Introduction

Childbirth memory is the birth experience that takes place in a woman’s long-term memory and can be recalled when needed (Topkara & Çağan, 2021). In addition to being the most important and unique event in a woman’s life, childbirth has profound psychological, physical, and social effects on women (Jafari et al., 2017). To protect a woman’s mental health in the postpartum period, it is expected that positive memories of childbirth will remain in her mind and that she will feel positive emotions when she remembers the birth (Ford & Ayers, 2009). Therefore, it is stated that birth memories and recall are important and these memories should be explored (Hatamleh et al., 2013). Birth memories are associated with how women cognitively process the postpartum birth experience and potentially with their adjustment to parenthood (Foley et al., 2014). How women remember birth events can be influenced by a number of factors, including the intensity of the birth experience, how the woman evaluates birth events, and postpartum mood or psychological disorders (Briddon et al., 2011). Birth memories related to birth experiences are among the strong factors affecting women’s future fertility and it is important to explore birth memories (Foley et al., 2014). Some practices and interventions during and after childbirth, the mode of delivery, birth traumas, and intervention during birth affect women’s birth memory and birth satisfaction (Alioğulları et al., 2016; Yılmaz-Esencan et al., 2018; Westerfield et al., 2018).

A woman’s satisfaction with childbirth is multifaceted and personal (Martin & Fleming, 2011). It is influenced by the woman’s previous life experiences, culture, education, temperament, stress level, and birth preparation (Hinic, 2017; Miron-Shatz & Konheim-Kalkstein, 2020). Negative birth satisfaction is associated with obstetric interventions and complications during labor such as emergency cesarean delivery, postpartum hemorrhage, instrumental delivery, and fetal distress (Falk et al., 2019). A mother’s satisfaction with her birth experience has important implications for her and her baby, especially breastfeeding. Mothers whose physical and psychological needs are met, who are intervened less, and who have higher coping skills are more satisfied with childbirth, and when there are factors that trigger the opposite, childbirth dissatisfaction increases, which brings problems such as postpartum depression risk, fear of childbirth, attachment difficulties, and breastfeeding difficulties (Nahaee et al., 2020; Mariño-Narvaez et al., 2021; Nakić Radoš et al., 2022). A positively perceived birth experience is associated with an increased sense of competence and breastfeeding attitude in the mother. Negative birth experiences may expose the mother to guilt and frustration. These experiences may negatively affect the mother’s mental health, self-efficacy, and breastfeeding attitude in the postpartum period (Hinic, 2017). A satisfying birth experience is crucial for a positive mother-infant interaction. Mothers who have a positive birth experience are more likely to safely engage in health-promoting behaviors such as breastfeeding (Hinic, 2017; Nahaee et al., 2020).

The postpartum period is a process that requires mothers to adapt to breastfeeding. In this period, positive memories of the birth in the woman’s mind and positive emotions when she thinks about the birth may affect her adaptation to the breastfeeding process. In the birth and postpartum period, midwives have a great role and responsibility in creating a positive birth experience, having positive memories of birth in the woman’s mind, ensuring mother-infant interaction, supporting breastfeeding, and ensuring the mother’s adaptation to breastfeeding. Therefore, this study aimed to prospectively examine the effects of mothers’ birth memory, birth satisfaction, and birth-related interventions on breastfeeding attitudes.

Research questions:

  1. 1.

    Do mothers’ birth memory and recall level affect breastfeeding attitudes on postpartum day 1, month 1, and month 3?

  2. 2.

    Does mothers’ satisfaction with childbirth affect breastfeeding attitudes on postpartum day 1, month 1, and month 3?

  3. 3.

    Do birth-related interventions affect mothers’ breastfeeding attitudes on day 1, month 1, and month 3?

Methods

Type of research

This is a correlational prospective study.

Place of research

The study was conducted in the postpartum clinic of a training and research hospital in the Central Anatolia Region of Turkey. The hospital offers health services to approximately 4000 people per month. Since the number of births per month is about 700–800 and 400–450 of them are vaginal births, this hospital was selected for this study.

