Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period

From Breastfeeding to Support in Mothers' Feeding Choices: A Key Role in the Prevention of Postpartum Depression?

The postpartum period represents a critical phase of profound transition for women. This timeframe encompasses the physical recuperation associated with childbirth, the intricate psychosocial adjustments inherent in assuming the role of motherhood and also important alterations in steroid and peptide hormones. Hence, as women navigate the reconfiguration of relationships and strive to address the diverse needs of their infants and family members, they concurrently grapple with dramatic transformations which are characteristic of the postpartum phase. In fact, relevant prevalence ranges are reported for maternity blues, a mild condition characterized by self-limited and transient depressive symptoms, but also a well-established risk factor for more serious postpartum mood disorders, such as depression (PPD), with an incidence of 10-15%. Unlike in the US, at the European level, there are no concrete recommendations for the routine integration of the assessment of the mother's emotional state by healthcare professionals, with a considerable risk of underdiagnosing or undertreating these conditions. In this regard, there is a growing body of scientific evidence on the important role of breastfeeding in reducing the risk of PPD and also of the importance of mothers' compliance with this practice. Indeed, sucking the baby regulates the circadian rhythm of the HPA axis and, together with the action of prolactin, the stress response is decreased. In addition, other positive consequences of breastfeeding, which are inversely correlated with the onset of PPD, include the regulation of sleep and waking patterns for mother and baby, the improvement of the mother's self-efficacy and her emotional involvement. It should also be considered that the request for support for breastfeeding can often conceal a request for support for motherhood itself and for the mother's emotional well-being. It therefore emerges that the personnel involved in primary pediatric care to provide adequate support in the transition to motherhood must support mothers in their breastfeeding choices, whether breastfeeding or formula feeding, so that each choice is made conscientiously and serenely. Therefore, neonatal feeding assumes a decisive role, since if, on the one hand, it regulates specific neurohormonal pathways that are protective for maternal emotional well-being (breastfeeding), on the other hand, support in mothers' breastfeeding choices, even in the case of formula feeding, means validating their being mothers in the absence of judgement and counteracting any feelings of inadequacy, conditions that are inversely correlated to DPP.

A perinatal social nutrition approach to improve breastfeeding in a culturally diverse group of low-income women

Alima, Perinatal Social Nutrition Centre, is an established community organization that adopts a perinatal social nutrition approach to provide multidimensional support to women living in vulnerable conditions, particularly those with a precarious migratory status. This study aims to (i) determine which maternal characteristics, pregnancy-related variables, and structural features of the Alima intervention are associated with breastfeeding; and (ii) examine whether the association between attending breastfeeding workshops and breastfeeding characteristics differ according to maternal factors. The Alima digital database was used to analyze data from women who received the perinatal intervention between 2013 and 2020. Infant feeding data were retrieved at 2 weeks postpartum (T0, n = 2925), 2 months postpartum (T2, n = 1475), and 4 months postpartum (T4, n = 890). Logistic regressions were used to estimate the odds of overall and exclusive breastfeeding depending on sociodemographic characteristics, pregnancy-related variables, and features of the intervention. The prevalence of overall and exclusive breastfeeding was, respectively, 96.1% and 60.7% at T0; 93.0% and 58.5% at T2; 83.0% and 48.4% at T4. Higher education, previous breastfeeding experience, and recent immigration were associated with a higher likelihood of breastfeeding at each time point. Breastfeeding workshop attendance was associated with a greater likelihood of overall and exclusive breastfeeding at T2 and T4, with a stronger effect among women aged 35 or less, those with lower education, and those with excessive gestational weight gain. In conclusion, the Alima intervention is associated with positive breastfeeding outcomes, especially among vulnerable women living with precarious migratory status in Canada.

How Exposure to Online Parenting Content Relates to Mothers' Self-Discrepancy and Postpartum Mental Health

Postpartum mental health problems are common and have deleterious effects on new mothers and their babies. This study developed a theoretically informed model of the relationship between exposure to images of motherhood in online parenting content and mothers' postpartum mental health. The model was tested using survey data collected from 509 Chinese mothers during their 12-month postpartum period. The results revealed that greater exposure to online public parenting content was indirectly related to lower levels of shame among new mothers via two mediators: the presumed influence of parenting media content on their partners, and the mothers' perceptions of the discrepancy between their actual selves as mothers and their partners' expectations of an ideal mother (i.e. actual/own - ideal/partner self-discrepancy). In contrast, increased exposure to online private parenting content shared by peers was indirectly related to increased levels of shame among new mothers via the mediation of social comparison with parenting media images, and of the mothers' perceptions of the discrepancy between their actual selves as mothers and their own expectations of an ideal mother (i.e. actual/own - ideal/own self-discrepancy). Additionally, new mothers were more likely to experience depressive symptoms and shame if they felt that they fell short of their partners' expectations of an ideal mother. However, increased social support reduced the anxiety and shame that stemmed from this belief.

Cross-cultural adaptation of the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) modified for preterm mothers in Brazil

OBJECTIVES

to conduct a cross-cultural adaptation of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) for mothers of ill and/or preterm infants among Portuguese-speaking mothers in Brazil.

METHODS

a methodological study was completed, including the translation of the tool, synthesis of translations, review by experts, synthesis, reassessment of experts, back-translation, pre-test, and validation of the content. The study involved 19 participants, including a translator and experts. In addition, 18 mothers from the target population were included in the pre-test.

RESULTS

the equivalences of the opinion obtained by the committee of experts were semantic (85%), idiom (89%), cultural (86%), and conceptual (94%). The content validation coefficient (CVC) on the scale was 0.93 for clarity and understanding; 0.89 for practical relevance; 0.92 for relevance; and the average overall CVC was 0.91.

CONCLUSIONS

the scale was translated and adapted to the Brazilian Portuguese language, which maintained the equivalences and confirmed the content validity.

The effect of midwife-oriented breastfeeding counseling on self-efficacy and performance of adolescent mothers: a clinical trial study

BACKGROUND

Breastfeeding behaviors are strongly influenced by self-efficacy. This research aimed to determine the effect of breastfeeding counseling based on the Ready Set Baby (RSB) education program on self-efficacy and breastfeeding performance in adolescent mothers.

METHODS

In 2022, a parallel randomized clinical trial was carried out in Hamadan city's comprehensive health centers, involving 64 pregnant teenagers. The block randomization method was employed to divide the participants into two groups. The data collection instruments were a demographic characteristics questionnaire, a breastfeeding self-efficacy questionnaire, and the Bristol breastfeeding checklist. Three individual counseling sessions during pregnancy were conducted based on the "RSB" program. The ANCOVA was used for comparing groups. The statistical analyst was blinded to the group assignment.

RESULTS

The study included 64 participants with a mean age of 16.97(1.30) years, data from 60 participants were analyzed. The demographic and clinical characteristics of the two groups were relatively similar (P > 0.05). Following the intervention, self-efficacy and breastfeeding performance scores were measured and adjusted for confounding factors. The mean scores for self-efficacy were 116.03(20.64) and 100.02(20.64) (P < 0.005), with effect size 0.77 [MD = 16.01 (95% CI: 5.34,26.67)], and the mean scores for breastfeeding performance were 6.30(2.07) and 4.12(2.07) (P < 0.002), with effect size 1.05 [MD = 2.18 (95% CI: 1.11,3.24)] in the intervention and control groups, respectively.

CONCLUSIONS

The Ready Set Baby education program's breastfeeding counseling for primiparous adolescent pregnant women significantly boosted their self-efficacy and performance in breastfeeding. Given the crucial role of breastfeeding in ensuring the well-being of both mother and child, further research is imperative to identify suitable and impactful interventions that can encourage breastfeeding practices among adolescents.

TRIAL REGISTRATION

The trial protocol of this study has been registered in Iranian Registry of Clinical Trials at 08/09/2021. The registration reference is IRCT20200530047596N3.

Psychometric Properties and Factorial Structure of Postpartum-Specific Anxiety Scale (PSAS) Within Arabic Language in a Palestinian Context

BACKGROUND

The Postpartum-Specific Anxiety Scale (PSAS) is an international measure designed to evaluate anxiety experienced by mothers in the postpartum period from one day to six months; the scale was translated into Arabic and validated within Palestinian context to test postpartum anxiety among Palestinian women.

