Evaluation of effect of breastfeeding support program given to mothers during postpartum period on exclusi̇ve breastfeeding

Objective: In the scope of the research, Breastfeeding Support Program (BSP), which aims to increase the proportion of only breastfeeding through the first six months in maternals who just gave birth, and includes one postnatal training session in hospital, the second week hospital follow-up after discharging and follow-up calls through the second, fourth and sixth months, and consultancy, has been developed. With this research, it has been aimed to evaluate the efficiency of the BSP by comparing the control group with regards to knowledge of maternals taking part into the intervention group, their self-efficacy of breastfeeding and feeding behaviours consisting of exclusive breastfeeding (EBF). Method and material: This is a controlled intervention research towards the assessment of training effectiveness. The research group consists of the maternals who gave birth between the dates of 04.11.2013 and 25.04.2014 at the gynecology and obstetrics clinic of Ege University Medical Faculty Hospital, are 18 years old and over, reside in the city center of İzmir, are single and gave birth in full-term. Influence difference towards the interference between the intervention and control group that has been reported in the previous studies that has been conducted to calculate the sample size has been evaluated, and with BSP it has been aimed that the percentage of continuance to EBF in the sixth month will reach 55%. By benefiting from NCSS-PASS 2005 program, the sample size that has been calculated with a α=0.05 and 80% power has been designated as 105 in the intervention group and as 105 in the control group and in total as 210 maternals. By taking loss of follow-ups into consideration 230 maternals have been included into the study. During the research, the follow-ups of four maternals in the intervention group and of six maternals in the control group has not been able to be completed. Before applying the training in the hospital to the maternals taking part into the intervention group, their data related to the features in terms of sociodemographic, fertility and breastfeeding, and their data related to the knowledge about breastfeeding, self-efficacy perception and breastfeeding behaviours have been gathered. After gathering the data the maternals in the intervention group have been given breastfeeding training with one on one interview by the researhcer by including them in BSP. After discharge; in the second week the follow-up in the hospital, follow-up calls in the seond, fourth and sixth months, and cobreastfeeding consultancy has been applied. Conjuction with the interview in the hospital, the follow-up calls have been applied to the control group during the second, fourth and sixth months, yet hospital follow-up has not been applied in the second week. By the researcher training hasn`t been applied to this group but the group has been directed to routine services. By the end of the week sixth all the maternal have been applied Information Assessment Form (post test) and level of knowledge in terms of breastfeeding has been assessed. Defining features in the statistical analysis of the data obtained have been compared to chi-squared analyze. Information form before and after the training with self-efficacy scale and the scores they have received from LATCH diagnosis device has been assessed with t test. While the change of the group according to the month they have in terms of breastfeeding has been examined by Cochrane Q test the determiners of breastfeeding has been studied with logistics regression analyze. Findings: In the last test applied on the sixth month after BSP average information score of maternal has been found higher (t=10.737; p=0.000) for intervention group compare to control group. The self-efficacy level of maternal has shown an increase for both groups on the second month and it has been found that the increase in intervention group is significantly higher than control group (t=7.90; p=0.000). LATCH scale scores used to assess the breastfeeding behaviors of maternal inside the hospital before and after training also have been obtained higher in intervention group compare to control group (t=7.250; p=0.000). The percentage of breastfeeding baby within the intervention group is significantly higher than control group (p<0.05) between the first monitoring and last one before being discharged of the hospital. Before being discharged from the hospital EBF level in intervention group is 88.3%, on the second month 83.8%, on the fourth month 71.2% and on the sixth month 58.6% and in control group it is respectively 70.6%, 46.8%, 31.2% and 19.3%. According to the control group being within the intervention group is increasing the possibility of only breastfeeding on discharge around 3.02 times, on the second month as 8.94, on the fourth month as 7.46 times and on the sixth month as 7.51 times. Other variants effective on only breastfeeding have been determined to be living in nuclear family, vaginal delivery, being multiparous and not using feeding bottle. During discharge the possibility of EBF for Maternal living in nuclear family is increasing around 3.18 times, on the second month 4.84 times, and on the sixth month 4.45 times compare to those living in big families. For those having vaginal delivery EBF possibility in hospital is 2.65 times higher than those having c-section delivery. Compare to prim parous maternal multiparous maternal feed their babies around 5.20 times on the second month, on the fourth month 2.95 and on the sixth month 4.08 times. As for those not using feeding bottle, it has been found that the level of EBF in the hospitals has increased around 3.60 times compare to those not using it. As a result of the evaluation of the monthly monitoring other findings are maternal have service more from family health centers, one out of three has not been assessed in terms of breastfeeding during that process, it is mainly the health professionals having influence on starting supplementary food and breastfeeding problems have increased for working maternal after they start working. Result: It has been determined that the BSP that has been formed with knowledge, efficiency and behavior components and is contributing significantly to the information level of maternal, strengthening the breastfeeding self-efficacy and increasing exclusive breastfeeding level and influencing the breastfeeding behavior of maternal and stated that it has influenced maternal positively . Key Words: Exclusive breastfeeding; Breastfeeding Training; Self efficacy; Breastfeeding support