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This study explored the factors which affect the feeding and weaning practices of Emirati mothers as well as the experiences and perceptions which influence their breastfeeding decisions. It used both quantitative and qualitative methods to examine Emirati mothers’ understanding of infant feeding and to identify the factors which appeared to have a relevant effect and locate them in their cultural context. n the survey, a convenientce sample of 593 mothers with infants aged up to 2 years was interviewed face to face in the maternal and child healthcare centers in Al Ain, Dubai and Abu Dhabi. The interview was based on a pretested structured questionnaire. The results of multiple logistic analysis showed that the time of initiation of the first breastfeed was significantly associated with the infant’s birth weight (OR=2.007; P<0.023), parity (OR=2.139; P<0.001) and rooming in (OR=21.70; P<0.001). As for the feeding patterns, the results of the multiple logistic analysis revealed that rooming in (OR=4.485; P<0.001), feeding on demand (OR=2.290; P<0.005) and feeding more frequently at night (P<0.001) emerged as significant factors associated with exclusive or almost exclusive breastfeeding practices. The duration of breastfeeding rate was significantly influenced by many variables. Concerning the duration of lactational amenorrhea, the, the multiple logistic analysis showed that mother's age, breastfeeding duration and the early introduction of formula milk and solid food emerged as significant variables. Among the 593 infants in the study, 24.1% were predominantly breastfed,25% of the infants were exclusively breastfed, and 49.4% were almost exclusively breastfed since birth. Fifteen Emirati mothers from each city were interviewed about their breastfeeding practices, beliefs and perceptions. The following themes emerged: the influence of others, the sources of information, infants’ behavior, knowledge of and attitudes towards current WHO recommendations and mothers’ perception of the benefits of breastfeeding. Health promotions and healthcare facilities failed to deliver the message of the importance of exclusive breastfeeding. Grandmothers and mothers-in-law appeared to influence the mother's breastfeeding practices. In conclusion, there is a need for a national community-based breastfeeding intervention programme for the promoting exclusive breastfeeding practices as part of a primary public health strategy.

Many benefits to breastfeeding exist for both mothers and infants, yet exclusive breastfeeding rates remain low across the nation. These benefits include decreased chance of infections for infants, low infant mortality, and decreased chances of breast and ovarian cancers for mothers (Binns et al., 2016; CDC, 2023). Education strategies have recently become imperative for health organizations to help mothers sustain their ability to breastfeed within the recommended six-month timeframe. Current literature on education supports that women who receive education at some point in their lactation journey are more likely to reach the six-month period and have more confidence in their ability to provide for their infant (Alianmoghaddam et al., 2018; Silva et al., 2016; Tseng et al., 2020). Occupational therapists are experts in role promotion and addressing routines to make them more effective. Therefore, occupational therapists may have a role in breastfeeding promotion to help women reach their occupational goals of breastfeeding and improve health outcomes for mothers and infants on a population level (Pitonyak, 2014; Visser et al., 2016). To demonstrate the need for occupational therapists in the field of lactation, a five-week postpartum breastfeeding course was developed to be implemented in the community. One participant attended all five sessions and completed a pre- and post-survey. Results from the COPM demonstrated an improved sense of importance (pre-average: 6.4, post-average: 8.3) and satisfaction (pre-average: 4.4, post-average: 6.4) in breastfeeding-related occupational performance. The BSES-S also demonstrated a self-reported improved sense of self-efficacy regarding breastfeeding (pre: 49, post: 55). Limitations of the study included a higher level of one-on-one support than the program intended and the lack of diversity in participant experience.

Health care should progress and change as the needs of the population change. As light is shed on the mothers’ experiences during the postpartum period, there is an increasing need to find and implement evidence-based interventions to promote their health and wellness. As a vulnerable population, postpartum women require appropriate treatments and interventions to avoid postpartum complications. Three key themes of postpartum health and well-being that directly and significantly impact mothers are postpartum depression, maternal and infant attachment, and exclusive breastfeeding. This integrative review addressed the correlation between each of these themes and how kangaroo care, upright skin-to-skin contact, impacts them. Inconsistent use of kangaroo care as an intervention for mothers postpartum was discovered in this review, as it is typically used for infants. Statistical evidence supporting the use of kangaroo care to improve overall maternal health was discussed in this integrative review. Keywords: kangaroo care (KC), postpartum depression, maternal and infant attachment, exclusive breastfeeding

Background: Breastfeeding duration is associated with multifactorial determinants including physiological and socio-demographic. An inflammatory diet could inhibit milk production via inhibition of mammary lipoprotein lipase (LPL) activity. We evaluated the association between dietary inflammation potential and exclusive breastfeeding (EBF) in a Midwestern U.S. setting where dietary patterns tend to be high in inflammatory foods.Methods: We used data from the Cincinnati subcohort of the Global Exploration of Human Milk (GEHM) Study, a longitudinal cohort of mother-infant pairs, in which mothers who did not achieve =75% breastfeeding by week 4 postpartum were excluded from further follow-up. 24-hour dietary recalls from 3 random days between weeks 4 and 13 postpartum were used to compute the dietary inflammatory potential via the Dietary Inflammatory Index (DII). Data were analyzed using R Studio. Participants (n=108) were categorized into low, medium, and high DII tertiles. Since we observed nearly identical EBF trends for the first two DII tertiles, we combined these categories to increase the precision of the estimate. Then, we compared the proportion of EBF at 6 and 13 weeks postpartum between low/medium DII (n=72) versus high DII (n=36) groups. Comparisons used Fisher exact test and logistic regression analysis (OR [95% CI]), the latter stratified by prepregnancy BMI and maternal race. Results: Maternal prepregnancy BMI and proportion of WIC enrollment were significantly higher in the high DII group (p

