Dysphoric Milk Ejection Reflex: Characteristics, Risk Factors, and Its Association with Depression Scores and Breastfeeding Self-Efficacy

Background: Dysphoric milk ejection reflex (D-MER) is a phenomenon that occurs before milk letdown and is described as a wave of negative or devastating emotions, ranging from mild to severe and lasting for seconds to minutes. To date, there has been little research regarding this phenomenon. This study aims to determine the prevalence of D-MER in our population as well as its association with postnatal depression scores and breastfeeding self-efficacy. Methods: Lactating persons between 4 and 12 weeks postpartum at our institution were invited to complete an anonymous 59-question survey via an online platform. Questions asked included patient demographics, presence of symptoms of dysphoria (including timing, duration, and frequency), the Edinburgh Postnatal Depression Scale (EPDS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-sf). Results: In total, 201 women completed the survey. Twelve women were classified as likely having D-MER (6%). Symptom resolution primarily occurred within a minute to 5 minutes (58%). Mean EPDS scores differed significantly between those with likely D-MER and those without (12.2 vs. 5.4, p = 0.002). BSES-sf scores differed significantly between the two groups (43.1 vs. 52.5, p = 0.009). Preexisting depression or anxiety was not associated with D-MER (p = 0.133), other reported mood disorders differed significantly between those with D-MER and those without (p = 0.004). Demographic characteristics of women with and without D-MER were similar. Conclusion: D-MER prevalence may be lower than previously reported. Patients with likely D-MER appear to have lower breastfeeding self-efficacy and higher depression scores. Those with preexisting mood disorders may be at higher risk of experiencing D-MER.

In-Hospital Formula Feeding Hindered Exclusive Breastfeeding: Breastfeeding Self-Efficacy as a Mediating Factor

Breastfeeding self-efficacy (BSE), defined as a mother's confidence in her ability to breastfeed, has been confirmed to predict the uptake of exclusive breastfeeding (EBF). Early experiences during the birth hospital stay, especially in-hospital formula feeding (IHFF), can impact both EBF and maternal breastfeeding confidence. Therefore, our objective was to examine the association between IHFF and EBF outcomes and investigate whether this association is influenced by BSE. The study included 778 infants from a larger cohort study conducted in 2021, with a one-year follow-up in rural areas of Sichuan Province, China. We used a causal mediation analysis to estimate the total effect (TE), natural direct (NDE), and nature indirect effects (NIE) using the paramed command in Stata. Causal mediation analyses revealed that IHFF was negatively associated with EBF (TE odds ratio = 0.47; 95% CI, 0.29 to 0.76); 28% of this association was mediated by BSE. In the subgroup analysis, there were no significant differences in the effects between parity subgroups, as well as between infant delivery subgroups. Our study found that IHFF hindered later EBF and that BSE mediated this association. Limiting the occurrence of in-hospital formula feeding or improving maternal breastfeeding self-efficacy is likely to improve exclusive breastfeeding outcomes.

The Effect of Breastfeeding Self-Efficacy on Infants' Weights and Breastfeeding Outcomes

OBJECTIVE

The aim of this study was to investigate the effects of breastfeeding self-efficacy (BSE) and breastfeeding success (BFS) on infants' weight gain rates and breastfeeding outcomes.

MATERIALS AND METHODS

Mothers were evaluated within the postpartum 72 hours with "Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF)" and "LATCH Scale." After 6 months, the mothers were called to learn the exclusive breastfeeding (EB) duration and the weight of the infants.

RESULTS

Two hundred mother-infant couples were enrolled, 176 (88%) of them could be reached in the sixth month. The BSES-SF scores were positively correlated with LATCH scores (P = .0001). The EB rate in the sixth month was positively correlated with BFS but not correlated with BSE (r, P = .218, .004; .79, .297, respectively). The percentage of weight gain and the rate of weight percentile change of babies according to birth weight at the sixth month of age were negatively correlated with BSE (r = -0.226, -0.148, P = .003, .049, respectively) but not correlated with BFS.

CONCLUSION

Higher BFS was associated with increased duration of EB in the first 6 months of life, and higher BSE was related to lower increase in the percentage of weight gain and a lower rate of weight percentile change of babies at 6 months of age.

Does Preoperative Pain Belief Affect Postoperative Pain and Breastfeeding?

PURPOSE

This research was carried out to determine the relationship between pain belief of women who experienced cesarean section for the first time and their postcesarean pain and breastfeeding self-efficacy levels.

DESIGN

The research is a descriptive study.

METHODS

The study was conducted with 144 patients who had not undergone any surgical operation and had their first cesarean section. Data were collected with an introductory information form, pain beliefs questionnaire (PBQ), visual analog scale (VAS), and breastfeeding self-efficacy scale (BSES).

FINDINGS

The patients' PBQ organic belief score (3.06 ± 0.61) was higher than their PBQ psychological belief score (1.87 ± 0.83), and their pain beliefs were based on an organic cause. The postcesarean section pain of the women was moderate-severe (6.75 ± 1.71), breastfeeding self-efficacy levels were high and sufficient (57.88 ± 4.86), and their pain beliefs were of organic origin. There was no significant relationship between patients' pain beliefs and postcesarean pain and breastfeeding self-efficacy levels.

CONCLUSIONS

The results of our study indicate that working status, income status, and chronic illness were associated with patients' pain beliefs, but we observed no relationship between pain beliefs and postcesarean pain and breastfeeding self-efficacy levels.

