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Running head: ATTITUDES ABOUT BREASTFEEDING AND CONTINUING 1

Attitudes About Breastfeeding and Continuing Exclusive Breastfeeding for 2 Weeks in First-

Time Breastfeeding Mothers in a Baby- Friendly Aspiring Hospital

Tamika Missouri

Coppin State University

Masters Thesis Guidelines

NURS 720

Dr. N. Philipsen

October 01, 2014

ATTITUDES ABOUT BREASTFEEDING AND CONTINUING 2

Attitudes About Breastfeeding and Continuing Exclusive Breastfeeding for 2 Weeks in First-

Time Breastfeeding Mothers in a Baby- Friendly Aspiring Hospital

Chapter One

Introduction

In the United States (U.S.), approximately 4 million babies are born each year (Center for

Disease Control [CDC], 2013). Many women are faced with the question of what form of

nutrition they will provide for their babies once they give birth. Variances effecting this

important decision include maternal age, educational attainability, race, and attitudes about

acceptable forms of feedings (Rossem, 2009). Throughout the history of human cultures, various

types of feedings have existed as normal practices for infant nutrition in that society. In the U.S.,

formula has been the primary source of infant nutrition since 1950’s. WIC (the Special

Supplemental Program for Women, Infants, and Children) purchases and distributes over half of

the infant formula used in the U.S. It is provided by the manufacturer at a discounted price, in

turn costing taxpayers approximately $627 million, which is equivalent to a $2 billion value in

the retail market (Ginty, 2011).

Human breast milk is the healthiest form of nutrition available for infants. In spite of

this, 59% of babies born in the U.S. are exclusively breastfed, and even fewer, 40% are still

breastfeeding at 3 months (CDC, 2013). In recent years, U.S. public health priority has been to

advance exclusive breast milk as the primary intake for babies up to 6 months of life and to be

used in combination with other foods up to 12 months of life (American Academy of Pediatrics

[AAP], 2012). Breast milk is beneficial as the primary source of nutrition because it has an

abundance of essential proteins, fats, carbohydrates, and vitamins. These are important for

newborn brain development, disease prevention, and prevention of ovarian and breast cancer in


women. Studies show, that babies who are breastfed have reduced comorbidities that greatly

impact health care costs [AAP], 2012). The concept of the importance of breastfed babies has

been an integral part of antenatal education for years. Healthcare facilities have the duty to

promote breastfeeding to encourage bonding of parent and child, cost effectiveness, and health

benefits of both mother and baby. Following Baby- Friendly hospital practices help mothers

achieve exclusive breastfeeding (Perrine, Scanlon, & Li, 2012). Women who breastfeed their

first baby for a continuum, are subsequently likely to breastfeed their other children. First- time

breastfeeding mothers’ attitudes related to breastfeeding directly impact initiation and

continuation of exclusive breastfeeding beyond the hospital stay (Persad & Mensinger, 2008).

Healthcare facilities should target first time breast feeders to increase the likelihood of starting

the traditions of breastfeeding in the family.

Significance of Study

Promotion of breastfeeding significantly impacts societal health. Healthier nations

prevail when mothers breastfeed. According to UNICEF, an increase of 90 percent of families

breastfeeding exclusively for 6 months, would decrease infant mortality by 1,000 deaths per year

(2013). Medical costs in the U.S. would decrease by $13 billion per year for breastfed infants

when compared to formula fed babies. Health benefits of breast milk on children include

prevention of obesity, diabetes, asthma, necrotizing enterocolitis, childhood leukemia, atopic

dermatitis, and sudden infant death syndrome (SIDS). Mothers benefit from a reduction in

postpartum depression, ovarian/ breast cancer, and type 2 diabetes. Breastfeeding also has a

benefit of reducing weight gain associated with pregnancy (Chapman, 2009). Other newborn

benefits include infants with fewer sick visits, prescriptions, and hospitalizations. Healthier


infants prevent loss of work for parents, contributing to a more productive work force. Employer

medical costs are subsequently lower as a result. Breastfeeding contributes to a greener

environment by eliminating plastic and trash waste associated with formula and bottles.

Healthcare personnel have the burden of educating women in the antepartum and

postpartum periods to promote breastfeeding as the primary source of nutrition for their babies.

