The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy

Effect of Lactation Management Model on Breastfeeding Process After Cesarean: A Prospective Randomized Controlled Study

It is important to implement supportive programs to ensure mothers breast feed for the desired period, and infants are fed by only mother's milk. In the research, it was aimed at evaluating the effects of lactation management model on mothers' breastfeeding process following a caesarean section. Women who gave birth by planned cesarean delivery were divided into two groups, randomized control and experimental. Data collection was performed during gestation, first day after postpartum, pre-discharge, on the 9th day in a face to face interview, and in the form of monthly phone interviews up to 6 months. While the experimental group exercised the lactation management model, the control group received routine lactation practices in clinic. In the scores of Breastfeeding Charting System and Documentation Tool, a significant difference was found between the groups (p<0.001). 87.9% of the experimental group and 48.5% of the control group were determined to apply successful breast-feeding techniques. In addition, it was found that all of the experimental group breast fed 1 month longer than the control group, and for the first month, 90.9% of the experimental group and 78.8% of the control group breast fed with mother's milk only and a higher breastfeeding. Among in the experimental group, it was found that breastfeeding self-efficacy was higher, and breastfeeding techniques were accurate and successful and breastfeeding only and continuity rates were higher while breastfeeding related breast problems developed less frequently. Clinical Trials.gov Protocol Registration Number: NCT04593719.

Breastfeeding Self-Efficacy: A Systematic Review of Psychometric Properties Using COSMIN

BACKGROUND

Breastfeeding self-efficacy has been proven to play a predictive role in enhancing breastfeeding initiation and continuation. Breastfeeding self-efficacy measurement tools have facilitated healthcare professionals' early identification and support of women at higher risk of early discontinuation of breastfeeding.

RESEARCH AIM

The aim of this study was to assess the psychometric properties of breastfeeding self-efficacy measurement tools.

METHOD

A systematic review was carried out in three phases. Phase One comprised a systematic literature review performed in PubMed, SCOPUS, Web of Science, and Cochrane Database of Systematic Reviews from February 2021 to January 2023, including 36 studies for final analysis. Phase Two provided a quality appraisal of the psychometric properties of each of the seven breastfeeding self-efficacy measurement tools, according to COnsensus-based Standards for the selection of health Measurement Instrument checklist (COSMIN) guidelines. Phase Three summarized and graded the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) modified approach.

RESULT

The included articles comprised 9,225 participants and seven breastfeeding self-efficacy measurement tools. The Breastfeeding Self-Efficacy Scale, Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), and Prenatal Breastfeeding Self-Efficacy Scale were supported by Grade A evidence sustaining their validity and reliability to assess breastfeeding self-efficacy in the continuum of maternity care. The BSES-SF is the most feasible tool in clinical practice and the most utilized internationally, available in 15 languages.

CONCLUSION

This systematic review provided a Grade A recommendation on breastfeeding measurement tools that will be helpful both for clinical and research purposes.Registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021238450).

Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study

Background

In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women.

Methods

Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28).

Results

The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034).

Conclusion

Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.

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.

Effect of the mHealth-supported Healthy Future programme delivered by community health workers on maternal and child health in rural China: study protocol for a cluster randomised controlled trial

INTRODUCTION

Millions of young rural children in China still suffer from poor health and malnutrition, partly due to a lack of knowledge about optimal perinatal and child care among rural mothers and caregivers. Meanwhile, there is an urgent need to improve maternal mental health in rural communities. Comprehensive home visiting programmes delivered by community health workers (CHWs) can bridge the caregiver knowledge gap and improve child health and maternal well-being in low-resource settings, but the effectiveness of this approach is unknown in rural China. Additionally, grandmothers play important roles in child care and family decision-making in rural China, suggesting the importance of engaging multiple caregivers in interventions. The Healthy Future programme seeks to improve child health and maternal well-being by developing a staged-based curriculum that CHWs deliver to mothers and caregivers of young children through home visits with the assistance of a tablet-based mHealth system. This protocol describes the design and evaluation plan for this programme.

METHODS AND ANALYSIS

We designed a cluster-randomised controlled trial among 119 rural townships in four nationally designated poverty counties in Southwestern China. We will compare the outcomes between three arms: one standard arm with only primary caregivers participating in the intervention, one encouragement arm engaging primary and secondary caregivers and one control arm with no intervention. Families with pregnant women or infants under 6 months of age are invited to enrol in the 12-month study. Primary outcomes include children's haemoglobin levels, exclusive breastfeeding rates and dietary diversity in complementary feeding. Secondary outcomes include a combination of health, behavioural and intermediate outcomes.