AIMS

The current study aimed to test the psychometric properties and the factorial structure within the Arabic language in a Palestinian context using confirmatory factor analysis (CFA). The sample of this study consisted of 475 Palestinian women recruited from health centers in the West Banks of Palestine using a convenience sample. 61% were of ages 20-30 years and 39% percent ages 31-40 years.

FINDINGS

The PSAS showed good validity and reliability indicators in assessing postpartum anxiety within Palestinian context. Results of CFA showed a stable construct of a four-factor structure in assessing postpartum anxiety among Palestinian mothers: (1) competence and attachment anxieties, (2) infant safety and welfare anxieties, (3) practical baby care anxieties and (4) psychosocial adjustment to motherhood, which is consisting with the original four-factor structure of the scale.

CONCLUSIONS

The PSAS showed good validity indicators within Palestinian context. Therefore, it is recommended to conduct similar studies with clinical and non-clinical groups in the Palestinian society. The PSAS can be a useful measure to assess anxiety levels among women during the postpartum months; which will enable mental health providers to provide psychological interventions for mothers whose anxiety levels are high.

Health literacy and its related factors as predictors for the breastfeeding self-efficacy in a western province in Iran

BACKGROUND

One of the effective factors on BF (Breastfeeding) continuation is Breastfeeding self-efficacy (BFSE). This study was conducted to determine the relationship between Health Literacy (HL) and BFSE in lactating mothers referring to primary health care centers.

METHODS

This cross-sectional descriptive study was carried out on lactating mothers referring to primary health care centers in 2022. Multi-stage cluster sampling was done with 160 samples. The data were collected using demographic questionnaire, Persian shortened form of the BSES is a self-reported instrument for measuring a mother's Breastfeeding self-efficacy and Health Literacy for Iranian Adults (HELIA). Data were analyzed using ANOVA, independent t-test, correlation test and liner regression by SPSS version 16, with a significance level of 5%.

RESULTS

There was a significant positive correlation between the HL score and its four domains( Reading, Behaviour and decision making, Accessing, and Understanding) except for the appraisal domain with BFSE score. The variables of use of formula, HL, duration of breastfeeding, and education were considered predictors of BFSE.

CONCLUSION

In general, the results indicate a possible relationship between BFSE and mothers' HL. Therefore, improving mother's HL can have a positive effect on promoting infants' nutrition.

An exploration of prenatal breastfeeding self-efficacy: a scoping review protocol

Objective: To synthesise the evidence on prenatal breastfeeding self-efficacy, including identifying concepts and theoretical frameworks that underpin its development, the evidence on its measurement, interventions used to improve it, and association with breastfeeding outcomes. Background: Breastfeeding self-efficacy is described as a woman's self-belief and confidence in her perceived ability to breastfeed. It is a modifiable measure that is strongly associated with breastfeeding outcomes such as initiation, exclusivity, and duration. Interventions aimed at increasing self-efficacy are often in the postnatal period and have been shown to be effective at improving breastfeeding outcomes. The prenatal period appears to be underexplored in the literature and yet focusing on enhancing it may have the potential for further improvements in self-efficacy and on subsequent breastfeeding outcomes. A comprehensive knowledge synthesis on prenatal breastfeeding self-efficacy is lacking. Methods: The search will include databases across health, psychology, sociology, and the grey literature on breastfeeding guidance. Once the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period) is met, sources of evidence from any contextual setting will be eligible for inclusion. Limits will not be applied on geographic location or year of publication. The PRISMA-ScR flow diagram of search and study selection will be used to report final figures. Two independent reviewers will perform title and abstract screening and full text review. Data will be charted to provide a logical and descriptive summary of the results that align with the objectives. Conclusion: The results will provide an understanding of what has been done in the space and what gaps exist, informing recommendations for the timing of measurement and the design of prenatal interventions.

Validity and reliability of the Turkish version of the paternal breastfeeding self-efficacy scale - Short form for fathers

BACKGROUND

Women supported by their partners are more likely to initiate and maintain breastfeeding and overcome related challenges. Therefore, reliable measurement tools are needed to determine whether fathers can provide this support.

AIM

This study aimed to (1) examine the psychometric properties of the Paternal Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) in Turkish fathers, including internal consistency reliability, test-retest reliability, construct validity using Confirmatory Factor Analysis (CFA); and (2) assess the relationship between the BSES-SF and paternal demographic factors.

METHODS

A methodologically study was conducted between December 26-2018 and June 26-2019 at the pediatrics clinics of two research hospitals of medical schools in Konya, Turkey. The sample consisted of 221 fathers of infants aged 2 to 6 weeks who visited the clinics for routine examinations. Data were collected using a sociodemographic questionnaire and the Turkish version of the Paternal BSES-SF. After evaluating the language equivalence and content validity of the scale, test-retest reliability, internal consistency and construct validity were examined. In evaluation of the data frequency/percentage, mean, standard deviation, independent groups t test, ANOVA Analysis, Bartlett's Test of Sphericity, Confirmatory Factor Analysis, Pearson Product-Moment correlation and Cronbach α analysis were used. The study was approved by Interventional Clinical Research Ethics Committee of the Faculty of Health Sciences of Selcuk University in Turkey.

RESULTS

The translated Paternal BSES-SF had a Cronbach's alpha of 0.93 and a test-retest reliability coefficient of 0.96. The factor loadings ranged from 0.42 to 0.76. The Paternal BSES-SF had a one-factor structure similar to the original scale. Fathers who were unemployed, had lower economic status, and unplanned pregnancy had significantly lower mean Paternal BSES-SF scores. Paternal education regarding breastfeeding increased mean Paternal BSES-SF retest scores (p<0.05).

CONCLUSIONS

The Paternal BSES-SF was a valid and reliable measure to assess fathers' confidence in their ability to assist mothers with breastfeeding in Turkey. Turkish researchers and health workers can use this instrument as a reference for promoting exclusive breastfeeding.

BREASTFEEDING SELF-EFFICACY IN PREGNANT WOMEN AND EFFECTIVE FACTORS IN THE COVID-19 PANDEMIC

This study was conducted to identify the factors affecting the breastfeeding self-efficacy of pregnant women in the COVID-19 pandemic.This descriptive correlational study was conducted between 15 January and 15 June, 2021. The sample consisted of 320 pregnant women’, who were in their third trimester, had a single and healthy fetus, a spontaneous pregnancy and no health problems. The data of the study were collected using an Information Form and the Prenatal Breastfeeding Self-Efficacy Scale.The mean total Prenatal Breastfeeding Self-Efficacy Scale score of the participants was 79.08±13.86. The seven variables with significant effects on the mean total Prenatal Breastfeeding Self-Efficacy Scale scores of the participants were, being knowledgeable on COVID-19, thinking breastfeeding is beneficial for the baby, going to prenatal care checkups on time, gestational week, educational status, age, and receiving breastfeeding consultancy in the COVID-19 pandemic. Especially young pregnant women who have low educational status and are not experienced or knowledgeable about breastfeeding should be provided with counseling on breastfeeding. This study is believed to contribute to the literature and guide interventional studies to be conducted in the future by evaluating the prenatal breastfeeding self-efficacy levels and affecting factors.

Psychometric Assessment of the Breastfeeding Self-Efficacy Scale-Short Form: A Confirmatory Factor Analysis in Malawian Mothers

BACKGROUND

Exclusive breastfeeding to 6 months postpartum has been related to breastfeeding self-efficacy in diverse populations. Globally, this is measured using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF).

RESEARCH AIM

To evaluate the psychometric properties of the BSES-SF among women in Malawi; and to examine the relationship between breastfeeding self-efficacy and demographic and health factors.

METHODS

The study design was a prospective, cross-sectional survey with a 2 week follow-up reliability check. Postpartum women (N = 180) were recruited at a maternity hospital in Lilongwe, Malawi. In addition to the BSES-SF, the World Health Organization's Quality of Life Scale (QoL) was also administered. Furthermore, confirmatory factor analysis, Cronbach's alpha, and Pearson's correlations were used to examine the construct validity, reliability, test-retest reliability, and convergent validity.

RESULTS

The confirmatory factor analysis supported a unidimensional structure of the Malawian version of the 12-item BSES-SF. Cronbach's alpha and the intra-class correlation coefficient were 0.79 and 0.75, respectively. BSES-SF scores had significant correlation with QoL domains (physical QoL: r = 0.31, p < .001; and environmental QoL: r = 0.22, p < .01). Participants' age, parity, and mode of delivery were positively correlated with breastfeeding self-efficacy scores.