Breast milk is the gold standard for infant nutrition because in addition to nutrients, it also provides bioactive components that benefit the health of the developing infant. Infants under six months are recommended to be exclusively breastfed (EBF). Infant feeding practices determined by parental recall methods have been reported to have discrepancies when compared with results measured by the deuterium dose-to-mother (DTM) technique. However, the DTM method is limited by its high workload of sample collection and its validity outside the sample collection window. Finding markers of infant feeding practice using a readily accessible biological sample (such as urine or feces) is a promising novel approach to determine infant feeding practices.Breast milk is dynamic and its composition is impacted by many factors among which maternal secretor status and Lewis blood type impacts the levels of several human milk oligosaccharides (HMOs). Previous research has demonstrated the influence of maternal HMO phenotype on the infant gut microbiome. However, these studies used recall methods to determine infant feeding practice and the sample size used were relatively small. Therefore, it is important to illustrate this impact in a larger infant population whose feeding practice were determined objectively. This dissertation investigates the impact of maternal HMO phenotype on the milk metabolome, infant metabolism and gut microbiome, and seeks to develop metabolic biomarkers of feeding practice from samples of infant feces and urine. Chapter 1 reviews the compositional differences between human milk and infant formula, as well as the recent efforts to narrow the gap between the two. Chapter 2 demonstrates the impact of maternal secretor status and Lewis blood type on breast milk metabolome. Fold change analysis showed that the non-secretor (Se-) Lewis negative (Le-) milk had major differences in free fatty acids, free amino acids, and metabolites related to energy metabolism. Chapter 3 shows the impact of maternal secretor status on the infant fecal metabolome and gut microbiome. Maternal secretor status did not alter the within-community (alpha) diversity, between-community (beta) diversity, or the relative abundance of bacterial taxa at the genus level. However, differences in infant gut microbial fermentation products were observed with succinate, amino acids and their derivatives, and 1,2-propanediol. Chapters 4 and 5 develop and validate metabolic biomarkers for the discrimination between EBF and nonexclusively breastfed (non-EBF) infants using fecal and urine samples, respectively. Metabolites with excellent prediction performance (area under the receiver operating curve (AUC) above 0.8) were identified as biomarkers, and these included HMOs, short-chain fatty acids, amino acids (AAs) and organic acids in infant feces, and AA derivatives, nicotinamide-adenine dinucleotide degradation products, and metabolites from dietary sources and/or host-microbial co-metabolism in infant urine. This work provides new insights into the impact of maternal secretor status and Lewis blood type on the breast milk metabolome, as well as a further knowledge on how maternal secretor status influences the EBF infant gut metabolome and microbiome. The results in this study pave the road to a deeper understanding of how the choice of feeding practices impacts infant metabolism and the gut microbiome, and demonstrates the power of utilizing metabolic biomarkers as a novel approach to determine infant feeding practice.

Background: Breast milk provides powerful benefits for infants. However, some newborns experience excess weight loss (EWL, loss ≥10% by DoL 4) while breastfeeding is being established. Objective(s): 1) Evaluate the Newborn Weight Loss Tool (NEWT) sensitivity and specificity in early identification of exclusively breastfed newborns who will lose ≥10% of birthweight once discharged to home. 2) Determine if NEWT trajectory is associated with breastfeeding outcomes in the home setting.Methods: We performed a secondary data analysis from California mother-infant dyads screened for inclusion in the WHO Growth Reference Study. For the present analysis, we excluded records where: newborns were given >60 mL of formula prior to DoL 4 home visit, relevant data were missing, or NEWT exclusion criteria were met (newborns admitted to special care, birthweight 5000g, or biologically implausible weight value recorded). We examined sensitivity and specificity of in-hospital newborn NEWT status in predicting EWL. We defined NEWT test-positive status as in-hospital weight falling at or below the NEWT trajectory intersecting with eventual 10% weight loss. We defined cases as having actual EWL. Results: In the final analytic sample (n=220), in-hospital newborn weight was recorded at 15±6h, and DoL4 weight was recorded at 82±7h. NEWT correctly identified 6 of 28 cases (21% sensitivity, 95% confidence interval (CI) [8-34%]), and 158 of 192 non-cases (82% specificity, 95% confidence interval (CI) [75-89%]) of EWL. NEWT test-positive status was associated with the following outcomes at DoL 4: greater weight loss, lower breastfeeding support, and less frequent infant cueing (all, p

