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The effect of breastfeeding counselling the mothers in the early period after birth on infant’s exclusively breastfeeding

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Aim: In this study, it was intended to promote mothers to exclusive breastfeed their infants for the first six months by preventing the possible flourishing problems of breast and breastfeeding in the early period just after the birth with the help of counselling and support. Material and method: Giving priority to the ones with breastfeeding problems, counselling and support were given to 254 mothers out of 708 mothers who gave birth in the birth clinic during three months while they were in the hospital. Counselling and support given on the first three days postpartum were repeated when necessary until the problems of breast and breastfeeding were resolved. The infants were exclusively breastfed when leaving the hospital. Excluding the mothers who gave multiple births and gave birth before the 34th gestation week; other mothers consulted were phoned in the office hours six months after the date of delivery. Information about the nutrition status of their infants was gathered from 101 mothers answering our phone calls by a questionnaire prepared. Data were evaluated in the computer by SPSS. Findings: Nearly 41.6% of mothers expressed that they exclusively breastfed their infants for the first six months. It was found that mother’s age, pregnancy, birth and the number of children had no effect on mother’s exclusively breastfeeding her infant for the first six months. While mothers who had diseases such as diabetes, hypertension in their pregnancies exclusively breastfed their infants for the first six months more than the mothers without any diseases, a statistically significant difference couldn’t be found between them. The ratio of feeding their infants only with the breast milk for the first six months of mothers who gave birth before the 37th gestation week was statistically more than that of the mothers who had full-term births. A statistically significant difference was found between mothers who gave only breast milk for the first six months and the ones who introduced complementary foods in the same period in terms of proper time to start contraception. Result: Counselling mothers in the early period after birth, even for a short time, affects the ratio of exclusive breastfeeding and the contraception status. Nurses and midwives should consult all mothers giving birth about breastfeeding and feeding with breast milk before leaving the hospital
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THEEFFECTOFBREASTFEEDINGCOUNSELLING
THEMOTHERSINTHEEARLYPERIODAFTER
BIRTHON...
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Studiu original J.M.B.
59
THE EFFECT OF BREASTFEEDING COUNSELLING THE MOTHERS IN THE
EARLY PERIOD AFTER BIRTH ON INFANT’S EXCLUSIVELY BREASTFEEDING
Sevgi GÖKDEMİREL¹, Tülay YILMAZ², Hacer NALBANT³, Ayşen Bulut³
¹Aydın School of Health, Adnan Menderes University
² Bakırköy School of Health, İstanbul University
³ Istanbul Medical Faculty, Istanbul University
Abstract:
Aim: In this study, it was intended to promote mothers to exclusive breastfeed their infants for the
first six months by preventing the possible flourishing problems of breast and breastfeeding in the early
period just after the birth with the help of counselling and support.
Material and method: Giving priority to the ones with breastfeeding problems, counselling and
support were given to 254 mothers out of 708 mothers who gave birth in the birth clinic during three months
while they were in the hospital. Counselling and support given on the first three days postpartum were
repeated when necessary until the problems of breast and breastfeeding were resolved. The infants were
exclusively breastfed when leaving the hospital. Excluding the mothers who gave multiple births and gave
birth before the 34th gestation week; other mothers consulted were phoned in the office hours six months
after the date of delivery. Information about the nutrition status of their infants was gathered from 101
mothers answering our phone calls by a questionnaire prepared. Data were evaluated in the computer by
SPSS.
Findings: Nearly 41.6% of mothers expressed that they exclusively breastfed their infants for the
first six months. It was found that mother’s age, pregnancy, birth and the number of children had no effect on
mother’s exclusively breastfeeding her infant for the first six months. While mothers who had diseases such
as diabetes, hypertension in their pregnancies exclusively breastfed their infants for the first six months more
than the mothers without any diseases, a statistically significant difference couldn’t be found between them.
The ratio of feeding their infants only with the breast milk for the first six months of mothers who gave birth
before the 37th gestation week was statistically more than that of the mothers who had full-term births. A
statistically significant difference was found between mothers who gave only breast milk for the first six
months and the ones who introduced complementary foods in the same period in terms of proper time to start
contraception.
Result: Counselling mothers in the early period after birth, even for a short time, affects the ratio of
exclusive breastfeeding and the contraception status. Nurses and midwives should consult all mothers giving
birth about breastfeeding and feeding with breast milk before leaving the hospital.
