Breastfeeding Self-efficacy Scores Research Articles

Ankyloglossia and breastfeeding self-efficacy in newborns: a birth cohort study

BackgroundThe impact of ankyloglossia (tongue-tie) on breastfeeding outcomes may be overestimated and surgical treatment in newborns remains a controversial topic. The aim of the present study was to assess and quantify the impact of ankyloglossia in newborns on breastfeeding self-efficacy at 14 days of life.MethodsA birth cohort study was conducted involving mothers and newborns soon after childbirth at a public hospital in the city of Canoas, southern Brazil. At the hospital, the lingual frenum of newborns were clinically examined and classified using the Bristol Tongue Assessment Tool. For every newborn with defined or suspected ankyloglossia, two newborns without ankyloglossia were co-enrolled for the study. At 14 days of the children’s lives, the mothers were interviewed at home to collect data on breastfeeding self-efficacy using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Poisson regression with robust variance was conducted to quantify differences in the Breastfeeding Self-Efficacy scores between exposed and nonexposed newborns after adjusting for maternal sociodemographic variables (mother’s completed years of schooling, mother’s age, family structure, progenitor status of child, mother’s smoking status), the gestational variables (number of prenatal appointments, gestational age, comorbidities, type of childbirth), and child related variables (sex, birth weight, birth length) as confounders.ResultsThe final sample was composed of 31 children with ankyloglossia (exposed) and 57 without ankyloglossia (nonexposed). No significant differences were found in the BSEF-SF scores between the 31 children with ankyloglossia (mean BSEF-SF scores: 56.0; median BSEF-SF scores: 60; 95% CI: 51.9–60.1) and the 57 children without ankyloglossia (mean BSEF-SF scores: 59.6; median BSEF-SF scores: 60; 95% CI: 57.5–61.7). The Poisson regression analysis showed no significant difference in the BSEF-SF scores between newborns with ankyloglossia and those without ankyloglossia (Ratio = 0.95; 95% CI: 0.88–1.02; p = 0.139).ConclusionAnkyloglossia at birth exerted no clinically relevant impact on breastfeeding self-efficacy in children at 14 days of life.

The Effect of the 2023 Turkey-Syria Earthquakes on the Sixth-Month Breastfeeding Rate of Infants: A Single-Centre Cohort Study

Background: We investigated the effect of earthquakes on the six-month breast milk intake rate in infants. Methods: In this single-centre prospective cohort study, 35 mother-baby dyads who were in the earthquake zone during the February 6, 2023, Turkey-Syria earthquakes were included as the study group, while 29 mother-baby dyads who were not in the earthquake zone were included as the control group. The physical, environmental, and social characteristics of the settlements after the earthquake, along with the nutritional characteristics of the infants, were evaluated through questionnaires during interviews and online assessments. The Breastfeeding Self-Efficacy Form and the Edinburgh Postnatal Depression Scale were administered to the mothers, and their scores were calculated. Results: No significant difference was found between the exclusive breastfeeding rates at six months in the study and control groups [18 (62.9%) vs. 22 (61.9%), n (%), P = 0.95]. The breastfeeding self-efficacy score was significantly higher in the study group [64 (33 - 70) vs. 54 (31 - 70), median (min-max), P = 0.02]. Although the Edinburgh Postpartum Depression Scale (EPDS) score was higher in the control group [10 (0 - 21) vs. 7 (0 - 26), median (min-max)], this difference was not statistically significant. Conclusions: In general, earthquakes do not affect breastfeeding rates in infants at six months. The continuation of breastfeeding, supported by increased resilience in difficult conditions, enhances breastfeeding self-efficacy and provides protection for the mother-baby dyad. Breastfeeding should be continued and supported during natural disasters.

Effects of responsive breastfeeding intervention on breastfeeding and infant growth in China: A randomised controlled trial.

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self-determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother-infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self-efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post-partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post-partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self-perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post-partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post-partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: -2.09; 95% CI: -2.88 to -1.31; p < 0.001), 6 weeks post-partum (MD: -4.35; 95% CI: -5.20 to -3.49; p < 0.001) and 3 months (MD: -4.89; 95% CI: -5.70 to -4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post-partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post-partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post-partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post-partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post-partum, the intervention group's infants showed slower weight (t = -0.90, p = 0.371) and length (t = -0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post-partum, there was a significant difference in both weight (t = -3.46, p = 0.001) and length (t = -2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self-confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow-up in future research.

