INTRODUCTION:

According to World Health Organization (WHO), breastfeeding is one of the most natural and cost-effective processes of feeding infants aged less than 24 months to obtain the right amount of nutrition needed for healthy growth and development. Benefits include reduced risk of conditions such as breast cancer, cardiovascular disease and rheumatoid arthritis in the mother, whilst aiding in mother’s weight reduction and enhancing close relationship with the child. Benefits to the newborn include good nutrient supply and immunity; decrease Risk of sudden infant death and conditions such as type 1 diabetes.¹

Breastmilk alone is sufficient to meet an infant’s requirement for food and water in the first six months of life. With frequent, on-demand feedings, babies do not need water or any other liquids even in hot climates; mother’s milk is all they need for survival and optimal growth and development. Foods given to infants in the first six months of life do not improve growth and, instead, are dangerous when they replace mother’s milk, because they can result in frequent infections and poor growth and development.²

Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections.³ The importance of breastfeeding has been emphasized in various studies. The importance of exclusive breastfeeding and the immunological and nutritional values of breast milk has been demonstrated. The beneficial effects of breastfeeding depend on breastfeeding initiation, its duration, and the age at which the breast-fed child is weaned.⁴

Breastfeeding is the first fundamental right of the child. It provides a unique biological and emotional basis for the health development of the children. It offers infants and young children complete nutrition, early protection against Illness and promote growth and development of the baby. Early initiation of breast Feeding lowers the mother’s risk of postpartum haemorrhage and anaemia. Boosts mother’s immune system and reduces the incidence of diabetes and Cancers.⁵ Exclusive breastfeeding for the first four to six months of life and Timely introduction of weaning foods are important for laying down proper Foundations of growth in later childhood. This is due to the fact that by five to six months of age babies need additional food besides breast milk, which supplies energy, protein and other nutrients. Since this form one of the most sensitive Periods, the combined effects of inadequate and un hygienically prepared Supplemented food that is prone to infections may ultimately lead to increased Risk of growth retardation.⁶

While breastfeeding rates have improved globally, disparities in Breastfeeding practices persist particularly in rural and low resource settings.⁷ In LMICs, only 37% of children are breastfed exclusively for the first 6 months of Life⁸ and India is no exception. According to The National Family and Health Survey-4, on average only 56% of Indian mothers practiced EBF for the full 6 Months. As India leads the world in the number of preterm births, under 5 years Malnutrition, and neonatal mortality, understanding the factors associated with Exclusive breastfeeding can help improve the nutritional status for millions of infants. Furthermore, understanding factors that influence EBF practices can contribute to achieving the United Nations Sustainable Development Goal 3 (SGD3) of reducing neonatal mortality to at least as low as 12 neonatal deaths per 1000 live births by 2030.⁹

Exclusive breastfeeding is of immense benefits both to infant and maternal health. It is the optimal feeding method for infants less than 6 months of age. However, it is more than infant feeding because it is also beneficial to other family members, the community and the society. It protects against common childhood illnesses and also has long term protective benefits such as lower risk of obesity later in life. The benefits of exclusive breastfeeding can be measured both in resource poor and affluent societies.¹⁰

OBJECTIVE OF THE STUDY:

1. To assess the Breastfeeding Practices among postnatal mothers.

2. To assess the Breastfeeding Self -Efficacy among postnatal mothers.

3. To correlate the breastfeeding practices with breastfeeding self-efficacy score among postnatal mothers.

4. To find out association between level of breast feeding practices among postnatal mothers with their selected demographic variables

HYPOTHESIS:

1. H1: There will be a significant relationship between the breastfeeding practices and breastfeeding among postnatal mothers.

2. H2: There will be a significant association between the level of the breastfeeding practices with their selected demographic variables.

MATERIALS AND METHODS:

Research Approach and Design:

A Quantitative non-experimental descriptive design adopted to conduct the study. Postnatal mothers and there neonates.

Sample and sampling technique:

With a sample size of 60 were selected by using Convenient sampling, subjects were selected, because of their convenient, accessibility and proximity to the researcher.

Criteria for Selection of Sampling:

Inclusion criteria:

Sampling characteristics are the eligibility or inclusion criteria specification constraints population should be driven to the extent possible. people are able to participate in study design with ethical consideration.

· The study included postnatal mothers who are

· admitted in postnatal and pediatric units.

· able to understand, read and write Telugu.

· willing to participate in the study.

· available at the time of data collection.

