The Advantages and Disadvantages of Breastfeeding for Maternal Mental and Physical Health

Article (PDF Available) · February 2013with 9,224 Reads 
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
Cite this publication
Abstract
"This chapter presents the state of the evidence concerning the advantages and disadvantages of breastfeeding for mothers."
Advertisement
C17 10/25/2012 15:39:45 Page 414
17
CHAPTER
Breastfeeding and Maternal Mental and
Physical Health
JENNIFER HAHN-HOLBROOK,CHRIS DUNKEL SCHETTER,
AND MARTIE HASELTON
INTRODUCTION
Expectant mothers are inundated with
information about the benets of breastfeed-
ing for their babies but are often poorly
informed about the consequences breast-
feeding has for their own mental and physi-
cal health. Women know about the
potential benets of breastfeeding for the
babys immune function and intellect
(Kramer et al., 2001; Kramer et al., 2008),
but mothers could also be asking themselves:
What about me? A deep desire to breastfeed
an infant is not shared by every mother. In
fact, even before the advent of bottles and
formula, many afuent women avoided
breastfeeding altogether by paying poorer
women to do it for them in an arrangement
called wet-nursing. As the anthologist Sarah
Hrdy (1992) noted, during the heyday of
wet-nursing at the end of the 18th century
. . . up to ninety percent of infants born in
urban centers such as Paris and Lyon were
nursed by women other than their biological
mother(p. 415).
Today, the World Health Organization
(2009) recommends exclusive breastfeeding
for the rst 6 months postpartum and the use
of breast milk as a supplementary form of
feeding for up to 2 years in order to confer
optimal health benets to the mother and
child. Despite these guidelines, recent esti-
mates are that while 70% of mothers initiate
breastfeeding after the birth of their child,
only 13.5% of infants in the United States are
exclusively breastfed for 6 months (Centers
for Disease Control and Prevention, 2011a).
Deciding how an infant will be fed is a
complex decision involving various social,
psychological, emotional, and environmen-
tal factors (Arora, McJunkin, Wehrer, &
Kuhn, 2000). In order of importance, the
top ve reasons women give for deciding to
breastfeed are (1) its benets for the infants
health, (2) that it is natural,(3) to
strengthen bonding with their infant,
(4) convenience, and (5) benets for their
own health (Arora et al., 2000). By contrast,
the top ve factors that discourage breast-
feeding are (1) opposition by the babys
father, (2) concerns that the baby is not
getting enough milk, (3) the need to return
to work, (4) discomfort while breastfeeding,
and (5) the misconception that breastfeeding
will adversely change the appearance of the
breasts (Arora et al., 2000). Given the level of
commitment that breastfeeding requires,
and the number of factors that mothers
take into account when making this com-
plex decision, it is important for mothers to
414
C17 10/25/2012 15:39:45 Page 415
have good information about what breast-
feeding can and cannot offer them in return.
This chapter presents the state of the
evidence concerning the advantages and
disadvantages of breastfeeding for mothers.
1
Questions addressed include: Does breast-
feeding really help mothers bond with their
infants? Are there health benets of breast-
feeding for mothers? Will breastfeeding
change the appearance of the breasts? We
use the term breastfeeding to refer to any
amount of breastfeeding, whether it is the
infants sole nutritional source or only a
supplemental form of feeding. We use exclu-
sive breastfeeding, by contrast, to refer to when
infants are only given breast milk and are not
given any other liquid, solid, or vitamins
(Labbok and Krasovec, 1990). This chapter
starts with an overview of the biology of
breastfeeding, which forms the basis of many
of the consequences of breastfeeding
discussed.
The core of the chapter summarizes the
evidence suggesting that breastfeeding aids
mothers in weight loss and reduces their risk
for ovarian and breast cancers, along with a
discussion of the inuence of breastfeeding
on maternal stress, postpartum depression,
and maternal bonding. We approach many
of these topics using the lenses of anthropol-
ogy and comparative research, highlighting
the ways that breastfeeding mothers are
sometimes very similar and sometimes
very different from their mammalian coun-
terparts. The chapter also presents informa-
tion on the physical, economic, and social
costs associated with breastfeeding for moth-
ers. Finally, we conclude by discussing
options women have in navigating the
mineelds associated with choosing an infant
feeding method.
THE BIOLOGY OF
BREASTFEEDING
Background on the biology of breastfeeding
is important for understanding how breast-
feeding can have a widespread impact on
maternal psychology and health. Here, we
present a brief overview. For a more detailed
account of the biological underpinnings of
breastfeeding, see Riordan (2005).
The two most important hormones
associated with lactation are oxytocin and
prolactin (see Riordan, 2005). Oxytocin,
named after the Greek word for speedy
birth,acts in the body as a smooth muscle
contractor, facilitating contractions during
labor and the release of milk during lacta-
tion. Prolactin is the primary hormone
responsible for milk production. Prolactin
levels increase slowly during pregnancy,
triggering changes in the breast tissue that
stimulate milk production. Oxytocin also
increases during pregnancy, although more
rapidly, quadrupling in volume to stimulate
labor (Riordan, 2005). Before a breastfeed-
ing session begins, the mothers body releases
oxytocin into the blood stream to aid in milk
ejection (White-Traut et al., 2009). Mothers
separated from their infants before a feeding
session do not show this prefeeding oxytocin
release; therefore, it appears that infant cues
drive this effect (McNeilly, Robinson,
Houston, & Howie, 1983). During the feed-
ing session, when tactile stimulation is
received from the nipple, oxytocin and
prolactin are released in pulsating patterns,
controlled by nerve bers linked to the
hypothalamus (Gimpl & Fahrenholz,
1
The majority of studies on the impacts of breastfeed-
ing have been conducted in the United States; for this
reason, studies discussed in this review were U.S.-
based unless otherwise noted.
Breastfeeding and Maternal Mental and Physical Health 415
C17 10/25/2012 15:39:45 Page 416
2001). Prolactin levels are generally height-
ened in women who are breastfeeding as
compared to women who are not breast-
feeding, although prolactin levels are pro-
portionate to breastfeeding frequency and
the infants milk demands (Battin, Marrs,
Fleiss, & Mishell, 1985).
Estrogen and progesterone are also sup-
pressed during lactation, resulting in a period
of postpartum infertility, called lactational
amenorrhea. This natural form of birth con-
trol remains 98% effective throughout the
rst 6 months of exclusive breastfeeding, as
long as breast milk is given to the child from
the breast at least every 4 hours during the
day and every 6 hours during the night
(Peterson et al., 2000; Valdes, Labbok, Pugin,
& Perez, 2000). Lactational amenorrhea
becomes a less effective form of contracep-
tion (94.6%) if mothers use a breast pump or
are separated from their infant for long peri-
ods (Valdes et al., 2000). This amenorrheic
state has been observed to last years in
malnourished populations seemingly because
of elevated levels of prolactin (Lunn, Austin,
Prentice, & Whitehead, 1984).
Until recently, scientists thought that
the functions of oxytocin and prolactin
were limited to birth and lactation, but
they now recognize the impact these hor-
mones have on psychological states. Oxyto-
cin and prolactin circulate in the brain and
act on their own receptors distributed widely
across different brain regions (Freeman,
Kanyicska, Lerant, & Nagy, 2000; Gimpl
& Fahrenholz, 2001). Animal research has
implicated oxytocin and prolactin in critical
maternal behaviors such as grooming, pro-
tection, and sensitivity to infant cues
(Freeman et al., 2000; Gimpl & Fahrenholz,
2001). As we discuss later, studies in humans
have revealed that breastfeeding mothers
experience lower levels of stress and negative
mood than do mothers who do not breast-
feed, perhaps aiding in the transition to
motherhood.
PHYSICAL HEALTH BENEFITS
OF BREASTFEEDING
A large research literature suggests that
women who breastfeed experience an array
of health benets (Bernier, Plu-Bureau,
Bossard, Ayzac, & Thalabard, 2000; Rea,
2004). In the short term, breastfeeding helps
mothers lose weight gained during preg-
nancy (Garza & Rasmussen, 2000; Kramer
& Kakuma, 2004) and helps the uterus
contract after pregnancy (Negishi et al.,
1999). Over the long term, breastfeeding
is associated with reduced risk of reproduc-
tive cancers (Bernier et al., 2000), metabolic
syndrome (Ford, Giles, & Dietz, 2002;
Kramer & Kakuma, 2004), type 2 diabetes
(Stuebe & Rich-Edwards, 2009), and
cardiovascular disease (Schwarz et al.,
2009). The literature linking breastfeeding
to improved health has been reviewed else-
where (Bernier et al., 2000; Rea, 2004).
Here, we provide a general overview.
Weight Loss and Metabolic Syndrome
Breastfeeding is calorically costly and is
therefore associated with weight loss after
pregnancy. Human mothers devote an esti-
mated 525 to 625 calories per day producing
the 750 mL of milk infants require daily over
the rst year of life (Garza & Ramussen,
2000). A caloric shortfall is experienced in
most breastfeeding women, who often do
not report more hunger than nonbreastfeed-
ing women (Heck & de Castro, 1993).
In a study that followed more than
20,000 Danish women from pregnancy to
416 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:45 Page 417
18 months postpartum, women who exclu-
sively breastfed for the recommended
6 months after birth lost an additional
2 kgs (4.4 pounds) of pregnancy-related
weight by 6 months postpartum than
women who breastfed for shorter durations
(Baker et al., 2008). In line with this result, a
systematic review of 20 studies showed that
exclusive feeding with breast milk for the
rst 6 months postpartum predicts signi-
cantly greater postpregnancy weight loss
than with mixed forms of breastfeeding
(breastfeeding while introducing other foods
or liquids) (Kramer & Kakuma, 2004).
Studies have also shown that women
with a history of breastfeeding have a
reduced risk of developing metabolic syn-
drome, a combination of medical disorders,
such as obesity, insulin resistance, and high
blood pressure, which increases the risk of
cardiovascular disease and diabetes (Ford et
al., 2002). A cross-sectional analysis of 2,516
midlife women found a 20% reduction in
the risk of developing metabolic syndrome
for every additional year of breastfeeding
women reported (Ram et al., 2008). The
authors noted that, although weight loss
associated with breastfeeding accounted for
a signicant portion of the reduced risk in
their sample, breastfeeding was associated
with reductions in metabolic syndrome
risk above and beyond weight loss, even
when health behaviors and sociodemo-
graphic variables were statistically con-
trolled. These additional benets could
owe to the observation that breastfeeding
primes the body to become more metaboli-
cally efcient. This idea, dubbed the reset
hypothesis,proposes that breastfeeding
reverses gestational increases in fat accumu-
lation, insulin resistance, and lipid and
tryglicerin levels more quickly and com-
pletely (Stuebe & Rich-Edwards, 2009).
According to the hypothesis, the reset pro-
cess causes long-term positive impacts
on womens health, reducing the risk for
metabolic syndrome, and, consequently,
reducing the risk of type 2 diabetes and
cardiovascular disease.
New research indicates that breastfeed-
ing may reduce the risk of developing both
type 2 diabetes and cardiovascular disease.
For example, Schwarz and colleagues (2009)
found that among 139,681 postmenopausal
women, those who reported a lifetime his-
tory of breastfeeding of more than 1 year
were less likely to develop postmenopausal
diabetes, hypertension, and cardiovascular
disease than women who never breastfed.
Likewise, another large study found that
women who breastfed over their lifetime
for 2 years or more were 23% less likely to
develop coronary heart disease than women
who never breastfed, even after controlling
for parental history, early adult adiposity, and
various lifestyle factors (Stuebe et al., 2009).
Interestingly, some evidence suggests that
longer durations of breastfeeding the same
child, rather than total time spent breastfeed-
ing over ones lifetime, has the greatest pro-
tective benet against coronary heart disease
(Stuebe, Rich-Edwards, Willett, Manson, &
Michels, 2005).
A study that investigated the relationship
between type 2 diabetes and breastfeeding in
two cohorts of more than 70,000 women
found that, although the total lifetime dura-
tion of breastfeeding was associated with
reduced risk of type 2 diabetes, it was longer
durations of breastfeeding involving the
same child, as opposed to the combined
duration of breastfeeding across multiple
children, that conferred the greatest protec-
tive benets (Stuebe et al., 2005). In this
sample, a year of continuously breastfeeding
one child was associated with a 44% decrease
Breastfeeding and Maternal Mental and Physical Health 417
C17 10/25/2012 15:39:45 Page 418
in risk of developing later diabetes, while a
year of breastfeeding spread across two chil-
dren was only associated with a 24%
decrease. Whether this nding can be attrib-
uted to the reset hypothesis is unclear,
although it seems possible that womens
bodies could require more than half a year
of breastfeeding after any given pregnancy to
completely reset metabolic action.
Breast and Ovarian Cancer
Breastfeeding may also protect against breast
and ovarian cancers by suppressing ovula-
tion, and thus limiting lifetime estrogen
exposure (Clemons & Goss, 2001; Key &
Pike, 1988). Theoretically, reductions in
total estrogen exposure may reduce the
risk of breast cancer, because estrogen
increases rates of breast cell proliferation
and differentiation, giving more opportuni-
ties for mutations to occur and, when they
do, fueling cancer growth (Clemons & Goss,
2001; Key & Pike, 1988). In support of this
model, a meta-analysis of 23 case-control
studies found a small protective effect of
breastfeeding on breast cancer: Any lifetime
history of breastfeeding, regardless of dura-
tion, yielded a benet, although this effect
was small compared to other known biolog-
ical risk factors (Bernier et al., 2000). This
effect was strongest in nonmenopausal
women and in women who had breastfed
for longer than 12 months.
