Archives of Gynecology and Obstetrics

, Volume 294, Issue 3, pp 455–466 | Cite as

Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important?

  • Stephanie Wallwiener
  • Mitho Müller
  • Anne Doster
  • Katharina Plewniok
  • Christian W. Wallwiener
  • Herbert Fluhr
  • Sandra Feller
  • Sara Y. Brucker
  • Markus Wallwiener
  • Corinna Reck
Maternal-Fetal Medicine



This study aimed to investigate socio-demographic, medical and psychological factors that have an impact on breastfeeding.


Questionnaires were administered to 330 women prenatally (TI third trimester) and postpartum (TII 3–4 days, TIII 4 months). Medical data were collected from the hospital records. Self-reported data on initiation and maintenance of breastfeeding was collected simultaneously. Primary endpoint was breastfeeding initiation and maintenance. Data analyses were performed using Spearman’s ρ correlations between breastfeeding and other study variables and generalized multiple ordinal logistic regression analysis.


Neonatal admission to the NICU, high BMI, cesarean section, difficulties with breastfeeding initiation and high maternal state anxiety were the strongest predictors of impaired breastfeeding initiation, explaining together 50 % of variance. After 4 months, the strongest predictors of impaired maintenance of breastfeeding were maternal smoking, a high BMI and a history of postpartum anxiety disorder, explaining 30 % of variance.


Successful initiation and maintenance of breast feeding is a multifactorial process. Our results underline the need of interdisciplinary approaches to optimise breastfeeding outcomes by demonstrating the equality of medical and psychological variables. Whereas practices on maternity wards are crucial for optimal initiation, continuous lifestyle modifying and supporting approaches are essential for breastfeeding maintenance. Healthcare providers can also significantly influence breastfeeding initiation and maintenance by counselling on the importance of maternal BMI.


Breastfeeding Breastfeeding initiation Breastfeeding duration Predictors Obesity, smoking, anxiety 



The Authors would like to thank Gabriele Nindl (Head of the European Institute for Breastfeeding and Lactation, EISL) and Anja Bier (EISL) for their ongoing support of this study.


Dr. Stephanie Wallwiener and Dr. Anne Doster were financially supported by the German Society of Psychosomatic Gynaecology and Obstetrics.

Authors’ contributions

S. Wallwiener: Project development, Protocol, Data management, Manuscript writing. M Mueller: Data analysis, Data management. C. Reck: Project development, Manuscript writing. C. W. Wallwiener: Manuscript editing. M. Wallwiener: Project development, Manuscript writing. K. Plewniok: Data collection and management. S. Feller: Data collection and management. H. Fluhr: Data collection. A. Doster: Data collection, Manuscript editing. S. Y. Brucker: Manuscript editing.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Stephanie Wallwiener
    • 1
  • Mitho Müller
    • 2
  • Anne Doster
    • 1
  • Katharina Plewniok
    • 1
  • Christian W. Wallwiener
    • 3
  • Herbert Fluhr
    • 1
  • Sandra Feller
    • 1
  • Sara Y. Brucker
    • 3
  • Markus Wallwiener
    • 1
  • Corinna Reck
    • 2
  1. 1.Department of Obstetrics and GynecologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of PsychologyLudwig Maximilian UniversityMunichGermany
  3. 3.Department of Women’s HealthUniversity of TübingenTübingenGermany

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