Understanding the Interaction Between Infant Feeding and Maternal Mental Health and Well-Being in Women who Experience Psychological Birth Trauma: A Scoping Review Protocol

Roisin O'Donovan; Zhuming Bao; Elaine Lehane; Aoife Long; Karen Matvienko-Sikar; Helen Mulcahy; Margaret Murphy; Orla Sheehan; Siobhan Ward; Patricia Leahy-Warren

doi:10.12688/hrbopenres.14414.1

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Study Protocol

Understanding the Interaction Between Infant Feeding and Maternal Mental Health and Well-Being in Women who Experience Psychological Birth Trauma: A Scoping Review Protocol

[version 1; peer review: 2 approved]

Roisin O'Donovan ¹, Zhuming Bao¹, Elaine Lehane¹, [...] Aoife Long¹, Karen Matvienko-Sikar², Helen Mulcahy¹, Margaret Murphy¹, Orla Sheehan¹, Siobhan Ward³, Patricia Leahy-Warren¹

Roisin O'Donovan ¹, Zhuming Bao¹, [...] Elaine Lehane¹, Aoife Long¹, Karen Matvienko-Sikar², Helen Mulcahy¹, Margaret Murphy¹, Orla Sheehan¹, Siobhan Ward³, Patricia Leahy-Warren¹

PUBLISHED 21 Apr 2026

Author details Author details

¹ University College Cork School of Nursing and Midwifery, Cork, County Cork, Ireland
² University College Cork School of Public Health, Cork, County Cork, Ireland
³ La Leche League Ireland, Cork, Ireland

Roisin O'Donovan
Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Zhuming Bao
Roles: Formal Analysis, Methodology, Validation, Writing – Review & Editing

Elaine Lehane
Roles: Formal Analysis, Methodology, Supervision, Validation, Writing – Review & Editing

Aoife Long
Roles: Writing – Review & Editing

Karen Matvienko-Sikar
Roles: Methodology, Writing – Review & Editing

Helen Mulcahy
Roles: Methodology, Writing – Review & Editing

Margaret Murphy
Roles: Writing – Review & Editing

Orla Sheehan
Roles: Formal Analysis, Methodology, Validation, Writing – Review & Editing

Siobhan Ward
Roles: Writing – Review & Editing

Patricia Leahy-Warren
Roles: Conceptualization, Methodology, Resources, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Objective

To review the literature to understand women’s experiences of and the interactions between infant feeding, mental health and wellbeing following psychological birth trauma.

Introduction

Childbirth can be a traumatic experience for some women and can ultimately only be defined by the woman experiencing it. Birth trauma leads to negative mental health and wellbeing outcomes for women, their children and their partners. Impacts on maternal mental health and wellbeing include post-traumatic stress disorder (PTSD), post-partum depression (PPD) and bonding issues but also potential for post-traumatic growth (PTG). Traumatic births can have a negative impact on breastfeeding experiences due to poorer maternal physical and psychological wellbeing. If breastfeeding does not go as planned, it can be associated with a sense of failure, guilt or shame. Therefore, infant feeding experiences may have the potential to either heal or compound the impact of traumatic births on maternal mental health and well-being.

Methods

The guidelines for scoping reviews from the JBI Manual for Evidence Synthesis will be followed. A key word search strategy will be used to search: Academic Search Complete; APA PsychInfo; MEDLINE; CINAHL and APA PsychArticles databases; Google scholar, Bielefeld Academic Search Engine (BASE) and the National Institute for Health and Care Excellence (NICE) website. English language and date restrictions (2000-current) will be used. Studies will be screened in Covidence by two independent reviewers. Titles and abstracts and full-text articles will be independently screened by two reviewers. Data will be extracted and presented graphically using figures and tables. Narrative summary text will accompany the tables and figures.

Conclusion

Given the potential for infant feeding experiences to either heal or compound the impact psychological birth trauma on maternal mental health and wellbeing, it is important to understand women’s experiences of these three constructs and how they interact with one another.

