Psychological birth trauma and breastfeeding self-efficacy: a parallel mediation model of resilience and bonding

BACKGROUND: Psychological birth trauma (PBT) is associated with early breastfeeding difficulties, but pathways linking PBT to reduced breastfeeding self-efficacy (BSE) remain underexplored. OBJECTIVES: To examine statistical associations among PBT, BSE, mother-infant bonding, and psychological resilience, evaluating bonding and resilience as parallel mediators. METHODS: In this cross-sectional study, 528 postpartum women recruited from a tertiary maternity hospital completed validated scales assessing PBT, BSE, bonding, and resilience. Data were analyzed using bivariate correlations and PROCESS Macro. Parallel mediation revealed significant indirect pathways via bonding (B = -0.070, 95% CI [-0.112, -0.026]) and resilience (B = -0.107, 95% CI [-0.166, -0.057]), with a total indirect effect of B = -0.177 (95% CI [-0.233, -0.121]). The direct association between PBT and BSE remained significant (B = -0.350, 95% CI [-0.435, -0.265]). CONCLUSIONS: PBT, dyadic bonding, and resilience demonstrate robust concurrent associations with initial maternal breastfeeding self-efficacy. While these cross-sectional findings delineate patterns of statistical covariance rather than temporal or causal pathways, they highlight the relevance of integrating relational and intrapersonal screening into early postpartum maternal care.