CONCLUSION

The findings of our study confirmed that the 12-item BSES-SF is a reliable and valid scale for assessing women's breastfeeding self-efficacy in Malawi.

Postnatal mental health, breastfeeding beliefs, and breastfeeding practices in rural China

Background

The importance of breastfeeding in low- and middle- income countries is well recognized, yet the importance of postnatal mental health on breastfeeding practices and beliefs in these settings has been understudied. This study investigates the associations between maternal mental health problems, breastfeeding beliefs and breastfeeding practices in rural China.

Methods

Cross-sectional data were collected in November and December 2019 from 742 mothers of infants under 6 months old in rural Sichuan Province, China. Maternal mental health (depression, anxiety, and stress symptoms) was assessed using the Depression, Anxiety, and Stress Scale (short form). Breastfeeding beliefs were assessed using the Iowa Infant Feeding Attitude Scale and Breastfeeding Self-Efficacy Scale (short form). Breastfeeding practices were assessed through a 24-h dietary recall questionnaire. Ordinary least squares regression, multiple logistic regression and heterogeneous effects analyses were used to identify associations between symptoms of mental health problems and breastfeeding outcomes.

Results

The average age of sample infants was 2.7 months. Among mothers, 13% showed symptoms of depression, 16% anxiety, and 9% stress. The prevalence of exclusive breastfeeding in the previous 24 h was 38.0%. Depression symptoms were significantly associated with breastfeeding attitude (𝛽= − 1.11, 95% CI: − 2.07, − 0.14) and breastfeeding self-efficacy (𝛽= − 3.19, 95% CI: − 4.93, − 1.45). Anxiety and stress symptoms were significantly associated with breastfeeding self-efficacy (𝛽= − 1.81, 95% CI: − 3.43, − 0.18 and 𝛽 = − 2.88, 95% CI: − 4.98, − 0.78, respectively). There were no significant associations between symptoms of mental health problems and exclusive breastfeeding. The heterogeneous effects analyses revealed that less educated mothers with symptoms of stress had lower odds of exclusive breastfeeding than educated mothers without symptoms of stress (OR: 0.53, 95% CI: 0.25,1.10). Mothers of younger infants had higher odds of exclusive breastfeeding than the mother of older infants, regardless of depression, anxiety, or stress symptoms.

Conclusion

Symptoms of maternal mental health problems are significantly associated with breastfeeding attitude and self-efficacy; however, these symptoms are not associated with breastfeeding practices. Maternal educational level and infant age may play a role in mothers’ breastfeeding practices. To improve breastfeeding practices, interventions should employ a multi-dimensional approach that focuses on improving maternal mental well-being and considers demographic characteristics.

Promoting maternal self efficacy and paternal attitudes towards breastfeeding: a randomized controlled trial

BACKGROUND

Counseling is one of the ways to improve the quantity and quality of breastfeeding. The present study was conducted to investigate the effect of couple-centered counseling on fathers' attitudes and mothers' self-efficacy towards breastfeeding.

METHODS

This randomized controlled trial study was conducted on 60 primigravida pregnant women and their spouses who were randomly selected among the pregnant women referred to the two maternity hospitals of Malayer City, a city in the province Hamadan in western Iran. Data collection tools included the demographic characteristics questionnaire, Breastfeeding Self-Efficacy Questionnaire, and Iowa Infant Feeding Attitude Scale. The intervention was performed according to the principles of GATHER counseling (Greet, Ask, Tell, Help, Explain, and Return). Mothers' self-efficacy and fathers' attitudes toward breastfeeding were assessed before the intervention and 4 weeks after birth in both groups. Data were analyzed with SPSS version 23 software and using a significance level of p = 0.05.

RESULTS

The participants of the control and test groups were homogeneous in terms of demographic characteristics. The change in mothers' breastfeeding self-efficacy score after intervention in the test group had a statistically significant difference compared to the control group (30.43 ± 2.53; 95%CI: 25.41,35.44), and the change in the score of fathers' attitude towards breastfeeding had a statistically significant difference after the intervention in the test group compared to the control group (19.3 ± 2.05; 95%CI: -23.36, -15.23). In the test group, the change in fathers' attitude towards breastfeeding after the intervention was significant compared to before the intervention (30.36 ± 2.38; 95%CI: 25.43, 35.25).

CONCLUSIONS

Appropriate counseling programs can change fathers' attitudes toward breastfeeding and increase mothers' breastfeeding self-efficacy, so couples' presence in breastfeeding counseling is recommended.

Impact of Breastfeeding Support Services on Mothers' Breastfeeding Experiences When Provided by an MD/IBCLC in the Pediatric Medical Home

Addressing breastfeeding issues enables mothers to reach their breastfeeding goals. We embedded a breastfeeding consultation service run by a pediatrician/International Board Certified Lactation Consultant (MD/IBCLC) in a medical home. This mixed-methods study investigated breastfeeding preparedness and the service's perceived benefits. Mothers with breastfeeding issues/concerns identified at well-baby appointments were referred to the service. Telephone interviews and chart reviews were conducted with 28 participating mothers approximately 1 month after the visits. Breastfeeding Self-Efficacy Scale scores improved significantly from the time of the in-person appointment to 1 month later. Most mothers felt unprepared for breastfeeding despite prenatal efforts. Trust in the pediatrician's recommendation, easy access, and insurance coverage were key factors in seeking the service. Reassurance provided by the MD/IBCLC increased mothers' confidence to breastfeed. The COVID-19 pandemic heightened feelings of isolation and anxiety due to lack of hands-on support from friends and family during the birth hospitalization and when at home.

Introducing the Postpartum Toolkit: An Examination of the Feasibility, Acceptability and Pilot Efficacy of an Online Clinical Tool to Enhance Postpartum Functioning and Emotional Wellbeing

During the postpartum period, a birth parent's level of functioning (ability to perform the activities and roles required to maintain wellbeing) is critical in determining the health of parents and their infants. However, existing approaches to support postpartum parents are insufficient, especially in the United States, and these individuals face barriers to care. The utilization of internet-based intervention may be an effective solution allowing access to resources for this population. In this study, we developed a patient-centered online tool to bolster postpartum functioning, and collected data on the feasibility, acceptability, and initial impact of this tool on functioning and emotional wellbeing. Data collection took place between February and June 2021 from a sample of 124 individuals who were within the first ten months postpartum and living in the US. Results suggest that the tool is acceptable, though there are barriers to feasibility of use. Additionally, pilot-efficacy data suggest that this tool may be effective in improving postpartum emotional wellbeing, though further controlled testing is warranted. A future iteration of the tool that incorporates participant feedback to improve feasibility of use could prove an effective means of delivering support to an at-risk population.

New Mothers' Perceptions of Pressure to Breastfeed

PURPOSE

Develop a measure to quantitatively assess perceived pressure to breastfeed and examine associations between perceived pressure, emotional distress, and the breastfeeding experience and self-efficacy among women with 2- to 6-month-old infants.

STUDY DESIGN AND METHODS

A cross-sectional study using an online survey to assess perceived pressure to breastfeed, emotional distress, and the breastfeeding experience and self-efficacy was conducted. Participants were recruited through ResearchMatch, a national online service that matches potential participants to research studies, and online community forums (e.g., Facebook).

RESULTS

Women (n = 187) reported themselves and society as the greatest sources of pressure. Pressure to breastfeed was negatively associated with the breastfeeding experience (r = -.34, p < .01) and self-efficacy (r = -.39, p < .01), but not emotional distress. Pressure to breastfeed remained a significant explanatory factor, even when considering demographic covariates, with the final models accounting for 16% and 20% of the variance in the breastfeeding experience and self-efficacy, respectively.

CLINICAL IMPLICATIONS

Perceived pressure to breastfeed may be an important psychosocial factor to consider when aiming to improve women's breastfeeding experiences. Reducing perceived pressure may be beneficial for promoting breastfeeding outcomes.

