Breastfeeding Confidence Research Articles

Supporting women to achieve breastfeeding to six months postpartum - The theoretical foundations of a successful program.

Although the benefits of breastfeeding to six months are well-established, only about half of Australian women succeed. The factors associated with successful breastfeeding are rarely translated into effective interventions. A new educational and support program, called the Milky Way program has been demonstrated to be effective in supporting women to achieve prolonged breastfeeding. In the Milky Way program, breastfeeding is considered an embodied performance which requires an engaged combination of body, mind and spirit. This paper aims to explain how the two theories that informed the program were used to better enable women's long term breastfeeding success. The theory of self-efficacy is first described as a way to develop women's cognitive processes to organise and execute the course of actions to breastfeed for a longer period of time. Birth territory theory is then presented. This theory discusses women as embodied selves; an essential concept for breastfeeding success. Birth territory theory also describes the effects of the holistic environment on the woman and explores the effects of power that is used in the environment. This power can be used integratively to strengthen the woman's breastfeeding confidence and success or, disintergratively which reduces her confidence and undermines her success. Strategies based on self-efficacy theory are helpful, but are not sufficient to promote breastfeeding to six months. Health educators also need to foster the woman's connection to, and trust in, her body and her baby's body to breastfeed spontaneously. Being aware of environmental impacts on how the woman and baby breastfeed; and using one's own power integratively is crucial to women being able to achieve prolonged breastfeeding.

Increasing Initiation and Exclusivity of Breastfeeding in the Hospitalized, Postpartum Dyad

<h2>Poster Presentation</h2><h3>Objective</h3> To increase initiation and exclusivity of breastfeeding in the hospitalized, postpartum dyad via an educational module for staff registered nurses (RNs). This module consisted of interventions to increase bedside lactation support and build maternal confidence in breastfeeding success, defined as <i>breastfeeding self‐efficacy</i>. The specific program objectives with measurable outcomes were set based on the Joint Commission Perinatal Core Measures and Healthy People 2020. <h3>Design</h3> The increasing breastfeeding rates program was designed as an evidence‐based practice change of increased bedside registered nurse (RN) lactation support. It was based upon education and involvement of the institution's current Lactation Operations Group (LOG) aligned with education of the bedside RN. It was designed as a quality improvement project with RN education as the intervention. <h3>Sample</h3> The target population included hospitalized women in the immediate postpartum period in a coastal mid‐Atlantic inner city hospital who desired to breastfeed. A convenience sample of one month's breastfeeding rates was compared retrospectively (preintervention) with one month's rates postintervention. <h3>Methods</h3> With the breastfeeding rates identified as the problem, the evidence‐based practice change began with the assessment of a need for change in the current breastfeeding support and an increase in education for bedside RNs. <h3>Implementation Strategies</h3> A mandatory 2 1/2 hour educational intervention for all labor and delivery, postpartum and newborn nursery nurses (<i>N</i> = 70) was presented on bedside lactation support aligned with maternal breastfeeding self‐efficacy. The intervention included skin‐to‐skin techniques, rooming in discussions, and scripting for no supplementation. The concept of self‐efficacy was addressed, specifically increasing maternal confidence in successful breastfeeding. <h3>Results</h3> The outcome measures demonstrated an increase in scores for breastfeeding. The initiation of breastfeeding within the first hour of life score increased from 55.4 % to 62.3%, whereas the exclusivity of breast milk feeding while in the hospital increased from 63.1% to 70.78%. <h3>Conclusion/Implications for Nursing Practice</h3> The advantages of breastfeeding for mother and infant are substantial and include protecting infants from allergens to reducing rates of maternal breast and ovarian cancer. These evidence‐based practices for lactation support have the potential to improve health outcomes not only for the hospitalized maternal/infant dyad, but also for society.

Why do mothers of young infants choose to formula feed in China? Perceptions of mothers and hospital staff.

