The contributing factors and effects of breastfeeding position-related pain: A mixed methods study

Background and Purpose: Breastfeeding has multiple health benefits for both children and mothers. Breastfeeding position-related pain (BPRP) has been established as prevalent in countries outside the United States and affects multiple body regions, including the back, neck, and shoulders. Pain is one of the reasons mothers terminate breastfeeding. The purpose of this study was to describe factors related to BPRP in postpartum mothers, the impact of BPRP on quality of life, and to develop a theory to summarize the findings. Methods: This convergent mixed methods study design surveyed 471 mothers and 83 healthcare providers. Quantitative data were collected and statistically analyzed. Open-ended responses were analyzed using thematic analysis, while qualitative methods ensured rigor, including the use of an audit trail, memo-writing, triangulation of methods and data sources, and reflexivity by the principal investigator. Quantitative and qualitative data were integrated. Results: Mothers reported the most intense pain in the upper back, breast, neck, and shoulders. Seated positions were found to be more painful than recumbent or semirecumbent positions. Pain was negatively correlated with breastfeeding self-efficacy. Pain appeared early in the postpartum period. Minutes breastfeeding per day were predictive of average body pain with breastfeeding. Healthcare providers used a variety of strategies to help mothers mitigate BPRP. These strategies included positioning, exercise, and posture reeducation. The qualitative results revealed an overall theme of support. Themes of internal factors, external factors, and temporal factors related to BPRP fit a bioecological model. Future areas of research included the need for intervention studies, understanding pain with pumping, returning to work, developing measurement tools for BPRP, biomechanical studies of breastfeeding positions, and communication issues between mothers and healthcare providers. Discussion and Conclusion: Pain is prevalent among breastfeeding mothers and appears to be multifactorial. This pain may impact a mother’s ability to reach her breastfeeding goals. Due to variability in BPRP, a person-centered approach by healthcare providers is warranted. Early intervention by healthcare providers using a multidisciplinary approach appears important. More research is needed to investigate BPRP, so that breastfeeding mothers will be able to breastfeed with reduced pain, enhanced comfort, and increased success.