[Relationship Between Maternal Negative Emotions and Feeding Patterns of Infants Aged 0-6 Months in Remote Rural Areas of Sichuan Province]

Objective To investigate the status of exclusive breastfeeding and bottle feeding in remote rural areas of Sichuan province and explore the relationship between negative emotions of mothers and feeding patterns of infants.Methods Multistage cluster sampling was employed to select the infants aged 0-6 months and their mothers in remote rural areas of Sichuan province.A self-designed questionnaire was used to collect the demographic characteristics of mothers and infants and the basic family information.The Chinese version of Depression Anxiety Stress scale was used to evaluate mothers' negative emotions,and the Breastfeeding Self-efficacy scale to assess the confidence level of mothers' behavior of adhering to exclusive breastfeeding.Results Totally 723 pairs of infants and their mothers were included.The exclusive breastfeeding and bottle feeding rates were 34.16% (247/723) and 57.54% (416/723),respectively.Mothers with depression tendency were less likely to adopt exclusive breastfeeding (OR=0.532,95%CI=0.291-0.974,P=0.041) and more likely to adopt bottle feeding (OR=1.877,95%CI=1.054-3.344,P=0.033).Further subgroup analysis of breastfeeding self-efficacy showed that in the group of low self-efficacy,the mothers with depression tendency were less likely to adopt exclusive breastfeeding (OR=0.461,95%CI=0.236-0.902,P=0.024) and more likely to adopt bottle feeding (OR=1.968,95%CI=1.047-3.701,P=0.036) than the mothers without depression tendency.In the group of high self-efficacy,mothers' depression,anxiety,and stress tendency had no significant correlation with infant feeding patterns (all P>0.05).Conclusions The mothers in the remote rural areas of Sichuan province are more likely to employ bottle feeding than exclusive breastfeeding.The mothers with stronger depression tendency demonstrate lower possibility of exclusive breastfeeding and higher possibility of bottle feeding.Breastfeeding self-efficacy may affect the association between maternal depression and infant feeding patterns.

The relationship of psychological well-being and cognitive emotions with breastfeeding self-efficacy in mothers in the postpartum period

To determine the relationship of psychological well-being and cognitive emotion regulation and breastfeeding self-efficacy in mothers in the postpartum period. The research was designed as cross-sectional and correlational and carried out between 1 November 2021 and 1 January 2022 in the pediatric outpatient clinic of a Medical Faculty Hospital of a province in the Central Anatolian Region of Turkey. Responses from a total of 325 mothers who were in postpartum 1-6 months were analyzed. Data were collected using a Personal Information Form, the Scales of Psychological Well-Being (SPWB), the Cognitive Emotion Regulation Questionnaire (CERQ), and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). The following factors were found to be important associated risk factors that negatively affected breastfeeding self-efficacy in 29% of the mothers (F = 14.536, p < .001): mothers' poor mental health, using self-blaming maladaptive cognitive coping strategy, inability to use positive reappraisal coping strategy, and feeding the baby only formula or both breast milk and formula. Weak and positive correlations were found between psychological well-being of mothers and adaptive cognitive coping subdimensions, and negative and weak correlations were found between psychological well-being of the mothers and maladaptive cognitive coping subdimensions (p < .001). Breastfeeding self-efficacy of mothers in a well psychological state, who can use adaptive cognitive coping strategies, and who exclusively breastfeed their babies is positively affected.

Self-Efficacy and Outcomes in Women with Diabetes: A Prospective Comparative Study

Background: Breastfeeding is especially beneficial to women with diabetes and their infants, yet diabetic mothers frequently experience less favorable breastfeeding outcomes. Objectives: To identify facilitators and barriers to breastfeeding for women with diabetes by comparing cognitive and social factors, health and hospital-related factors, and breastfeeding outcomes between women with and without diabetes. Design/Methods: Women with any type of diabetes (n = 28) and without diabetes (n = 29) were recruited during pregnancy. Data were collected from the electronic medical record and maternal surveys at 24-37 weeks' gestation, birth hospitalization, and 4 weeks' postbirth. We compared differences in mother's regard for breastfeeding, breastfeeding intention, and birth hospital experience by diabetes status, and estimated odds ratios for exclusive breastfeeding (EBF) and unmet intention to breastfeed. Results: Women with and without diabetes had similar breastfeeding intentions, attitudes, and self-efficacy. Women with diabetes were less likely to EBF, and more likely to have unmet intentions to EBF at hospital discharge, compared to women without diabetes. At 4 weeks' postpartum, there was no difference in breastfeeding by diabetes status, although EBF at hospital discharge was strongly associated with EBF at 4 weeks. Infant neonatal intensive care unit (NICU) admission and hypoglycemia were significantly associated with diabetes status, reduced EBF rates, and unmet breastfeeding intentions. Conclusions: Despite having a strong intent to breastfeed, women with diabetes experienced less favorable early breastfeeding outcomes and were less likely to meet their own breastfeeding goals. These differences may be driven by neonatal complications, such as infant hypoglycemia and NICU admissions, rather than maternal cognitive and social factors.

A Pilot Randomized Controlled Trial of an Online Educational Program for Primiparous Women to Improve Breastfeeding

BACKGROUND

There are different approaches to breastfeeding interventions, but the global 6-month exclusive breastfeeding rates remain suboptimal. The COVID-19 pandemic has brought extra difficulties in promoting breastfeeding.