Recent research has also begun to
examine the impact of breastfeeding on
women with hereditary predispositions to
develop breast cancers, with mixed results.
Jernstrom and colleagues (2004), for exam-
ple, evaluated the role of breastfeeding in
women who carried the genetic mutations
BRCA1 or BRCA2, which are known to
raise the lifetime risk of breast cancer by
approximately 80% (King, Marks, &
Mandell, 2003). In this study, 685 carriers
ofBRCA1and280carriersofBRCA2
were compared to 965 women with no
history of ovarian or breast cancer. They
found that cumulative breastfeeding for
longer than a year reduced the risk of
hereditary breast cancer in women with
the BRCA1 mutation, but not the BRCA2
mutation. By contrast, neither Lee et al.
(2008) nor Andrieu et al. (2006) observed
an association between breastfeeding and
breast-cancer risk in women with BRCA1
or BRCA2.
Studies suggest that the risk of ovarian
cancer is reduced by breastfeeding behaviors
as well. A review by Shoham (1994) revealed
that 6 of 11 studies found that breastfeeding
was related to reduced risk of ovarian cancer.
More recently, researchers analyzed 391
cases of epithelial ovarian cancer among
149,693 women in the NursesHealth Study
(Danforth et al., 2007). They found that for
each month of additional breastfeeding, the
risk of epithelial ovarian cancer was reduced
by 2%. Another study documented a similar
1.4% reduction in ovarian cancer risk for
every additional month of breastfeeding
(Jordan, Siskind, Green, Whiteman, &
Webb, 2010), although the reduction in
risk did not continue to accrue beyond
the rst 12 months. Breastfeeding has
been found not only to reduce the risk of
developing ovarian cancer, but also to
improve the chances of surviving in women
who do develop it. One study found that
women diagnosed with ovarian cancer lived
longer if they had ever breastfed than if they
had never breastfed (Nagle, Bain, Green, &
Webb, 2008). In this same study, there was
no relationship between duration or fre-
quency of breastfeeding and improved ovar-
ian cancer outcomes.
418 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:45 Page 419
Evidence continues to accumulate dem-
onstrating an association between breast-
feeding and reduced risk of ovarian and
breast cancers, diabetes, and cardiovascular
disease. Breastfeeding is a biologically com-
plex phenomenon, involving changes in hor-
mone levels that act on receptors throughout
the brain and the body. Although the links to
maternal health arenot yet fully known,these
hormone dynamics may exert long-term
impacts on womens health. Reductions in
diseases related to metabolic syndrome
may owe, in part, to weight loss and
improved metabolic function associated
with breastfeeding. Breastfeeding also reduces
lifetime estrogen exposure, potentially
accounting for reduced risk of reproductive
cancers among women with a history breast-
feeding. Some studies nd dose-response
relationships between increased total dura-
tion of lifetime breastfeeding and better
health outcomes.
MENTAL HEALTH BENEFITS
OF BREASTFEEDING
Stress Regulation
Being a new parent is as stressful as it is
rewarding. Sources of maternal stressors
range from worries about being a good
mother (Mercer, 1986) to physical stressors,
such as sleep deprivation, body changes, and
sexual dysfunction (Gjerdingen, Froberg,
Chaloner, & McGovern, 1993). New moth-
ers struggle to nd time for their baby while
trying to meet the needs of partners, other
children, and themselves (Gruis, 1977). The
vigilance required to be a good parent is also
a stressor for new mothers (Hahn-Holbrook,
Holbrook, & Haselton, 2011). Given all the
stressful demands and challenges parenthood
brings, it is perhaps unsurprising that approx-
imately one in ve women self-report depres-
sive symptoms within the rst year after birth
(Gavin et al., 2005). However, nature may
also have provided mothers with a stress-
buffer: breastfeeding (Carter & Altemus,
1997; Groer, Davis, & Hemphill, 2002).
Only recently have scientists begun to
recognize the ways that lactation alters a
mothers stress responses (Groer et al.,
2002; Lonstein, 2007; Mezzacappa, 2004).
The earliest studies done on rodents revealed
that lactating dams were remarkably resistant
to stress. Lactating rodents exposed to stress-
ors, such as electric shocks, erce predators,
or complex mazes, displayed fewer hormo-
nal and cardiovascular signs of anxiety than
their nonlactating female counterparts (see
Neumann, 2001, for a review).
Corresponding research in humans has
shown a similar association between breast-
feeding and reduced stress. The rst study
conducted in humans showed that breast-
feeding women had signicantly lower hor-
monal stress responses (as evidence by lower
cortisol and ACTH) during exercise stress
than nonbreastfeeding mothers or women
without children (Altemus, Deuster, Gal-
liven, Carter, & Gold, 1995). Several fol-
low-up studies have since examined
womens cardiovascular and hormonal stress
responses to the classic Treir Social Stress
Task, which involves giving a public speech
and doing difcult mental arithmetic in front
of a critical audience. Although these studies
tend not to nd evidence of lower stress
reactivity using hormonal markers of stress,
such as cortisol, they consistently nd that
breastfeeding women have lower cardiovas-
cular markers of stress than do formula-
feeding women.
For example, one study detected lower
cardiovascular markers of stress (as evidence
Breastfeeding and Maternal Mental and Physical Health 419
C17 10/25/2012 15:39:45 Page 420
by lower basal systolic blood pressures,
higher levels of cardiac parasympathetic con-
trol, and modulation of heart rate reactivity)
during the task in breastfeeders compared
with nonbreastfeeding mothers and women
without children (Altemus et al., 2001).
Another study found similar cardiovascular
patterns for breastfeeding mothers during
the anticipation of the public-speaking
stressor (Light et al., 2000). It is possible
that any stress-buffering effects of breastfeed-
ing are more potent directly after the act.
Mothers randomly assigned to breastfeed
before this public-speaking stressor have
blunted cortisol responses when compared
to breastfeeding women who were
instructed to hold their infants (Heinrichs
et al., 2001).
The stress-reducing effects of breast-
feeding may extend to other stressors as
well. Mezzacappa, Kelsey, and Katkin
(2005), for example, compared the cardio-
vascular responses to difcult mental arith-
metic (verbal serial subtractions) and
immersion of ones hand into ice water in
four groups of womenthose exclusively
breastfeeding, exclusively formula-feeding,
mixed feeding (breast and formula), and
women without children. In response to
the challenging mental arithmetic, mothers
who breastfed exclusively displayed attenu-
ated heart-rate reactivity and shortened pre-
ejection period (PEP; an indicator of the
reduced cardiac stress related to the sympa-
thetic nervous system) compared to all other
groups. Moreover, this study found a dose-
response relationship between breastfeeding
frequency and stress reduction. Women
who breastfed more times per day had lower
heart rates in reaction to doing the difcult
mental arithmetic and reduced sympathetic
reactivity to the cold water task than women
who breastfed less frequently. In this study,
the stress buffering effects of breastfeeding
appeared to fade as children grew older.
Breastfeeding mothers with very young
infants derived greater stress-buffering
from breastfeeding than women who had
1-year-old children.
Preliminary research suggests links
between breastfeeding and reduced stress
in womens daily lives outside of the labora-
tory. Breastfeeding mothers are more likely
to report positive mood states, less anxiety,
and increased calm as compared to formula-
feeding mothers (Altshuler, Hendrick, &
Cohen, 2000; Carter & Altemus, 1997;
Fleming, Ruble, Flett, & Van Wagner,
1990; Ford et al., 2002; Heinrichs et al.,
2001). These differences between breast-
feeding and formula-feeding mothers
remain after controls for possible confounds,
including maternal age, work status, income,
and health behaviors (Mezzacappa, Gueth-
lein, & Katkin, 2002; Mezzacappa, Gueth-
lein, Vaz, & Bagiella, 2000; Mezzacappa &
Katlin, 2002).
While studies in rodents indicate that
the stress reduction associated with lactation
is mediated by the hormones oxytocin
(Neumann, Torner, & Wigger, 2000;
Windle, Shanks, Lightman, & Ingram,
1997) and prolactin (Bole-Feysot, Gofn,
Edery, Binart, & Kelly, 1998; Freeman
et al., 2000), data in humans are more
limited. We do know that women with
higher plasma oxytocin and prolactin in
the early postpartum period report less anxi-
ety than do women with lower levels of
these hormones (Nissen, Gustavsson, Wid-
strom, & Uvnas-Moberg, 1998; Uvnas-
Moberg, Widstrom, Werner, Matthiesen,
& Winberg, 1990). Furthermore, breast-
feeding women who release more oxytocin
during infant suckling have lower levels of
cortisol than women who release less
420 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:46 Page 421
oxytocin during infant feedings (Chiodera et
al., 1991). In addition, breastfeeding women
with higher oxytocin show reduced markers
of stress while preparing for a public-speak-
ing stressor relative to those with lower
oxytocin (Light et al., 2000).
Research in humans and other species
has shown that physiological responses to
stressors are reduced among lactating relative
to nonlactating females. In studies with
human mothers, the stress-buffering effects
of breastfeeding appear to be stronger in the
early postpartum period and soon after a
feeding session. Cardiovascular measures of
stress, which tap into sympathetic and para-
sympathetic nervous system activity, are
more likely to reveal differences in stress
reactivity between breast- and formula-
feeding women than hypothalamic-pitui-
tary-adrenal (HPA) axis hormones like cor-
tisol. Breastfeeding mothers also report less
perceived stress in their daily lives than
formula-feeding mothers. The stress-buffer-
ing effect of lactation appears to result from
the hormones oxytocin and prolactin in
nonhumans, although direct evidence in
humans in lacking. Collectively, nonhuman
and human evidence strongly suggests that
breastfeeding is an important regulator of
maternal stress in the postpartum period.
Postpartum Depression
Although the birth of a child typically con-
jures images of joy and fulllment, many
women experience feelings of hopelessness
and despair instead. Postpartum depression is
a devastating mental illness affecting approx-
imately 13% of women worldwide within
the rst 12 weeks after giving birth (OHara
& Swain, 1996), and roughly one in ve
women within the rst postpartum year
(Gaynes et al., 2005). Postpartum depression
is distinct from other postpartum mood dis-
orders like the common and transient post-
partum blues,which affects 50% to 80% of
mothers worldwide (Pitt, 1973; Yalom,
Lunde, Moos, & Hamburg, 1968), or the
very serious, although rare, occurrence of
postpartum psychosis (Herzog & Detre,
1976). The effects of postpartum depression
are insidious because they can disrupt
parenting behaviors (Field, 2010), resulting
in long-term negative consequences on the
cognitive, emotional, and behavioral devel-
opment of children (Grace, Evindar, &
Stewart, 2003). Because of the serious nega-
tive consequences of this disorder, there has
been much research identifying predictors of
postpartum depression.
A recent systematic review identied 12
studies that reported that breastfeeding
women had lower rates of postpartum
depression in comparison to formula-feed-
ing women (Dennis & McQueen, 2009).
However, there is an important question
that few studies explicitly address: Does
less breastfeeding lead to more depression,
or does more depression lead to less breast-
feeding? The vast majority of research on
this topic to date has focused solely on the
ways that depression can lead to less
breastfeeding.
It is easy to imagine why depression
might interfere with breastfeeding. Symp-
toms of depression commonly include
decreased motivation, increased anxiety,
and, for new mothers, avoidance of the
infant (Beck, 1992). Breastfeeding is an inti-
mate behavior demanding sustained periods
of direct motherinfant contact, which
many depressed mothers may nd difcult.
Formula-feeding then might seem the more
attractive option for depressed mothers,
because it can be performed by other care-
givers. Furthermore, anxiety associated with
Breastfeeding and Maternal Mental and Physical Health 421
C17 10/25/2012 15:39:46 Page 422
depression can interfere with the maternal
milk supply (Riordan, 2005), leading depre-
ssed mothers to feel that they have insufcient
milk and need to switch to formula to ensure
that their infant receives adequate nutrition.
Finally, many antidepressant medications are
not recommendedfor breastfeeding mothers,
because the active ingredients can be trans-
ferred to the baby through breast milk and
could have adverse impacts on infant devel-
opment (Riordan, 2005). It is not surprising,
then, that studies nd depressed mother are
less likely to breastfeed.
Depressed mothers commonly report
more difculties with breastfeeding (Edh-
borg, Friberg, Lundh, & Widstrom, 2005;
Tamminen, 1988), lower levels of breast-
feeding self-efcacy (Dai & Dennis, 2003),
and more failed breastfeeding attempts
(Fergerson, Jamieson, & Lindsay, 2002).
One study found that depressive symptoms
seven weeks after delivery predicted higher
rates of weaning by 24 weeks postpartum
(Galler et al., 1999). Similarly, another study
found that women who were depressed at
2 weeks postpartum were more likely to
wean before 2 months postpartum than
women who were not depressed at 2 weeks
postpartum (Taveras et al., 2003).
