Breastfeeding self-efficacy and breastmilk feeding for moderate and late preterm infants in the Family Integrated Care trial: a mixed methods protocol

Effectiveness of a Postpartum Breastfeeding Support Group Intervention in Promoting Exclusive Breastfeeding and Perceived Self-Efficacy: A Multicentre Randomized Clinical Trial

There are numerous recognized benefits of breastfeeding; however, sociocultural, individual, and environmental factors influence its initiation and continuation, sometimes leading to breastfeeding rates that are lower than recommended by international guidelines. The aim of this study was to evaluate the effectiveness of a group intervention led by midwives supporting breastfeeding during the postpartum period in promoting exclusive breastfeeding, as well as to assess the impact of this intervention on perceived self-efficacy. This was a non-blind, multicentric, cluster-randomized controlled trial. Recruitment started October 2021, concluding May 2023. A total of 382 women from Andalusia (Spain) participated in the study. The results showed that at 4 months postpartum there was a higher prevalence of breastfeeding in the intervention group compared to formula feeding (p = 0.01), as well as a higher prevalence of exclusive breastfeeding (p = 0.03), and also at 6 months (p = 0.01). Perceived self-efficacy was similar in both groups for the first two months after delivery, which then remained stable until 4 months and decreased slightly at 6 months in both groups (p = 0.99). The intervention improved the average scores of perceived self-efficacy and indirectly caused higher rates of exclusive breastfeeding (p = 0.005). In conclusion, the midwife-led group intervention supporting breastfeeding proved to be effective at maintaining exclusive breastfeeding at 6 months postpartum and also at increasing perceived self-efficacy.

Maternal performance after childbirth and its predictors: a cross sectional study

BACKGROUND AND OBJECTIVES

Birthing parents need to use specialized skills as the first caregiver of the newborn. Several factors may affect performance. Yet there is a paucity of research in this area, and evidence remains inconsistent. Consequently, this study aimed to determine maternal performance after childbirth and its predictors.

METHODS

This cross-sectional study was conducted with those (n = 450) who had given birth (< two months) and been referred for the vaccination of their newborn. The multi-stage sampling method was carried out from April 2022 to February 2023. Participants who met the inclusion criteria completed a demographic and obstetric information questionnaire, along with the childbirth experience 2 (CEQ2), Barkin maternal performance and maternal self-efficacy scales. Multiple linear regression was used to investigate the predictive effect of the independent variables of childbirth experience, maternal self-efficacy, demographic and obstetric variables on the dependent variable of maternal performance.

RESULTS

The mean age of the participants was 26.78 and the mean total score of maternal performance was 91.04 (0-120). The highest and lowest scores related to the 'maternal competence' and the 'maternal needs' domains, with mean score calculated at 77.51 and 72.81 respectively. 'Childbirth experience' and 'maternal self-efficacy' domains had a statistically significant relationship with maternal performance (P < 0.05). Among the predictive factors of maternal performance, the results of our linear regression demonstrated the variables of birth experience (B = 0.63), maternal self-efficacy (B = 1.53), spouse's employment status (B = 5.78 for worker level, B = 3.99 for employee level), the number of previous childbirth experiences (B = -8.46), frequency of receiving antenatal care (B = -6.68), length of stay in the birth suite (B = -2.22) and length of stay in the hospital (B = 2.84) remained in the model. 53.2% of changes in maternal performance can be explained by these independent variables.

CONCLUSION

The promotion of evidence-based, person-centered, and respectful perinatal care during pregnancy and childbirth are of paramount importance. Strategies to improve the experience of childbirth and self-efficacy are especially required to improve maternal performance in the postpartum period. Prenatal care aimed at improving maternal function after childbirth will be important in achieving this overall.

Application of the Extended Theory of Planned Behavior to Predict Exclusive Breastfeeding Intention, In Pregnant Nulliparous Women. A Cross-Sectional Study

OBJECTIVE.

This study investigated the effect of Extended Theory of Planned Behavior (ETPB) extended theory of planned behavior in comparison with the Theory Of Planned Behavior (TPB) in explaining the intention of Exclusive Breastfeeding Intention (EBF) in Pregnant nulliparous women of Kerman (Iran).

METHODS.

In this descriptive study, 249 pregnant women in Kerman participated via simple random sampling. The research instruments included Questionnaire related to the structures of the theory of planned behavior, breastfeeding self-efficacy and social support questionnaire for breastfeeding.

RESULTS.

The results of the correlation test showed a significant relationship between all constructs of the theory of extended planned behavior and the intention of EBF. The highest correlation belonged to the construct of subjective norms (r=0.49). Path regression coefficients in the second model showed that the Self-Efficacy mediator variable is fully capable of meaningful mediation between Social Support and Intention (p<0.001; B=0.383). The conceptual diagram of Structural equation modeling showed a higher explained variance or R2 index for the intention variable for the developed model compared to that of the first model, i.e. (the first model: R2=0.37, the second model: R2=0.46). The goodness-of-fit index had a better status for the developed model.

