Background
Methods
Aim
Design
Setting
Sample
Data collection
Measures
Quantitative data
Data analysis
Quantitative data
Qualitative data
Results
Quantitative results
Total (n = 543) | |
---|---|
Mother’s age (years) (Mean ± SD) | 24.16 ± 6.17 |
Gestational age (weeks) (Mean ± SD) | 38.8 ± 1.29 |
Type of delivery (%) | |
Cesarean section | 260 (47.88) |
Vaginal | 283 (52.12) |
Parity (Number of children) (%) | |
None | 241 (44.38) |
1 | 158 (29.10) |
2 or more | 144 (26.52) |
Indigenousb (yes) (%) | 34 (6.27) |
Educational level (%) | |
Less than high school | 303 (57.28) |
High school or similar | 162 (30.62) |
Undergraduate or more | 64 (12.10) |
Employment statusc (%) | |
Formal work | 125 (23.06) |
Informal work | 41 (7.56) |
Student | 68 (12.55) |
Housewife | 308 (56.83) |
Type of healthcare institution (%) | |
Mexican Social Security | 236 (43.46) |
Ministry of Health | 240 (44.20) |
Private | 67 (12.34) |
Area of residenced (%) | |
Urban | 347 (73.30) |
Rural | 196 (26.70) |
State (%) | |
Chihuahua | 272 (50.09) |
Puebla | 271 (49.91) |
Infant feeding practices
Healthcare unit | Maternal age | Type of birth | Place of residence | Total | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Hospital data and infant feeding practices | Public (n = 476) | Private (n = 67) | P value | Adolescents (n = 123) | Adults (n = 420) | P value | Vaginal (n = 283) | Cesarean (n = 260) | P value | Urban (n = 347) | Rural (n = 196) | P value | |
Birthweight (kg) (mean ± SD) | 3.17 ± 0.38 | 3.13 ± 0.32 | 0.43 | 3.10 ± 0.36 | 3.18 ± 0.38 | 0.04 | 3.14 ± 0.38 | 3.19 ± 0.37 | 0.12 | 3.17 ± 0.39 | 3.15 ± 0.39 | 0.69 | 3.16 ± 0.39 |
Gestational age (38–40 wks) | 89.08 | 92.54 | 0.63 | 91.87 | 88.81 | 0.33 | 90.11 | 88.85 | 0.89 | 88.18 | 91.84 | 0.33 | 89.50 |
Knowledge of breastfeeding support groups (yes) | 14.95 | 14.93 | 0.99 | 8.13 | 16.95 | 0.01 | 16.25 | 13.51 | 0.37 | 17.34 | 10.71 | 0.03 | 14.94 |
Attended breastfeeding support group (yes) | 63.38 | 80.00 | 0.30 | 60.00 | 66.20 | 0.70 | 60.87 | 71.43 | 0.32 | 65.00 | 66.67 | 0.89 | 65.43 |
Health personnel advising on breastfeeding | |||||||||||||
Doctor | 42.62 | 50.00 | 0.23 | 63.64 | 39.29 | 0.31 | 50.00 | 35.48 | 0.48 | 47.62 | 36.00 | 0.06 | 43.28 |
Nurse | 39.34 | 16.67 | 36.36 | 37.50 | 27.78 | 48.39 | 26.19 | 56.00 | 37.31 | ||||
Health promoter or assistant | 6.56 | 0 | 0 | 7.14 | 8.33 | 3.23 | 7.14 | 4.00 | 5.97 | ||||
Other (nutritionist, social worker, midwife, psychologist or a combination of them) | 9.84 | 16.67 | 0 | 12.50 | 11.11 | 9.68 | 16.67 | 0 | 10.45 | ||||
Doesn’t know | 1.64 | 16.67 | 0 | 3.57 | 2.78 | 3.23 | 2.38 | 4.00 | 2.99 | ||||
Timely initiation of breastfeeding (< 60 min) | 52.21 | 29.85 | 0.004 | 58.54 | 46.78 | 0.05 | 62.19 | 35.52 | 0.0001 | 41.91 | 62.76 | 0.0001 | 49.45 |
Rooming-in (Yes) | 96.21 | 97.01 | 0.74 | 93.50 | 97.14 | 0.06 | 96.11 | 96.53 | 0.79 | 97.98 | 93.37 | 0.006 | 96.31 |
Baby was given formula in the hospital (Yes) | 33.89 | 40.30 | 0.30 | 30.08 | 36.04 | 0.22 | 28.27 | 41.70 | 0.001 | 45.95 | 14.80 | 0.0001 | 34.69 |
Mother had breastfed her baby at least once at the time of discharge from the hospital (Yes) | 96.08 | 84.75 | 0.0001 | 93.81 | 95.00 | 0.61 | 95.75 | 93.59 | 0.28 | 93.35 | 97.18 | 0.06 | 94.73 |
Breastfeeding since mother left the hospital, to one-month postpartum (Yes) | 99.08 | 96.61 | 0.10 | 100.00 | 98.42 | 0.17 | 98.46 | 99.15 | 0.48 | 98.10 | 100.00 | 0.06 | 98.78 |
EBF at one month postpartum | 48.03 | 21.05 | < 0.01 | 24.78 | 50.93 | < 0.01 | 46.48 | 43.10 | 0.45 | 36.98 | 58.76 | 0.0001 | 44.88 |
(n = 166) | (n = 36) | (n = 57) | (n = 145) | (n = 91) | (n = 109) | (n = 151) | (n = 51) | (n = 201) | |||||
Infant formula feeding at one month postpartum | 44.35 | 74.47 | 0.0001 | 66.67 | 42.99 | 0.0001 | 43.33 | 52.15 | 0.07 | 56.60 | 32.47 | 0.0001 | 47.73 |
Information on breastfeeding during pregnancy (Scale: 0–10) | 6.18 ± 3.30 | 5.00 ± 3.39 | 0.006 | 5.02 ± 3.17 | 6.33 ± 3.32 | 0.0001 | 6.08 ± 3.24 | 5.98 ± 3.43 | 0.74 | 6.06 ± 3.26 | 5.99 ± 3.45 | 0.82 | 6.03 ± 3.33 |
