Variables Impacting Breastfeeding Duration

By Jan Tedder, BSN, FNP, IBCLC; President of HUG Your Baby; See Roadmap to Breastfeeding Success Online Course

Research confirms that a woman's misunderstanding of normal child development is an important, and often over-looked, cause for abandoning breastfeeding. Though these issues are covered in depth in The Roadmap to Breastfeeding Success online course, we must be aware of the other, complex variables that may impact a woman's ability to initiate breastfeeding and to continue to breastfeed.

Demographic variables
Demographic variables that make women less likely to begin and continue breastfeeding include: prenatal smoking (Bertino et al., 2012); lower socio-economic, racial or ethnic status; having an unplanned pregnancy or not having a partner; being less-educated (Li et al., 2008); participating in a WIC program (Thulier & Mercer, 2009); and being obese, which is associated with a delay in milk coming in (Stuebe et al., 2014).

Social Variables

Other research moves demographic data to a wider screen by identifying particular social variables that impact initiation and duration of breastfeeding: worries about breastfeeding in public (Stuebe & Bonuck, 2011); lack of partner support and marital distress (Stuebe & Bonuck, 2011; Hinsliff-Smith et al., 2014); giving birth at a non-Baby-Friendly hospital; and returning to work.

We know that breastfeeding rates increase when pregnant women get together with successful breastfeeding mothers. In addition, an important study demonstrates that women who observe breastfeeding role models through videos (and who receive praise from their partners or their own mothers for breastfeeding) have significantly higher levels of confidence in and commitment to breastfeeding than do mothers who lack this kind of support (Kingston, 2008).

It is important to ask what kind of help and support new mothers need. A study from China showed that a grandparent in the home, among other variables, is associated with shorter breastfeeding duration (Liu et al., 2013). Research in Japan showed that the more fathers were involved with care of their infant the less anxiety their partners had—but the more formula the baby received (Ito et al., 2013). Both of these studies may indicate that loved ones need to be shown ways other than feeding to connect with a baby and help a new mother.

Biological Variables
Biological variables that impact breastfeeding include: a mother having physical challenges such as sore nipples, engorgement, mastitis, or plugged ducts before a baby is four weeks of age.

Remember that a woman who identifies any breastfeeding concerns at day 3 and 7 postpartum is less likely to be successfully breastfeeding at 2 months (Wagner et al., 2013). Mothers with early complaints need careful follow-up and ongoing support.

Interesting work by Kathleen Kendall-Tackett makes a connection between a woman’s experience of postpartum pain and its impact on breastfeeding (Kendall-Tackett, 2007). She explains that pain increases the body’s inflammatory process. This inflammatory process causes neuro-hormonal changes that are associated with depression. Kendall-Tackett concludes that pain from c-sections, or with breastfeeding, may create the conditions that result in postpartum depression.

Studies also show that mothers who have pain the first two weeks postpartum—and do not receive the help they need—are more likely to have postpartum depression at two months (Watkins et al., 2011). These studies confirm the importance of getting immediate lactation help for women having postpartum pain.

As one would expect, physical problems in the baby—such as prematurity, illness, or tongue-ties—also contribute to decreased breastfeeding duration and require both special medical care and more lactation support.

Psychological Variables
Though more research has been focused on how psychological variables impact the initiation rather than the duration of breastfeeding (De Jager et al., 2012), current literature suggests that at least four psychological issues influence breastfeeding success: postpartum depression, a mother’s intention and confidence to breastfeed, her sensitivity to her baby, and maternal-child attachment.

Postpartum depression occurs in 13% of mothers (Borra et al., 2014). Work by Kathleen Kendall-Tackett and others explores how the hormones of pregnancy help protect women from postpartum depression, a process, they say, that explains why women who breastfeed have a lower incidence of depression (Kendall-Tackett, 2010). 

In addition, other research shows that women with postpartum depression or anxiety often misread their baby’s body language (Arteche et al., 2011). Studies show that a woman with postpartum depression or anxiety can accurately identify her baby’s distressed face, as do mothers without these psychological conditions. However, the depressed or anxious mother will see her baby’s neutral face as distressed. And, this same mother seems unable to see her baby’s happy face (Arteche et al., 2011) Therefore, helping a mother with postpartum depression accurately read her baby’s body language may increase both that mother’s confidence and her breastfeeding duration.

Second, a women’s intention to breastfeed is a contributing factor to breastfeeding duration. Women who decide prenatally to breastfeed are more likely to be successful breastfeeding mothers (Meedya et al., 2010). Besides identifying an expectant woman's intention to breastfeed, helping her also say how long she plans to breastfeed has been shown to be important.

However, it is important to bear in mind that if a woman intends to breastfeed, and then is unsuccessful in meeting her breastfeeding goals, she will suffer a higher incidence of depression than if she had not intended to breastfeed in the first place (Borra et al., 2014). This research reinforces the need for immediate and effective breastfeeding support as soon as any breastfeeding problem arises.

Lack of confidence leads many women to give up breastfeeding when there are challenges to overcome. Fortunately, work by Dr. T. Berry Brazelton and others (Kadivar & Mozafarinia, 2013) demonstrates the remarkable power of using the baby’s behavior to enhance the confidence of young parents (Brazelton & Sparrow, 2006; Nugent et al., 2007).

