Currently, two-thirds of US mothers who intend to breastfeed exclusively for at least three months do not reach their goals. Why? The US Surgeon General’s 2011 Call to Action to Support Breastfeeding identified some of the barriers women face:
- Lack of knowledge
- Social norms based on bottle-feeding
- Poor family and social support
- Embarrassment about breastfeeding in public or social settings
- Lactation problems
- Employment and child care
- Problems related to health-care services
Missing from this list is one personal factor that has been closely linked to breastfeeding duration and exclusivity: “breastfeeding self-efficacy,” or a mother’s belief that she can make breastfeeding work.
Belief Affects Actions
Scientists have found that a mother’s level of breastfeeding self-efficacy is a stronger predictor of whether she meets her goals than whether she gives her baby formula. Some areas that determine a mother’s breastfeeding self-efficacy include whether she knows when baby has finished breastfeeding and if he’s gotten enough milk, if she can help the baby latch well most of the time, if she feels satisfied about how she’s managing breastfeeding, if she breastfeeds comfortably with family members present, her ability to comfort her fussy baby, and whether she continues to breastfeed at every feeding.
Research reveals that a mother’s level of breastfeeding self-efficacy influences her in major ways:
- whether she decides to breastfeed at all (people avoid tasks they don’t think they can accomplish),
- the amount of effort she’s willing to devote to it,
- how she interprets behaviors and events (whether her self-talk encourages or undermines her efforts),
- her decisions (such as whether or not she gives formula supplements), and
- how long she continues breastfeeding when faced with difficulties.
Women with low breastfeeding self-efficacy are likely to have little breastfeeding experience and to be more familiar with bottle-feeding. During pregnancy, they may say they will “try” breastfeeding but doubt that it will work. They may spend little or no time learning about it and feel greater stress when baby is at breast. They may worry that frequent breastfeeding—which is normal—is a sign they don’t have enough milk. They may give up quickly rather than trying to learn more or find a solution to a problem. Many begin supplementing with formula early “just in case.”
Pathways to Confidence
Breastfeeding self-efficacy is not a constant. It is a variable that can go higher or lower, depending on a mother’s experiences and actions. Research has identified four pathways to greater breastfeeding self-confidence. Using these four pathways can help mothers find the inner resources they need to reach their breastfeeding goals.
Mastering breastfeeding. The first pathway is positive personal experiences. Experienced breastfeeding mothers believe they can make breastfeeding work because they have already mastered it. Success reinforces success, which can start with small victories as they learn. This is also referred to as “task mastery.”
Watching other mothers breastfeed. This pathway, also known as “modeling,” can be used before a mother has much personal experience. This explains why mother-to-mother breastfeeding support increases breastfeeding duration. Time with other mothers and their thriving breastfed babies relieves doubts and proves that breastfeeding can work. New mothers may feel as though “if they can do it, so can I.” New York lactation consultant Diane Wiessinger describes how this transformation occurs:
“I remember a well-educated client, a speech pathologist with a specialty in geriatric problems. No amount of reassurance on my part gave her confidence that her baby’s squeaks and gurgles were normal. They were, after all, the very sounds about which she warned her nursing-home students. I invited her to a breastfeeding support group. The dozen or so mothers all nodded calmly when she described the sounds: “Yes, our babies do that too. Maybe it’s because they can’t clear their throats.” They showed the same calm unanimity over several other anxious questions she asked: “Yes, our babies spit up sometimes. It looks like a lot, doesn’t it? Especially on a mother-in-law!” “Yes, our babies often want to nurse within minutes of seeming full. We don’t know why. More nursing seems to work.” Afterwards, my client told me, “You know, I was going from here straight to the doctor’s. Now I think I’ll just go home and enjoy my baby.”
Encouragement and support from others. Mothers can also find this at mother-support gatherings and through phone and online contact with supportive women. On the flip side, criticism is more effective at decreasing self-efficacy than encouragement is at boosting it. In other words, the more time mothers spend with those who discourage their efforts, the lower their confidence in breastfeeding is likely to be.
Physical comfort and positive emotions. A mother’s physical and emotional states have a major effect on her level of self-efficacy. If she is tired, in pain, stressed, or anxious, this decreases her confidence that she can meet her goals. If she feels rested, calm, happy, and comfortable, this boosts her confidence.
How can breastfeeding supporters use this information to boost breastfeeding self-efficacy in the mothers they help?
- Before and after birth, share the knowledge and skills that make breastfeeding work
- Help mothers reduce pain or fatigue by offering effective strategies to overcome problems
- Encourage women to spend time with breastfeeding mothers
- Provide support and encouragement
Avoid using fear to motivate mothers, which may decrease breastfeeding self-efficacy. Instead provide positive reinforcement, reframe self-defeating thoughts, and create opportunities to practice key skills.
Mothers with high breastfeeding self-efficacy are more likely to seek help when needed and to access available resources. They are more likely to devote time and effort to overcoming breastfeeding problems. They are also more likely to persist until they reach their goals. Widespread efforts to help more mothers achieve greater breastfeeding self-efficacy could help many more reach their breastfeeding goals.
References
Bandura, A. 1997. Self-efficacy: The Exercise of Control. New York: W. H. Freeman and Company.
Bolton, T. et. al. 2009. Characteristics associated with longer breastfeeding duration: An analysis of a peer counseling support program. J Hum Lact, 25(1):18-27.
Bowles, B.C. 2011. Promoting breastfeeding self-efficacy: Fear appeals in breastfeeding management. Clin Lact 2 (1): 11-14.
Dennis, C-L. 2003. The Breastfeeding Self-Efficacy Scale: Psychometric assessment of the short form. JOGGN 32(6):734-744.
Dennis, C-L. 1999. Theoretical underpinnings of breastfeeding confidence: A self-efficacy framework. J Hum Lact 15(3): 195-201.
Dunn, S., Davies, B., McClearly, L., Edwards, N., & Gaboury, I. 2006. The relationship between vulnerability factors and breastfeeding outcomes. JOGNN, 35(1), 87-96.
Perrine, C.G., Scanlon, K.S., Li, R., Odom E., & Grummer-Strawn, L. 2012. Baby-friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics 130(1): 54-60.
U.S. Department of Health and Human Services. 2011. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General.
Wiessinger, D. 2002. “Last step first.” In Current Issues in Clinical Education, edited by K. Auerbach, 69-73. Sudbury: Jones and Bartlett.