Healthcare facilities have the responsibility of training staff members to ensure adequacy in

education for them to be effective communicators of pertinent information to patients. Hospitals

should exercise “Baby Friendly” practices to prepare staff members and patients for exclusive

breastfeeding (Brown & Isaacs, 2010). Intercepting women in this preliminary phase will impact

the course of breastfeeding throughout the continuum.

Statement of Problem

Attitudes about breastfeeding may contribute to mothers’ intent and continuation to

exclusively breastfeed for the first- time. Healthcare facilities must be held accountable for

educating first time mothers on the breastfeeding health benefits to the family. Baby- Friendly

hospital practices provide a blueprint for supportive practices that educate and assist mothers

who choose to breastfeed. Foundational knowledge and early support related to breastfeeding

influences a mother’s decision to opt for exclusive breast milk as a primary source of nutrition

for her newborn.


Purpose of the Study

The purpose of the study is to investigate the relationship between attitudes of first- time

mothers and their choosing to breastfeed and continuing to exclusively breastfeed their babies for

two weeks postpartum.

Hypotheses

Attitudes about breastfeeding among first time mothers is significantly related to the

decision to initiate and successfully continue to exclusively breastfeed for the first two weeks

postpartum.

Assumptions

Factors associated with women breastfeeding their babies include race, maternal age,

educational attainment, and attitudes regarding best feeding practices for newborns (Persad &

Mensinger, 2007). White mothers are more likely to exclusively breastfeed, whereas African

American mothers are more likely to breastfeed and formula feed interchangeably (Purdy, 2010).

In the U.S., women of lower socioeconomic backgrounds benefit from WIC, which decreases

financial considerations related to formula feeding. Until recently, WIC provided no incentive to

mothers choosing to breastfeed, thus unintentionally encouraging formula feeding (Jensen,

2012). Education limits pertaining to the true benefit of breastfeeding greatly inhibits a

women’s willingness to breastfeed her baby (Marrone, Vogeltanz- Holm, & Holm). Body image

disturbance, as well as attitudes about breastfeeding, have an impact on a woman’s ability to feed

her baby human milk (Persad & Mensinger, 2007). Also a woman’s age at delivery directly


correlates to educational attainment, which would limit the knowledge base of the benefits of

breastfeeding. Healthcare facilities that promote breastfeeding have an increased incidence of

women that choose to breastfeed their newborns.

Theoretical Definitions

Attitude- a cognition, often with some degree of aversion or attraction (emotional

valence), that reflects the classification and evaluation of objects and events

(Encyclopedia- Britannica, 2013).

Exclusive breastfeeding- when a newborn receives only breast milk and no other liquids

or solids except for drops or syrups consisting of vitamins, minerals, or medicines (WHO,

2014).

First- time breastfeeding mothers- Women who choose breastmilk feedings for their

newborn for the first time.

Antepartum- time period occurring before birth (Youngkin & Davis, 2013).

Postpartum- time period immediately after birth, until about 6 weeks after delivery

(Youngkin & Davis, 2013).

Comorbidities- two or more disorders or illnesses occurring in the same person

(Valderas, 2009).

Antenatal- during or relating to pregnancy; before birth (Youngkin & Davis, 2013).

Baby- Friendly Hospital Initiatives (BFHI)- a global programme developed by World

Health Organization (WHO) and UNICEF to improve maternity services role (UNICEF,

2014).


Operational Definitions

Attitudes- an opinion formed before having adequate knowledge about breastfeeding

Exclusive breastfeeding- when a newborn receives only breast milk and no

supplementation with formula.

First- time breastfeeding mothers- mothers who choose to use breast milk as a form of

nutrition for the first time.

Baby- Friendly Hospital Initiatives (BFHI)- Maternity/ Birthing facilities that implement

program of ten (10) step practice to support and promote breastfeeding.

Chapter One Summary

Healthcare facilities have a public health duty to mothers using their services. Promotion

and support of breastfeeding encourages healthier women and babies, and healthier populations.

Understanding that mothers have attitudes related to the best feeding methods for their babies are

an essential step in assessment for supporting mothers choosing to breastfeed for the first time.

New breastfeeding mothers need to be made aware of realistic expectations that come along with

the demands of breastfeeding. Education should be provided before, during, and after the

hospital stay to support mothers opting to breastfeed for the first time. Mothers that are

breastfeeding for the first time need access to resources to help them in the beginning stages of

breastfeeding, when the rates of reconsideration are so high. Adhering to BFHI, increases

compliance with exclusive breastfeeding during the hospital stay and also provides support for

the mother to continue to breastfeed for at least 2 weeks after discharge. Consideration of

contributing factors such as race, age, highest educational level completed, and foundational


knowledge determine the success of exclusive breastfeeding. If these hospital level changes are

followed, the success rate of first time breast feeders will increase.