Keywords

Traumatic Birth; Infant feeding; Maternal Mental Health; Well-Being; Post-Traumatic Growth

Corresponding author: Roisin O'Donovan

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2026 O'Donovan R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: O'Donovan R, Bao Z, Lehane E et al. Understanding the Interaction Between Infant Feeding and Maternal Mental Health and Well-Being in Women who Experience Psychological Birth Trauma: A Scoping Review Protocol [version 1; peer review: 2 approved]. HRB Open Res 2026, 9:39 (https://doi.org/10.12688/hrbopenres.14414.1) First published: 21 Apr 2026, 9:39 (https://doi.org/10.12688/hrbopenres.14414.1) Latest published: 21 Apr 2026, 9:39 (https://doi.org/10.12688/hrbopenres.14414.1)

Introduction

Childbirth can be a traumatic experience for some women (Shorey & Wong, 2022). A traumatic birth experience can include objective birth experiences such as operative birth (Chan et al., 2020), preterm birth (Dikmen-Yildiz et al., 2018), or childbirth complications (Chan et al., 2020). They also include the trauma of perinatal loss, including miscarriage and stillbirths (Berry, 2022). Given the subjective nature of the birth experience, a traumatic birth can ultimately only be defined by the woman experiencing it (Beck, 2004; Sun et al., 2023). A concept analysis based on 44 studies published between 2002–2022 defined the concept of psychological birth trauma as including the following attributes: (1) Women’s subjective feelings; (2) Intertwined painful emotional experiences; (3) Originate in the birth process; (4) Last until postpartum. Within this conceptualisation, psychological birth trauma emphasises women’s subjective experiences above the objective aspects of the birth process. The same events that occur during birth are perceived differently by every woman and childbirth that appears normal and straightforward to healthcare professionals can be perceived as traumatic by the woman (Sun et al., 2023).

Psychological birth trauma can lead to negative mental health and relationship outcomes for women, their children and their partners (Alcorn et al., 2010; Ayers, 2017; de Graaff et al., 2018; Leinweber et al., 2022; Shorey & Wong, 2022). The experience of a traumatic birth is associated with difficult emotions for women such as feeling like a “bad” mother, struggling to bond with their baby as well as postpartum anxiety, postpartum depression (PPD), and post-traumatic stress disorder (PTSD) (Ayers et al., 2016; Frankham et al., 2023; Leach et al., 2017). These experiences bring added challenges to what is already a vulnerable transitional time for women (Huschke et al., 2020; Molloy et al., 2021; World Health Organization, 2022). The cost of untreated maternal mental illness impacts both families and society as a whole (Make Mothers Matter, 2023). It therefore represents a significant public health problem. International prevalence rates for PTSD are between 3 and 4.7% (Grekin & O’Hara, 2014; Heyne et al., 2022; Yildiz et al., 2017). Despite the prevalence and impact of maternal mental health issues, most women globally do not receive the care and support they need (World Health Organization, 2022) and perinatal mental health conditions are still under recognised and undertreated (Wilson et al., 2024).

While birth trauma is associated with adverse outcomes, there is also potential for post-traumatic growth (PTG) to occur following psychological birth trauma. This is a positive psychological change that can occur alongside the distress associated with challenging life circumstances (Beck et al., 2018; Beck & Watson, 2016; Tedeschi & Calhoun, 2004). PTG consists of five dimensions: appreciation of life, relating to others, personal strength, new possibilities, and spiritual change (Tedeschi & Calhoun, 2004). PTG can occur following psychological birth trauma and can lead to increased self-confidence and pride, better relationship with partners, friends, children, and stronger faith and a better reported understanding of spiritual and religious matters (Beck & Watson, 2016; Ketley et al., 2024). At a societal level, giving voice to birth stories that include both trauma and PTG may contribute to the development of varied and positive narratives around birth (Ketley et al., 2024).

