Background: Cesarean delivery is associated with delayed initiation and shorter duration of exclusive breastfeeding. Motivational interviewing, by addressing ambivalence and enhancing women’s confidence, may improve breastfeeding outcomes. Research Aim: To compare breastfeeding self-efficacy, breastfeeding importance and confidence, and exclusive breastfeeding duration between women who received motivational interviewing-based breastfeeding counseling and those who received standard counseling. Methods: A single-blind randomized controlled trial was conducted in Türkiye between September 2023 and June 2024. Women who delivered by Cesarean section ( n = 74) were randomly assigned to the intervention group (motivational interviewing, n = 37) or the control group (standard counseling, n = 37). Participants in both groups received three breastfeeding counseling sessions, consisting of either motivational interviewing-based or routine standardized counseling according to group allocation. Outcomes were assessed at baseline and at 24–48 hours, 14 days, 1 month, 3 months, and 6 months postpartum. Results: Of the 74 women recruited, 63 completed the study. No significant baseline differences were found between the groups in sociodemographic or obstetric characteristics. At follow-up, women in the intervention group reported significantly higher breastfeeding self-efficacy, greater importance attached to breastfeeding, and higher breastfeeding confidence scores compared to controls ( p < .05). Exclusive breastfeeding rates were significantly higher in the intervention group at 6 months postpartum ( p < .05). Conclusions: Motivational interviewing-based breastfeeding counseling appears to enhance maternal breastfeeding self-efficacy, perceived confidence, the importance attributed to breastfeeding, and exclusive breastfeeding outcomes. Results suggest that motivational interviewing may be considered as a promising strategy to support breastfeeding among women planning Cesarean delivery.
Background: Human milk is the gold standard for newborn nutrition. Maternal self-efficacy has emerged as an essential determinant of breastfeeding success. However, the proliferation of assessment instruments over recent decades has produced a fragmented evidence base, underscoring the need for an overarching synthesis to clarify their validity and clinical utility. Aim: To identify, describe, and critically appraise instruments assessing maternal breastfeeding self-efficacy and to develop an evidence-based framework for midwifery practice. Methods: An umbrella review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology from August to October 2025. Systematic searches were performed in MEDLINE, CINAHL, EMBASE, and the Cochrane Database of Systematic Reviews. Two reviewers independently assessed methodological quality and risk of bias using the JBI Critical Appraisal Checklist and the ROBIS tool. Data extraction focused on review characteristics and psychometric properties, using a standardized template to ensure consistency. The protocol for this umbrella review was prospectively registered in PROSPERO (CRD420251124383). Results: Seven reviews were included—five systematic reviews, one scoping review, and one narrative review—identifying eight measurement instruments. The Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF) and the Prenatal Breastfeeding Self-Efficacy Scale (PBSES) demonstrated the strongest psychometric evidence and were assigned Grade A recommendations. Conclusions: Findings confirm the theoretical relevance of Bandura’s self-efficacy construct in breastfeeding and highlight the need for concise, valid, and culturally adaptable instruments. A two-stage screening strategy, PBSES during pregnancy and BSES-SF postpartum, is recommended to guide tailored interventions.
Background: Despite growing recognition of its importance, effective breastfeeding support remains limited worldwide. A meta-analysis on the effectiveness of Biological Nurturing (BN) or the laid-back position revealed its efficacy to prevent early breast problems. Aim: To elicit whether a film on BN (intervention), compared to a film on traditional breastfeeding positions (control), watched during pregnancy, reduced breast problems and increased the exclusivity of breastfeeding at initiation stage. Methods: A real-life parallel quasi-randomized controlled trial embedded in a prospective cohort was conducted, using an online survey administered through REDCap software with alternating group allocation. Survey items were both quantitative and qualitative, with data collected at TR (registration), T0 (birth to 21 days) and T1 (22–42 days). SPSS (Version 31.0) was used to calculate Chi square, Mann-Whitney-U-test, median and frequencies. Google Gemini was used as an assistive tool for preliminary categorization and translation support of qualitative data, while final coding, interpretation, and validation were performed by the research team. Primary outcomes were breast problems and exclusive breastfeeding at 3 weeks postpartum. Results: A total of 380 participants provided data for the study. The intervention group showed a lower incidence of any breastfeeding-related problems at 3 weeks postpartum, measured at T0 ( p = 0.002) and T1 ( p = 0.03). However, there was no significant difference in exclusive breastfeeding at 3 weeks postpartum ( p > 0.1). Conclusion: While this study contributes to growing evidence on BN reducing early breast problems and the effectiveness of antenatal education, its lack of effect on early exclusive breastfeeding highlights the ongoing need for skilled breastfeeding support.
The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) outlines how nutritional support should be provided to the mothers and caregivers of infants in emergencies to maximize child health and survival. The OG-IFE outlines the necessity of ensuring support for breastfeeding mothers and the caregivers of infants who cannot be breastfed. It has strict and limited indications for providing infant formula, amongst which maternal preference to formula feed is not included. However, mothers who do not meet OG-IFE indications commonly request infant formula, and those to whom such requests are made can find it difficult to refuse them. This paper applies the ethical principles of beneficence, non-maleficence, health maximization, justice, and autonomy to the OG-IFE’s preclusion of infant formula provision on the basis of maternal request. It presents an analysis weighing the possible negative and positive consequences of providing infant formula without and within the indications of the OG-IFE. It also describes how to mitigate against donations of infant formula, application of OG-IFE principles in high-resource settings, and how to respond to and support breastfeeding women who request infant formula and implement the OG-IFE regarding infant formula. Enabling governments, policy makers, humanitarians, health workers and donors to understand the ethical foundations of the OG-IFE regarding infant formula provision will assist in promoting good practice in disaster response and child health and survival.
Background: People who induce lactation may be of any sex or gender and may pursue lactation induction to feed an infant, to develop their breast tissue, or for gender affirmation. Existing research focuses on cisgender women and research into lactation induction for transgender, Two-Spirit, and non-binary (TTNB) people is limited to experiences of transgender women.Research Aim: The aim was to explore how clinicians support TTNB people with lactation induction.Methods: An online qualitative survey was distributed internationally to clinicians providing lactation induction support to TTNB people. The responses of 14 participants were analyzed using qualitative directed content analysis.Results: Participants supported TTNB people inducing lactation by individualizing care, modifying expectations, and building a support team. Care was individualized by adjusting lactation induction protocols according to each client's goals and gender health. Clinicians modified expectations by encouraging clients to set achievable goals and focus on the experience of infant feeding rather than the amount of milk produced. Finally, recognizing that TTNB clients often experience anti-trans bias when accessing healthcare, the participants emphasized the critical need for clinical and social support when inducing lactation and for gender-affirming infant feeding care. Recommendations are provided for clinicians supporting TTNB clients to induce lactation.Conclusion: The research findings indicate the importance of a flexible, holistic approach to provide gender-affirming support to TTNB clients who are inducing lactation.
