Cite as: Bick, D. and Chang, YS. (2014) Maternal extraversion, emotional stability and
conscientiousness are associated with initiation and continuation of breastfeeding.
Commentary. Evidence Based Nursing July 11. doi: 10.1136/eb-2014-101872. [Epub
ahead of print]
Title: Maternal extraversion, emotional stability and conscientiousness are associated
with initiation and continuation of breastfeeding
Authors: Debra Bick and Yan-Shing Chang
King’s College London, Florence Nightingale School of Nursing and Midwifery
Correspondence to: Professor Debra Bick, King’s College London, Florence
Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57
Waterloo Road, London SE1 8WA, UK; debra.bick@kcl.ac.uk
Commentary on: Brown A. Maternal trait personality and breastfeeding duration: the
importance of confidence and social support. J Adv Nurs 2014;70:587-98.
Category: Midwifery
Study type: Cross-sectional study
Implications for practice and research
 Understanding maternal trait personality could inform targeted interventions for
women identified as requiring additional breastfeeding support and help to
facilitate discussion of barriers to breastfeeding
 Further research is needed to explore the impact of maternal personality on
effectiveness of interventions designed to increase coping strategies and
influence of social networks among women who wish to commence and continue
to breastfeed.
Context
It is well established that influences on breastfeeding initiation and duration are multifactorial. These include socio-demographic factors, environmental context, maternal
confidence and self-efficacy, social and emotional support, personality, and beliefs about
benefits of breastfeeding.1,2,3 Although some empirical studies have suggested that
personality is associated with infant-feeding decisions, these have tended to be smallscale, undertaken in non-UK populations and limited to breastfeeding intent.2,3 This
exploratory study conducted in the UK by Brown examined associations between
maternal personality and attitudes, breastfeeding initiation, and duration and
experiences of breastfeeding.
Methods
A cross-sectional survey approach was used. A self-selected sample of 602 women with
infants aged 6 to 12 months completed self-report inventories on personality and
attitudes towards breastfeeding. Women were recruited from local mother and baby
groups, or via adverts placed on online parenting forums in the UK. Participants were
asked to self-report duration of breastfeeding, with those who breastfed for less than 6
months asked to indicate reasons for stopping from a series of questions examining
why. Participants’ demographic information including age, education, marital status,
occupation and parity (eg primiparity) was also collected. An exploratory factor analysis
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was used to identify key themes. Further analyses were used to determine which
variables should be retained for entry into a multiple analysis of variance. Data were
transformed to enable parametric rather than non-parametric tests to be run, although
some aspects of the data indicated that without transformation they did not meet
accepted criteria for parametric tests.
Findings
Maternal personality trait was associated with breastfeeding initiation and duration.
Women who were introverted or had high levels of trait anxiety were less likely to initiate
and continue breastfeeding. Maternal introversion and anxiety may affect women’s
ability to breastfeed successfully. These personality traits were associated with social
and psychological variables known to predict low breastfeeding duration. For example,
women self-reported to have high levels of introversion were more likely to stop
breastfeeding because of feeling embarrassed, or feeling pressured by others to stop
breastfeeding.
Commentary
This was an exploratory cross-sectional study and caution should be applied to findings.
Nevertheless, some important issues were raised with respect to the potential influence
of maternal personality traits on infant feeding decisions.
The study included a reasonably large sample of women, although participants were
self-selected and did not appear to be representative of a cross-section of UK women.
The personality inventory also required self-report. These aspects may limit the reliability
of information provided, as women who breastfed or experienced breastfeeding
difficulties may have been more likely to participate in the study. Moreover, the author
did not include measures of other factors which could have acted as confounders on
outcomes over time, such as maternal mental and physical health and perceived level of
social support—factors which may be associated with higher levels of anxiety.
The statistical analyses seemed thorough, although the number of corrections for skew
and the need for some data to be transformed may limit the reliability of findings. While
future research should consider including these measures, it would also seem important
to include trained researchers’ observations to determine women’s personality traits. The
translation and implementation of findings into practice would have to be considered, as
would potential for such an intervention to influence other aspects of maternal health
behaviour, including smoking and diet, as well as potential to generate further
introversion and anxiety if women feel under pressure to breastfeed.
Overall this was an interesting study in a complex health area, but more work is needed
to find out how reliable personality measurements are, and whether current study
findings could be replicated in a larger, more representative sample of women. It is also
important to consider how women who were more anxious and introverted could be
effectively helped to develop positive attitudes towards breastfeeding, taking
experiences and social environment into consideration.
References
1. Meedya S, Fahy K, Kable A. Factors that positively influence breastfeeding
duration to 6 months: a literature review. Women Birth 2010;23:135-45.
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2. Kearney MH. Identifying psychosocial obstacles to breastfeeding success. J
Obstet Gynecol Neonatal Nurs 1988;17:98-105.
3. Wagner CL, Wagner MT, Ebeling M, et al. The role of personality and other
factors in a mother’s decision to initiate breastfeeding. J Hum Lact 2006;22:1626.
Competing interests
None
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