Psychological Trauma and Breastfeeding: What We Know So Far
Main Article Content
Introduction: Childhood and adult trauma are common experiences in perinatal women worldwide. Psychological trauma has a well-documented effect on mothers’ mental health, but less is known about its impact on breastfeeding.
Objectives: This article synthesizes the results from recent studies on trauma on breastfeeding and perinatal mental health. I describe possible mechanisms by which trauma influences breastfeeding and mental health and provide practical suggestions for working effectively with this population.
Method: Studies were identified via searches in PubMed and PsychInfo. Key words were adverse childhood experiences, child abuse, child maltreatment, intimate partner violence, birth trauma, pregnancy, postpartum, breastfeeding, postpartum depression, postpartum anxiety, and posttraumatic stress disorder (PTSD). Preference was given to studies published in the past 5 years, but older studies were included if more recent studies were not available. Review articles were also included.
Results: Psychological trauma can affect anyone regardless of income, religion, country of origin, age, or race and ethnicity. Pregnant and postpartum women are no exception. Traumatic experiences can make breastfeeding more difficult, but it is often an important goal for trauma survivors. Some studies have found that trauma survivors are more likely to breastfeed. Breastfeeding may be particularly important for trauma survivors in that it lessens trauma symptoms, improves mental health, and lowers the risk of mothers maltreating their children. When working with trauma survivors, it is important that practitioners avoid making assumptions that mothers will not breastfeed. It is important to support their breastfeeding goals.
Clinical Implications: Providers who work with new mothers will likely encounter a substantial percentage who are trauma survivors. Trauma survivors may not share their stories with providers, even if they directly ask, but these mothers’ experiences can influence both breastfeeding and their mental health. Practitioners who understand trauma and support breastfeeding in a trauma-informed way can positively influence both breastfeeding and mental health outcomes. Both childhood and adult trauma can have a negative effect on breastfeeding, but the mechanism may vary. Recent trauma can directly impact hormones needed for breastfeeding whereas childhood trauma may impact it via trauma sequelae, such as depression, anxiety, and PTSD.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Rich-Edwards JW, Spiegelman D, Hibert ENL, et al. Abuse in childhood and adolescence as a predictor of type-2 diabetes in adult women. American Journal of Preventive Medicine. 2010;39(6):529-536.
3. American Psychiatric Association. Diagnostic and Statistical Manual-V. American Psychiatric Association; 2013.
4. Haravuori H, Kiviruusu O, Suomalainen L, Marttunen M. An evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: factor analysis and comparisons to ICD-10 and DSM-IV. BMC Psychiatry. 2016/05/12 2016;16(1):140. doi:10.1186/s12888-016-0849-y
5. Anda RF, Dong M, Brown DW, et al. The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health. 2009;9:106. doi:1471-2458-9-106 [pii]
6. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. May 1998;14(4):245-258. doi:S0749379798000178
7. Sachs-Ericsson N, Cromer K, Hernandez A, Kendall-Tackett KA. Childhood abuse, health and pain-related problems: The role of psychiatric disorders and current life stress. Journal of Trauma & Dissociation. 2009;10:170-188.
8. Slopen N, Loucks EB, Appleton AA, et al. Early origins of inflammation: An examination of prenatal and childhood social adversity in a prospective cohort study. Psychoneuroendocrinology. 2015;51:403-413.
9. Danese A, Pariante CM, Caspi A, Taylor A, Poulton R. Childhood maltreatment predicts adult inflammation in a life-course study. Proceedings of the National Academy of Sciences U S A. Jan 23 2007;104(4):1319-24. doi:0610362104 [pii]
10. Danese A, Moffitt TE, Harrington H, et al. Adverse childhood experiences and adult risk factors for age-related disease: Depression, inflammation, and clustering of metabolic risk factors. Archives of Pediatric and Adolescent Medicine. 2009;163(12):1135-1143.
11. Alvarez-Segura M, Garcia-Esteve L, Torres A, et al. Are women with a history of abuse more vulnerable to perinatal depressive symptoms? A systematic review. Archives of Women's Mental Health. 2014;17:343-357.
