'They're born to get breastfed'- how fathers view breastfeeding: a mixed method study

Fathers' needs of breastfeeding support: Perspective of health nurses

PURPOSE

To explore the improvement of health education on father's participation in breastfeeding from the perspective of maternal and child health nurses.

METHODS

Qualitative phenomenological research was used, and 15 maternal and child health nurses who provided breastfeeding support were invited. With semi-structured deep interviews and on-site recordings, data were analyzed through content analysis.

RESULTS

Four main themes were extracted, including 'cultivating fathers' awareness of participation in breastfeeding', 'collaboration of multiple disciplines to improve health education on breastfeeding for fathers in hospital', 'Simulated scenarios to develop fathers' skills in solving breastfeeding problems', and 'establishing a hospital-community interface network to improve breastfeeding continuation care after hospital discharge'.

CONCLUSIONS

Medical and health care departments should attach importance to guidance on health education for fathers' breastfeeding participation, cultivate fathers' awareness of participation in breastfeeding, provide multi-disciplinary collaboration-based health education on breastfeeding for fathers from the prenatal period and improve post-discharge health education on breastfeeding. The additional education being suggested would contribute to fathers being able to play an important role in breastfeeding.

Fathers' Attitudes Toward Mothers with Infants and its Association with Exclusive Breastfeeding in a Rural Community of Karnataka

Male participation in reproductive and child health improves breastfeeding rates. The role of fathers in breastfeeding may be crucial in improving exclusive breastfeeding (EBF) rates. This study explored the fathers' attitudes and support and its association with EBF in mothers with infants attending a rural primary health center in Karnataka. A cross-sectional descriptive study was conducted on mothers with infants visiting a rural primary health center between December 2020 and February 2021. A pretested semi-structured questionnaire was used to collect data to ascertain the exclusivity of breastfeeding and other sociodemographic factors. The fathers' attitudes and support toward mothers during and after pregnancy were measured on a 5-point Likert scale. Quantitative variables were expressed in median and interquartile ranges, and qualitative variables were expressed using percentages and proportions. The association was determined using the Chi-square test and Spearman's correlation test. The data were collected using Epi Data and analyzed using Epi info v 3. A total of 169 mothers participated in the study. The self-reported EBF was 148 (87.1%). The fathers' attitudes and support to the mothers were found to be more favorable during the antenatal period in 97% of the women. The fathers' attitudes and support in the antenatal period and after delivery were not associated with the mothers' exclusivity in breastfeeding. The present study concluded that there is no association between the fathers' attitudes and support before and after the delivery of the infant and mothers' exclusivity in breastfeeding.

A qualitative descriptive study of Thai fathers' experiences in supporting their partners' breastfeeding

Background

The crucial role of fathers in the well-being of mothers and infants is widely acknowledged. This study focuses on the specific context of how Thai fathers support their partners in breastfeeding, with the goal of gaining a deeper understanding of the strategies they employ in providing this support.

Objective

This study aimed to explore the experiences of fathers in supporting their partners in breastfeeding.

Methods

The study used a qualitative descriptive design from December 2018 to February 2020. Nineteen Thai fathers were purposefully selected, each with partners and infants who did not face any complications that would serve as barriers to breastfeeding. Data collection occurred at vaccination clinics and family planning wards in two major hospitals in Chiang Mai province, Thailand. The data were collected through in-depth interviews, and a thematic analysis approach was employed for data analysis.

Results

Four themes emerged: a) Facing barriers to breastfeeding support, b) Believing in the value of breast milk, c) Seeking ways to increase milk supply, and d) Making an effort to support continued breastfeeding.

Conclusion

Thai fathers demonstrated a strong eagerness to support their partners in sustaining breastfeeding. Their willingness highlights the importance of nurses, midwives, and other healthcare providers providing additional education and support to empower them as supportive partners to mothers.

Breastfeeding experiences and women's self-concept: Negotiations and dilemmas in the transition to motherhood

Introduction

Breastfeeding is much more than a biological event. It is a social construction, full of cultural meanings and framed by social structures. Being, simultaneously, a natural event and a social practice, breastfeeding poses challenges to feminist approaches in the sense it may be acknowledged as an empowering practice for women and/or as a setback in the process of women's social emancipation. Often focused on the product, i.e., the milk and its beneficial properties for the infant's health, the dominant discourse on breastfeeding makes it a trait of good mothering, withdrawing the understanding of the particular (but also structural) contexts in which this practice occurs.

