A comparison of two methods of antenatal breast-feeding education

Women's Satisfaction with Breastfeeding and Risk of Exclusive Breastfeeding Interruption

This prospective cohort study was conducted to evaluate the association between women's satisfaction with breastfeeding at 1 month post-partum and the risk of exclusive breastfeeding (EBF) interruption before 6 months. 287 mother-infant dyads randomly selected from two maternity hospitals were followed from birth to 24 months of infant's age. Women's satisfaction with breastfeeding was assessed using the Maternal Breastfeeding Evaluation Scale (MBFES) at 1 month. The association between women's satisfaction with breastfeeding and risk of EBF interruption before 6 months was estimated using Cox proportional hazards model. Kaplan-Meier survival curves for EBF were compared between women with lower satisfaction with breastfeeding (MBFES score < median 124) and those with higher satisfaction (MBFES score ≥ 124). Median EBF duration in women with higher satisfaction was 120 days (95%CI 109-131), vs. 26 days (95%CI 19-33) in less satisfied women. Each additional point on MBFES promoted a reduction of 2.0% in the risk of EBF interruption. Among women with satisfaction scores < 124, the risk of EBF interruption was 86% higher when compared with those ≥ 124 (adjusted hazard ratio 1.86; 95%CI 1.41-2.46). Lower maternal satisfaction with breastfeeding in the first month post-partum is associated with a higher risk of EBF interruption before 6 months.

Validation of the Arabic Maternal Breastfeeding Evaluation Scale (MBFES-A) among Lebanese women

Background

Maternal satisfaction with the breastfeeding experience is an important determinant of breastfeeding success. There is currently no valid tool to measure perceived maternal satisfaction with breastfeeding in the Arab context.

Methods

This cohort study tested the Maternal Breastfeeding Evaluation Scale (MBFES) on 450 healthy Lebanese mothers for internal consistency reliability and construct validity. Participants were recruited between April 2018 and February 2020.

Results

The Cronbach’s alpha reliability coefficient of the Arabic MBFES (MBFES-A) was 0.87. Exploratory factor analysis revealed that it has three components: Infant Satisfaction/Growth, Maternal Enjoyment/Role Attainment, and Lifestyle/Body Image with reliability coefficients of 0.88, 0.87, and 0.68, respectively. Four items were deleted because of low factor loadings and three items were relocated to the Infant Satisfaction/Growth subscale based on their factor loadings. Participants who were exclusively breastfeeding at one and/or 3 months had higher mean MBFES-A total and Infant Satisfaction/Growth and Maternal Enjoyment/Role Attainment subscale scores than participants who were partially breastfeeding, and significantly higher mean scores than mothers who were not breastfeeding (all p values < 0.001), findings that support the scale’s construct validity. Moreover, scores on the Infant Satisfaction/Growth subscale correlated with exclusive breastfeeding at one (r = 0.37, p < 0.001) and 3 months (r = 0.31, p < 0.001). The MBFES-A score had positive modest correlations with maternal attitude towards breastfeeding (r = 0.30, p < 0.001), exclusive breastfeeding at one (r = 0.27) and at 3 months (r = 0.26, p < 0.001 for both), as well as with the longest previous exclusive breastfeeding (r = 0.27, p < 0.001).

Conclusions

The 26-item MBFES-A is a reliable and valid instrument to use in future breastfeeding research in Middle East North Africa countries. There is a need for replication of our findings in other Arab contexts using new constructs to establish stronger construct validity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00409-w.

Maternal satisfaction with breastfeeding in the first month postpartum and associated factors

BACKGROUND

Breastfeeding success has been measured based on its duration, disregarding satisfaction with the maternal experience. Studies to investigate maternal satisfaction with breastfeeding are rare, especially in Brazil, and little is known about their determinants. The aim of this study was to measure the level of satisfaction with breastfeeding in a group of women in the first month of their child's life, and to identify factors associated with higher maternal satisfaction.