Chapter 2

Review of Literature

Introduction

The objective of this study is to investigate the relationship between attitudes of first- time

mothers and their choosing to breastfeed and continuing to exclusively breastfeed their babies for

two weeks postpartum. Ramona T. Mercer’s, “Maternal Role Attainment Theory” provides the

framework for this study.

Breastfeeding is the most natural, nutritive choice of feeding for a newborn. Successful

support of breastfeeding is a public health imperative in the U.S. showing an incline from 60%

to 77% in the past 10 years (CDC, 2013). American society has spearheaded various

interventions aimed at informing and educating the public, especially new mothers, about the

healthiest choice that women can offer their newborns. This education has mainly targeted

informing new mothers about the benefits of breast milk. Breast milk is loaded with Lactoferrin

(limits iron availability for bacteria consumption in the gut), Lysozyme (aids in digestion),

Carnitine (fatty acid for energy), and DHA & ARA (for brain and retina development). This

information is conveyed to women to enlighten them to the newborn benefits of breastfeeding

(Mannel & Martens, 2012).

Nutrition for infants should be addressed as a public health concern and not simply as an

inconsequent maternal choice, as it has in the recent past. Influences of formula marketing can

directly affect a woman’s feeding choice. The World Health Organization’s International Code

of Marketing of Breast-milk Substitutes asserts the position to not market infant formula to the

public (2013). The U.S. has failed to follow these guidelines. Although the initiation and

duration of breastfeeding has been given lip- service in the U.S., formula is frequently suggested


as an equal choice. This practice is not helpful and can be even misleading for mothers with low

intentions of breastfeeding that are also influenced by subjective norms. (Zhang, Carlton, Fein).

Infant mortality and morbidity of the target area should be considered when approaching

topics of breastfeeding. The impact of substituting a commercial formula for mother’s milk on

short- and long- term health is significant. Breastfeeding has been shown to decrease rates of

infant mortality and morbidity by 3% per year. Healthy People 2020 propose a decrease in

infant mortality to rates of 6.0 per 1,000 live births. Infant morbidity associated with otitis media,

gastroenteritis, childhood obesity, leukemia, type 1&2 diabetes, pneumonia, and SIDS all show

increased incidences in infants receiving formula instead of mother’s milk (American Academy

of Pediatrics, 2010). This alone should be a driving force of healthcare facilities urging of

breastfeeding as the primary source of infant nutrition.

The infants need for breast milk for healthy and optimum development is relayed to the public,

but health care agencies have an obligation to educate the pregnant woman about breastfeeding

as the healthy choice for her newborn. Educating new mothers on the long term benefits to their

newborns from breast milk would influence mothers desiring the best outlook for their babies.

The immunoprotective and nutritive value profoundly impact a newborns health as compared to

formula fed babies (Cramton et al, 2009). Direct patient education during the antepartum period,

postpartum period, and support after discharge play a critical role in the process of initiating and

continuing to breast feed for the first time. Educators should have a sound knowledge base to

provide mothers with proper information to make informed feeding decisions, and to implement

them, as few new mothers in the U.S. have extensive experience with breastfeeding.

In 1991 with a revision in 2006, The United Nations Children’s Fund (UNICEF) and the

World Health Organization (WHO) launched the Baby- Friendly Hospital Initiative (BFHI) to


increase breastfeeding rates worldwide. According to Association of Women’s Health, Obstetric

and Neonatal Nurses (AWHONN), hospitals that trend with policies similar to Baby- Friendly

practices have an increase in breastfeeding initiation and compliance (2010). To be successful,

health facilities must take active steps and adhere to specific guidelines. Ten steps for Baby-

Friendly status achievement are standard, but variations exist between facilities. The primary

goal of any facility practicing these standards of care share a common outcome of optimal health

choice for mother and child.

The BFHI provides a framework that protects, promotes, and supports new mothers in

breastfeeding their babies. Specific interventions are outlined that highlight steps to follow that

proves beneficial in establishing and promoting successful breastfeeding patterns. Steps needed

to progress towards Baby- Friendly practices include:

1. Have a written Breastfeeding Policy that is routinely communicated to all health care

staff.