ETHICS AND DISSEMINATION

Ethical approval has been provided by Stanford University, Sichuan University and the University of Nevada, Reno. Trial findings will be disseminated through national and international peer-reviewed publications and conferences.

TRIAL REGISTRATION NUMBER

ISRCTN16800789.

Prenatal Perception of WIC Breastfeeding Recommendations Predicts Breastfeeding Exclusivity and Duration in the Infants' First Year

BACKGROUND

Pregnant participants who perceived that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) recommends breastfeeding only were more likely to have better early breastfeeding outcomes.

OBJECTIVES

Our objective was to examine the association between prenatal perception of WIC's breastfeeding recommendations and breastfeeding duration through the first year of infant life.

METHODS

This observational study used a national longitudinal sample of 1594 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 in 2013. Four measures of breastfeeding duration were used: 1) a discrete measure of exclusive breastfeeding through 5 mo; 2) a continuous measure of exclusive breastfeeding (in days up to 7 mo); 3) a discrete measure of any breastfeeding through 11 mo; and 4) a continuous measure of any breastfeeding (in days up to 13 mo). The primary explanatory variable was the participant's prenatal perception of whether WIC recommended breastfeeding only. The univariate analyses of time to breastfeeding cessation were performed using Kaplan-Meier curves. The Cox regression model was adopted to estimate the likelihood of breastfeeding outcomes over time. All analyses accounted for complex survey design effects.

RESULTS

Compared with their peers who perceived WIC to recommend formula only or both breastfeeding and formula equally, participants who perceived WIC as recommending breastfeeding only were less likely to stop exclusive breastfeeding through 5 mo (HR = 0.83; 95% CI: 0.69, 0.99) or to stop any breastfeeding through 11 mo (HR = 0.80; 95% CI: 0.69, 0.92), without controlling for prenatal infant feeding intentions. Similar patterns were observed in the 2 continuous measures, as they were also less likely to stop exclusive breastfeeding by 7 mo (HR = 0.78; 95% CI: 0.69, 0.90) or to stop any breastfeeding by 13 mo (HR = 0.82; 95% CI: 0.71, 0.95).

CONCLUSIONS

Prenatal perception of WIC's breastfeeding recommendation can be a useful predictor of breastfeeding duration in WIC participants.

Welcoming, supportive care in US birthing facilities and realization of breastfeeding goals

BACKGROUND

Emotional and physical support for birthing parents is positively associated with realization of their breastfeeding goals. However, few studies have investigated maternal descriptions of their postnatal unit experience of these domains.

RESEARCH AIM

The objective was to investigate maternal report of their birthing facility experiences and quantify the extent to which accounts of postpartum support were associated with meeting their breastfeeding goals.

METHODS

After IRB review, data were obtained through an online survey distributed from November 2016-May 2017. This analysis utilizes data from 2,771 birthing parents who were at least 18 years of age, experienced maternity care in the United States within five years, and reported that they had intended to breastfeed. Bivariate analysis was followed by logistic regression controlling for significant covariates.

RESULTS

In this sample of primarily non-Hispanic white birthing parents with intent to exclusively breastfeed, the following postnatal unit variables were associated with higher odds of meeting their breastfeeding goals, birthing parents feeling: welcomed (adjusted OR=1.36), that health care promoted their physical health (adjusted OR=1.41), that care promoted their emotional health (adjusted OR=1.38), that they were supported (adjusted OR=1.56), and that they were recognized by their health care team (adjusted OR=1.30). All the measured postnatal unit support variables were significantly correlated with each other, with correlation coefficients ranging from 0.15 to 0.81.

CONCLUSIONS

Before the COVID-19 pandemic, birthing parents' experiences on the postnatal unit were interrelated and associated with meeting their breastfeeding goals. As health care services are reviewed and prioritized during the COVID-19 pandemic and as part of ongoing strengthening of systems, qualitative and observational research can address the mechanisms underlying breastfeeding outcomes to inform the provision of more holistic and effective support.

