Nurturing the Nurturers: Addressing the Unseen Trauma behind Human Milk Feeding

Editor’s Note - July 2025

Originally published in 2023, this post explores the often-overlooked intersections of perinatal mental health, breastfeeding trauma, and human milk feeding. In anticipation of World Breastfeeding Week (August 1–7), we’ve updated it to reflect new research and reaffirm the importance of inclusive, trauma-informed care for all feeding journeys.

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Understanding the relationship between perinatal mental health and human milk feeding is vital to trauma-informed care. While breastfeeding/chestfeeding are often associated with bonding and nourishment, they can also surface deep psychological stress - especially when feeding doesn’t unfold as planned.

Human milk feeding is one of the most natural and biologically designed ways to nourish an infant - but for many, it’s far from simple. Many individuals find the experience challenging, and the resulting emotional distress can be enduring. As Kendall-Tackett (2022) explains, breastfeeding difficulties can lead to a loss in confidence, feelings of failure and worthlessness, and in some cases may be described as traumatic.

While most are aware of the many well-known benefits of human milk for infant health, breastfeeding/chestfeeding also benefits the parent by releasing feel-good hormones, such as oxytocin and prolactin (Breastfeeding and Mental Health, 2017), lowering the risk of depression, helping them get more sleep, and overcoming past adversity (Kendall-Tackett, 2019).

However, despite these benefits, only a small number of birthing parents exclusively breastfeed/chestfeed for the recommended duration (Pezley et al., 2022). Among transgender and gender-diverse parents, only 33.5% report exclusive breastfeeding/chestfeeding, and 41.3% continue up to six months (Yang et al., 2023). There are various considerations contributing to these statistics, with perinatal mental health being a significant underlying factor (Duncan et al., 2022).

Mental Health and Human Milk Feeding

The relationship between mental health and human milk feeding is bidirectional. “Maternal mental health status, in particular anxiety and depression, can influence the duration and exclusivity of breastfeeding,” and “breastfeeding experiences can affect maternal psychological well-being” (Pezley et al., 2022).

In a case study published in the Journal of Human Lactation, a parent navigating pre-existing depression and anxiety described her feeding experience as “fraught with uncertainty, shame, and emotional distress.” After two months of struggle, she made the decision to discontinue direct breastfeeding (Elder et al., 2021). Her story highlights the need for responsive care that acknowledges emotional as well as physical feeding challenges.

Breastfeeding intention also plays a key role. “Women who planned to breastfeed and actually did had the lowest risk of postpartum depression, while those who planned to breastfeed and did not had the highest risk” (Borra et al., 2014).

Unseen Trauma in Human Milk Feeding

Trauma can manifest in multiple ways during infant feeding, yet is frequently left unaddressed in both research and clinical care. One example is breastfeeding aversion response (BAR), which Morns et al. (2023) describe as “a phenomenon whereby the breastfeeding mother experiences a spectrum of negative emotions while feeding their child at the breast.” In their study of 210 participants, they found that “49% of respondents reported receiving no support to help with their experience of BAR” and that “over 50% of participants reported unlatching their child due to their feelings of aversion.”

The impact of trauma on lactation outcomes is increasingly recognized. As Kendall-Tackett (2022) notes:

“Traumatic experiences can make breastfeeding more difficult. But paradoxically, some trauma survivors are more likely to breastfeed.” - Kathleen Kendall-Tacket

Screening for Breastfeeding Trauma

Despite the prevalence of trauma in perinatal and lactation experiences, there has long been a lack of validated tools to assess breastfeeding trauma. That changed in 2022 with the introduction of the Existential Breastfeeding Difficulties Scale (ExBreastS) - a psychometric screening tool designed to identify breastfeeding-related post-traumatic stress (BF-PTSD).

In the validation study, researchers found that “the ExBreastS is categorized as a good and acceptable instrument for predicting the presence of BF-PTSD” (Black et al., 2022). They identified a cut-off score of 33 as optimal, with “sensitivity and specificity peaked at 63% and 79% respectively.” The study also revealed that “7% scored as experiencing BF-PTSD” using the PCL-5 measure.

This research marks the first time BF-PTSD has been identified using quantitative methods, opening the door to more targeted support through trauma-specific interventions like EMDR and Trauma-Focused CBT.

