The Effect of Breastfeeding Counseling on Postpartum Breastfeeding Self-efficacy and Infant Feeding Attitudes

Breast milk is a natural source of nutrition that provides everything an infant needs for healthy physical growth, brain development, and a strong immune system. Starting breastfeeding within the first hour after birth, continuing exclusively for the first six months, and maintaining it alongside safe and appropriate complementary foods for up to two years or longer is one of the most effective ways to support a child's health and survival. However, only 43% of newborns worldwide are breastfed within that first hour. The highest early breastfeeding rates are found in Eastern and Southern Africa (65%), while the lowest are in East Asia and the Pacific (32%). In Türkiye, 71% of infants begin breastfeeding within the first hour after birth.

Although breastfeeding is a natural and physiological process, it also needs to be learned and it is not always easy to sustain. Several factors can make breastfeeding more challenging. These include the mother's young age, limited maternity leave for working mothers, lack of support from family or a partner, mode of birth, insufficient knowledge about breastfeeding, limited access to prenatal care and health education, low milk supply, difficulties with latching, medical issues affecting either the mother or the baby, and discomfort or embarrassment about breastfeeding in public.

According to the literature, face-to-face support from healthcare professionals promotes breastfeeding among healthy mothers and full-term infants. A mother's decision to start and continue breastfeeding, along with her attitudes and efforts toward it, is closely linked to her level of self-efficacy.

Self-efficacy beliefs play a key role in shaping an individual's behavior, motivation, and actions. Bandura (1977) defines self-efficacy as a person's belief or confidence in their ability to plan and carry out the actions necessary to handle future situations. In breastfeeding, self-efficacy is a crucial factor. It influences whether a mother chooses to breastfeed, how much effort she puts into it, whether she continues despite initial challenges, and how actively she works to improve her breastfeeding skills.

Breastfeeding self-efficacy during the prenatal period plays a key role in shaping a mother's intention and readiness to breastfeed after birth. This study examined the impact of breastfeeding counseling provided to pregnant women during the prenatal period on their breastfeeding self-efficacy and infant feeding attitudes in the postpartum period.

Hypotheses of this study:

H11: There is a difference in postpartum breastfeeding self-efficacy between the intervention group that received prenatal breastfeeding counseling and the control group.

H10: There is no difference in postpartum breastfeeding self-efficacy between the intervention group that received prenatal breastfeeding counseling and the control group.

H21: There is a difference between the intervention group that received prenatal breastfeeding counseling and the control group in terms of postnatal infant feeding attitude.

H20: There is no difference between the intervention group that received prenatal breastfeeding counseling and the control group in terms of postnatal infant feeding attitude.

Study Design This study is a single-blind randomized controlled experimental study. Population and Sample of the Study The population of the study consisted of pregnant women who attended the outpatient clinics of the Gynecology and Obstetrics Department at Ordu Training and Research Hospital, located in the Black Sea Region of Türkiye. 138 primiparous pregnant women were included in the study. 69 women were included in the training group and 69 women were included in the control group.

Pregnant women who were 18 years of age or older, had at least primary school education, had given birth for the first time, were in their 27th week of pregnancy or later, had no chronic disease, had no communication barriers, and agreed to participate in the study were included in the study.

Women were excluded from the study if they had any medical condition that might prevent breastfeeding, multiple pregnancy, multiparity, diagnosed mental illness, or were unwilling to continue participating in the study.

The independent variables of the study were age, education level and number of children.

The dependent variables of the study were receiving education on breastfeeding, the Iowa Infant Feeding Attitude Scale score, and the Breastfeeding Self-Efficacy Scale score.

The Control variables included a range of sociodemographic and obstetric characteristics such as age, education level, employment status, income level, spouse's education level, spouse's employment status, gestational week, health problems during pregnancy, structural nipple issues, prior breastfeeding education, and having a person around supporting breastfeeding.

Data Collection Tools Data were collected using several tools: a personal information form covering the participants' sociodemographic characteristics, the Antenatal Breastfeeding Self-Efficacy Scale-Short Form, the Postnatal Breastfeeding Self-Efficacy Scale-Short Form, and the Iowa Infant Feeding Attitude Scale. Before the breastfeeding counseling intervention, pregnant women completed these forms and scales themselves through face-to-face interviews. In the postpartum period, the same tools were completed by the participants via face-to-face interviews, telephone calls, or email.

Ethical Considerations Permission to use the scales was obtained via email from the authors. Ethical approval was obtained from the Ordu University Clinical Research Ethics Committee. Institutional approval was received from the Ordu Provincial Health Directorate. All pregnant women gave written and verbal informed consent to participate in the study.