METHODS

A cross-sectional study nested within a cohort was conducted with 287 women recruited at two (one public, one private) maternity services in the city of Porto Alegre, southern Brazil, from January to July 2016. Women residing in the municipality who had given birth to a healthy singleton born at term, were rooming in, and had initiated breastfeeding were randomly included. During the week after the child was 30 days old, women were interviewed at their homes to measure the level of maternal satisfaction with breastfeeding, using the Maternal Breastfeeding Evaluation Scale (MBFES), validated for use in the Brazilian population. Associations between maternal satisfaction and explanatory variables were estimated using multivariate Poisson regression with robust variance in a four-level hierarchical approach. Satisfaction level was categorized using as cutoff point the median score obtained with the MBFES. Women with scores equal to or above the median were considered to have higher levels of satisfaction, whereas those scoring below the median were considered to be less satisfied.

RESULTS

Maternal satisfaction with breastfeeding in the first month postpartum was high, with a median score of 124 on MBFES, close to the maximum score (145 points). The prevalence of more elevated levels of satisfaction with breastfeeding was higher among women with brown (pardo) and black skin color (prevalence ratio [PR] 1.33, 95%CI 1.05;1.69), those who lived with the partner (PR 1.75, 95%CI 1.05;2.94), who planned to breastfeed for 12 months or more (PR 1.48, 95%CI 1.02;2.17), and who did not report low milk supply (PR 1.47, 95%CI 1.03;2.10) or cracked nipples (PR 1.29, 95%CI 1.01;1.65).

CONCLUSIONS

The factors associated with maternal satisfaction with breastfeeding in the first month postpartum include individual factors and maternal expectations, family constitution, as well as breastfeeding-related problems.

Validation of a tool to evaluate women's satisfaction with breastfeeding for the Brazilian population

OBJECTIVE

To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population.

METHODS

Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient.

RESULTS

The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved significantly higher mean values in the scale. The tool showed adequate internal consistency (Cronbach's alpha=0.88, 95% CI: 0.86-0.90), as did the pleasure and fulfillment of the maternal role subscales (0.92, 95% CI: 0.91-0.93%); child growth, development, and satisfaction (0.70; 95% CI: 0.65-0.75); and maternal physical, social, and emotional aspects (0.75, 95% CI: 0.70-0.79).

CONCLUSIONS

The validation process of the Brazilian version of the Maternal Breastfeeding Evaluation Scale tool showed that it is valid and reliable tool to be applied to the Brazilian population.

Perinatal breastfeeding interventions including fathers/partners: A systematic review of the literature

OBJECTIVE

Support from fathers is consistently associated with improved breastfeeding duration and exclusivity rates. Additionally, there is growing evidence that fathers want to be included in breastfeeding interventions provided by health care professionals. The objective of this review was to determine the effect of partner-inclusive educational and psychosocial interventions on breastfeeding initiation, duration, and exclusivity.

DESIGN

A systematic review was conducted using a search strategy developed with an expert health sciences librarian. Electronic databases MEDLINE, EMBASE, CINAHL, and PsycINFO were systematically searched for randomized controlled trials and quasi-experimental studies from inception to August 4, 2018. Independent data extraction and quality assessments were conducted by authors using Cochrane Collaboration tools. Due to significant heterogeneity in intervention content, outcome measures, and follow-up time points, data were synthesized qualitatively.

FINDINGS

3982 articles were identified, of which 12 studies in 15 publications met the inclusion criteria and were included. All of the studies improved at least one breastfeeding outcome, including duration (n = 5/9) and exclusivity (n = 8/10) up to 24 weeks postpartum. Six studies examined increasing paternal breastfeeding support and all found beneficial effects. Biases were identified in the studies with the most common bias relating to the randomization process and the blinding of outcome assessors.

IMPLICATIONS FOR PRACTICE

The inclusion of fathers/partners in breastfeeding interventions improves breastfeeding initiation, duration, and exclusivity rates. Interventions that include face-to-face information delivery, are designed in a culturally appropriate manner, and provide information on how partners can support breastfeeding are more likely to have a beneficial effect. Research is warranted to examine the underlying intervention mechanisms.

Is baby-friendly breastfeeding support in maternity hospitals associated with breastfeeding satisfaction among Japanese mothers?