Psychological Distress and Feeding Outcomes

A growing body of research supports the bidirectional influence of mental health and infant feeding. In a systematic review, Dennis et al. (2022) concluded that “maternal psychological distress has the potential to adversely affect lactation and breastfeeding outcomes, and positive breastfeeding experiences may, in turn, reduce distress.”

This is echoed in a recent meta-synthesis by Billings et al. (2024), who found that while “breastfeeding was experienced as therapeutic and healing,” it also surfaced “feelings of distress, anger, frustration and grief, particularly when experiences fell short of expectations.” Additionally, inconsistent, poor, or absent support often worsens distress and undermines feeding goals - especially for those already navigating perinatal mental health challenges (Billings et al., 2024).

Human milk feeding is emotionally and psychologically complex, deeply personal, and often shaped by trauma. As World Breastfeeding Week approaches, it’s essential that we celebrate the resilience and intention behind each feeding journey - not just the outcomes.

As perinatal mental health professionals, we have the unique opportunity to advocate for screening tools like the ExBreastS, validate clients’ experiences, and support inclusive, trauma-informed interventions.

World Breastfeeding Week is just around the corner, but the complexities of feeding, trauma, and mental health unfold every day. If you're a clinician supporting clients through trauma and infant feeding challenges, explore our trauma-informed trainings designed for perinatal mental health professionals.

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References

Billings, H., Horsman, J., Soltani, H., et al. (2024). Breastfeeding experiences of women with perinatal mental health problems: A systematic review and thematic synthesis. BMC Pregnancy and Childbirth, 24, 582. https://doi.org/10.1186/s12884-024-06735-1

Black, R., Sinclair, M., Miller, P. W., McCullough, J. E. M., Palmér, L., Slater, P., & Tesler Stein, M. (2022). Developing a screening tool for breastfeeding trauma using the Existential Breastfeeding Difficulties Scale (ExBreastS). https://doi.org/10.13140/RG.2.2.34698.95688

Borra, C., Iacovou, M., & Sevilla, A. (2014). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intentions. Maternal and Child Health Journal, 18(4), 889–900. https://doi.org/10.1007/s10995-013-1311-1

Breastfeeding and Mental Health: Joint statement from WABA & LLLI in celebration of World Health Day. (2017, April 7). World Alliance for Breastfeeding Action (WABA). https://waba.org.my/v3/wp-content/uploads/2018/10/Statement_World-Health-Day_2017.pdf

Dennis, C. L., & Falah-Hassani, K. (2022). Maternal psychological distress and lactation and breastfeeding outcomes: A systematic review. International Breastfeeding Journal, 17, Article 14. https://doi.org/10.1186/s13006-022-00501-9

Elder, M., Murphy, L., Notestine, S., & Weber, A. (2021). Realigning expectations with reality: A case study on maternal mental health during a difficult breastfeeding journey. Journal of Human Lactation, 38(1), 190–196. https://doi.org/10.1177/08903344211031142

Kendall-Tackett, K. (2019, January 16). Why breastfeeding is good for mothers’ mental health. La Leche League International. https://llli.org/why-breastfeeding-is-good-for-mothers-mental-health/

Kendall-Tackett, K. (2022). Psychological trauma and breastfeeding: What we know so far. Medical Research Archives, 10(11). https://doi.org/10.18103/mra.v10i11.3288

Morns, M. A., Steel, A. E., McIntyre, E., & Burns, E. (2023). Breastfeeding aversion response (BAR): A descriptive study. Journal of Midwifery & Women's Health. https://doi.org/10.1111/jmwh.13474

Pezley, L., Cares, K., Duffecy, J., Koenig, M. D., Maki, P., Odoms-Young, A., Clark Withington, M. H., Lima Oliveira, M., Loiacono, B., Prough, J., Tussing-Humphreys, L., & Buscemi, J. (2022). Efficacy of behavioral interventions to improve maternal mental health and breastfeeding outcomes: A systematic review. International Breastfeeding Journal, 17(1), Article 14. https://doi.org/10.1186/s13006-022-00501-9

Yang, H., Na, X., Zhang, Y., Xi, M., Yang, Y., Chen, R., & Zhao, A. (2023). Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: A cross-sectional study. eClinicalMedicine, 57, 101847. https://doi.org/10.1016/j.eclinm.2023.101847