Breastfeeding Self-Efficacy as a Predictor of Breastfeeding Intensity Among African American Women in the Mama Bear Feasibility Trial

Background: Improving breastfeeding rates among African American (AA) families is an important public health goal. Breastfeeding self-efficacy, a known predictor of breastfeeding behavior, has seldom been assessed among AAs, in relation to breastfeeding intensity (% breastfeeding relative to total feeding) or as a protective factor in combating the historical breastfeeding challenges faced by people of color. We aimed to test the association between breastfeeding self-efficacy assessed during pregnancy and breastfeeding intensity assessed in the early postpartum period. Methods: This was a secondary data analysis of a randomized controlled feasibility trial of breastfeeding support and postpartum weight management. AA women were recruited during pregnancy from a prenatal clinic in Detroit, MI. Data presented, in this study, were collected at enrollment (n = 50) and ∼6 weeks postpartum (n = 31). Linear regression models were used, adjusting for potential confounders. Results: There were no differences in breastfeeding intensity by study arm; data are from all women with complete data on targeted variables. Age ranged from 18 to 43 years, 52% were Women, Infant's, and Children program enrollees, and 62% had ≥ some college. Breastfeeding self-efficacy during pregnancy was a significant predictor of breastfeeding intensity in the early postpartum period (β = 0.125, p < 0.05) with only slight attenuation in the fully adjusted model (β = 0.123, p < 0.05). Implications for Practice: Our results confirm that self-efficacy is an important predictor of breastfeeding practice. Furthermore, the simple act of assessing breastfeeding self-efficacy permits an opportunity for women to reflect on breastfeeding possibilities, and can inform individualized confidence-building interventions to improve the disproportionately low breastfeeding rates among AAs. Clinical Trial Registration number NCT03480048.

Prenatal perception of breastfeeding recommendations predicts early breastfeeding outcomes of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

BACKGROUND

Prenatal psychosocial factors predict breastfeeding practices but are not assessed in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

OBJECTIVES

This study examined how prenatal perceptions of WIC's breastfeeding recommendations were associated with early breastfeeding outcomes.

METHODS

This study used longitudinal data from a national sample of 2053 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2) in 2013, the only national data assessing prenatal perceptions of WIC's breastfeeding recommendations. Early breastfeeding outcomes included breastfeeding initiation, breast milk first fed after birth, breastfeeding in the first hour, breast milk first fed after leaving the hospital, and breastfeeding status at the first and third months. The primary predictor was the participant's prenatal perception of whether WIC recommended breastfeeding only or not. Log-binomial regression was used with adjustment for socio-demographics, previous breastfeeding, WIC participation, breastfeeding support, and infant feeding intentions (IFI).

RESULTS

Without controlling for IFI, the perception of WIC recommending breastfeeding only predicted breastfeeding outcomes positively. The risk ratio (RR) associated with prenatal perceptions varied from 1.14 (95% CI: 1.03, 1.25; P = 0.008) for breastfeeding in the first hour, to 1.27 (95% CI: 1.12, 1.43; P < 0.001) for breast milk first fed after leaving hospital, to 1.66 (95% CI: 1.35, 2.04; P < 0.001) for 3-mo breastfeeding only. After controlling for IFI, the RRs were 1.13 (95% CI: 1.02, 1.24; P = 0.017) for breastfeeding in the first hour, 1.20 (95% CI: 1.06, 1.35; P = 0.004) for breast milk first fed after leaving hospital, and 1.49 (95% CI: 1.21, 1.84; P < 0.001) for 3-mo breastfeeding only, suggesting that prenatal perception was independently associated with breastfeeding outcomes.

CONCLUSIONS

Prenatal perception of WIC's breastfeeding recommendations can be regarded as a new psychosocial predictor of breastfeeding and a possible target for future intervention.

A mixed methods study of perinatal sleep and breastfeeding outcomes in women at risk for postpartum depression

INTRODUCTION

Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied.

METHODS

In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. Forty-eight women (mean age 28.2 ± 4.9 years) who were euthymic at enrollment but had a history of major depression (n = 43) or bipolar disorder (n = 5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants' experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined "lower sleep efficiency" (LSE) and "higher sleep efficiency" (HSE) groups based on the median split of actigraphic SE at 33 weeks' gestation (cutoff SE = 84.9%) and classified mothers as No-BF, Mixed-BF (BF + formula), and Exclusive-BF at 2 weeks postpartum.

RESULTS

Percentages of women who did any breastfeeding were: Week 2 = 72.3%, Week 6 = 62.5%, Week 16 = 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE = 45.8%, HSE = 16.7%, P < .05). Average actigraphic sleep onset, sleep offset, time in bed, sleep duration, and SE did not differ based on breastfeeding status at any time point. Qualitative themes included insufficient preparation for the demands of breastfeeding, interrupted and nonrestorative sleep, and unrelenting daytime tiredness.

CONCLUSIONS

In our sample, preserved actigraphic SE during pregnancy was associated with initiation and continuation of breastfeeding. Future work should examine whether improving sleep in pregnancy improves mothers' feeding experiences.

Enhancing Patient-Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women

OBJECTIVES

The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women.

METHODS

Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors.

RESULTS

The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035).