12. Seng JS, Sperlich MA, Low LK, Ronis DL, Muzik M, Liberzon I. Childhood abuse history, posttraumatic stress disorder, postpartum mental health, and bonding: A prospective cohort study. Journal of Midwifery and Women's Health. 2013;58(1):57-68.
13. Benedict MI, Paine L, Paine L. Long-term effects of child sexual abuse on functioning in pregnancy and pregnancy outcomes (Final Report)
National Center of Child Abuse & Neglect; 1994.
14. Prentice JC, Lu MC, Lange L, Halfon N. The association between reported childhood sexual abuse and breastfeeding initiation. Journal of Human Lactation. 2002;18:291-226.
15. Kendall-Tackett KA, Cong Z, Hale TW. Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: A comparison of breastfeeding, mixed-feeding, and formula-feeding mothers Breastfeeding Medicine. 2013;8 (1):16-22.
16. Coles J, Anderson A, Loxton D. Breastfeeding duration after childhood sexual abuse: An Australian Cohort Study. Journal of Human Lactation. 2016;32(3):NP28-35.
17. Ukah UV, Adu PA, De Silva DA, von Dadelzen P. The impact of history of adverse childhood experiences on breastfeeding initiation and exclusivity: Findings from a National Population Health Survey. Breastfeeding Medicine. 2016;11:544-550. doi:10.1089/bfm.2016.0053
18. Sorbo MF, Lukasse M, Brantsaeter AL, Grimstad H. Past and recent abuse is associated with early cesation of breast feeding: Results from a large prospective cohort in Norway. BMJ Open. 2015;5(12):009240. doi:10.1136/bmjopen-2015-009240.
19. Valentine JM, Rodriguez MA, Lapeyrouse LM, Zhang M. Recent intimate partner violence as a prenatal predictor of maternal depression in the first year postpartum among Latinas. Archives of Women's Mental Health. 2011;14:135-143.
20. Miszkurka M, Zuzunegui MV, Goulet L. Immigrant status, antenatal depressive symptoms, and frequency and source of violence: What's the relationship. Archives of Women's Mental Health. 2012;15:387-396.
21. Bair-Merritt MH, Blackstone M, Feudtner C. Physical health outcomes of childhood exposure to intimate partner violence: A systematic review. Pediatrics. 2006;117:278-290.
22. James JP, Taft A, Amir LH, Agius P. Does intimate partner violence impact on women's initiation and duration of breastfeeding? Breastfeeding Review. 2014;22(2):11-19.
23. Mezzavilla RDS, Vianna GVDB, Lindsay AC, Hasselmann MH. Intimate partner violence, breastfeeding, breastmilk substitutes, and baby bottle use in the first year of life. Ciencia & Saude Coletiva. 2021;26(5):1955-1964. doi:10.1590/1413-81232021265.10012019
24. Ribeiro MRC, Batista RFL, Schraiber LB, et al. Recurrent violence, violence with complications, and intimate partner violence against pregnant women and breastfeeding duration. Journal of Women's Health (Larchmont). 2021;30(7):979-989. doi:10.1089/jwh.2020.8378.
25. Walters CN, Rakotomanana H, Komakech JJ, Stoecker BJ. Maternal experience of intimate partner violence is associated with suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia: Insights from a DHS analysis. International Breastfeeding Journal. 2021;16(1):20. doi:10.1186/s13006-021-00365-5
26. Caleyachetty R, Uthman OA, Bekele HN, et al. Maternal exposure to intimate partner violence and breastfeeding practices in 51 low-income and middle-income contries: A population-based cross-sectional study. PLoS Medicine. 2019;16(10):e1002921. doi:10.1371/journal.pmed.1002921
27. Tran LM, Nguyen PH, Naved RT, Menon P. Intimate partner violence is associated with poorer mental health and breastfeeding practices in Bangladesh. Health Policy & Planning. 2020;35(Supplement_1):i19-i29. doi:10.1093/heapol/czaa106
28. Mezzavilla RDS, Ferreira MDF, Curloni CC, Lindsay AC, Hasselman MH. Intimate partner violence and breastfeeding practices: A systematic review of observational studies. Jornal de Pediatria. 2018;94(3):226-237. doi:https://doi.org/10.1016/j.jped.2017.07.007
29. Normann AK, Bakiewicz A, Madsen FK, Khan KS, Rasch V, Linde DS. Intimate partner violence and breastfeeding: A systematic review. BMJ Open. 2020;10(10):e034153. doi:10.1136/bmjopen-2019-034153
30. Holland ML, Thevenent-Morrison K, Mittal M, Nelson A, Dozier AM. Breastfeeding and exposure to past, current, and neighborhood violence. Maternal & Child Health Journal. 2017;doi:10.1007/s10995-017-2357-1.