Study population

The population of the study consisted of primiparous pregnant women presented to the hospital for delivery and admitted to the delivery room between 15.11.2022 and 15.05.2023.

Sample of the study

The sample size of the study was calculated based on the mean breastfeeding attitude score (61.57 ± 5.34) reported in the study by Akın et al. (2021) using the G-power 3.1.9.2 program (Faul et al., 2007). Considering a difference of 1 unit, 80% power, a margin of error of 0.05 and an effect size of 0.18, it was determined that 226 mothers should be included in the study. In this study, 248 mothers were included by calculating 10% more, considering possible data loss. Mothers were included in the study according to the random sampling method.

Participants

The study included volunteering pregnant women who presented to the hospital for delivery and were admitted to the delivery room. Inclusion criteria: The study included mothers who were 18 years of age or older, primiparous, admitted to the hospital in the latent phase, delivered vaginally, married or with a partner, spontaneously conceived, delivered at term, delivered a healthy single baby, had a vertex position, and could read and understand Turkish. Exclusion criteria: The study excluded mothers with high-risk pregnancies, intellectual disability, visual/hearing impairment, a history of depression or diagnosis of mental illness, or a history of postpartum depression. Exclusion criteria during the research process: During the study, the study excluded women for the following reasons: any postnatal complication (hemorrhage, puerperal infection, mastitis or thromboembolic disease)1; stillbirth; delivery with fetal anomaly; grade 4 perineal laceration; infant requiring intensive care in the postnatal period; maternal or neonatal condition that would prevent breastfeeding (such as cleft palate, cleft lip, sunken nipple, breast abscess, and previous breast operation); and dropout at any stage of the study.

Data collection method

In the first stage, after the pregnant woman was admitted to the delivery room, the purpose and method of the study were explained and written informed consent was obtained from the pregnant women who met the research criteria and volunteered to participate in the study. Then, the personal information form was filled out. During the labor and delivery process, the labor and delivery follow-up form was completed by the researcher. The Birth Memory and Recall Scale, the Birth Satisfaction Scale, and the Infant Feeding Attitude Scale were administered in the first four hours after delivery. In the first and third months, the mothers were given appointments according to the doctor’s follow up days and the Birth Memory and Recall Scale, the Birth Satisfaction Scale, and the Infant Feeding Attitude Scale were administered again via face-to-face interviews. Mothers who could not be interviewed face-to-face were contacted by telephone and the scales were administered online. It took an average of 20 min to answer the questions. Before the data collection started, the forms were administered in 24 mothers (10%) to pilot the questions in the data forms. The mothers who were included in the pilot study were not included in the sample.

Data collection tools

A Personal Information Form, developed by the researcher in line with the literature, a Labor Monitoring Form, the Birth Memory and Recall Scale, the Birth Satisfaction Scale, and the Infant Feeding Attitude Scale were used to collect the data.

Personal information form

The Personal Information Form developed by the researcher in line with the literature consists of two parts. The first part includes 11 items about the sociodemographic characteristics of the mother such as age, education level, income perception, smoking status, alcohol use, family type, and duration of marriage. The second part consists of 14 items on obstetric characteristics such as the number of pregnancies, history of miscarriage/abortion, whether the pregnancy was planned or not, gender of the baby, whether the mother is satisfied with the gender of the baby, the time she first breastfed the baby after birth, whether she received breastfeeding training before, whether she received support in baby care, and the person (nurse or physician) who delivered the baby (Göncü Serhatlıoğlu, 2018; Buran, 2022).

Labor monitoring form

The Labor Monitoring Form consists of 12 items about the labor process, including oxytocin infusion, episiotomy, duration of labor, presence of a companion during labor, massage during labor, breathing exercises, status of using a birth ball, status of having a hot shower, listening to music, freedom of movement, and APGAR score at the first and 5th minutes (Göncü Serhatlıoğlu, 2018; Buran, 2022). The Labor Monitoring Form was completed by the researcher by participating in the labor process of each pregnant woman.

