Baptie G, Januario EM, Norman A. Empowered or powerless? Contributing factors for women's appraisal of traumatic and non-traumatic childbirth. Br J Midwifery. 2021; 29:(12)674-682

Costs of perinatal mental health problems. 2014. (accessed 5 September 2022)

Borra C, Iacova M, Sevilla A. New evidence on breastfeeding and postpartum depression: the importance of understanding women's intentions. Mat Child Health J. 2015; 19:(4)897-907

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3:(2)77-101

Britton JR. Postpartum anxiety and breastfeeding. J Reprod Med. 2007; 52:(8)689-695

Brown A, Shenker N. Experiences of breastfeeding during COVID-19: lessons for future practical and emotional support. Mat Child Nutr. 2021; 17:(1)

Costantini C, Joyce A, Britez Y. Breastfeeding experiences during the COVID-19 lockdown in the United Kingdom: an exploratory study into maternal opinions and emotional states. J Human Lactation. 2021; 37:(4)649-662

Couto G, Dias V, Oliveira I. Benefits of exclusive breastfeeding: an integrative review. Nurs Pract Today. 2020; 7:(4)245-254

Creswell JW. Qualitative inquiry and research design.London: SAGE; 2013

Dennis CL, McQueen K. Does maternal postpartum depressive symptomatology influence infant feeding outcomes?. Acta Paediatr. 2007; 96:590-594

Field T, Diego M, Hernandez-Reif M, Figueiredo B, Ezell S, Siblalingappa V. Depressed mothers and infants are more relaxed during breastfeeding versus bottle feeding interactions: brief report. Infant Behav Dev. 2010; 33:241-244

Gibbs BG, Forste R, Lybbert E. Breastfeeding, parenting, and infant attachment behaviors. Mat Child Health J. 2018; 22:579-588

Gonzalez-Jimenez E, Garcia PA, Aguilar MJ, Padilla CA, Alverez J. Breastfeeding and the prevention of breast cancer: a retrospective review of clinical histories. J Clin Nurs. 2004; 23:2397-2403

Hahn-Holbrook J, Haselton MG, Dunkel Schetter C, Glynn LM. Does breastfeeding offer protection against maternal depressive symptomatology?: a prospective study from pregnancy to 2 years after birth. Arch Womens Ment Health. 2013; 16:(5)411-422

Hanson WE, Creswell JW, Plano C, Vicki L, Petska KS, Creswell JD. Mixed methods research designs in counselling psychology. J Counselling Psychol. 2005; 52:(2)224-235

Heidari Z, Keshvari Kohan S Empowerment in breastfeeding as viewed by women: a qualitative study. J Educ Health Promot. 2017; 6

Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15:1277-1288

Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries. Breastfeed Med. 2009; 4:(S1)S17-30

Johnson RB, Onwuegbuzie AJ, Turner LA. Towards a definition of mixed methods research. J Mixed Methods Res. 2007; 1:112-133

Keevash J, Norman A, Mortimer S. What influences women to continue or stop breastfeeding: a thematic analysis. Br J Midwifery. 2018; 26:(10)651-658

Krol KM, Grossman T. Psychological effects of breastfeeding on children and mothers. Bundesgenundheitbl. 2018; 61:977-985

Lewallen L, Dick MJ, Flowers J Breastfeeding support and early cessation. J Obst Gynaecol Neonat Nurs. 2006; 35:(2)166-172

Marshall JL, Godfrey M, Renfrew MJ. Being a ‘good mother’: managing breastfeeding and merging identities. Soc Sci Med. 2007; 65:(10)2147-2159

Infant Feeding Survey 2010. 2012. (accessed 5 September 2022)

National Institute for Health and Care Excellence. Maternal and child nutrition. 2008. (accessed 5 September 2022)

National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance. 2014. (accessed 5 September 2022)

NHS England. Perinatal mental health. 2022. (accessed 5 September 2022)

Breastfeeding celebration week – supporting mothers who breastfeed. 2021. (accessed 5 September 2022)

Norman A, Mortimer S, Baptie G, Perculievska N, Ferrario H. Breastfeeding experiences and support: a mixed-methods approach to identifying factors influencing breastfeeding behaviour. Br J Midwifery. 2022; 30:(4)190-201

O'Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Clin Obstet Gynaecol. 2014; 28:(1)3-12

Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. 2012. (accessed 5 September 2022)

Silva CS, Lima MC, Sequeira-de-Andrade L Association between postpartum depression and the practice of exclusive breastfeeding in the first three months of life. J Paediatr. 2016; 93:(4)356-364

Smith J, Firth J. Qualitative data analysis: the framework approach. Nurse Res. 2011; 18:(2)52-62

Srivastava K, Norman A, Ferrario H, Mason E, Mortimer S. A qualitative exploration of the media's influence on UK women's views of breastfeeding. Br J Midwifery. 2022; 30:(1)10-18

Thurgood SL, Clark-Carter D, Dean SE. An online questionnaire study investigating the impact of psychosocial factors on the duration of breastfeeding. Midwifery. 2022; 109

Vazquez-Vazquez A, Dib S, Rougeaux E, Wells JC, Fewtrell MS. The impact of the covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: preliminary data from the COVID-19 new mum study. Appetite. 2021; 156

Victoria CG, Bahl R, Barros AJ Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016; 387:(10017)475-490

Webber E, Benedict B. Postpartum depression: a multidisciplinary approach to screening, management and breastfeeding support. Arch Psych Nurs. 2019; 33:(3)284-289

World Health Organization. Health topics/breastfeeding. 2022. (accessed 5 September 2022)

World Health Organization, UNICEF. Ten steps to successful breastfeeding. 2012. (accessed 5 September 2022)

The bidirectional relationship between breastfeeding and mental health

02 October 2022
Volume 30 · Issue 10



Breastfeeding rates in the UK are among the lowest in the world, despite its well-known benefits to maternal and infant health. The impact of breastfeeding on women's mental health may contribute to this. This study aimed to better understand the bidirectional relationship between breastfeeding and maternal mental health.


Women aged 20–45 years who had attempted to breastfeed between 2018 and 2019 were recruited. A mixed-methods design encompassed two components; 109 participants completed an online questionnaire and 24 took part in telephone interviews, analysed using a thematic approach.


Five main themes were identified: pressure to breastfeed, provision of information and support, mixed impact on mental health, mental health impacting breastfeeding and attachment.


While a positive breastfeeding experience can lead to positive wellbeing, women highlighted a pressure to breastfeed that often led to negative wellbeing. Support and information are needed to promote mental health and longer breastfeeding duration, specifically for those mothers experiencing mental health difficulties.

Breastfeeding provides significant benefits for mothers, infants and society, yet breastfeeding rates in the UK are among the lowest in the world (McAndrew et al, 2012). Typically, in the UK, 80% of women initiate breastfeeding; however, exclusive breastfeeding rates are less than 50% by 6 weeks, and drop to less than 1% after 6 months (Renfrew et al, 2012; Nicholson and Hayward, 2021). The World Health Organization (WHO, 2022) recommends exclusive breastfeeding for the first 6 months, followed by breastfeeding alongside the introduction of solids up to and past 2 years old. Breastmilk provides protection from infection and disease, while also supporting physical and cognitive development (Victoria et al, 2016), and the maternal benefits include a lower risk of breast and ovarian cancer (Gonzalez-Jimenez et al, 2004; Ip et al, 2009).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month