Techniques for breastfeeding initiation | 55.30 | 42.30 | 0.06 | 46.34 | 57.04 | 0.03 | 52.90 | 54.40 | 0.74 | 56.07 | 52.04 | 0.36 | 54.61 |
Techniques for breastfeeding maintenance | 43.50 | 22.00 | 0.002 | 25.20 | 44.87 | 0.0001 | 42.40 | 39.30 | 0.47 | 40.46 | 40.31 | 0.97 | 40.41 |
Support to maintain breastfeeding at one month postpartum | |||||||||||||
Health providers | 17.92 | 21.74 | 0.66 | 16.67 | 18.92 | 0.05 | 16.13 | 20.39 | 0.27 | 9.80 | 21.38 | 0.38 | 18.37 |
Partner or spouse | 11.56 | 4.35 | 0 | 14.19 | 10.75 | 10.68 | 13.73 | 9.66 | 10.71 | ||||
Mothers /mothers in law of participants | 48.55 | 43.48 | 58.33 | 44.59 | 54.84 | 41.75 | 50.98 | 46.90 | 47.96 | ||||
Family/friends | 20.81 | 30.43 | 25.00 | 20.95 | 18.28 | 25.24 | 23.53 | 21.38 | 21.94 | ||||
Otherb | 1.16 | 0 | 0 | 1.35 | 0 | 1.94 | 1.96 | 0.69 | 1.02 |
Received breastfeeding information and support
Factors related to initiation, continuation or cessation of breastfeeding
Timely initiation (< 1 h) (n = 479) | EBF (n = 484) | Infant formula use (n = 411) | ||||
---|---|---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | |
Age group (adult women)a | 0.95 (0.92;0.98) | 0.006 | 1.05 (1.02;1.09) | 0.001 | 0.93 (0.90;0.97) | 0.001 |
Indigenous ethnicity (yes) | 0.84 (0.56;1.25) | 0.39 | 1.18 (0.79;1.77) | 0.41 | 0.66 (0.42;1.04) | 0.07 |
Educational level (Secondary or less) | 1.12 (0.74;1.71) | 0.56 | 0.91 (0.59;1.40) | 0.67 | 0.87 (0.55;1.39) | 0.58 |
Marital status (yes) | 0.63 (0.33;1.18) | 0.15 | 1.47 (0.77;2.84) | 0.23 | 0.72 (0.35;1.47) | 0.37 |
Employment (yes) | 0.79 (0.52;1.21) | 0.29 | 0.77 (0.50;1.19) | 0.25 | 1.19 (0.74;1.89) | 0.46 |
Timely initiation (< 1 h) | – | – | 1.81 (1.19;.2.75) | 0.005 | 0.46 (0.29;0.73) | 0.001 |
Type of delivery (cesarean) | 0.37 (0.25;0.54) | 0.0001 | 1.18 (0.78;1.79) | 0.41 | 1.06 (0.68;1.65) | 0.78 |
Type of health unit (private) | 0.48 (0.24;0.94) | 0.03 | 0.48 (0.23;1.00) | 0.05 | 1.95 (0.91;4.16) | 0.08 |
Area of residence (urban) | 0.60 (0.39;0.93) | 0.02 | 0.47 (0.30;0.72) | 0.001 | 2.27 (1.40;3.66) | 0.001 |
Breastfeeding information during pregnancy (Scale: 0 to 9) | 1.07 (1.01;1.14) | 0.01 | 1.13 (1.06;1.20) | 0.0001 | 0.88 (0.82;0.94) | 0.001 |
Qualitative results
Category | Quotations | Category | Quotations |
---|---|---|---|
Immediate Postpartum period | One month postpartum period | ||
Meaning and concept of breastfeeding and EBF | [the child can] grow up with breastmilk, so they grow healthy and strong, because it prevents diseases for him and me. (CHIMSSR03) … well, the mother transfers all the vitamins to the baby. (CHIMSSR08) | Information from health personnel to maintain the breastfeeding at home | Uh, no. They did not say anything to me. They did not even give me a diet. (PIMSSR87) … to nurse my baby as much as I could … they gave me positions like in the form of holding a ball, the common one, which is lying down and that’s it. (CHIMSSU06) |
Information and knowledge about breastfeeding in the hospital | Well, that helps both me and my baby and what it is for … I have been told that right now, that since she (the baby) is little, the best thing is breastmilk. And it’s like a vaccine that helps her develop and I also have to give, well, I can breastfeed up to 6 months and from 6 months to 2 years (give her) breastmilk and a balanced diet. (PSSAR25) … they have told me not to eat irritating foods, … to keep a balanced diet, to drink plenty of water or plenty of fluids during the day … to drink something, even water before breastfeeding the baby. (CHSSAR35) | Difficulties for breastfeeding at home | Of course, I would like to fill him up myself. (CHIMSSU57) Mm, no, I have thought about giving her the powder, because I want to go out with my husband, because it is required to go out with your partner. I mean, I want to give her powdered milk to leave her with my sister. (CHIMSSR39) It was difficult because I had a lot of pain. (CHSSAU55) That they would teach me because I did not know anything at the beginning. (CHPR05) |