In China the exclusive breastfeeding rate remains low and infant formula is widely used. This study aimed to elicit and compare mothers’ and hospital staff perceptions of the reasons that shaped mothers’ decision to formula feed. In-depth interviews with 50 mothers, and four focus group discussions with 33 hospital staff, were conducted in Hangzhou and Shenzhen in November 2014. Responses given by the mothers and hospital staff showed a number of commonalities. The perception of “insufficient breast milk” was cited by the majority of women (n = 37, 74%) as the reason for formula feeding. Mothers’ confidence in breastfeeding appears to be further reduced by maternal mothers or mothers-in-law’s and “confinement ladies” misconceptions about infant feeding. Inadequate breastfeeding facilities and limited flexibility at their workplace was another common reason given for switching to formula feeding. A substantial proportion of mothers (n = 27, 54%) lacked an understanding of the health benefits of breastfeeding. Antenatal education on breastfeeding benefits for expectant mothers and their families is recommended. Moreover, mothers should be provided with breastfeeding support while in hospital and be encouraged to seek professional assistance to deal with breastfeeding problems after discharge. Employers should also make work environments more breastfeeding-friendly.

The development of a new breast feeding assessment tool and the relationship with breast feeding self-efficacy

Objectiveto develop a breast feeding assessment tool to facilitate improved targeting of optimum positioning and attachment advice and to describe the changes seen following the release of a tongue-tie. Designdevelopment and validation of the Bristol Breastfeeding Assessment Tool (BBAT) and correlation with breast feeding self-efficacy. Settingmaternity hospital in South West England. Participants218 breast feeds (160 mother–infant dyads); seven midwife assessors. Findingsthe tool has more explanation than other tools to remind those supporting breast-feeding women about the components of an efficient breast feed. There was good internal reliability for the final 4-item BBAT (Cronbach׳s alpha=0.668) and the midwives who used it showed a high correlation in the consistency of its use (ICC=0.782).Midwives were able to score a breast feed consistently using the BBAT and felt that it helped them with advice to mothers about improving positioning and attachment to make breast feeding less painful, particularly with a tongue-tied infant. The tool showed strong correlation with breast feeding self-efficacy, indicating that more efficient breast feeding technique is associated with increased confidence in breast feeding an infant. Conclusionsthe BBAT is a concise breast feeding assessment tool facilitating accurate, rapid breast feeding appraisal, and targeting breast feeding advice to mothers acquiring early breast feeding skills or for those experiencing problems with an older infant. Accurate assessment is essential to ensure enhanced breast feeding efficiency and increased maternal self-confidence. Implications for practicethe BBAT could be used both clinically and in research to target advice to improve breast feeding efficacy. Further research is needed to establish its wider usefulness.

Application of the Breastfeeding Personal Efficacy Beliefs Inventory and Acknowledgment of Barriers for Improving Breastfeeding Initiation Rates in an Urban Population

Introduction: Breastfeeding (BF) is recognized as the preferred method of infant nutrition by American Academy of Pediatricians, American College of Obstetricians and Gynecologists, and the World Health Organization. Despite the benefits of BF, in 1998 only 69% of new mothers in the United States initiated BF and 29% continued to breastfeed at 6 months. Objective: To assess perceived breastfeeding confidence (BFC) and determine barriers in regards to BF in an urban population. Methods: The Breastfeeding Personal Efficacy Beliefs Inventory (BPEBI) was used to determine perceived BFC. The survey was distributed to 271 women during prenatal appointments at an urban Milwaukee medical center. BF initiation rate at discharge was determined by records review. A principal component factor analysis with varimax rotation was used to examine the structure of the BPEBI in this population. Results: Survey response rate was 89%. Overall BFC was 74%. BF initiation rate at discharge was 62%, exclusively BF (EBF) at discharge (no bottle-feeding) was 55%. In multivariate models, EBF decreased with black race (p=0.02) and with residence in the low socioeconomic status zip codes of the central city of Milwaukee (p=0.01). BFC increased with prior exposure to BF (p=0.03), EBF (p=0.03) and length of BF (p=0.02). Factor analysis identified two constructs: BFC increased with prior exposure to BF (p=0.006) and EBF (p=0.001) within the motivation construct, and BFC increased with EBF (p=0.000) within the technique/environment construct. Conclusions: The main barriers to increased BFC were lack of prior exposure to BF and nonexclusive breastfeeding practices. BF initiation rate at discharge was low compared to self-reported level of confidence. EBF decreased with black race and with closer proximity to the central city of Milwaukee.