Health literacy and its related factors as predictors for the breastfeeding self-efficacy in a western province in Iran

BackgroundOne of the effective factors on BF (Breastfeeding) continuation is Breastfeeding self-efficacy (BFSE). This study was conducted to determine the relationship between Health Literacy (HL) and BFSE in lactating mothers referring to primary health care centers.MethodsThis cross-sectional descriptive study was carried out on lactating mothers referring to primary health care centers in 2022. Multi-stage cluster sampling was done with 160 samples.The data were collected using demographic questionnaire, Persian shortened form of the BSES is a self-reported instrument for measuring a mother's Breastfeeding self-efficacy and Health Literacy for Iranian Adults (HELIA). Data were analyzed using ANOVA, independent t-test, correlation test and liner regression by SPSS version 16, with a significance level of 5%.ResultsThere was a significant positive correlation between the HL score and its four domains( Reading, Behaviour and decision making, Accessing, and Understanding) except for the appraisal domain with BFSE score. The variables of use of formula, HL, duration of breastfeeding, and education were considered predictors of BFSE.ConclusionIn general, the results indicate a possible relationship between BFSE and mothers' HL. Therefore, improving mother's HL can have a positive effect on promoting infants’ nutrition.

The effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy during COVID-19 pandemic: a ramdomized controlled trial

BackgroundSuccessful breastfeeding is related to the psychosocial conditions of the mother. Covid19 pandemic resulted in psychological consequences in women during postpartum period. Maternal anxiety and distress reduce the chances of exclusive breastfeeding. The present study aimed to investigate the effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy (BSE) during COVID-19 pandemic.MethodThis randomized controlled clinical trial was conducted on 64 breastfeeding mothers referred to health care centers in Tabriz, Iran in 2021. Participants were assigned into the intervention and control groups in a ratio of 1: 1 using block randomization in a block size of 4 and 6. The intervention group participated in six individual 60–90 min sessions. Spielberger State-Trait Anxiety Inventory (STAI), postpartum distress (PMD), and BSE questionnaires were completed before and 4-week after the intervention by the control and intervention groups. Independent t-test and ANCOVA were used to compare the outcomes between two groups.ResultsAccording to the ANCOVA results by controlling the baseline values and after the intervention, the mean score of anxiety in the intervention group was lower than that in the control group [Adjusted Mean Difference (AMD): -13.82, 95%, confidence interval (CI): -12.35 to -15.29, (p < 0.001)]. Further, the mean score of postpartum distress after intervention was lower in the intervention group compared with that in the control group [AMD:5.31 95% CI: -3.00 to -7.37 (p < 0.001)]. After the intervention, the mean score of BSE in the intervention group was significantly higher than that in the control group [AMD: 25.57, 95% CI: 22.85 to 28.29 (p < 0.001)].ConclusionStress management counseling can improve postpartum anxiety and distress and BSE and increase breastfeeding. However, more studies are needed for a definitive conclusion.Trial registrationIranian Registry of Clinical Trials (IRCT): IRCT20171007036615N6. Date of registration: 15/09/2021.

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

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). 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. 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. 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. 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 Effectiveness of Dialectical Behavioral Therapy on the Success of Breast Feeding in Traumatic Childbirth: A Randomized Controlled Trial.

