Mother-infant bonding is not associated with feeding type: A community study sample

Ilana S. Hairston*, Jonathan E. Handelzalts, Tamar Lehman-Inbar, Michal Kovo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Bonding refers to emotions and cognitions towards one's infant. Breastfeeding is believed to facilitate bonding, yet only a handful of studies have empirically tested this assertion. This study aimed to confirm whether a positive association between breastfeeding and bonding exists and whether breastfeeding may be protective against the negative consequences of mood and sleep disturbances on bonding. Method: A cross-sectional survey was administered to a convenience sample of Israeli mothers of infants ages 1-9 months. The main outcome measures were breastfeeding history, bonding (Postpartum Bonding Questionnaire, PBQ), mood (Edinburgh Postnatal Depression Scale, EPDS) and sleep (Pittsburgh Sleep Quality Index, PSQI). Results: Two hundred seventy-one mothers (21-46 years) completed the survey. 65.7% reported current breastfeeding, 22.1% past breastfeeding, 12.2% never nursed. The PBQ correlated with both the EPDS and PSQI. Breastfeeding was associated with greater daytime fatigue, but not with any other sleep problem, and was not associated with bonding. This negative result was confirmed with Bayesian analysis demonstrating that the probability for the null hypothesis was 4.5 times greater than the hypothesized effect. Further, hierarchical regression revealed a positive relationship between bonding, daytime fatigue and depression symptoms only among women who were currently breastfeeding. Conclusions: These findings suggest that among healthy mothers, breastfeeding may not be a central factor in mother-infant bonding, nor is it protective against the negative impact of mood symptoms and bonding difficulties. Theoretical and methodological bases of these findings are discussed.

Original languageEnglish
Article number125
JournalBMC Pregnancy and Childbirth
Issue number1
StatePublished - 11 Apr 2019


  • Bayesian statistics
  • Nursing
  • Postpartum depression
  • Sleep disturbances


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