The main purpose of this descriptive study were to determine the factors that encourage breastfeeding initiation decision, to determine the factors that encourage completion of exclusive breastfeeding, and to investigate the external factors that promote, or inhibit, exclusive breastfeeding among Middle Eastern women. A Qualtrics online self-administered survey was distributed through snowball sampling technique. The 42-question survey was divided into 5 sections (a) demographic data about the participants, (b) data about the most recent pregnancy and the feeding experience with the baby, (c) the top influences that encouraged the mother to breastfeed and the top barriers she incurred, (d) a 5-point Likert scale question testing the breastfeeding knowledge among mothers, (e) yes and no, and open answer questions about the breastfeeding experience in general. Out of the 636 participants who started the survey, only 436 (68%) completed the survey and met the inclusion criteria. Participants ages were from 18 to 60 years old, and they all had previous breastfeeding experiences or currently breastfeeding. Results were collected and analyzed via the Statistical Package for Social Science (SPSS) Version 25. The results showed that almost a third of the participants successfully completed exclusive breastfeeding for the recommended period of 6 months. Results also showed that approximately70% of mothers who successfully breastfed held a bachelor degree or a higher degree. More than third of the participants chose work as the top barrier to breastfeeding, followed by lack of milk as the second most chosen barrier of breastfeeding. The study results suggest that all workplaces should be enforced to have nursing rooms for working mothers, also, hospitals should emphasize on different solutions for lack of milk problems.

Maternal-child health authorities recommend that infants breastfeed exclusively for the first six months of life. Currently, 25% of infants in the United States do so. Breastfeeding specific care that mothers receive from their postpartum nurses and lactation specialists is integral to successfully initiating exclusive breastfeeding. Due to the time sensitive nature of establishing milk supply, interrupting the process of lactogenesis with supplementation puts infants at high risk for early termination of breastfeeding. The purpose of this dissertation is to examine the relationship of breastfeeding care received during the postpartum hospital stay, defined as the first 48-72 hours of life, and breastfeeding exclusivity among term, healthy infants. First, an integrated review of the literature was performed to identify aspects of the postpartum hospital experience and behavior of nurses that mothers perceive as helpful or not toward establishing exclusive breastfeeding. Mothers reported they perceived nurses were too busy to help with breastfeeding. When nurses did offer help, their advice was inconsistent between providers and not evidence based. Mothers also noted that providers were hesitant to offer encouragement for a mother’s decision to breastfeed, for fear of causing guilt should the mother experience difficulty. Additionally, special consideration is needed for breastfeeding mothers after cesarean birth. Next, a secondary analysis of data was performed to identify if maternal perception of the hospital experience is a predictor of exclusive breastfeeding during the postpartum hospital stay. Data was retrieved from the control group of a two-part randomized, controlled trial of a breastfeeding education intervention. Forty-five participants were included in this analysis. The outcome of interest was exclusive breastfeeding at hospital discharge and at four weeks after birth. The hospital experience was measured using a survey titled “Every Step Counts”. This 16-question survey measured hospital adherence to the Ten Steps to Successful Breastfeeding, guidelines that promote breastfeeding exclusivity and duration. Rating the hospital experience with a score of 13 or greater was associated with an increased likelihood of breastfeeding exclusively at the time of discharge. The influence of the hospital experience on breastfeeding exclusivity did not remain at four weeks after birth. Finally, a primary investigation was conducted to further examine the relationship between hospital care and exclusive breastfeeding. In this study, a different tool was used to measure breastfeeding care in the hospital. The “Questionnaire for the Breastfeeding Mother” from the hospital self-appraisal and monitoring guide developed by the Baby Friendly Hospital Initiative was distributed on the day of discharge. This study revealed that a higher score on the questionnaire was associated with an increased likelihood of breastfeeding exclusively at discharge. Whether or not a participant’s own mother breastfed was also a predictor of breastfeeding exclusivity at discharge. In summary, quality breastfeeding specific care from nurses and lactation specialists is critical to helping women to establish breastfeeding exclusivity in the immediate postpartum period. Close adherence to the Ten Steps yields positive outcomes of breastfeeding exclusivity. Thus, hospitals could benefit from following the Ten Steps in order to continue the national trend of increasing breastfeeding exclusivity and duration.

This research examined two interrelated issues relevant to maternal and neonatal health in Pakistan, namely, the rising rates of C-section delivery and low rates of exclusive breastfeeding. By using the Andersen's health behavioral model to frame two empirical studies, the data from the Pakistan Demographic and Health Survey (PDHS) 2012-13 was used. The first empirical study examined the correlation between place of delivery and the odds of cesarean section in Pakistan. Not all Pakistani women have an equal chance of delivering at a health facility where C-section delivery takes place; therefore, the study modeled mode of delivery as a two-step process. In the first step, place of delivery was a function of medical indications and various sociodemographic and community factors. Women who delivered at a health facility were included in the second step, where C-section was a function of medical indications and type of facility (private, public). It is found that women who delivered at a private health facility were more likely to have a C-section, even after controlling for the effects of medical/clinical factors, which is concerning. Findings suggest that the private maternal health sector in Pakistan may be over-medicalizing childbirth. The second study examined this paradox of low exclusive breastfeeding in Pakistan, taking into account not only individual-level characteristics of the child and parents, but also place and mode of delivery, sociocultural factors, and community composition. The sample consisted of 1,044 children 0-5 months old, currently living with their mothers. Binary logistic regressions of exclusive and predominant breastfeeding found women who delivered vaginally, whether at home or health care facility were more likely than mothers who delivered via C-section to predominantly breastfeed their infant, and that mothers who delivered vaginally at a health care facility were more likely than their peers who delivered via C-section to exclusively breastfeed their infants. Collectively, the findings of both empirical studies suggest that private maternal health care services in Pakistan may be facilitating medically unnecessary C-sections, either for profit making or time management. An extended and integrated policy regarding medically unnecessary C-section delivery and low rates of exclusive breastfeeding is needed in Pakistan to address both issues together effectively.