Objective: Traumatic childbirth may expose mothers to physical and psychological postpartum disorders. The reduced rate of exclusive breast feeding is an essential consequence of this problem. The goal of this study was to see if dialectical behavioral therapy could help with the onset and duration of exclusive breast feeding after a traumatic delivery. Method : This clinical trial study included, 210 primiparous women with traumatic vaginal births were admitted to Bahar hospital in Shahroud. A standard protocol was designed and administered. The group allocation imbalance happened by chance and was averted by utilizing block randomization with a size of four and sequentially numbering the intervention or control groups with a sealed concealed envelope Participants in the intervention group had one individual session and four group counseling sessions by the researcher, while the control group participants obtained a routine care. Breast feeding self-efficacy was measured using a related questionnaire before the intervention, six and 12 weeks postpartum. Exclusive breast feeding was determined using a related form at the end of each month until the fourth month. Results: The outcome of repeated measure ANOVA Before the intervention, based on the greenhouse geisser test indicated no statistically significant difference in breast feeding self-efficacy (P = 0.07) or infant weight between the two groups. (P = 0.98). Nevertheless, a statistically significant difference between the mean score of breast feeding self-efficacy and infant's weight was discovered by a post hoc test utilizing the Bonferroni correction, (P = 0.001) between the two groups after the intervention. Therefore, in the intervention group, the level of exclusive breast feeding was higher than in the control group, and four months after birth, more infants in the intervention group were exclusively breastfed (58% vs 32%) (P < 0.001). The analysis of data using the GEE model showed that the odds of adherence to exclusive breast feeding in the intervention group were 3.4 (0.95 CI: 2.04-5.7). Conclusion: Dialectical behavior therapy is a powerful tool for minimizing the negative features of traumatic childbirth and increase the success of breast feeding mothers. Therefore, it can be used as a supportive method for mothers.

The relationship of breastfeeding self-efficacy with relationship satisfaction and family function in mothers during the first year postpartum

ABSTRACT This study was conducted to determine the relationship of breastfeeding self-efficacy with relationship satisfaction and family function in mothers during the first year postpartum. The study was carried out between 01 November 2021 and 01 January 2022 in the paediatric outpatient clinic of the Medical Faculty Hospital of a province in the Central Anatolian Region of Turkey. Responses from a total of 331 mothers who were within the first year postpartum were analyzed. The mothers' mean breastfeeding self-efficacy score was 55.3 (SD 9.1), and their effective breastfeeding status was found to be moderate. The following parameters were risk factors negatively affecting mothers' breastfeeding self-efficacy at a rate of 27% (F = 11.603, p < 0.001): low spouse/partner relationship satisfaction, unhealthy communication, unhealthy attention, unhealthy behaviour control, and feeding the baby only formula. Breastfeeding self-efficacy of the mothers who have high relationship satisfaction, have healthy family functions, and only breastfeed their babies is positively affected.

Relationship Between the Rates of Breast Milk Production of Preterm Mothers in the First Week Post-Delivery and Continuation of Breastfeeding Through Discharge

BackgroundMothers of preterm infants born between 26- and 35-weeks’ gestation often report challenges with maintaining a pumping schedule and experience perceptions of low milk supply, both of which may contribute to early termination of breastfeeding within the first few weeks.PurposeThe purpose of this study was to assess the relationship between the amount of expressed milk volumes in the first 2 weeks after delivery and infant’s continuing to receive mother’s milk at hospital discharge. These results were part of a larger study that examined multiple maternal variables that may impact the amount of milk volumes and continuation of breastfeeding in the preterm infant admitted to the NICU.MethodsMothers of infants (N = 37) in the NICU were recruited for this correlational, longitudinal study. Data was collected at 24–48 hours post-delivery, at 2 weeks, at 4 weeks from mothers participating in the study and from infant chart reviews.Results/OutcomesMothers who reported higher expressed milk volumes at 3 days post-delivery had consistently higher volumes of expressed breast milk and a higher percentage of continued breastfeeding at hospital discharge. There was no statistically significant relationship between breastfeeding self-efficacy scores, socio-demographic variables, or pumping frequency and the percentage of infants receiving breast milk at hospital discharge. Overall, 76.4% of the infants enrolled in the study were receiving 100% of their intake with fortified mother’s milk at hospital discharge.Discussion/Implications for PracticeThe use of a breast pump log in the first 2 weeks to monitor milk volumes may assist in predicting mothers who are at risk of lower milk supply and early discontinuation of breastfeeding.

Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study

BackgroundDespite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors.MethodsUsing a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes.ResultsAlmost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum.ConclusionThis study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.