Traumatic births can have a negative impact on postpartum infant feeding experiences, including breastfeeding, Commercial Milk Formula feeding or combination feeding experiences due to poorer maternal physical and psychological wellbeing (Norman et al., 2022, 2025). Both postnatal PTSD and PPD are associated with lower breastfeeding initiation and duration rates (Cook et al., 2018; Garthus-Niegel et al., 2018). If breastfeeding does not go as planned, it can be associated with challenges, including breastfeeding grief (Aderibigbe, 2026), a sense of failure, guilt or shame (Jackson et al., 2021; Leeming et al., 2022). However, breastfeeding can also contribute to physical and psychological benefits for both mothers and babies, such as improved mother-infant bonding, increased maternal confidence, and reduced risk of infection, cancer and diabetes (Del Ciampo & Del Ciampo, 2018; Scarborough et al., 2022). Therefore, it is also important to consider the role infant feeding experiences might play in fostering PTG following psychological birth trauma.

To date, there has been limited research exploring the interactions between infant feeding experiences and maternal mental health and wellbeing outcomes in women who experience psychological birth trauma. Infant feeding experiences have the potential to either heal or compound the impact psychological birth trauma can have on maternal mental health and wellbeing outcomes. Therefore, it is important to understand women’s experiences of these three constructs and how they interact with one another in order to support infant feeding and maternal mental health and wellbeing in women with psychological birth trauma.

Objective

This scoping review will explore the breadth and nature of the experiences of and interactions between infant feeding experiences, maternal mental health and well-being in women who experience psychological birth trauma. It will seek to understand women’s experiences of infant feeding and maternal mental health and wellbeing following psychological birth trauma, identify proposed mechanisms and conceptual pathways, and highlight gaps for future research.

Research questions

The overarching research question for this review is: What is the current evidence explaining the interactions between infant feeding experiences and maternal mental health and well-being outcomes in women who experience psychological birth trauma? We will seek to understand and gain insight into: a) what experiences support maternal wellbeing (including PTG) following psychological birth trauma? And b) how have women’s narratives related to their experiences infant feeding and mental health and wellbeing following psychological birth trauma been shared and presented within the literature?

Methods and analysis

Design

This review will follow Joanna Briggs Institute (JBI) guidelines for scoping reviews (Peters et al., 2020). It will be reported in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) extension for scoping reviews, PRISMA-ScR (Tricco et al., 2018).

Inclusion criteria

Any study examining or exploring interactions between traumatic birth, infant feeding and maternal mental health and well-being outcomes. Studies will only be included if the participants have reported experience of birth trauma. Reviews published in English since 2000 will be considered for inclusion. This date restriction was chosen based on the dates of studies identified in a recent conceptual analysis on psychological birth trauma (Sun et al., 2023).

Participants

Any birthing person who has experienced a traumatic birth.

Phenomena of interest

This review is focused on: psychological birth trauma (women’s subjective feelings of having a traumatic birth experience with intertwined painful emotional experiences that originate in the birth process and last until postpartum), infant feeding experiences (including breastfeeding, bottle feeding or combination feeding) and maternal mental health (diagnosed or self-reported mental health symptoms including PTSD, Postnatal Depression and anxiety) and well-being (self-reported or measured mental wellbeing including post traumatic growth) outcomes.

Outcomes

Infant feeding experiences and maternal mental health and well-being outcomes in women with experience of psychological birth trauma.

Context/Setting

Studies conducted in any setting or context will be eligible for inclusion.

Types of studies

Any peer reviewed study, including qualitative, quantitative or mixed methods, examining or exploring the interaction or relationship between traumatic birth, infant feeding and maternal mental health and well-being outcomes. Identified reviews, including systematic review, scoping review or meta-analysis, will not be included but their reference lists will be searched, and relevant peer reviewed studies will be extracted and assessed for inclusion.

Exclusion criteria

Studies that do not report on the interaction between women’s experiences of birth trauma, infant feeding and maternal mental health outcomes together. Studies not available in English.

