Associations Between Postpartum Physical Symptoms and Breastfeeding Outcomes Among a Sample of US Women 2-6 Months' Postpartum: A Cross-Sectional Study

Objective: Postpartum urogynecologic and other physical symptoms are common and burdensome. Whether they interfere with breastfeeding has not been thoroughly examined, and this study aims to fill this gap.Methods: Mothers with an infant (2 to 6 months) were recruited from the U.S. ResearchMatch volunteer registry and completed the Life After Pregnancy Study, which assessed postpartum physical symptoms and breastfeeding self-efficacy, experiences, and problems. Modified Poisson regression and linear regression with fully conditional specification multiple imputation to handle missing data were used to examine the associations between physical symptoms and breastfeeding-related outcomes.Results: Among 222 participants, postpartum physical symptoms were common [e.g., painful sex (42%), urinary incontinence (32%)]. Breastfeeding problems were experienced by most participants [e.g., engorged breasts (72%), sore or cracked nipples (70%), breastfeeding or pumping was painful (67%)]. Although postpartum physical symptoms were not associated with breastfeeding for less than 2 months versus greater than/equal to 2 months (beta = 0.94, 95% confidence interval [CI]: 0.78, 1.13), women with excess weight retention and those reporting painful sex or hemorrhoids were more likely to report breastfeeding problems such as sore or cracked nipples or perceived low milk supply. Overall, more physical symptoms were associated with more breastfeeding problems (adj beta = 0.39, 95% CI: 0.17, 0.62) and lower breastfeeding self-efficacy (adj beta = -2.24, 95% CI: -4.36, -0.13).Conclusions: Postpartum physical symptoms were associated with breastfeeding problems and overall poorer breastfeeding self-efficacy, but not with short-term breastfeeding duration. Future studies should explore how addressing physical symptoms among postpartum mothers might improve breastfeeding outcomes.