Psychometric Assessment of the Paternal Breastfeeding Self-Efficacy Scale-Short Form: A Confirmatory Factor Analysis of Malawian Fathers

BACKGROUND

Only 61% of Malawian women exclusively breastfeed to the recommended 6 months. Paternal support is predictive of exclusive breastfeeding, and significantly related to paternal breastfeeding self-efficacy, defined as fathers' confidence in their ability to assist mothers with breastfeeding.

RESEARCH AIMS

To (1) examine the psychometric properties of the Paternal Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) in Malawian fathers, including internal consistency reliability, test-retest reliability, construct validity using Confirmatory Factor Analysis (CFA), and convergent validity; and (2) assess the relationship between the BSES-SF and paternal demographic and health factors.

METHODS

A cross-sectional study was conducted at a maternity hospital in Lilongwe, Malawi, and 180 fathers whose partners had delivered a singleton infant were included. Participants completed the Breastfeeding Self-Efficacy Scale and Quality of Life with confirmatory factor analysis performed to assess the construct validity. The internal consistency reliability and test-retest reliability were evaluated using Cronbach's alpha coefficient and intra-class correlations. Convergent validity was also assessed.

RESULTS

A unidimensional factorial structure of the Malawian Paternal BSES-SF was identified using confirmatory factor analysis. The scale had an excellent Cronbach's alpha of .90 and a test-retest reliability of .93. Participants' breastfeeding self-efficacy was significantly correlated with the Quality of Life domains of psychological health (r = .23; p < .01), social relationships (r = .28; p < .001), and environmental health (r = .30; p < .001). Participants who were older, married, and with ≥ two children had significantly higher breastfeeding self-efficacy and were more confident in their ability to support their partner's breastfeeding.

CONCLUSION

The Paternal Breastfeeding Self-Efficacy Scale-Short Form was a valid and reliable measure to assess fathers' confidence in their ability to assist mothers with breastfeeding in Malawi.

Development of a breastfeeding duration risk nomogram for use in postpartum Chinese women

Previous studies have investigated influencing factors of early discontinuation of breastfeeding, but few studies have developed an easy-to-use tool to identify risk of breastfeeding cessation at 6 months after birth. This research team aimed to develop and validate an exclusive breastfeeding duration risk nomogram in Chinese mothers. A longitudinal cohort survey was conducted. Data were collected from 394 postpartum women in three hospitals in Hubei Province, China from December 2017 to December 2018. The LASSO regression model was used to screen for optimized factors in an exclusive breastfeeding duration model. Multivariable logistic regression was applied to construct a prediction model. Discrimination and calibration were assessed using a C-index and calibration curve, and internal validity was established using bootstrapping validation. Factors integrated in the prediction risk nomogram were monthly household income (odds ratio [OR] = 1.31, 95% confidence interval [CI]: [0.95, 1.80]), experiences of breastfeeding (OR = 1.23, 95% CI: [0.92, 1.63]), attitude (OR = 1.72, 95% CI: [0.94, 3.16]), self-efficacy (OR = 2.45, 95% CI: [1.40, 4.29]), perceived insufficient milk supply (OR = 0.12, 95% CI: [0.06, 0.25]) and postpartum depression (OR = 0.06, 95% CI: [0.02, 0.17]). The model displayed good discrimination with a C-index of 0.87 (95% CI: [0.84, 0.91]) and good calibration. The C-index interval validation was confirmed to be 0.86. This study resulted in the development of a novel nomogram with good accuracy to aid healthcare professionals in assessing the probability of a mother discontinuing exclusive breastfeeding at the breast before 6 months.

Partner influences, breastfeeding, and body image and eating concerns: An expanded biopsychosocial model

BACKGROUND

Recent research among postpartum women has considered body image and eating attitudes as well as exclusive breastfeeding within common theoretical models. However, these efforts have so far neglected to include partner-related constructs, which constitutes an important gap. Thus, the aim of this study was to examine an integrated model of body image and eating concerns, and exclusive breastfeeding among mothers of infants six months and younger, that included partner appearance influences as well as general postpartum support.

METHODS

A sample of new mothers (N = 156), aged 20-47 years, mean = 32.7 (SD = 4.7) years, reported on postpartum partner support and appearance pressures, thin-ideal internalization and body dissatisfaction, symptoms of disordered eating, depression, breastfeeding self-efficacy and exclusive breastfeeding. Path analyses were conducted to test the hypothetical model.

RESULTS

Findings revealed that the final model was a good fit to these data. Postpartum partner support was associated with lower depression and higher breastfeeding self-efficacy, through which it was related to higher reports of exclusive breastfeeding and lower eating disorder symptoms. In addition, partner appearance pressures and thin-ideal internalization were associated with higher body dissatisfaction, and thin-ideal internalization was also related to lower breastfeeding self-efficacy.

CONCLUSIONS

Partner influences may be important to account for in models of body image and eating concerns among postpartum women, and exclusive breastfeeding, and further research on ways in which they can support mothers of young infants is warranted.

Effect of peer support on breastfeeding self-efficacy in ilamian primiparous women: A single-blind randomized clinical trial

Introduction:

Mother's belief, ability, and self-confidence, which is interpreted as breastfeeding self-efficacy, play a key role in the initiation and continuation of breastfeeding. Numerous factors affect this ability of the mother. Therefore, this study aimed to investigate the effect of peer support on breastfeeding self-efficacy in primiparous women.

Materials and Methods:

In this clinical trial, 240 primiparous women were randomly divided into experimental and control groups. The control group program included routine training, and the experimental group received counseling and training by 30 peers during the first three months after delivery. To determine breastfeeding self-efficacy, Denis's long-term breastfeeding self-efficacy questionnaire was used at the end of week 12 after delivery. Data were analyzed using SPSS software program, version 16.0 and independent t test, Chi-square test, and Mann–Whitney U test.

Results:

The mean of breastfeeding self-efficacy score at the end of week 12 after delivery was 141.11 ± 93.4 in the experimental group versus 114.40 ± 60.16 in the control group. Then, the two groups had a statistically significant difference (P = 0.001). Also, exclusive breastfeeding in the experimental group was higher than in the control group (P = 0.001).

Conclusion:

Peer support for primiparous women can effectively improve breastfeeding self-efficacy and continuity of exclusive breastfeeding.

Telephone intervention to promote maternal breastfeeding self-efficacy: randomized clinical trial

OBJECTIVE

To analyze the effects of an educational intervention via telephone on maternal breastfeeding self-efficacy.

METHOD

Randomized controlled clinical trial including 240 puerperae from a secondary care hospital randomized into two groups: control and intervention. The educational intervention took place at seven, 30, 90, and 150 days postpartum and centered on self-efficacy and motivational interviewing principles. Self-efficacy was measured by the Breastfeeding Self-Efficacy Scale - Short Form. The data followed the abnormal distribution, so non-parametric tests were used.

RESULTS

The intervention group obtained higher median breastfeeding self-efficacy scores across the three outcome measures when compared to the control group (p < 0,001). Furthermore, the intervention group showed increased self-efficacy scores at all monitoring moments, which shows that the educational intervention was able to raise and maintain women's confidence in breastfeeding their child over time.

CONCLUSION

The use of a telephone-based intervention focused on self-efficacy principles and delivered by trained nurses effectively promoted maternal confidence in breastfeeding. Brazilian Clinical Trial Registry: RBR-7m7vc8.

The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool

INTRODUCTION

While breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month.

METHODS

A methodological study with longitudinal design among 586 mother-infant dyads, as part of the "BrEaST Start in Life" project. BSES was assessed 24-48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis.

RESULTS

With Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbach's α = 0.94) while factor analysis revealed a two-factor structure. BSES scores were higher among mothers who initiated exclusive breastfeeding (M = 3.92, SD = 0.80) compared to breastfeeding not exclusively (M = 3.29, SD = 0.84) and not breastfeeding (M = 3.04, SD = 1.09; p-value < 0.001). There was a stepwise association with exclusivity (40.5% in the highest vs 7.9% lowest quartile of self-efficacy). The association between in-hospital BSES and long-term EBF persisted in multivariable models. Women in the upper quartile of BSES at 48 h were more likely to breastfeed exclusively by adjOR = 5.3 (95% CI 1.7-17.1) at the 1st and adjOR = 13.7 (95% CI 2.7-68.6) at the 4th month. Similar associations were observed between self-efficacy at the 1st month and BF at subsequent time-points. High first month BSES (> 3.96 as per ROC) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months which reflects higher sensitivity but lower specificity.

