"Motivate to Lactate": Utilizing Motivational Interviewing to Improve Breastfeeding Rates

The effect of motivational interview-based breastfeeding education on breastfeeding motivation, success, self-efficacy perceptions, and exclusive breastfeeding duration after cesarean section: a randomized controlled trial

The aim of this study was to investigate the effect of motivational interview-based breastfeeding education on breastfeeding motivation, breastfeeding success, self-efficacy perceptions, and exclusive breastfeeding duration in primiparous mothers after cesarean section. A parallel-group randomized controlled experimental study. Mothers were randomly assigned to an intervention group (IG; n = 39) and a control group (CG; n = 37). IG was provided with four sessions of motivational interview-based breastfeeding education, while CG did not receive any motivational interview-based education. The research data were collected by using 'Introductory Information Form', 'Breastfeeding Self-Efficacy Scale-Short Form', 'LATCH Breastfeeding Assessment Tool', 'The Primipara Breastfeeding Motivation Scale', and 'Importance and Confidence-Sufficiency Rulers'. In addition, in the follow-ups except for the pretest, mothers were asked about exclusive breastfeeding. The study was registered at ClinicalTrials database (NCT05562245). Group × time interactions in mothers, breastfeeding self-efficacy, breastfeeding success, the value ascribed to breastfeeding, breastfeeding self-effectiveness, and confidence sufficiency in breastfeeding ability were statistically significant (P < 0.05). A motivational interviewing-based breastfeeding education provided to mothers increased their breastfeeding self-efficacy, the value ascribed to breastfeeding, and confidence sufficiency in breastfeeding ability. Therefore, motivational interviewing can contribute to mothers' positive experience of breastfeeding.

Breastfeeding interventions for preventing postpartum depression

BACKGROUND

Postpartum depression is a debilitating mental health disorder, which occurs in approximately 6% to 13% of women who give birth in high-income countries. It is a cause of great suffering for women and can have long-term consequences for child development. Postpartum depression can also negatively influence breastfeeding duration and breastfeeding exclusivity (i.e. feeding the infant only breast milk). However, a positive early, and continued, breastfeeding experience may reduce the risk of having postpartum depression. Breastfeeding interventions that increase the duration and exclusivity of breastfeeding may help prevent or reduce postpartum depressive symptoms.

OBJECTIVES

The primary objective of this review was to assess the effect (benefits and harms) of breastfeeding support interventions, in comparison to standard perinatal care, on maternal postpartum depression. The secondary objective was to assess whether breastfeeding support interventions had an effect on depression symptoms, and whether the effect was dependent on the duration and exclusivity of breastfeeding.

SEARCH METHODS

We searched CENTRAL (Wiley), MEDLINE ALL (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL Complete (Ebsco) and several other bibliographic databases and trial registers. The most recent search was conducted in June 2024.

SELECTION CRITERIA

Randomised controlled trials (RCTs) that evaluated educational, psychosocial, pharmacological, alternative (any breastfeeding support intervention that promotes relaxation and reduces stress) or herbal breastfeeding support interventions targeting the prevention or reduction of postpartum depression were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Each title and abstract we identified was screened by two authors independently. Two review authors then independently examined full-text manuscripts to decide if the study met the inclusion criteria. If so, they extracted data from included studies using Covidence software. Two review authors also independently conducted a risk of bias assessment of each study using the RoB 2 tool. We contacted study authors when necessary for more information. We conducted meta-analyses using a random-effects model.

MAIN RESULTS

We included 10 RCTs with 1573 participants in this review. Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) in all studies, where scores range between 0 and 30 (higher scores indicating more depressive symptoms). The studies used a score of over 10 as the cut-off for a diagnosis of depression. Primary outcome It is very uncertain whether psychosocial breastfeeding interventions had any effect on the incidence of postpartum depression immediately post-intervention (RR 0.78, 95% CI 0.23 to 2.70; 1 study, 30 participants), but we found low-certainty evidence that psychosocial breastfeeding interventions may prevent the incidence of postpartum depression in the short term (one to three months) post-intervention (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.14 to 0.93; 1 study, 82 participants). It is very uncertain whether alternative breastfeeding interventions had any effect in preventing the incidence of postpartum depression immediately post-intervention (RR 0.64, 95% CI 0.27 to 1.54; 1 study, 60 participants). The short-term time point was not measured. Secondary outcomes It is very uncertain whether psychosocial breastfeeding interventions had any effect on reducing depressive symptoms immediately post-intervention (mean difference (MD) -0.67, 95% CI -1.63 to 0.28; 4 studies, 512 participants). There is very low-certainty evidence that psychosocial breastfeeding interventions could reduce symptoms of anxiety immediately post-intervention as measured with the Zung Self-rating Anxiety Scale (SAS), where scores between 45 and 59 out of 80 on the SAS indicate mild to moderate anxiety, scores between 60 and 74 marked severe anxiety levels and > 75 extreme anxiety levels (MD -2.30, 95% CI -4.36 to -0.24; 1 study, 100 participants). There was no difference in rates of exclusive breastfeeding immediately post-intervention between those offered a psychosocial breastfeeding intervention and those receiving standard care, but the evidence is very uncertain (RR 1.20, 95% CI 0.96 to 1.51; I2 = 29%; 571 participants; very low-certainty evidence). We found low-certainty evidence that a psychosocial breastfeeding intervention may increase the duration of breastfeeding in the long term (RR 1.64, 95% CI 1.08 to 2.50; 129 participants; low-certainty evidence). For the comparison of alternative breastfeeding intervention versus standard care (which was evaluated in only one study), there was no difference between groups immediately post-intervention in anxiety measured with the State-Trait Anxiety Inventory (STAI); range 20 to 80; higher scores indicate more severe anxiety symptoms (MD 1.80, 95% CI -9.41 to 13.01; 60 participants; very low-certainty evidence), or in stress measured with the Perceived Stress Scale (PSS)-NICE; range 1 to 230, higher scores indicate higher levels of stress (MD 1.90, 95% CI -10.28 to 14.08; 60 participants; very low-certainty evidence), but the evidence is very uncertain. No adverse events connected to the intervention itself were stated in any of the trials, but for most studies, we do not know if this is because there were none or because they were not measured or reported.

AUTHORS' CONCLUSIONS

There is low-certainty evidence that psychosocial breastfeeding interventions may prevent postpartum depression in the short term and increase the duration of breastfeeding in the long-term. The evidence is very uncertain about the effect of psychosocial breastfeeding interventions on other outcomes. The evidence is very uncertain about the effect of alternative breastfeeding interventions on postpartum depression or other outcomes. The included studies did not report any adverse events directly related to the interventions, but it is not clear if this outcome was measured in most studies. Future trials of breastfeeding interventions should be conducted carefully to reduce their risk of bias, and they should be large enough to detect differences between mothers in their mental health.

The Philosophy That Enables the Return to Our Essence in Breastfeeding: HypnoBreastfeeding

Different initiatives have been implemented along with the results from and recommendations of multiple international meetings to improve breastfeeding. The most common interventions to improve breastfeeding are education and counseling. Although studies are reporting that breastfeeding education and counseling programs improve breastfeeding results, the lack of breastfeeding rates to reach the targeted levels suggests that there is a requirement for a different approach. In addition to these results, a paradigm shift in education and counseling, which are the most frequently used methods to improve breastfeeding, is necessary. Hence, the philosophy of HypnoBreastfeeding has emerged. This study addresses the origin and development of HypnoBreastfeeding philosophy, its concepts, and the correlations between the concepts and the relevant philosophical claims.