The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool

IntroductionWhile breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month.MethodsA methodological study with longitudinal design among 586 mother-infant dyads, as part of the “BrEaST Start in Life” project. BSES was assessed 24–48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis.ResultsWith Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbach’s α = 0.94) while factor analysis revealed a two-factor structure. BSES scores were higher among mothers who initiated exclusive breastfeeding (M = 3.92, SD = 0.80) compared to breastfeeding not exclusively (M = 3.29, SD = 0.84) and not breastfeeding (M = 3.04, SD = 1.09; p-value < 0.001). There was a stepwise association with exclusivity (40.5% in the highest vs 7.9% lowest quartile of self-efficacy). The association between in-hospital BSES and long-term EBF persisted in multivariable models. Women in the upper quartile of BSES at 48 h were more likely to breastfeed exclusively by adjOR = 5.3 (95% CI 1.7–17.1) at the 1st and adjOR = 13.7 (95% CI 2.7–68.6) at the 4th month. Similar associations were observed between self-efficacy at the 1st month and BF at subsequent time-points. High first month BSES (> 3.96 as per ROC) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months which reflects higher sensitivity but lower specificity.ConclusionsThe Greek version of BSES-SF showed good metric properties (construct, know-group, concurrent and predictive validity). In the absence of community support structures or programmes in Cyprus, prevalence of breastfeeding remains low. This suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.

The Effect of Maternal Emotion and Discomfort on Breastfeeding Realization Scores

Background: Exclusive breastfeeding (EBF) outcomes can vary by concomitant emotions and breastfeeding selfefficacy. Ongoing pain during breastfeeding, concomitant emotions, and breastfeeding self-efficacy scores (BSES) have not been explored in association with EBF at 6 weeks postpartum. Research Aims: To examine the association of ongoing pain with breastfeeding, concomitant emotions and BSES with EBF outcomes at 6 weeks postpartum. Method: A secondary analysis of a randomized pilot trial of a breastfeeding pain self-management (BSM) intervention for 56 mothers (26 BSM, 30 controls). The BSM intervention provided self-management strategies for breastfeeding and breastfeeding pain. Using multiple regression analyses, associated symptoms of depression, anxiety, sleep, well-being pain severity scores, BSES, and group assignment was assessed related to EBF at 6 weeks postpartum. Results: EBF was significantly associated with Group, depression, anxiety, sleep, BSES, and pain severity, (F(6, 49)=5.751, p<0.000, R2=0.413) BSES (p<0.005) and anxiety (p<0.041) were significant variables in the prediction model. A second model which included Group, BSES, pain severity, anxiety, depression, sleep and well-being was significantly associated with EBF (F (7, 49)=4,728, p<0.0004, R2=0.403). BSES again, significantly added to the prediction, p<0.002. Conclusion: Examinations of EBF at 6 weeks should include evaluation of mothers’ ongoing pain and emotional distress, as mothers continue to breastfeeding even at personal cost. Early validation of breastfeeding challenges, ongoing pain, and emotional distress are needed to bolster mothers’ confidence in their breastfeeding skills, thus supporting their EBF goals.

Postpartum Anxiety, Breastfeeding Self-Efficacy &amp; Breastfeeding Outcomes

Abstract Objectives Postpartum anxiety is associated with failure to meet breastfeeding (BF) goals. While BF self-efficacy is a potential moderator of this relationship, the relationship between postpartum anxiety, BF self-efficacy, and exclusive breastfeeding (EBF) has not yet been assessed. The objective was to assess relationships between EBF, anxiety, depression, and BF self-efficacy scores. Methods An online survey using the State-Trait Anxiety Inventory (STAI), Edinburgh Postnatal Depression Scale (EPDS), and Breastfeeding Self-Efficacy Scale (BSES) was conducted. Eligible mothers were ³ 18 years old, had infants 4–24 weeks old, and had provided breastmilk in the prior 2 weeks. Screening stratified by anxiety across 4 groups (no, low, moderate, high) using the Generalized Anxiety Disorder-7 (GAD) tool to ensure sample variability. Possible score ranges for each scale were: GAD (0–21), STAI (20–80), EPDS (0–30), and BSES (14–70). Full sample correlations assessed relationships between STAI, EPDS, and BSES scores. Independent t-tests assessed for differences in scale scores by EBF status. Results Participants (n = 129) were primarily white (92.2%), non-Hispanic (90.7%), married (74.4%), and primiparous (62%). About half were low income and 56.6% reported EBF. Mean scale scores were as follows: GAD = 8.2 (+5.7); STAI = 24.6 (+12.9); EPDS = 9.7 (+4.6); and BSES = 56.8 (+11.4). STAI and EPDS scores were positively correlated (P &amp;lt; .001). BSES scores negatively correlated with STAI (P = .027) and EPDS (P &amp;lt; .001) scores. BSES scores were higher among those reporting EBF (60.0 vs. 53.3; P &amp;lt; .001). Conclusions In this sample of mostly white, non-Hispanic, married women, preliminary findings indicate potentially important relationships between BF self-efficacy and anxiety and depression, and suggest these relationships may impact EBF. Future work, increasing our understanding of the relationship between postpartum anxiety and EBF, may provide important intervention pathways. Funding Sources There was no funding source for this project.