CONCLUSIONS

The Greek version of BSES-SF showed good metric properties (construct, know-group, concurrent and predictive validity). In the absence of community support structures or programmes in Cyprus, prevalence of breastfeeding remains low. This suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.

Religiosity/Spirituality and Mental Health and Quality of Life of Early Pregnant Women

The present study aims to investigate how religious/spiritual (R/S) beliefs are associated with depressive, anxious and stress symptoms and quality of life (QOL) of 160 Brazilian women in early pregnancy. In this cross-sectional study, religiosity/spirituality (DUREL, Daily Spiritual Experiences, Brief-RCOPE), mental health (DASS-21) and quality of life (WHOQOL-Bref) were assessed. Negative R/S coping was associated with higher levels of depressive, anxious and stress symptoms and worse physical and psychological QOL. On the other hand, positive R/S coping, intrinsic religiosity, and spirituality were associated with better psychological QOL, while only spirituality was associated with better social QOL.

Challenges, supports, and postpartum mental health symptoms among non-breastfeeding mothers

Women face a high degree of pressure to breastfeed. However, some women are not able to breastfeed, or choose not to. Few studies have examined the experiences of non-breastfeeding mothers, including their challenges, supports, and mental health sequelae. We sought to identify women's experiences with breastfeeding, specifically their reasons for not breastfeeding, challenges faced, and supports received, and the association between breastfeeding and postpartum mental health. Self-identified postpartum women (N = 70) completed a questionnaire investigating perinatal health. Open-ended responses were analyzed using thematic analysis and quantitative measures were analyzed using descriptive statistics and multivariate analysis of variance (MANOVA). Qualitative analysis identified two main themes reflecting reasons for not breastfeeding (maternal factors and infant factors) and three primary challenges associated with not breastfeeding (emotional health, physical health, and perceived lack of support). Authors identified two main themes categorizing non-breastfeeding mothers' experiences with support (sources of support and type of support). A MANOVA revealed significantly greater levels of distress, anxiety, and depression, and lower levels of social support, among non-breastfeeding, relative to breastfeeding mothers. Findings reveal limitations in the availability of information and resources for non-breastfeeding mothers. It is possible that the pressure women may experience regarding breastfeeding may contribute to increased psychological distress for mothers who cannot or choose not to breastfeed. Based on our findings, future research and applied action should target the development and evaluation of informational resources and supports for non-breastfeeding women.

Women's Mental Health as a Factor Associated with Exclusive Breastfeeding and Breastfeeding Duration: Data from a Longitudinal Study in Greece

Background: This study investigated the relationship between exclusive breastfeeding and breastfeeding duration, and maternal psychological well-being in the perinatal period. Methods: A longitudinal study involving a retrospective follow-up of a group of 1080 women from pregnancy to the 1st year postpartum, who gave birth during the 5-year period between January 2014 and January 2019 in Athens, Greece, was designed. Women’s history and two psychometric tools—the Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) administered at 5-time points—were used for data collection. Logistic regression analysis and a series of multiple analysis of variance (MANOVA) tests were performed. Results: The chance for exclusive breastfeeding (giving only breast milk) appeared to decrease (a) with an increase of the scores for psychometric tools antenatally (PHQ-9, p = 0.030) or at the 6th week postpartum (EPDS, p < 0.001 and PHQ-9, p < 0.001), (b) with an increase in the number of psychotherapeutic sessions needed antenatally (p = 0.030), and (c) when the initiation of psychotherapy was necessary postpartum (p = 0.002). Additionally, a shorter duration of any breastfeeding (with or without formula or other types of food/drink) seems to be associated with (a) the occurrence of pathological mental health symptoms (p = 0.029), (b) increased PHQ-9 scores antenatally (p = 0.018), (c) increased EPDS scores at the 6th week (p = 0.004) and the 12th month postpartum (p = 0.031), (d) the initiation of psychotherapy postpartum (p = 0.040), and e) the need for more than 13 psychotherapeutic sessions (p = 0.020). Conclusions: This study demonstrates a negative relationship between exclusive breastfeeding and breastfeeding duration, and poor maternal mental health in the perinatal period.

The breastfeeding and early motherhood experiences of older first-time mothers: A constructivist grounded theory study

OBJECTIVE

The objective of this paper is to present the results of a qualitative study that explored the factors surrounding decision-making related to breastfeeding and the experiences of early motherhood for 23 first-time mothers over the age of 35 in Canada. Previous studies on breastfeeding have not examined older first-time mothers as a group that is unique due to their experience of coming to motherhood in the context of the growing phenomenon of delayed childbearing in the 21st century. Many older women come to motherhood with both well- established life and professional experiences, and as such their needs may differ from their younger or multiparous counterparts. The research question was: "What factors affect how first-time mothers >35 years of age make decisions about breastfeeding, and how do these factors affect the decisions they make related to breastfeeding and their transition to motherhood in the first six months postpartum?"

DESIGN

Constructivist grounded theory FINDINGS: The theory of From Ideology to Independence: Older First-time Mothers, Breastfeeding, and Becoming a Mother provides a lens to view the underlying processes influencing the decisions the mothers made related to breastfeeding and early motherhood. The mothers worked through the processes of learning breastfeeding, redefining self, and defining motherhood. The mothers' belief that breastfeeding defines motherhood, coupled with lack of knowledge and control, had a negative effect on both early breastfeeding and their transition to motherhood. As the idea of breastfeeding equating successful mothering waned the mothers became active agents in decision-making related to infant feeding and mothering.

Breastfeeding Monitoring Improves Maternal Self-Efficacy and Satisfaction

PURPOSE

The purpose of this study was to determine the effects of an interactive web-based breastfeeding monitoring system on breastfeeding self-efficacy and satisfaction among mothers of full-term infants at 1, 2, and 3 months after hospital discharge.

STUDY DESIGN

We conducted a secondary data analysis of our two-arm, repeated-measures randomized controlled trial that took place in three Midwestern hospitals. Participants were assigned to either control or intervention groups using random numbers. Of the 141 mother-baby dyads enrolled and randomized, 35 dropped out of the study, leaving 57 mothers in the control group and 49 in the intervention group. Mothers in both groups received care based on the hospital protocol, but mothers in the intervention group were also given access to an interactive web-based breastfeeding monitoring system prior to discharge. Participants were asked to enter breastfeeding data, receive educational messages for 30 days, and complete the Breastfeeding Self-Efficacy Scale (BFSE) at 1, 2, and 3 months and the Maternal Breastfeeding Evaluation Scale (MBFES) at 3 months. Mothers received feedback in case of breastfeeding problems.

RESULTS

A significant difference between groups in BFSE at the 2 and 3 months (p = 0.04; p = 0.04) with medium effect size (0.52, 0.53) was found. There was a significant difference between groups in the total score of MBFES (p = 0.02, effect size 0.53). Mean scores were 122.2, SD = 17.68 for intervention and 112.8, SD = 18.03 for control group. The MBFES scores were positively correlated to BFSE scores among intervention group at all time points (r = .714, n = 45, p < .00; r = .611, n = 41, p < .00; r = .637, n = 39, p < .00).

CLINICAL IMPLICATIONS

Interactive web-based breastfeeding monitoring improved maternal breastfeeding self-efficacy and satisfaction and may be a promising innovation to promote maternal breastfeeding self-efficacy and satisfaction.

The effect of breastfeeding education with grandmothers' attendance on breastfeeding self-efficacy and infant feeding pattern in Iranian primiparous women: a quasi-experimental pilot study

Background

One of the most important factors that affects breastfeeding self-efficacy and exclusivity is breastfeeding support provided by the family. The aim of this study was to determine the effect of breastfeeding education sessions for primiparous women, with and without the attendance of maternal grandmothers, on breastfeeding self-efficacy and infant feeding patterns.

Methods

This quasi-experimental study was conducted on 64 primiparous women who referred to the Antenatal Clinic of Amiralmomenin Hospital, Tehran, Iran from June to December, 2018. Eligible pregnant women were allocated into two groups; either with and without grandmothers in attendance. Group assignments were determined according to the week the women had prenatal care at the hospital. All eligible women seen in the clinic during 1 week were assigned to one group and women who presented in the alternating week were assigned to the other group. In the education group with grandmothers in attendance, each woman participated in two prenatal education programs with her mother and one postpartum program approximately 3 h before discharge. In the other group, participating mothers attended breastfeeding education sessions without the grandmother’s attendance. The participating mothers answered questions from the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at the time of the hospital discharge, and 4 and 8 weeks after delivery. Questions about the infants’ feeding patterns were asked by telephone contact with the participating mothers from both groups at the same time periods.

