Breastfeeding difficulties and maternal-infant bonding at three months postpartum in a Turkish cohort

Breastfeeding difficulties are common in the early postpartum period and have been hypothesized to negatively affect maternal-infant bonding. We aimed to investigate the relationship between breastfeeding problems and mother-infant bonding at 3 months postpartum in a sample of Turkish mothers.

We conducted a cross-sectional observational study of 257 mothers of 3-month-old infants in Turkey. Participants completed a questionnaire including demographic and obstetric information, breastfeeding practices and difficulties, and the Postpartum Bonding Questionnaire (PBQ) to assess maternal-infant bonding. Bonding difficulty was defined as a PBQ total score >25. Bivariate analyses (chi-square or Fisher's exact tests) compared mothers with and without bonding difficulties, and a multivariable logistic regression model was used to identify independent predictors of bonding problems at 3 months postpartum.

Overall, 33 mothers (12.8%) met criteria for bonding difficulties at 3 months. A total of 144 mothers (56.0%) reported at least one breastfeeding problem during the first 3 months postpartum. In bivariate analyses, breastfeeding difficulties were more common among mothers with bonding difficulties than among those without (81.8% vs. 52.2%, P = .001). Mothers with bonding difficulties were also more likely to have higher education (81.8% vs. 54.9% with ≥ secondary education; P = .003), to be employed outside the home (21.2% vs. 8.9%; P = .06), and to have a female infant (66.7% vs. 38.8% female; P = .003). No significant differences were found by maternal age, parity, or feeding mode (exclusive breastfeeding vs. formula feeding, P = .64). In multivariable logistic regression, breastfeeding difficulties were independently associated with bonding impairment (adjusted odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-8.0, P = .003). Maternal higher education (adjusted OR 3.0, 95% CI 1.1-8.0, P = .031) and having a female infant (adjusted OR 3.1, 95% CI 1.2-7.5, P = .016) were also independent predictors; maternal employment showed a positive but non-significant association (adjusted OR 2.2, 95% CI 0.9-5.5, P = .081).

In this Turkish sample, mothers who reported breastfeeding difficulties had higher odds of impaired maternal-infant bonding at 3 months postpartum. These findings support routine assessment of breastfeeding-related distress during postpartum care.