Stressful life events increase the risk of postpartum depression and anxiety, both of which not only decrease breastfeeding initiation, duration, but have a negative effect on infant growth and development. For the short and long-term health of the dyad, a conversation about breastfeeding ought to include a warm reception for the sharing of life challenges, stressors and maternal mental health.