Results

The mean BFSE scores were signficantly different between the groups with grandmothers and without grandmothers at the time of the hospital discharge (60.15 ± 4.47 vs. 56.84 ± 6.22, independent t-test; p = 0.017), and at 4 weeks (61.71 ± 2.66 vs. 56.62 ± 9.12, p = 0.004) and 8 weeks after delivery (63.68 ± 2.14 vs. 60.03 ± 6.32, p = 0.003). No significant difference existed in infant feeding patterns between the groups at the same time periods.

Conclusions

This study suggests that breastfeeding education with grandmothers’ attendance is effective in improving the mothers’ breastfeeding self-efficacy. A family-centered program should be considered in beastfeeding education for increasing of exclusive breastfeeding.

Maternal Sense of Control During Childbirth and Infant Feeding Method

OBJECTIVE

To estimate whether maternal sense of control in labor is associated with breastfeeding at 4-8 weeks postpartum.

METHODS

This is a secondary analysis of data from a multicenter randomized controlled trial of elective induction of labor at 39 weeks of gestation in low-risk nulliparous women. In this trial, women completed the Labor Agentry Scale, a validated measure of women's feelings of control over the childbirth process, 6-96 hours after delivery. The Labor Agentry Scale score, which is higher with more perceived control during childbirth, was analyzed both as a continuous and a categorical variable (quintiles). Self-reported breastfeeding at 4-8 weeks postpartum was categorized as exclusive breastfeeding, breastfeeding and formula feeding, or exclusive formula feeding. Women were included in this analysis if they labored, filled out a Labor Agentry Scale questionnaire, had a neonate who survived until the postpartum visit, and provided information on infant feeding. Multinomial logistic regression was used to adjust for confounders.

RESULTS

Of 5,185 women, 32.9% (n=1,705) were exclusively breastfeeding, 31.2% (n=1,620) were breastfeeding and formula feeding, and 35.9% (n=1,860) were exclusively formula feeding 4-8 weeks after delivery. Overall Labor Agentry Scale score ranged from 34 to 203 (median 167, interquartile range 145-182). The median Labor Agentry Scale score was 169 (interquartile range 151-183) for women exclusively breastfeeding, 166 (interquartile range 142-182) for women who were breastfeeding and formula feeding, and 164 (interquartile range 142-181) for women who were only formula feeding (P<.001). In the unadjusted multinomial model, women with Labor Agentry Scale scores in the lowest two quintiles (ie, those with lower perceived control during childbirth) were less likely to be exclusively breastfeeding (as compared with those exclusively formula feeding) than women in the highest Labor Agentry Scale quintile. When controlling for confounders, however, this association was no longer significant.

CONCLUSION

After adjustment for confounders, perceived control during childbirth was not associated with breastfeeding at 4-8 weeks postpartum among nulliparous women.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT01990612.

The Effect of Motivational Interviewing on Self-Efficacy and Continuation of Exclusive Breastfeeding Rates: A Quasi-Experimental Study

Background: Self-efficacy is a decisive psychological and motivational factor in maintaining exclusive breastfeeding (EBF). The aim of this study was to explore the impact of motivational interviewing (MI) on EBF self-efficacy and EBF in primiparous women. Materials and Methods: This quasi-experimental study was conducted on 140 primiparous women admitted to a number of comprehensive health centers in Zahedan in 2019. The health centers were determined through multistage random sampling, and the subjects were selected from each center using convenience sampling. The selected women were equally divided into the intervention and control groups. The two groups took the pretest by filling out a demographic questionnaire and a breastfeeding self-efficacy questionnaire. The intervention group attended four 45- to 60-minute MI sessions on breastfeeding. The EBF continuation sheet and the breastfeeding self-efficacy questionnaire were filled out 6 months postpartum. Data were analyzed in SPSS 22 using paired t-test, independent t-test, chi-square test, and covariance analysis. Results: Based on the results, the mean and standard deviation of the number of EBF days were significantly higher in the intervention group (137.68 ± 65.50) compared with that of the control group (99.51 ± 80.62). In addition, the mean score of breastfeeding self-efficacy after MI was significantly different between the two groups (p = 0.0001). Conclusion: Because of the significantly positive impact of MI on enhancing EBF self-efficacy and continuation, it is recommended to integrate this counseling strategy into the care programs designed for women in pregnancy and even postpartum period.

The Role of Perinatal Anxiety and Depression in Breastfeeding Practices

Objective: Maternal mental health difficulties are common during the perinatal period and have a negative impact on breastfeeding practices. Most research has focused on the role of postpartum depression, whereas maternal anxiety has been less studied, despite its high prevalence. A better understanding of the mental health variables that impact breastfeeding practices is necessary to support maternal and infant health and well-being. The aim of this study is to explore the association between breastfeeding practices and maternal mental health, with an emphasis on maternal anxiety. Materials and Methods: Two hundred twenty-nine women were followed from the third trimester of gestation to 3 and 6 months postpartum. The participants provided self-reports of depression, anxiety, and breastfeeding practices. Mental health symptoms were compared between participants who reported exclusive versus mixed breastfeeding at 3 months postpartum, and between mothers who maintained breastfeeding versus those who had weaned their infants at 6 months postpartum. Logistic regression analysis was used to explore the variables contributing to breastfeeding practices. Results: High levels of depressive symptoms during pregnancy were associated to nonexclusive breastfeeding at 3 months postpartum. At 3 months postpartum, both high levels of anxiety and depression were associated with nonexclusive breastfeeding at that time. Logistic regression analyses revealed that exclusive breastfeeding at 3 months postpartum predicted breastfeeding continuation at 6 months after childbirth. Conclusion: Both maternal depression and anxiety negatively impact breastfeeding practices. Early identification of maternal mental health problems during the perinatal period is relevant to promote maternal emotional well-being and to prevent breastfeeding difficulties.

The significance of early breastfeeding experiences on breastfeeding self-efficacy one week postpartum

Many new mothers do not reach their breastfeeding goals. Breastfeeding self-efficacy is a modifiable determinant influenced by prior and new breastfeeding experiences. More knowledge about factors associated with early breastfeeding experiences and breastfeeding self-efficacy would allow us to qualify breastfeeding counselling and increase breastfeeding duration. This study aimed to identify prevalence and factors associated with early negative breastfeeding experience, low breastfeeding self-efficacy in the first week postpartum, and drop in self-efficacy from late pregnancy to early postpartum period. A prospective longitudinal study was performed in Denmark from 2013 to 2014, including 2, 804 mothers. Results showed that 1 week postpartum almost 10% of mothers had negative breastfeeding experiences, 36% had low breastfeeding self-efficacy, and 26% drop in self-efficacy from pregnancy. Negative breastfeeding experiences were significantly associated with epidural analgesia, interrupted skin-to-skin contact immediately postpartum, short previous breastfeeding duration, and lacking social support. Low breastfeeding self-efficacy was associated with low breastfeeding intention, short previous breastfeeding duration, and negative breastfeeding experiences in the first week postpartum. Finally, significant associations of drop in breastfeeding self-efficacy from late pregnancy were no or short education, early negative breastfeeding experiences, prior short breastfeeding duration, and low general breastfeeding self-efficacy in pregnancy. Negative breastfeeding experiences in the first week postpartum is crucial for maternal breastfeeding self-efficacy 1 week following birth. It is important to identify and support mothers at risk of negative breastfeeding experiences in the first week following birth and address factors that might increase the probability of early successful breastfeeding experiences.

Do postpartum anxiety and breastfeeding self-efficacy and bonding at early postpartum predict postpartum depression and the breastfeeding method?

