Impact of Traumatic Childbirth and Birth-Related Posttraumatic Stress Disorder on Breastfeeding Outcomes: A Systematic Review of Longitudinal and Cohort Studies.

Abstract

<h4>Background</h4>Breastfeeding is the most recommended form of infant nutrition during the first months of life. Mother's perception of childbirth as traumatic, or birth-related diagnosis of Posttraumatic Stress Disorder (PTSD) or symptoms (PTSS), may negatively affect breastfeeding outcomes, but there is not enough evidence about its influence. The aim of this study was to examine and summarize the available literature on the impact of traumatic childbirth and/or PTSD/PTSS related to childbirth on breastfeeding outcomes.<h4>Methods</h4>Following PRISMA guidelines (PROSPERO: CRD42023407019), a systematic review of prospective longitudinal and cohort studies was conducted, involving searches across PubMed, PsycINFO, Scopus, Web of Science, and PsycARTICLES. The PICOS model guided inclusion criteria, and the Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess study quality.<h4>Results</h4>From the 1471 identified records, eight studies (involving 3091 participants) met our inclusion criteria and demonstrated an overall low risk of bias, according to NOS. Results consistently revealed a negative association between traumatic childbirth and/or birth-related PTSS/PTSD and breastfeeding outcomes, including initiation, duration, self-efficacy, and exclusive breastfeeding in the baby's early months.<h4>Discussion</h4>A traumatic birth can have lasting effects on both maternal mental health and breastfeeding outcomes.<h4>Limitations</h4>Potential omission of relevant studies despite searches across five databases and the absence of a calculated size effect, preventing the determination of the strength of the studied variables' relationship. Predominant focus on European studies questions the generalizability of the results.<h4>Conclusion</h4>Mothers suffering from traumatic childbirth and/or childbirth-related PTSS or PTSD have an increased risk of poorer breastfeeding outcomes.<h4>Registration and protocol</h4>The systematic review protocol was registered in PROSPERO. The registration number is: CRD42023407019.