Breastfeeding is well established as a critical determinant of maternal and infant health, associated with reduced infant mortality and a lower risk of maternal breast cancer. Thus, identifying the determinants of early breastfeeding cessation is an important public health concern. Among the various factors suggested to interfere with breastfeeding, maternal pain is suspected to potentially contribute to early cessation. Persistent perineal pain following vaginal delivery is a commonly reported condition affecting up to 48% of women [1], yet its impact on breastfeeding duration has never been studied. This study aimed to investigate the association between breastfeeding duration and the intensity of persistent perineal pain among postpartum women following vaginal delivery. We hypothesize that higher perineal pain intensity may be associated with shorter breastfeeding duration.

This is a cross-sectional correlational study nested within a larger multicenter trial investigating 322 women in postpartum who had experienced at least one vaginal delivery. A total of 237 women (73.6%) consented to participate in the present study. The duration of breastfeeding was assessed using the Brief Breastfeeding and Milk Expression Recall Survey [2]. The intensity of persistent perineal pain lasting more than eight weeks post-delivery was measured using a numerical rating scale (1–10). Confounding variables potentially affecting duration of breastfeeding were identified using the conceptual model proposed by Amir and colleagues [3], relevant literature, and national surveys. These variables included sociodemographic characteristics, maternal and infant post-delivery outcomes, and postpartum depression, which was assessed using the Bromley Postnatal Depression Questionnaire. Bivariate linear regression analyses were conducted to identify statistically significant confounding variables (p-value<.10). Multiple linear regression analyses were subsequently performed to investigate the association between the intensity of persistent perineal pain and the duration of breastfeeding while controlling for significant confounding variables (p<.05).

Of the 237 participants, 86 (36.3%) reported perineal pain persisting beyond eight weeks postpartum with a mean intensity of 5.8 (±1.9). Multiple linear regression analysis revealed that perineal pain intensity was significantly associated with breastfeeding duration (standardized β = -157.2, 95%CI [-251.4, -62.9], p=.001) while controlling for the significant confounding variables (maternal age, immigration status, infant torticollis/jaw or neck stiffness, maternal breast-related complications, perceived community support, and instrumented vaginal delivery). The statistical model explained 31.7% of the variance in breastfeeding duration.

Higher persistent perineal pain intensity was associated with a shorter duration of breastfeeding. These results suggest that pain intensity may be a key factor contributing to the early cessation of breastfeeding. This study represents the first step toward screening for and addressing perineal pain in postpartum care to improve breastfeeding outcomes.

Findings highlight the impact of persistent postpartum perineal pain on breastfeeding duration. Moreover, integrating early pain management into interdisciplinary care may prolong the duration of breastfeeding, benefiting the infant and the mother. Further studies are needed to confirm these results and investigate potential perineal pain management treatments.

Komatsu, R., Ando, K., & Flood, P. D. (2020). Factors associated with persistent pain after childbirth: a narrative review. British journal of anaesthesia, 124(3), e117–e130. https://doi.org/10.1016/j.bja.2019.12.037
Keim, S. A., Smith, K., Ingol, T., Li, R., Boone, K. M., & Oza-Frank, R. (2019). Improved estimation of breastfeeding rates using a novel breastfeeding and milk expression survey. Breastfeeding Medicine, 14(7), 499–507. https://doi.org/10.1089/bfm.2018.0258
Amir, L. H., Jones, L. E., & Buck, M. L. (2015). Nipple pain associated with breastfeeding: Incorporating current neurophysiology into clinical reasoning. Australian Family Physician, 44(3), 127–132. PMID: 25770578