While the World Health Organization's Baby-Friendly Hospital Initiative has increased breastfeeding duration and exclusivity, a survey found that only 8.5 % of maternity hospitals in 31 developed countries could be designated baby-friendly. Baby-friendly breastfeeding support is sometimes criticized as mother unfriendly. This study examined whether baby-friendly breastfeeding support was associated with breastfeeding satisfaction, duration, and exclusivity among Japanese mothers. In this cross-sectional study, 601 breastfeeding Japanese mothers completed questionnaires at their infants' 4-month health checkups at two wards in Yokohama, Japan; 363 were included in the analysis. Baby-friendly breastfeeding support was measured based on the WHO's "Ten Steps to Successful Breastfeeding." We measured satisfaction using two subscales of the Japanese version of the Maternal Breastfeeding Evaluation Scale. The association of baby-friendly support with maternal satisfaction was assessed using multiple linear regression, while the prevalence ratios (PRs) for breastfeeding were estimated using Poisson regression. Mothers were stratified by prepartum exclusive breastfeeding intention (yes, n = 256; no, n = 107). Mothers who experienced early skin-to-skin contact with their infants were more likely to report breastfeeding satisfaction than those who did not. Among mothers without exclusive breastfeeding intention, those who were encouraged to feed on demand were more likely to be breastfeeding without formula at 1 month (PR 2.66 [95 % CI 1.32, 5.36]) and to perceive breastfeeding as beneficial for their baby (regression coefficient = 3.14 [95 % CI 0.11, 6.17]) than those who were not so encouraged. Breastfeeding satisfaction was a useful measure of breastfeeding outcome. Early skin-to-skin contact and encouragement to feed on demand in the hospital facilitate breastfeeding satisfaction.

Group versus Individual Professional Antenatal Breastfeeding Education for Extending Breastfeeding Duration and Exclusivity: A Systematic Review

Although breastfeeding initiation rates have increased substantially in many developed countries over the past several decades, breastfeeding duration and exclusivity remain suboptimal. In the antenatal period, both group and individual education interventions have been implemented to improve breastfeeding. The purpose of this review was to compare the effectiveness of group and individual antenatal professional education on breastfeeding exclusivity and duration. A systematic search of the literature was conducted using Medline (1946-June 2014), PubMed (1883-June 2014), the Cumulative Index to Nursing and Allied Health Literature (1947-June 2014), EMBASE (1947-June 2014), British Nursing Index (1994-June 2014), Google Scholar, and the Cochrane Library. Included studies were limited to health care professional-conducted education delivered to pregnant women only. Only studies reporting breastfeeding duration or exclusivity were included. Nineteen studies were included, of which 13 evaluated antenatal group education, 5 evaluated individual antenatal education, and 1 evaluated both a group and an individual antenatal education. When compared with standard care, 4 out of 12 studies supported the effectiveness of antenatal group education on breastfeeding duration or exclusivity, whereas 4 out of 6 studies supported the effectiveness of antenatal individual education. Two studies compared antenatal group education with peer-led education and neither study showed a significant difference in breastfeeding outcomes. The methodological heterogeneity and the small number of high quality studies limited our ability to draw firm conclusions about the effectiveness of either mode of antenatal education.

Impact of male-partner-focused interventions on breastfeeding initiation, exclusivity, and continuation

Informal sources of support, particularly the male partner, have more influence on breastfeeding behaviors than formal support from health care providers. This systematic review examined the impact of male-partner-focused breastfeeding interventions on breastfeeding initiation, exclusivity, and continuation. Four unique interventions were identified that were tested through randomized controlled studies or quasi-experimental design. These 4 provided breastfeeding education to fathers, with breastfeeding outcomes reported by the mother. Three of the 4 studies compared initiation rates between intervention and control conditions, and 2 showed significantly higher rates of breastfeeding initiation in the intervention group. Although studies were inconsistent in their categorization and reporting of full, partial, or no breastfeeding, significantly higher rates of breastfeeding initiation, exclusivity, and/or continuation were seen for 2 interventions. Because all 4 interventions found at least 1 breastfeeding outcome to be superior in the treatment group, breastfeeding education should be offered to male partners. Future studies should test if intervention effectiveness can be increased if education is supplemented with other activities. Future studies also should use controlled designs and validated outcome measures.