2. Train all health care staff in skills necessary to implement this policy. Mandatory

education via in services, supplemental education, and hands on practices should be

mandated.

3. Inform all pregnant women of the benefits and management of breastfeeding.

Prenatal packages with breastfeeding information should be made available to pregnant

mothers. Prenatal breastfeeding classes should be offered. Lactation consultants also

visit Women’s, Infant’s, and Children’s (WIC) sites to inform pregnant moms about

breastfeeding, inquire about future plans, and encourage expectant moms to visit the OB

offices. Mothers make up their minds to bottle or breast feed very early in their

pregnancy (Forster and McLachian, 2007).


4. Help mothers initiate breastfeeding within one hour of birth. Babies should be put to

breast as soon as possible in the delivery room, even following a c-section birth. The

assistance by a lactation consultant can be utilized at this time.

5. Discuss breastfeeding basics and techniques to mothers that are separated from their

newborns for medical reasons. Steps to initiate and maintain lactation, such as use of a

breast pump.

6. Only give newborns breastmilk, unless medically indicated. An order by a nurse

practitioner or pediatric resident is required before any supplementation is provided.

7. Rooming- in practices should be encouraged. Mothers and babies are encouraged to

remain together 24 hours per day and staff is expected to perform as many infant daily

cares as possible at the mother’s bedside.

8. Encourage breastfeeding on demand. Breastfeeding times should be every two to

three hours to establish a good breastfeeding pattern and initiate good milk supply.

9. Give no artificial nipples or pacifiers to breastfeeding infants. Pacifiers can cause

nipple confusion for the infant because different mechanisms are used when sucking at

the breast as compared to sucking a pacifier. Parents are taught to syringe- feed to avoid

use of a nipple.

10. Encourage and educate mothers to utilize breastfeeding resources. Mothers are

instructed to call a resource telephone number to access a lactation consultant for help.

Breastfeeding groups that support new mothers should be offered, as well as follow- up

outpatient support by lactation consultants. Additionally, not offering gift bags containing

formula is strongly recommended. This practice puts a budgeting strain on the healthcare


facility because formula is usually given to the facility at no cost for advertising

purposes.

The Association of Women’s Health, Obstetric and Neonatal Nursing (AWHONN)

endorses the BFHI framework in helping maternity areas in hospitals progress forward with

promoting breastfeeding as the primary nutrition for newborns (2014). Hospitals should have

staff members that are active in the organization and understand AWHONN’s guidelines and

practices. According to AWHONN, when choosing breastfeeding as the most optimal form of

nutrition, women should receive proper education and support (2014). AWHONN’s standards

centers around the belief that it takes the entire health care team to successfully initiate and

sustain breastfeeding. This team of people supporting the breastfeeding process should include

physicians, nurses, and lactation consultants. Discussions with women concerning breastfeeding

should begin during the antepartum period, to assess preconceived knowledge about

breastfeeding and bridge any education gaps that may pose an obstacle to initiating and

continuing to breastfeed for an extended period of time. Healthy People 2020, set forth a goal to

increase the proportion of mothers who breastfeed their babies. This goal includes initiatives to

raise the rate of breastfeeding initiation in the early postpartum period to 81 percent, to increase

to 46 percent the proportion of women who continue exclusive breastfeeding until their infants

are three months of age, and to 25 percent the proportion of infants who are exclusively breastfed

until 6 months of age (2014).

Influences of Attitudes

Breastfeeding is not instinctual or natural for all women. In an effort to improve

breastfeeding rates in the U.S., identification of factors that influence initiation and continuation

of breastfeeding should be studied. A woman’s preconceived knowledge concerning


breastfeeding as a nutritive choice directly correlates with her decision to initiate breastfeeding,

whereas, the support offered in the postpartum period influences her decision to continue to

exclusively breastfeed (Perrine et al., 2012). Limited knowledge about the benefits of

breastfeeding for both the health of mother and baby affect a woman’s intent to breast feed;

however the attitude and subjective norms that these women possess play a role in intention as

well. This coincides with Sharps et al., study that determined that maternal self motivation to

breastfeed appears to supersede the perception of influences around her (2003).

According to Ajzen’s Theory of Planned Behavior (TPB), attitudes and personal beliefs

effect intention and control behavior (1987). The foundational knowledge base that women

believe as truth concerning breastfeeding is a great determination of what her decision will be

concerning initiating breastfeeding. Personal attributes that are influenced by tradition, culture,

family, and social entities carry considerable weight when decisions about breastfeeding are

made before delivery (McCarter- Spaulding, 2002). Social norms of the woman’s environment,

without the influence of education, determine what feeding techniques will be chosen (Sharps et

al., 2003).

