Archives of Women's Mental Health

, Volume 21, Issue 3, pp 365–374 | Cite as

Physical health, breastfeeding problems and maternal mood in the early postpartum: a prospective cohort study

  • A. R. Cooklin
  • L. H. Amir
  • C. D. Nguyen
  • M.L. Buck
  • M. Cullinane
  • J. R. W. Fisher
  • S. M. Donath
  • the CASTLE Study Team
Original Article


This study aimed to investigate prospectively the contribution of maternal physical health and/or breastfeeding problems to maternal mood (depression, anxiety, fatigue, irritability, confusion, vigor) at 8-weeks postpartum. A prospective study was conducted. Participants were recruited antenatally from a public and a private maternity hospital in Melbourne, Australia. Nulliparous pregnant women (N = 229), ≥ 18 years of age, ≥ 36-week gestation, singleton pregnancy and with sufficient English were eligible. Data were collected by self-report questionnaire (pregnancy, weeks 1–4 postpartum) and telephone interview (week 8 postpartum). A high burden of physical problems was classified as ≥ 3 problems (caesarean/perineal pain; back pain; constipation; haemorrhoids; urinary and bowel incontinence) for ≥ 2 time points. A high burden of breastfeeding problems was having ≥ 2 problems (mastitis; nipple pain; frequent expressing; over- or under-supply of milk) for ≥ 2 time points. Multivariate linear regression was used to investigate the relationship between maternal mood, assessed using Profile of Mood States (8-week postpartum), and a high burden of breastfeeding and/or physical health problems. Forty-six women (20.1%) had a high burden of physical symptoms, 44 (19.2%) a high burden of breastfeeding problems only and 25 women (11.0%) had both. A high burden of breastfeeding problems alone (β = 10.6, p = 0.01) or with co-morbid physical problems (β = 15.35, p = 0.002) was significantly associated with poorer maternal mood at 8 weeks. Early, effective postnatal treatment of maternal health and breastfeeding problems could reduce women’s risk for poor mental health.


Postpartum Mental health Physical health Breastfeeding Mastitis 



The authors thank all women who participated in the study and provided data here. The CASTLE Study Team comprises Lisa H. Amir, Susan M. Donath, Suzanne M. Garland, Sepehr N. Tabrizi, Catherine M. Bennett, Meabh Cullinane and Matthew S. Payne. CASTLE was funded by a National Health and Medical Research Council Project Grant (2009–2011, Grant Number 541907). Amanda Cooklin and Cattram Nguyen were supported though the Australian Communities Foundation, Transition to Contemporary Parenthood Program, La Trobe University.

Funding information

MoAT was a sub-study nested within the CASTLE study. CASTLE was funded by a National Health and Medical Research Council Project Grant (2009–2011, Grant Number 541907). Amanda Cooklin and Cattram Nguyen were supported though the Australian Communities Foundation, Transition to Contemporary Parenthood Program, La Trobe University.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2017

Authors and Affiliations

  • A. R. Cooklin
    • 1
  • L. H. Amir
    • 1
  • C. D. Nguyen
    • 1
  • M.L. Buck
    • 1
  • M. Cullinane
    • 1
  • J. R. W. Fisher
    • 2
  • S. M. Donath
    • 3
    • 4
  • the CASTLE Study Team
  1. 1.Judith Lumley CentreLa Trobe UniversityBundoora, MelbourneAustralia
  2. 2.Jean Hailes Research UnitMelbourneAustralia
  3. 3.Murdoch Children’s Research InstituteMelbourneAustralia
  4. 4.Department of PaediatricsUniversity of MelbourneMelbourneAustralia

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