Methods

Based on results from a focus group with five mothers of a first child, this paper addresses first-person testimonies about breastfeeding and transition to motherhood, aiming to capture eventual self-concept dilemmas, impacts of social judgments, difficulties related to the work-family balance, as well as negotiation processes taking place within couples and early-parents.

Results and discussion

Despite being subject to tensions and sometimes stressful adaptation processes, motherhood and breastfeeding tend to be ultimately described by women as experiences that enhance welcome changes in personal trajectories, life priorities and identities.

Sociodemographic factors associated with mixed- feeding practices among a cohort of mothers with infants aged 4 - 14 weeks in Tlokwe subdistrict, North West Province, South Africa

Background. Exclusive breastfeeding for the first 6 months of an infant’s life is the recommended gold standard for infant feeding; however, mixed feeding (MF) is common in various settings. In South Africa (SA), especially in the Tlokwe subdistrict of North West Province, there is little information on the association between sociodemographic factors and infant MF practices.Objective. To identify the sociodemographic factors associated with MF practices in a cohort of mothers of infants aged 4 - 14 weeks in the Tlokwe subdistrict of North West. Methods. The study setting was 8 health facilities in the Tlokwe subdistrict. Participants comprised postpartum women with infants aged 4 - 14 weeks. Data analysis used SPSS version 25.0. Normal data are presented as means (standard deviation (SD)), skewed data as median values (25th, 75th percentiles) and categorical values as percentages and frequencies. Chi-square tests and logistic regression analysed the association between sociodemographic factors and MF practices at time point 2 (10 - 14 weeks). Results. The majority of the mothers were aged between 25 and 29 years, and 37% had at least 2 live children. MF increased with infant age. There was no significant association between any of the sociodemographic variables and MF practices. Logistic regression analysis showed a significant association between increased parity and MF. There was also a significant association between changes in infant- feeding practices after receiving the child support grant at 10 - 14 weeks. Conclusion. The high proportion of mothers who mixed-fed indicates that it is still the norm, as in other SA contexts. Therefore, strengthened breastfeeding education regarding appropriate infant-feeding choices in the promotion of infant development and survival for the short and long term should be emphasised.

Relationship Between Feeders and Exclusive Breastfeeding and Mixed Feeding During the First Month of Life

BACKGROUND

The critical time to continue or stop breastfeeding is during the first month after hospital discharge. Mothers receive lactation and physical support by fathers and others bottle-feeding human or formula milk to their infants.

PURPOSE

To describe the effect of feeders (mothers, fathers, and others) and different milk feeding on infants' weekly exclusive breastfeeding rates, from birth to 1 month after discharge.

METHODS

This study was a secondary analysis of a descriptive longitudinal study of mothers' (full-term: n = 77; late preterm: n = 39) breastfeeding experience, frequency of feeding, and infant feeding behaviors. Mothers completed a weekly questionnaire of who (mothers, fathers, and others) fed their infants human or formula milk by direct breastfeeding or bottle-feeding.

RESULTS

More than 60% of mothers reported fathers and others bottle-fed their infants. Exclusive breastfeeding rates were significantly higher when only mothers fed their infants at week 1 (P < .001), week 3 (P < .05), and week 4 (P < .05). Exclusive breastfeeding rates were negatively affected across time by bottle-feeding any human or formula milk for all feeders. When fathers bottle-fed their infants at week 1, the relative rates of exclusive breastfeeding at week 4 decreased to 52% (OR = 0.103; 95% CI, 0.26-0.404; P < .0001).

IMPLICATION FOR PRACTICE

Individuals providing early bottle-feeding adversely affect breastfeeding outcomes. Providers need to address maternal and paternal knowledge gaps about early breastfeeding practice.

IMPLICATIONS FOR RESEARCH

Further research is needed to explore clinical standard of care for management of infant weight loss, early supplementation, and support of exclusive breastfeeding outcomes.

Longitudinal changes in wellbeing amongst breastfeeding women in Australia and New Zealand during the COVID-19 pandemic

