Developing a screening tool for Breastfeeding trauma using the Existential Breastfeeding Difficulties Scale (ExBreastS)

Background:
Many women find breastfeeding challenging and the resulting emotional distress can be enduring. Women often describe the experience as ‘traumatic’. From a research perspective, it is essential to have confidence in any screening tool used to identify women who have had a traumatic breastfeeding experience. This is essential if you are planning to test the efficacy and effectiveness of an intervention.
Aims: To explore the suitability of the Existential Breastfeeding Difficulties Scale (ExBreastS) as a screening tool for breastfeeding trauma and the establishment of a clinical cut-off score.
Methods:
Ethical approval was granted by the University Ethics Committee ref: REC 21.0020. An online cross-sectional survey was conducted in June 2021. 1074 responses were analysed using Receiver Operating Characteristic (ROC) analysis to compare the sensitivity and specificity of the ExBreastS with participants who scored above the threshold on the Post-Traumatic Stress Disorder (PTSD) checklist for DSM-5 (PCL-5). The area under curve was examined to find the optimal cut off score for breastfeeding post-traumatic stress (BF-PTSD).
Findings:
Results were significant (>o.o1), the area under curve (AUC) was found to be 0.79 (95% CI 0.74 – 0.85) suggesting the ExBreastS is a good instrument for predicting the presence of BF-PTSD. Independent T-tests on ExBreastS scores found significant results when comparing ‘No PTSD’ (x̄ = 27.98, SD = 9.14) with ‘PTSD present’ (x̄ = 42.08, SD = 14.73; t(76) = -8.06, p = <.01. Confirmatory factor analysis on the ExBreastS provided an acceptable fit and a three-factor model was confirmed.
Conclusions and implications:
This is the first study to demonstrate the presence of BF-PTSD using a quantitative approach. This tool can now be used to identify BF-PTSD and will be of great benefit to researchers and clinicians who need robust measures of PTSD before testing the effectiveness of a range of therapeutic interventions such as EMDR.