Effects of healthy behavioral capability and psychological resilience on breastfeeding self-efficacy in primiparas

Objective To analyze the relationship between healthy behavioral capability, psychological resilience and breastfeeding self-efficacy in primiparas. Methods Totally 140 primiparas who delivered in Children's Hospital Affiliated of Zhengzhou University from September 2018 to March 2019 were selected by convenient sampling and investigated with the Demographic Information Questionnaire, Self-rated Abilities for Health Practices Scale (SRAHP) , The Connor-Davidson Resilience Scale (CD-RISC) and Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) . The relationship between healthy behavioral capability, psychological resilience and breastfeeding self-efficacy in primiparas was then analyzed based on the data. Totally 140 questionnaires were distributed in this study, and 137 valid questionnaires were collected, accounting for an effective recovery rate of 97.86%. Results The total SRAHP score of the 137 primiparas was (68.25±13.85) , whose total average score of the different items of this scale was (2.43±0.92) . The total CD-RISC score of the 137 primiparas was (57.41±13.82) , whose total average score of the different items of this scale was (2.30±1.22) . The total BSES-SF score of the 137 primiparas was (48.83±10.87) , whose total average score of the different items of this scale was (3.87±1.26) . Pearson correlation analysis showed that there were positive correlations between the dimensions of healthy behavioral capability, the dimensions of psychological resilience and the scores of breastfeeding self-efficacy in primiparas (P<0.01) . Healthy behavioral capability showed a mediating effect between psychological resilience and breastfeeding self-efficacy in primiparas, accounting for 37.19% of the total effect. Conclusions There is a positive correlation between breastfeeding self-efficacy and the level of healthy behavioral capability and psychological resilience, and the level of healthy behavioral capability plays a mediating role between psychological resilience and breastfeeding self-efficacy. Therefore, enhancing psychological resilience and the level of healthy behavior can significantly improve the self-efficacy of breastfeeding, which has a significant effect on the breastfeeding rate of primiparas. Key words: Resilience, psychological; Breast feeding; Primipara; Health behavioral capability; Self-efficacy

Enhancing Breastfeeding - Home-Based Education on Self-Efficacy: A Preventive Strategy.

Background:The aim of this study is to evaluate the effects of home-based education intervention on the exclusivity and promoting the rates of self-efficacy of breastfeeding.Materials and Methods:A randomized controlled trial was conducted Arak University of Medical Sciences in Takeghani Hospital in Iran between June 2015 and October 2015. A total of 130 eligible and voluntary women hospitalized in Arak University of Medical Sciences Hospital postpartum wards were randomized to receive usual care (n = 65) or education with CD and pamphlets (n = 65). Data regarding exclusive breastfeeding were collected using Denis and Fox's breastfeeding self-efficacy questionnaire. The primary outcome was collected by one assistant researcher during first postpartum visit. The secondary outcome was collected 4 weeks after birth of babies by telephone interviews. Data analysis was performed using descriptive (frequency, mean), independent samples t-test, Student's t-test, t2-test, and Chi-square test. All values of P < 0.05 were considered statistically significant.Results:There was no significant differences between the intervention and control groups with regard to age (P = 0.086) and gestational age (P = 0.741). The breastfeeding self-efficacy scores were higher in the intervention group (63.66 ± 6.11) than in the control group (57.04 ± 6.18) after 1 month of childbirth (P = 0.001). The exclusive breastfeeding rate in intervention group was 89.2 (n = 58) at 1st month after education compared with 55.4% (n = 36) in control group (P = 0.001).Conclusions:In a setting, a high breastfeeding rate and self-efficacy scores were found in education group. Therefore, nurses and midwives are thus required to adopt various health education strategies, such as home education, encourage breastfeeding.