Researchers have found that women who
experience depression in pregnancy are less
likely to initiate breastfeeding (Seimyr,
Edhborg, Lundh, & Sjogren, 2004). These
studies show that decreased breastfeeding
behavior follows depression during preg-
nancy and in the early postpartum period.
However, the existence of this relationship
does not preclude the possibility that breast-
feeding may also exert protective effects
against postpartum depressive symptoms.
There are reasons to think that breast-
feeding could protect mothers against
depression. The act of breastfeeding releases
oxytocin, which has been found in lower
levels in depressed mothers than in nonde-
pressed mothers (Skrundz, Bolten, Nast,
Hellhammer, & Meinlschmidt, 2011).
Women currently using both breastfeeding
and formula-feeding methods report lower
levels of negative mood if they are randomly
assigned to breastfeed their infant in the
laboratory than if they are randomly assigned
to formula-feed (Mezzacappa & Katlin,
2002), perhaps from the oxytocin released
by breastfeeding. Breastfeeding is also asso-
ciated with reduced stress (Mezzacappa,
2004), and because stress is one of the stron-
gest risk factors in the development of
depression (Hammen, 2005), breastfeeding
could buffer women against depression.
Breastfed infants tend to have easier temper-
aments (Jones, McFall, & Diego, 2004) and
fewer health problems over the long term
(Ip et al., 2007), which could also have
positive downstream consequences for
maternal mental health. Taken together,
these ndings suggest that breastfeeding
could confer protective benets against
depression.
Very few studies have investigated the
possibility that breastfeeding might be pro-
tective against postpartum depression. Two
studies found that never having breastfed
versus having breastfed was associated with
subsequent postpartum depression (Chau-
dron et al., 2001; Hannah, Adams, Lee,
Glover, & Sandler, 1992), and one study
found that discontinuing breastfeeding ver-
sus continuing to breastfeed was also associ-
ated with subsequent depression (Nishioka
et al., 2011). Critically, however, none of
these studies controlled for baseline levels of
depression during pregnancy, leaving open
the possibility that women who engaged in
breastfeeding were simply less depressed
from the outset.
422 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:46 Page 423
Only one published study was identied
that explicitly set out to test the hypothesis
that breastfeeding is protective against the
development of postpartum depression
(Dennis & McQueen, 2007). This study
found that women who exclusively
breastfed at one week postpartum were
equivalently likely to become depressed at
4 or 8 weeks postpartum as women who
exclusively formula-fed (Dennis &
McQueen, 2007), suggesting that there is
no protective benet of exclusive breast-
feeding at one week against the develop-
ment of depressive symptoms at 4 and 8
weeks postpartum. Importantly, however,
this study may have been limited in its ability
to detect the mental health benets of
breastfeeding, because the mothers in the
sample had only been breastfeeding for a
very short time. Furthermore, the time
frame within which depression was assessed
(between 1 and 8 weeks postpartum) may
have been too narrow to detect the down-
stream effects of breastfeeding on depression.
Breastfeeding is clearly related to post-
partum depression; however, the nature of
that relationship remains somewhat unclear.
On the one hand, much research has shown
that depression predicts lower rates of breast-
feeding initiation and shorter durations of
breastfeeding. These effects likely result
from the increased problems depressed
women encounter while breastfeeding.
On the other hand, very little research has
assessed the possibility that breastfeeding
might also be protective against postpartum
depression. Given the theoretical reasons to
think that breastfeeding might be protective
against depression, further research using
longitudinal or experimental designs is
clearly needed before conclusions can be
drawn about whether the relationship
between depression and breastfeeding is
bidirectional (depression leading to less
breastfeeding and less breastfeeding leading
to depression) or simply unidirectional
(depression leading to less breastfeeding).
Maternal Bonding
Conventional wisdom holds that breastfeed-
ing helps mothers bond with their babies. In
fact, one of the most common reasons given
by women for wanting to breastfeed is the
opportunity to bond with their children
(Arora et al., 2000). In the scientic literature
as well, breastfeeding is often assumed to aid
in maternalinfant attachment, without nec-
essarily giving reference to direct evidence
(for examples, see Jansen, Weerth, &
Riksen-Walraven, 2008). Given this, it is
surprising that only a few studies have actu-
ally tested this hypothesis in humans, and
even fewer have found signicant results.
Here, we review the small literature on the
impact of breastfeeding on the motherchild
bond (for a more in-depth review, see Jansen
et al., 2008). Although the motherinfant
relationship is bidirectionalin that the
mother can bond with the infant and the
infant can bond with the motherour pri-
mary focus is maternal bonding. Briey,
however, we found no studies with evi-
dence that breastfed infants are more
securely attached to their mothers than for-
mula-fed infants (see Jansen et al., 2008, for a
review). Like the data linking lactation and
stress, most of what we have learned about
breastfeeding and bonding comes from ani-
mal studies.
Lactation is critical for inciting maternal
behaviors in many mammalian species,
because it releases the hormones oxytocin
and prolactin, which facilitate maternal
behavior (see Kendrick, 2000, for a review).
For example, female rats will suddenly
Breastfeeding and Maternal Mental and Physical Health 423
C17 10/25/2012 15:39:46 Page 424
display maternal behaviors if oxytocin
(Pedersen, Caldwell, Peterson, Walker, &
Mason, 1992) or prolactin (Bridges, DiBiase,
Loundes, & Doherty, 1985) is injected into
their brains. If a chemical that blocks the
actions of oxytocin or prolactin is injected
into the brain of a rat shortly after birth, a
rodents mothering behavior is signicantly
impaired (Bridges, Rigero, Byrnes, Yang, &
Walker, 2001; van Leengoed, Kerker, &
Swanson, 1987). In nonhuman primates,
however, hormonal changes linked to lacta-
tion play a smaller role in the onset of
maternal behaviors, with early learning
and social experience making up the differ-
ence (Pedersen, 2004). For example, admin-
istration of an oxytocin antagonist into the
brain of a female rhesus monkey reduces
certain caregiving behaviors, while leaving
others fully intact (Boccia, Goursaud,
Bachevalier, Anderson, & Pedersen, 2007).
Years of observations by primatologists also
tell us that maternal behaviors routinely
emerge in female primates without the
inuence of lactation. For example, female
primates who do not have offspring of their
own often seek out caregiving opportuni-
ties, such as carrying and grooming infants
(Hrdy, 1999).
Breastfeeding is certainly not necessary
for parental bonding to occur in humans, as
adoptive mothers, formula-feeding mothers,
and fathers can attest. However, might
breastfeeding give mothers, especially if
they are reluctant or are experiencing moth-
ering challenges, extra incentives to care for
their infant?
Recent studies in humans suggest that
oxytocin is important for maternal bonding.
For instance, plasma oxytocin levels during
pregnancy and the postpartum period pre-
dict more maternal bonding behaviors, such
as eye gaze, vocalizations, positive affect, and
affectionate touch, and more attachment-
related thoughts (Feldman, Weller,
Zagoory-Sharon, & Levine, 2007). Also,
mothers who provide high levels of affec-
tionate touch during a play session with their
children have higher levels of oxytocin after
the encounter than mothers who provide
low levels of affectionate touch (Feldman,
Gordon, Schneiderman, Weisman, &
Zagoory-Sharon, 2010). Given this evi-
dence, one might predict breastfeeding,
which gives women extra bursts of oxytocin,
would lead to greater levels of maternal
bonding.
Three out of four studies investigating
whether breastfeeding promotes maternal
bonding have found supportive evidence
(see Martone & Nash, 1988, for the null
result). In the largest study on the topic,
motherinfant interactions were observed
at 4 and 12 months postpartum in women
who had either breastfed for at least a week
(n¼439) versus women who had not initi-
ated breastfeeding (n¼94) (Else-Quest,
Hyde, & Clark, 2003). The researchers
found that mothers who had breastfed for
at least 1 week showed higher-quality inter-
actions with their babies at 12 months, but
not at 4 months postpartum. In another
study of 405 women, mothers who were
supplying over half of their infants diet
though breastfeeding at 5 months postpar-
tum reported that they were more emotion-
ally bonded to their infant at that time than
women who were supplying less than half of
their infants diet through breast milk or
were not breastfeeding at all (Nishioka
et al., 2011).
Similarly, Britton, Britton, and Gron-
waldt (2006) found that mothers who were
breastfeeding at 3 months reported that they
felt they were more sensitive to their childs
needs than women who were not currently
424 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:46 Page 425
breastfeeding. The ndings of the previous
two studies should be interpreted with cau-
tion, however, because maternal behavior
was not rated by objective observers. In fact,
Britton, Britton, and Gronwaldt (2006)
found women who intended to breastfeed
in pregnancy also reported higher sensitivity
toward their infants at 3 months, suggesting
that women who choose to breastfeed may
just be more sensitive (or report being more
sensitive) from the outset. In fact, other
studies suggest that the quality of the mater-
nalinfant bond predicts a mothers willing-
ness to breastfeed. A study found that better
bonding behavior 48 hours after birth pre-
dicted higher rates of exclusive breastfeeding
at 6 months in a sample of more than 500
women (Cernadas, Noceda, Barrera, Marti-
nez, & Garsd, 2003).
At this early stage of the research, it is
too soon to tell whether breastfeeding
increases bonding between mothers and
infants as compared to other forms of feed-
ing. This topic deserves additional research
attention with prospective or experimental
designs and objective measures of bonding,
especially given that many women worry
that not breastfeeding will interfere with
their ability to bond with their babies.
One important observation in the largest
of the studies noted (Else-Quest et al.,
2003) was that women who had never
breastfed at all exhibited maternal sensitivity
well within the normal range dened by
clinicians. Oxytocin could still facilitate
maternal bonding for mothers who do not
breastfeed. For example, direct skin-to-skin
contact with the infant and affectionate
touch likely increases maternal oxytocin
levels (Uvnas-Moberg, 1998). These alter-
native mechanisms may be partly responsible
for bonding in mothers of adopted infants,
fathers, and other caretakers.
POTENTIAL MATERNAL COSTS
OF LACTATION
Breastfeeding has many possible benets for
mothers, but it can also clash with other
goals for women, such as having a full-time
career. Some of the costs associated with
breastfeeding are probably overstated, like
sagging breasts, whereas others are likely
understated, for example, the social stigma
associated with breastfeeding in some socie-
ties. Breastfeeding can also be problematic
for women with certain physical or health
conditions. Furthermore, many women nd
breastfeeding very difcult because of work
constraints or physical pain. Here, we review
the potential physical, economic, and social
costs associated with breastfeeding for
mothers.
Physical Costs
Breastfeeding does have some physical costs
for women. Most mothers will have some
nipple discomfort during the rst 10 days of
breastfeeding (Riordan, 2005). If pain is
prolonged, a medical assessment by a lacta-
tion consultant or nurse is usually required to
identify the source of the problem. The most
common causes of severe nipple pain are
nonideal positioning of the infant at the
breast or poor suckling technique on the
part of the infant (Morland-Schultz & Hill,
2005). Both of these can usually be identied
and remedied by a trained lactation consul-
tant or nurse (Riordan, 2005). Severe nipple
pain can sometimes be a sign of a more
serious breastfeeding-related infection.
Common infections include mastitis, a usu-
ally benign infection that is easily treatable
by increasing breast milk expression and
antibiotics, and candidiasis (or thrush), a
yeast infection transferred from the babys
Breastfeeding and Maternal Mental and Physical Health 425
C17 10/25/2012 15:39:46 Page 426
mouth into the nipple that is treatable with
antifungal medications (Riordan, 2005).
Women can reduce their risk for these
and other breastfeeding-related infections
by employing good positioning and latching
techniques, and by massaging their breasts to
facilitate milk ow (Riordan, 2005).
Beyond the potential for discomfort,
breastfeeding restricts the types of medica-
tions a mother can take. A Scandinavian
study found that up to 25% of women
took some form of medication while they
were breastfeeding, and uncertainty regard-
ing the drugs safety was a major reason for
the discontinuation of breastfeeding (Math-
eson, Kristensen, & Lunde, 1990). There are
often alternative forms of a drug within the
same drug class (e.g., antibiotics, selective
serotonin reuptake inhibitors, oral contra-
ceptives) that are safe for breastfeeding
women. For example, a women who
requires medication to treat depression but
who also wants to breastfeed could talk to her
doctor about taking Paxil (paroxetine)
instead of Prozac (uoxetine) or Trilafon
(perphenazine) instead of Nardil (phenel-
zine), both of which are considered safe for
breastfed infants (Riordan, 2005). Mothers
and healthcare professionals can nd advice
about the safety of medications for breast-
feeding mothers online at LactMed (http://
toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?
LACT), the U.S. National Library of Medi-
cines drugs and breastfeeding database (U.S.
National Library of Medicine, 2001).
