Knowledge, attitude, and practice of techniques of breastfeeding among new mothe

Himanshu VERMA, Sirshti SINGH,Nitika BAHUGUNA, Mukul DAHIYA, Jyoti SHAH

1Department of Otolaryngology, Speech and Hearing Unit,PGIMER, Chandigarh, India; 2Department of Swallowing Service, Amrita Vishwa Vidhyapeetham, Kollam, Kerala, India;3Department of Speech Pathology, Sarthak Educational Trust,New Delhi, India; 4Ashtavakra Institute of Rehabilitation Sciences and Research, Delhi, India; 5Speech-Swallowing and Hearing Care Clinic, New Delhi, India; 6Department of Audiology and Speech-Pathology, Saroj Hospital, New Delhi, India

ABSTRACT

Objective:The present study aims to evaluate aims to assess the knowledge, attitude, and practice of primiparous mothers in the immediate postpartum period regarding breastfeeding techniques which will be helpful in forming awareness and training programs.

Materials and Methods:A cross-sectional survey was used.A total of 120 primiparous mothers with a mean age of 24.92 years participated in the survey and filled the questionnaire related to the knowledge, attitude, and practice of techniques of breastfeeding.

Results:Results revealed that 48.3% of new mothers were not aware of the correct techniques to initiate breastfeeding, whereas 68.3% of subjects reported that during latching, the baby’s upper and lower lip should be everted.The majority of new mothers were aware of breastfeeding techniques with some misconceptions as in our culture, most of the breastfeeding information passed from generation to generation.

Conclusion:The level of awareness about feeding skills among primiparous mothers can be further improved by antenatal counseling or training from health-care workers during the gestational period.This will further help new mothers to educate and will provide adequate information which will decrease the myths.

Keywords:Breastfeeding, breastfeeding techniques, lactation, primiparous mother

INTRODUCTION

Maternal bond develops between the mother and her baby from the news of pregnancy, and when the baby is born, it gives an overwhelming sense of love and joy to the mother.The first contact between mother and baby begins with the breastfeeding process.Breastfeeding is nature’s very own way to nurture a newborn, and it is a precious gift to the mother.According to the National Institute of Child Health and Human Development,[1]breastfeeding is the process of feeding human breast milk to an infant, either directly from the breast or by expressing (pumping out) the milk from the breast and bottle-feeding it to the infant.The World Health Organization and United Nations Children’s Fund[2]in the year 2003 and the American Academy of Pediatrics[3]recommended that breastfeeding should begin within the 1sth of infant life.They further stated that breastfeeding should be exclusive for the first 6 months of life as it provides immunity to infants and protects mothers from many health issues (e.g., breast cancer).James and Lessen[4]reported that breastfeeding helps in reducing the risk of otitis media,gastroenteritis, respiratory illness, necrotizing enterocolitis,hypertension, obesity, and sudden infant death syndrome.Studies reported that breastfeeding helps in releasing oxytocin and prolactin due to skin-to-skin contact that relaxes the mother and protects the mother against postnatal depression.[5,6]Increased oxytocin hormone levels make the uterus contract and return to its normal size more quickly.[5,7]

Earlier it was taboo to talk about breastfeeding in families,and knowledge related to this had been passed from older ladies of families to new mothers.From the last few decades,communication and information strategies have been changed.People are inclined toward health and nutrition for both child and mother.Many organizations and health-care workers are already working for awareness about feeding techniques and issues caused if children are not fed properly.Several factors comprise appropriate feeding techniques such as correct time of initiation of feeding, latching, and mothers’ position while feeding.Inappropriate breastfeeding techniques such as delay in breastfeeding initiation and improper feeding may fail lactation and deprive neonates of the natural passive immunity that milk provides.A decreased level of natural passive immunity in neonates may lead to hypoglycemic seizures, resulting in sensory and cognitive developments.[8]In the same way, inappropriate feeding techniques also affect the health of the new mothers.Many awareness programs and studies were reported in past literature to prevent health issues in new mothers and neonates due to inappropriate feeding techniques.A recent study was conducted on the island of Abu Dhabi to assess the knowledge, attitude, and practice of breastfeeding among visiting primary health care clinics and revealed that women had good knowledge about breastfeeding, but breastfeeding practice was suboptimal.[9]Kitiyoetal.[10]in Kenya, Elmougyetal.[11]in Saudi Arabia, and Alamirewetal.[12]in Northwest Ethiopia reported that most of the new mothers had good knowledge and a positive attitude toward breastfeeding;however, breastfeeding practice was low.