We investigated whether postpartum anxiety (PPA) and breastfeeding self-efficacy and bonding at the early postpartum period can be used to predict postpartum depression and the breastfeeding method, and we sought to identify factors related to postpartum depression. Of the 510 eligible women, 185 (36%) returned the questionnaire on all three occasions (1 day, 3 days, and 1 month after childbirth). The mothers' progress on the State-Trait Anxiety Inventory (STAI), Breastfeeding Self-Efficacy Scale Short Form (BFSES-SF), and Postnatal Bonding Questionnaire (PBQ) was observed over three periods. A repeated-measures ANOVA revealed that the mothers at high risk of developing postpartum depression (PPD) were those who did not show an increase in BFSES-SF score at early postpartum, and mothers whose bonding disorders have deteriorated rapidly. The results of the logistic regression analysis revealed a significant difference in employment as a factor related to postpartum depression. Compared to Regular, Part-time status was 4.4 times more likely and Unemployed status was 2.3 times more likely to cause postpartum depression. For the early detection of PPD, it is necessary to identify (1) mothers who do not show an increase in the BFSES-SF score, (2) mothers whose bonding disorders have deteriorated rapidly, and (3) part-time or unemployed mothers as characteristic of postpartum depression.

Mothers' parenting self-efficacy, satisfaction and perceptions of their infants during the first days postpartum

OBJECTIVE

The first aim of this study was to describe mothers' self-efficacy, satisfaction and perceptions when parenting their infants during the first days postpartum. Furthermore, the study aimed to explore the distinct sociodemographic as well as mother and infant related factors that are associated with the above parenting aspects.

DESIGN

A descriptive and cross-sectional study design was used.

SETTING

Three separate postpartum wards 1-7 days after childbirth in one university level hospital in Finland.

PARTICIPANTS

All mothers who gave birth during March 1st to May 20th, 2019 and filled the inclusion criteria, were invited to participate in this study. A convenience sample of 250 mothers with healthy singleton infants agreed to participate.

MEASUREMENTS AND FINDINGS

The following instruments were used: The Parenting Self-Efficacy (PSE) scale, the Evaluation subscale of What Being the Parent of a New Baby is Like-revised (WBPL-R) and the Perception of Infant scale. Mothers' parenting self-efficacy and parenting satisfaction were high during the first days postpartum. Age, marital status, education and type of birth were not associated with parenting self-efficacy nor satisfaction. Mothers who were unemployed or working only part-time reported higher scores across all categories of parenting self-efficacy, compared to full time employed mothers (p < .001). A higher number of children (≥ 3) were positively associated with both parenting self-efficacy and satisfaction. Mothers who reported poor breastfeeding initiation success also reported significantly lower scores in parenting self-efficacy and parenting satisfaction across all categories. Mothers' perceptions of their infants' fussiness were not associated with parenting self-efficacy (p = .113) nor parenting satisfaction (p = .091).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The results of this study can benefit postpartum maternity health care professionals by suggesting factors that could be focused on during the very short period that mothers stay in hospital. Discussing prior mothering experiences, work life before maternity leave, breastfeeding initiation experiences and perception of infant with the mothers after childbirth, may lead to better PSE and PS during the postpartum period.

Prenatal infant feeding intentions and actual feeding practices during the first six months postpartum in rural Rwanda: a qualitative, longitudinal cohort study

Background

Exclusive breastfeeding (EBF) is advocated by the WHO for the first 6 months. In Rwanda, the percentage of infants who are exclusively breastfed decreases from 94% among infants aged 0–1 month to 81% among those aged 4–5 months. Little is known about what influences mothers’ breastfeeding practices. This study aimed to gain insights into expectant mothers’ prenatal feeding intentions, the underlying reasons, actual practices after birth, and factors facilitating or impeding EBF for the first 6 months of a child’s life in Muhanga District, Rwanda.

Methods

This qualitative longitudinal study, conducted between December 2016 and October 2017 as part of a larger study, recruited a purposive sample of 39 pregnant women attending prenatal consultations during their last trimester in two rural health centers. Women were interviewed during pregnancy, within the first week after birth and at 4 and 6 months postpartum to explore intentions, actual practices, critical transition points, and facilitating or impeding factors. Interviews were recorded, transcribed verbatim, and analyzed thematically.

Results

Of the 39 participants, 38 intended to breastfeed within the first hour after birth, and 32 intended to breastfeed exclusively for the first 6 months. In practice, 34 initiated breastfeeding within the first hour, and 12 breastfed exclusively for 6 months. Impeding factors include perceived breastmilk insufficiency, pressure from family members, past experiences, mothers’ concerns over their infants’ health, mothers’ heavy workload, poverty and food insecurity. Factors facilitating early initiation and EBF include mothers’ awareness of EBF’s advantages, confidence in their breastfeeding ability, and support from health professionals and family members.

Conclusion

Despite participants’ intentions about breastfeeding, there was a gap between intentions and actual practices. An interplay of barriers at individual, group and societal levels impeded women from EBF for the first 6 months. EBF promotion interventions should consider supporting and equipping breastfeeding mothers with skills to deal with perceived breastmilk insufficiency and to recognize the true signs of baby hunger cues. Furthermore, important influential family and community members should be targeted to support mothers to breastfeed. Interventions that consider addressing the issue of poverty-driven food insecurity should not be overlooked either.

Breastfeeding beliefs and experiences of African immigrant mothers in high-income countries: A systematic review

Breastfeeding provides optimal nutrition for the healthy growth of infants and is associated with reduced risks of infectious diseases, child and adult obesity, type 2 diabetes, and other chronic diseases. Migration has been shown to influence breastfeeding especially among migrants from low-and-middle-income countries. This mixed-methods systematic review aimed to identify, synthesise, and appraise the international literature on the breastfeeding knowledge and experiences of African immigrant mothers residing in high-income countries. MEDLINE, CINAHL, Embase, PsychINFO, Scopus, and Web of Knowledge databases were searched from their inception to February 2019. Grey literature, reference, and citation searches were carried out and relevant journals hand-searched. Data extraction and quality assessment were independently carried out by two reviewers. An integrated mixed-methods approach adopting elements of framework synthesis was used to synthesise findings. The initial searches recovered 8,841 papers, and 35 studies were included in the review. Five concepts emerged from the data: (a) breastfeeding practices, showing that 90% of African mothers initiated breastfeeding; (b) knowledge, beliefs, and attitudes, which were mostly positive but included a desire for bigger babies; (c) influence of socio-demographic, economic, and cultural factors, leading to early supplementation; (d) support system influencing breastfeeding rates and duration; and (e) perception of health professionals who struggled to offer support due to culture and language barriers. African immigrant mothers were positive about breastfeeding and willing to adopt best practice but faced challenges with cultural beliefs and lifestyle changes after migration. African mothers may benefit from more tailored support and information to improve exclusive breastfeeding rates.

Prior breastfeeding experience and infant feeding at discharge among women with pregestational diabetes mellitus

OBJECTIVE

To compare multiparous women with pregestational diabetes mellitus (PGDM) with and without prior breastfeeding (BF) experience and to ascertain their infants' feeding type during hospitalization and at discharge.

METHODS

A retrospective cohort study of 304 women with PGDM who delivered at ≥34 weeks gestational age (GA). Prior BF experience and infant feeding preference was declared prenatally. At discharge, BF was defined as exclusive or partial.

RESULTS

BF experience and no experience groups were similar in diabetes type 1 and 2, race and number of pregnancies. Women with no experience had more spontaneous abortions (35 vs 27%), fewer term deliveries (51 vs 61%) and living children (median 1 vs 2). In the current pregnancy, mode of delivery: vaginal (36 & 37%), cesarean (64 & 63%), birthweight (3592 & 3515 g), GA (38 & 37 w), NICU admission (14 & 11%) and hypoglycemia (44 & 43%) were similar. Women with experience intended to BF (79 vs 46%), their infants' first feeding was BF (64 vs 36%) and had lactation consults (96 vs 63%) more often than those without experience. At discharge, women with BF experience were different in rate of exclusive BF (33 vs 11%), partial BF (48 vs 25%) and formula feeding (19 vs 64%).

CONCLUSION

Prior BF experience leads to better BF initiation rates while the absence of BF experience adds a risk for BF initiation failure. A detailed BF history could provide insight into obstacles that lead to unsuccessful BF experiences and may help define appropriate preventive or corrective strategies.