Birth Memories and Recall Questionnaire (BirthMARQ)

The scale developed by Foley et al. (2014) has 21 seven-point Likert-type items. Scale items range from 1 point “Strongly disagree” to 7 points “Strongly agree”. While the Cronbach’s Alpha internal consistency coefficient value of the scale is 0.80, this value is 0.81, 0.80, 0.80, 0.80, 0.74, 0.84, and 0.84 in the sub-dimensions, respectively (Foley et al., 2014). The Turkish validity and reliability study of the scale was conducted by Topkara and Çağan (2021). The original Turkish version of the scale consists of 21 items and 6 sub-dimensions: Emotional Memory, Ambivalent Emotional Memory, Centrality of Memory, Consistency and Reliving, Sensory Memory, and Involuntary Recall. The Cronbach Alpha coefficient of the entire scale was determined as 0.794. As a result of the split-half analysis, the Cronbach Alpha value of the first half was determined as 0.654, the Cronbach Alpha value of the second half was 0.586, the Spearman Brown coefficient was 0.882, the Guttman-Split-Half coefficient was 0.877, and the correlation coefficient between the two halves was 0.789. Hotelling’s T-square test was performed to determine whether there was response bias in the scale, and Hotelling’s T-square value was found to be 856.243 (p < 0.001). As a result of the analysis, it was determined that there was no response bias in the scale. Whether the scale was collectible for the Turkish sample was evaluated by Tukey’s Additivity analysis, and as a result of the analysis, F was 0.258 and p was 0.612. These results showed that the scale was collectible for the Turkish sample (Topkara & Çağan, 2021). While the Cronbach alpha coefficient of the scale was 0.79 in the overall scale, it was 0.79, 0.64, 0.76, 0.67, 0.78, and 0.72 in the sub-dimensions, respectively. In this study, the Cronbach alpha coefficient of internal consistency was 0.80 for the overall scale and 0.71, 0.70, 0.72, 0.72, 0.69, 0.76, and 0.70 for the sub-dimensions, respectively.

Birth satisfaction scale (BSS)

The scale consists of 10 items and three sub-dimensions, and the Cronbach’s Alpha internal consistency coefficient value was reported as 0.74 (Hollins Martin & Martin, 2014). Turkish validity and reliability study was conducted in 2018 (Göncü Serhatlıoğlu, 2018). The Kaiser-Meyer-Olkin (KMO) proficiency measurement in the construct validity of the scale is 0.691, which is a moderate value for KMO and indicates that it is appropriate to analyze the relevant data group. The Likert-type scale is scored between 4 and 0 points. The lowest score is “0” and the highest score is “40”. The higher the score, the higher the level of satisfaction with childbirth. In the study, the cut-off scores of the scale were calculated by dividing the total score into three equal parts as follows: Low satisfaction level is ˂13 points, moderate satisfaction level is 14–27 points, and high satisfaction level is ≥ 28 points. The Cronbach’s alpha value of the scale was reported as 0.71 (Göncü Serhatlıoğlu, 2018). In this study, the total score of the scale ranged between 10 and 46 and the Cronbach’s alpha internal consistency coefficient was calculated as 0.70.

Iowa infant feeding attitude scale (IOWA)

The scale was developed to evaluate breastfeeding attitudes of mothers and to predict the duration of breastfeeding as well as the choice of infant feeding method. Cronbach’s alpha coefficient of the scale was reported to be 0.86 (De La Mora & Russell, 1999). The scale was validated in Turkish and the Cronbach’s alpha internal consistency coefficient was 0.71 (Ekşioğlu et al., 2016). For validity analysis, predictive validity was evaluated within the scope of language validity, content validity, face validity and criterion validity. Expert opinion was sought for content validity. The average of the scores obtained from the evaluation made by the experts was taken and the Kendall Coefficient of Concordance (Kendall Coefficient of Concordance) was calculated. In evaluating the criterion validity of the scale, participants’ infant nutrition attitude scale scores and infant feeding at the 6th postpartum week were examined using one-way analysis of variance. To evaluate the reliability level of the scale, test-retest method was used for (1) item total score correlations, (2) Cronbach’s alpha internal consistency coefficient and (3) invariance over time. The mean score and standard deviation of each item were calculated.