RESEARCH AIM

To test the feasibility and effectiveness of a theory-based, real-time online educational and support program for breastfeeding related outcomes.

METHODS

An assessor-blinded, prospective pilot randomized controlled trial with parallel-group, repeated-measures design was used. The sample was low-risk primiparous mothers (N = 40) who delivered in the local public hospitals. Study outcomes consisted of exclusive breastfeeding rate, breastfeeding self-efficacy, and other breastfeeding outcomes measured by a self-reported questionnaire, including the Breastfeeding Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Comparisons between the differences in the intervention and control groups were carried out.

RESULTS

Thirteen participants in the intervention group successfully completed the program. They had a higher exclusive breastfeeding rate, breastfeeding self-efficacy, breastfeeding initiation rate, and longer exclusive breastfeeding duration than the control group. Additionally, the intervention group had a lower partial breastfeeding rate, and a higher maternal postnatal depression score and infant's morbidity at postnatal 2 months. However, all the results were not statistically significant (p > .050). Overall, the intervention was highly valued by all participants who appreciated the regular postnatal follow-ups.

CONCLUSIONS

Despite showing the satisfactory feasibility of the program, no significant improvements were found in all study outcomes. Considering the participants' comments, we suggest refining and further testing the intervention with a larger sample size over a longer-term follow-up to confirm its effectiveness.This study has been registered at ClinicalTrials.gov (NCT04741425).

Breastfeeding self-efficacy predicts breastmilk feeding in preterm infants at discharge from the neonatal intensive care unit

AIM

To examine the association between breastfeeding self-efficacy (BSE) and breastmilk feeding at discharge from the neonatal intensive care unit among mothers of preterm infants.

DESIGN

Secondary analysis of the Family Integrated Care (FICare) cluster randomized controlled trial.

METHODS

Data from 221 mothers of preterm infants who participated in the standard care group of the trial were analysed. BSE at admission was assessed using the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Breastmilk feeding was assessed using 24 hr maternal recall at discharge.

RESULTS

Mothers who were exclusively breastmilk feeing their infants at discharge had statistically significantly higher mean BSES-SF scores at admission (68.4, SD = 13.7) than those providing a combination of breastmilk and formula or only formula (59.6, SD = 14.7; p < .001). Multivariable logistic regression showed that higher BSE at admission, maternal birth in Canada, and absence of diabetes were statistically significant predictors of exclusive breastmilk feeding at discharge.

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

BACKGROUND

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

RESEARCH AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Association Between Breastfeeding Self-Efficacy and Mode of Infant Feeding

Introduction: It is well established that low breastfeeding self-efficacy is associated with early breastfeeding cessation. Over the past several decades, expressed human milk feeding has increased among parents of healthy infants. Researchers have hypothesized an association between maternal breastfeeding confidence and expressed human milk feeding, but it has not been empirically examined. Therefore, the primary objective of this study was to assess the associations between breastfeeding self-efficacy and human milk expression practices. The secondary objective was to assess the effect of breastfeeding self-efficacy on breastfeeding duration and exclusivity. Methods: This study used a prospective cohort design. From 2017 to 2018, we recruited 821 healthy mothers with term births in two public hospitals in Hong Kong. Participants completed a self-administered questionnaire in the immediate postpartum period, which gathered information about sociodemographic characteristics and Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Participants were followed up for 6 months or until infants were weaned. The proportion and type of infant feeding were assessed at telephone follow-up. Results: The overall mean BSES-SF score in our sample was 46.5 (standard deviation = 10.1). Every one-point increase in the BSES-SF score was associated with 4-5% lower risk of any expressed human milk feeding and 4-7% higher odds of breastfeeding continuation across the first 6 months postpartum. Conclusion: Higher breastfeeding self-efficacy is associated with a lower risk of expressed human milk feeding and a longer duration of any and exclusive breastfeeding. Further studies should explore how improving breastfeeding self-efficacy may affect the mode of human milk feeding.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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.

Evaluation of the Effects of Skin-to-Skin Contact on Newborn Sucking, and Breastfeeding Abilities: A Quasi-Experimental Study Design

Mother and newborn skin-to-skin contact (SSC) after birth has numerous protective effects. Although positive associations between SSC and breastfeeding behavior have been reported, the evidence for such associations between early SSC and breastfeeding success was limited in high-income countries. This quasi-experimental intervention design study aimed to evaluate the impact of different SSC regimens on newborn breastfeeding outcomes in Taiwan. In total, 104 healthy mother–infant dyads (52 in the intervention group and 52 in the control group) with normal vaginal delivery were enrolled from 1 January to 30 July 2019. The intervention group received 60 min of immediate SSC, whereas the control group received routine care (early SSC with 20 min duration). Breastfeeding performance was evaluated by the IBFAT and BSES-Short Form. Generalized estimating equations (GEEs) were used to evaluate the effectiveness of the intervention. In the intervention group, the breastfeeding ability of newborns increased significantly after 5 min of SSC and after SSC. The intervention also improved the total score for breastfeeding self-efficacy (0.18 point; p = 0.003). GEE analysis revealed that the interaction between group and time was significant (0.65 point; p = 0.003). An initial immediate SSC regimen of 60 min can significantly improve neonatal breastfeeding ability and maternal breastfeeding self-efficacy in the short term after birth.