Objective(s): To determine if maternal obesity is a risk factor for: 1) elective formula use, and 2) medically necessary formula use, in the context of a Baby-Friendly Hospital with high prevalence of obesity.Study Design: We included singleton, term deliveries at a community hospital in 2016. We defined elective as formula given per maternal request, and medically necessary as formula given due to excess weight loss, hyperbilirubinemia, hypoglycemia, or low urine output. We used logistic regression to determine the odds ratio and 95% confidence interval (OR[95%CI]) for formula use according to BMI class and obesity status. We adjusted for covariates and mediating conditions exacerbated by obesity. Results: 1,588 mother-baby pairs met inclusion criteria, of which 42% were obese. Overall, 33% of mothers elected to use formula, with significantly higher use in Class III Obesity versus normal BMI after adjusting for covariates (2.1[1.4-3.2]), and covariates plus mediators (2.4[1.5-3.7]), but there was no significant difference in elective formula use across other BMI categories. Of the remaining 1,069 mothers, the prevalence of medically necessary formula was 9% overall, 6% in infants of non-obese mothers, and 14% in infants of obese mothers. Obesity significantly increased the risk for medically necessary formula after adjusting for covariates (2.6[1.7-3.9]) and covariates plus mediating conditions exacerbated by obesity (1.7[1.1-2.8]). Conclusions: Elective formula use was high across all BMI categories, indicating need for prenatal education on exclusive breastfeeding. Among mothers who attempted exclusive breastfeeding, obesity indirectly or directly increased the overall prevalence of medically necessary formula by 33%.

Over recent years, breastfeeding has gained renewed significance in research and practice. Both in the United States and around the world, especially in poor countries that do not have easy access to quality healthcare, breastfeeding has been shown to dramatically and positively affect the health and lifespan of infants. However, there is still a low prevalence of effective breastfeeding practices universally. Even with the presence of global programs and goals that are geared toward exclusive breastfeeding habits, global rates are lower than what is desired. There are various determinants of breastfeeding that factor into a woman’s decision and practice of breastfeeding. Suggestions can further improve healthy breastfeeding practices, especially in the form of exclusive breastfeeding.

INTRODUCTION: Father support has recently been associated with increasing breastfeeding rates, but there is limited research on how the American father’s perspective of breastfeeding rates affect those rates. AIM: The aim of this study was to investigate the perspective American fathers have on breastfeeding and understand if it contributed to mothers’ decisions to initiate and continue exclusive breastfeeding for at least six months. METHODS: This study analyzed 10 semi-structured in-depth interviews conducted with both fathers and mothers of ever-breastfeed infants at least six months of age. Interviews were transcribed verbatim and openly coded to identify common themes, and then analyzed using principles of grounded theory. RESULTS: Results suggested that mothers were often the lead decision makers in the decision to breastfeed based on her prepartum knowledge of breastfeeding and its benefits. Many fathers had no prepartum perspective of breastfeeding, though they were not opposed to it. Those fathers who had prepartum opinions about breastfeeding traced their beliefs about breastfeeding to their families’ cultures or traditions. DISCUSSION: Data suggested that among this population of 30 – 44 year old educated, heterosexual married couples breastfeeding was common, but the recent increasing rates may not necessarily be influenced by the American father's perspective of breastfeeding.