The Swedish Version of the Breastfeeding Self-Efficacy Scale–Short Form

Among Swedish mothers, breastfeeding duration has been declining in recent years. An instrument for early identification of women at risk for shorter breastfeeding duration may be useful in reversing this trend. The aims of this study were to translate and psychometrically test the Swedish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), examine the relationship between breastfeeding self-efficacy and demographic variables, and evaluate associations with breastfeeding continuation plans in Swedish mothers. The BSES-SF was translated into Swedish using forward and back translation. The sample consisted of 120 mothers who, during the first week postpartum, came for a routine follow-up visit at the postnatal unit in a university hospital. The mothers were compared based on demographic data and their future breastfeeding plans. The Cronbach's alpha coefficient for internal consistency for the BSES-SF was 0.91 and the majority of correlation coefficients exceeded 0.3. A 1-factor solution was found that explained 46% of the total variance. There was no difference in confidence in breastfeeding between mothers with early hospital discharge and mothers who received postnatal care at the hospital. Primiparas who stayed longer at the hospital were less confident in breastfeeding than primiparas who had a shorter hospital stay. Breastfeeding mothers who planned to partially breastfeed in the near future had lower BSES-SF scores, compared to those who planned to continue exclusive breastfeeding. The Swedish version of the BSES-SF has good reliability, validity, and agreement with mothers' plans regarding breastfeeding continuation and exclusivity.

A mixed methods evaluation of peer support in Bristol, UK: mothers’, midwives’ and peer supporters’ views and the effects on breastfeeding

BackgroundInternational studies suggest that breastfeeding interventions in primary care are more effective than usual care in increasing short and long term breastfeeding rates. Interventions that combine pre- and postnatal components have larger effects than either alone, and those that including lay support in a multicomponent intervention may be more beneficial. Despite the mixed reports of the effectiveness of breastfeeding peer support in the UK, targeted peer support services are being established in many areas of the UK. In 2010, NHS Bristol Primary Care Trust commissioned a targeted breastfeeding peer support service for mothers in 12 lower socio-economic areas of the city, with one antenatal visit and postnatal contact for up to 2 weeks.MethodsMothers receiving the peer support service were invited to complete an on-line survey covering infant feeding; breastfeeding support; and confidence in breastfeeding (using the Breastfeeding Self-Efficacy Scale). Semi-structured interviews and a focus group explored perceptions of mothers, midwives and peer supporters. The effects of the service on breastfeeding rates were documented and compared.Results163 mothers completed the on-line survey; 25 participants were interviewed (14 mothers, 7 peer supporters and 4 maternity health professionals); exclusive and total breastfeeding rates for initiation and at 8 weeks were compared for 12 months before and after the service started.The targeted peer support service was associated with small non-significant increases in breastfeeding rates, (particularly exclusive breastfeeding), compared to the rest of the city. The service was very positively evaluated by mothers, health professionals and peer supporters. Mothers felt that peer support increased their confidence to breastfeed; peer supporters found the contacts rewarding, enjoyable and important for mothers; midwives and maternity support workers were positive about the continuity of an antenatal visit and postnatal support from the same local supporter.ConclusionsThe introduction of a targeted peer support service was associated with psycho-social benefits for mothers, health professionals and peer supporters. Continuity of peer support with an antenatal visit and postnatal support from the same local supporter was also thought to be beneficial.

Alternative hospital gift bags and breastfeeding exclusivity.

The type of gift bags given to new mothers at the time of discharge from the hospital can influence their confidence in breastfeeding. Most hospitals in the US continue to distribute commercial gift bags containing formula samples despite the reported negative influence of commercial bags on the duration of breastfeeding. This study compared breastfeeding outcomes in women receiving three different kinds of gift bags at discharge. A prospective intervention study was conducted during 2009-2010 in New Jersey. Three breastfeeding cohorts were recruited and assigned to three groups: COMMERCIAL received discharge bags containing formula samples, BF-INFO received breastfeeding information and supplies, and PUMP received breastfeeding information/supplies plus a manual breast pump. Follow-up contacts were at 2, 4, and 12 postpartum weeks to determine breastfeeding outcome. The mean durations of exclusive (EBF) and partial breastfeeding were compared between groups using ANOVA. A total of 386 participants completed the study. The mean EBF duration (weeks) in the PUMP (n = 138, 8.28 ± 4.86) and BF-INFO (n = 121, 7.87 ± 4.63) were significantly longer (P < 0.01) than COMMERCIAL (n = 127, 6.12 ± 4.49). The rate of EBF through 12 weeks in PUMP was most consistent. The mean duration of partial breastfeeding showed similar results: significantly longer in PUMP and BF-INFO than COMMERCIAL (P < 0.01).