Associations Between Postpartum Physical Symptoms and Breastfeeding Outcomes Among a Sample of U.S. Women 2-6 Months' Postpartum: A Cross-Sectional Study

Objective: Postpartum urogynecologic and other physical symptoms are common and burdensome. Whether they interfere with breastfeeding has not been thoroughly examined, and this study aims to fill this gap. Methods: Mothers with an infant (2 to 6 months) were recruited from the U.S. ResearchMatch volunteer registry and completed the Life After Pregnancy Study, which assessed postpartum physical symptoms and breastfeeding self-efficacy, experiences, and problems. Modified Poisson regression and linear regression with fully conditional specification multiple imputation to handle missing data were used to examine the associations between physical symptoms and breastfeeding-related outcomes. Results: Among 222 participants, postpartum physical symptoms were common [e.g., painful sex (42%), urinary incontinence (32%)]. Breastfeeding problems were experienced by most participants [e.g., engorged breasts (72%), sore or cracked nipples (70%), breastfeeding or pumping was painful (67%)]. Although postpartum physical symptoms were not associated with breastfeeding for less than 2 months versus greater than/equal to 2 months (β = 0.94, 95% confidence interval [CI]: 0.78, 1.13), women with excess weight retention and those reporting painful sex or hemorrhoids were more likely to report breastfeeding problems such as sore or cracked nipples or perceived low milk supply. Overall, more physical symptoms were associated with more breastfeeding problems (adj β = 0.39, 95% CI: 0.17, 0.62) and lower breastfeeding self-efficacy (adj β = -2.24, 95% CI: -4.36, -0.13). Conclusions: Postpartum physical symptoms were associated with breastfeeding problems and overall poorer breastfeeding self-efficacy, but not with short-term breastfeeding duration. Future studies should explore how addressing physical symptoms among postpartum mothers might improve breastfeeding outcomes.

Exploring Greater Rates of Breastfeeding Among Civilian Military Wives

OBJECTIVE

To explore factors contributing to the greater rates of breastfeeding initiation and duration among civilian military wives (e.g., legally married to an active-duty spouse) and to determine what might be learned from these factors for intervention design for the broader population of women in the postpartum period.

DESIGN

The study was conducted online using a concurrent mixed-methods design.

SETTING

National and International U.S. military bases.

PARTICIPANTS

The sample consisted of 28 civilian military wives whose ages ranged from 18 to 45 years.

INTERVENTIONS/MEASUREMENTS

The Breastfeeding Self-Efficacy Scale-Short Form and semistructured interviews.

RESULTS

Breastfeeding self-efficacy was high among civilian military wives. Seven main themes with 16 subthemes emerged from the descriptions of the semistructured interviews. The results of the integrative analysis showed that factors within the military environment influence a sense of community and that there were supportive and pro-breastfeeding health care facilitators (especially lactation consultants).

CONCLUSION

Civilian military wives described breastfeeding facilitators who they believed promote their greater rates of breastfeeding initiation and continuation, quantified their high level of breastfeeding self-efficacy, and identified descriptive factors that contributed to both areas, topics that are lacking in the literature among this population.

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.

Improvement of the breastfeeding self-efficacy and postpartum mental health after lactation consultations - Observational study

OBJECTIVE

Maternal self-efficacy in breastfeeding may be undermined by common mental health difficulties in the postpartum, leading to an early breastfeeding cessation. The relationship may also be the opposite: problems with effective breastfeeding and breastfeeding cessation may increase the postpartum mental health difficulties. The purpose of this study was the assessment of the effectiveness of lactation consultations in strengthening the breastfeeding self-efficacy and maternal postpartum mental health.

DESIGN AND PARTICIPANTS

160 Polish women (90 consultation participants and 70 controls) completed a structured interview, the General Health Questionnaire, and the Breastfeeding Self-Efficacy Scale twice: before lactation consultation and one month later.

SETTING

Research was conducted in the city of Gdańsk, Poland.

FINDINGS

Study revealed that women seeking lactation support exhibited greater mental health difficulties while their breastfeeding self-efficacy was similar to the control group. Initial breastfeeding self-efficacy was negatively correlated with the severity of the postpartum mental health problems. One month after lactation consultations, a significant increase in the breastfeeding self-efficacy and significantly reduced symptoms of mental health difficulties (somatic symptoms, functional disorders, and anxiety and insomnia) were observed among mothers.

KEY CONCLUSIONS

Women willing to benefit from the lactation consultations may exhibit symptoms of mental health difficulties that may be associated with difficulties in breastfeeding. Strengthening the breastfeeding confidence during lactation consultations, may reflect in the improvement of the woman's mental health.

IMPLICATIONS FOR PRACTICE

Midwives and lactation consultants can make a difference in the mental health promotion by offering breastfeeding interventions which address the emotional needs of a mother.

The Effect of Labor Comfort on Traumatic Childbirth Perception, Post-Traumatic Stress Disorder, and Breastfeeding

