Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3 months postpartum: a longitudinal study

Abstract

Background: The prevalence of exclusive breastfeeding of infants at 3 months postpartum is only 50% in Japan. In order to increase this rate, we aimed to examine modifiable factors related to exclusive breastfeeding at 3 months postpartum by focusing on breastfeeding-related and psychosocial variables at 1 month postpartum. Methods: This prospective cohort study was conducted in a secondary medical care center in Osaka, Japan from February 2017 to October 2018. Demographic variables, infant feeding modality, breastfeeding-related variables, and psychosocial variables were obtained using questionnaires at 1 month postpartum. Daytime salivary cortisol levels before and after breastfeeding at 1 month postpartum were measured as a biological marker for stress responses associated with breastfeeding. Each infant’s feeding modality was re-assessed at 3 months postpartum. Multiple logistic regression analyses were performed to examine the factors affecting exclusive breastfeeding at 3 months postpartum. Results: Of the 104 participants, 61 reported exclusive breastfeeding at 3 months postpartum. The following factors were significantly associated with exclusive breastfeeding at 3 months postpartum: multiparity (adjusted odds ratio, 95% confidence interval: 11.13, 2.08–59.59), having a university degree (5.25, 1.04–26.53), no plan to return to work by 6 months postpartum (0.02, 0.00–0.46), exclusive breastfeeding at 1 month postpartum (42.84, 6.05–303.52), lower cortisol level after breastfeeding at 1 month postpartum (0.00, 0.00–0.02), and higher breastfeeding self-efficacy scale score at 1 month postpartum (1.07, 1.00–1.14). In parity-specific analyses, exclusive breastfeeding (25.33, 4.75–134.98) and lower cortisol level after breastfeeding (0.00, 0.00–0.21) at 1 month postpartum in primiparous women, and lower cortisol level after breastfeeding (0.00, 0.00–0.94), higher breastfeeding self-efficacy score (1.18, 1.05–1.32), and absence of breast complications (0.09, 0.01-0.82) at 1 month postpartum in multiparous women were associated with exclusive breastfeeding at 3 months postpartum. Conclusions: Stress levels after breastfeeding, breastfeeding self-efficacy, and presence of breast complications could be modifiable factors related to subsequent exclusive breastfeeding. Further research is needed to examine whether approaches to reducing breastfeeding-related stress, improving breastfeeding self-efficacy, and preventing breast complications during lactation are effective to increase exclusive breastfeeding practices.

Breastfeeding Self-Efficcacy pada Ibu Hamil Trimester III Hingga Menyusui

“…Ibu dengan keyakinan dirinya yang tinggi untuk berhasil menyusui bayinya (breastfeeding self-efficacy), akan berpengaruh pada durasi menyusui serta keberhasilan pemberian ASI eksklusif. Hal ini telah dibuktikan pada penelitian mengenai breastfeeding self-efficacy di beberapa negera seperti di Afrika Selatan, Jepang (p-value 0,001), dan Turki (p-value 0,001) (Shiraishi, Matsuzaki, Kurihara, Iwamoto, & Shimada, 2020).…”

“…Skor BSE ditemukan lebih rendah pada ibu yang tidak mempraktikan ASI eksklusif selama 3 bulan postpartum. Selanjutnya diketahui ada hubungan BSE dengan ASI eksklusif dengan p-value<0,001 (Shiraishi et al, 2020).…”