Resilient mothers: Prevalence and predictors of breastfeeding in survivors of abuse
Background: Breastfeeding has been designated a research priority by the Centers for Disease Control and the National Institutes of Health, and is known to reduce risks for significant maternal and infant morbidities. However, only 16% of infants are currently breastfed at one year, and extensive intervention efforts have had only modest success at increasing this rate. A history of trauma or abuse is a common experience for women, affecting an estimated 55%, and early quantitative and qualitative work suggests that women with a history of childhood abuse have lower breastfeeding rates than other women. However, no current research has examined the relationship of trauma and post-traumatic stress disorder (PTSD) to breastfeeding outcomes. Previous research has shown that PTSD mediates the effect of trauma on perinatal outcomes, and that it is this psychophysiologic response to the trauma, rather than the trauma itself, that predicts outcomes such as lowered birth weight and shorter gestation. This study specifically addresses the role of PTSD in breastfeeding outcomes for survivors of CMT.
Methods: This is a secondary analysis of a subset (n=519) of a large (n=1581) prospective cohort study conducted between 2006-2008 in the Midwest. We compared the variables known in the literature to affect breastfeeding (e.g., education, maternal age, race, cesarean birth, etc.) across three groups (trauma-exposed resilient, PTSD-positive, and non-exposed). The significant variables were then entered into a stepwise logistic regression analysis to identify the relationships between these variables.
Results: The three groups differed significantly in their intent to breastfeed (x2=6.338,df=2,p=.042), initiation of breastfeeding (x2=9.677, df=2, p=.008), and continuation of breastfeeding at 6 weeks postpartum (x2=10.408, df=2, p=.005). Compared to women with PTSD, women in the non-exposed group were 16% more likely to breastfeed at 6 weeks, and women in the trauma-exposed resilient group were 30% more likely to be breastfeeding at 6 weeks. The stepwise logistic regression model, organized according to the Seng theoretical framework of effects of early trauma on perinatal outcomes, explained 68% of the variance in breastfeeding rates at 6 weeks postpartum.
Implications: These preliminary findings empirically support the use of the existing theoretical framework previously used for perinatal research in survivors of CMT to describe and predict breastfeeding rates for these women. Additionally, this study suggests that interventions specifically targeting PTSD may be effective in improving breastfeeding rates for women who have survived CMT. Because abuse/trauma are common experiences for women in the US, and because the disclosure rates are very low, universal use of trauma-informed interventions may increase the success of breastfeeding-promotion efforts. However, because of the inherent limitations of secondary analysis, more research is needed to confirm and expand findings.