Objective: This study aims to examine the effect of labor comfort on traumatic childbirth perception, post-traumatic stress disorder (PTSD), and breastfeeding after the fourth postpartum week. Methods: This prospective longitudinal study was conducted between June 2019 and February 2020 in Turkey (n = 102). A personal information form and the Childbirth Comfort Questionnaire were administered to pregnant women with cervical dilatation of 5-8 cm in the delivery room. They were also administered the Traumatic Childbirth Perception Scale (TCPS), PTSD Scale, and Breastfeeding Self-Efficacy Scale twice, including 4 weeks and 3 months after childbirth. Additionally, the TCPS and PTSD Scale were reapplied 6 months after childbirth. Results: The prevalence of traumatic childbirth perceptions and PTSD at 4 weeks of the postpartum period was 68.6% and 59.8%, respectively. The multiple linear regression analysis revealed a significant relationship between physical labor comfort (p = 0.003), transcendence (p = 0.023), family history of labor difficulty (p = 0.027), and feelings about birth before labor begins (p = 0.005) and traumatic childbirth perceptions 4 weeks after childbirth. Additionally, there was a significant relationship between physical labor comfort (p = 0.001), psychospiritual labor comfort (p = 0.006), transcendence (p = 0.001), primiparity (p = 0.009), place of residence (p = 0.044), and traumatic childbirth perceptions (p < 0.001) and PTSD 4 weeks after childbirth. Physical labor comfort affected traumatic childbirth perceptions 3 and 6 months after childbirth (p < 0.05). Physical labor comfort affected breastfeeding self-efficacy 4 weeks and 3 months after childbirth (p < 0.05). A significant relationship was also found between high traumatic childbirth perception levels, high PTSD prevalence, and low breastfeeding self-efficacy 3 months after giving birth (p < 0.05). Conclusions: Puerperal women had high traumatic childbirth perception levels and PTSD prevalence. Low labor comfort increased traumatic childbirth perception and PTSD prevalence. There was a significant relationship between low labor comfort, high traumatic childbirth perception level, high PTSD prevalence, and low breastfeeding self-efficacy. Therefore, midwives should support pregnant women to increase labor comfort by using alternative methods. Thus, traumatic childbirth perception may decrease and breastfeeding self-efficacy may increase.

The CRIAA Program complex intervention in primary care to support women and their families in breastfeeding: Study protocol for a pilot trial

AIM

To report a pilot study protocol to assess the feasibility of a complex intervention, in the primary healthcare context, to support women and their families in breastfeeding.

DESIGN

A pilot/feasibility trial with control and intervention groups.

METHODS

The study will be conducted in two primary healthcare centres with 40 childbearing women (20 control group; 20 intervention group), with their partner/meaningful person and their respective healthcare professionals. Intervention group participants will receive the intervention: (a) in a breastfeeding workshop during their third trimester of pregnancy; and (b) via virtual breastfeeding support for six months postpartum. Health professionals will be trained to deliver the intervention. The control group will receive standard care in the outpatient clinic. The pilot will help determine the intervention's feasibility. Data collected pre-intervention, 10-days postpartum and two-, four-, and six-months postpartum will provide estimates of the intervention's preliminary effects on self-efficacy and main outcomes. Research Ethics Committee approval was obtained in April 2019.

DISCUSSION

Breastfeeding support is a complex reality influenced by multiple factors. Therefore, approaches to breastfeeding are also, requiring interventions that address its multidimensional nature, including all actors involved. The proposed intervention will be applied by an interdisciplinary professional health team, allowing for its incorporation into standard practice and its perpetual maintenance.

IMPACT

The study will produce an original, comprehensive, complex intervention addressing contextual, and organizational factors to promote breastfeeding support using an interdisciplinary and family-based approach; breastfeeding self-efficacy is the core concept. The program evaluation and feasibility study will permit exploration of the integration of the intervention's novel aspects into the daily work of professionals and reveal how to better use existing resources in a full-scale clinical trial.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03944642.

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

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

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

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

Supporting, failing to support and undermining breastfeeding self-efficacy: Analysis of helpline calls

Although a complexity of factors explain early cessation of breastfeeding, the encounter of a problem is often a critical point in this decision. For this reason, breastfeeding self‐efficacy, a mother's evaluations of her ability to successfully overcome challenges, is an effective target in interventions to sustain breastfeeding. This study examined factors affecting the success of one such intervention, reactive telephone support. Across a 4‐week period, recordings of all calls to a nurse‐staffed parent helpline in Queensland, Australia were made. Of these calls, 60 were from mothers encountering a breastfeeding problem. Using a standard protocol, each call was scored for trajectories of mother's breastfeeding self‐efficacy from opening to close of call. Calls showing an upward trajectory were defined as supporting (53%), those with no change were defined as ineffective (25%), and those with downward trajectory as undermining (22%). Using trajectory scores, case exemplars were purposively selected for detailed analysis of interactional sequences to identify strategies that distinguished outcome. The supportive call was distinguished by information sharing, mutual trust and respectful relationships, and personalized affirmation and advice. The ineffective call focused on technical aspects of breastfeeding, whereas the undermining call made moral judgements of mother's behaviour. The findings identify interactional quality of telephone support, not simply provision, as the key success factor in reactive telephone support. The findings also present interactional quality as a potential explanation for inconsistent outcomes in evaluation of reactive telehealth interventions to support breastfeeding.

The Relationship of Emotional Intelligence and Breastfeeding Self-Efficacy in Mothers in the Early Postpartum Period

Introduction: Women have widespread breastfeeding problems in postpartum period. Emotional intelligence (EI) is thought to be important in problem-solving related to breastfeeding. Research Aims: The study was conducted to investigate the correlation between the EI and breastfeeding self-efficacy (BFSE) of women in the early postpartum period and the associated factors. Materials and Methods: A cross-sectional study was conducted in cesarean-postpartum service of a hospital in Erzurum between May 2015 and May 2016. The sample of the study consisted of 271 women. The dependent variables constituted the EI and BFSE mean scores. Descriptive statistics, independent samples t tests, one-way analysis of variance, Kruskal-Wallis test, Mann-Whitney U test, and Pearson correlation analysis were used. Results: The age, education level, perceived income status, and the status of planned pregnancy of the mothers affected their EI mean score, whereas their residence place, income status, the number of pregnancy and living children, and status of receiving prenatal care affected their BFSE levels. No significant correlation was found between the EI and BFSE mean scores in the early postpartum period (r = 0.77, p = 0.207). Conclusions: No significant correlation was determined between the EI and BFSE in the early postpartum period.

