Abstract
ObjectivesThe aim of this study was to examine the relationships among maternal and infant characteristics, breastfeeding techniques, and exclusive breastfeeding initiation in different modes of birth using structural equation modeling approaches.MethodsWe examined a hypothetical model based on integrating concepts of a breastfeeding decision-making model, a breastfeeding initiation model, and a social cognitive theory among 952 mother-infant dyads. The LATCH breastfeeding assessment tool was used to evaluate breastfeeding techniques and two infant feeding categories were used (exclusive and non-exclusive breastfeeding).ResultsStructural equation models (SEM) showed that multiparity was significantly positively associated with breastfeeding techniques and the jaundice of an infant was significantly negatively related to exclusive breastfeeding initiation. A multigroup analysis in the SEM showed no difference between the caesarean section and vaginal delivery groups estimates of breastfeeding techniques on exclusive breastfeeding initiation. Breastfeeding techniques were significantly positively associated with exclusive breastfeeding initiation in the entire sample and in the vaginal deliveries group. However, breastfeeding techniques were not significantly associated with exclusive breastfeeding initiation in the cesarean section group. Maternal age, maternal race, gestations, birth weight of infant, and postnatal complications had no significant impacts on breastfeeding techniques or exclusive breastfeeding initiation in our study. Overall, the models fitted the data satisfactorily (GFI = 0.979–0.987; AGFI = 0.951–0.962; IFI = 0.958–0.962; CFI = 0.955–0.960, and RMSEA = 0.029–0.034).ConclusionsMultiparity and jaundice of an infant were found to affect breastfeeding technique and exclusive breastfeeding initiation respectively. Breastfeeding technique was related to exclusive breastfeeding initiation according to the mode of birth. This relationship implies the importance of early effective interventions among first-time mothers with jaundice infants in improving breastfeeding techniques and promoting exclusive breastfeeding initiation.
Highlights
Breastfeeding is nationally promoted as the ideal method of infant nutrition due to its numerous benefits to mothers, children, and communities [1,2]
Structural equation models (SEM) showed that multiparity was significantly positively associated with breastfeeding techniques and the jaundice of an infant was significantly negatively related to exclusive breastfeeding initiation
A multigroup analysis in the SEM showed no difference between the caesarean section and vaginal delivery groups estimates of breastfeeding techniques on exclusive breastfeeding initiation
Summary
Breastfeeding is nationally promoted as the ideal method of infant nutrition due to its numerous benefits to mothers, children, and communities [1,2]. Long-term breastfeeding depends on exclusive breastfeeding initiation in early postpartum [4]. In particular cesarean section, are widely believed to affect early breastfeeding adversely [7]. Cesarean section is a commonly performed surgical procedure which the World Health Organization (WHO) proposed should not exceed 15% of all births [8]. It accounts for 15% of all deliveries globally [9,10] and it is even more widespread in Asia, where the cesarean section rate is 27.3% [11]. Its incidence has increased rapidly worldwide over the last two decades [12] and it is no exception in Singapore, where it saw a significant increase in cesarean section rate from 19.9% in 2000 to 29.6% in 2010 [13]
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