The COVID-19 pandemic has impacted new mothers' wellbeing and breastfeeding experience. Women have experienced changes in birth and postnatal care and restricted access to their support network. It is unclear how these impacts may have changed over time with shifting rates of infection and policies restricting movement and access to services in Australia and New Zealand. This study investigated the longitudinal effect of the COVID-19 pandemic on breastfeeding and maternal wellbeing in Australia and New Zealand. Mothers (n = 246) completed an online survey every 4 weeks for 6 months that examined feeding methods, maternal mental wellbeing, worries, challenges, and positive experiences during the pandemic. Mothers maintained high full breastfeeding rates at 4 months (81%) which decreased to 37% at 6 months. Perceived low milk supply contributed to the earlier cessation of full breastfeeding. Poor infant sleep was associated with stress, perinatal anxiety, mental wellbeing, and breastfeeding status. Although mothers initially reported that lockdowns helped with family bonding and less pressure, prolonged lockdowns appeared to have adverse effects on access to social networks and extended family support.    Conclusion: The results highlight the changing dynamic of the pandemic and the need for adaptable perinatal services which allow mothers access to in-person services and their support network even in lockdowns. Similarly, access to continuous education and clinical care remains critical for women experiencing concerns about their milk supply, infant sleep, and their own wellbeing. What is Known: • The COVID-19 pandemic and lockdown restrictions have significantly affected perinatal mental health, disrupted maternal services, and subsequent breastfeeding. What is New: • In Australia and New Zealand, breastfeeding women experienced challenges to their mental wellbeing, sleep, and breastfeeding, which was likely exacerbated over time by the pandemic. Lockdowns, while initially beneficial for some families, became detrimental to maternal support and wellbeing.

Translating fathers' support for breastfeeding into practice

Breastfeeding has numerous health benefits for the mother and child. For breastfeeding to be successful and continue for longer, women need adequate support. Fathers/partners play an important role in providing this support to women, but research suggests that fathers/partners often feel inadequately informed and supported by health professionals. Midwives and health visitors are in ideal positions to offer women and their partner's timely and relevant breastfeeding information and support throughout the perinatal period. This article discusses the benefits of breastfeeding, presents research evidence of the crucial role fathers/partners play in promoting and supporting breastfeeding, and recommends ways in which health professionals can provide breastfeeding information and support to fathers/partners.

A mixed-methods feasibility study of an intervention to improve men's mental health and wellbeing during their transition to fatherhood

BACKGROUND

Many health visiting services in England use the Promotional Guide system with mothers and fathers, an intervention to support their transition to parenthood, but there is little known about its use and effectiveness, especially with fathers. The aim of this study was to test the feasibility and acceptability of the Promotional Guide system with first-time fathers and pilot potential outcome measures to assess their mental health and wellbeing.

METHODS

A mixed methods prospective observational cohort study. Expectant first-time fathers were recruited from four London (UK) local authority boroughs. Data were collected through online pre and post intervention questionnaires, and semi-structured telephone interviews. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using framework analysis.

RESULTS

Eighty-six fathers were interested in participating; 7 did not meet inclusion criteria and 79 were invited to complete the baseline questionnaire. Questionnaires completed by 45 men at both timepoints were included in the final analysis. Mean and standard deviations were calculated for all outcomes, showing a slight deterioration in the scores across all measures in the postnatal period compared to the antenatal. Ten of these men were also interviewed. Six major categories were identified: 1) Experience of health visitor contact, 2) Experience of Promotional Guides, 3) Experience of perinatal health services, 4) Experience of fatherhood, 5) Fathers' mental health and wellbeing, and 6) Experience of the research process. While antenatal and postnatal outcomes were collected from 45 first-time fathers, none had received the intervention in its entirety. This study identified major gaps in the implementation of the Promotional Guide system with fathers.

CONCLUSION

This study assessed recruitment of first-time fathers, time to complete recruitment, and retention rates and identified outcome measures that could be used in a future definitive study. While it wasn't possible to examine the potential changes following the use of the Promotional Guide system, the study reported on the changes in the fathers' 'states' in the antenatal and postnatal period. It provided a narrative on whether first-time fathers found it acceptable to be asked about their mental health and wellbeing, highlighted their specific needs during their transition to fatherhood, and how they wanted to be supported. It also identified barriers to implementation of the Promotional Guide system by health visitors, which need to be addressed prior to any future research into this intervention. These findings have a number of implications for researchers, health professionals, health service managers, commissioners, policy makers and parents.