Foundational knowledge based on educational disparities play a role in a mother’s

decision to breastfeed. Women with higher education attainability are better informed about the

health benefits of breastfeeding for mother and child. Despite what is deemed normal feeding

methods for these groups of women, decisions can be individually based to provide optimal

health outcomes for the couplet. Implementing BFHI, with mothers desiring to breastfeed

imprints the same knowledge principles to first-time breastfeeding mothers, prompting initiation

of exclusive breastfeeding ( Difrisco et al., 2011).


Exclusive Breastfeeding for 2 weeks

Exclusive breastfeeding is when a newborn receives only breast milk and no other liquids

or solids except for drops or syrups consisting of vitamins, minerals, or medicines (WHO, 2014).

Inability to establish successful breastfeeding is a main culprit in mothers not continuing to

breastfeed. The U.S Preventative Services Task Force determined breastfeeding education as the

most effective intervention for increasing breastfeeding initiation and short- term continuation

(2014). The Joint Commission implemented the Perinatal Care Core Measure Set, a standardized

performance measurement that monitors care of “exclusively breastfed” term-babies to examine

practices for supplementation other than medical reasons (2012). In alignment with BFHI

guidelines, exclusive breastfed babies should not be offered supplementation of formula unless

medically necessary to optimize breastfeeding (Baby- Friendly, 2010). BFHI practices is

associated with increased rates of breastfeeding and a primary hospital practice associated with

discontinuing exclusive breastfeeding before discharge was babies receiving supplementation

(Perrine et. al, 2012).

Lack of support from hospital staff is another strong indicator of early breastfeeding

cessation. Support during the hospital stay by educated health care staff members, including

Licensed Lactation Consultants (LLCs), are influential in increased rates of exclusive

breastfeeding rates for a short duration (Murray, 2007). Healthcare staff having evidenced-

based breastfeeding knowledge combined with the expertise of LLCs, offers the mother essential

support with being successful with the breastfeeding process. The benefit of LLC’s offers an

irreplaceable advantage to mothers needing support during the early stages of breastfeeding.

Follow- up support via discharge telephone calls or postpartum group sessions post- discharge to


troubleshoot problems with breastfeeding is also important with continuation of breastfeeding

(DiFrisco, 2011).

Nursing Theory

Nursing theories offer structure by providing a foundational basis that nursing can use as

a guide to provide patient care. Ramona T. Mercer’s, “Maternal Role Attainment- Becoming a

Mother” was used as a guide for this research study. Recognizing the woman, the patient as the

primary focus served as a rationale for Mercer’s theory selection. Her theory uses the mother as

the focal point, with variables of social influences, nursing, health impacts of mom and newborn,

and role identity (Mercer, 1985). The process used in Mercer’s theory helps the mother develop

an attachment to the infant, which in turn helps the infant form a bond with the mother.

Breastfeeding facilitates this mother- child bond, which is enhanced as the infant grows

(Schwarze et al., 2014). Mercer’s theory asserts developmental and interactional change over a

period of time. Throughout this process, the mother bonds with the infant, acquires competence

in general caretaking tasks, and then comes to express joy and pleasure in her role as a mother.

Twelve of Mercer’s concepts are evident in this study. Many aspects of Mercer’s theory support

this study. Her theory predicts relationship among the concepts that are outlined between

hospital practices and procedures and their influence on new mothers. Mercer’s theory provides

support for the assertion that new mothers need extensive psychological, social, and physical

attention to make a healthy transition into motherhood (Mercer, 1981). Nursing plays a major

role in Mercer’s theory helping new mothers learn and grow in their new identities (Mercer,

1985).

Mercer’s revision of the language contained in her theory based on more recent research

parallels the premise of the research study. She highlights “becoming a mother” as an ongoing


process rather than an endpoint (Mercer, 1985). In the study, the consideration of breastfeeding

over a 2 week duration closely mimics this framework’s idea of the research being a process over

time rather than reflecting the initiation of breastfeeding only.