Search strategy

A three- phase search process will be used to locate both published and unpublished studies (Aromataris et al., 2024). An initial search was carried out on Academic Search Complete; APA PsychInfo; MEDLINE; CINAHL and APA PsychArticles to identify articles on the topic. The initial keywords are informed by the relevant identified studies and by a recent concept analysis of psychological birth trauma (Sun et al., 2023).

A full search strategy was then developed and reviewed by topic experts and knowledge users who are professionals in this area ( Tables 1 and 2).

Table 1. Developing the search strategy.

Search concepts	Birth trauma	Infant feeding	Maternal mental health outcomes
Search terms	“Trauma* birth” OR “birth trauma” OR “trauma* labour” OR “trauma labor” OR “labor trauma” OR “labour trauma” OR “Psychological birth trauma” OR “traumatic childbirth,” OR “traumatic delivery” OR “childbirth trauma” OR “delivery trauma”	Breastfeeding OR Breast-feeding OR Breastfeed OR Breast-feed OR Breastfed OR Breast-fed OR Lactation OR “Infant feed*” OR Infant-fed OR “Breastfeeding support” OR “Formula Fed” OR “Formula Feeding” OR “Commercial Milk Formula” OR “Bottle fed” OR “Bottle feeding”	“Post-traumatic Stress Disorder” OR “Postnatal Post-traumatic Stress Disorder” OR PTSD OR “Postnatal PTSD” OR Depression OR “Postnatal Depression” OR “Postpartum Depression” OR “Post-partum Depression” OR “Post partum Depression” OR “Post-natal Depression” OR PPD OR “Depressive Symptoms” OR Symptoms of depression” OR “Anxiety” OR “Anxiety Symptoms” OR “Symptoms of anxiety” OR “Anxiety Disorder” OR Wellbeing OR “mental health” OR “Post-Traumatic Growth” OR “posttraumatic growth” OR PTG

Table 2. Search strategy.

Search	Query
#1	Title/Abstract: “Trauma* birth” OR “birth trauma” OR “trauma* labour” OR “trauma labor” OR “labor trauma” OR “labour trauma” OR “Psychological birth trauma” OR “traumatic childbirth,” OR “traumatic delivery” OR “childbirth trauma” OR “delivery trauma”
#2	Title/Abstract: Breastfeeding OR Breast-feeding OR Breastfeed OR Breast-feed OR Breastfed OR Breast-fed OR Lactation OR “Infant feed*” OR Infant-fed OR “Breastfeeding support” OR “Formula Fed” OR “Formula Feeding” OR “Commercial Milk Formula” OR “Bottle fed” OR “Bottle feeding”
#3	“Post-traumatic Stress Disorder” OR “Postnatal Post-traumatic Stress Disorder” OR PTSD OR “Postnatal PTSD” OR Depression OR “Postnatal Depression” OR “Postpartum Depression” OR “Post-partum Depression” OR “Post partum Depression” OR “Post-natal Depression” OR PPD OR “Depressive Symptoms” OR Symptoms of depression” OR “Anxiety” OR “Anxiety Symptoms” OR “Symptoms of anxiety” OR “Anxiety Disorder” OR Wellbeing OR “mental health” OR “Post-Traumatic Growth” OR “posttraumatic growth” OR PTG
#4	#1 AND #2 AND #3
Limits	2000-present

Database-specific searches will be conducted for Academic Search Complete; APA PsychInfo; MEDLINE; CINAHL and APA PsychArticles. A grey literature search will be undertaken on Google scholar, BASE and the National Institute for Health and Care Excellence (NICE) website. The reference list of all included reviews will be searched manually for studies that meet inclusion criteria. Date restrictions (2000-current) will be used. One full search has been included in this protocol ( Table 3).

Table 3. Full sample search string for APA PsychInfo.