What Does It Mean to Be Breastfed? A Concept Analysis in the Context of Healthcare Research, Clinical Practice, and the Parent Perspective

Over the past 3 decades, there have been attempts to define breastfeeding for scientific research. However, a lack of clarity remains, with concurrent ambiguity in clinical practice and insufficient inclusion of the parent perspective. Furthermore, previous concept analyses of "breastfeeding" may not fully represent what it means for an infant to be breastfed. Therefore, this concept analysis sought to define "breastfed" in the context of Western healthcare research, clinical practice, and the parent perspective. Informed by Rodgers' evolutionary method, a literature search resulted in 16 representative articles, with related terms, attributes, antecedents, and consequences identified. Analysis of the literature resulted in a theoretical definition of breastfed as a valuable process, experience, or characteristic that involves human milk consumption by an infant through a variety of delivery methods. To be breastfed relies on the existence of lactation, whether from a parent or another source, and depends upon the intentional decision of a birthing person, caregiver, or provider. It is recommended that healthcare providers and institutions adopt this inclusive definition, committing to a linguistic and conceptual distinction between a breastfed infant and direct breastfeeding. Increased clarity may improve comparability between studies, reporting to government agencies, provider communication, and supportive, family-centered care.

Relationships between paternal attitudes, paternal involvement, and infant-feeding outcomes: Mixed-methods findings from a global on-line survey of English-speaking fathers

The breastfeeding intention-behaviour gap remains wide in developed countries. Current studies have focused on maternal attitudes and behaviours concerning infant feeding in order to explore barriers to breastfeeding continuation. There has been limited consideration of the impact of paternal attitudes and behaviours, despite contemporary parenthood evolving and evidence indicating that there are greater levels of paternal involvement in routine childcare tasks. This mixed-methods study used a triangulation design to examine the associations between paternal attitudes towards parenthood and infant-feeding methods, levels of paternal involvement, infant-feeding outcomes, and father-infant relationships. Fathers of infants <52 weeks completed an online survey providing quantitative data (N = 212) and qualitative data (N = 208). For the quantitative data, fathers completed validated measures about their attitude towards parenthood and infant feeding, levels of paternal involvement, and infant-feeding history. For the qualitative data, questions explored influences on paternal attitudes towards infant feeding and the father-infant relationship. After controlling for covariates, regression analyses found egalitarian attitudes towards parenthood were positively associated with both attitudes towards breastfeeding and levels of paternal involvement. Positive paternal attitudes towards breastfeeding were significantly associated with increased likelihood of breastfeeding. A thematic framework analysis indicated fathers' attitudes towards infant feeding were largely influenced by their families and partners or healthcare professionals. Polarised views were expressed about the impact infant-feeding methods had on the father-infant relationship, although fathers were united in their desire to bond with their infant. Addressing paternal attitudes and the importance of father-infant involvement in domains other than feeding maybe beneficial in supporting breastfeeding and the father-infant relationship.

Relatively speaking? Partners' and family members' views and experiences of supporting breastfeeding: a systematic review of qualitative evidence

This review aimed to synthesize qualitative evidence of views and experiences of partners and other family members who provided breastfeeding support for a relative. The Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal and Infant Care, and Web of Science were searched. Partners and other family members (e.g. grandmothers, siblings) of women in any countries were included. Included papers were critically appraised. The JBI meta-aggregative approach was used to analyze data and form synthesized findings. Seventy-six papers from 74 studies were included. Five synthesized findings were: (i) spectrum of family members' breastfeeding knowledge, experiences and roles; (ii) the complexity of infant feeding decision making; (iii) the controversy of breastfeeding in front of others; (iv) impact of breastfeeding on family; and (v) it takes more than just family members: support for family members. Partners' and family members' views and experiences of breastfeeding support reflected multi-faceted personal, social, financial, cultural, religious, emotional, psychological, and societal factors of the support they provided (or not). Healthcare professionals should engage them in breastfeeding discussions with the woman, and offer tailored and practical guidance relevant to help them to appropriately support the woman. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

From dyad to triad: a survey on fathers' knowledge and attitudes toward breastfeeding