The IOWA has 5-point Likert-type items scored between 1 and 5. The scale consists of 17 items scored between 17 and 85. In this study, the Cronbach’s alpha internal consistency coefficient was calculated as 0.72.

Statistical analysis

The NCSS (Number Cruncher Statistical System) 2020 Statistical Software (NCSS LLC, Kaysville, Utah, USA) was used for statistical analysis. An expert statistician was consulted for the statistics of the study. Quantitative variables are shown as mean, standard deviation, median, min and max values and qualitative variables are shown as descriptive statistical methods such as frequency and percentage. The Shapiro Wilks test and Box Plot graphs were used to evaluate the conformity of the data to normal distribution. Since the Skewness and Kurtosis values of all scales were between − 1.50 and + 1.50 in the normality analysis, independent samples t tests were performed (Tabachnick & Fidell, 2013). Skewness and kurtosis values of the scales: IOWA postpartum day 1 (skewness=-0.038 ± 0.155; kurtosis=-0.750 ± 0.308), IOWA postpartum 1st month (skewness=-0.071 ± 0.155; kurtosis=-0.783 ± 0.308), IOWA postpartum 3rd month (skewness = 0.025 ± 0.155; kurtosis=-0.755 ± 0.308), BSS postpartum day 1 (skewness = 0.044 ± 0.155; kurtosis=-0.596 ± 0.308), BSS postpartum 1st month (skewness = 0.027 ± 0.155; kurtosis=-0.775 ± 0.308), BSS postpartum 3rd month (skewness=-0.007 ± 0.155; kurtosis=-0.867 ± 0.308), BirthMARQ postpartum day 1 (skewness=-0.038 ± 0.155; kurtosis=-0.905 ± 0.308), BirthMARQ postpartum 1st month (skewness=-0.090 ± 0.155; kurtosis=-0.692 ± 0.308), BirthMARQ postpartum 3rd month (skewness = 0.032 ± 0.155; kurtosis=-0.768 ± 0.308). Student’s t test was used for two-group evaluations of normally distributed variables. The Mann Whitney U test was used for two-group evaluations of variables that did not show normal distribution. Pearson correlation analysis was used to evaluate the relationships between variables according to the distribution. As a multivariate analysis, the effects of BirthMARQ score, and subscale scores on the Infant Feeding Attitude Scale score were evaluated by Backward Linear Regression analysis. The results were evaluated at 95% confidence interval and significance was evaluated at p < 0.05 level (Evans, 1996).

Ethics of the research

Before the study, institutional approval was obtained from both the local ethics committee (Ethics permit: # blinded for review) and the relevant hospital (Institution approval: # blinded for review). Permissions were obtained to use all the scales in the study. Mothers who met the inclusion criteria were given detailed information about the study. Participating mothers were informed that they could withdraw from the study without giving any reason. They were also informed that their participation was completely voluntary and that their identities would remain confidential. Written informed consent was obtained from all participants. This study was conducted in accordance with the ethical standards included in the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. The expenses of the study were covered by the investigator without any support.

Results

The distribution of sociodemographic and obstetric characteristics of the mothers who participated in the study is shown in Table 1. The age of the mothers who participated in the study ranged between 18 and 35 years and the mean age was 23.9 ± 3.3 years. The age of the spouses ranged between 18 and 44 years and the mean age of the spouses was 26.9 ± 3.8 years. The participants’ duration of marriage ranged between 1 and 8 years, with a mean of 1.8 ± 1 years of marriage.

Table 1 Distribution of sociodemographic and obstetric characteristics of mothers (n = 248)
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Oxytocin infusion was administered in 54% (n = 134) and episiotomy was performed in 98.8% (n = 245) of the mothers during labor. The duration of labor ranged between 120 and 480 min, and the mean duration of labor was 190.8 ± 107 min. In the study, 69.4% (n = 172) of the mothers had a companion during labor, 51.6% (n = 128) received massage, 91.1% (n = 226) performed breathing exercises, 50% (n = 1224) used a birth ball during labor, 49. 2% (n = 122) took a shower during labor, 9.3% (n = 23) listened to music during labor, and 72.6% (n = 180) were able to move freely during labor. The 1st minute APGAR score of newborns ranged between 7 and 9, with a mean 1st minute APGAR score of 8.9 ± 0.3; the 5th minute APGAR score of newborns ranged between 8 and 10, with a mean 5th minute APGAR score of 9.9 ± 0.3.