Key-words: Exclusive breast milk, after birth, breastfeeding counselling
Preface
Feeding with breast milk is the most
appropriate, reliable and ideal form of nutrition
with proven reliability for infants. Exclusively
breastfeeding the infants for the first six months
and receiving complementary foods with conti-
nued breastfeeding after the sixth month up to 2
years of age have numerous benefits. These
benefits are very important positive effects on
healthy life not only in the first years but also in
the years ahead. Therefore, in establishing the
foundations for healthy life, the importance of
feeding with breast milk cannot be arguable [1,
2, 8, 10].
According to the data of Turkey
Population and Health Survey (TPHS-2003), in
our country, the ratio of exclusively breastfed
infants among 4-5 months old infants is 10.6%
but 13.4% of the infants weren’t breastfed at all.
18.0% of breastfed infants younger than 6
months also were fed by formula feeding and
76.0% of them were also introduced comple-
mentary foods [5].
In a research conducted in Istanbul,
while 83.0% of mothers expressed their wishes
to exclusively breastfeed their infants in the
interview just 4-5 hours after the delivery, one
month later only 18.0% of them could achieve
exclusively breastfeeding [7]. This case shows
that mothers are, in need, of learning how to
breastfeed and support to apply it more than
Studiu original J.M.B.
60
being persuaded on the benefits of breastfeeding
[11].
There are some studies which show that
direct skin-to-skin contact accomplished
immediately after delivery positively affects the
relationship between mother and the infant and
increases the duration of breastfeeding period
[9, 11, 13, 14].
In the western region of our country,
although nearly 9 out of 10 births take place in a
health institution, only half of them (51.5%) can
accomplish to breastfeed their infants within the
first hour. In the hospitals, a lot of erroneous
practices such as breastfeeding the infants later,
separating the infant from its mother, giving the
infants foods and drinks before breastfeeding
starts are frequently seen [5]. This situation may
result in problems with breastfeeding and affect
the duration of nourishment with exclusive
breastfeeding [7]. Needs to be done in order to
generalize exclusive breastfeeding were issued
in a joint statement in a title of which is “Ten
Steps to Successful Breastfeeding” in the
initiative of establishing “Baby-Friendly
Hospitals” by UNICEF and WHO. [13] In the
fifth step of this statement says “Show mothers
how to breastfeed and how to maintain lactation
even if they should be separated from their
infants in the hospital”.
If mothers receive adequate information
and support about breastfeeding and infant
nutrition on the first days after delivery and
have enough experiences on the techniques of
breastfeeding, more infants may be provided to
be breastfed exclusively for the first six months
by preventing the mothers to introduce
complementary foods earlier.
The fundamental aim of our study is to
enable mothers to breastfeed their infants
exclusively for the first six months by
counselling and supporting mothers in order to
prevent the recurrence of the problems in the
early period of after delivery.
Method
The study was carried out in a university
hospital in Istanbul. As being a Baby-Friendly
Hospital, following the fifth step of the
statement called “Ten Steps to Successful
Breastfeeding” there has been a breastfeeding
polyclinic in the hospital. Counselling and
support services are provided for mothers who
have problems about breasts or breastfeeding to
continue breastfeeding in the polyclinic, by
lactation consultant nurses.
This study has been carried out by three
nurses trained and experienced about
breastfeeding and family planning who work in
the polyclinic of breastfeeding counselling.
Within the weekdays and working hours for
three months, giving priority to the ones with
breastfeeding problems these three nurses
consulted 254 mothers out of 704 mothers who
gave birth in the clinic during the first three
days. All mothers were consulted to inform
about breastfeeding and the infant nutrition
about acquiring skills, treatment and advice and
the needs for other issues (family planning,
birth-end women health etc.). Mothers were
particularly informed to breastfeed their infants
exclusively for the first six months and then to
continue breastfeeding up to the age of two.
This consultation lasted for 20 minutes on
average. At the end of counselling; brief
demographic, obstetrical information of mothers
and their infants was collected via data
collection form prepared earlier and their oral
affirmations to be phoned later were taken. The
telephone numbers of breastfeeding counselling
polyclinic were given to all mothers in case of
need to phone.
Excluding the mothers who gave
multiple births and gave birth before the 34th
gestation week among 254 mothers consulted,
101 mothers who gave birth to one baby were
phoned at the office hours six months after the
birth date. Data collected via data collection
form were evaluated on the SPSS computer
program.
Findings
As we conducted our study at a
university hospital, women who have a high-
risk pregnancy and give risky birth constitute a
major part of potential patients. Moreover,
multiple births are also frequently seen in the
hospital because there is an infertility clinic in
which test-tube treatments are also applied.