Dallaketal.[13]in Sana’s city and Bush[14]in Sarawak, Malaysia,conducted a study among mothers about knowledge and awareness of breastfeeding.The result revealed that most mothers lacked knowledge about breastfeeding, hence,a lack of breastfeeding practice.In India, Tellaetal.[15]conducted a study among 118 postnatal mothers in the coastal district of Karnataka regarding the knowledge and breastfeeding practice.They revealed Indian women had a good level of knowledge about breastfeeding skills and had good breastfeeding practices.However, they had suboptimal knowledge of good breastfeeding techniques,which improved with some basic training and counseling.Pandeyetal.[16]conducted a study of comparing the knowledge level and attitude toward breastfeeding between the two generations in the Manipal city of Karnataka and revealed that both generations had a high level of awareness about breastfeeding, but their attitude toward practicing breastfeeding was lacking.Upadhyeetal.[17]surveyed postnatal mothers of Central India regarding breastfeeding practice and found a good level of breastfeeding practice.They further reported that antenatal counseling about breastfeeding could help increase good breastfeeding practice.

Feeding is essential for boosting a baby’s immune system.If feeding is not done properly, it may result in a lack of nourishment, leading to malnourishment, and failure of lactation.It may also harm the mother as well as babies health.From past literature, we can conclude that several studies were conducted on breastfeeding with diverse results.The majority of studies revealed that people are not much aware of feeding techniques and skills due to a lack of resources.Therefore, the present study is an attempt to evaluate the awareness and attitude and practice about breastfeeding skills among primiparous mothers, which will help form an awareness and training program if required.

MATERIALS AND METHODS

Study design

A cross-sectional survey was used.

Participants

In the present study, a total of 120 primiparous women with the mean age of 24.9 ± 23.36 years (range 19-33 years)participated from five different government hospitals.All participants had a full-term normal vaginal delivery with no history of complications during pregnancy.All neonates had adequate birth weight, birth cry, and no other health issues.Of all, 20 subjects were educated (i.e., had secondary or higher-level education) and 100 were uneducated.The majority of subjects received antenatal advice from older women at home.

Inclusion and exclusion criteria

Only mothers with full-term vaginal delivery and not more than 3 days postpartum period were included in the study.Mothers with any delivery complications or neonates with any health complications were excluded from the present study.

Study tools

A detailed case history was taken, including the demographic details, detailed about the antenatal advice if given,gestational age, any complication during pregnancy,medication, delivery mode, birth cry, birth weight, and any other complication during delivery.We used the closed-end questionnaire from the research work of Tellaetal.[15]to assess the knowledge, attitude, and practice of breastfeeding techniques among new mothers.This questionnaire is divided into four sections.The first section consists of one question related to the initiation of breastfeeding.The second section consists of five questions concerned with latching.The third section includes three questions related to the mother position during breastfeeding.The last section includes three questions regarding postfeeding techniques.

Procedure

Before collecting the study’s data, the study was explained to the subjects, and informed consent was taken.Initially,detailed case history was taken from all the participants using the interview method, and the questionnaire was provided to all the subjects.Assistance was provided to the uneducated subjects.There was no time limitation to complete the questionnaire.

Statistical analysis

The data were arranged in an Excel sheet.Percentage,mean score, and standard deviation were computed using descriptive analysis on SPSS software 20.00 version (IBM,Armonk, New York, USA).

Ethical considerations

Ethical approval for this study was exempt according to the guidelines of Ashtavakra Institute of Rehabilitation Sciences and Research (AIRSR), Branch of Tecnia, Delhi, but the present study was conducted as per the ethical guidelines of the institute and the researchers strived to do no harm to the participants.The written informed consent was taken from all the participants.

RESULTS

Section A:Initiation of breastfeeding

A total of 62 (51.7%) participants reported that they would initiate breastfeeding by placing the nipple between the baby’s upper lip and nose and by gently brushing her upper lip with the nipple and encourage the baby to open her mouth wide with skin-to-skin which is the correct procedure to initiate feeding.However, 58 (48.3%) new mothers were not aware of the correct techniques to initiate breastfeeding.They reported that they would initiate feeding by holding the nipple within the fingers and pushing the nipple into the baby’s mouth with skin-to-skin contact.