Development and psychometric testing of the Japanese version of the maternal breastfeeding evaluation scale

BACKGROUND

Exclusive breastfeeding for 6 months after delivery is globally recommended as optimal infant feeding. However, if mothers evaluate their own breastfeeding by this standard, many might be disappointed because they fail to meet it. In contrast, the Maternal Breastfeeding Evaluation Scale (MBFES) measures mothers' satisfaction with breastfeeding regardless of the duration or exclusivity of breastfeeding. The MBFES has been used in Western countries, but not in Japan.

OBJECTIVES

This study aimed to develop a Japanese version of the MBFES (the JMBFES) and to conduct psychometric testing among Japanese-speaking mothers in Japan.

METHODS

The JMBFES was developed using forward translation, blind back-translation, panel discussion, and pilot testing. Breastfeeding Japanese mothers (n = 414) completed the JMBFES when their infants were 4 months old. For validation testing we used principal components analysis (promax rotation). We deleted items as necessary to improve reliability. We also used multiple linear regression to examine associations of JMBFES scores with breastfeeding intention and with breastfeeding outcomes.

RESULTS

The analysis revealed subscales that were generally similar to the original 30-item MBFES. Reliability was satisfactory (Cronbach's alpha ≥ .77). Scores on the JMBFES and on most of its subscales were positively associated with both breastfeeding intention and breastfeeding outcomes. The subscale measuring potentially negative experiences was not statistically significantly associated with breastfeeding at 1 month, after adjustment for likely confounders.

CONCLUSION

The results of reliability testing (Cronbach's alpha) and of validation testing indicate that the JMBFES can be used in Japan to explore mothers' satisfaction with breastfeeding.

Peer-led prenatal breast-feeding education: a viable alternative to nurse-led education

OBJECTIVE

To evaluate a prenatal breast-feeding class developed and facilitated by peer Breast-feeding Buddies.

DESIGN AND INTERVENTIONS

Non-equivalent control group quasi-experimental study comparing participants of the peer-led class (PLC) to those attending an established hospital-based breast-feeding nurse-led class (NLC). A brief questionnaire was completed immediately prior to the class, and telephone interviews were conducted approximately one week following the class, and one and six months post partum.

SETTING AND PARTICIPANTS

54 expectant mothers who registered for the community PLC and 55 expectant mothers who registered for the NLC.

MEASUREMENTS AND FINDINGS

Breast-feeding intentions were measured at all time-points. Class evaluations, breast-feeding experiences, and breast-feeding support were measured at all post-class interviews. Both classes were considered worthwhile, but the PLC class was rated as more helpful and participants appreciated learning from the peers' personal experiences. Mothers taught by peers were more likely to access peer breast-feeding support. PLC participants initially decreased their prenatal breast-feeding duration intentions but had significantly stronger intentions to continue breast feeding at six months than did NLC mothers.

KEY CONCLUSIONS

A peer-led prenatal breast-feeding class is as effective as a traditional model of breast-feeding education and is a valuable tool to promote and support successful breast feeding. RECOMMENDATIONS FOR PRACTICE: Peer-led breast-feeding classes should be provided to enhance the accessibility of breast-feeding education and support for expectant mothers.

The seeking of baby-feeding information by Canadian women pregnant with twins

OBJECTIVE

To analyse baby-feeding information needs and seeking described by Canadian women pregnant with twins.

DESIGN

Qualitative; data were collected by in-depth semi-structured interviews. Transcripts provided the data for discourse analysis of the use of two interpretative repertoires.

SETTING

Ontario, Canada.

PARTICIPANTS

19 women pregnant with twins.