Therefore, 104 out of 254 mothers consulted
were the ones who gave multiple births and
gave birth before the 34th gestation week.
Although 49 mothers were called at least three
times at different times and weekdays, they
couldn’t be reached by phone.
Studiu original J.M.B.
61
28 ± 4.6 years of age on
average
9 ± 3.4 years of average
education
31.0’% housewife
37.0% first pregnancy
47.5% first child
52.5% a normal birth
38.8 ± 2.2 weeks of gestation
on average
Mothers (n=101)
15% problems in their
pregnancies (diabetes, hyper-
tension, heart disease etc.)
Table 1. Features of Mothers
Mothers were in the 18-42 age group
and two thirds of them were working.79% of
mothers gave birth between the 38th-42nd
gestation weeks.
Exclusively breast-
fed for the first 6
months
41.6%
The reasons to in-
troduce comple-
mentary foods
(n=59)
20% insufficient breast milk
20 % not being satisfied
17% no weight gain
0.7 % starting work
Table 2. The Nutrition Status of Infants (n=101)
When the nutrition status of infants was
examined, nearly 41.6% of mothers stated that
they breastfed their infants exclusively for the
first six months.
Some of the mothers showed that they
had insufficient breast milk, their babies weren’t
satisfied or that they thought their infants didn’t
gain enough weight (only one infant gained less
than 500 grams per month) as the reasons for
introducing the complementary foods before the
sixth month. Some of them state that they
wanted their infants to get used to the
complementary foods and that their infants cried
and their having problems about breastfeeding
and breasts as reasons for it. Only four mothers
stated that they introduced the complementary
foods because they started to work.
In our study, it was found that mother’s
age, pregnancy, birth and the number of
children had no effect on infant’s being
exclusively breastfed for the first six months.
While 10 out of 15 mothers (66.7%) who had
diseases such as diabetes, hypertension etc. in
their pregnancies exclusively breastfed their
infants for the first six months ,only 32 out of 86
mothers (37.2 %) who didn’t have any diseases
exclusively breastfed. But this difference
couldn’t be found statistically significant
(x²=3.43, p=0.06).
Mothers in our study group gave birth
between 34th-42nd gestation weeks. 47.6% of 21
mothers who gave birth before the 38th gestation
week and 40.0% of 80 mothers who gave birth
after the 42nd gestation week exclusively
breastfed their infants for the first six months.
This difference was statistically significant
(x²=3.81, p=0.05).
No statistically significant difference
was found between the delivery types of
mothers and the infants’ being exclusively
breastfed for the first six months (x²=0.68,
p=0.4). 47.2% of mothers who gave normal
birth and) 36.2% of them who gave birth by
caesarean section exclusively breastfed for the
first six months.
98% protected from pregnancy by any
method
Mothers
(n=98)
50% protected from pregnancy by
effective methods
Table 3. Contraception Status of Mothers *
* Two mothers whose husbands were in the
army and one mother who was pregnant again were
excluded from the table.
When the contraception status of
mothers was examined, except two mothers
whose husbands were in the army and one
pregnant mother; it was determined that only 2
out of 98 mothers used no methods to be
protected from pregnancy. Half of the mothers
protected from pregnancy were using a medical
method (Table 3).
During the consultation in the hospital,
mothers were also informed about contraception
and the lactation amenorrhea method. When the
duration of the infants’ exclusively breast-
feeding by their mothers and the time for
starting to use a method to be protected from
pregnancy were compared, it was determined
that 87.5% of mothers who exclusively
breastfed their infants and 52.5% of mothers
who introduced the complementary foods
started at the right time to use a method for
being protected from pregnancy. This difference
Studiu original J.M.B.
62
between the mothers who exclusively breastfed
their infants for the first six months and the ones
who introduced the complementary foods in this
period was found statistically significant
(x²=10.65 p=0.001) in terms of the time to begin
being protected from pregnancy.
Another important finding of this study
was that all of the mothers were very pleased to
have a phone call from the hospital where they
gave birth six months ago and they stated that
they were expecting such a phone call. After
they gave all the necessary information
requested, they also asked questions about
different subjects such as infant nutrition,
complementary foods, baby health and diseases,
vaccines, contraception, sexual life, women’s
health, losing weight, chronic diseases, sister
relationship during the telephone conversations.
In the conversations, mothers were consulted
and informed about their questions and
appointments for inspections and controls were
made related with their problems or were
forwarded to relevant units.
Discussions
The ratio of mothers who participated in
our study with 9 years of education or over
(59.0%) was more than the ratio of mothers in
the western region of our country who had the
secondary school or higher education mentioned
in TDHS [5]. This case can be explained in a
way that our study was conducted in a
university hospital and that most of the mothers
were working [5].
