Factors Affecting Infant Feeding Practices Among Women With Severe Mental Illness

Abstract

Background: The health benefits of breastfeeding are well-established but for mothers with severe mental illness (SMI), the decision to breastfeed can be complex. Very few prior studies have investigated the infant feeding choices of women with SMI, or the factors associated with this. Our aims were to examine antenatal infant feeding intentions and infant feeding outcomes in a cohort of women admitted for acute psychiatric care in the first postpartum year. We also aimed to examine whether demographic and clinical characteristics associated with breastfeeding were similar to those found in previous studies in the general population, including age, employment, education, BMI, mode of delivery, smoking status, and social support.Methods: This study was a mixed-methods secondary analysis of a national cohort study, ESMI-MBU (Examining the effectiveness and cost-effectiveness of perinatal mental health services). Participants had been admitted to acute care with SMI in the first postpartum year. Infant feeding outcomes were retrospectively self-reported by women during a 1-month post-discharge interview. Free-text responses to questions relating to infant feeding and experience of psychiatric services were also explored using thematic analysis.Results: 144 (66.1%) of 218 women reported breastfeeding (mix feeding and exclusive breastfeeding). Eighty five percentage of the cohort had intended to breastfeed and of these, 76.5% did so. Factors associated with breastfeeding included infant feeding intentions, employment and non-Caucasian ethnicity. Although very few women were taking psychotropic medication contraindicated for breastfeeding, over a quarter (n = 57, 26.15%) reported being advised against breastfeeding because of their medication. Women were given this advice by psychiatry practitioners (40% n = 22), maternity practitioners (32.73% n = 18) and postnatal primary care (27.27% n = 15). Most women stopped breastfeeding earlier than they had planned to as a result (81.1% n = 43). Twenty five women provided free text responses, most felt unsupported with infant feeding due to inconsistent information about medication when breastfeeding and that breastfeeding intentions were de-prioritized for mental health care.Conclusion: Women with SMI intend to breastfeed and for the majority, this intention is fulfilled. Contradictory and insufficient advice relating to breastfeeding and psychotropic medication indicates that further training is required for professionals caring for women at risk of perinatal SMI about how to manage infant feeding in this population. Further research is required to develop a more in-depth understanding of the unique infant feeding support needs of women with perinatal SMI.

A mixed methods systematic review exploring infant feeding experiences and support in women with severe mental illness

“…Breastfeeding initiation and duration are predicted by demographic factors such as maternal age, ethnicity and socioeconomic status (McAndrew et al, 2012) and by clinical characteristics (body mass index, smoking status), social and professional support (Amiel Castro et al, 2017; Chang et al, 2020; Scott et al, 2006). We found similar findings were reported by Baker et al (2021) and Bogen et al (2010) though outcomes relating to ethnicity and breastfeeding differed between the two studies. This is perhaps more reflective of racial disparities in infant feeding trends generally in the United States, compared to the United Kingdom.…”

“…Interestingly, 86% of Chang et al, 2020;Scott et al, 2006). We found similar findings were reported by Baker et al (2021) and Bogen et al (2010) though outcomes relating to ethnicity and breastfeeding differed between the two studies. This is perhaps more reflective of racial disparities in infant feeding trends generally in the United States, compared to the United Kingdom.…”

“…This made infant feeding choices more challenging and resulted in discontinuing breastfeeding earlier than planned. Baker et al (2021)'s mixed methods secondary data analysis presented some of the findings from free‐text comments and several women in the study described contradictory advice from HCPs. For example:

Was on Quetiapine in pregnancy.

…”

“…For example:

Was on Quetiapine in pregnancy. Psychiatrist said I could not breastfeed on the medication but OB/GYN said I could (Baker et al, 2021, p. 6).

…”

“…Women's background characteristics, including sociodemographic, clinical and lifestyle characteristics were found to be associated with infant feeding outcomes in two studies. Baker et al (2021) found that women from Black, Asian and other minority ethnic (BAME) backgrounds in the United Kingdom were more likely to report breastfeeding compared to White women (adjusted odds ratio…”