Section B:Latching

Among 120 participants, 36 (30.0%) subjects selected“palmar grasp hold (C-hold)” as a comfortable hold for latching, whereas 84 (70.0%) mothers selected “scissor grasp hold (V-hold)” as a comfortable hold for latching, which is an incorrect method of hold.A total of 26 (21.7%) mothers reported that nipples should be placed exclusively in the baby’s mouth, and 94 (78.3%) subjects selected that nipple,areola, and ½ of the breast must be placed inside the mouth.Eighty-two (68.3%) subjects reported that during latching,the baby’s upper and lower lip should be everted, which is the correct technique; however, 38 (31.7%) mothers were not aware of the correct method.On asking how you will prevent baby’s nose from getting blocked during latching, 78 (65.0%)mothers were not aware of the same and reported that it could not be prevented, 42 (35.0%) mothers were aware and said that they would gently press the upper breast with thumb next to baby’s nose.The majority of mothers (83.3%) said that if babies fall asleep at the breast, they will stimulate the baby either by stroking one of the baby’s cheeks or the body,whereas 20 (16.7%) mothers were not aware of the same.

Section C:Mother’s position during feeding

A total of 74 (61.7%) new mothers reported that practicing adequate positioning during breastfeeding is essential for the comfort of mother and baby; however, 46 (38.3%) mothers were unaware.Among 120 subjects, 51 (42.5%) reported that upright sitting in a chair is a good position to breastfeed the baby, 26 (21.7%) reported side-lying as a preferred position.In contrast, only 43 (35.8%) mothers were aware of the correct position (i.e., sitting in a chair in a semi-reclined posture) to feed the baby.The majority (83.3%) of mothers were aware of the correct position while feeding (i.e., pull the baby close to the breast by moving the arms).

Section D:Postfeeding techniques

On asking how to stop breastfeeding, 100 (83.3%) mothers reported that they would insert the finger between the baby’s gums and breast, whereas 20 (16.7%) said they would push the baby away from the breast.The majority (90.8%) of subjects said they would try to burp the baby immediately after feeding, and 11 (9.2%) participants reported that they would put the baby in a lying-down position after a feed.A total of 83 (69.2%) subjects reported that they would burp the baby after feeding each breast and at the end of feeding;however, 37 (30.8%) mothers were not aware of the same.

DISCUSSION

The present study included a majority of the uneducated population from the lower socioeconomic group.Most mothers experienced myalgia during the postpartum period and breast pain postfeeding which was also reported by Cocaetal.[18]In the present study, half of the participants were unaware of the techniques to initiate breastfeeding.The same was reported by Al Ketbietal.[9]who conducted a survey and reported that mothers had suboptimal awareness about breastfeeding techniques.Kronborg and Vaeth[19]also reported that one-half of the mothers were unaware of the breastfeeding techniques.The present study also revealed that most mothers were not aware of how to hold the baby for latching and unaware of how to prevent the baby’s nose from getting blocked, which was consistent with the study result of Tellaetal.[15]The present result is further supported by Goyaletal.[20]who conducted the study in Libya and revealed that primiparous mothers had poor latching and positioning technique.

The study further revealed that half of the new mothers were unaware of the appropriate position to feed the baby.The result of our study went hand in hand with the study conducted by Goyaletal.[20]and Dallaketal.[13]The majority of new mothers were aware of postfeeding techniques in India, and most antenatal counseling and information are passed from generation to generation, which was supported by Pandeyetal.[16]and Upadhyeetal.[17]The present study revealed that the majority of the population had a good level of awareness about the feeding techniques.However, also they were not fully aware and had some misconceptions as in our culture, most of the information passed from older ladies to new mothers.In the present scenario, antenatal counseling should be done by health-care workers, which helps improve breastfeeding techniques among mothers.

CONCLUSION

From the present study, we can conclude that most of the new mothers are aware of breastfeeding techniques and consider breastfeeding as a part of the culture.This positive attitude toward breastfeeding is due to the antenatal counseling by older women of the family.However, there is a lack of information and some myths, which can be overcome by providing antenatal counseling done by health-care workers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.