The Effect Of Postpartum Therapeutıc Touch On Breastfeedıng Self-Effıcacy, Maternal Attachment, And Postpartum Depressıon In Prımıparous Women: A Randomızed Controlled Study

Pregnancy, childbirth, and the postpartum period are critical processes that shape the health of both mother and baby, marked by biological, psychological, and social changes. The postpartum period, in particular, is crucial for the mother's physiological return to pre-pregnancy state and for strengthening the mother-baby bond. During this period, the mother's breastfeeding self-efficacy, level of maternal bonding, and psychological health have long-term effects not only on individual health but also on public health (Erdoğan and Hocaoğlu, 2020; Çevik and Avcıbay Vurgeç, 2022).

Breastfeeding is the most suitable method of nutrition for all babies and is considered the gold standard (Oddy, 2017). The milk of every living creature is unique to its offspring and is an unparalleled source of nutrition. Breast milk meets all the needs of babies for the first six months. Breastfeeding affects the health of the mother and society as well as the baby. It is recommended that babies receive only breast milk for the first six months and that breastfeeding continue with complementary foods until the age of two (Irmak, 2016). Breastfeeding can be influenced by factors such as the mother's physiological characteristics, social conditions, the presence of social support systems received after birth, the desire to breastfeed, and the baby's characteristics (Mahmood et al., 2011). Another factor affecting breastfeeding is the mother's breastfeeding self-efficacy (Lau et al., 2018). Breastfeeding self-efficacy is the ability to anticipate the mother's desire to breastfeed, the positive or negative nature of her thoughts during the breastfeeding process, and how she can cope with problems she experiences during breastfeeding. Breastfeeding self-efficacy is also a concept that can be influenced by various factors. These factors include the mother's breastfeeding experiences, events she has observed in others, the support she receives from her social environment, and the mother's age, type of delivery, occupation, and psychological state (Aluş Tokat et al., 2010; Ngo et al., 2019).

Some individuals may be negatively affected psychologically during the postpartum period. A mother's unpreparedness for the role of parenthood, certain difficulties experienced after the baby is born, lack of social support systems, insufficient spousal support, unwanted pregnancy, and problems experienced during the birthing process can all lead to mental health disorders. The most common psychological problems encountered in the postpartum period are postpartum depression, maternal sadness, and psychosis (Oskay and Avcı, 2020; Türkmen et al., 2021). Postpartum depression is generally described as a psychological distress in mothers during the postpartum period, characterized by a depressed mood, decreased interest, sadness, feelings of worthlessness, and hopelessness. According to the APA DSM-5, postpartum depression is defined as major depression that begins peripartum and occurs within 4 weeks postpartum, while the other diagnostic system, ICD-10, states that postpartum depression can occur within 6 weeks postpartum (Erdoğan and Hocaoğlu, 2020). Psychological disorders, especially postpartum depression, also affect maternal bonding (Nakić Radoš, 2021).

Maternal attachment describes the warm, continuous, and close relationship that develops between mother and baby. It is a unique process in which mother-baby love develops (Kınık and Özcan, 2020). Maternal attachment begins to form from the moment pregnancy is learned and is a long process. The mother's acceptance and adoption of the baby during pregnancy positively contributes to this attachment process. The postpartum period is a time when mother-baby bonding is experienced more intensely. Early contact between mother and baby during this period, and mothers' quick adaptation to their maternal role, improves the quality of parenting. Maternal attachment supports the baby's physical, social, and psychological development (Hoca Nacar and Gökkaya, 2019).

As can be seen, issues such as breastfeeding self-efficacy, maternal attachment, and postpartum depression in the postpartum period affect the health of both mother and baby, and consequently, the health of society. There are some practices that are effective in improving these processes. Education, social support, and some complementary alternative therapy methods are some of them (Pekcan and Yılmaz, 2021; Uçakcı and Sözbir, 2023).

Therapeutic touch is an evidence-based, non-pharmacological, complementary treatment method that uses universal energy to help individuals regain balance and health by regulating imbalanced energy fields or resolving blockages in energy transmission (TTIA, 2020). Therapeutic touch can be used at every stage of a woman's life. Many studies have shown beneficial results in its application during pregnancy, childbirth, and the postpartum period (Peters, 1999). For example, a study examining the effect of therapeutic touch on pain and anxiety during childbirth in women who had vaginal deliveries reported that women who received therapeutic touch experienced less pain and anxiety during labor, thus having a more positive effect on childbirth (Ertekin Pınar and Demirel, 2021). Another study...