Nutrients to synthesize breast milk are
often mobilized from maternal stores at the
mothers expense (Dewey, 1997). To offset
these costs, the body generally has mecha-
nisms in place that help the mother rebound
from the nutritional stores used during
breastfeeding. For example, by producing
600 to 1,000 mL of breast milk per day, a
mother loses 200 mg of calcium daily (Rea,
2004); however, calcium absorption
becomes more efcient during pregnancy
and after weaning often resulting in net
calcium gains over the long term (Riordan,
2005). However, in women who are mal-
nourished or immunologically compro-
mised, the nutrients required for
breastfeeding can overwhelm the mothers
body and lead to health problems. For
example, a randomized clinical trial found
that breastfeeding among HIV-infected
women increased maternal death by three-
fold at a 2-year follow-up as compared to
formula feeding (Nduati et al., 2001). The
investigators postulated that the nutritional
demands posed by breastfeeding may be too
great for HIV-infected women. With the
exception of malnourished women or
women with HIV, the nutritional costs of
breastfeeding can usually be met by simply
increasing caloric intake of nutrient-rich
foods by 200 to 700 calories per day,
depending on the frequency of breastfeeding
(Riordan, 2005). Mothers are often advised
to take a multivitamin with 100 mg of iron,
along with a calcium and omega-3 fatty
acid supplement, to ensure proper nutrition
for the mother and breastfed infant
(Riordan, 2005).
A common reason that women give for
not breastfeeding is the belief that it will
adversely affect the appearance of the breasts
(Arora et al., 2000). Fathers also commonly
worry that breastfeeding will have these
effects, leading some men to discourage their
partners from breastfeeding (Bar-Yam &
Darby, 1997). These concerns, however,
are not supported by empirical evidence.
For example, a study of 93 women who
were seeking plastic surgery to improve the
shape of their breasts found no signicant
relationship between objective ratings of
426 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:46 Page 427
breast ptosis (drooping or sagging) and
breastfeeding initiation or duration (Rinker,
Veneracion, & Walsh, 2008). The notion
that breastfeeding makes breasts sag likely
stems from the fact that pregnancy does lead
to changes in breast tissue. This same study
found that number of pregnancies, along
with age, body mass index, larger prepreg-
nancy bra cup size, and smoking history
were positively related to breast ptosis. Sim-
ilarly, a prospective Italian study found that
mothers frequently reported that the size and
the shape of their breasts had changed after
childbirth, but these changes were not dif-
ferent as a function of infant feeding behav-
iors (Pisacane & Continisio, 2004).
Breastfeeding appears to have some clear
physical costs for mothers, although these are
usually transitory, and most can be amelio-
rated by proper breastfeeding techniques and
nutrition during breastfeeding. With the
exception of women with HIV or severely
malnourished women, there is little evi-
dence for any long-term physical costs asso-
ciated with breastfeeding.
Labor and Economic Costs
Breastfeeding can place a burden on wom-
ens time and freedom from childcare
responsibilities. A woman providing breast
milk exclusively to her child has to breast-
feed her child or express milk approximately
8 to 12 times per day during the rst 6
months of exclusive breastfeeding (U.S.
Department of Health and Human Services
Ofce on Womens Health [OWH], 2011).
Each breastfeeding or expression session
takes approximately 15 to 20 minutes,
meaning that women will spend an esti-
mated 2 to 4 hours per day breastfeeding
(OWH, 2011). Actual time spent feeding is
lessened by formula-feeding because the
infant drinks milk from a bottle more
quickly and formula is digested more slowly;
therefore, feedings can be performed faster
and less frequently. In addition, because
feeding responsibilities can be shared by
other caregivers, feeding with formula
may also give the mother more freedom.
The time commitment associated with
breastfeeding can place a burden on women
in the workplace. A breastfeeding mother
needs to allocate approximately 45 to 75
minutes per workday to express breast milk
(Mohler, 2011). In addition, breastfeeding
women need a private place to express milk,
a place to store breast milk, and the ability to
take several breaks per day. It is also possible
that women who need to make these
arrangements are perceived as less serious
about their jobs, or are stigmatized by co-
workers who are uncomfortable with breast-
feeding (Smith, Hawkinson, & Paull, 2011).
Given the burden that pumping breast milk
at work places on women, it is not surprising
that women who return to work within 12
weeks after birth wean sooner than those
who do not return to work within 12 weeks
(Callen & Pinelli, 2004).
In a cross-cultural comparison, the
United States was found to have the lowest
breastfeeding initiation rates compared to
other industrialized nations such as Canada,
Sweden, and Australia (Callen & Pinelli,
2004), a fact that may be related to American
maternity leave policies (Guendelman et al.,
2009). In the United States, the Family and
Medical Leave Act allows mothers only 12
weeks of unpaid maternity leave. Compare
this to Sweden, where parents are entitled to
approximately 16 months of paid leave after
the birth of a child (Galtry, 2003). As a result
of this, approximately one-third of Ameri-
can women return to work within 3 months
of giving birth, as compared to in Sweden,
Breastfeeding and Maternal Mental and Physical Health 427
C17 10/25/2012 15:39:46 Page 428
where only about 5% return to work within
3 months (Klerman & Leibowitz, 1999). It
should not be surprising that breastfeeding
initiation is nearly universal in Sweden (97%
of mothers), with approximately 40% of
infants still breastfeeding exclusively at 6
months (Galtry, 2003). The possible link
between breastfeeding rates and maternity
leave policies highlights the role of structural
factors in shaping infant feeding decisions,
which are normally thought to simply reect
personal choices.
Recently, the U.S. government has
taken steps that might increase rates of
breastfeeding initiation and its duration. In
2010, President Obama signed the Patient
Protection and Affordable Care Act, which
includes a provision requiring employers to
provide a place other than the bathroom and
reasonable break time for female employees
to express breast milk for the rst year after a
childs birth. Some employers are exempted,
however, because they have fewer than 60
employees or because allowing breaks
would cause an unreasonable burden for
the business.
Although breastfeeding does require
substantial time commitments for the
mother, which may reduce the time availa-
ble for work, there may be some economic
benets of breastfeeding. The increased cost
of formula as compared with breastfeeding is
between $1,000 and $4,000 per year per
baby (Mohler, 2011). Additional indirect
cost savings include the possibility that there
will be fewer medical bills related to infant
illness and fewer absences from paid work
time for doctor visits with sick infants (Moh-
ler, 2011). Because there are possible health
benets of breastfeeding, such as reduced
risk of type 2 diabetes in mothers (Stuebe
& Rich-Edwards, 2009) or reduced risk of
gastrointestinal infection in infants (Kramer
et al., 2001), breastfeeding is associated with
reductions in medical costs (Mohler, 2011).
Breastfeeding also does not require environ-
mental waste from formula production and
packaging. Furthermore, breastfeeding
women may save some time that would
otherwise be spent preparing formula and
sterilizing bottles.
Breastfeeding poses signicant burdens
on womens time and freedom during the
postpartum period. Feeding with formula
allows mothers more freedom, because
other caregivers can care for the infant
more readily. Pumping breast milk for feed-
ings when the mother is absent is also not
feasible for many women who do not have
access to adequate support. These costs,
however, may be offset to some extent by
the fact that breastfeeding is less expensive
than formula-feeding, and may lead to con-
siderable reductions in healthcare costs and
time taken from work because of child and
maternal illness over the long term. Future
research might address whether women gain
equivalent health benets from breast
pumping and breastfeeding, given that this
question has important implications for
women who are in the workforce and
need to pump regularly.
Social Costs
Breastfeeding can have some social costs for
women. For example, women often feel
embarrassed about breastfeeding in public,
although it is legal in 45 states in the United
States. A study found that low-income preg-
nant women in Missouri felt that discreetly
breastfeeding in ones home in front of
visitors was acceptable, but that it was less
acceptable to breastfeed in public, especially
if people were embarrassed by it or if the
breastfeeding was not discrete (Libbus &
428 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:46 Page 429
Kolostov, 1994). Similarly, women often
reported feeling vulnerablewhile breast-
feeding in public and expect to receive
negative attention for it (Sheeshka et al.,
2001). These feelings can lead women to
remain housebound or restrict their move-
ments during exclusive breastfeeding to
avoid the social stigma of breastfeeding in
public (Sheeshka et al., 2001).
In cultures where breastfeeding is widely
accepted, women often have more freedom
to breastfeed in public places. For example,
Dettwyler (1995b) asserts that in places such
as Mali or Nepal, women are able to breast-
feed their infants in public freely and with-
out stigmatization. Dettwyler (1995b) argues
that the sexualization of the breast in many
Western cultures accounts for much of the
taboo surrounding breastfeeding in public,
noting that in Mali and Nepal, where breast-
feeding in public is completely socially
acceptable, breasts do not have the same
sexual connotation for men or women
that they do elsewhere in the world. In
cultures where the primary function of the
breast is thought to be sexual, the sight of a
women breastfeeding is often considered
pervertedor obscene.For example,
the popular social networking website, Face-
book, ofcially banned pictures of women
breastfeeding their infants, claiming that these
photos violated their decency code by show-
ing an exposed breast (Worthman, 2009).
Women who breastfeed in cultures where
breastfeeding is taboo often face continual
pressure from friends and family to use for-
mula, have low breastfeeding condence, feel
intense stigma around breastfeeding in public,
and have very little access to breastfeeding
information outside of medical professionals
(Scott & Mostyn, 2003).
The social acceptability of breastfeeding
varies by culture and ethnicity, which has
implications for breastfeeding rates (see
Kelley, Watt, and Nazoo, 2006, for a
review). Women who immigrate to the
United States from cultures where breast-
feeding is more common have higher rates
of breastfeeding than the U.S. population.
For example, Black women who immigrate
to the United States from West Indian Coun-
tieswhere breastfeeding is the normare
more likely to intend to breastfeed exclu-
sively after birth than are African American
women (Bonuck, Freeman, & Trombley,
2005). Among Puerto Rican women, length
of residence in the continental United States
is inversely associated with breastfeeding ini-
tiation (Perez-Escamilla et al., 1998), indicat-
ing that living in a culture like the United
States where breastfeeding is less common
than in Puerto Rico can alter breastfeeding
practices.
There is also variation across cultures in
beliefs about the appropriate age to wean a
child. Women who violate their local norms
can face social stigma. Although the average
duration of breastfeeding in traditional soci-
eties is approximately 2.5 years (Dettwyler,
1995a), many women in the United States
report that they receive negative reactions
from others if they breastfeed past the rst
few months postpartum (Kendall-Tackett &
Sugarman, 1995). In a survey conducted in
the United States, the percentage of mothers
citing social stigmaas a negative aspect of
breastfeeding was strongly related to the age
of the child: 29% of women breastfeeding
past 6 months and 61% of women breast-
feeding past 24 months reported feeling
stigma as a result of breastfeeding
(Kendall-Tackett & Sugarman, 1995).
Recent research also suggests that
breastfeeding women face social stigma in
the United States regardless of where or how
long they choose to feed their infants. In a
Breastfeeding and Maternal Mental and Physical Health 429
C17 10/25/2012 15:39:46 Page 430
series of studies conducted with college
students, breastfeeding mothers were rated
as less competent and less likely to be hired
for a hypothetical job compared to mothers
who were not breastfeeding or women
without children (Smith et al., 2011). In
this research, the negative effects of breast-
feeding were comparable, in terms of the
negative perceptions evoked in the minds of
both male and female students, to a womans
decision to purposefully sexualize her breasts
(Smith et al., 2011). These results suggest
that although breastfeeding may have many
benets for the mother, mothers who choose
to breastfeed may also suffer social costs.
Moving into the private realm, mothers
may also be concerned that breastfeeding
will have negative consequences for their
social relationships. Breastfeeding is an inti-
mate experience between a mother and her
child that can sometimes lead the other
parent to feel left out. Fathers sometimes
report that breastfeeding interrupts their
ability to form a relationship with the new
infant (Bar-Yam & Darby, 1997). Even
when fathers are supportive of their partners
breastfeeding, many also admit to feelings of
jealousy at their inability to contribute dur-
ing the feeding process (Rempel & Rempel,
2011). In-depth interviews with fathers sug-
gest that these feelings can lead fathers to
postpone the forming of a relationship with
the child until after the infant is weaned or to
compensate by becoming more involved in
other aspects of caring for the infant (i.e.,
baths, diapers) (Gamble & Morse, 1993).
Presumably, the feeling of being left out
of the parenting process can also extend to
families in which two women co-parent, but
only one breastfeeds the baby.
Families can sometimes alleviate these
negative feelings in co-parents by framing
breastfeeding as a team effort, discussing with
co-parents the benets of breastfeeding for
their child, involving co-parents in breast-
feeding decisions, and having co-parents
provide instrumental support (like helping
with chores or entertaining company)
(Gamble & Morse, 1993). Additionally,
co-parents may participate in infant feeding
directly if breastfeeding mothers use a breast-
pump to express milk that can be fed to the
infant in a bottle.
Another factor that can lead partners to
have negative attitudes toward breastfeeding
is its impact on womens sexuality (Rempel
& Rempel, 2011). Breastfeeding lowers
womens estrogen levels in the early post-
partum period (Battin et al., 1985), which
can lead to decreases in sexual desire and
cause vaginal dryness for a subset of women,
making sex painful (Brown & McDaniel,
2008). For example, breastfeeding women
report more vaginal pain during intercourse
at 3 months postpartum than formula-feed-
ing women, although there was no differ-
ence at 6 months postpartum (Connolly,
Thorp, & Pahel, 2005). Another study found
that breastfeeding at 3 months (but not 6
months) was related to reduced frequency of
sex, sexual desire, and sexual satisfaction as
compared to women who were not breast-
feeding (Judicibus & McCabe, 2002). Over-
all, women perceive that breastfeeding has a
slightly negative impact on the physiological
aspects of sexuality; however, most report
that it does not greatly affect the sexual
relationship with their partner (Avery,
Duckett, & Frantzich, 2000). In one study,
the majority of women (60.3%) perceived
that the babys father thought breastfeeding
made them neither more nor less sexually
desirable than before pregnancy, while
12.7% thought it made them less sexually
attractive, and 27% thought it made them
more attractive to their partner.
