The Effect of Breastfeeding Difficulties and Associated Supports on Postpartum Depression: a mixed-methods study

Date
2013-09-05
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Abstract
Introduction: Postpartum depression (PPD) is the most common complication of pregnancy in Canada, affecting 10% to 15% of mothers. Depression interferes with parenting ability, putting children at increased risk of developmental and cognitive delays, abuse, neglect, addiction and emotional problems. Current strategies for managing PPD in Alberta include postpartum screening and treatment programs, which are problematic, because depressed women are only identified after depression onset. In order to develop preventive strategies for PPD, identification of its modifiable causes is needed. A link between breastfeeding difficulties and PPD has been established, and there is evidence that initiatives intended to promote breastfeeding may place stress on new mothers, and contribute to PPD risk. Hypotheses: The current study measures and describes the association between breastfeeding difficulties, support for breastfeeding and PPD, and hypothesizes that: Breastfeeding difficulties are a significant cause of PPD; and that breastfeeding supports modify a woman's risk of PPD. Method: A prospective cohort study of 425 women was conducted. Mothers intending to breastfeed were recruited within 72 hours of delivering a full-term, singleton infant in Calgary. Paper and online questionnaires were administered at delivery, six weeks and six months postpartum and measured breastfeeding difficulties, experience with breastfeeding supports and PPD. Results: Breastfeeding difficulties were common, reported by 87% of women. A qualitative assessment revealed 4 parameters of negative experiences with breastfeeding support: 1. Lack of knowledge/expertise, 2. Insensitivity/pressure, 3. Ineffective advice/suggestions and 4. Unwanted/unsolicited help. Among women who reported having a negative experience with breastfeeding support, those with breastfeeding difficulties were at 2.74 times higher risk of PPD than those without breastfeeding difficulties (RR=2.74, p=0.04). Among women who had positive experiences with breastfeeding supports, those with breastfeeding difficulties were at decreased risk of PPD (RR=0.36, p=0.042). Conclusion: The quality of breastfeeding support is important not only for breastfeeding outcomes, but also for maternal mental health. Educating front-line care providers, peer and informal supporters about the parameters of positive and negative breastfeeding support experiences and the importance of their role in maternal mental health can potentially prevent PPD, and improve maternal and child health.
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Epidemiology
Citation
Chaput, K. H. (2013). The Effect of Breastfeeding Difficulties and Associated Supports on Postpartum Depression: a mixed-methods study (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/28076