SETTING OF THE STUDY:

The setting of the study included NRI General Hospital, Chinakakani, Guntur.

The tool for the study was chosen by the investigator based on the thorough review of literature and consultation with experts in the field of obstetrics and paediatrics. Tool includes 4 sub-sections.

SECTION-A:

Based on objectives-demographic data included Mother Details-age, religion, occupation, education, income, residential area, type of gravida, mode of delivery, maternity leaves, Baby Details- Birth order, age of baby and Birth weight.

SECTION–B:

The section consists of 15 items on knowledge regarding breast feeding. The item as developed as to cover the entire aspects of breast feeding self efficacy. Each item is closed ended multiple choice question. Each correct answer allotted a score of “one” and score “zero” for the incorrect answer. The maximum score for the section “B” is 15.

Score interpretation:

· 0-10 (<50%)- Inadequate practice

· 11-15 (51-75%) moderately adequate practice

· 16-20 (>75%) Adequate practice.

SECTION-C:

A tool to assess breastfeeding self-efficacy. Standardized tool of Breastfeeding self-efficacy short form scale by Dennis, (2002) it includes 14 items deals about the breastfeeding self-efficacy. It is graded on points score maximum score of 70, 1- not at all confident 2-confident, 3-some what confident, 4- confident 5- always confident graded of breastfeeding self -efficacy.

Interpretation of the self-efficacy

· 1-40 – Low self -efficacy confident

· 41-60 – Moderate self- efficacy confident

· 61-70-High self -efficacy confident

SECTION-D:

Checklist on LATCH to assess the breastfeeding practices among postnatal mothers, the observational checklist includes 5 items.

· Latch

· Audible swallowing

· Type of nipple

· Comfort

· Hold

Each item scored on 0-poor, 1-moderate, 2-good observation. The total score on breastfeeding was categorized into 0-3 poor feeding, 4-7 moderate feeding, 8-10 High feeding.

Content Validity:

The prepared tool along with objectives was submitted to 2 doctors. The modifications and suggestions of expert were incorporated in the final preparation of the tool.

RELIABILITY:

Reliability refers to the degree of consistences and the accuracy of the information obtained in the study. In the present study reliability of the tool was assessed by breastfeeding practices by split half method and spearman's brown prophecy formula showed score of 1.0. It indicates the tool was highly reliable. Breastfeeding Self-Efficacy short form scale (Dennis) Cronbach’s score is 0.97 it indicates the tool was reliable. LATCH Cronbach’s score is 0.98 it indicates tool was reliable.

PILOT STUDY:

Pilot study was conducted at NRI General hospital with purpose to find out feasibility and practicability of the study design. In the present study 10% sample taken for pilot study. The investigator selected from 6 postnatal mothers. The pilot study was conducted on 17/3/2019. The pilot study samples are not included in the main study. It was found to be a feasible and easily understandable for the subjects.

Ethical Consideration:

Ethical consideration was obtained from the institutional ethical committee permission was obtained from significant authorities and the consent was taken from the subject.

Collection of Data:

Data collection is the gathering of information needed to address a research problem. The data collected from 19.4.2019 to 21.4.2019, in NRI General Hospital, Chinnakakani Guntur. The formal permission was obtained from the Medical Superintendent of NRI General and Super Specialty Hospital, Chinnakakani, Guntur district. The convenient sampling used for selecting the sample, informed consent was taken from participants. Tool was distributed to the participants to fill the questionnaire on demographic variables, breastfeeding practices, breastfeeding self-efficacy scale and observation was taken by using the LATCH tool by the researcher during breast feeding. Tool was checked at the Centre for completeness and missing data was filled by the respondent.

Plan for Data Analysisp:

Data analysis is the process of organizing and synthesizing the data so as to answer the research questions and test hypothesis by using the collected data the following methods were used to analyze data.

Descriptive Statistics:

Frequency and percentage were computed to summarize the demographic data, breastfeeding practices, observational checklist on LATCH parameters to analyse by item wise analysis. Chi-square test was used to analyse the association between Breast feeding practices with their selected variables. Correlation co-efficient to find out relationship between Breastfeeding Practices and Breast feeding Self-Efficacy.

RESULTS:

The results of the study based on the objectives sections were done. Descriptive and inferential statistics were used for analysis.

Section I:

Age of mother:

Regarding the age of mother. Majority of respondent were in the age group of 20-25years 24 (40%) and 26-30years 15 (25%), below 20 years 11(18.4%), 26-30 years 15 (25%), 31-35years 6(10%), above 35 years 4(6.6%).