Third, research indicates that prenatal women who establish their intention to breastfeed exhibit increased sensitivity to their infants’ cues. In addition, these mothers show an increase in both their duration of breastfeeding and in their exclusive breastfeeding rates (Thulier & Mercer, 2009; Tharner et al., 2012).

Helping a father experience his baby’s ability to interact, or a mother see her baby’s ability to turn toward her face when she calls her name, are techniques that have been shown to increase parent-child bonding and to boost parent confidence. Other studies show that mothers who are highly confident about breastfeeding are more likely to be exclusively breastfeeding at one week and at four months postpartum (Blyth et al., 2009).

Fourth and finally, the issue of maternal-child attachment and breastfeeding is important, both to parents and to the health care providers who serve them. A 2012 study used the well-accepted Ainsworth Sensitivity Scales to assess the impact of breastfeeding on attachment and continued breastfeeding. Mothers who breastfeed to six months demonstrate the highest levels of maternal sensitivity and secure attachment to their baby (Tharner et al., 2012).

Arteche, A., et al. (2011). The effects of postnatal maternal depression and anxiety on the processing of infant faces. Journal of Affective Disorders, 133(1-2), 197-203.

Bertino, E., Varalda, A., Magnetti, F., Nicola, D., Cester, E., Occhi, L., Perathoner, C., Pradi, G., Soldi, A. (2012). Is breastfeeding duration influenced by maternal attitude and knowledge? A longitudinal study during the first year of life. Journal of Maternal-Fetal and Neonatal Medicine, 25(53), 32-36.

Blyth, R., Creedy, D., Dennis, C. et al. (2009). Effects of maternal confidence on Breastfeeding duration: An application of Breastfeeding self-efficacy theory. Birth, 29 (4), 278-284.

Borra, C., Iacovau, M. & Sevilla, A. (2014). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intention. Maternal Child Health Journal, Retrieved from

Brazelton, T. & Sparrow, J. (2006). Touchpoints: Birth to 3. New York, NY: Perseus.

De Jager, E., Skouteris, H., Broadbent, J., Amir, L, Mellor, K. (2013). Psychological correlates of exclusive breastfeeding: A systematic review. Midwifery, 29(5), 506-518.

Hinsliff-Smith, K., Spencer, R., Walsh, D. (2014). Realities, difficulties, and outcomes for mothers choosing to breastfeed: Primigravid mothers’ experiences in the early postpartum period (6-8 weeks). Midwifery, 30(1), 14-19.

Ito, J., Fujiwara, T., Barr, R. (2013). Is paternal infant care associated with breastfeeding? A population-based study in Japan. Journal of Human Lactation, 29(4), 491-9.

Kadivar, M. & Mozafarinia, M. (2013). Supporting fathers in a NICU: Effects of the HUG Your Baby program on father’s understanding of preterm infant behavior. Journal of Perinatal Education, 22(2), 113-119.

Kendall-Tackett, K. (2010). Four research findings that will change what we think about perinatal depression. Journal of Perinatal Education, 19(4), 7-9.

Kendall-Tackett, K. (2007). A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal, 2(6).

Kingston, D., Dennis, C., Sword, W. (2007). Exploring breastfeeding self-efficacy. Journal of Perinatal and Neonatal Nursing, 21(3), 207-215.

Li, R., Fein, S., et al. (2008). Why mothers stop breastfeeding: Mothers’ self-reported reasons for stopping during the first year. Pediatrics 122, S69-76.

Liu, P., Qiao, L., Xu, F., Zhang, M., Want, Y., Binns, C. (2013). Factors associated with breastfeeding duration: a 30-month cohort study in northwest China. Journal of Human Lactation, 29(2), 253-9.

Meedya, S., Fahy, K., Kable, A. (2010). Factors that positively influence breastfeeding duration to 6 months: A literature review. Women Birth, 23(4), 135-145.

Nugent, K., Keefer, C., Minear, S., Johnson, L. (2007). Understanding newborn behavior and early relationships: The Newborn Behavioral Observation System Handbook. Baltimore, MD: Paul H. Brookes Publishing Company.

Stuebe, A., Horton, B., Chetwynd, E., Watkins, S., Grewen, K., Meltzer-Brody, S., (2014). Prevalence and risk factors for early, undesired weaning attributed to lactation dysfunction. Journal of Women’s Health, 23(5), 404-12.

Stuebe, A., Bonuck, K. (2011). What predicts intent to breastfeed exclusively? Breastfeeding knowledge, attitudes, and belief in a diverse urban population. Breastfeeding Medicine, 6(6), 413-420.

Tharner, A., Lujil, M., Raat, H., Ijzendoorn, M., Bakermans-Kranenburg, M., Moll, H., Jaddoe, V., Hofman, A., Verhulst, F., Tiemeier, H. (2012). Breastfeeding and its relation to maternal sensitivity and infant attachment. Journal of Developmental & Behavioral Pediatrics, 33(5), 396-404.

Thulier, D. & Mercer, J. (2009). Variables associated with Breastfeeding duration. Journal of Obstetric, Gynecologic, & Neonatal Nursing, May/June 38(3), 259-268.

Wagner, E., Chantry, C., Dewey, K., Nommsen-Rivers, A. (2013). Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics, 132(4), e 865-875.

Watkins, S., Meltzer-Brody, S., Zolnoun, D., Stuebe, A. (2011). Early breastfeeding experiences and postpartum depression. Obstetrics & Gynecology, Aug 118 (2 Pt 1), 214-21.

©HUG Your Baby 2018