Rediscovering empowerment with breastfeeding in an urban First Nation's population

Background

An inner-city neighbourhood of Regina, Saskatchewan continues to have recurring issues of drug and alcohol use affecting parents’ caregiving opportunity. In relation to this, many children, mostly of First Nations descent, are raised in out-of-home care away from their families. With the promotion of breastfeeding, in a neighbourhood prenatal/postnatal support program, breastfeeding rates have doubled and mothers’ participation in their children’s care has increased. Recognition and promotion of cultural beliefs about breastfeeding is integral to raise community awareness of the practice. To bring additional support for breastfeeding, the empowerment effects observed were measured.

Methods

Using a longitudinal study design, indicators of empowerment were assessed prenatally and again at two months postpartum. Indicators included self-esteem, caregiving activities, and drug and alcohol use. Outcomes of assessments were correlated to infant feeding practices and findings compared.

Results

Findings supported a statistically significant improvement for empowerment scores when mothers breastfed. Mean scores for self-esteem increased from 2.87 to 3.57 (r = .90, p = <.001); for caregiving, scores increased from 2.60 to 3.16 (r = .91, p = <.001); and for drug and alcohol use, scores decreased from 59 to 9% (p = <.001).

Conclusions

The study brings attention to the value of breastfeeding for caregiving in situations of addiction and limited resources. Practitioner reflexivity in regards to their support for breastfeeding is critical and includes openness to alternate breastfeeding situations and beliefs. The study found that a positive outlook on breastfeeding is the first step for a practitioner-client relationship that fosters confidence for marginalized populations.

Significance statement

According to research, less breastfeeding occurs when mothers are marginalized. In turn, as marginalization increases, a mother’s self-esteem regarding her ability to adequately care for her child decreases. Healthcare professionals tend to be less likely to support a decision to breastfeed if there is concern about the mother’s resources and lifestyles. This research brings new attention to the importance of breastfeeding in disadvantaged situations related to an empowerment effect of breastfeeding for caregiving which includes cessation of drug and alcohol use. This effect has not previously been measured.

Investigating Predictors of Prenatal Breastfeeding Self-Efficacy

Background

While breastfeeding is considered the optimal method of infant feeding, Canadian breastfeeding rates remain below the World Health Organization recommendations. Breastfeeding self-efficacy is known to positively influence breastfeeding outcomes. While previous research has identified predictors of breastfeeding self-efficacy in the immediate postpartum, this study identified predictors of breastfeeding self-efficacy in the prenatal period. Research aim: The aim of this study was to identify predictors of breastfeeding self-efficacy in the prenatal period among both primiparous and multiparous women.

Methods

A sample of 401 Canadian pregnant women in their third trimester completed an online survey. Stepwise multiple linear regression identified predictors of breastfeeding self-efficacy.

Results

The following variables explained 41.2% of the variance in breastfeeding self-efficacy among the entire sample: feeling prepared for labor and birth, number of children, breastfeeding knowledge, anxiety, length of plan to exclusively breastfeed, income, plan to exclusively breastfeed, and type of health-care provider. Among primiparous women, the following variables explained 31.6% of the variance in breastfeeding self-efficacy: feeling prepared for labor and birth, income, anxiety, length of plan to exclusively breastfeed, education, and marital status. Among the multiparous women, the following variables explained 33.6% of the variance in breastfeeding self-efficacy: anxiety, length of prior exclusive breastfeeding experience, breastfeeding knowledge, and plan to exclusively breastfeed.

Conclusion

Through the identification of predictors of breastfeeding self-efficacy in the prenatal period, health-care providers can strategically target women at risk of low breastfeeding self-efficacy and intervene early to promote breastfeeding.

Breastfeeding Support Guided by Swanson's Theory of Caring

PURPOSE

Many women struggle with initiation of breastfeeding. The purpose of this study was to explore mothers' perceptions of care and support received from clinicians during breastfeeding initiation and the utility of Swanson's (1991) Theory of Caring to provide person-centered care to breastfeeding mothers and infants.

STUDY DESIGN AND METHODS

Directed content of secondary analysis of data obtained from 11 women via in-person interviews at three time points: before birth, a week after giving birth, and 6 to 8 weeks after giving birth. All women were breastfeeding at the end of the study interview series. Swanson's Theory of Caring provided the theoretical framework for the analysis.

RESULTS

Two overarching themes The Acts of Caring and The Lapses in Caring summarized women's experiences of care received during the initiation of breastfeeding. Five subthemes supported the Acts of Caring theme, and three subthemes supported the Lapses in Caring theme.

CLINICAL IMPLICATIONS

Although all study participants chose to breastfeed after hospital discharge and the majority felt well supported, some received care that was perceived as uncaring, unsupportive, or harmful. Providing breastfeeding support consistent with research evidence and underpinnings of Swanson's Theory of Caring may help women build trusting relationships with clinicians and feel confident in meeting their breastfeeding goals.

The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF): a validation study in Iranian mothers

OBJECTIVE

The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) is a widely used instrument that measures breastfeeding self-efficacy. This study aimed to examine the reliability and validity of the Persian version of BSES-SF in Iranian mothers.

RESULTS

The English version of BSES-SF was translated into Persian using the standard forward-backward translation procedure. No changes (i.e., neither delete nor rephrase the items) were made to the BSES-SF items. The mean BSES-SF total score was 50.80 ± 8.91. The Cronbach's alpha coefficient for internal consistency for the BSES-SF was 0.910. The confirmatory factor analysis results provided evidence for unidimensionality of the scale (χ²/df = 4.42; CFI = 0.96; NFI = 0.95; IFI = 0.96; RMSEA = 0.095 and SRMR = 0.054). The divergent validity of the BSES-SF was proved via a significant negative correlation with scores of the Edinburgh Postnatal Depression Scale (r = - 0.273, P < 0.001). In sum, the Persian version of the BSES-SF is a reliable and valid instrument for measuring breastfeeding self-efficacy in Iranian mothers. Trial registration number This was a cross-sectional study (not clinical trial).

Previous breastfeeding difficulties: an existential breastfeeding trauma with two intertwined pathways for future breastfeeding-fear and longing

PURPOSE

Experiencing breastfeeding difficulties poses a risk for early cessation of breastfeeding and decreases the likelihood of breastfeeding a future child. To further understand breastfeeding outcomes, the aim of this study is to explain the phenomenon of breastfeeding difficulties in order to understand how women's previous experiences of breastfeeding difficulties relate to their decisions about future breastfeeding.

METHODS

A reflective lifeworld hermeneutical approach was adopted. The study consisted of 15 lifeworld interviews with eight women who had previously experienced difficulties with initial breastfeeding.

RESULTS

Previously experienced breastfeeding difficulties represent an existential breastfeeding trauma in an individual woman's life, from which there are two intertwined pathways for future breastfeeding: a fear of breastfeeding, which renders the idea of future breastfeeding unthinkable, and a longing for breastfeeding, which increases the likelihood of future breastfeeding. Fear and longing are intertwined in ambiguous ways in an individual woman's life.

CONCLUSION

Women with previous breastfeeding difficulties may bring negative breastfeeding experiences with them, which are etched into the woman's being as a mother as an embodied memory. A lifeworld-led caring science perspective as a foundation for care can contribute to the development of caring practices, which grasp the existential nature of the breastfeeding trauma.

Husbands' participation in prenatal care and breastfeeding self-efficacy in Iranian women: A randomized clinical trial

Background: Self-efficacy is an important psychological and motivational factor for continuation of exclusive breastfeeding. This study aimed to examine the effect of husband participation on self-efficacy of breastfeeding in postpartum period. Methods: This study was a single-blind clinical trial (IRCT2014012115163N2) conducted on 66 pregnant women who referred to health centers of Urmia in 2014. Convenience sampling method was used to select the participants and then they were randomly allocated to control and intervention groups using RANDBETWEEN function in Excel. Participants in the intervention group had 2 training sessions with 4-week interval. They could also use telephone counseling over study time. Those in the control group received the routine pregnancy care, and their breastfeeding self-efficacy was compared 1 month after delivery using Dennis Breastfeeding Self-Efficacy questionnaire. The data were analyzed using SPSS version 20. Chi square, independent and paired samples t test were used. Results: In this study, the mean score of breastfeeding self-efficacy in the intervention and control groups after intervention was 50.36±8.65 and 44.12±10.41, respectively, which showed a statistically significant difference (p=0.017). Conclusion: According to the results, one of the considerable strategies to enhance self-efficacy of breastfeeding is to involve husbands in prenatal care, which should be considered by the authorities and health professionals, including doctors, nurses, and midwives.