The effect of delivery mode on maternal and newborn comfort: An analytical study

Aim: This study was conducted to evaluate the effect of delivery mode on maternal and newborn comfort. Material and Methods: It is an analytical study. 60 mothers who had vaginal delivery and 60 mothers who had caesarean section and their newborn infants.It was conducted in a State Hospital located in a province in the southern Turkey. The data of the study were collected with Mother and Newborn Information Form, the Postpartum Comfort Questionnaire, the Newborn Comfort Behavior Scale, and the Breastfeeding Self-Efficacy Scale. Before starting the study, written and verbal permissions were obtained from the institution, the ethics committee and the mothers.Results: In this study, it was determined that those who had a caesarean delivery experienced more problems related to sitting on the bed, standing up, personal hygiene, perineal hygiene, urinary incontinence, flatus, and pain at the operation site compared to those who had a vaginal delivery (p0.05). The breastfeeding self-efficacy scores did not differ between the two groups (p>0.05). Conclusions: Future studies should evaluate the effect of the method of delivery on maternal and newborn comfort.According to the literature, women who had vaginal delivery according to cesarean section; postpartum comfort, breastfeeding success and self-efficacy of breastfeeding were reported to be higher. In this study, it was determined that the delivery mode did not affect the maternal and newborn comfort and mother’s breastfeeding self-efficacy.

Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial.

To evaluate the effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6months postpartum in mothers who began breastfeeding in the first hour after birth and to explore the role of general and breastfeeding self-efficacy in this relationship. A multi-centre randomized controlled clinical trial. Data were collected from February 2018 - March 2019. Women were randomly assigned to an intervention group that received a brief motivational intervention (N=44) or a control group that was offered standard education on breastfeeding (N=44). Survival analysis techniques were carried out with a follow-up of 6months. In addition, the roles of breastfeeding and general self-efficacy in the association between BMI and breastfeeding duration were explored through mediation/moderation analysis. Among 88 randomized patients (mean age, 32.82years), 81 (92.04%) completed the trial. The survival analyses of exclusive breastfeeding and breastfeeding (exclusive and non-exclusive) showed reductions in the risk of abandonment in the intervention group of 63% (aHR: 0.37 [0.22-0.60] p<.001) and 61% (aHR: 0.39 [0.20-0.78] p=.008), respectively. We found that self-efficacy acted as a moderator of the effect of brief motivational intervention on breastfeeding self-efficacy. A discrete indirect effect of brief motivational intervention through increased breastfeeding self-efficacy was found on breastfeeding duration, with an index of moderated mediation of 0.08 (95% CI: 0.02-0.19). Greater positive variations in the breastfeeding self-efficacy scores during follow-up predicted exclusive and non-exclusive breastfeeding duration. A brief motivational intervention conducted in the immediate postpartum period increases breastfeeding and exclusive breastfeeding duration in the first 6months. Although breastfeeding self-efficacy seems to moderate the effect of brief motivational intervention on the increase in breastfeeding duration, other factors may influence its effectiveness. Further studies could focus on exploring how brief motivational intervention works and whether it also works for pregnant mothers who have not yet decided whether to breastfeed. Brief motivational intervention could be introduced as part of routine care of women who begin breastfeeding to improve the low rates of exclusive breastfeeding at 6months postpartum. Unique Protocol ID: Moti003; https://ClinicalTrials.gov ID: NCT03357549.

BREASTFEEDING SELF-EFFICACY (BSE): COMPARATION BETWEEN ANTENATAL AND POSTPARTUM PERIOD

Breastfeeding is the process of giving mother’s breast milk to baby. Breast milk is the best nutrition for babies. However, there are inhibiting factors that influence mother to decide stop breastfeed. One of the factors is the low Breastfeeding Self-Efficacy (BSE). BSE can be used to predict mothers, who will stop the breastfeeding earlier in the future. BSE will increase during pregnancy until 6 weeks postpartum. The purpose of this study was to analysis comparation of BSE during third trimester pregnancy and postpartum period. The design of this study was observational analytic with a prospective cohort study approach. The study was conducted in Malang, on Kedungkandang District from January to May 2018. Fifty-eight respondents were involved in this study. The instruments used in this study were Prenatal Breastfeeding Self Efficacy Scale (PBSES) and Breastfeeding Self-Efficacy Scale Short Form (BSES-SF). The data were analysed using paired t-test. The result of this study was the average BSE score of mothers during pregnancy is 57,59 ± 7,49 and BSE at postpartum, 58.53 ± 5,99. While, the paired t-test obtained a p value of 0.365, it can be concluded that there were no significant differences between BSE mothers during pregnancy and postpartum.