Search	Query	Records retrieved
#1	Title/Abstract: “Trauma* birth” OR “birth trauma” OR “trauma* labour” OR “trauma labor” OR “labor trauma” OR “labour trauma” OR “Psychological birth trauma” OR “traumatic childbirth,” OR “traumatic delivery” OR “childbirth trauma” OR “delivery trauma”	574
#2	Title/Abstract: Breastfeeding OR Breast-feeding OR Breastfeed OR Breast-feed OR Breastfed OR Breast-fed OR Lactation OR “Infant feed*” OR Infant-fed OR “Breastfeeding support” OR “Formula Fed” OR “Formula Feeding” OR “Commercial Milk Formula” OR “Bottle fed” OR “Bottle feeding”	10,039
#3	Title/Abstract: “Post-traumatic Stress Disorder” OR “Postnatal Post-traumatic Stress Disorder” OR PTSD OR “Postnatal PTSD” OR Depression OR “Postnatal Depression” OR “Postpartum Depression” OR “Post-partum Depression” OR “Post partum Depression” OR “Post-natal Depression” OR PPD OR “Depressive Symptoms” OR Symptoms of depression” OR “Anxiety” OR “Anxiety Symptoms” OR “Symptoms of anxiety” OR “Anxiety Disorder” OR Wellbeing OR “mental health” OR “Post-Traumatic Growth” OR “posttraumatic growth” OR PTG	379,109
#4	#1 AND #2 AND #3	15
Limits	2000-present

Screening

All identified articles will be uploaded to Covidence. Duplicates will be removed. Title and abstracts of the remaining articles will be screened by two independent reviewers. The full text of all articles that meet the inclusion criteria will then be reviewed and screened by two independent reviewers on Covidence. If there are any disagreements between reviewers during the screening process, a third reviewer will assess the relevant records, and consensus will be reached on eligibility through discussion. Reasons for article exclusion will be reported. Results of the screening process will be presented in a PRISMA flow diagram (Tricco et al., 2018).

Data extraction

Data extraction will be conducted by two independent reviewers using a data extraction template that will be adapted by reviewers based on the standardised JBI data extraction tools, the review objectives and research questions ( Table 4). The data extraction tool will be piloted and revised before use and during the process of data extraction, if needed. If disagreements arise between reviewers during data extraction, they will be resolved through discussion or with a third reviewer. If necessary, authors of papers will be contacted to request missing or additional information.

Table 4. Data extraction instrument.

Author/Year

Objectives

Participants (characteristics/total number)

Setting/context

Study appraisal rating

Definition of traumatic birth

Definition and measurement of infant feeding experience

Definition and measurement of mental health outcome

Results: Experiences of and Interactions between traumatic birth, infant feeding and maternal mental health outcome(s)

Women’s narratives around experiences a birth trauma, infant feeding and maternal mental health and wellbeing

Quality assessment

Given that this scoping review aims to map the nature and extent of available evidence in relation to the interaction between birth trauma, infant feeding experiences and maternal mental health and wellbeing and will not be assessing intervention effectiveness or strength of associations, a quality assessment will not be necessary (Peters et al., 2020).

Data analysis

The information captured by the data extraction tool will be mapped and summarised according to the aims and objectives of this review. The included studies will be summarised based on the studies’ characteristics, including the year, study aim and objectives, participants, and context.

Narrative summaries will outline the identified interactions between traumatic birth experiences, infant feeding experiences and maternal mental health outcomes. This information will be analysed to identify key themes and findings across the included studies. Where suitable, data will be presented graphically using figures and tables. Narrative summaries will explain the results presented in all figures and tables.

A reflexive approach will be adopted throughout the review process. The reviewers will critically reflect on the selection of studies, interpretation of the literature and the potential biases inherent in the synthesis process. Reflexivity will involve the reviewers’ being transparent about their perspectives, decisions made during the review process, and how these may influence findings. A reflexive statement will be included in the review discussing these considerations to provide a richer understanding of the choices made and how these may shape the conclusions drawn.

Data summary

A narrative synthesis will be presented to summarise the relationships and interactions between infant feeding experiences and maternal mental health outcomes in women who have experienced psychological birth trauma. The results of the review will inform our understanding of women’s experience of infant feeding and mental health and wellbeing following a traumatic birth, future research and our understanding of how the interactions between infant feeding experiences and maternal mental and wellbeing health can be harnessed to improve outcomes for women who experience psychological birth trauma.