31. World Health Organization. The prevention and elimination of disrespect and abuse during facility-based childbirth. http://apps.who.int/iris/bitstream/10665/134588/1/WHO_RHR_14.23_eng.pdf?ua=1&ua=1
32. Beck CT, Gable RK, Sakala C, Declercq ER. Posttraumatic stress disorder in new mothers: Results from a two-stage U.S. national survey. Birth. 2011;38(3):216-227.
33. Declercq ER, Sakala C, Corry MP, Applebaum S. New mothers speak out: National survey results highlight women's postpartum experiences. Childbirth Connection; 2008.
34. Galea S, Vlahov D, Resnick H, et al. Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. American Journal of Epidemiology. 2003;158:514-524.
35. de Schepper S, Vercauteren T, Tersago J, Jacquemyn Y, Raes F, Franck E. Posttraumatic stress disorder after childbirth and the influence of maternity team care during labour and birth: A cohort study. Midwifery. 2016;32:87-92.
36. Dikmen-Yildiz P, Ayers S, Phillips L. Factors associated with posttraumatic stress symptoms (PTSS) 4-6 weeks and 6 months after birth: A longitudinal population-based study. Journal of Affective Disorders. 2017;221:238-245.
37. Dikmen-Yildiz P, Ayers S, Phillips L. Longitudinal trajectories of posttraumatic stress disorder (PTSD) after birth and associated risk factors. Journal of Affective Disorders. 2018;229:377-385.
38. Alcorn KL, O'Donovan A, Patrick JC, Creedy D, Devilly GJ. A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychological Medicine. 2010;40:1849-1859.
39. Ruglass L, Kendall-Tackett KA. The Psychology of Trauma 101. Psychology 101. Springer; 2015.
40. Soderquist I, Wijma B, Thorbert G, Wijma K. Risk factors in pregnancy for post-traumatic stress and depression after childbirth. British Journal of Obstetrics & Gynecology. 2009;116:672-680.
41. Stramrood CA, Paarlberg KM, Velt EMHIT, et al. Posttraumatic stress following childbirth in homelike- and hospital settings. Journal of Psychosomatic Obstetrics & Gynecology. 2011;32(2):,88-97.
42. Kendall-Tackett KA, Beck CT. Secondary traumatic stress and moral injury in maternity care providers: A narrative and exploratory review. Frontiers in Global Women's Health. 835811. 2022;3. doi:10.3389/fgwh.2022/835811
43. Modarres M, Afrasiabi S, Rahnama P, Montazeri A. Prevalence and risk factors of childbirth-related post-traumatic stress symptoms. BMC Pregnancy and Childbirth. 2012;12:88. doi:http://www.biomedcentral.com/1471-2393/12/88 http://www.biomedcentral.com/1471-2393/12/88
44. Kendall-Tackett KA, Cong Z, Hale TW. Birth interventions related to lower rates of exclusive breastfeeding and increased risk of postpartum depression in a large sample. Clinical Lactation. 2015;6(3):87-97.
45. Rowlands IJ, Redshaw M. Mode of birth and women's psychological and physical wellbeing in the postnatal period. BMC Pregnancy and Childbirth. 2012;12:138. doi:http://www.biomedcentral.com/1471-2393/12/138 http://www.biomedcentral.com/1471-2393/12/138
46. Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: A prospective cohort study. International Breastfeeding Journal. 2006;1(1):24
47. Hiltunen P, Raudaskoski T, Ebeling H, Moilanen I. Does pain relief during delivery decrease the risk of postnatal depression? Acta Obstetrica Gynecologica Scandanavica. 2004;83(3):257-261.
