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Breast-feeding initiation rates have increased in the USA; however, maintenance of breast-feeding for recommended durations is low. The objective of the present study was to identify factors that may facilitate breast-feeding for longer durations among first-time mothers, including physiological and social experiences and changes in maternal perceptions.
Survival analysis and linear regression methods were used to explore the relationship between experiences and breast-feeding duration, and the possible mediating effect of changes in maternal perceptions.
Secondary data from the Infant Feeding Practices Study II, conducted in the USA between 2005 and 2007.
Data from 762 first-time mothers who ever breast-fed were analysed.
Experiencing trouble with baby’s latch, problems with milk flow/supply and painful breast-feeding were significantly associated with breast-feeding duration (64, 26 and 36 % shorter duration, respectively). Meanwhile, positive changes in perception with respect to breast-feeding self-efficacy, opinion about infant feeding and belief about breast milk were associated with 16–27 % longer duration. Furthermore, changes in perception were observed to partially mediate the impact of physiological experiences on breast-feeding duration.
Perceptions of breast-feeding self-efficacy, beliefs and opinions can change over time and are influenced by breast-feeding experiences. The combined effect of experience and perception plays a key role in influencing breast-feeding duration. Future research should explore interventions to maintain or improve these perceptions while accounting for physiological experiences to support breast-feeding for recommended durations among first-time mothers.
To determine the effect of intention to breast-feed on short-term breast-feeding outcomes in women delivering term and preterm infants.
Data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS) for three states, Ohio, Michigan and Arkansas, during 2000–2003 were analysed. SAS 9·1·3 and SUDAAN 10 statistical software packages were used for analyses.
Arkansas, Michigan and Ohio, USA.
Mothers of recently delivered infants, selected by birth certificate sampling.
Of 16 839 mothers included, 9·7 % delivered preterm. Some 52·2 % expressed definite intention to breast-feed, 16·8 % expressed tentative intention, 4·3 % were uncertain and 26·8 % had no intention to breast-feed. Overall 65·2 % initiated breast-feeding, 52·0 % breast-fed for ≥4 weeks and 30·8 % breast-fed for ≥10 weeks. Women with definite intention were more likely to initiate (OR = 24·3, 95 % CI 18·4, 32·1), to breast-feed for ≥4 weeks (OR = 7·12, 95 % CI 5·95, 8·51) and to breast-feed for ≥10 weeks (OR = 2·75, 95 % CI 2·20, 3·45) compared with women with tentative intention. Levels of intention did not differ between women delivering preterm and term. Women delivering at <34 weeks were more likely to initiate breast-feeding (OR = 2·24, 95 % CI 1·64, 3·06) and to breast-feed for ≥4 weeks (OR = 2·58, 95 % CI 1·96, 3·41), but less likely to breast-feed for ≥10 weeks (OR = 0·55, 95 % CI 0·44, 0·68), compared with those delivering at term. Women delivering between 34 and 36 weeks were less likely to breast-feed for ≥10 weeks than those delivering at term (OR = 0·63, 95 % CI 0·49, 0·81).
Prenatal intention to breast-feed is a powerful predictor of short-term breast-feeding outcomes in women delivering both at term and prematurely.
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