Maternal perceptions of partner support during breastfeeding

BackgroundMany women find breastfeeding challenging to sustain beyond the first three postpartum months. Women rely on a variety of resources to aid and encourage breastfeeding, including ‘partner support’. Women’s perception of partner support during breastfeeding may influence maternal satisfaction and confidence but it remains understudied. We asked women about their perceptions of partner support during breastfeeding and measured the effect on maternal confidence, commitment, and satisfaction with respect to breastfeeding.MethodsUsing a descriptive, cross sectional design, we recruited 76 mothers from community health clinics in Calgary, Alberta. Participants completed a questionnaire addressing perceptions of partner support, the Breastfeeding Self-Efficacy Scale (BSES) measuring maternal confidence and ability to breastfeed, and the Hill and Humenick Lactation Scale (HHLS) measuring commitment, perceived infant satiety, and breastfeeding satisfaction. Descriptive analysis was performed on socio-demographic and survey responses. Multiple regression modeling was used to examine the association between partner support and breastfeeding outcomes.ResultsWomen who reported active/positive support from their partners scored higher on the BSES (p < 0.019) than those reporting ambivalent/negative partner support when we controlled for previous breastfeeding experience and age of infant. There were no significant differences between the two groups of women on total score of HHLS or any of the subscales with respect to perceptions of partner support.ConclusionMothers feel more capable and confident about breastfeeding when they perceive their partners are supportive by way of verbal encouragement and active involvement in breastfeeding activities. Mothers with partners who seemed ambivalent, motivated only by “what’s best for baby,” or provided negative feedback about breastfeeding, felt less confident in their ability to breastfeed. It is important that health care professionals appreciate the influence that positive and active partner support has upon the development of maternal confidence in breastfeeding, a known predictor for maintaining breastfeeding. Common support strategies could be communicated to both the partner and mother in the prenatal and postpartum periods. Health professionals can provide information, invite partners to become active learners and discuss supportive partner functions. Further research should address those functions that are perceived as most supportive by mothers and that partners are willing to perform.

Labor Epidural Anesthesia, Obstetric Factors and Breastfeeding Cessation

Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia's association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. A pooled analysis using Kaplan-Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within 1 month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95% confidence interval 1.10, 1.44], p < 0.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01, 1.41], p < 0.04; non-BFH: 1.65 [1.31, 2.08], p < 0.01). A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies.

Clinical Application of Measurement of Breastmilk

We aimed to assess whether measurement of 24‐h milk production (MP) affects breastfeeding (BF) confidence, which may in turn affect BF exclusivity and duration.Mothers (n=105) reported their BF confidence and perception of milk supply before and after measuring MP by test‐weighing (BabyWeigh scales, Medela AG) and being advised of the normal range of MP (478–1298g). A second measurement of MP was done 3.7 ± 2.9 weeks later in a self‐selected sub‐group (n=19, MP 237–863g) after advice from a lactation consultant.Of 76 mothers initially confident in their BF, only 4 lost confidence, and these 4 had MP&lt;700g. Of 29 mothers initially not confident in their BF, 18 gained confidence. Of the 11 still not confident, 6 had MP&lt;700g. BF confidence was not related to actual MP either before (P=0.787) or after (P=0.236) measurement of MP.Mothers who initially perceived that their milk supply was normal gained confidence in their BF after measurement (P=0.009). Mothers who perceived that their milk supply was low had no change in BF confidence before and after measurement (P=0.658).Mothers who repeated measurement of MP showed an increase of 154±128g (P=0.013). The majority (n=11) remained confident throughout, and 7 gained confidence.We conclude that BF confidence is improved by measuring MP when MP is &gt;700g. Moreover, measurement can quantitate improvement in MP.Research support was an unrestriced grant from Medela AG.

Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly

ObjectiveBreast pumping or hand expression may be recommended when newborns latch or suck poorly. A recent trial found worse outcomes among mothers who used a breast pump in the early...

Confidence in Breastfeeding Among Pregnant Women

Little is known about prenatal breastfeeding confidence, although such knowledge is necessary for developing the content of counseling and tailoring it for individuals. The purpose of this study was to describe women's prenatal breastfeeding confidence and how their sociodemographic characteristics, breastfeeding knowledge, and attitudes relate to it. The electronic confidence scale was used in data collection, and 123 Finnish women filled in the questionnaire. The mean confidence score was 83.88 when the maximum possible score was 120. Confidence scores varied when parity, breastfeeding knowledge, and attitudes were involved. Variables regarding breastfeeding as difficult, regarding breastfeeding as exhausting, and parity explained 38.1% of the variation of the breastfeeding confidence scores. Pregnant women need information about managing potential breastfeeding problems and the physiology of breastfeeding. Interventions designed to promote breastfeeding confidence need to be focused on primiparas and women with a lack of breastfeeding knowledge.

The Effect of Structured Group Prenatal Education on Breastfeeding Confidence, Duration, and Exclusivity to 12 Weeks Postpartum

The Effect of Structured Group Prenatal Education on Breastfeeding Confidence, Duration, and Exclusivity to 12 Weeks Postpartum

Evaluation of the acceptability of a new oral vitamin K prophylaxis for breastfed infants

The aim of this study was to investigate the acceptability and tolerability of the oral food supplement Neokay for the prevention of vitamin K deficiency bleeding in newborns. A questionnaire survey was conducted among 45 midwives in which they were asked 10 questions about their use of Neokay, its advantages and disadvantages, and their perceptions of parental attitudes towards this new prophylactic treatment. During a 6-month period one dose of Neokay was given to 1794 healthy newborns at birth and further daily doses were given to 812 breastfed infants for 3 months. The midwives listed as main advantages ease of administration, no need for prescription or written consent, and transfer of responsibility to parents. As disadvantages, they mentioned possible reduced compliance as a result of the frequency of dosing, decreased parental confidence in breastfeeding and technical issues with packaging. A prophylactic vitamin K dosage regimen of 1 mg oral vitamin K (Konakion MM Paediatric or Orakay) given to all healthy neonates at birth, combined with daily doses of 50 microg Neokay for 3 months for breastfed babies is well tolerated and acceptable to midwives and parents.

Development and evaluation of a self care program on breastfeeding in Japan: A quasi-experimental study

BackgroundAlthough the importance of breastfeeding is well known in Japan, in recent years less than 50% of mothers were fully breastfeeding at one month after birth. The purpose of this study was to develop a self-care program for breastfeeding aimed at increasing mothers' breastfeeding confidence and to evaluate its effectiveness.MethodsA quasi-experimental pretest-posttest design was conducted in Japan. The intervention, a breastfeeding self-care program, was created to improve mothers' self-efficacy for breastfeeding. This Breastfeeding Self-Care Program included: information on the advantages and basics of breastfeeding, a breastfeeding checklist to evaluate breastfeeding by mothers and midwives, and a pamphlet and audiovisual materials on breastfeeding. Mothers received this program during their postpartum hospital stay.A convenience sample of 117 primiparous women was recruited at two clinical sites from October 2007 to March 2008. The intervention group (n = 55), who gave birth in three odd-numbered months, received standard care and the Breastfeeding Self-Care Program while the control group (n = 62) gave birth in three even numbered months and received standard breastfeeding care.To evaluate the effectiveness of the Breastfeeding Self-Care Program, breastfeeding self-efficacy and breastfeeding rate were measured early postpartum, before the intervention, and after the intervention at one month postpartum. The study used the Japanese version of The Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) to measure self-efficacy.ResultsThe BSES-SF score of the intervention group rose significantly from 34.8 at early postpartum to 49.9 at one month after birth (p < 0.01). For the control group, the score rose from 39.5 at early postpartum to 46.5 at one month after birth (p = 0.03). The early postpartum fully breastfeeding rate was 90% for the intervention group and 89% for the control group. At one month postpartum, the fully breastfeeding rate declined significantly to 65% for the control group compared to 90% for the intervention group (p = 0.02).ConclusionResults indicate that the Breastfeeding Self-Care Program increased mothers' self-efficacy for breastfeeding and had a positive effect on the continuation of breastfeeding.Trial Registration NumberUMIN000003517