430 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:47 Page 431
Although there are social costs associated
with breastfeeding for mothers, there can
also be social costs associated with not breast-
feeding (Hauck & Irurita, 2003). Because of
the widespread beliefs about the positive
effects of breastfeeding on a child, women
sometimes feel extensive social pressure to
breastfeed. Although most mothers (approx-
imately 96%; Simopoulos & Grave, 1984)
are physically capable of breastfeeding, other
barriersjust as realcan make breastfeed-
ing nearly impossible. If women do not have
access to accurate information regarding
proper breastfeeding techniques, they may
not produce enough milk to support the
needs of their infant or may develop physical
problems that make breastfeeding painful.
Furthermore, many mothers must work to
nancially support the needs of their chil-
dren and are not allowed convenient or
exible breaks to breast pump, nor are
they given the space necessary to pump
and store their breast milk.
Whatever the reasons behind the deci-
sion not to breastfeed, many women feel
that this decision will lead to the perception
that they are bad mothers(Ladd-Taylor &
Umansky, 1998). As one mother recounts,
I was feeling very guilty [for stopping
breastfeeding] and I didnt know what to
do(Hauck & Irurita, 2003, p. 70). There
have even been select reports of medical
professionals pushing the breast is best
message, regardless of the mothers circum-
stances and choices, leading some mothers to
report they are breastfeeding just to keep
the nurses happy(Bauer, 2000, p. 15).
These overt instances of pressure from health
professionals are likely extreme, rare exam-
ples. For many years, physicians, breastfeed-
ing consultants, nurses, and clinical experts
have been aware that encouraging mothers
to breastfeed by supporting them is helpful,
but that pressuring them or creating guilt for
lack of success is not (Dillaway & Douma,
2004). Nonetheless, even when healthcare
professionals are sensitive in their approach,
family, friends, and even strangers share their
advice about best practices for breastfeeding
initiation, duration, and weaning. Interviews
with new mothers have revealed that when
the expectations of others do not match the
choices of the mother, mothers can often
feel guilt (Hauck & Irurita, 2003).
Breastfeeding is associated with some
social costs. Mothers can become socially
restricted by breastfeeding because they do
not feel comfortable breastfeeding in public
places. Furthermore, breastfeeding mothers
are stigmatized and perceived as less compe-
tent than nonbreastfeeding mothers, a fact
that could have negative consequences for
women in the workplace or for women who
breastfeed for periods beyond the cultural
norm. Finally, some women nd that breast-
feeding reduces their sex drive for a time or
makes their partners feel left out of the
childcare experience. There are, however,
also social costs associated with not breast-
feeding, such as being branded a bad
motheror being made to feel guilty.
CONCLUSIONS
This chapter reviewed the scientic research
on the benets and costs associated with
breastfeeding for mothers. Many studies
point out that breastfeeding is associated
with many health benets for mothers,
including reduced risk for metabolic syn-
drome and certain reproductive cancers.
Furthermore, evidence suggests that breast-
feeding could buffer women against biolog-
ical and psychosocial stressors during the
postpartum period. Little evidence is
Breastfeeding and Maternal Mental and Physical Health 431
C17 10/25/2012 15:39:47 Page 432
available examining whether breastfeeding
reduces the risk of postpartum depression
or increases maternal bonding to the infant.
More research isneeded in each of these areas.
Although research has often focused on
the benets of breastfeeding for mothers,
there is also evidence of substantial costs
associated with breastfeeding. Mothers
must devote several hours per day to breast-
feeding if it is the sole feeding method, and
some mothers feel conned to their homes
because they are uncomfortable breastfeed-
ing in public. Breastfeeding mothers also
face signicant logistical and professional
challenges in the workplace. Finally, the
majority of women will experience some
discomfort during breastfeeding, particularly
early in the postpartum period, which can
sometimes develop into painful conditions
requiring medical attention.
More studies are needed to evaluate
these many trade-offs in the benets and
costs of breastfeeding at both the population
and individual level. Even if studies demon-
strate that the benets of breastfeeding out-
weigh the costs for women as a group,
decisions for individual mothers need to
be made based on their personal circum-
stances, which will vary in the many com-
plex and multifaceted trade-offs described in
this chapter. Because of the growing evi-
dence of the health benets of breastfeeding
for infants and their mothers, it makes sense
for social policies to attempt to reduce bar-
riers to breastfeeding. Policy makers and
healthcare professionals have made strides
in breastfeeding promotion in recent years
(Centers for Disease Control and Preven-
tion, 2011b). Educating mothers, partners,
families, and communities about the health
benets of breastfeeding, along with how to
overcome the challenges, have proven to be
particularly effective (Centers for Disease
Control and Prevention, 2011b). However,
policy makers and medical professionals
should also realize that variation in mothers
circumstancesboth personal and struc-
turalaffect whether breastfeeding is the
best choice for a particular woman and
her child.
REFERENCES
Altemus, M., Deuster, P. A., Galliven, E., Carter, C.
S., & Gold, P. W. (1995). Suppression of hypo-
thalmic-pituitary-adrenal axis responses to stress
in lactating women. Journal of Clinical Endocrinol-
ogy & Metabolism,80(10), 29542959. doi:
10.1210/jc.80.10.2954
Altemus, M., Redwine, L. S., Leong, Y. M., Frye, C.
A., Porges, S. W., & Carter, C. S. (2001).
Responses to laboratory psychosocial stress in
postpartum women. Psychosomatic Medicine,63
(5), 814821.
Altshuler, L. L., Hendrick, V., & Cohen, L. S. (2000).
An update on mood and anxiety disorders during
pregnancy and the postpartum period. Primary
Care Companion Journal of Clinical Psychiatry,2(6),
217222.
Andrieu, N., Goldgar, D. E., Easton, D. F., Rookus,
M., Brohet, R., Antoniou, A. C., . . . Chang-
Claude, J. (2006). Pregnancies, breast-feeding,
and breast cancer risk in the International
BRCA1/2 Carrier Cohort Study (IBCCS). Jour-
nal of the National Cancer Institute,98(8), 535544.
doi: 10.1093/jnci/djj132
Arora, S., McJunkin, C., Wehrer, J., & Kuhn, P.
(2000). Major factors inuencing breastfeeding
rates: Mothers perception of fathers attitude and
milk supply. Pediatrics,106(5), E67.
Avery, M. D., Duckett, L., & Frantzich, C. R. (2000).
The experience of sexuality during breastfeeding
among primiparous women. The Journal of
Midwifery & Womens Health,45(3), 227237.
doi: 10.1016/s1526-9523(00)00020-9
Baker, J. L., Gamborg, M., Heitmann, B. L., Lissner,
L., Sorensen, T. I., & Rasmussen, K. M. (2008).
Breastfeeding reduces postpartum weight reten-
tion. American Journal of Clinical Nutrition,88(6),
15431551. doi: 10.3945/ajcn.2008.26379
432 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:47 Page 433
Bar-Yam, N. B., & Darby, L. (1997). Fathers and
breastfeeding: A review of the literature. Journal
of Human Lactation,13(1), 4550. doi: 10.1177/
089033449701300116
Battin, D. A., Marrs, R. P., Fleiss, P. M., & Mishell, D.
R., Jr. (1985). Effect of suckling on serum pro-
lactin, luteinizing hormone, follicle-stimulating
hormone, and estradiol during prolonged lacta-
tion. Obstetrics and Gynecology,65(6), 785788.
Bauer, C. (2000). Pressure to breastfeed. AJN: The
American Journal of Nursing,100(11), 15.
Beck, C. T. (1992). The lived experience of postpar-
tum depression: A phenomenological study.
Nursing Research,41(3), 166170. doi: 10.1097/
00006199-199205000-00008
Bernier, M. O., Plu-Bureau, G., Bossard, N., Ayzac, L.,
& Thalabard, J. C. (2000).Breastfeeding and risk of
breast cancer: A metaanalysis of published studies.
Human Reproduction Update,6(4), 374386.
Boccia, M. L., Goursaud, A.-P. S., Bachevalier, J.,
Anderson, K. D., & Pedersen, C. A. (2007).
Peripherally administered non-peptide oxytocin
antagonist, L368,899
1
, accumulates in limbic
brain areas: A new pharmacological tool for
the study of social motivation in non-human
primates. Hormones and Behavior,52(3), 344
351. doi: 10.1016/j.yhbeh.2007.05.009
Bole-Feysot, C., Gofn, V., Edery, M., Binart, N., &
Kelly, P. A. (1998). Prolactin (PRL) and its recep-
tor: Actions, signal transduction pathways and
phenotypes observed in PRL receptor knockout
mice. Endocrine Reviews,19(3), 225268.
Bonuck, K. A., Freeman, K., & Trombley, M. (2005).
Country of origin and race/ethnicity: Impact
on breastfeeding intentions. Journal of Human
Lactation,21, 320326. doi: 10.1177/
0890334405278249
Bridges, R. S., DiBiase, R., Loundes, D. D., &
Doherty, P. C. (1985). Prolactin stimulation of
maternal behavior in female rats. Science,227
(4688), 782784.
Bridges, R. S., Rigero, B. A., Byrnes, E. M., Yang, L.,
& Walker, A. M. (2001). Central infusions of the
recombinant human prolactin receptor antago-
nist, S179D-PRL, delay the onset of maternal
behavior in steroid-primed, nulliparous female
rats. Endocrinology,142(2), 730739. doi:
10.1210/en.142.2.730
Britton, J. R., Britton, H. L., & Gronwaldt, V. (2006).
Breastfeeding, sensitivity, and attachment.
Pediatrics,118(5), e1436e1443. doi: 10.1542/
peds.2005-2916
Brown, H., & McDaniel, M. (2008). A review of the
implications and impact of pregnancy on sexual
function. Current Sexual Health Reports,5(1), 51
55. doi: 10.1007/s11930-008-0009-6
Callen, J., & Pinelli, J. (2004). Incidence and duration
of breastfeeding for term infants in Canada,
United States, Europe, and Australia: A literature
review. Birth,31(4), 285292. doi: 10.1111/j.
0730-7659. 2004.00321.x
Carter, C. S., & Altemus, M. (1997). Integrative
functions of lactational hormones in social behav-
ior and stress management. Annals of the New York
Academy of Sciences,807, 164174.
Centers for Disease Control and Prevention. (2011a).
Breastfeeding among U.S. children born 2000
2008. CDC National Immunization Survey.
Retrieved from http://www.cdc.gov/breast-
feeding/data/nis_data/
Centers for Disease Control and Prevention. (2011b).
Breastfeeding report cardUnited States, 2011.
Retrieved from http://www.cdc.gov/breast-
feeding/pdf/2011breastfeedingreportcard.pdf
Cernadas,J.M.,Noceda,G.,Barrera,L.,Martinez,
A. M., & Garsd, A. (2003). Maternal and
perinatal factors inuencing the duration of
exclusive breastfeeding during the rst 6
months of life. Journal of Human Lactation,
19(2), 136144.
Chaudron, L. H., Klein, M. H., Remington, P., Palta,
M., Allen, C., & Essex, M. J. (2001). Predictors,
prodromes and incidence of postpartum depres-
sion. Journal of Psychosomatic Obstetrics & Gynecol-
ogy,22, 103112.
Chiodera, P., Salvarani, C., Bacchi-Modena, A., Spal-
lanzani, R., Cigarini, C., Alboni, A., . . . Coiro,
V. (1991). Relationship between plasma proles
of oxytocin and adrenocorticotropic hormone
during suckling or breast stimulation in women.
Hormone Research,35(34), 119123.
Clemons, M., & Goss, P. (2001). Estrogen and the risk
of breast cancer. New England Journal of Medicine,
344(4), 276285. doi: 10.1056/NEJM
200101253440407
Connolly, A., Thorp, J., & Pahel, L. (2005). Effects
of pregnancy and childbirth on postpartum
sexual function: A longitudinal prospective
study. International Urogynecology Journal,16(4),
263267. doi: 10.1007/s00192-005-1293-6
Breastfeeding and Maternal Mental and Physical Health 433
C17 10/25/2012 15:39:47 Page 434
Dai, X., & Dennis, C. L. (2003). Translation and
validation of the Breastfeeding Self-Efcacy Scale
into Chinese. Journal of Midwifery and Womens
Health,48(5), 350356.
Danforth, K. N., Tworoger, S. S., Hecht, J. L.,
Rosner, B. A., Colditz, G. A., & Hankinson,
S. E. (2007). Breastfeeding and risk of ovarian
cancer in two prospective cohorts. Cancer Causes
Control,18(5), 517523. doi: 10.1007/s10552-
007-0130-2
Dennis, C. L., & McQueen, K. (2007). Does maternal
postpartum depressive symptomatology inu-
ence infant feeding outcomes? Acta Paediatrica,
96(4), 590594. doi: 10.1111/j.1651-2227.
