Introduction: Exclusive breastfeeding (EBF) outcomes can vary by concomitant emotions, ongoing pain, and breastfeeding self-efficacy. The purpose of this study is to examine the association of ongoing pain with breastfeeding, concomitant emotions and breastfeeding self-efficacy scores (BSES) with EBF outcomes at 6 weeks postpartum. Design: A secondary analysis of a randomized pilot trial of a home-based breastfeeding pain self-management (BSM) intervention for 56 mothers (26 BSM, 30 Control). The BSM intervention provided self-management strategies for breastfeeding and breastfeeding pain. Effect modification of EBF and associated symptoms of depression, anxiety, sleep, well-being pain severity scores, BSES, and group assignment was assessed using the likelihood ratio test. Results: EBF at 6 weeks controlling for demographic covariates, the group, pain severity, anxiety and sleep were significant predictors. Mothers with every one point increase in their pain severity score and sleep score, had a decrease of 9% (OR = .91, 95%CI = [.79, .98]) and 25% (OR = .75, 95% CI = [.52, .95]) respectively and with a one point increase in the anxiety score, a 58% (OR = 1.58, 95% CI = [1.13, 2.72]) increase in the odds of EBF at week 6. Conclusion: Examinations of EBF at 6 weeks should include evaluation of mothers ongoing pain and emotional distress, as mothers continue breastfeeding even at personal cost. Early identification and validation of breastfeeding challenges, ongoing pain, and emotional distress are needed to bolster mothers confidence in their breastfeeding skills, thus supporting their EBF goals.

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