Correlation between Infantile Colic and Maternal Breastfeeding Self-Efficacy, Breastfeeding Success and Breast Milk Amount

AIM

The study was conducted to determine the correlation between infantile colic and maternal breastfeeding self-efficacy, breastfeeding success and breast milk amount.

MATERIALS AND METHODS

This descriptive study included 154 mothers, with infants of age between 3 weeks and 6 months who were diagnosed with infantile colic and who were admitted to the paediatric outpatient clinics of a hospital located in northern Turkey.

RESULT

A negative correlation was found between 'parent-infant interaction + problem infant' and 'immature gastrointestinal system' subscales of the Infantile Colic Scale (ICS) and the total mean scores of mothers on the Breastfeeding Self-Efficacy Scale. In addition, correlation analysis showed a statistically significant negative correlation between mean scores of mothers in breastfeeding success and subscale and total mean scores of ICS.

CONCLUSION

The breastfeeding self-efficacy and breastfeeding success is low in mothers of infants with infantile colic.

Facebook support for breastfeeding mothers: A comparison to offline support and associations with breastfeeding outcomes

Objectives

For breastfeeding mothers, online support groups through Facebook may be a more convenient and preferred source for accessing breastfeeding information and support, but few studies exist that examine the use of Facebook groups specifically for breastfeeding support. This study explores the sources of support among users of Facebook breastfeeding support groups and a possible mechanism by which support received on Facebook may translate to behavioral outcomes among breastfeeding mothers.

Methods

From July–September 2017 a survey was distributed online to African American mothers (N = 277) who participate in breastfeeding support groups on Facebook. The survey assessed network support from Facebook and other sources of breastfeeding support, perceived breastfeeding norms, breastfeeding self-efficacy and breastfeeding attitudes. Correlations and linear regression analysis were used to examine the relationship between covariates and outcome variables.

Results

The average intended breastfeeding duration among participants in this study was 19 months. Participants reported the highest amount of breastfeeding support received from their Facebook support group, in comparison to other sources of support, and Facebook support was significantly correlated with intended breastfeeding duration (p < 0.05). Self-efficacy and breastfeeding attitudes remained significant predictors of intended breastfeeding duration within the final regression model.

Conclusions

Breastfeeding support received within Facebook groups may compensate for inadequate support received within mothers’ networks. More research is needed to understand the mechanism through which Facebook support may contribute to prolonged breastfeeding durations.

Features and Educational Content Related to Milk Production in Breastfeeding Apps: Content Analysis Informed by Social Cognitive Theory

BACKGROUND

Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with promoting, interpreting, tracking, or learning about milk production. It is not known whether breastfeeding apps contain high-quality, engaging, and diverse content and features that could be used by mothers to increase their breastfeeding self-efficacy and answer their questions about milk production.

OBJECTIVE

The overarching objective of this study was to identify and evaluate features and content within breastfeeding apps that could be used by mothers to increase breastfeeding self-efficacy and answer their questions about milk production. The secondary objectives were to quantify the diversity of representation of breastfeeding experiences within breastfeeding apps and to define the type of organization that is most likely to create free apps and/or apps with high-quality, engaging, and diverse features and content related to milk production.

METHODS

Breastfeeding apps were identified in the Apple App Store. All features that assist mothers with tracking, promoting, or interpreting milk production in the first 0-6 months postpartum were noted. Every screen containing educational information about milk production was identified and saved for review. Images of mothers and caretakers within the selected screenshots were assessed. Three scoresheets informed by Social Cognitive Theory were created to evaluate all identified features, educational content, and images representing the breastfeeding experience.

RESULTS

Forty-one breastfeeding apps were reviewed. Only seven apps contained both features and educational content related to milk production. Thirteen apps that contained educational content related to milk production received a mean combined content and cultural diversity score of 15.3 of 78. Of the 48 photos reviewed in screenshots that contained educational content on milk production, 87.5% (n=42) were of white women and their infants. For-profit companies and large organizations were most likely to create free apps and apps that received high scores on the combined content and diversity or features scoresheet, respectively.

CONCLUSIONS

Features and educational content related to milk production and breastfeeding imagery within breastfeeding apps were evaluated using three novel scoresheets informed by Social Cognitive Theory. Few apps contained both features that promote breastfeeding self-efficacy and high-quality, engaging, educational content with images of diverse caretakers. Thus, it is likely that parents, especially those from minority or low-income groups, have limited options when selecting a breastfeeding app. App developers could use the scoresheets and findings in this review to develop breastfeeding apps that assist mothers with interpreting, tracking, or learning about milk production through high-quality and engaging features, content, and imagery.

