Background Maternal satisfaction with the breastfeeding experience is an important determinant of breastfeeding success. There is currently no valid tool to measure perceived maternal satisfaction with breastfeeding in the Arab context. Methods This cohort study tested the Maternal Breastfeeding Evaluation Scale (MBFES) on 450 healthy Lebanese mothers for internal consistency reliability and construct validity. Participants were recruited between April 2018 and February 2020. Results The Cronbach’s alpha reliability coefficient of the Arabic MBFES (MBFES-A) was 0.87. Exploratory factor analysis revealed that it has three components: Infant Satisfaction/Growth, Maternal Enjoyment/Role Attainment, and Lifestyle/Body Image with reliability coefficients of 0.88, 0.87, and 0.68, respectively. Four items were deleted because of low factor loadings and three items were relocated to the Infant Satisfaction/Growth subscale based on their factor loadings. Participants who were exclusively breastfeeding at one and/or 3 months had higher mean MBFES-A total and Infant Satisfaction/Growth and Maternal Enjoyment/Role Attainment subscale scores than participants who were partially breastfeeding, and significantly higher mean scores than mothers who were not breastfeeding (all p values < 0.001), findings that support the scale’s construct validity. Moreover, scores on the Infant Satisfaction/Growth subscale correlated with exclusive breastfeeding at one (r = 0.37, p < 0.001) and 3 months (r = 0.31, p < 0.001). The MBFES-A score had positive modest correlations with maternal attitude towards breastfeeding (r = 0.30, p < 0.001), exclusive breastfeeding at one (r = 0.27) and at 3 months (r = 0.26, p < 0.001 for both), as well as with the longest previous exclusive breastfeeding (r = 0.27, p < 0.001). Conclusions The 26-item MBFES-A is a reliable and valid instrument to use in future breastfeeding research in Middle East North Africa countries. There is a need for replication of our findings in other Arab contexts using new constructs to establish stronger construct validity.

Background Women with inverted nipples may struggle with breastfeeding and may stop exclusive breastfeeding before six months. The use of an inverted syringe to evert the nipples was successful in achieving high rates of infant latching and exclusive breastfeeding in case series but has not been tested in clinical trials. This open label, parallel group, randomized clinical trial investigated whether the use of the inverted syringe technique in women with inverted nipples would increase exclusive breastfeeding rate at one month, as compared to standard care. Methods/Design Between June 2018 and January 2020, healthy pregnant women (N=54) with grades 1 or 2 inverted nipples were randomly allocated to standard care or to an experimental group that used the inverted syringe technique to evert the inverted nipple prior to every breastfeeding. The primary outcome measure was the rate of exclusive breastfeeding at one month. Secondary outcomes included the rates of exclusive breastfeeding at three and six months, any breastfeeding at one, three, and six months, nipple eversion, successful infant latching, breastfeeding-associated complications, maternal satisfaction with breastfeeding, maternal quality of life, and adverse events. Descriptive and bivariate analyses were conducted according to the intention to treat principle. Results Participants in the experimental group were less likely to be exclusively breastfeeding at one (RR = 0.65, 95% CI: 0.44, 0.95; n = 47), and at three months (RR = 0.66, 95% CI: 0.47, 0.91; n = 45), or to practice any breastfeeding at six months (RR = 0.54, 95% CI: 0.34, 0.87; n = 44). Only 14.3% of women in the experimental group complied with the use of the inverted syringe during the first month. Breast pump and breastfeeding-associated complications were more commonly reported in the control group (p < 0.05 for both). Both groups had similar rates of nipple eversion, successful infant latching, and similar satisfaction with breastfeeding and quality of life issues. Conclusion The inverted syringe technique was not associated with improvement in breastfeeding outcomes of women with inverted nipples. Larger clinical trials are needed to confirm our findings. Trial registration ClinicalTrials.gov NCT03529630; Registered May 8, 2018.