University of Wisconsin Milwaukee UWM Digital Commons Theses and Dissertations December 2016 The otP ential Effect of Breastfeeding on Maternal Senstivity During the First Year of Life Sawsan Hammad Hammad University of Wisconsin-Milwaukee Follow this and additional works at: https://dc.uwm.edu/etd Part of the Nursing Commons Recommended Citation Hammad, Sawsan Hammad, "The otP ential Effect of Breastfeeding on Maternal Senstivity During the First Year of Life" (2016). Theses and Dissertations. 1372. https://dc.uwm.edu/etd/1372 This Dissertation is brought to you for free and open access by UWM Digital Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of UWM Digital Commons. For more information, please contact [email protected]. THE POSSIBLE EFFECT OF BREASTFEEDING ON MATERNAL SENSITIVITY DURING THE FIRST YEAR OF LIFE by Sawsan H. Abuhammad A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing at The University of Wisconsin, Milwaukee December 2016 ABSTRACT THE INFLUENCE OF BREASTFEEDING ON MATERNAL SENSITIVITY DURING THE FIRST YEAR OF LIFE by Sawsan H. Abuhammad The University of Wisconsin-Milwaukee, 2016 Under the Supervision of Professor Teresa Johnson Poor maternal sensitivity may lead to insecure infant attachment that is associated with consequences in cognitive and mental health in school-aged children and later life. Maternal sensitivity is defined as the mother’s ability to recognize and respond to her infant’s cues consistently and appropriately. Maternal sensitivity is an indicator of the interactions between mothers and infants that are characterized by mutual and concurrent interchanges, often referred to as the “mother–infant dance.” If the mother is able to accurately recognize the infant’s cues, then she can provide an appropriate and secure foundation to encourage the infant’s exploration, watching over and protecting the infant when necessary (Bowlby,1969) . Literature suggests that maternal sensitivity is enhanced as the oxytocin level of the mother increased in the early postpartum period. One factor that increases the level of oxytocin is breastfeeding. Oxytocin level remains high in a breastfeeding mother compared to a formula feeding mother. It is unknown if breastfeeding is associated with maternal sensitivity or if sensitive mothers during pregnancy will breastfeed her infant ii © Copyright by Sawsan H. Abuhammad, 2016 All Rights Reserved iii DEDICATION With all my love, to my family: My dad Hammad, My mom Nawal, My brothers and sisters, My Aunt Laila, My friend in USA, Kimberly My best friend Tasneem You have all supported me in my journey during the tough times and the joyous times. I could not have completed this without each and every one of you. Words cannot express the appreciation and love I have for you all. Thank you. iv TABLE OF CONTENTS TITLE PAGE ................................................................................................................. i ABSTRACT .................................................................................................................. ii COPYRIGHT PAGE ................................................................................................... iii DEDICATION ............................................................................................................. iv ACKNOWLEDGEMENTS ...........................................................................................v LIST OF FIGURES .......................................................................................................x LIST OF TABLES ....................................................................................................... xi CHAPTER ONE: INTRODUCTION Study Problem and Purpose .............................................................................. 1 Significance ...................................................................................................... 4 Cultural Role ..................................................................................................... 9 Theoretical Framework ................................................................................... 11 Study Summary ............................................................................................... 19 Manuscripts ..................................................................................................... 20 Definition of Variables ................................................................................... 21 CHAPTER TWO: REVIEW OF LITERATURE/MANUSCRIPT ONE: The Possible Effect of Breastfeeding on Maternal Sensitivity during the First Year of Life Introduction Chapter ....................................................................................... 23 Abstract ........................................................................................................... 23 Introduction ..................................................................................................... 25 Methods........................................................................................................... 26 Results ............................................................................................................. 27 Critique ........................................................................................................... 31 Discussion ....................................................................................................... 33 Implication ...................................................................................................... 35 Conclusion ...................................................................................................... 35 References ....................................................................................................... 37 v CHAPTER THREE: MANUSCRIPT TWO: Measures of Maternal Sensitivity during the First Year of Life: A Systematic Review Chapter Introduction ....................................................................................... 53 Abstract ........................................................................................................... 53 Introduction ..................................................................................................... 55 Method ............................................................................................................ 56 Results ............................................................................................................. 57 Critique ........................................................................................................... 65 Implications..................................................................................................... 69 Conclusion ...................................................................................................... 70 References ....................................................................................................... 72 CHAPTER FOUR: MANUSCRIPT THREE: Breastfeeding and Maternal Sensitivity during The First Year of Life Chapter Introduction ....................................................................................... 87 Abstract ........................................................................................................... 87 Introduction ..................................................................................................... 89 Conceptual Framework ................................................................................... 91 Methods........................................................................................................... 92 Design ............................................................................................................. 92 Setting and Participants................................................................................... 93 Measures ......................................................................................................... 93 Results ............................................................................................................. 95 Discussion and Limitations ............................................................................. 96 Implications for Practice and Research......................................................... 99 Conclusion .................................................................................................... 100 References ..................................................................................................... 101 CHAPTER FIVE: ANALYSIS OF THE MANUSCRIPTS Chapter Introduction ..................................................................................... 110 Synthesis of the Manuscripts ........................................................................ 110 Limitations .................................................................................................... 117 Implications................................................................................................... 119 Theory ........................................................................................................... 119 Practice .......................................................................................................... 119 Policy ............................................................................................................ 120 Future Research ...........................................................................................