CONCLUSIONS

Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

Investigation of the Relationship Between Maternal Attachment and Breastfeeding Self-Efficacy and Affecting Factors in Turkish Sample

PURPOSE

This research aimed to investigate the factors affecting the perception of mothers about breastfeeding self-efficacy and their maternal attachment between the fourth and eighth postnatal weeks and their relation.

DESIGN AND METHODS

This research, which is descriptive, was conducted on 351 postpartum women between December 2017-2018. The study used the Mother Descriptive Information Form, Maternal Attachment Inventory (MAI), and the Short Form of the Breastfeeding Self-Efficacy Scale (BSES-SF).

RESULTS

It was found that, mothers' mean scores on the BSES-SF and MAI were affected by their educational level, the status of regular health checkups during the last pregnancy, the number of visits for health checkups during the last pregnancy, the place where they held their babies, the status of breastfeeding previous babies, prenatal breastfeeding training, the status of finding their own breast milk sufficient, the time when they first breastfed the baby, the first food the baby received, the status of being willing to breastfeed, the status of having fatigue due to breastfeeding, the planned duration of breastfeeding, the status of using additional infant formula, and the status of having a close relative or friend also breastfeeding. It was also determined that there was a low positive relationship between breastfeeding self-efficacy and maternal attachment.

CONCLUSIONS

The level of breastfeeding self-efficacy and maternal attachment status of mothers should be determined in the postpartum period, and health personnel should intervene on alterable factors that adversely affect breastfeeding self-efficacy and attachment status, especially in mothers at risk.

Parity and the Association Between Maternal Sociodemographic Characteristics and Breastfeeding

Objective: Although clinicians recognize the importance of breastfeeding for child health, breastfeeding initiation can be limited by maternal characteristics such as race/ethnicity, age at first birth, and educational attainment. We hypothesized that the strong influence of prior infant feeding experiences on multiparous women's decision to initiate and continue breastfeeding may mean that these maternal characteristics influence breastfeeding more strongly for primiparas than multiparas. Materials and Methods: Using Pregnancy Risk Assessment and Monitoring System (PRAMS) (Phase 8) survey data from 2016 to 2017, we analyzed mothers' responses to the supplemental question about parity, "Before you got pregnant with your new baby, did you ever have any other babies who were born alive?" Study variables were summarized by using weighted means and proportions and compared according to parity by using Wald tests. In the overall cohort, we evaluated the interaction between parity and each covariate by using logistic regression. Results: In our sample (N = 20,694), 40% of respondents were first-time mothers, and 88% had initiated breastfeeding. Primiparas were more likely to breastfeed than multiparas (92% versus 86%; p < 0.001), but they had shorter mean breastfeeding duration. On unadjusted analysis, four covariates were more strongly associated with breastfeeding initiation among primiparas than multiparas (maternal age, educational attainment, receiving breastfeeding information from a nurse or other medical professional, and receiving breastfeeding information from family or friends). Conclusions: Breastfeeding initiation is impacted more strongly by maternal characteristics for primiparas than multiparas.

Marital Adjustment and Prenatal Breastfeeding Efficacy of First Time Mothers in A Low-Income Community in The Philippines

Introduction: All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. This study aims to assess the level of marital satisfaction and its influence to prenatal breastfeeding self-efficacy in   first time mothers during late pregnancy.Methods: A descriptive correlational was conducted among 128 simple randomized prim gravid women who agreed to participate and had prenatal care check-up in the health center at the time of data gathering. The instruments used were 15-item Marital Adjustment Test (MAT) to measure marital adjustment and 14-item Breastfeeding Self efficacy Scale-Short Form (BSES-SF) as a measure of breastfeeding self-efficacy. Pearson’s correlation coefficient was utilized to test the relationships between the sample’s marital adjustment scores to correlate with BFSE of the respondents. Fisher’s t test was utilized to determine the significance of correlations. A p-value of equal to or less than .05 was considered statistically significant.Results: The study revealed that the sampled mothers have a high level of marital adjustment score (112.05± 21.83). Prenatal mothers responded in the study were highly confident and have high self-efficacy in breastfeeding first child currently bearing (4.55±.51). Lastly, it was found that there is no significant correlation between marital adjustment and prenatal breastfeeding self-efficacy (β=-.052, p-value=.280).Conclusion: It was found  that there is a high level of marital adjustment and breastfeeding self-efficacy among sampled mothers. However, there is no significant correlation between marital adjustment and prenatal breastfeeding self-efficacy. The study suggests incorporating co-parenting intervention involving father’s involvement and assistance with breastfeeding when creating interventions in breastfeeding.