CONCLUSION.

Extended TPB with social support and breastfeeding self-efficacy constructs can be appropriate model for predicting the intention and behavior of EBF.

Effect of continuous supportive telephone counselling on improving breastfeeding self-efficacy in mothers with late preterm infants four months after discharge: A randomized, controlled study

BACKGROUND

Breastfeeding self-efficacy is an important motivational factor in the continuity of lactation in mothers with preterm infants.

OBJECTIVE

The study aimed to determine the effect of continuous supportive telephone counselling on improving breastfeeding self-efficacy in mothers with late preterm infants.

MATERIAL AND METHODS

This randomized, controlled study was carried out with 65 eligible mothers (control n = 32, intervention n = 33) recruited in Ahvaz, Iran, in 2020. The eligible women were allocated into two groups- intervention and control-according to the block design. Data were measured monthly up to four months after discharge using the Dennis Breastfeeding Self-Efficacy Questionnaire. The control group received only routine care. Continuous supportive telephone counselling was provided for the intervention group members daily for 14 days after neonatal discharge. Data were analyzed using chi-square, repeated measures analysis of variance, independent t-test, and paired t-test at the significant level of 0.05. Statistical analysis was performed using the SPSS 16.0 software (SPSS Inc., Chicago, IL, USA).

RESULTS

The overall score in breastfeeding self-efficacy showed a statistically significant difference between the two study groups during the four months after discharge compared to the pre-intervention stage (P = 0.001). In the intervention group, the mean score of breastfeeding self-efficacy increased from 33.18 to 53.48, and in the control group it decreased from 31.17 to 28.56.

CONCLUSION

The results showed that continuous supportive telephone counselling can improve breastfeeding self-efficacy in mothers with preterm infants. The approach seems to be an acceptable basis for designing intervention programs in this field.

Breastfeeding Outcomes, Self-Efficacy, and Satisfaction Among Low-Income Women With Late-Preterm, Early-Term, and Full-Term Infants

OBJECTIVE

To assess breastfeeding exclusivity and rate of breastfeeding, breastfeeding self-efficacy, and satisfaction with breastfeeding after hospital discharge among low-income women with late-preterm and early-term infants compared with women with full-term infants.

DESIGN

Prospective, comparative, with repeated measures.

SETTING

Four Midwestern U.S. Special Supplemental Nutrition Program for Women, Infants, and Children offices.

PARTICIPANTS

Participants included 270 mother-infant dyads.

METHODS

We assessed breastfeeding exclusivity, rate of breastfeeding, and breastfeeding self-efficacy at 2 weeks, 2 months, and 5 months and satisfaction with breastfeeding at 5 months after birth or when participants stopped breastfeeding.

RESULTS

More than 50% of women in each subgroup were non-Hispanic White. Late-preterm and early-term infants had lower breastfeeding exclusivity rates than full-term infants across the three time points (40%, 51%, and 65% at 2 weeks, p = .029; 22.5%, 34%, and 58% at 2 months, p < .001; and 7%, 15%, and 28.46% at 5 months, p < .001, respectively). The overall exclusive breastfeeding rate for all groups was 55.93% at 2 weeks, 44.07% at 2 months, and 20.37% at 5 months; 55.56% continued any breastfeeding at 5 months. Breastfeeding self-efficacy during the first 5 months after birth, satisfaction with breastfeeding, level of education, and attending breastfeeding classes were positively correlated with breastfeeding exclusivity. We found significantly less exclusive breastfeeding, lower breastfeeding self-efficacy, and lower satisfaction with breastfeeding among participants with late-preterm and early-term infants compared to those with full-term infants.

CONCLUSION

Ongoing professional breastfeeding support for women is needed to improve and promote breastfeeding exclusivity and continuation among their late-preterm and early-term infants.

Protocol for the Pregnancy During the COVID-19 Pandemic (PdP) Study: A Longitudinal Cohort Study of Mental Health Among Pregnant Canadians During the COVID-19 Pandemic and Developmental Outcomes in Their Children

BACKGROUND

The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments.

OBJECTIVE

The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring.

METHODS

The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development.

RESULTS

Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing.

CONCLUSIONS

This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/25407.

An Observational Cohort Study and Nested Randomized Controlled Trial on Nutrition and Growth Outcomes in Moderate and Late Preterm Infants (FLAMINGO)

Background: Over the past decades, the preterm birth rate has increased, mostly due to a rise in late and moderate preterm (LMPT, 32–36 weeks gestation) births. LMPT birth affects 6–7% of all births in the United Kingdom and is associated with increased morbidity risk after birth in infancy as well as in adulthood. Early life nutrition has a critical role in determining infant growth and development, but there are limited data specifically addressing LMPT infants, which was the rationale for the design of the current study.