Religion:

Regarding religion of the mother, majority of respondents were Hindu’s 24(40%), Christians 22(36.6%), and Muslims 14(23.4%), none of them were from any other religion.

Occupation:

Regarding the occupation of mother majority of respondent were house wife’s 28(46.6%), technician and associate professionals 8(13.3%), professionals, clerks, skilled agricultural or fishery workers, and also elementary occupation were 5(8.3%), and skilled workers shop and market sales workers 4(6.6%) none of them were from craft related trade worker, plant and machine operators and assemblers, senior officials and managers.

Education of mother:

Regarding the education of the mother. Majority of respondent were graduates 18(30%), intermediate or diploma 15(25%), primary school certificate 9(15%), middle school certificate 6(10%), both profession or honors and also high school certificate 5(8.3%), and only few were illiterate 2(3.3%).

Income:

Regarding income of the family majority of respondent earned Rs 18,953-31,589/- were 18(30%), Rs >126,360/- and also income of Rs 31,59163,178/- were 8(13.3%), Rs 6,327-18,471-were 9(15%) and Rs 63,182-126,356/- and also Rs <6,323/- were 5(8.3%).

Socio-economic status:

Regarding socio-economic scale in majority of respondents were upper middle class 22(36.6%), upper lower 19(31.6%), lower middle 12(20%), upper 4(6.6%), and lower 3 (5%).

Residential area:

Regarding the type of residential area majority of respondents resides in urban 33(55%), whereas slum 19(31.6%), and in rural area 8 (13.3%).

Type of gravida:

Regarding type of gravid of mother. Majority of respondents were primi gravida 31(51.6%) and multi gravid 29(48.4%).

Mode of delivery:

Regarding the mode of delivery of mother. The majority of respondents undergone lower segment caesarean section 24(40%), normal vaginal delivery 23(38.4%), and instrumental delivery 13(21.6%).

Maternity leaves:

Regarding availing of maternity leaves of mother majority out of 32 employed respondents were 1-3 months 18(30%) and 4-6months 14(23.3%).

Birth order of child:

Regarding birth order of child majority of respondents are 1^st child 29(48.3%), 2^nd child 22(36.6%) and 3^rd child 9(15%).

Age of baby:

Regarding the age of baby in the majority of respondents were 0-7 days 42(70%) and 7-14 days age 18(30%).

Birth weight:

Regarding birth weight of baby majority of respondents were 3.1-3.5kgs 19(31.6%), >3.5kgs 17(28.3%), <2.5kgs 16(26.6%) and 2.6-3.0kgs 8(13.3%).

Fig 2: Percentage distribution regarding Mode of delivery of post-natal mothers.

Regarding the mode of delivery of mother, Lower segment cesarean section were 24(40%), Normal vaginal delivery was 23(38.4%), and Instrumental delivery were 13(21.6%).

Fig 3: Percentage distribution regarding birth order of child.

Regarding birth order of child are 1^st child were 29(48.3%), 2^nd child was 22(36.6%) and 3^rd child 9(15%).

Fig. 4: Percentage distribution regarding age of the baby.

Regarding the age of baby in the 0-7 days are 42(70%) and 7-14 days age are 18(30%).

Section-II:

Table 1: Breastfeeding practices of the mothers.

S. No.	Parameters	Frequency	%	Mean	SD
1.	Inadequate practices	11	18.4%	1.1	0.4
2.	Moderately adequate practices	40	66.6%	8.6	0.56
3.	Adequate practices	9	15%	2.7	1.97

The data represented the table 1, regarding the Breast-feeding practices frequency and percentage distribution of inadequate practices were 11(18.4%), moderately adequate practices were 40(66.6%), and adequate practices were 9(16%), mean and standard deviation of Inadequate practices were 1.1(0.4) moderately adequate practices were 8.6 (0.56) and adequate practices were 2.7(1.97).

Table 2: Frequency, percentage, mean and standard deviation of LATCH among postnatal mothers

S. No.	Parameters	Frequency	%	Mean	SD
1	Poor feeding	6	10%	0.1	0.07
2	Moderate feeding	36	60%	3.6	0.3
3	Good feeding	18	30%	2.7	0.8

The data represented table 2, regarding the LATCH frequency and percentage poor feeding were 6(10%), moderate feeding were 36 (60%), and good feeding were 18(30%). Mean and standard deviation of LATCH poor feeding were 0.1 (0.2) moderate feeding were 3.6(0.3) and good feeding were 2.7(0.8).