Major Concepts Identification

Mercer pinpoints major concepts that coincide with the theory that she portrays. These

focus areas directly correlate with the ideas of the research study. Maternal role attainment,

which is the mother bonding and confidently grasping her new role as a parent is one concept

(Mercer, 1985). Mothers have to possess confidence with the challenges that breastfeeding

proposes. A mom’s perception of her birth experience is another insightful concept that

correlates with a mother’s sense of self while breastfeeding. Mothers rate their birth experience

based on what took place during the whole experience. Challenges of breastfeeding can force

mothers to rate their experiences negatively if everything didn’t go as planned. This can impact

success of exclusive breastfeeding. Mercer points out self -esteem as another concept (Mercer,

1985). Mothers’ perception of what others think about them plays an important role in mothers

choosing to initiate and continue to breastfeed. Another concept, flexibility, is discussed by

Mercer. New moms must not have a rigid approach to the breastfeeding experience.

Allowances for situations that are not ideal is a needed attribute. Childrearing attitudes and

beliefs of what is best for the newborn is one of the single most important characteristics that

influence a mother’s decision to breastfeed. In addition, Mercer identifies health status as a

concept (1985). Breastfeeding plays an instrumental role in improved maternal and newborn

health. Attitudes related to the benefits of breast milk associates with this concept. Anxiety is

discussed throughout Mercer’s theory, and is closely associated with the stress that all new

breastfeeding mothers exhibit. Role strain is another concept mentioned by Mercer. Taking hold


of breastfeeding and the demands associated with breastfeeding, proves to be a challenge for

new mothers. Once the obstacles that come along with breastfeeding are conquered, the

pleasures associated with breastfeeding settles in. The reward and pleasure of the bonding

experience gives a breastfeeding mother great satisfaction. This closely associates with Mercer’s

gratification- satisfaction and attachment concept (1985). The discussion of infant temperament,

infant characteristics, and infant cues all are congruent concepts discussed by Mercer that

parallels the research study. Finally, social support is the most important concept that Mercer

proposes that ties into the study (1985). Hospital policies and practices that support the

mother’s decision to breastfeed help to spearhead the mother’s initiation and continuation of

nursing her newborn.

Conclusion

Breastfeeding rates in the U.S. continue to incline. Health disparities that continue to

plague populations commit governmental agencies, community agencies, and healthcare

facilities to spearhead initiatives to target breastfeeding as a public health concern. Recognizing

barriers that impede most mothers that deliver newborns to exclusively breastfeed will warrant

closer examination as goals set to increase breastfeeding further continue. It has long been a

predictor that age, education level, and race have posed disparities that interfere with mothers

choosing to breastfeed. A mother’s fore knowledge of breastfeeding influences her decision to

initiate and continue breastfeeding, as well. BFHI practices adapted by healthcare facilities, can

serve as an educational blueprint to expose the same knowledge to mothers choosing to

exclusively breastfeed.


Chapter Three

Introduction

Chapter three will describe the study design. The hypothesis, sample, and study

limitations will be examined. Procedures for the study, protection of human rights, and

instruments for measurement will be discussed as well.

Design of the Study

A quantitative descriptive study will be conducted to evaluate the relationship between

attitudes about breastfeeding and its influence on initiating and continuing to breastfeed. This

particular study was chosen because of its affiliation with current practices and naturally

occurring situations.

Sample

Convenience sampling was selected to be used in this study. It’s considered an

accidental approach because subjects are considered until the desired sample size is reached.

This type of sampling is cost effective, and easier to obtain when compared to other sampling

selections (Burns & Grove, 2009). For this study, once consent is obtained, a selection of 25

breastfeeding women will be placed into the convenience sampling for the study. Diffusion of

sampling will eliminate breast feeders that are new versus experienced. Biases will be identified

to wean all breastfeeding mothers from first time breastfeeding mothers. These women will be

surveyed at Mercy Medical Center in Baltimore City, Maryland during the postpartum period.

Typical delivery capacity at this facility is well over 2,000 per year, so the sample size is

obtainable. Breastfeeding rates are above 70%, which further allows a decent sample size.


Study Limitations

A limitation of this study is choosing first- time breastfeeding mothers at one facility of

reference to provide the sampling. Dedication of time of the participants is another barrier.

Getting accustomed to the new role of motherhood is taxing enough without the demands of

doing any extra activities. Losing participants for follow-up two weeks after delivery may also

be a limitation.

Procedure

Participation in the study will be limited to first time breastfeeding mothers. Special

attention must be given to not eliminate mothers who have had prior formula fed babies.