Examining Exclusive Breastfeeding Practice in Indonesia, and its Association to Maternal Socio-demographic Determinants, to Inform Intervention Efforts Aimed at Reducing Infant Mortality Introduction Exclusive breastfeeding, the gold standard of infant feeding practices, has been identified as the single most effective strategy to improve child survival. However, this recommendation is not highly practiced in Indonesia, while Indonesia’s infant and under five mortality is still high. Interventions to promote, protect, and support breastfeeding practice are critical public health needs in Indonesia. Aim The current study examined socio-demographic factors associated with exclusive breastfeeding practice in Indonesia: whether maternal age, level of education, occupation status, wealth index, and region of residence, as well as breastfeeding initiation are associated with exclusive breastfeeding practice in Indonesia for mothers having infants up to age five months. Methods This study analyzed 1695 women having infant aged 0-5 month old data from the 2012 Indonesia Demographic Health Survey. Chi-square test was used for preliminary analysis and logistic regression analyses were used to primary analysis by using SAS 9.4 program. Results Exclusive breastfeeding practice in Indonesia was low (36.1%). Mothers aged 30-39 years old were more likely to exclusively breastfeed compare to mothers under 20 years old (OR=1.56, 95% CI 1.04-2.35). Mothers with high education level had higher odds to exclusively breastfeed compare to low education mothers. Unemployed mother were more likely to exclusively breastfeed than working mothers (OR=1.65, 95% CI 1.28-2.13). Mothers coming from richer wealth index were less likely to exclusively breastfeed compare to mothers having poorest wealth index (OR= 0.49, 95% CI 95% 0.34-0.72). Those who initiated breastfeeding early had increased odds to exclusively breastfeed than mothers who delayed breastfeeding initiation (OR=1.47 95% CI 1.19-1.83). Finally, mothers who lived in Eastern Indonesia were more likely to exclusively breastfeed compare to mothers who lived in Sumatera and Kalimantan (OR=1.82, 95% CI 1.30-2.55). Conclusion This study found characteristics of Indonesian mothers who were more likely to exclusively breastfeed compared to the reference group: aged 30-39 years old, high education level, unemployed, richer wealth index, and those who live in Eastern Indonesia; as well as, mother who initiate breastfeeding early. Having tailored strategies and interventions to targeted at-risk populations may increase the likelihood of exclusive breastfeeding practices, and ultimately, decreasing infant mortality rates in Indonesia.

Background: Formula supplementation of healthy, term, breastfed infants born to mothers who plan to exclusively breastfeed persists at high rates, in spite of global reduction efforts. The identification of modifiable risk factors for supplementation and effective nursing care for successful breastfeeding is understudied. Purpose: This study aimed to better understand the obstetrical, hospital, and nursing factors associated with supplementation during the hospital stay. The aims were: (1) examine the relationships between aspects of hospital care of infants who are supplemented compared to infants exclusively breastfed and (2) determine what in-hospital risk factors increase the odds of formula supplementation among a sample of breastfeeding infants. Methods: This was a retrospective analysis of prospectively collected data from the electronic medical record. The cohort was a 25% random sampling of term, healthy, singleton infants born to mothers planning exclusive breastfeeding at a large tertiary hospital between January and June 2015. Adjusted odds ratios and 95% confidence intervals was calculated using logistic regression. Results: Total sample was 1,023 with 222 (22%) supplemented. Most of the women were primiparous (88%) and 69% experienced a vaginal birth. Less than 50% of infants, reportedly initiated breastfeeding in the first hour after birth. If first breastfeed was after one hour, odds of supplementation increased to 1.42 (1.02, 1.96) Infants born to multiparous mothers had an OR 3.01 (1.95, 4.64) and similar odds were observed for women with a cesarean. Infants born during the evening hours had twice the odds of being supplemented compared to those born 6 am to noon (OR 2.10; 95% CI 1.30, 3.09). No other birth time periods showed a statistically significant increase. Mother-infant dyads who experienced a lactation consultation were more than three times as likely to be supplemented (OR 3.08 [1.88, 5.03]). Conclusions: Hospital policy to support attempts or initiation of breastfeeding in the first hour of life may help to reduce the odds for formula supplementation. Reducing the percentage of cesareans among healthy, women with uncomplicated pregnancies, may decrease odds for formula supplementation. The effect of the breastfeeding experience with the first birth on subsequent births needs more study.

Health organizations and institutions (e.g. WHO, UNICEF and the Indonesian Ministry of Health) overwhelmingly recommend breastfeeding, ideally for a period of at least six months, since it benefits both a baby and its mother. Although the practice has been widely recommended, the rate of women who exclusively breastfeed for six months in Indonesia is lower compared to elsewhere. This study empirically investigates the effects of framed-messages and source credibility on the intention to provide six months of exclusive breastfeeding in Indonesia. In building a model of these potential effects, Prospect Theory and the elaboration likelihood model (ELM) were relied on: Prospect Theory is the basis for explaining the effect of message framing; ELM is used as a framework for investigating the moderating effect of source credibility. Although the effects of framed-messages and source credibility on health behaviour in general have been assessed by scholars, no studies have investigated the effect on breastfeeding behaviour. To come to a more comprehensive understanding, the framework of the Theory of Planned Behaviour (TPB) was also used, enabling the relationship among relevant antecedents of behavioural intentions such as attitude, subjective norms, perceived behavioural control (PBC), and perceived value to be explored. To test these effects, this study proposed 17 hypotheses. The manipulation of message framing and source credibility followed a 2x2 factorial design. Data was collected from 279 Indonesian pregnant women and analysed by using Partial Least Squares and Analysis of Variance. Findings show that while message framing does not have a significant main effect on the variables under study, it does have significant effect when considered in conjunction with source credibility. Specifically, a positively-framed message with a high credibility source is the most effective combination to influence perceived value, attitude, PBC and the intention to provide exclusive breastfeeding. This finding supports both Prospect Theory and ELM. In terms of the relationships among behavioural intention, attitudes, perceived value, PBC and subjective norms, this study has shown that only attitudes and perceived value are predictors of intention to breastfeed. Furthermore, it was shown that perceived value and subjective norms have a significant effect on attitudes. Moreover, this study indicates that attitudes and perceived value partially mediate the interaction effect of message framing and source credibility on intention.