Table 3: Breast feeding self-efficacy among postnatal mother’s Frequency, Percentage, mean and standard deviation.

S. No	Item	Frequency	%	Mean	SD
1	Low confident	14	23.3%	4.9	2.07
2	Moderate confident	20	33.3%	17	4.18
3	High confident	26	43.3%	28.16	4.7

The data represented the data related to breast feeding self-efficacy frequency and percentage low confident 14(23.3%), moderate confident 20 (33.3%) and high confident 26 (43.4%). Mean and standard deviation low confident 4.9(2.07), moderate confident 17(4.18) and high confident 28.16 (4.7).

Table 4: co relational co-efficient value of breastfeeding practices.

Parameters	Correlational co-efficient value
Breast feeding practices with Breast feeding self efficacy	1.0

The data represented related to the correlational coefficient breastfeeding practices with breastfeeding self-efficacy value is 1.0 which refers they were strongly positive correlated.

DISCUSSION:

The results showed that breastfeeding practices among postnatal mothers the majority of respondent were breastfeeding exclusively 52(86.6). With regard to, the majority of respondent hold baby were 18(30%). With regard to, the majority of respondent were in wrapped without much skin contact 44(73.3%). With regard to, the majority of respondent were in I had been given anaesthesia and was so not held 24(40%).With regard to how long did you hold your baby this first time the majority of respondent were holding baby for less than 30 min 25(41.6%). With regard to, help with positioning and attaching your baby the majority of respondent were yes 50(83.3%).

The results showed that majority of respondent took support and obtained information of Exclusive Breast Milk were 50(83.3%). With regard to, the majority of respondent my baby always with me both day and night was 27(45%). With regard to, the majority of respondent took advices on feeding the baby were in every hour were 18(28.3).

The results showed that majority of respondent baby sucked as long as baby wants to were 24(40%).With regard to supplements, the majority of the respondents were don’t know reason (33.3%). With Regard to mode of feeding supplements, the majority of respondent were bottle with teat or nipple16 (32%). sucking on a pacifier, the majority of respondent were 29 (48.3%). With regard to, getting suggestions a problem of feeding the majority of respondent received suggestions were in yes 45(75%). With regard to, suggestions the majority of respondent were got help from professionals 22(36.6%).

The results showed that breast feeding self-efficacy among postnatal mothers. Breastfeeding self-efficacy were With regard to baby getting enough milk the majority of respondents were always confident 25 (41.6%). With regard to successfully cope with breastfeeding like I have with other challenging tasks. The majority of respondents were both confident and also always confident 20 (33.3%). With regard to Breast feed baby without formula supplements the majority of respondent were always confident 28(46.6%).

With regard to Ensure that baby is properly latched, the majority of respondent were always confident 25(41. 6%). With regard to Manage breast feeding situation with my satisfaction, the majority of respondents were always confident 25(41.6%). With regard to Manage to breast feed even if baby is crying, the majority of respondents were always confident 23(38.3%).

With regard to Keep wanting to breast feed, the majority of respondent were always confident 24(41.6%). With regard to comfortably breastfeed with family members present, the majority of respondents were always confident 25(41.6%). With regard to Be satisfied with family members present, the majority of respondents were always confident 26(43. 3%). With regard to Deal with the fact that breast feeding can be time consuming, the majority of respondent were always confident 27(45%).

With regard to Feeding baby on one breast before switching to other breast, the majority of respondents were always confident 25(41.6%). With regard to Continue to breastfeed baby for every feeding, the majority of respondents were always confident 26(43.3%). With regard to Manage to keep up with baby's breastfeeding demands, the majority of respondents were always confident 28(46.6%). With regard to Tell when the baby is finished breastfeeding, the majority of respondents were always confident 35(58.3%).

In this study prepare and administered informational booklet regarding the breast-feeding practices and administered the postnatal mothers after a collecting the data, in a view to guide good practices and solve problems about latching. It deals with the discussion of the study with reference of objective and supportive studies.

CONCLUSION:

The following conclusion was formed on the bases of the study results.

· The findings revealed that information booklet improved the breast-feeding practices among postnatal mothers.

· The findings revealed that the improve the breast feeding self-efficacy of postnatal mother's. There was a significant relation between breast feeding practice and self-efficacy.

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Received on 15.07.2021 Modified on 30.07.2021

Int. J. of Advances in Nur. Management. 2021; 9(4):389-394.

DOI: 10.52711/2454-2652.2021.00090