Data availability

This is a scoping review protocol and does not have any associated data.

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Version 1

VERSION 1 PUBLISHED 21 Apr 2026

Author details Author details

¹ University College Cork School of Nursing and Midwifery, Cork, County Cork, Ireland
² University College Cork School of Public Health, Cork, County Cork, Ireland
³ La Leche League Ireland, Cork, Ireland

Roisin O'Donovan
Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Zhuming Bao
Roles: Formal Analysis, Methodology, Validation, Writing – Review & Editing

Elaine Lehane
Roles: Formal Analysis, Methodology, Supervision, Validation, Writing – Review & Editing

Aoife Long
Roles: Writing – Review & Editing

Karen Matvienko-Sikar
Roles: Methodology, Writing – Review & Editing

Helen Mulcahy
Roles: Methodology, Writing – Review & Editing

Margaret Murphy
Roles: Writing – Review & Editing

Orla Sheehan
Roles: Formal Analysis, Methodology, Validation, Writing – Review & Editing

Siobhan Ward
Roles: Writing – Review & Editing

Patricia Leahy-Warren
Roles: Conceptualization, Methodology, Resources, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

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Published: 21 Apr 2026, 9:39

https://doi.org/10.12688/hrbopenres.14414.1

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© 2026 O'Donovan R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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O'Donovan R, Bao Z, Lehane E et al. Understanding the Interaction Between Infant Feeding and Maternal Mental Health and Well-Being in Women who Experience Psychological Birth Trauma: A Scoping Review Protocol [version 1; peer review: 2 approved]. HRB Open Res 2026, 9:39 (https://doi.org/10.12688/hrbopenres.14414.1)

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Reviewer Report 08 Jun 2026

Susanna Foxworthy Scott, Butler University, Indianapolis, Indiana, USA

Approved

https://doi.org/10.21956/hrbopenres.15878.r55493

This is a well-developed protocol addressing an important and underexplored relationship between infant feeding and traumatic birth. The section on post-traumatic growth (PTG) was a particular strength.

One area that could further enrich the background is the ... Continue reading

This is a well-developed protocol addressing an important and underexplored relationship between infant feeding and traumatic birth. The section on post-traumatic growth (PTG) was a particular strength.

One area that could further enrich the background is the relationship between traumatic birth and physiological low milk production, specifically, the disruption of lactogenesis II that can follow complicated or traumatic deliveries. Acknowledging this mechanistic pathway alongside the psychological dimensions would strengthen the theoretical grounding of the review. The authors may also wish to consider whether including search terminology related to delayed lactogenesis and intrapartum factors affecting milk onset would meaningfully expand the yield of included studies.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: health communication, low milk supply, lactation, birth narratives

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report 03 Jun 2026

Sarah Myers, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany

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https://doi.org/10.21956/hrbopenres.15878.r55222

I think this is an interesting and important topic. I offer some thoughts which the authors may wish to consider when approaching the scoping review and I hope they find useful, but broadly speaking the methodology appears sound and the ... Continue reading

I think this is an interesting and important topic. I offer some thoughts which the authors may wish to consider when approaching the scoping review and I hope they find useful, but broadly speaking the methodology appears sound and the outcome will be a useful step in the literature.