Shattered expectations: when mothers’ confidence in breastfeeding is undermined – a metasynthesis

Why do mothers give up breastfeeding, even though breastfeeding has great importance to them? This study examines what has affected mother's confidence in breastfeeding when she gives up breastfeeding. A metasynthesis of seven studies on mothers' experiences with breastfeeding was conducted using Noblit and Hare's methodological approach. The metasynthesis shows that confidence in breastfeeding is shaped by shattered expectations and is affected on an immediate level by mothers' expectations, the network and the breastfeeding experts and on a discourse level by the discourses: breastfeeding as nature, the female body as a machine and the note of caution. Foucault's concept of discourse is used to discuss how these discourses affect mothers' confidence in breastfeeding by giving the right to speak about breastfeeding to the breastfeeding experts, by isolating the mothers who do not breastfeed and by organizing knowledge about breastfeeding in a certain way. The individual mother is responsible for the success of breastfeeding and the discourses are hiding that general perceptions of breastfeeding undermines the mothers' confidence in breastfeeding and leads to shattered expectations.

The Breast-feeding Conversation

Nurses play a vital role in mothers' early experiences with breast-feeding. Literature enumerates both supportive and nonsupportive behaviors, as well as the "interpersonal" aspect of breast-feeding support, although little direction is given to nurses about how to facilitate the relationship. This article conceptualizes breast-feeding support within Gadamerian hermeneutics as a conversation among nurses, mothers, and their newborns. Hermeneutically, breast-feeding conversation encompasses a text (a particular feeding at the breast), conversational partners (a mother, her newborn, and a nurse), and a dialogue that facilitates effective breast-feeding and maternal breast-feeding confidence through interpretation or understanding of the text. History and language are essential as a partnership is formed.

Understanding Maternal Breastfeeding Confidence: A Gadamerian Hermeneutic Analysis of Women's Stories

Our aim in this Gadamerian hermeneutic study was to understand maternal breastfeeding confidence and its meaning through listening to women's voices describing their experiences within the context of the United States. We asked 13 women, aged 23 to 42 years, who had breastfed a child within the last 2 years to tell us their breastfeeding stories. Women experienced maternal breastfeeding confidence as a dynamic interaction between their expectations, their infant’s breastfeeding behavior, and sources of support. They described experiences that enhanced or diminished their confidence. Health professionals can use these findings to plan approaches that promote and support maternal breastfeeding confidence.

The Relationship Between Breastfeeding Self-Efficacy and Perceived Insufficient Milk Among Japanese Mothers

To examine the relationship between maternal perceptions of insufficient milk and breastfeeding confidence using the Breastfeeding Self-Efficacy Scale. Cross-sectional study. Two hundred and sixty-two in-hospital breastfeeding mothers in Japan. Breastfeeding self-efficacy was measured in-hospital and perception of insufficient milk was measured at 4 weeks postpartum. Although most mothers intended to exclusively breastfeed, less than 40% were doing so at 4 weeks postpartum. Among the mothers using formula, 73% cited perceived insufficient milk as the primary reason for supplementation or completely discontinuing breastfeeding. Mothers' perception of insufficient milk at 4 weeks postpartum were significantly related to breastfeeding self-efficacy in hospital in the immediate postpartum period (r=.45, p<.001). Hierarchical multiple regression revealed that breastfeeding self-efficacy explained 21% of the variance in maternal perceptions of insufficient milk, and the contribution was independent of sociodemographic variables. Enhancing breastfeeding self-efficacy in the immediate postpartum period may reduce maternal perceptions of insufficient milk and the premature discontinuation or supplementation of breastfeeding. Additional research is warranted.