Fathers are known to impact breastfeeding outcomes. We aimed to explore paternal knowledge and attitude toward breastfeeding, and possible association with breastfeeding rates at discharge. In this cross-sectional study, we enrolled 200 fathers of healthy term neonates. At discharge, fathers were asked to rate their degree of agreement to 12 items on a 5-point Likert scale. A total score was obtained from their answers. Univariate binary logistic regression analysis was used to verify if the total score was predictive of exclusive breastfeeding at discharge. A multivariable logistic regression model was then used to adjust for possible confounders. ROC analysis was performed, and a Youden's total score cut-off value was determined to define total score's performance in predicting exclusive breastfeeding at discharge. Fathers showed a solid knowledge of maternal (87%) and neonatal (98%) benefits of breastfeeding, skin-to-skin (99.5%), rooming-in (79%), and responsive feeding (67.5%); conversely, only 51% knew about the recommended use of pacifiers. Fathers felt personally involved in babies' feeding in 79% of cases. An association was found between total score and exclusive breastfeeding at discharge at univariate (OR: 1.07, p = 0.04) but not at multivariable analysis (OR: 1.07, p = 0.067). ROC analysis was not statistically significant (AUC 0.58, p = 0.083).Conclusion: By using a novel instrument aimed at quantifying fathers' knowledge and overall attitude toward breastfeeding, this study underlines the importance of including fathers in the promotion of breastfeeding. Expanding the classic mother-baby dyad to a more modern mother-father-baby triad may impact breastfeeding outcomes at discharge. What is known: • Social support plays a major role in improving breastfeeding outcomes. • Fathers may greatly influence initiation and duration of breastfeeding; the more they know, the more helpful they can be. What is new: • A multidisciplinary team created a structured questionnaire aimed at quantifying fathers' knowledge and attitude toward breastfeeding. • The association between a higher questionnaire total score and exclusive breastfeeding rates at discharge highlights the importance of including fathers in the promotion of breastfeeding, as part of the breastfeeding team.

Fathers' Experiences and Perspectives of Breastfeeding: A Scoping Review

During the transition to parenthood, fathers may experience significant challenges, including finding a place for themselves as important participants in the context of infant breastfeeding by female partners. Although generally viewed as a healthy process and the preferred method of infant feeding, breastfeeding may result in some fathers feeling excluded, inadequate, and helpless. Breastfeeding is known to adversely affect various aspects of a father’s life, including parenting self-efficacy, quality of life (QOL), the relationship with the partner, and the perception that breastfeeding limits time available for father–infant bonding. The current scoping review explores the experiences, roles, and needs of fathers of breastfed infants by synthesizing and discussing the findings from relevant published research studies (n = 18). Recommendations, drawn from the scoping review findings, are offered to guide primary health providers and services.

Hidden Realities of Infant Feeding: Systematic Review of Qualitative Findings from Parents

A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent's attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent's expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.

Predictors of Early Introduction of Core and Discretionary Foods in Australian Infants-Results from HSHK Birth Cohort Study

Early introduction of complementary foods can have a detrimental impact on children's long-term health. This study examined the timing and determinants of early introduction of core and discretionary foods among infants in Sydney, Australia. Mothers (n = 1035) from an ongoing population-based birth cohort study were interviewed at 8, 17, 34 and 52 weeks postpartum. The outcome was 'age at which particular core and discretionary food items were first introduced'. Multivariable logistic regression models were used to investigate family and infant-related determinants of early introduction of core (<17 weeks of age) and discretionary foods (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 12% (n = 113) of infants were introduced core foods before 17 weeks of age (median: 22). Mothers working part-time (adjusted odds ratio (OR): 3.42, 95% confidence interval (CI): 1.54-7.62) and those exclusively formula-feeding their babies at four-weeks postpartum (adjusted OR 3.26, 95% CI: 1.99-5.33) were most likely to introduce core foods early. Ninety-five percent (n = 858) of infants were introduced discretionary foods before 52 weeks of age (median: 28). Low socio-economic status was significantly associated with early introduction of discretionary foods (adjusted OR: 3.72, 95% CI: 1.17-11.78). Compliance with infant feeding guidelines related to core foods was better; however, discretionary foods were introduced early in most infants.

Integrative Review of Fathers' Perspectives on Breastfeeding Support

OBJECTIVE

To critically review and summarize the results of published articles on fathers' perspectives regarding breastfeeding support for their partners.

DATA SOURCES

We searched the following databases for articles published between January 2010 and May 2019: CINAHL, MEDLINE, PubMed, Scopus, Web of Science, ThaiJo, and ThaiLis. We included articles published in English and Thai.

STUDY SELECTION

After duplicates were removed, our initial search yielded 3,927 articles. We excluded articles in accordance with pre-established criteria. We performed a quality appraisal of the selected full-text articles and ultimately included 27 in this review.

DATA EXTRACTION

We analyzed studies that met inclusion criteria and extracted and organized data related to fathers' perspectives on breastfeeding support into a structured table.

DATA SYNTHESIS

The data were synthesized into three themes: Attitude Toward Breastfeeding, Knowledge of Breastfeeding, and Fathers' Perceptions of the BreastfeedingSupportThey Provided.

CONCLUSION

Our results showed that fathers' perspectives on breastfeeding support were shaped by their knowledge of breastfeeding and participation in the breastfeeding process. To promote breastfeeding, further research is required to design and implement appropriate interventions to help fathers effectively support their breastfeeding partners.