While I find the need for such a scoping review compelling, I do find the framing somewhat limited. The authors state that their goal is to “understand women’s experiences of these three constructs”, the constructs being infant feeding, psychological birth trauma, and mental health; however, positive infant feeding experience/outcomes appear to primarily framed in terms of breastfeeding. To lead with an assumption of breastfeeding being the default intention of birthing individuals and that birth trauma will only meaningfully disrupt the experience of breastfeeding, is to ignore the experiences of those who did not ever wish to breastfeed and those whose decision to switch to formula/combined feeding is not experienced as negative per se, but rather their subsequent experience of formula is (which is common in the absence of birth trauma: Myers, S., Page, A.E. and Emmott, E.H., 2021. The differential role of practical and emotional support in infant feeding experience in the UK. Philosophical Transactions of the Royal Society B: Biological Sciences, 376(1827)). I also see the potential to misattribute the cessation of breastfeeding to trauma, if it is assumed that it would otherwise have continued, when in fact at a country level it is not uncommon for the majority of infants to not exclusively breastfeed for the WHO recommended period. Moreover, while I do not doubt that there are benefits associated with breastfeeding, there are also costs and it is not always what is best for the birthing parent – I would also note that Del Ciampo and Del Ciampo (2018) is not a confidence inspiring citation, having no methodology and a clear agenda. I appreciate that the authors state they will take a reflexive approach and this is to be encouraged, particularly when it is the lived experiences of those suffering birth trauma that should be foregrounded; however, it would have been nice to see a little more of this in the opening set up too.

I would caution against implying causality when it comes to the correlations found between the three constructs in quantitative studies. The vast majority of quantitative research in this area has not been conducted in a manner the permits causal inference and much of it is reported in such a way as to make any reported correlations/associations uninterpretable – if an identified paper does not employ methodology incorporating causal modelling/directed acyclic graphs/potential outcomes then its results should be treated with extreme caution (see: Tennant, P.W., Murray, E.J., Arnold, K.F., Berrie, L., Fox, M.P., Gadd, S.C., Harrison, W.J., Keeble, C., Ranker, L.R., Textor, J. and Tomova, G.D., 2021. Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations. International journal of epidemiology, 50(2), pp.620-632)).

Following on from this point, I would be inclined to disagree that quality assessment is not required; while exclusion on the basis of perceived quality is perhaps not warranted (particularly given the limited number of articles covering all three concepts), quality is important when considering evidence availability. A quantitative paper reporting confounded statistical modelling is potentially indicative of limited to no evidence (though it may contain useful data if open access); to consider such a paper as reporting evidence of equal value to a statistically robust paper or a nuanced qualitative study is at best to overstate the available evidence, and at worst to embed misguided interpretations into the literature.

Finally, please note I responded ‘partly’ to the question ‘Are sufficient details of the methods provided to allow replication by others?’ simply because elements of the methodology, e.g. data extraction, can only be fully described in the final study’s presentation – it is not a criticism.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Infant feeding, postnatal depression, social support, quantitative methods, causal inference.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Sarah Myers, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
Susanna Foxworthy Scott, Butler University, Indianapolis, USA

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08 Jun 2026 | for Version 1

Susanna Foxworthy Scott, Butler University, Indianapolis, Indiana, USA

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Approved

This is a well-developed protocol addressing an important and underexplored relationship between infant feeding and traumatic birth. The section on post-traumatic growth (PTG) was a particular strength.

One area that could further enrich the background is the relationship between traumatic birth and physiological low milk production, specifically, the disruption of lactogenesis II that can follow complicated or traumatic deliveries. Acknowledging this mechanistic pathway alongside the psychological dimensions would strengthen the theoretical grounding of the review. The authors may also wish to consider whether including search terminology related to delayed lactogenesis and intrapartum factors affecting milk onset would meaningfully expand the yield of included studies.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

health communication, low milk supply, lactation, birth narratives

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

1 Views

03 Jun 2026 | for Version 1

Sarah Myers, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany

1 Views Cite this report Responses(0)

Approved

I think this is an interesting and important topic. I offer some thoughts which the authors may wish to consider when approaching the scoping review and I hope they find useful, but broadly speaking the methodology appears sound and the outcome will be a useful step in the literature.