MEASUREMENTS AND FINDINGS

The first interpretative repertoire represented caring for twins as fundamentally distinct from caring for singly born babies, and therefore emphasised the commonality of mothers of twins regardless of their background or situation. The second highlighted the uniqueness and individuality of each person. These repertoires intersect with discourses of baby feeding and good mothering, resulting in a complex discursive interplay of similarity and difference, commonality and individuality, information seeking, baby feeding and good mothering. Participants used the two interpretative repertoires to (1) frame information needs; (2) construct complex accounts of the biomedical, experiential and personalised authority of information sources; (3) describe the helpfulness of information sources independent of their authority; and (4) describe the barriers encountered in the finding appropriate sources of baby-feeding information in pregnancy.

IMPLICATIONS

Understanding and respecting the discursive constructions of pregnancy and mothering can help practitioners understand the complex discursive interplay underlying participants' baby-feeding decisions, and may facilitate more sensitive support for women's individual needs and understandings.

Developing a Prenatal Breastfeeding Workshop to Support Maternal Breastfeeding Self‐Efficacy

A prenatal breastfeeding workshop developed for primiparous women was specifically designed to increase a woman's breastfeeding self-efficacy in the early postpartum period. Research has shown that breastfeeding self-efficacy, defined as a woman's confidence in her ability to breastfeed, is positively related to breastfeeding success. Teaching strategies, based on Bandura's Self-Efficacy Theory and adult learning principles, were incorporated in the workshop design.

Development and testing of a prenatal breastfeeding education intervention for Hispanic women

Many immigrant Hispanic women in the United States choose to bottle-feed rather than breastfeed. This article describes an intervention that was developed and tested in a two-step process. Two studies were undertaken. First, a qualitative inquiry explored the breastfeeding beliefs, attitudes, meanings, and practices of Hispanic women. Results informed the design of a culturally appropriate prenatal breastfeeding education intervention. Secondly, the researchers undertook a quantitative study of the intervention's success in increasing breastfeeding duration among Hispanic women. Methodology and findings of this study have implications for future interventions that promote breastfeeding.

Australian women's stories of their baby-feeding decisions in pregnancy

OBJECTIVE

To describe the baby-feeding decisions of a group of Australian women prior to birth.

DESIGN, SETTING AND PARTICIPANTS

A qualitative study using face-to-face in depth interviews was undertaken with 29 women. All interviews were audio-tape recorded and transcribed verbatim. Data were analysed using thematic analysis.

FINDINGS

The women observed and sought information from a variety of sources as well as exploring their own understandings of themselves and their breasts. Based on this knowledge the women made their antenatal baby-feeding decisions. These baby-feeding decisions grouped into four thematic groups, 'assuming I'll breast feed'; 'definitely going to breast feed'; 'playing it by ear' and 'definitely going to bottle feed'. Each of these standpoints was associated with, and precipitated a number of behaviours and strategies.

IMPLICATIONS

The findings of this research highlight the need for antenatal educators and midwives who provide care in pregnancy to acknowledge a range of experiences and expectations of women and to provide diverse educational opportunities to meet a range of needs. There is a need for further research to identify how midwives can encourage and assist women to explore and challenge their assumptions about breast feeding as they relate to other aspects of their lives.

Contemporary breast-feeding policy and practice: implications for midwives

In this paper, the authors draw upon recent Australian research to provide a critical commentary on the current policies and professional practices surrounding breast feeding. These studies, conducted by the first and second authors, explored aspects of the breast-feeding experience, with the findings highlighting areas for concern in relation to the promotion and support of breast feeding in western societies. Of particular concern to the authors was the number of women in these studies who equated breastfeeding with being a 'good' mother. This perception meant that some women maintained a strong commitment to breast feeding despite enormous difficulties. In this paper we firstly, overview the findings of these studies and use women's stories to illustrate their perseverance and their intense commitment to breast feeding. In the second part of the paper, we consider the consequences of the strong public rhetoric surrounding breast feeding in Australia and challenge some of the assumptions underlying policies and professional practices related to breast feeding. We examine the consequences of 'professionalising' breast feeding, and make suggestions for a way forward in the promotion of breast feeding that encompasses the range of perspectives held by women. In conclusion, the authors highlight the complexity of establishing appropriate breast-feeding policies that guide professional practices in a flexible manner, allowing for diversity in individual breast-feeding experiences.