Abstract
BackgroundThe rate of exclusive breastfeeding at 3 months postpartum is only 50% in Japan. In order to increase this rate, we aimed to examine modifiable factors related to exclusive breastfeeding at 3 months postpartum by focusing on breastfeeding-related and psychosocial variables at 1 month postpartum.MethodsThis prospective cohort study was conducted at a secondary medical care center in Osaka, Japan from February 2017 to October 2018. Demographic variables, infant feeding modality, breastfeeding-related variables, and psychosocial variables were obtained using questionnaires at 1 month postpartum. Daytime salivary cortisol levels before and after breastfeeding at 1 month postpartum were measured as a biological marker for stress responses associated with breastfeeding. Each infant’s feeding modality was re-assessed at 3 months postpartum. Multiple logistic regression analyses were performed to examine factors affecting exclusive breastfeeding at 3 months postpartum.ResultsOf the 104 participants, 61 reported exclusive breastfeeding at 3 months postpartum. The following factors were significantly associated with exclusive breastfeeding at 3 months postpartum: multiparity (adjusted odds ratio, 95% confidence interval: 11.13, 2.08–59.59), having a university degree (5.25, 1.04–26.53), no plan to return to work by 6 months postpartum (0.02, 0.00–0.46), and exclusive breastfeeding (42.84, 6.05–303.52), lower cortisol level after breastfeeding (0.00, 0.00–0.02), and higher breastfeeding self-efficacy scale score (1.07, 1.00–1.14) at 1 month postpartum. In parity-specific analyses, exclusive breastfeeding (25.33, 4.75–134.98) and lower cortisol level after breastfeeding (0.00, 0.00–0.21) at 1 month postpartum in primiparous women, and lower cortisol level after breastfeeding (0.00, 0.00–0.94), higher breastfeeding self-efficacy score (1.18, 1.05–1.32), and absence of breast complications (0.09, 0.01–0.82) at 1 month postpartum in multiparous women were associated with exclusive breastfeeding at 3 months postpartum.ConclusionsStress levels after breastfeeding, breastfeeding self-efficacy, and the presence of breast complications could be modifiable factors associated with subsequent exclusive breastfeeding. Further research is needed to examine whether approaches to reducing breastfeeding-related stress, improving breastfeeding self-efficacy, and preventing breast complications during lactation are effective to increase exclusive breastfeeding practices.
Highlights
The rate of exclusive breastfeeding at 3 months postpartum is only 50% in Japan
Stress levels after breastfeeding, breastfeeding self-efficacy, and the presence of breast complications could be modifiable factors associated with subsequent exclusive breastfeeding
Multiple logistic regression analysis revealed the following factors as having significantly affected exclusive breastfeeding at 3 months postpartum: multiparity, having a university degree, no plan to return to work by 6 months postpartum, exclusive breastfeeding at 1 month postpartum, higher Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) score at 1 month postpartum, and lower cortisol level after breastfeeding at 1 month postpartum in all the participants; exclusive breastfeeding and lower cortisol level after breastfeeding at 1 month postpartum in the primiparas; and lower cortisol level after breastfeeding, higher BSES-SF score, and absence of breast complications at 1 month postpartum in the multiparas (Table 3)
Summary
The rate of exclusive breastfeeding at 3 months postpartum is only 50% in Japan. Mothers who did not experience breast complications such as nipple pain, reported practicing exclusive breastfeeding more than those with breast complications [7]. Such physiological barriers might increase stress levels and cause women to discontinue breastfeeding sooner [8, 9]. Psychosocial factors, including breastfeeding-related self-efficacy, stress levels, and family support, might predict exclusive breastfeeding practice. Kaneko et al [13] reported that husband support, such as advice on childrearing, is associated with exclusive breastfeeding The effects of these physiological and psychosocial factors on subsequent exclusive breastfeeding practice have not been longitudinally examined
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