Approval to conduct the study will be obtained from Coppin State University’s IRB Committee

prior to conducting the study. Permission will then be sought from the Director of the Maternal/

Child Unit and Mercy Medical Center’s Hospital IRB Committee to conduct the study at the site.

Surveys will be conducted by the nursing staff on the Mother/ Baby Unit to obtain initial results

surrounding the initiation of breastfeeding. Continued data collection to evaluate the

continuation of breastfeeding over a 2 week period, will be conducted by telephone. The data

collection will end with the last information obtained from the last delivered patient. Assessment

of attitudes about breastfeeding and the initiation and continuation of

breastfeeding will be analyzed at that time.

Protection of Human Participants

Respecting the dignity and health of individuals is an ethical responsibility. While conducting

research, the rights to self- determination, privacy, confidentiality, fair treatment, and protection

from harm are all considered (Burns & Grove, 2009). Anonymity will be safe guarded. The

participants will be inpatients and are already protected Health Insurance Portability and


Accountability Act (HIPPA); however, their rights under that protection will be reiterated with

consent to participate in the study and with telephone follow-up after discharge. The

demographics of the patient will be secured and kept anonymous for purposes of evaluating the

data after the study is complete. Participation will be voluntary and confidential. Compliance

with the protection of participants’ rights, will comply with the regulations set forth by the

United States Department of Health and Human Services Protections of Human Subjects

Regulations, the Office for Human Research Protection , and the code of Federal Regulations

(CFR), Title 45, Part 46, Protection of Human Subjects (HHS, 2009).

Instrument

The instrument selected for this research study is The Breastfeeding Attrition Prediction

Tool (BAPT), based on Theory of Planned Behavior (TPB) is the chosen instrument for this

study. This tool has proven reliable in evaluating breastfeeding trials in the past. It was

developed by Jill Real Janke to evaluate factors affecting the duration of breastfeeding in

women. The tool’s purpose is to evaluate current patient beliefs as they relate to breastfeeding

practices in the patient. The tool goes further to determine information of breastfeeding

knowledge to determine its affect on starting breastfeeding. A modified version of the tool using

46 questions that evaluates the mother’s perceptions on breastfeeding as well as demographic

data will be used. A 5 point Likert scale is used to measure questions. The BAPT tool boasts a

73 % rate of obtaining breastfeeding data and has a reliability coefficient of 0.80%. The study

proposes to use the tool to evaluate a mother’s preconceived ideas on breastfeeding and the

association that age, race, and educational levels have on a mother’s decision to breastfeed. A

bubble in survey style will be used with a pencil to fill in the appropriate data.


Data Analysis

Variables and descriptive statistics will be described. The relationship between attitudes

about breastfeeding and the influence on the initiation and continuation of breastfeeding for 2

weeks will be analyzed. Questions 1-29 of the BAPT will serve as the basis for data collection.

Most of these questions pertain to the mother’s subjective data of perceptions related to

breastfeeding. Questions surround the mother’s knowledge base of breastfeeding, convenience of

breastfeeding, comparison to formula feeding, and health benefits of breastfeeding for mom and

baby. There is a range of numbers 1-6, correlating with strongly disagree to strongly agree,

respectively. Other questions pertaining to demographics will be analyzed from another subset

of the tool as well. The International Business Machines (IBM) Statistical Package for the Social

Sciences (SPSS) version 22.0 will be used to implement statistical analysis.

Summary

Attitudes related to breastfeeding directly impact a mother’s decision to choose this

optimal method of feeding for her newborn. Societal views of the importance of breastfeeding

weigh heavily on a mother’s decision to choose nutrition for her newborn. Perspectives vary;

however, breastfeeding as the healthiest feeding option for moms and their babies is

indisputable. The ten steps outlined in (BFHI) provide consistent, structured recommendations

for educating, assisting, and supporting new mothers breastfeed their infants. It serves as a

global framework that can be applied to any maternity area in any country. The increase in infant

morbidity and mortality among formula fed infants should be a primary motivator associated

with prioritizing breast milk as the nutritive choice for newborns. Instituting practices associated

with BFHI will increase education among mothers that will influence proper nutritive choices.


Following these guidelines and evaluating the efficacy of their employment will result in

successful breastfeeding rates among first time breastfeeding mothers.


References

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Attitudes About Breastfeeding and Continuing Exclusive ...tamikamissouri.weebly.com/uploads/5/1/9/0/51902345/... · Web viewVariances effecting this important decision include maternal