Investigation of the relationship between social support and breastfeeding self-efficacy in primiparous breastfeeding mothers

Background: Breastfeeding is one of the public health priorities in the world. Reduction and early discontinuation of breastfeeding have many harmful effects on maternal, child, and community health. Various factors affect breastfeeding and its sustainability including breastfeeding self-efficacy (BSE) and social support. Since breastfeeding is a behavior that needs knowledge, skills, support, and self-confidence for the mother.Objective: to investigate the relationship between social support and self-efficacy in primiparous breastfeeding women referring to Mashhad health centers. This cross-sectional study was conducted on 300 primiparous breastfeeding mothers with less than 6 months infants referring to healthcare centers of Mashhad, Iran.Materials and methods: The study population was selected through a multistage random sampling method. Data gathering was done by demographic form, Breastfeeding Self-efficacy Scale and perceived social support questionnaire. Data were analyzed using descriptive and inferential statistics, through SPSS version 16 (SPSS Inc., Chicago, IL).Results: Mean score of BSE and social support was 130.89 ± 13.60 and 67.36 ± 5.52, respectively. Stepwise linear regression analysis was used to examine the relationship between social support and BSE precisely. The results showed that social support had a significant effect on BSE (p < .001, β = 0.35, t = 6.44).Conclusions: According to the present study, social support was significantly related to the BSE. Therefore, those with more social support had higher rates of BSE. Therefore, receiving support from the woman's social network members in form of participation and encouragement, during the breastfeeding is necessary.

[The Influence of Breastfeeding Self-Efficacy and Breastfeeding Intention on Breastfeeding Behavior in Postpartum Women]

BACKGROUND

World Health Organization (WHO) guidelines recommend that infants should be breastfed for six month after childbirth. The average duration of breastfeeding in Taiwan still falls short of this sixth-month timeline. In order to improve the duration of breastfeeding, it is crucial to understand the factors that affect related behavior.

PURPOSE

To explore the effects of breastfeeding self-efficacy and breastfeeding intention among exclusive-breastfeeding women during the initial six months after childbirth and to verify the reliability and validity of the infant feeding intentions scale (Chinese version).

METHODS

Purposive sampling was used to select and enroll a total of 167 breastfeeding women from a southern metropolitan medical-teaching hospital. Data were collected using a structured questionnaire and phone interviews. Data were analyzed using SPSS 18.0, LISREL8.7, and S-Plus package software to obtain scores for the independent-sample t test, Pearson's product-moment correlation coefficient, one-way analysis of variance, survival analysis, and reliability and validity.

RESULTS

Breastfeeding self-efficacy scores ranged from 14 to 70, with a mean score of 44.80 (±11.56). Infant feeding intention scores ranged from 14 to 70, with a mean score of 12.20 (±3.14). Additionally, 29.9% of the participants breastfed exclusively for the entire six months after childbirth. Breastfeeding self-efficacy and breastfeeding intention were positively correlated (r = .45, p < .001). Education level, occupation, and breastfeeding intention were each identified as factors that significantly influenced the success of exclusive breastfeeding during the initial six months after childbirth.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

Breastfeeding self-efficacy and breastfeeding intention are correlated with breastfeeding behavior. Based on findings, medical staff should target promotion and education regarding the importance of breastfeeding particularly toward women who have lower levels of education, who are employed, and who express low initial intention to breastfeed.

Effectiveness of interventions on breastfeeding self-efficacy and perceived insufficient milk supply: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to assess the efficacy on an intervention on breastfeeding self-efficacy and perceived insufficient milk supply outcomes. The literature search was conducted among 6 databases (CINAHL, Medline, PsyncInfo, Scopus, Cochrane, and ProQuest) in between January 2000 to June 2016. Two reviewers independently assessed the articles for the following inclusion criteria: experimental or quasi-experimental studies; healthy pregnant women participants intending to breastfeed or healthy breastfeeding women who gave birth to a term singleton and healthy baby; intervention administered could have been educational, support, psycho-social, or breastfeeding self-efficacy based, offered in prenatal or postnatal or both, in person, over the phone, or with the support of e-technologies; breastfeeding self-efficacy or perceived insufficient milk supply as outcomes. Seventeen studies were included in this review; 12 were randomized controlled trials. Most interventions were self-efficacy based provided on 1-to-1 format. Meta-analysis of RCTs revealed that interventions significantly improved breastfeeding self-efficacy during the first 4 to 6 weeks (SMD = 0.40, 95% CI 0.11-0.69, p = 0.006). This further impact exclusive breastfeeding duration. Only 1 study reported data on perceived insufficient milk supply. Women who have made the choice to breastfeed should be offered breastfeeding self-efficacy-based interventions during the perinatal period. Although significant effect of the interventions in improving maternal breastfeeding self-efficacy was revealed by this review, there is still a paucity of evidence on the mode, format, and intensity of interventions. Research on the modalities of breastfeeding self-efficacy should be pursued.

Why Chinese mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first six months

The reasons why mothers in mainland China stop breastfeeding before their infants were six months old was investigated. Five hundred sixty-two mothers within two to three days after delivery in a hospital in Guangzhou, China, were followed up via telephone interview at one, four, and six months postpartum between January and August 2015 to assess their infant's feeding patterns and mother's reasons for breastfeeding cessation. Measures included the questionnaire about sociodemographic, psychosocial, and perinatal characteristics, the Breastfeeding Outcome Questionnaire and the Breastfeeding Self-efficacy Scale-Short Form. Compared with mothers who continued breastfeeding for at least six months, the mothers who stopped breastfeeding were less likely to have attended the perinatal classes, used more inhospital formula, and were less self-efficacious regarding breastfeeding and less intention to exclusive breastfeeding. The reasons that 180 mothers stopped breastfeeding before their infants were six months old were analyzed with content analysis. The reasons given for breastfeeding cessation were insufficient milk supply, medical reasons, lactational factors, and return to work. Lactational factors were nipple soreness and mastitis. In order to prolong breastfeeding, pregnant women should be encouraged to attend more prenatal classes. Attendance would enhance self-efficacy and intention to breastfeed longer. Strategies helping working mothers to continue breastfeeding are also needed.