Breastfeeding is well established as the optimal feeding practice for all infants and is an innate healthy behavior for human beings. Although the breastfeeding initiation rate in Taiwan is high, the incidence and duration of exclusive breastfeeding does not meet the current recommendations. The aim of this study was to determine if a perinatal breastfeeding program (PBP), which included prenatal breastfeeding education, birth kangaroo mother care (BKMC) with the first breastfeeding, continuous 24-hour rooming-in, ongoing kangaroo mother care (KMC) with breastfeeding on cue, and hospital support visits, would improve breastfeeding outcomes for low risk, primiparous mothers who give birth vaginally to healthy full-term infants at a Baby-Friendly Hospital in southern Taiwan. This study was based on the nonseparation innate mutual self-regulation model, which is adapted from Anderson’s mutual caregiving model (Anderson, 1977) and Dennis’s breastfeeding self-efficacy framework (Dennis, 1999).The repeated measures longitudinal study used a quasi-experimental cohort design, with the control group receiving current care studied first, following by the experimental group receiving the PBP at a Baby-Friendly Hospital in southern Taiwan. The research concepts included initial breastfeeding experiences (IBE), psychophysiological breastfeeding outcomes, and incidence of exclusive breastfeeding. Three psychophysiological breastfeeding outcomes were examined: perceived onset of lactation (POL), perceived milk supply (PMS), and maternal breastfeeding self-efficacy (MBSE). The major outcome of interest was incidence of exclusive breastfeeding at hospital discharge and one month postpartum.Mothers were contacted at 34-37 weeks’ gestation. Data collection points were: prenatal, hospital discharge, and one month postpartum. A total of 60 mother-infant dyads (control = 30, experimental = 30) were included. Mothers who participated in the PBP had a greater incidence of exclusive breastfeeding (x2= 13.32, p < .01), higher ratings of their initial breastfeeding experiences (t = -3.85, p < .001), and more positive psychophysiological breastfeeding outcomes (POL: t = 2.20, p = .03; PMS: x2 = 30.01, p < .001; MBSE: t = -4.41, p < .001) when compared to mothers in the control group at hospital discharge. Positive initial breastfeeding experiences, maternal perceived early onset of lactation and sufficient milk supply, and a higher maternal breastfeeding self-efficacy score were significantly associated with greater incidence of exclusive breastfeeding.The multistrategy interventions that were included in the PBP are closed linked. Based on the findings and conclusions, it is recommended that the infants should stay with their mothers from BKMC with the first breastfeeding to ongoing KMC with breastfeeding on cue. It is also clear that delivery room and postpartum ward routines should be designed so as to not disturb the mother/infant relationship. The results of this study have supported previous research findings and provide initial evidence to support the implementation of mother-infant nonseparation practices (skin-to-skin contact) in improving breastfeeding outcomes in Taiwan.

วัตถุประสงค์: เพื่อศึกษาอำนาจในการทำนายของ รายได้ ระดับการศึกษา ทัศนคติ การสนับสนุนการเลี้ยงลูกด้วยนมแม่ ระยะเวลาที่ลาคลอด และชั่วโมงการทำงานต่อการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 เดือนในมารดาที่ทำงานนอกบ้าน รูปแบบการวิจัย: การศึกษาวิจัยเชิงทำนาย วิธีดำเนินการวิจัย: กลุ่มตัวอย่างเป็นมารดาหลังคลอดที่กลับไปทำงานนอกบ้านที่มีบุตรอายุ 6 เดือน ถึง 1 ปี ที่มารับบริการที่คลินิกสุขภาพเด็กดี โรงพยาบาลสระบุรี โรงพยาบาลพระพุทธบาท และโรงพยาบาลพระนารายณ์มหาราช จำนวน 182 ราย เก็บรวบรวมข้อมูลโดยใช้ แบบสัมภาษณ์ข้อมูลส่วนบุคคล แบบสอบถามทัศนคติเกี่ยวกับการเลี้ยงลูกด้วยนมแม่ แบบสอบถามการรับรู้การสนับสนุนการเลี้ยงลูกด้วยนมแม่ แบบสัมภาษณ์การให้อาหารทารก วิเคราะห์ข้อมูลโดยสถิติพรรณาและสถิติถดถอยโลจิสติค ผลการวิจัย: รายได้ ระดับการศึกษา ทัศนคติ การสนับสนุนการเลี้ยงลูกด้วยนมแม่ ระยะเวลาที่ลาคลอด และชั่วโมงการทำงาน สามารถร่วมกันทำนายความสำเร็จในการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 เดือน ได้ร้อยละ 43.90 (R2 = .439, p < .05) แต่มีเพียง 2 ปัจจัยที่สามารถทำนายการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 เดือนในมารดาที่ทำงานนอกบ้านได้อย่างมีนัยสำคัญทางสถิติ คือ ทัศนคติ (OR = 1.149, 95%CI = 1.075, 1.228, p < .001) และระยะเวลาที่ลาคลอด (OR = 2.903, 95%CI = 1.327, 6.350, p = .008) สรุปและข้อเสนอแนะ: ทัศนคติ และระยะเวลาที่ลาคลอดมีอิทธิพลต่อการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 เดือน ในมารดาที่ทำงานนอกบ้าน จึงมีข้อเสนอแนะว่า บุคลากรทางการแพทย์โดยเฉพาะพยาบาลควรมีบทบาทในการเสริมสร้างทัศนคติที่ดีต่อการเลี้ยงลูกด้วยนมแม่ให้กับมารดาและครอบครัว รวมทั้งร่วมผลักดันนโยบายสนับสนุนการเลี้ยงลูกด้วยนมแม่ และให้มารดาหลังคลอดที่ทำงานสามารถลาคลอดได้นานกว่า 90 วัน