Indication of infant formula use | Yes, the pediatrician of the evening [shift] told me to start with NAN1. (CHIMSSU57) Yesterday afternoon a doctor gave him formula because he (baby) was not filling up. (CHIMMSR11) A nurse, because last night that I breastfed her she did not get full and so they complemented. (CHIMSSU06) | Facilitators for breastfeeding at home | Well, I do not spend money and (the baby) is well fed. (CHIMSSR20) I do not have to prepare the portions or heat water. (CHIMSSR39) Well, I do not carry bottles and milk, and I do not have to get up at night to warm up milk. (CHIMSSU61) Right now, not because its easy for me, when she asks for it... well, the fact that I’m here, that I do not work and I have peace of mind and I do not find it annoying. (CHIMSSU61) Well, I almost always give him lying down, when I’m out in the street, I hold him inclined. [I do it because] well, they told me that children grow healthier and stronger and avoid diseases. (CHPR01) Sometimes my husband helps me to put the baby to the breast. (CHSSAU53) |
Reasons (“motivating factors”) for giving or not giving infant formula | [Reasons for not giving formula] I have been told that bottles are bad, because they hurt their teeth and can give your baby colic. (PIMSSU66) [Reasons for giving formula] I think it was a decision of the pediatrician because they took him to the incubator and said that the most advisable thing was to give him formula. [the baby was] 3 h (in the incubator) because he lacked a little oxygen. (PPR86) | Perception of recommendations/ Opportunities to practice breastfeeding | Good, it (breastfeeding) helped me put off some weight, because I gained almost the 19.8 pounds that are recommended. Well, I weighed 143.3 pounds and they tell me that I need to lose more (PIMSSR87). It’s cool because we can see the gestures the baby makes. (CHSSAR03) Well, do not despair when breastfeeding, because one still does not know how to place the baby. I learned alone to attach the baby, I put a cushion on my arm and shape my nipple. I make sure I am not holding him too tight so that he (the baby) does not suffocate. I make sure that he has the entire nipple in his mouth. Well, eating regularly, because I neglected myself a lot. (CHPR06) Well, give him breastmilk … to grow healthy, and milk is the first vaccine the baby receives. And when you are breastfeeding, you are cutting off the bleeding. (CHSSAR30) |
Facilitators to start breastfeeding in hospital stay | … I have hospital gowns, they are comfortable, so there is not as much struggle to give him breast. (CHIMSSR08) Well, that the nurses and people (family) explain to me how to breastfeed my baby … well, [to have] a pillow and the bed. (CHSSAU35) |
Facilitators | Barriers |
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Immediate postpartum | |
a) Knowledge of breastfeeding emotional and physical benefits and techniques (information received during pregnancy) b) Breastfeeding counseling | a) BMS promotion b) Maternal and child hospital care practices (breastfeeding initiation after one hour after birth, infant formula feeding during first hour after birth, birth by cesarean section) c) Lack of support to women to initiate breastfeeding at hospital d) Lack of information about techniques to initiate and maintain breastfeeding |
One month postpartum | |
a) Knowledge of side effects of BMS b) Receiving information about breastfeeding during pregnancy c) Experiencing breastfeeding benefits d) Appreciation of breastfeeding practicality e) Appreciation of monetary savings with breastfeeding f) Family support (grandmothers, partner and other family members) | a) Milk insufficiency syndrome (perceived insufficient milk production) b) Belief that BMS complement breastfeeding c) BMS recommendation by health personnel and family members d) Sore/ cracked nipples e) Absence of breastfeeding counseling |