Examining maternal anxiety and infant feeding from pregnancy to parenthood.

This thesis uses an exploratory sequential design to examine the relationship between maternal anxiety and infant feeding from pregnancy to parenthood. Chapter 1 provides an overview of the thesis and a contextual framework of breastfeeding behaviour. Chapter 2 systematically reviews the literature examining prenatal anxiety and infant feeding, while Chapter 3 systematically reviews the literature examining postpartum anxiety and infant feeding. Chapter 4 uses qualitative, longitudinal methods to explore the impact of pregnancy-specific anxiety on prenatal infant feeding intentions and subsequent postpartum breastfeeding behaviour. Chapters 5 and 6 examine the emotional and practical experiences of breastfeeding and formula feeding women to identify potentially influencing mechanisms within the relationship. Chapter 7 reports the development and validation of a new measure of postpartum-specific anxiety. Chapter 8 then examines whether this measure is a more effective predictor of infant feeding outcomes than a general measure of anxiety. First, the findings reveal that there is insufficient evidence to make firm conclusions regarding the relationship between prenatal anxiety and infant feeding outcomes. However, the thesis finds convincing evidence for the relationship between postpartum anxiety and diverse infant feeding outcomes and behaviours. Second, a qualitative, longitudinal design suggests that pregnancy-specific anxiety may strengthen breastfeeding intentions in pregnancy, but this does not translate into improved breastfeeding outcomes postpartum. Third, the findings provide consistent evidence that failure to adhere to current infant feeding recommendations elicits negative emotional and practical experiences, which may potentially influence the relationship. Finally, the findings reveal new evidence for the efficacy of a validated measure of postpartum specific anxiety, relative to general measures of anxiety and depression, in predicting infant feeding outcomes and behaviours. Collectively, this thesis demonstrates that maternal anxiety, particularly in the months following childbirth is; like depression; an individual-level determinant of breastfeeding. Policy makers should raise awareness of this under-recognised psychological determinant, and distinguish it from depression, and anxiety occurring at other times of life