วัตถุประสงค์: เพื่อศึกษาอำนาจการทำนายของ อายุ ความรู้เกี่ยวกับการเลี้ยงลูกด้วยนมแม่ ความเชื่อทางวัฒนธรรม การสนับสนุนการเลี้ยงลูกด้วยนมแม่ และการเข้าถึงบริการ ต่อการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 สัปดาห์ในมารดาหลังคลอดชาวเขา รูปแบบการวิจัย: การศึกษาความสัมพันธ์เชิงทํานาย วิธีดำเนินการวิจัย: กลุ่มตัวอย่างเป็นมารดาหลังคลอดชาวเขาที่รับการตรวจหลังคลอด ณ โรงพยาบาลอมก๋อย จังหวัดเชียงใหม่ และโรงพยาบาลแม่สะเรียง จังหวัดแม่ฮ่องสอน จำนวน 177 ราย โดยใช้เครื่องมือแบบสอบถามข้อมูลส่วนบุคคล แบบสอบถามความรู้เกี่ยวกับการเลี้ยงลูกด้วยนมแม่ แบบสอบถามความเชื่อทางวัฒนธรรม แบบสอบถามการสนับสนุนการเลี้ยงลูกด้วยนมแม่ แบบสอบถามการเข้าถึงบริการ และแบบสัมภาษณ์การเลี้ยงลูกด้วยนมแม่ วิเคราะห์ข้อมูลโดยใช้สถิติพรรณาและสถิติถดถอยโลจิสติก ผลการวิจัย: ผลการศึกษาพบว่าอายุ ความรู้เกี่ยวกับการเลี้ยงลูกด้วยนมแม่ ความเชื่อทางวัฒนธรรม การสนับสนุนการเลี้ยงลูกด้วยนมแม่ และการเข้าถึงบริการ สามารถร่วมกันทำนายการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 สัปดาห์ในมารดาหลังคลอดชาวเขาได้อย่างมีนัยสำคัญทางสถิติ ร้อยละ 9 (p < .05, Nagelkerke R2 = .09) โดยการเข้าถึงบริการเป็นเพียงตัวแปรเดียวที่สามารถทำนายการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 สัปดาห์ในมารดาหลังคลอดชาวเขาได้อย่างมีนัยสำคัญทางสถิติ (Exp(B) = 4.60, 95%CI = 1.07, 19.83, p < .05) สรุปและข้อเสนอแนะ: การเข้าถึงบริการช่วยให้มารดาหลังคลอดชาวเขาประสบผลสำเร็จในการเลี้ยงลูกด้วยนมแม่อย่างเดียว ดังนั้นพยาบาลผดุงครรภ์ควรเพิ่มช่องทางการติดต่อสื่อสาร เพื่อให้มารดาหลังคลอดชาวเขาที่มีปัญหาเกี่ยวกับการเลี้ยงลูกด้วยนมแม่ สามารถเข้าปรึกษาปัญหาได้และให้คำแนะนำและส่งเสริมการเลี้ยงลูกด้วยนมแม่อย่างเดียวในมารดาหลังคลอดชาวเขา

