Effects of perinatal depression on early breastfeeding: the role of childbirth experience

BACKGROUND: Perinatal depression is a common mood disorder that can negatively affect maternal health and early mother-infant interactions, including breastfeeding practices. Although depression has been linked to lower breastfeeding initiation and duration, the mechanisms underlying this relationship remain poorly understood. Childbirth experience-a subjective psychological response to labor and delivery-may play a key mediating role, yet limited research has examined this pathway in the early postpartum period. This study aimed to understand the mediating effect of childbirth experience on the correlation between perinatal depression and early breastfeeding behavior. METHODS: One hundred and one puerpera with natural childbirth were enrolled at the Lianyungang Maternity and Child Health Hospital during September and October 2022 through convenient sampling. Questionnaires were completed within three days postpartum. We investigated the demographic characteristics and early breastfeeding behaviors and measured the childbirth experience and perinatal depression levels using the Childbirth Experience Questionnaire (CEQ 2.0) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Pearson correlation analysis and T-tests were used to explore their early-stage correlation, and the mediating effect of the childbirth experience was analyzed using Bootstrap. RESULTS: Childbirth experience had a negative correlation with perinatal depression (r = -0.217, P < 0.05). T-test results indicated a significant relationship between early breastfeeding behavior, perinatal depression level, and childbirth experience (P < 0.05). Mediation analysis revealed that childbirth experience accounted for 39.9% of the total effect of perinatal depression on early breastfeeding behavior, indicating partial mediation. However, perinatal depression remained directly and significantly associated with early breastfeeding behavior after accounting for the mediator (P < 0.05). CONCLUSIONS: Childbirth experience partially mediates the relationship between perinatal depression and early breastfeeding behavior. These findings suggest an association rather than a causal relationship, and highlight the importance of addressing both psychological well-being and childbirth experiences in clinical settings to promote breastfeeding.