Quasi-Experimental Longitudinal Cohort of the Perinatal Breastfeeding Program (PBP): Effects on Breastfeeding Outcomes in Taiwan

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.