วัตถุประสงค์: การศึกษาครั้งนี้เป็นการศึกษาอิทธิพลของปัจจัยส่วนบุคคล ดัชนีมวลกาย ทัศนคติ การสนับสนุนทางสังคมต่อการเลี้ยงลูกด้วยนมแม่อย่างเดียว 4 สัปดาห์ในมารดาหลังคลอด รูปแบบการวิจัย: การศึกษาวิจัยเชิงทำนาย วิธีดำเนินการวิจัย: กลุ่มตัวอย่างเป็นมารดาที่เข้ารับการตรวจหลังคลอดที่โรงพยาบาลมหาวิทยาลัย 2 แห่ง จำนวน 107 ราย เก็บรวบรวมข้อมูลโดยใช้แบบสอบถามข้อมูลส่วนบุคคล แบบสอบถามทัศนคติเกี่ยวกับการเลี้ยงลูกด้วยนมแม่ แบบสอบถามการสนับสนุนการเลี้ยงลูกด้วยนมแม่จากสมาชิกในครอบครัว และแบบสัมภาษณ์ระยะเวลาการเลี้ยงลูกด้วยนมแม่อย่างเดียว วิเคราะห์ข้อมูลโดยการคำนวณค่าร้อยละ ค่าเฉลี่ย ส่วนเบี่ยงเบนมาตรฐาน และสถิติถดถอยโลจิสติค ผลการวิจัย: อายุ การคลอดบุตร ดัชนีมวลกาย ทัศนคติ และการสนับสนุนทางสังคมจากสมาชิกในครอบครัว สามารถร่วมกันทำนายโอกาสในการเลี้ยงลูกด้วยนมแม่อย่างเดียว 4 สัปดาห์ได้ร้อยละ 14 (Nagelkerke R2 = .14) โดยมี 2 ปัจจัยที่สามารถทำนายการเลี้ยงลูกด้วยนมแม่อย่างเดียว 4 สัปดาห์ในมารดาหลังคลอดได้อย่างมีนัยสำคัญทางสถิติ คือ อายุ (OR = .88, 95%CI = .80, .97, p < .05) และทัศนคติเกี่ยวกับการเลี้ยงลูกด้วยนมแม่ (OR = 1.15, 95%CI = 1.02, 1.29, p < .05) สรุปและข้อเสนอแนะ: อายุ และทัศนคติเกี่ยวกับการเลี้ยงลูกด้วยนมแม่ช่วยเพิ่มโอกาสของการเลี้ยงลูกด้วยนมแม่อย่างเดียว 4 สัปดาห์ในมารดาหลังคลอดได้ จากผลการศึกษาครั้งนี้มีข้อเสนอแนะว่า พยาบาลควรให้การพยาบาลด้วยความเอาใจใส่ และมีเวลาให้กับมารดาหลังคลอด โดยเฉพาะในมารดาที่มีอายุมาก และเสริมสร้างทัศนคติที่ดีเกี่ยวกับการเลี้ยงลูกด้วยนมแม่ให้กับมารดาหลังคลอด

วัตถุประสงค์: เพื่อศึกษาผลของการวางทารกแรกเกิดบนอกมารดาแบบเนื้อแนบเนื้อภายหลังคลอดโดยเร็ว ต่อประสิทธิภาพการดูดนมของทารกก่อนจำหน่ายและการเลี้ยงลูกด้วยนมแม่อย่างเดียวนาน 1 เดือน รูปแบบการวิจัย: การวิจัยเชิงทดลองแบบสุ่มมีกลุ่มควบคุม (แบบปกปิดสองทาง) วิธีดำเนินการวิจัย: กลุ่มตัวอย่างเป็นมารดาและทารกแรกเกิดจำนวน 59 คู่ โดยกำหนดให้เป็นมารดาที่มีบุตรคนแรก อายุตั้งแต่ 18 ปี และน้อยกว่า 35 ปี ตั้งครรภ์ครบกำหนด และคลอดปกติ ณ โรงพยาบาลของรัฐแห่งหนึ่งในกรุงเทพมหานคร มารดาทารกจำนวน 64 คู่ถูกสุ่มเข้ากลุ่มที่ศึกษาสองกลุ่ม เมื่อสิ้นสุดการศึกษามี 30 คู่ในกลุ่มควบคุม และ 29 คู่ในกลุ่มทดลอง กลุ่มควบคุมได้รับการดูแลตามปกติ และกลุ่มทดลองได้รับการดูแลด้วยวิธีวางทารกแรกเกิดบนอกมารดาแบบเนื้อแนบเนื้อภายใน 5 นาทีหลังคลอด นานอย่างน้อย 1 ชั่วโมง เก็บรวบรวมข้อมูลโดยใช้เครื่องมือ 5 ชุด ได้แก่ แบบสัมภาษณ์ข้อมูลส่วนบุคคล แบบบันทึกข้อมูลการตั้งครรภ์และคลอด แบบบันทึกการให้นมทารก แบบประเมินประสิทธิภาพการดูดนมของทารก และแบบสัมภาษณ์การให้อาหารทารก วิเคราะห์ข้อมูลโดยใช้สถิติพรรณาและไคสแควร์ ผลการวิจัย: กลุ่มทดลองมีสัดส่วนทารกที่ดูดนมมารดาได้มีประสิทธิภาพเมื่อจำหน่ายออกจากโรงพยาบาลมากกว่ากลุ่มควบคุมอย่างมีนัยสำคัญทางสถิติ (p < .05) แต่อัตราการเลี้ยงลูกด้วยนมแม่อย่างเดียวภายหลังคลอด 1 เดือนไม่แตกต่างกันที่ระดับนัยสำคัญ .05 สรุปและข้อเสนอแนะ: พยาบาลผดุงครรภ์ควรนำวิธีการวางทารกบนอกมารดาโดยเร็วหลังคลอดเป็นเวลาอย่างน้อย 1 ชั่วโมง ไปใช้ในการเริ่มต้นเลี้ยงลูกด้วยนมแม่ระยะแรกในห้องคลอด เนื่องจากสามารถเพิ่มประสิทธิภาพการดูดนมของทารกก่อนออกจากโรงพยาบาลได้