Elsevier

Midwifery

Volume 23, Issue 4, December 2007, Pages 382-391
Midwifery

Breast feeding self-efficacy and other determinants of the duration of breast feeding in a cohort of first-time mothers in Adelaide, Australia

https://doi.org/10.1016/j.midw.2006.05.004Get rights and content

Abstract

Objective

to assess the ability of a Breast-Feeding Self-Efficacy Scale (BSES) score measured at 1 week postpartum to predict the duration of breast-feeding in first-time mothers, and to develop a minimal set of potential confounders, including the BSES and demographic variables, for comparing the apparent effect of other influences on the duration of breast-feeding.

Design

a prospective cohort study, with primary outcome the duration of breast feeding up to 6 months postpartum.

Participants

317 women who had given birth to their first baby (at term) in a large teaching maternity hospital in Adelaide, South Australia, during the period March to November, 2003.

Findings

the BSES at 1 week postpartum was a strong predictor of the duration of breast-feeding in these first-time mothers. Its ability to predict the duration of breast-feeding was largely independent of the other factors (intended duration of breast-feeding, mother's level of education, country of birth, housing situation, smoking status and method of delivery), which were also found to be significant predictors of breast-feeding duration.

Implications for practice

the BSES (including a new short form version) has been confirmed by our study as an important instrument for identifying women at risk of early cessation of breast-feeding. Together with other demographic variables, it should be useful for targeting limited resources to those most in need.

Introduction

In Australia, the importance of breast-feeding is officially recognised in the National Health and Medical Research Council's Dietary Guidelines for Children and Adolescents, with the advice to ‘encourage and support breast-feeding’ (NHMRC, 2003). The last national survey of breast-feeding in Australia was contained in the 1995 Australian Health Survey, which found that 46% of women were breast-feeding at least partially (only 19% fully) at 6 months postpartum (Donath and Amir, 2000). This figure fell well short of the Australian target, for the year 2000, of 50% fully breast-feeding and 80% at least partially breast-feeding their babies at 6 months (Nutbeam et al., 1993).

Those wishing to encourage breast-feeding are confronted with a constellation of factors associated with the initiation, duration and exclusivity of breast-feeding. However, many of them are broad social determinants, such as maternal age, education and socio-economic status. Although they provide valuable indicators of sub-populations where interventions to promote breast-feeding might best be targeted, they provide little insight into the underlying mechanisms, and they are not especially amenable to interventions in themselves. Recently, however, Dennis and Faux (1999) developed a self-report instrument, the Breast-feeding Self-Efficacy Scale (BSES), which assesses a woman's confidence in her perceived ability to breast feed, and may provide new insights into interventions to promote breast-feeding in future. The instrument attempts to operationalise, within the context of breast-feeding, a self-efficacy concept of Bandura (1977) containing (1) an outcome expectancy (the belief that a given behaviour will produce a particular outcome) and (2) a self-efficacy expectancy (an individual's conviction that one can successfully perform certain tasks or behaviours to produce the desired outcome).

The extent to which the BSES adds new predictive information on breast-feeding, and the extent to which it ‘captures’ elements of the seemingly less mutable socio-cultural and socio-economic factors, has not been explored in much detail. Dennis (2003) reported no relationship between scores for an abbreviated version of the BSES and maternal age, marital status, education or income (but lower BSES scores in women who had a caesarean delivery). Blyth et al. (2002) reported higher BSES scores in multiparous compared with primaparous women, but no significant differences in ethnic, marital or education status.

In this study of first-time mothers, we examine the relationship between the actual duration of breast-feeding and (1) the intended duration; (2) the BSES Score at around 1 week postpartum; and (3) socio-demographic characteristics of both women and their partners. The use of survival analysis techniques, which make full use of the continuous nature of the duration of breast-feeding (compared with simply looking at who had stopped breast-feeding at, say, 3 or 6 months), enabled us to derive a minimal set of predictors that can then be used to explore the efficacy of other strategies (e.g. the WHO/UNICEF ‘Ten Steps to Successful Breast-feeding’), with minimal risk of confounding (see companion paper, Pincombe et al., 2006).

Section snippets

Participants

The study was conducted in a large teaching hospital in Adelaide, South Australia, in which around 4000 births take place each year. To be eligible for the study, women were required to be 18 years of age or older; primiparous; 37 weeks gestation or more; intending to breast feed; able to understand and communicate in both written and spoken English; and have given informed consent. Women with multiple pregnancies, or whose baby subsequently required prolonged care in a Special Care Nursery,

Findings

Recruitment took 6 months to complete, with 482 women approached in our antenatal clinic and invited to participate. A total of 85 women were either ineligible or declined to participate. After exclusions for prolonged stays in the Special Care Nursery, not attempting breast-feeding, delivering at a different hospital, being missed at the postpartum period and a neonatal death, 378 (78.4%) women remained eligible. On administration of the BSES (1 week postpartum), 41 women had already stopped

Discussion

Our work confirms that the BSES score for first-time mothers who managed to breast feed for the first week of their baby's life is a useful predictor of how long they will continue to breast feed. Furthermore, this instrument captures information that is not contained in the demographic factors that are so repeatably associated with intention and duration of breast-feeding. The BSES is, therefore, a valuable tool for identifying women who might benefit considerably from postnatal interventions

Acknowledgement

The authors wish to thank the WCH Research Foundation for funding this research.

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