Objective: The Feeding Late and Moderate Infants and Growth Outcomes (FLAMINGO) study aims to improve understanding of the longitudinal growth, nutritional needs, and body composition of LMPT infants as well as their microbiome development and neurodevelopment. In addition, having a nested non-inferiority trial enables evaluation of the nutritional adequacy of a concept IMF with large milk phospholipid-coated lipid droplets comprising dairy and vegetable lipids. The primary outcome of this RCT is daily weight gain until 3 months corrected age.

Methods: A total of 250 healthy LMPT infants (32+0–36+6 weeks gestational age) with birth weight 1.25–3.0 kg will be recruited to the cohort, of which 140 infants are anticipated to be enrolled in the RCT. During six visits over the first 2 years of life, anthropometry, body composition (using dual energy X-Ray absorptiometry), feeding behavior, and developmental outcomes will be measured. Saliva and stool samples will be collected for oral and gut microbiota assessment.

Discussion: The FLAMINGO study will improve understanding of the longitudinal growth, body composition development, and feeding characteristics of LMPT infants and gain insights into their microbiome and neurodevelopment.

Study Registration:www.isrctn.com; Identifier ISRCTN15469594.

Does breastfeeding self-efficacy theory apply to mothers of moderate and late preterm infants? A qualitative exploration

BACKGROUND

Breastmilk feeding reduces morbidities and improves outcomes related to prematurity. However, breastmilk feeding rates in preterm infants are substantially lower than those in term infants. Breastfeeding self-efficacy theory is a social change theory, which is predictive of exclusive breastmilk feeding at 2 months postpartum in mothers of full-term infants. However, this theory has not been well explored in mothers of moderate and late preterm infants.

AIMS AND OBJECTIVES

To explore maternal experiences with feeding moderate (32^0/7 - 33^6/7  weeks' gestational age) and late preterm infants (34^0/7 - 36^6/7  weeks' GA) in neonatal intensive care units and assess applicability of breastfeeding self-efficacy theory.

METHODS

We conducted a qualitative descriptive exploration of maternal experiences with infant feeding in neonatal intensive care units. Using purposive, maximum variation sampling, we selected mothers of preterm infants born at 32^0/7 - 34^6/7  weeks, who experienced high mean differences in their BSE scores between admission and discharge. Fourteen mothers participated in semi-structured telephone interviews. Data were examined using thematic analysis. To explore and describe breastfeeding self-efficacy within the context of neonatal intensive care units, we super-imposed the four sources of information from breastfeeding self-efficacy theory onto the defined themes.

RESULTS

Three main themes emerged: (a) institutional influences, (b) relationship with the pump and (c) establishing breastfeeding, with an emphasis on the importance of direct breastfeeding at discharge. Overlaying the four sources of information from breastfeeding self-efficacy highlighted the presence of three sources of information: verbal persuasion, performance accomplishment and physiologic/affective responses. Vicarious experience was not identified in maternal experiences with infant feeding.

CONCLUSION

Our findings indicate that breastfeeding self-efficacy is an applicable theory for mothers of preterm infants.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers need to be aware of the influence that institutional culture and policies may have on maternal breastfeeding self-efficacy and breastfeeding outcomes.

Effects of a maternal role adjustment program for first time mothers who use postpartum care centers (Sanhujoriwon) in South Korea: a quasi-experimental study

BACKGROUND

Many South Korean women stay in specialized postpartum care centers called Sanhujoriwon for 2 weeks after childbirth, a time which is widely recognized as a critical period for maternal role adjustment. Mothers' time within the postpartum care center offers a unique opportunity for nursing intervention to promote a successful transition to motherhood, especially for first time mothers. This study aimed to develop a maternal role adjustment program within the Sanhujoriwon based on the ecological model, and to evaluate its effects on maternal role confidence and breastfeeding success.

METHODS

A non-equivalent control group pretest-posttest design was used. Data were collected from 30 participants in the experimental group and 37 in the control group at four measurement times, i.e., admission day to Sanhujoriwon, discharge day from Sanhujoriwon, 4-6 weeks postpartum, and 12 weeks postpartum. The experimental group received the maternal role adjustment program, which included family education and counseling regarding breastfeeding and infant care, and encouraged rooming-in practices during their stay in the Sanhujoriwon. The data were analyzed using the IBM SPSS statistics 25.0 program using descriptive statistics, t-test, chi-square test, ANCOVA, and GEE.

