OBJECTIVE:

Breast-feeding initiation rates have increased in the USA; however, maintenance of breast-feeding for recommended durations is low. The objective of the present study was to identify factors that may facilitate breast-feeding for longer durations among first-timemothers, including physiological and social experiences and changes in maternal perceptions.

DESIGN:

Survival analysis and linear regression methods were used to explore the relationship between experiences and breast-feedingduration, and the possible mediating effect of changes in maternal perceptions.

SETTING:

Secondary data from the Infant Feeding Practices Study II, conducted in the USA between 2005 and 2007.

SUBJECTS:

Data from 762 first-time mothers who ever breast-fed were analysed.

RESULTS:

Experiencing trouble with baby's latch, problems with milk flow/supply and painful breast-feeding were significantly associated with breast-feeding duration (64, 26 and 36 % shorter duration, respectively). Meanwhile, positive changes in perception with respect to breast-feeding self-efficacy, opinion about infant feeding and belief about breast milk were associated with 16-27 % longer duration. Furthermore, changes in perception were observed to partially mediate the impact of physiological experiences on breast-feeding duration.

CONCLUSIONS:

Perceptions of breast-feeding self-efficacy, beliefs and opinions can change over time and are influenced by breast-feedingexperiences. The combined effect of experience and perception plays a key role in influencing breast-feeding duration. Future research should explore interventions to maintain or improve these perceptions while accounting for physiological experiences to support breast-feeding for recommended durations among first-time mothers.