Breastfeeding Aversion: Prevalence and Coping Strategies: A 2025 Study

This article examines the prevalence of the breastfeeding aversion response (BAR) among mothers in Turkey and the main factors associated with this phenomenon.

Definition of Breastfeeding Aversion and Context

Breastfeeding aversion is defined as a compulsion to remove the baby from the breast in association with unpleasant physical sensations, accompanied by overwhelming feelings of irritation, agitation, or disgust during breastfeeding.

It is distinct from Dysphoric Milk Ejection Reflex (D-MER), which occurs primarily just before the milk ejection reflex and is limited to the first few minutes of a feeding session, whereas breastfeeding aversion can occur throughout the entire feeding session or at various points in the breastfeeding process.

The author notes that the scientific literature on breastfeeding aversion remains limited and has been built in part from testimonials shared in online support groups.

Objective and Methodology

The primary objective was to estimate the prevalence of breastfeeding aversion and to identify associated factors among mothers with breastfeeding experience in Turkey. This was a cross-sectional study conducted via an online questionnaire distributed through Instagram and through healthcare professionals (midwives, nurses) between November 2023 and January 2024.

Participants were mothers aged 18 or older who were currently breastfeeding or had breastfed within the previous three years (to limit recall bias). Out of 1,081 responses, 1,046 women were included.

Main Results: Prevalence and Associated Factors

Among the 1,046 participants, 9.8% (103 mothers) reported having experienced breastfeeding aversion. The most frequently reported reactions were: thoughts of abruptly weaning the baby, immediately removing the baby from the breast because they could not continue, and experiencing the aversion as an uncontrollable response.

Several variables were associated with a higher prevalence:

Employment status: breastfeeding aversion was more prevalent among mothers working outside the home.
Partner support: the absence of partner support in the postpartum period was significantly associated with a higher rate of breastfeeding aversion.
Mental health: mothers diagnosed with postpartum depression more frequently experienced breastfeeding aversion.
Breastfeeding difficulties: problems such as nipple pain, mastitis, latch difficulties, or perceived insufficient milk supply were more frequent among mothers experiencing aversion.

Circumstances of Onset of Breastfeeding Aversion

Participants identified several typical situations associated with the onset of aversion:

Extreme fatigue or exhaustion, especially in the first 3 months postpartum, a period characterised by sleep deprivation and a high physical and emotional burden.
Nursing a toddler, sometimes with accounts of weariness, lack of pleasure, or discomfort at continuing to breastfeed an older child.
Onset of breast pain described as stinging, itching, or painful reactions to the slightest contact, sometimes accompanied by nausea, suggesting an affective dimension beyond purely nociceptive processes.
Tandem nursing: in particular during simultaneous nursing of two children, several mothers described aversion directed primarily at the older child.
Return of menstruation: some women dated the onset of breastfeeding aversion to the resumption of their menstrual cycle, or reported a worsening of aversion during menstruation.

The article also highlights cases where breastfeeding aversion occurred:

· In the very early postpartum period, but transiently.

· During pregnancy while nursing an older child, although this situation is less common in Turkey for cultural reasons, as many women cease breastfeeding when a new pregnancy begins.

· Following traumatic events (serious marital disputes, family conflicts, the 2023 earthquake), suggesting a link between trauma, activation of stress systems, and hormonal disruptions (oxytocin, prolactin).

Distinction from D-MER

The results confirm that breastfeeding aversion differs from D-MER in two key respects:

· Timing: breastfeeding aversion can occur before, throughout, or after a feeding session, whereas D-MER is confined to the milk ejection reflex phase.

· Quality of emotions: women describing breastfeeding aversion do not use terms such as "terror" or "despair" classically associated with D-MER, but rather disgust, irritation, tension, or agitation.

Support Received and Coping Strategies

Some mothers experiencing breastfeeding aversion had to temporarily interrupt breastfeeding, and nearly one third ceased breastfeeding entirely for this reason. Yet the majority did not perceive aversion as a "problem" requiring help, or received no specific support; and when support was obtained, it was rarely considered genuinely helpful.

The most commonly reported coping strategies were:

Distraction (checking their phone, watching television, mentally occupying themselves with something else during the feed).
Shortening feeding duration or reducing feeding frequency, particularly during the daytime, or even eliminating night feeds.
Practising basic self-regulation techniques (deep breathing, positive self-talk, patience with biting, pinching, etc.)

The author discusses the ongoing debate about the potential effect of these distraction strategies on the mother-infant relationship: studies cited in the article do not demonstrate a systematically negative association between smartphone use during breastfeeding and the quality of dyadic interactions, but do call for clinical vigilance.

Interpretation and Clinical Implications

The findings suggest that breastfeeding aversion is strongly influenced by psychological and contextual factors, rather than purely physiological ones. The factors highlighted include:

Maternal fatigue and exhaustion, related to sleep deprivation, role accumulation, and mental load.
Postpartum depression and, more broadly, psychological vulnerability in the early months following birth.
Lack of partner support and unaddressed breastfeeding difficulties, which increase the emotional burden of breastfeeding.

The article recommends approaching breastfeeding as a holistic experience that integrates psychological, social, and cultural dimensions, and not solely the physiology of lactation. For midwives, nurses, and other healthcare professionals, this implies:

Systematically including questions about sensations and emotions during breastfeeding.
Recognising breastfeeding aversion as a legitimate source of distress, even in the absence of any visible physical problem.
Offering personalised strategies, including psychological support, fatigue management, interventions to redistribute household tasks, and weaning support if that is the mother's choice.

In conclusion, the article highlights breastfeeding aversion as a real and relatively common experience for a non-negligible proportion of mothers, influenced by fatigue, pain, relational context, and psychological factors, and emphasises the need for a broader, more empathic clinical perspective on breastfeeding.