2007.00184.x
Dennis, C. L., & McQueen, K. (2009). The relation-
ship between infant-feeding outcomes and post-
partum depression: A qualitative systematic
review. Pediatrics,123(4), e736e751. doi:
10.1542/peds.2008-1629
Dettwyler, K. A. (1995a). A time to wean: The
hominid blueprint for the natural age of weaning
in modern human populations. In P. Stuart-
Macadam& K. A. Dettwyler (Eds.), Breastfeeding:
Biocultural perspectives (pp. 3973). New York,
NY: Aldinde Gruyter.
Dettwyler, K. A. (1995b). Beauty and the breast: The
cultural context of feeding in the United States.
In P. Stuart-Macadam& K. A. Dettwyler (Eds.),
Breastfeeding: Biocultural perspectives (pp. 167215).
New York, NY: Aldine deGruyter.
Dewey, K. G. (1997). Energy and protein require-
ments during lactation. Annual Review of Nutri-
tion,17,1936. doi: 10.1146/annurev.
nutr.17.1.19
Dillaway, H. E., & Douma, M. E. (2004). Are pediat-
ric ofces supportiveof breastfeeding?
Discrepancies of mothersand healthcare provid-
ersreports. Clinical Pediatrics,43(5), 417430.
doi: 10.1177/000992280404300502
Edhborg, M., Friberg, M., Lundh, W., & Widstrom,
A. M. (2005). Struggling with life: Narratives
from women with signs of postpartum depres-
sion. Scandinavian Journal of Public Health,33(4),
261267. doi: 10.1080/14034940510005725
Else-Quest, N. M., Hyde, J. S., & Clark, R. (2003).
Breastfeeding, bonding and the mother-infant
relationship. Merrill-Palmer Quarterly,49, 495517.
Feldman, R., Gordon, I., Schneiderman, I., Weisman,
O., & Zagoory-Sharon, O. (2010). Natural
variations in maternal and paternal care are
associated with systematic changes in oxytocin
following parent-infant contact. Psychoneuroen-
docrinology,35(8), 11331141. doi: 10.1016/
j.psyneuen.2010.01.013
Fergerson, S. S., Jamieson, D. J., & Lindsay, M. (2002).
Diagnosing postpartum depression: Can we do
better? American Journal of Obstetrics and Gynecol-
ogy,186(5), 899902.
Field, T. (2010). Postpartum depression effects on
early interactions, parenting, and safety practices:
A review. Infant Behavior and Development,33(1),
16. doi: 10.1016/j.infbeh.2009.10.005
Feldman, R., Weller, A., Zagoory-Sharon, O., &
Levine, A. (2007). Evidence for a neuro-
endocrinological foundation of human aflia-
tion: Plasma oxytocin levels across pregnancy
and the postpartum period predict mother-infant
bonding. Psychological Science,18, 965970.
Fleming, A. S., Ruble, D. N., Flett, G. L., & Van
Wagner, V. (1990). Adjustment in rst-time
mothers: Changes in mood and mood content
during the early postpartum months. Develop-
mental Psychology,26(1), 137143. doi: 10.1037/
0012-1649. 26.1.137
Ford, E. S., Giles, W. H., & Dietz, W. H. (2002).
Prevalence of the metabolic syndrome among
US adults: Findings from the third National
Health and Nutrition Examination Survey.
JAMA,287(3), 356359.
Freeman, M. E., Kanyicska, B., Lerant, A., & Nagy, G.
(2000). Prolactin: Structure, function, and regu-
lation of secretion. Physiological Reviews,80(4),
15231631.
Galler, J. R., Harrison, R. H., Biggs, M. A., Ramsey,
F., & Forde, V. (1999). Maternal moods predict
breastfeeding in Barbados. Journal of Developmental
and Behavioral Pediatrics,20(2), 8087.
Galtry, J. (2003). The impact on breastfeeding of
labour market policy and practice in Ireland,
Sweden, and the USA. Social Science & Medicine,
57(1), 167177. doi: 10.1016/s0277-9536(02)
00372-6
Gamble, D., & Morse, J. M. (1993). Fathers of
breastfed infants: Postponing and types of
involvement. Journal of Obstetric, Gynecologic, &
Neonatal Nursing,22(4), 358369. doi: 10.1111/
j. 1552-6909.1993.tb01816.x
Garza, R., & Ramussen, K.M. (2000). Pregnancy and
lactation. In J. S. Garrow, W. P. T. James, & A.
434 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:47 Page 435
Ralph (Eds.), Human nutrition and dietetics (10th
ed., pp. 437448). Edinburgh, Scotland:
Churchill-Livingstone.
Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-
Brody, S., Gartlehner, G., & Swinson, T. (2005).
Perinatal depression: A systematic review of
prevalence and incidence. Obstetrics and Gynecol-
ogy,106(5, Pt. 1), 10711083. doi: 10.1097/01.
AOG.0000183597.31630.db
Gaynes, B. N., Gavin, N., Meltzer-Brody, S., Lohr, K.
N., Swinson, T., Gartlehner, G., . . . Miller, W.
C. (2005). Perinatal depression: Prevalence,
screening accuracy, and screening outcomes.
Evidence ReportTechnology Assessment (Sum-
mary),119,18.
Gimpl, G., & Fahrenholz, F. (2001). The oxytocin
receptor system: Structure, function, and regula-
tion. Physiological reviews,81(2), 629683.
Gjerdingen, D. K., Froberg, D. G., Chaloner, K.
M., & McGovern, P. M. (1993). Changes in
womens physical health during the rst post-
partum year. Archives of Family Medicine,2(3),
277283.
Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The
effect of postpartum depression on child cogni-
tive development and behavior: A review and
critical analysis of the literature. Archives of Wom-
ens Mental Health,6(4), 263274. doi:
10.1007/s00737-003-0024-6
Groer, M. W., Davis, M. W., & Hemphill, J. (2002).
Postpartum stress: Current concepts and the pos-
sible protective role of breastfeeding. Journal of
Obstetric,Gynecologic, & Neonatal Nursing,31(4), 411
417. doi: 10.1111/j.1552-6909.2002.tb00063.x
Gruis, M. (1977). Beyond maternity: Postpartum
concerns of mothers. American Journal of Maternal
Child Nursing,2, 182188.
Guendelman, S., Kosa, J. L., Pearl, M., Graham, S.,
Goodman, J., & Kharrazi, M. (2009). Juggling
work and breastfeeding: Effects of maternity
leave and occupational characteristics. Pediatrics,
123(1), e38e46. doi: 10.1542/peds.2008-2244
Hahn-Holbrook, J., Holbrook, C., & Haselton, M. G.
(2011). Parental precaution: Neurobiological
means and adaptive ends. Neuroscience & Biobe-
havioral Reviews,35(4), 10521066. doi:
10.1016/j.neubiorev.2010.09.015
Hammen, C. (2005). Stress and depression. Annual
Review of Clinical Psychology,1(1), 293319. doi:
10.1146/annurev.clinpsy.1.102803.143938
Hannah, P., Adams, D., Lee, A., Glover, V., &
Sandler, M. (1992). Links between early post-
partum mood and post-natal depression. The
British Journal of Psychiatry,160(6), 777780.
doi: 10.1192/bjp.160.6.777
Hauck, Y., & Irurita, V. (2003). Incompatible expect-
ations: The dilemma of breastfeeding mothers.
Health Care for Women International,24(1), 6278.
doi: 10.1080/07399330390170024
Heck, H., & de Castro, J. M. (1993). The caloric
demand of lactation does not alter spontaneous
meal patterns, nutrient intakes, or moods of
women. Physiology & Behavior,54(4), 641648.
doi: 10.1016/0031-9384(93)90071-m
Heinrichs, M., Meinlschmidt, G., Neumann, I., Wag-
ner, S., Kirschbaum, C., Ehlert, U., & Hellham-
mer, D. H. (2001). Effects of suckling on
hypothalamic-pituitary-adrenal axis responses
to psychosocial stress in postpartum lactating
women. Journal of Clinical Endocrinology and
Metabolism,86(10), 47984804.
Herzog, A., & Detre, T. (1976). Psychotic reactions
associated with childbirth. Diseases of the Nervous
System,37(4), 229235.
Hrdy, S. B. (1992). Fitness tradeoffs in the history and
evolution of delegated mothering with special
reference to wet-nursing, abandonment, and
infanticide. Ethology and Sociobiology,13(56),
409442. doi: 10.1016/0162-3095(92)90011-r
Hrdy, S. B. (1999). Mother nature: A history of mothers,
infants, and natural selection. New York, NY:
Pantheon Books.
Ip, S., Chung, M., Raman, G., Chew, P., Magula, N.,
DeVine, D., . . . Lau, J. (2007). Breastfeeding
and maternal and infant health outcomes in
developed countries. Evidence ReportTechnology
Assessment (Full Report),153,1186.
Jansen, J., Weerth, C. d., & Riksen-Walraven, J. M.
(2008). Breastfeeding and the mother-infant rela-
tionshipA review. Developmental Review,28(4),
503521. doi: 10.1016/j.dr.2008.07.001
Jernstrom, H., Lubinski, J., Lynch, H. T., Ghadirian,
P., Neuhausen, S., Isaacs, C., . . . Narod, S. A.
(2004). Breast-feeding and the risk of breast
cancer in BRCA1 and BRCA2 mutation carriers.
Journal of the National Cancer Institute,96(14),
10941098. doi: 10.1093/jnci/djh211
Jones, N. A., McFall, B. A., & Diego, M. A. (2004).
Patterns of brain electrical activity in infants of
depressed mothers who breastfeed and bottle
Breastfeeding and Maternal Mental and Physical Health 435
C17 10/25/2012 15:39:47 Page 436
feed: The mediating role of infant temperament.
Biological Psychology,67(12), 103124. doi:
10.1016/j.biopsycho.2004.03.010
Jordan, S. J., Siskind, V., Green, C. A., Whiteman, D.
C., & Webb, P. M. (2010). Breastfeeding and risk
of epithelial ovarian cancer. Cancer Causes
Control,21(1), 109116. doi: 10.1007/s10552-
009-9440-x
Judicibus, M. A. D., & McCabe, M. P. (2002).
Psychological factors and the sexuality of preg-
nant and postpartum women. The Journal of Sex
Research,39(2), 94103.
Kelley, Y. J., Watt, R. G., & Nazoo, J. Y. (2011).
Racial/ethnic differences in breastfeeding initia-
tion and continuation in the United Kingdom
and comparison with ndings in the United
States. Pediatrics,118, 14281435. doi: 10.1542/
peds.2006-0714\
Kendall-Tackett, K. A., & Sugarman, M. (1995). The
social consequences of long-term breastfeeding.
The Journal of Human Lactation,11, 179183. doi:
10.1177/089033449501100316
Kendrick, K. M. (2000). Oxytocin, motherhood and
bonding. Experimental Physiology,85(Spec),
111S124S.
Key, T. J., & Pike, M. C. (1988). The role of
oestrogens and progestagens in the epidemiology
and prevention of breast cancer. European Journal
of Cancer and Clinical Oncology,24(1), 2943.
King, M. C., Marks, J. H., & Mandell, J. B. (2003).
Breast and ovarian cancer risks due to inherited
mutations in BRCA1 and BRCA2. Science,
302(5645), 643646. doi: 10.1126/science.
1088759
Klerman, J. A., & Leibowitz, A. (1999). Job continuity
among new mothers.Demography,36(2), 145155.
Kramer, M. S., Aboud, F., Mironova, E., Vanilovich,
I., Platt, R. W., Matush, L., . . . For The Pro-
motion of Breastfeeding Intervention Trial Study
Group. (2008). Breastfeeding and child cognitive
development: New evidence from a large ran-
domized trial. Archives of General Psychiatry,65(5),
578584. doi: 10.1001/archpsyc.65.5.578
Kramer, M. S., Chalmers, B., Hodnett, E. D., Sev-
kovskaya, Z., Dzikovich, I., Shapiro, S., . . . For
The Promotion of Breastfeeding Intervention
Trial Study Group. (2001). Promotion of Breast-
feeding Intervention Trial (PROBIT): A ran-
domized trial in the Republic of Belarus. JAMA,
285(4), 413420. doi: 10.1001/jama.285.4.413
Kramer, M. S., & Kakuma, R. (2004). The optimal
duration of exclusive breastfeeding: A systematic
review. Advances in Experimental Medicine and
Biology,554,6377.
Labbok, M., & Krasovec, K. (1990). Toward consis-
tancy in breastfeeding denitions. Studies in Fam-
ily Planning,21, 226230.
Ladd-Taylor, M., & Umansky, L. (1998). Bad
mothers: The politics of blame in twentieth-century
America. New York, NY: New York University
Press.
Lee, E., Ma, H., McKean-Cowdin, R., Van Den
Berg, D., Bernstein, L., Henderson, B. E., &
Ursin, G. (2008). Effect of reproductive factors
and oral contraceptives on breast cancer risk in
BRCA1/2 mutation carriers and noncarriers:
Results from a population-based study. Cancer
Epidemiology Biomarkers & Prevention,17(11),
31703178. doi: 10.1158/1055-9965. epi-08-
0396
Libbus, M. K., & Kolostov, L. S. (1994). Perceptions
of breastfeeding and infant feeding choice in a
group of low-income mid-Missouri women.