Perception of Not Having Enough Milk and Actual Milk Production of First-Time Breastfeeding Mothers: Is There a Difference?

OBJECTIVE

This study aimed to determine the relationship between perceived insufficient milk supply (PIMS) and actual insufficient milk supply (AIMS) and the relative contributions of physiological and psychosocial variables on both PIMS and AIMS of first-time breastfeeding mothers.

PARTICIPANTS AND METHODS

Data were collected among 123 breastfeeding mothers at a Canadian, French-speaking maternal care hospital. Birth events, breastfeeding practices, infant and maternal capacities, and PIMS and AIMS were collected at 48 hours after birth, postnatal weeks 2 and 6.

RESULTS

No significant relationship was found between PIMS and AIMS. Maternal breastfeeding self-efficacy and number of feeds were related to PIMS at week 2, and skin-to-skin contact at birth and number of feeds were related to AIMS as measured by 24-hour milk production at week 2.

CONCLUSION

Maternal breastfeeding self-efficacy impacts PIMS. Interventions should be directed to increase maternal confidence in breastfeeding, which in turn influences breastfeeding duration.

The Effect of a Perinatal Breastfeeding Support Program on Breastfeeding Outcomes in Primiparous Mothers

The purpose of this study was to examine the effect of a self-efficacy intervention on primiparous mothers' breastfeeding behaviors. Participants were recruited from an antenatal clinic at a university-affiliated hospital. Seventy-five primiparous mothers were recruited from November 2013 to February 2014 for the control group, and 75 primiparous mothers were recruited from March to June 2014 for the intervention group. The intervention group participated in a 1-hr prenatal breastfeeding workshop and a 1-hr breastfeeding counseling session within 24 hr after delivery. The Breastfeeding Self-Efficacy Scale-Short Form and the infant feeding method were assessed at hospital discharge, as well as 4 and 8 weeks postpartum. The breastfeeding support program was found to be effective and beneficial to mothers. Nurses should incorporate breastfeeding self-efficacy interventions into their routine care to support new mothers and to increase their breastfeeding self-efficacy and the duration of their breastfeeding exclusivity.

Factors influencing exclusive breastfeeding at 4 months postpartum in a sample of urban Hispanic mothers in Kentucky

BACKGROUND

Although Hispanic mothers in the United States have slightly higher rates of breastfeeding initiation than the national average, they are more likely to supplement with formula.

OBJECTIVES

To describe infant feeding decisions in a sample of 72 urban Hispanic mothers and assess whether demographic and personal factors influence exclusive breastfeeding (EBF) status at 4 months postpartum.

METHODS

The study was longitudinal and included assessments during pregnancy, in the hospital following childbirth, and monthly up to 4 months following birth.

RESULTS

Nearly all of the 72 mothers were breastfeeding at discharge after the birth of their infant (94%); half of these were EBF. By 2 months postpartum, the rate of EBF had declined to 26%, dropping to 22% by 4 months. Significant predictors of EBF status at 4 months included the baseline indicator for mother's partner as the most important person in life (adjusted odds ratio [AOR], 5.42; 95% confidence interval [CI], 1.03-28.66) and breastfeeding self-efficacy score at 1 month (AOR, 1.20; 95% CI, 1.07-1.34).

CONCLUSION

These findings have particular relevance in this population, given the high rate of breastfeeding initiation coupled with breastfeeding self-efficacy being a modifiable factor. Support during pregnancy and postpartum, including consultation with a lactation consultant, may increase the self-efficacy of EBF in this low-income population, leading to higher rates of extended EBF among Hispanics.

The effects of a breastfeeding self-efficacy intervention on short-term breastfeeding outcomes among primiparous mothers in Wuhan, China

AIMS

To evaluate the effects of a breastfeeding intervention on primiparous mothers' breastfeeding self-efficacy, breastfeeding duration and exclusivity at 4 and 8 weeks postpartum.

BACKGROUND

Few studies have examined the effects of breastfeeding self-efficacy on improved breastfeeding outcomes among primiparous mothers in China.

DESIGN

An experimental pre-test and posttest, two-group design was used in the study.

METHODS

A total of 74 participants were recruited to the study from a tertiary hospital in central China, from June-October 2012. An individualized, standardized nursing intervention based on the Self-Efficacy Theory was delivered to enhance mothers' breastfeeding self-efficacy, breastfeeding duration and exclusivity at 4 and 8 weeks postpartum. Participants were randomly assigned to an intervention or referent group. Participants in the intervention group received three individualized, self-efficacy-enhancing sessions. Participants in the referent group received standard care.

RESULTS

Participants in the intervention group showed significantly greater increases in breastfeeding self-efficacy, exclusivity and duration than participants in the control group at 4 and 8 weeks postpartum (except for duration at 4 weeks). High baseline breastfeeding self-efficacy predicted higher breastfeeding self-efficacy later and more exclusive breast-feeding.

CONCLUSION

The findings in this study suggest that intervention aimed at increasing self-efficacy has a significant impact on maternal breastfeeding self-efficacy and short-term breastfeeding outcomes.