While I find the need for such a scoping review compelling, I do find the framing somewhat limited. The authors state that their goal is to “understand women’s experiences of these three constructs”, the constructs being infant feeding, psychological birth trauma, and mental health; however, positive infant feeding experience/outcomes appear to primarily framed in terms of breastfeeding. To lead with an assumption of breastfeeding being the default intention of birthing individuals and that birth trauma will only meaningfully disrupt the experience of breastfeeding, is to ignore the experiences of those who did not ever wish to breastfeed and those whose decision to switch to formula/combined feeding is not experienced as negative per se, but rather their subsequent experience of formula is (which is common in the absence of birth trauma: Myers, S., Page, A.E. and Emmott, E.H., 2021. The differential role of practical and emotional support in infant feeding experience in the UK. Philosophical Transactions of the Royal Society B: Biological Sciences, 376(1827)). I also see the potential to misattribute the cessation of breastfeeding to trauma, if it is assumed that it would otherwise have continued, when in fact at a country level it is not uncommon for the majority of infants to not exclusively breastfeed for the WHO recommended period. Moreover, while I do not doubt that there are benefits associated with breastfeeding, there are also costs and it is not always what is best for the birthing parent – I would also note that Del Ciampo and Del Ciampo (2018) is not a confidence inspiring citation, having no methodology and a clear agenda. I appreciate that the authors state they will take a reflexive approach and this is to be encouraged, particularly when it is the lived experiences of those suffering birth trauma that should be foregrounded; however, it would have been nice to see a little more of this in the opening set up too.

I would caution against implying causality when it comes to the correlations found between the three constructs in quantitative studies. The vast majority of quantitative research in this area has not been conducted in a manner the permits causal inference and much of it is reported in such a way as to make any reported correlations/associations uninterpretable – if an identified paper does not employ methodology incorporating causal modelling/directed acyclic graphs/potential outcomes then its results should be treated with extreme caution (see: Tennant, P.W., Murray, E.J., Arnold, K.F., Berrie, L., Fox, M.P., Gadd, S.C., Harrison, W.J., Keeble, C., Ranker, L.R., Textor, J. and Tomova, G.D., 2021. Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations. International journal of epidemiology, 50(2), pp.620-632)).

Following on from this point, I would be inclined to disagree that quality assessment is not required; while exclusion on the basis of perceived quality is perhaps not warranted (particularly given the limited number of articles covering all three concepts), quality is important when considering evidence availability. A quantitative paper reporting confounded statistical modelling is potentially indicative of limited to no evidence (though it may contain useful data if open access); to consider such a paper as reporting evidence of equal value to a statistically robust paper or a nuanced qualitative study is at best to overstate the available evidence, and at worst to embed misguided interpretations into the literature.

Finally, please note I responded ‘partly’ to the question ‘Are sufficient details of the methods provided to allow replication by others?’ simply because elements of the methodology, e.g. data extraction, can only be fully described in the final study’s presentation – it is not a criticism.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Infant feeding, postnatal depression, social support, quantitative methods, causal inference.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Understanding the Interaction Between Infant Feeding and Maternal Mental Health and Well-Being in Women who Experience Psychological Birth Trauma: A Scoping Review Protocol

Abstract

Objective

Introduction

Methods

Conclusion

Keywords

Introduction

Objective

Research questions

Methods and analysis

Design

Inclusion criteria

Exclusion criteria

Search strategy

Table 1. Developing the search strategy.

Table 2. Search strategy.

Table 3. Full sample search string for APA PsychInfo.

Screening

Data extraction

Table 4. Data extraction instrument.

Quality assessment

Data analysis

Data summary

Data availability

References

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Understanding the Interaction Between Infant Feeding and Maternal Mental Health and Well-Being in Women who Experience Psychological Birth Trauma: A Scoping Review Protocol

Abstract

Objective

Introduction

Methods

Conclusion

Keywords

Introduction

Objective

Research questions

Methods and analysis

Design

Inclusion criteria

Exclusion criteria

Search strategy

Table 1. Developing the search strategy.

Table 2. Search strategy.

Table 3. Full sample search string for APA PsychInfo.

Screening

Data extraction

Table 4. Data extraction instrument.

Quality assessment

Data analysis

Data summary

Data availability

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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Are you a HRB-funded researcher?

Thank you!