Journal of Human Lactation,10(1), 1723. doi:
10.1177/089033449401000123
Light, K. C., Smith, T. E., Johns, J. M., Brownley, K.
A., Hofheimer, J. A., & Amico, J. A. (2000).
Oxytocin responsivity in mothers of infants: A
preliminary study of relationships with blood
pressure during laboratory stress and normal
ambulatory activity. Health Psychology,19(6),
560567.
Lonstein, J. S. (2007). Regulation of anxiety during
the postpartum period. Frontiers in Neuro-
endocrinology,28(23), 115141. doi: 10.1016/j.
yfrne.2007.05.002
Lunn, P., Austin, S., Prentice, A., & Whitehead, R.
(1984). The effect of improved nutrition on
plasma prolactin concentrations and postpartum
infertility in lactating Gambian women. The
American Journal of Clinical Nutrition,39(2),
227235.
Martone, D. J., & Nash, B. R. (1988). Initial differ-
ences in postpartum attachment behavior in
breastfeeding and bottle-feeding mothers. Journal
of Obstetric, Gynecologic, & Neonatal Nursing,17(3),
212213. doi: 10.1111/j.1552-6909.1988.
tb00427.x
Matheson, I., Kristensen, K., & Lunde, P. K. (1990).
Drug utilization in breast-feeding women. A
436 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:48 Page 437
survey in Oslo. European Journal of Clinical Phar-
macology,38(5), 453459.
McNeilly, A. S., Robinson, I. C., Houston, M. J., &
Howie, P. W. (1983). Release of oxytocin and
prolactin in response to suckling. British Medicine
Journal (Clinical Research Ed.),286(6361), 257
259.
Mercer, R. T. (1986). First-time motherhood. New
York, NY: Springer.
Mezzacappa, E. S. (2004). Breastfeeding and maternal
stress response and health. Nutrition Reviews,62(7,
Pt. 1), 261268.
Mezzacappa, E. S., Guethlein, W., & Katkin, E. S.
(2002). Breast-feeding and maternal health in
online mothers. Annals of Behavioral Medicine,
24(4), 299309.
Mezzacappa, E. S., Guethlein, W., Vaz, N., &
Bagiella, E. (2000). A preliminary study of
breast-feeding and maternal symptomatology.
Annals of Behavioral Medicine,22(1), 7179.
Mezzacappa, E. S., & Katlin, E. S. (2002). Breast-
feeding is associated with reduced perceived stress
and negative mood in mothers. Health Psychology,
21(2), 187193.
Mezzacappa, E. S., Kelsey, R. M., & Katkin, E. S.
(2005). Breast feeding, bottle feeding, and mater-
nal autonomic responses to stress. Journal of
Psychosomatic Research,58(4), 351365. doi:
10.1016/j.jpsychores.2004.11.004
Mohler, B. (2011). Is the breast best for business? The
implications of the breastfeeding promotion act.
William and Mary Business Law Review,2(1), 155
184.
Morland-Schultz, K., & Hill, P. D. (2005). Prevention
of and therapies for nipple pain: A systematic
review. Journal of Obstetric, Gynecologic, and
Neonatal Nursing,34(4), 428437. doi: 10.1177/
0884217505276056
Nagle, C. M., Bain, C. J., Green, A. C., & Webb, P.
M. (2008). The inuence of reproductive and
hormonal factors on ovarian cancer survival.
International Journal of Gynecological Cancer,18
(3), 407413. doi: 10.1111/j.1525-1438
.2007.01031.x
Negishi, H., Kishida, T., Yamada, H., Hirayama, E.,
Mikuni, M., & Fujimoto, S. (1999). Changes in
uterine size after vaginal delivery and cesarean
section determined by vaginal sonography in the
puerperium. Archives of Gynecology and Obstetrics,
263,1316.
Nduati, R., Richardson, B. A., John, G., Mbori-
Ngacha, D., Mwatha, A., Ndinya-Achola, J.,
( &S Kreiss, J. (2001). Effect of breastfeeding
on mortality among HIV-1 infected women:
A randomised trial. Lancet,357(9269), 1651
1655. doi: 10.1016/S0140-6736(00)04820-0
Neumann, I. D. (2001). Alterations in behavioral and
neuroendocrine stress coping strategies in preg-
nant, parturient and lactating rats. Progress in Brain
Research,133, 143152.
Neumann, I. D., Torner, L., & Wigger, A. (2000).
Brain oxytocin: Differential inhibition of neuro-
endocrine stress responses and anxiety-related
behaviour in virgin, pregnant and lactating rats.
Neuroscience,95(2), 567575.
Nishioka, E., Haruna, M., Ota, E., Matsuzaki, M.,
Murayama, R., Yoshimura, K., & Murashima, S.
(2011). A prospective study of the relationship
between breastfeeding and postpartum depres-
sive symptoms appearing at 15 months after
delivery. Journal of Affective Disorders,133(3),
553559. doi: 10.1016/j.jad.2011.04.027
Nissen, E., Gustavsson, P., Widstrom, A. M., &
Uvnas-Moberg, K. (1998). Oxytocin, prolactin,
milk production and their relationship with per-
sonality traits in women after vaginal delivery or
Cesarean section. Journal of Psychosomatic Obstetrics
and Gynecology,19(1), 4958.
OHara, M. W., & Swain, A. M. (1996). Rates and risk
of postpartum depressionA meta-analysis.
International Review of Psychiatry,8(1), 3754.
doi: 10.3109/09540269609037816
Pedersen, C. A. (2004). Biological aspects of social
bonding and the roots of human violence. Annals
of the New York Academy of Sciences,1036(1), 106
127. doi: 10.1196/annals.1330.006
Pedersen, C. A., Caldwell, J. D., Peterson, G., Walker,
C. H., & Mason, G. A. (1992). Oxytocin activa-
tion of maternal behavior in the rat. Annals of the
New York Academy of Sciences,652(1), 5869. doi:
10.1111/j.1749-6632.1992.tb34346.x
Perez-Escamilla, R., Himmelgreen, D., Segura-
Millan, S., Gonz
alez, A., Ferris, A. M., Damio,
G., & Bermudez-Vega, A. (1998). Prenatal and
perinatal factors associated with breast-feeding
initiation among inner-city Puerto-Rican
women. Journal of the American Dietetic Association,
98, 657663.
Peterson, A. E., Perez-Escamilla, R., Labbok, M.
H., Hight, V., von Hertzen, H., & Van Look,
Breastfeeding and Maternal Mental and Physical Health 437
C17 10/25/2012 15:39:48 Page 438
P. (2000). Multicenter study of the lactational
amenorrhea method (LAM) III: Effectiveness,
duration, and satisfaction with reduced client-
provider contact. Contraception,62(5), 221230.
Pisacane, A., & Continisio, P. (2004). Breastfeeding
and perceived changes in the appearance of the
breasts: A retrospective study. Acta Paediatrica,
93(10), 13461348.
Pitt, B. (1973). Maternity blues. British Journal of
Psychiatry,122(569), 431433.
Ram, K. T., Bobby, P., Hailpern, S. M., Lo, J. C.,
Schocken, M., Skurnick, J., & Santoro, N.
(2008). Duration of lactation is associated with
lower prevalence of the metabolic syndrome in
midlife: SWAN, the Study of Womens Health
Across the Nation. American Journal of Obstetrics
and Gynecology,198(3), 268 e261e266. doi:
10.1016/j.ajog.2007.11.044
Rea, M. F. (2004). Benets of breastfeeding and
womens health. Journal of Pediatrics (Rio J),80
(5 Suppl), S142S146.
Rempel, L. A., & Rempel, J. K. (2011). The breast-
feeding team: The role of involved fathers in the
breastfeeding family. Journal of Human Lactation,27
(2), 115121. doi: 10.1177/0890334410390045
Rinker, B., Veneracion, M., & Walsh, C. P. (2008).
The effect of breastfeeding on breast aesthetics.
Aesthetic Surgery Journal,28(5), 534537. doi:
10.1016/j.asj.2008.07.004
Riordan, J. (2005). Breastfeeding and human lactation (3rd
ed.). Sudbury, MA: Jones & Bartlett.
Scott, J. A., & Mostyn, T. (2003). Womens experi-
ences of breastfeeding in a bottle-feeding culture.
Journal of Human Lactation,19, 270277.
Schwarz, E. B., Ray, R. M., Stuebe, A. M., Allison,
M. A., Ness, R. B., Freiberg, M. S., & Cauley, J.
A. (2009). Duration of lactation and risk factors
for maternal cardiovascular disease. Obstetrics and
Gynecology,113(5), 974982. doi: 10.1097/01.
AOG.0000346884.67796.ca
Seimyr, L., Edhborg, M., Lundh, W., & Sjogren, B.
(2004). In the shadow of maternal depressed
mood: Experiences of parenthood during the
rst year after childbirth. Journal of Psychosomatic
Obstetrics & Gynecology,25(1), 2334. doi:
10.1080/01674820410001737414
Sheeshka, J., Potter, B., Norrie, E., Valaitis, R.,
Adams, G., & Kuczynski, L. (2001). Womens
experiences breastfeeding in public places. Journal
of Human Lactation,17(1), 3138.
Shoham, A. (1994). Epidemiology, etiology, and fer-
tility drugs in ovarian epithelial carcinoma:
Where are we today? Fertility and Sterility,62,
433438.
Simopoulos, A. P., & Grave, G. D. (1984).
Factors associated with the choice and duration
of infant-feeding practice. Pediatrics,74(4),
603614.
Skrundz, M., Bolten, M., Nast, I., Hellhammer, D.
H., & Meinlschmidt, G. (2011). Plasma oxytocin
concentration during pregnancy is associated
with development of postpartum depression.
Neuropsychopharmacology,36(9), 18861893. doi:
10.1038/npp.2011.74
Smith, J. L., Hawkinson, K., & Paull, K. (2011).
Spoiled milk: An experimental examination of
bias against mothers who breastfeed. Personality
and Social Psychology Bulletin,37(7), 867878. doi:
10.1177/0146167211401629
Stuebe, A. M., Michels, K. B., Willett, W. C., Man-
son, J. E., Rexrode, K., & Rich-Edwards, J. W.
(2009). Duration of lactation and incidence of
myocardial infarction in middle to late adult-
hood. American Journal of Obstetrics and Gynecology,
200(2), 138.e131138.e138. doi: 10.1016/
j.ajog.2008.10.001
Stuebe, A. M., & Rich-Edwards, J. W. (2009). The
reset hypothesis: Lactation and maternal metab-
olism. American Journal of Perinatology,26(1), 81
88. doi: 10.1055/s-0028-1103034
Stuebe, A. M., Rich-Edwards, J. W., Willett, W. C.,
Manson, J. E.,& Michels, K. B. (2005).Duration of
lactation and incidence of type 2 diabetes. JAMA:
The Journal of the American Medical Association,294
(20), 26012610. doi: 10.1001/jama.294.20.2601
Tamminen, T. (1988). The impact of mothers depres-
sion on her nursing experiences and attitudes
during breastfeeding. Acta Pædiatrica,77,87
94. doi: 10.1111/j.1651-2227.1988.tb10864.x
Taveras, E. M., Capra, A. M., Braveman, P. A.,
Jensvold, N. G., Escobar, G. J., & Lieu, T. A.
(2003). Clinician support and psychosocial risk
factors associated with breastfeeding dis-
continuation. Pediatrics, 112(1, Pt. 1), 108115.
U.S. Department of Healthand Human Services, Ofce
on Womens Health (OWH). (2011). Your guide to
breastfeeding. Washington, DC: Author.
U.S. National Library of Medicine. (2001). LactMed.
Retrieved from http://toxnet.nlm.nih.gov/
cgi-bin/sis/htmlgen?LACT
438 REPRODUCTIVE HEALTH
C17 10/25/2012 15:39:48 Page 439
Uvnas-Moberg, K. (1998). Oxytocin may mediate the
benets of positive social interaction and emo-
tions. Psychoneuroendocrinology,23(8), 819835.
doi: 10.1016/s0306-4530(98)00056-0
Uvnas-Moberg, K., Widstrom, A. M., Werner, S.,
Matthiesen, A. S., & Winberg, J. (1990). Oxy-
tocin and prolactin levels in breast-feeding
women: Correlation with milk yield and dura-
tion of breast-feeding. Acta Obstetricia et Gyneco-
logica Scandinavia,69(4), 301306.
Valdes, V., Labbok, M. H., Pugin, E., & Perez, A.
(2000). The efcacy of the lactational amenor-
rhea method (LAM) among working women.
Contraception,62(5), 217219.
van Leengoed, E., Kerker, E., & Swanson, H. H.
(1987). Inhibitionof post-partum maternal behav-
iour in the rat by injecting an oxytocin antagonist
into the cerebral ventricles. Journal of Endocrinology,
112(2), 275282. doi: 10.1677/joe.0.1120275
White-Traut, R., Watanabe, K., Pournaja-
Nazarloo, H., Schwertz, D., Bell, A., & Carter,
C. S. (2009). Detection of salivary oxytocin
levels in lactating women. Developmental Psy-
chobiology,51(4), 367373. doi: 10.1002/dev
.20376
Windle, R. J., Shanks, N., Lightman, S. L., & Ingram,
C. D. (1997). Central oxytocin administration
reduces stress-induced corticosterone release and
anxiety behavior in rats. Endocrinology,138(7),
28292834.