BirthMARQ total score ranged between 2 and 6.5 and the mean score was 4.1 ± 0.9. The total score of BSS ranged between 10 and 46 and the mean score was 26.3 ± 5.7. It was determined that the mothers who participated in our study had a moderate level of birth satisfaction. The IOWA total score of the mothers ranged between 31 and 82 and the mean score was 64.3 ± 7.7.

The comparison of the labor monitoring form and IOWA mean scores is given in Table 2. Using a ball during labor had a positive effect on breastfeeding attitude on the 1st day, 1st month, and 3rd month postpartum compared to not using a ball during labor (p < 0.05). Listening to music during labor had a positive effect on breastfeeding attitude on postpartum day 1 (p < 0.05).

Table 2 Comparison of the mean IOWA scores with the labor monitoring form
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A positive statistically weak significant correlation was found between BirthMARQ total score and sensory memory subscale score and IOWA postpartum day 1, month 1, and month 3 scores (p < 0.05, Table 3). There was a positive correlation between the BirthMARQ centrality of memory subscale score and IOWA postpartum 1st day and 1st month scores (p < 0.05, Table 3). There was a significant positive correlation between the BirthMARQ consistency and reliving subscale score and IOWA postpartum 1st month score (p < 0.05, Table 3). A positive statistically weakly significant relationship was found between the BirthMARQ Involuntary recall subscale score and IOWA postpartum day 1 score (p < 0.05, Table 3). No significant correlation was found between the mothers’ BSS and IOWA mean scores on the 1st day, 1st month, and 3rd month (p > 0.05, Table 3).

Table 3 The relationship between the mean IOWA scores of mothers on postpartum day 1, 1st month, and 3rd months and the mean scores of BirthMARQ and its subscales and BSS
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The change between the mean IOWA scores at postpartum day 1, month 1 and month 3 is given in Table 4. A significant difference was found between the measurements of breastfeeding attitude at different times (postpartum day 1, month 1 and month 3) (F(1.073, 264.007) = 90.192; p < 0.001). Breastfeeding attitude at postpartum month 1 and postpartum month 3 was significantly higher than breastfeeding attitude at postpartum day 1 (p < 0.05, Table 4). Breastfeeding attitude at postpartum month 3 was significantly higher than breastfeeding attitude at postpartum month 1 (p < 0.05, Table 4).

Table 4 Change in mean IOWA scores at postpartum day 1, month 1, month 3
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The model summary showing the effect of risk factors on breastfeeding attitude on postpartum day 1, postpartum month 1, and postpartum month 3 is given in Table 4. Backward Linear Regression analysis was applied to show multivariate effects. In the univariate analysis determined as risk factors, BirthMARQ total score, BirthMARQ centrality of memory sub-dimension score, BirthMARQ consistency and reliving” sub-dimension score, BirthMARQ sensory memory” sub-dimension score, BirthMARQ involuntary recall sub-dimension score, use of birth ball, and listening to music were found to be separately effective risk factors on the postpartum day 1 breastfeeding attitude measurement score. As a result of the regression analysis, it is seen that BirthMARQ sensory memory sub-dimension score has a significant effect in the model. The regression model for the effects of risk factors on breastfeeding attitude on postpartum day 1 was significant (F = 6.855, p = 0.001; Table 5) and affected the variance by 5.3%.

Table 5 Regression analysis according to risk factors affecting breastfeeding attitude on postpartum day 1, month 1, and month 3
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In the univariate analysis determined as risk factors, BirthMARQ total score, BirthMARQ centrality of memory sub-dimension score, BirthMARQ consistency and reliving sub-dimension score, BirthMARQ sensory memory sub-dimension score and use of a birth ball were risk factors affecting breastfeeding attitude on the postpartum 1st month measurement score separately. As a result of the regression analysis, it is seen that the use of BirthMARQ consistency and reliving sub-dimension has a significant effect in the model. The regression model for the effects of risk factors on breastfeeding attitude at postpartum month 1 was significant (F = 7.532, p = 0.001; Table 5) and was found to affect the variance by 5.8%.