The caesarean birth rate in the western
region of our country is 21.9% [5], but in our
study, 47.0% of mothers had caesarean births.
The reasons for having such a high rate may be
that there are more high-risk pregnancies in the
university hospital in which the study was
conducted and that mothers have high education
levels. As training period in our country in-
creases, the rate of having caesarean operations
for women also increases.
While the rate of exclusively breastfed
infants among the 4-5 months old ones is 10.6%
in our country, this rate is 63.0% in the fourth
month in our study. Although it decreased in the
sixth month, the rate is still higher (42.0%).
According to different applications in our
country, this very different rate can be explained
by the effect of counselling. In a similar study
conducted in the same hospital by Turan et al.
(2000), counselling and support given were conti-
nued by phoning mothers in the 2nd, 4th, 6th weeks
and the 4th month after birth and the ratio of
exclusively breastfed infants was found to increase
up to 83.0% in the fourth month [11]. As coun-
selling and support given in the hospital for breast-
feeding are continued later, this case may result in
an increase in the rate of exclusive breastfeeding.
Support given for breastfeeding in the
early period after birth increases the ratio of
being exclusively breastfed [11]. However,
introduction of the complementary foods by
some mothers early for various reasons instead
of not receiving counselling and support again
to continue the exclusive breastfeeding the
infants shows that environment has an important
effect on this matter. Four mothers stated that
they introduced the complementary foods
because they started to work. Not having
sufficient legal support of working mothers is a
situation which negatively affects the infant
nutrition. Similar reasons were also expressed in
other researches [3, 11].
Although it isn’t statistically significant,
the reason for mothers’ exclusively breast-
feeding more who had diseases in their
pregnancies may be the effect of information
given during the consultation about the breast
milk‘s protection from chronic diseases
(x²=0.68 p=0.04) this case shows the effect of
counselling the mothers of premature babies.
These mothers have treated in feeding their
babies more sensitively. Premature babies with
low birth weight have higher risk of death than
the others. [6] It is a fact that breast milk has a
special place for feeding the premature babies
and feeding with the breast milk increases the
chances of their survival [4]. Therefore, breast-
feeding counselling the mothers of premature
babies has a special importance.
The training of family planning in the
early period after birth is known to increase the
utilization rate of contraceptive methods [6]. In
this study, a statistically significant difference
was found between the mothers who exclusively
breastfed their infants for the first six months
and the ones who introduced the complementary
foods in this period in terms of the time to begin
being protected from pregnancy (x²=10.65,
p=0.001). This difference in an opposite case
shows that exclusively breastfeeding mothers
Studiu original J.M.B.
63
are more careful than the ones who introduce
complementary foods and have more risks in
being protected from pregnancy by any method.
This situation is finding that counselling affects
the mothers not only about breastfeeding but
also about being protected from pregnancy.
Another important finding of this study
is mothers’ expression of pleasure about being
phoned by the hospital where they gave birth six
months ago and their wishes to ask questions
about the subjects they need. This finding shows
that mothers need to be supported on different
subjects after birth and they are satisfied with
these when the opportunities are provided.
Results and suggestions
The rate of mothers’ exclusively breast-
feeding their infant in our study is higher than the
average rate of Turkey. This case shows the effect
of counselling once and even for a short time in
the early period after birth. Therefore, every
mother should be supported to breastfeed in the
maternity hospitals or there should be polyclinics
for the mothers with breast and breastfeeding
problems and the health personnel should be
trained about this subject. But it should not be
forgotten that legal arrangements should be
improved as well as counselling the mothers to
generalize the breastfeeding. For example, as a
result of national policies created in Tunisia, only
an increase in the total duration of breastfeeding
and giving breast milk has been seen [12].
Counselling after birth is also very
helpful in terms of contraception. Therefore,
governing laws for organizing the health,
education and working life are needed to be
developed in order to improve health of
maternity, infant and community and gain
economical benefits. WHO states that nurses
and midwives constitute more than the half of
health workforce and recommends that gover-
nments should create new policies in the
planning and implementation of health services
with the participation of nurse and midwife
leaders [15]. Therefore, nurses and other health
workers must take an active role in the
formation of these policies. The breastfeeding
status of the babies should be re-evaluated when
they are at the age of two to determine the effect
of counselling in the early period after birth on
the breastfeeding duration.
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Factors affecting the practice of breastfeeding in Menofia
  • A M Eissa
  • A Khashaba
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