World Health Organization. (2009). Infant and young
child feeding: Model chapter for textbooks for medical
students and allied heath professionals. Washington,
DC: Author.
Worthman, J. (2009, January 2). Facebook wont
budge on breastfeeding photos. New York Times.
Retrieved from http://bits.blogs.nytimes.com/
2009/01/02/breastfeeding-facebook-photos/
Yalom, I. D., Lunde, D. T., Moos, R. H., & Ham-
burg, D. A. (1968). Postpartum bluessyn-
drome: A description and related variables.
Archives of General Psychiatry,18(1), 1627.
Breastfeeding and Maternal Mental and Physical Health 439
  • ... Pemberian Air Susu Ibu (ASI) dianggap sebagai strategi yang praktis dan berkelanjutan dalam meningkatkan kesehatan ibu dan anak dan konsekuensinya mendukung pembangunan kesehatan, sosial, dan ekonomi. Telah dilaporkan bahwa pemberian ASI memiliki manfaat kesehatan bagi bayi dan juga ibu (Hahn-Holbrook, Schetter, & Haselton, 2013;Victora et al., 2016). Studi yang didukung UNICEF menemukan bahwa di Indonesia, praktik pemberian ASI yang optimal secara nasional dapat menghemat sekitar Rp 3 triliun untuk belanja kesehatan dan menghemat Rp 17 triliun untuk upah karena adanya perbaikan dalam kemampuan kognitif dan peningkatan pendapatan di kemudian hari (Walters et al., 2016). ...
    Article
    Full-text available
    Pemberian Air Susu Ibu (ASI) diketahui memberikan dampak positif pada kesehatan ibu dan anak sehingga dapat menunjang pembangunan dalam hal menciptakan sumber daya manusia yang sehat dan berkualitas tinggi. Namun, cakupan pemberian ASI di Indonesia belum sesuai target. Dukungan sosial yang diperoleh ibu dalam upayanya untuk menyusui adalah salah satu faktor yang mempengaruhi keberhasilan pemberian ASI. Seiring kemajuan teknologi informasi dan komunikasi, dukungan sosial tidak hanya didapat dari lingkungan sekitar, tetapi bisa diperoleh online melalui media sosial, seperti Facebook. Penelitian ini bertujuan untuk menganalisis pengaruh penggunaan Facebook dan dukungan sosial online dengan perilaku pemberian ASI. Penelitian menggunakan pendekatan kuantitatif dengan metode purposive sampling, yaitu pada anggota group Facebook Asosiasi Ibu Menyusui Indonesia. Metode analisis data menggunakan path analysis atau Analisis Jalur. Hasil penelitian menunjukkan bahwa terdapat pengaruh tidak langsung positif dari penggunaan Facebook terhadap perilaku pemberian ASI yang dimediasi oleh variabel dukungan sosial online, sedangkan karakteristik ibu dan dukungan lingkungan tidak berpengaruh pada penggunaan Facebook maupun dukungan sosial online. Dengan demikian, dapat disimpulkan bahwa penggunaan Facebook bagi ibu menyusui yang efektif untuk meningkatkan kepatuhan perilaku pemberian ASI adalah jika Facebook digunakan untuk memperoleh dukungan sosial online.
  • Article
    Full-text available
    Background Bonding refers to emotions and cognitions towards one’s infant. Breastfeeding is believed to facilitate bonding, yet only a handful of studies have empirically tested this assertion. This study aimed to confirm whether a positive association between breastfeeding and bonding exists and whether breastfeeding may be protective against the negative consequences of mood and sleep disturbances on bonding. Method A cross-sectional survey was administered to a convenience sample of Israeli mothers of infants ages 1–9 months. The main outcome measures were breastfeeding history, bonding (Postpartum Bonding Questionnaire, PBQ), mood (Edinburgh Postnatal Depression Scale, EPDS) and sleep (Pittsburgh Sleep Quality Index, PSQI). Results Two hundred seventy-one mothers (21–46 years) completed the survey. 65.7% reported current breastfeeding, 22.1% past breastfeeding, 12.2% never nursed. The PBQ correlated with both the EPDS and PSQI. Breastfeeding was associated with greater daytime fatigue, but not with any other sleep problem, and was not associated with bonding. This negative result was confirmed with Bayesian analysis demonstrating that the probability for the null hypothesis was 4.5 times greater than the hypothesized effect. Further, hierarchical regression revealed a positive relationship between bonding, daytime fatigue and depression symptoms only among women who were currently breastfeeding. Conclusions These findings suggest that among healthy mothers, breastfeeding may not be a central factor in mother-infant bonding, nor is it protective against the negative impact of mood symptoms and bonding difficulties. Theoretical and methodological bases of these findings are discussed. Electronic supplementary material The online version of this article (10.1186/s12884-019-2264-0) contains supplementary material, which is available to authorized users.
  • Conference Paper
    Full-text available
    Nutrition is still a health problem that needs attention in Indonesia. Based on the data of Basic Health Research (Riskesdas) (2010), the 12.2 % prevalence of toddlers’ obesity in 2007 increased to 14.0 % in 2010; whereas, in national scale, the 18.4 % prevalence of malnutrition in 2007 increased to 19.6% in 2013 (Riskesdas, 2013). Recent nutrition management programs have not shown maximum improvement. One of the programs to improve the nutritional status in the community is Posyandu, Pos Pelayanan Terpadu (United Service Post). In order to optimize the role of Posyandu, cadre leadership is needed. The purpose of this study is to analyz e how effective the transformation of Posyandu cadre leadership is in the effort to improve nutritional status. This study used a qualitative research method with snowball sampling technique. A head of Posyandu cadre became the main informant in this study; in addition, a Public Health Center (Public Health Center) nutritional officer and a mother who had a toddler during the head’s leadership period became the triangulation informants. The Data collection of this study used in-depth interviews. The result of the research indicates that the head of cadre had too much burden in her job; she assumed that her cadres cannot do the given tasks, while the cadres said that she did not give clear instruction and she always took over the tasks by herself. In conclusion, the leadership transformation did not go well because the head of cadre did not delegate tasks optimally to her cadres.
  • Article
    Self-reports of mothers currently breast-feeding (n = 561) and mothers who had breast-fed in the past (n = 452) were compared for perceived stress, self-reports of upper respiratory infection symptoms, and physician visits for psychological illnesses. Possible demographic confounds were controlled statistically. In analyses examining breast-feeding status as a dichotomous variable (current vs. past), breast-feeding was negatively associated with perceived stress and upper respiratory symptoms (the latter association dissolved when controlling for perceived stress), but not with physician visits for psychological illnesses. However, analyses of the continuous variables of frequency of breast-feeding and cumulative amount of breast-feeding revealed negative associations, and analyses of times since last nursing revealed positive associations with likelihood for physician visits for psychological illnesses. Frequency of bottle-feeding was positively associated with perceived stress. The results support the interrelatedness of breast-feeding and maternal health in online mothers.
  • Article
    This study examined the influence of role quality, relationship satisfaction, fatigue, and depression oil women's: sexuality during pregnancy and after childbirth. Questionnaire data were obtained from 138 women pregnant with their first child, of whom 104 responded at 12 weeks postpartum, and 70 responded at 6 months postpartum. women reported sign flcant reductions in sexuality during pregnancy and postpartum. Relationship satisfaction explained levels of sexual satisfaction during pregnancy, and was a predictor of sexual desire in the postpartum. Depression was an important predictor of reduced sexual desire and sexual satisfaction during pregnancy, and of reduced frequency of intercourse at 12 weeks postpartum. At 6 months postpartum, the quality of the mother role strongly related to measures of sexuality. Throughout the perinatal period, fatigue impacted on measures of sexuality, either directly or/and indirectly. The iniplications of these results in terms of the impact of pregnancy and childbirth on relationships and sexuality are discussed.
  • Article
    Full-text available
    Context Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries.Objective To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants.Design The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996–December 1997 with a 1-year follow-up.Setting Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.Participants A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up.Interventions Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies.Main Outcome Measures Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups.Results Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P = .01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28).Conclusions Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.
  • Article
    In the past quarter century, "bad" mothers have moved noticeably toward center stage in American culture. While Susan Smith will eventually fade from the tabloids, the monster mother that she represents has a storied and long history. Mothers have been blamed for a host of problems, from autism in children (due to chilly "refrigerator" mothers), to homosexuality (attributed to "smothering" moms), to welfare dependency and crime (caused by black "matriarchs" and single mothers). Some mothers are not good mothers. No one can deny that. There are women who neglect their children, abuse them, and fail to provide them with proper psychological nurturance. While such mothers have always stimulated the American imagination, the definition of what constitutes a bad mother has expanded significantly in recent years. Indeed, with a distinct minority of American families living the two-parent, one-worker lifestyle once considered the norm, we all face the discomfiting question, Do most mothers now qualify as "bad" mothers in one way or another? Drawing together the work of prominent scholars and journalists, "Bad" Mothers considers such diverse topics as the mother-blaming theories of psychological and medical "experts," bad mothers in the popular media, the scapegoating of mothers in politics, and the punitive approach to "bad" mothers by social service and legal authorities. The volume also includes the stories of individual "bad" mothers, from sterilization survivor Willie Mallory to rock star Courtney Love. Ably edited by two leading scholars, "Bad" Mothers marks an important contribution to the literature on motherhood.
  • Article
    The expression of maternal behavior in the newly parturient rat is under endocrine regulation. Blocking endogenous PRL secretion with bromocriptine delays the normal rapid expression of maternal care shown toward foster young in steroid-primed virgin female rats. The recent development of the PRL receptor antagonist S179D-PRL, a mutant of human PRL in which the serine residue at the 179 position is replaced with aspartate, provides a potentially useful tool to examine the role of PRL in neural processing. In the present report, three experiments were conducted that examined the effects of this PRL antagonist on the induction of maternal behavior. In each experiment, ovariectomized, nulliparous rats were treated sequentially with SILASTIC capsules implanted sc with progesterone (days 1–11) and estradiol (days 11–17), a treatment that stimulates a rapid onset of maternal behavior in virgin rats. On day 11, females were implanted with Alzet miniosmotic pumps connected to cannulae directed unilaterally at the lateral ventricle (Exp 1) or bilaterally at the medial preoptic area (MPOA; Exp 2 and 3). Pumps contained either doses of S179D-PRL (0.115 or 1.15 mg/ml; Exp 1 and 2), wild-type human PRL (1.15 mg/ml; Exp 3), or the saline vehicle (Exp 1–3). Testing for maternal behavior began on day 12, a day after pump insertion, and animals were tested daily for 6 days. Latencies to contact, retrieve, and group foster test young were recorded. Administration of both the high and low doses of S179D-PRL infused into the lateral ventricle (Exp 1) or MPOA (Exp 2) significantly delayed the onset of maternal behavior. In contrast, MPOA infusions of the control hormone, wild-type human PRL, in Exp 3 did not delay the onset of maternal behavior. These findings support the concept that the effects of S179D-PRL are caused by its actions as a PRL receptor antagonist rather than by a nonspecific effect of the protein. Overall, these results demonstrate the effectiveness of S179D-PRL acting at the level of the central nervous system (and, more specifically, within the MPOA) to regulate maternal behavior, a PRL-mediated response.
  • Article
    During breastfeeding or suckling, maternal oxytocin levels are raised by somatosensory stimulation. Oxytocin may, however, also be released by nonnoxious stimuli such as touch, warm temperature etc. in plasma and in cerebrospinal fluid. Consequently, oxytocin may be involved in physiological and behavioral effects induced by social interaction in a more general context. In both male and female rats oxytocin exerts potent physiological antistress effects. If daily oxytocin injections are repeated over a 5-day period, blood pressure is decreased by 10–20 mmHg, the withdrawal latency to heat stimuli is prolonged, cortisol levels are decreased and insulin and cholecystokinin levels are increased. These effects last from 1 to several weeks after the last injection. After repeated oxytocin treatment weight gain may be promoted and the healing rate of wounds increased. Most behavioral and physiological effects induced by oxytocin can be blocked by oxytocin antagonists. In contrast, the antistress effects can not, suggesting that unidentified oxytocin receptors may exist. The prolonged latency in the tail-flick test can be temporarily reversed by administration of naloxone, suggesting that endogenous opioid activity has been increased by the oxytocin injections. In contrast, the long-term lowering of blood pressure and of cortisol levels as well as the sedative effects of oxytocin have been found to be related to an increased activity of central α2-adrenoceptors. Positive social interactions have been related to health-promoting effects. Oxytocin released in response to social stimuli may be part of a neuroendocrine substrate which underlies the benefits of positive social experiences. Such processes may in addition explain the health-promoting effects of certain alternative therapies. Because of the special properties of oxytocin, including the fact that it can become conditioned to psychological state or imagery, oxytocin may also mediate the benefits attributed to therapies such as hypnosis or meditation. © 1998 Elsevier Science Ltd. All rights reserved.