In the univariate analysis determined as risk factors, BirthMARQ total score, BirthMARQ emotional memory sub-dimension score, BirthMARQ centrality of memory sub-dimension score, BirthMARQ sensory memory sub-dimension score and use of a birth ball were found to be risk factors on the IOWA postpartum 3rd month. As a result of the regression analysis, BirthMARQ sensory memory sub-dimension was found to be a risk factor in the model. The regression model for the effects of risk factors on breastfeeding attitude at postpartum month 3 was significant (F = 4.264, p = 0.015; Table 5) and was found to affect the variance by 3.4%.

Discussion

In this study, the effects of birth memory, recall, and related factors on postpartum mothers’ breastfeeding attitudes were investigated.

Discussing the effect of birth memory on breastfeeding attitudes

Birth is a unique life event for women and their families. Birth experiences that take place in women’s memories can positively or negatively affect women’s life and well-being in the short and long term (Nilvér et al., 2017). In previous studies, the characteristics of birth memories have been associated with the way women process their birth experiences in their memories and their breastfeeding attitudes (Ghanbari-Homayi et al., 2019). In this study, statistical analysis revealed a significant positive correlation between the BirthMARQ total score and the IOWA postpartum day 1, month 1, and month 3 scores. There exist limited studies in the literature on the relationship between the BirthMARQ and the IOWA. In another study, it was reported that breastfeeding rates were negatively affected in women with negative, distressing, and traumatic birth experiences (Türkmen et al., 2020). In another study, a positive birth experience was associated with an increase in the mother’s ability to care for the newborn and self-efficacy for breastfeeding (Smorti et al., 2020).

In our study, mothers’ BirthMARQ “Centrality of Memory” sub-dimension score was positively correlated with their breastfeeding attitudes at day 1 and month 1, but not at month 3. There exist limited studies in the literature on the “Centrality of Memory” sub-dimension. It is thought that interventions for labor, other life experiences of women, and birth expectations may affect the centrality of memory.

In our study, a positive correlation was found between the BirthMARQ “Consistency and Repetition” sub-dimension and mothers’ breastfeeding attitude level at the 1st month postpartum. At the same time, in the regression analysis, the “Consistency and Reliving” subscale was found to be a risk factor for the mother’s breastfeeding attitude. In a prospective study conducted for eight weeks and eight months after birth, it was found that positive memories of the birth experience were formed by memories of the delivery room and the first contact with the newborn, while women who received an intervention during birth experienced feelings of fear and anxiety when they remembered their birth (Pereda-Goikoetxea et al., 2023). In a study, it was reported that breastfeeding success of women who experienced traumatic birth decreased (Gregory, 2023). In the study conducted by Çankaya and Ocaktan, the perception of traumatic birth increased and breastfeeding attitudes decreased in women who developed complications in childbirth, received an intervention during birth, and did not receive midwife support in childbirth (Çankaya & Ocaktan, 2022).

In our study, it was found that the BirthMARQ “Sensory Memory” sub-dimension score and breastfeeding attitude levels of mothers had a positive effect on the 1st day, 1st month and 3rd month postpartum. At the same time, in our regression analysis, it was found to be a risk factor for postpartum day 1 and month 3. There exist limited studies in the literature on the “Sensory Memory” sub-dimension. It is thought that interventions during labor, birth expectations of women, and long duration of labor may affect sensory memory.