Breast feeding knowledge and self-efficacy and its influencing factors among multiparae

Objective To investigate the breast feeding knowledge and self-efficacy among hospitalized multiparae and to explore the influencing factors of breast feeding self-efficacy. Methods From January to August 2018, we selected hospitalized multiparae at Yuyao People's Hospital and Zhejiang Provincial People's Hospital as subjects by simple random sampling. All of the multiparae were investigated with the general information questionnaire, breast feeding knowledge questionnaire and breastfeeding self-efficacy scale. A total of 400 questionnaire were sent out and 372 valid questionnaire were collected with 93.0% for the valid recovery rate. Results Among 372 hospitalized multiparae, the total score of breast feeding knowledge questionnaire was (5.53±1.02) ; the total score of breastfeeding self-efficacy was (80.36±16.72) . Single factor analysis showed that there were statistical differences in the scores of breast feeding self-efficacy among hospitalized multiparae with different ages, education levels, working state, living styles, income levels, delivery modes, number of complications, training for breast feeding, mastery of breast feeding knowledge, breast feeding for the first time (P<0.01) . Correlation analysis showed that breast feeding knowledge had a statistically positive correlation with the self-efficacy among hospitalized multiparae (r=0.117, P=0.026) . Multiple linear regression analysis proved that the main influencing factors of breast feeding self-efficacy among multiparae included working state, number of complications, training for breast feeding and breast feeding knowledge with a statistical difference. Conclusions The breast feeding knowledge and self-efficacy of hospitalized multiparae are not good enough. Communities and hospitals need to work hard together to improve styles and strategies of breast feeding education so as to increase the rate of breast feeding. Key words: Breast feeding; Knowledge; Multiparae; Influencing factors; Self-efficacy

Application of nursing intervention based on transtheoretical model and stages of change in breastfeeding for primiparas

Objective To explore the effect of nursing intervention based on the transtheoretical model and stages of change on breastfeeding knowledge, self-efficacy, and duration of breastfeeding in newly born pregnant women, aimed to provide reference for breastfeeding behavior health education model for pregnant women. Methods The 130 primiparas who came to the hospital graded a class- three of Shanxi Province for perinatal examination were selected as the research subjects from May to June in 2017, they were divided into test group and control group by random digits table method. In the control group, the normal breastfeeding health guidance was carried out in the three stages of prenatal, hospitalized and after discharge. The test group divided the primipara from the beginning of pregnancy to 6th months postpartum period into 5 stages according to transtheoretical model and stages of change. The new strategy of breastfeeding should be formulated and implemented according to different stages and behavior changing processes. Results The total score of breastfeeding knowledge of primipara were (8.76±1.14), (8.92±1.21), (9.90±1.27), (9.94±1.29) points in control group before intervention, the 3rd day, the 42nd day and the 6th month after delivery, and they were (9.11±1.42), (12.02±1.64), (13.04±1.67), (15.00±1.83) points respectively in test group, the differences were statistically significant(Ftime= 51.823, Fgroup=10.406, Finteractive=56.641, all P < 0.05). The total scores of breastfeeding self-efficacy of primipara were (84.62±1.14), (88.96±1.41), (86.65±1.47), (84.31±1.57) points respectively in control group before intervention, the 3rd day, the 42nd day and the 6th month after delivery, while in test group they were (84.98±1.20), (104.02±1.42), (111.00±1.45), (120.04±1.40) points, the differences were statistically significan (Ftime=12.592, Fgroup=229.674, Finteractive=79.955, all P<0.05). The pure breastfeeding rates of primipara were 60.0% (33/55), 41.8% (23/55), 21.8% (12/55) in control group on the 3rd day, the 42nd day and the 6th month after delivery, they were 84.7% (50/59), 76.3% (45/59), 49.2% (29/59) in the test group. The differences was statistically significant (χ2=8.804, 14.038, 9.235, all P <0.01). Conclusion Breastfeeding intervention based on the theory of behavioral staged transition can help primipara to improve breastfeeding knowledge and self-efficacy, and improve breastfeeding status. Key words: Breast-feeding; Transtheoretical model and stages of change; Nursing care; Intervene