RESULTS

There were significant interaction effects showing different patterns in maternal role confidence and breastfeeding success scores over the four time points. Maternal role confidence in the experimental group gradually increased over time. Maternal role confidence in the control group also increased from baseline to 4 to 6 week postpartum, but abruptly decreased at 12 week postpartum. At 12 weeks postpartum, maternal role confidence in the experimental group was significantly higher than that of the control group. In addition, breastfeeding success scores in the experimental group also gradually increased over the four time points, while those of the control group showed a gradual decline. Breastfeeding success scores were significantly higher than those of control group at both 4-6 weeks and 12 weeks postpartum.

CONCLUSIONS

These results indicate that the maternal role adjustment program was effective in improving maternal role confidence and breastfeeding success among first time mothers in the postpartum care center.

Impacts of antenatal nursing interventions on mothers' breastfeeding self-efficacy: an experimental study

Background

A considerable amount of research demonstrates how breastfeeding self-efficacy significantly influences breastfeeding outcomes. The aim of this study was to evaluate the role of nursing intervention on mother’s breastfeeding self-efficacy.

Methods

In this experimental investigation, 130 pregnant women who attended a primary health care centre were randomly assigned to the experimental (n = 65) or control (n = 65) groups. The experimental group received two 60–90 min group breastfeeding educational sessions based on the breastfeeding self-efficacy theory along with routine care. Mothers’ knowledge, attitudes, prenatal and postnatal self-efficacy towards the breastfeeding were compared between both groups. The Iowa Infant Feeding Attitude Scale measured the attitudes. Prenatal Breastfeeding Self-Efficacy Scale measured the self-efficacy during pregnancy and Breastfeeding Self-Efficacy-Short Form measured the self-efficacy in postnatal period.

Results

Breastfeeding self-efficacy during pregnancy and following two months of delivery in the experimental group was significantly higher. The experimental group had a higher level of knowledge and attitude in comparison with subjects in the control group. In addition, the mothers who breastfed exclusively had higher levels of postnatal self-efficacy in both experimental and control groups compared to formula feeding women (52.00 vs. 39.45 in the control and 57.69 vs. 36.00 in the experimental subjects; P < 0.001).

Conclusion

The present investigation suggests that antenatal breastfeeding education is an effective way to increase the level of breastfeeding self-efficacy, which increases exclusive breastfeeding practice.

Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol

Background

Family Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes.

Methods

This exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2).

Discussion

This study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings.

Trial registration

ClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017.

Factors affecting breast-feeding practice among a sample of Iranian women: a structural equation modeling approach

Background

Breastfeeding is one of the most sensitive stages in the development of children, having many benefits for the mother and the child. The present study aimed to determine factors associated with breastfeeding intention and behavior in mothers living in Taft County, Iran.

Methods

In this cross-sectional design, the statistical population consisted of 420 mothers with infants under 1 year of age living in Taft County of Yazd province, Iran. The research data were collected from health records of infants under one in health centers of the county as well as a researcher-made questionnaire including demographic information, knowledge and attitude towards breastfeeding, social support and perceived self-efficacy, and breastfeeding intention and behavior. Structural Equation Modeling (SEM) based on AMOS 18 were employed to analyze the relationship between research variables.

Results

The mean age of mothers was 28.04 ± 6.49 year and the children were 10 ± 6 months. Half of the mothers (50.3%) had cesarean sections and more than half (55.8%) of the children were males. Mothers’ attitude (β = 0.442; 95% CI: 0.284, 0.599), self-efficacy (β = 0.186; 95% CI: 0.047, 0.324) and perceived social support (β = 0.178; 95% CI: 0.035, 0.322) were respectively the strongest predictors of breastfeeding intention. Besides, the breastfeeding intention affected breastfeeding behavior with a high coefficient (0.857; 95% CI: 0.735, 0.979).

Conclusions

The study provided informative pathways on the association of maternal attitude, social support and self-efficacy with breast feeding behavior. These findings could be useful for designing health education and promotion programs about breast feeding among women.

Do a Few Weeks Matter? Late Preterm Infants and Breastfeeding Issues

The late preterm infant population is increasing globally. Many studies show that late preterm infants are at risk of experiencing challenges common to premature babies, with breastfeeding issues being one of the most common. In this study, we investigated factors and variables that could interfere with breastfeeding initiation and duration in this population. We conducted a prospective observational study, in which we administered questionnaires on breastfeeding variables and habits to mothers of late preterm infants who were delivered in the well-baby nursery of our hospital and followed up for three months after delivery. We enrolled 149 mothers and 189 neonates, including 40 pairs of twins. Our findings showed that late preterm infants had a low rate of breastfeeding initiation and early breastfeeding discontinuation at 15, 40 and 90 days of life. The mothers with higher educational levels and previous positive breastfeeding experience had a longer breastfeeding duration. The negative factors for breastfeeding were the following: Advanced maternal age, Italian ethnicity, the feeling of reduced milk supply and having twins. This study underlines the importance of considering these variables in the promotion and protection of breastfeeding in this vulnerable population, thus offering mothers tailored support.