In this study, a positive correlation was found between the BirthMARQ “Involuntary Recall” subscale and breastfeeding attitude level on postpartum day 1. In a study comparing traumatic and non-traumatic birth memories, it was reported that mothers who experienced traumatic birth experienced more involuntary recall, reliving, and negative/mixed emotions (Crawley et al., 2018). In another study, it was found that negative birth memory causes more frequent involuntary recall and reliving, affects postpartum psychological well-being, and causes memory irregularities. At the same time, it was stated that negative birth memory causes cesarean delivery and decreased postpartum maternal well-being, and may affect the mother’s parenting adjustment and subsequent pregnancies (Hughes et al., 2020). In a study, it was reported that “emotional memory”, a sub-dimension of the BirthMARQ, positively affected mothers’ maternal function (Çankaya & Akın, 2023). Birth memory, which is negatively affected by traumatic birth experiences, negatively affects breastfeeding attitude in the short and long term.

Discussion of the effect of birth satisfaction on breastfeeding attitudes

Each pregnant woman’s expectation and satisfaction with birth may be positive or negative according to various factors (Mollard & Kupzyk, 2022). Oxytocin infusions, epidural analgesia-anesthesia, frequent use of medical methods, midwife-led births, home-water births, births in single rooms in hospitals, and changes in cesarean section rates can positively or negatively affect the birth experiences and birth satisfaction of pregnant women (Aktas & Pasinlioğlu, 2021). In this study, no statistically significant relationship was found between mothers’ birth satisfaction and breastfeeding attitude. Unlike this result, in a study, it was reported that women’s breastfeeding self-efficacy levels increased in the early postpartum period with increasing labor satisfaction (Amanak et al., 2020). In a study in which breastfeeding was initiated early in the postpartum period, it was determined that birth satisfaction levels were high (Tosun & Taştekin Ouyaba, 2021). In a study, it was reported that perceived postpartum stress negatively affected labor satisfaction and breastfeeding self-efficacy (Gila-Díaz et al., 2020). In a study, it was concluded that pregnant women with high traumatic birth perception had high anxiety levels and low birth satisfaction levels (Coates et al., 2020). In another study, it was observed that women with high levels of birth satisfaction had a reduced risk of posttraumatic stress disorder and postpartum depression (Nakić Radoš et al., 2022). In a study investigating the effect of skin-to-skin contact applied according to the type of delivery on birth satisfaction, women who gave birth normally had higher satisfaction levels immediately and second months after delivery compared to women who gave birth by cesarean section (Kahalon et al., 2021).

Birth satisfaction, which is one of the measures of quality standards in health, has become an important criterion in terms of maintaining maternal and infant health. Positive birth experience and maternal satisfaction are directly proportional to the provision of quality health care services (Çıtak Bilgin et al., 2018). If quality care is provided, both the health levels and mother-infant interaction of mother and baby in the postpartum period are positively affected (Fernández-Arranz et al., 2019; Kahalon et al., 2021; Urbanová et al., 2021). There exist limited studies in the literature in which birth satisfaction and breastfeeding attitude were assessed together. This difference is associated with the fact that the institution where the study was conducted was mother-baby friendly, standardization was ensured in health care practices, and uninterrupted midwife support was provided.

Strengths and limitations

Since the participants were recruited from only one hospital, the results cannot be generalized to the whole country; however, since the hospital is one of the largest hospitals in the province where it is located and many pregnant women and mothers from provinces and districts are referred to the maternity clinic, our results can be generalized to the province, but cannot be generalized to the whole country due to regional and cultural differences.

Conclusion

Women’s positive or negative memories and recollections of past and current childbirth can increase or decrease breastfeeding attitudes over time. It was determined that positive birth memory and recall positively affected mothers’ breastfeeding attitude. Birth satisfaction and breastfeeding attitude of mothers were found to be similar to each other at postpartum day 1, month 1, and month 3. In the regression analysis, it was determined that sensory memory, consistency, and reliving, which are the sub-dimensions of the birth memory and recall scale affecting breastfeeding attitude, were significant associated risk factors for postpartum day 1, consistency and reliving for postpartum month 1, and birth memory and recall for postpartum month 3. The results of the study suggest that midwives should develop a consistent procedure for assessing past and current psychosocial stressors for mothers with negative birth memories. Midwives should closely monitor the postnatal life of mothers with negative birth memories and support them with infant care and breastfeeding. They should help mothers with high traumatic symptoms to see a psychologist or psychiatrist.