48. Ding T, Wang DX, Chen Q, Zhu SN. Epidural labor analgesia is associated with a decreased risk of postpartum depression: A prospecitive cohort study. Anesthesia & Analgesia. 2014;119(2):383-392. doi:10.1213/ANE.0000000000000107
49. Beck CT, Watson S. Impact of birth trauma on breast-feeding. Nursing Research. 2008;57(4):228-236.
50. Brown AE. Why breastfeeding grief and trauma matter. Pinter and Martin; 2019.
51. Coo S, Garcia MI, Mira A, Valdes V. The role of perinatal anxiety and depression in breastfeeding practices. Breastfeeding Medicine. 2020;15(8):495-500. doi:10.1089/bfm.2020.0091
52. Garthus-Niegel S, Horsch A, Ayers S, Junge-Hoffmeister J, Weidner K, Eberhard-Gran M. The influence of postpartum PTSD on breastfeeding: A longitudinal population-based study. Birh. 2018;45(2):193-201. doi:10.1111/birt.12328
53. Horsely K, Nguyen T-V, Ditto B, Da Costa D. The association between pregnancy-specific anxiety and exclusive breastfeeding status early in the postpartum period. Journal of Human Lactation. 2019;35(4):729-736. doi:10.1177/0890334419838482
54. Figueiredo B, Pinto TM, Costa R. Exclusive breastfeeding moderates the association between prenatal and postpartum depression. Journal of Human Lactation. 2021;doi:10. 1177/ 0890 3344 21991051
55. Shields B. Down came the rain: My journey through postpartum depression. Hyperion; 2005.
56. Uvnas-Moberg K, Ekstrom-Bergstrom A, Buckley S, et al. Maternal plasma levels of oxytocin during breastfeeding. PLoS One. 2020;15(8):e0235806. doi:10.1371/journal.pone.0235806
57. Grajeda R, Perez-Escamilla R. Stress during labor and delivery is associated with delayed onset of lactation among urban Guatemalan women. Journal of Nutrition. 2002;132:3055-3060.
58. Handlin L, Jonas W, Pettersson M, et al. Effects of sucking and skin-to-skin contact on maternal ACTH and cortisol levels during the second day postpartum--Influences of epidural analgesia and oxytocin in the perinatal period. Breastfeeding Medicine. 2009;4(4):207-220.
59. Heinrichs M, Meinlschmidt G, Neumann I, et al. Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women. Journal of Clinical Endocrinology & Metabolism. 2001;86:4798-4804.
60. Uvnas-Moberg K. Oxytocin: The biological guide to motherhood. Praeclarus Press; 2015.
61. Uvnas-Moberg K. The hormone of closeness: The role of oxytocin in relationships. Pinter & Martin; 2013.
62. Kendall-Tackett KA, Cong Z, Hale TW. The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation. 2011;2(2):22-26.
63. Strathearn L, Mamun AA, Najman JM, O'Callaghan MJ. Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study. Pediatrics. Feb 2009;123(2):483-93. doi:123/2/483 [pii]
64. Hahn-Holbrook J, Haselton MG, Schetter CD, Glynn LM. Does breastfeeding offer protection against maternal depressive symptomatology? A prospective study from pregnancy to 2 years after birth. Archives of Women's Mental Health. 2013;16:411-422.
65. Dorheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Sleep and depression in postpartum women: A population-based study. Sleep. 2009;32(7):847-855.
66. Kendall-Tackett KA. A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal. 2007;2:6doi:doi:10.1186/1746-4358-2-6
67. Jones NA, McFall BA, Diego MA. Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: The mediating role of infant temperament. Biological Psychology. 2004;67:103-124.
68. UNICEF-UK. Benefits of breastfeeding. 2022. https://www.unicef.org.uk/babyfriendly/about/benefits-of-breastfeeding/