The effect of in-home supportive counseling on breastfeeding Performance and maternal functioning following cesarean section among primiparous women

Abstract

Abstract Background: Iran has one of the highest Cesarean section (CS) rates and mothers undergoingCS need more help and support to begin and continue breastfeeding. It seems that counseling athome, can provide useful support interventions and shifts the care approach from a hospitaloriented state to a client-oriented one. This study aimed at evaluating the effect of in-homesupportive counseling on breastfeeding performance and maternal functioning (primaryoutcomes) and on breastfeeding and maternal self-efficacy and infant’s weight (secondaryoutcomes) following CS among primiparous women.Method: This randomized controlled clinical trial was performed on 60 primiparous womenaged 18-35 years following CS who gave birth at Alavi Educational and Treatment Center inArdabil in 2021. Participants were randomly assigned into the intervention and control groupswith a ratio of 1:1 by block randomization with block sizes of 4 and 6. The intervention groupreceived in-home supportive counseling during three sessions on days 3, 7, and one month afterbirth for 45-60 minutes. The control group received only routine postpartum care. Breastfeedingperformance checklist, breastfeeding self-efficacy scale-short form, maternal self-efficacyquestionnaire, and Barkin index of maternal functioning completed by both groups 10-15 days,two, and four months after birth. Infant’s weights were recorded at birth day, two and fourmonths after birth. Chi-square, RMANOVA and independent t-test were used to analyze thedata.Results: The comparison of breastfeeding performance in terms of the frequency ofbreastfeeding during twenty-four hours period, duration of each breastfeeding, Exclusive breastfeeding, and frequency of breastfeeding problems revealed a significant difference between thetwo groups during 10-15 days, two and four months after birth (P< 0.05).The total mean (SD) score of maternal functioning 10-15 days after birth was 102.16 (5.06) inthe intervention group and 78.70 (9.18) in the control group (P <0.001). Two months afterdelivery, the total mean (SD) score of maternal functioning was 105.56 (2.80) in the interventiongroup and 77.26 (11.14) in the control group. Four months after delivery, the total mean score ofmaternal functioning in the intervention group was significantly higher than that in the controlgroup [AMD: 28.51, 95% CI = 24.91 to 32.10, P < 0.001].The total mean (SD) score of maternal self-efficacy 10-15 days after delivery was 25.06 (1.38) inthe intervention group and 26.23 (2.90) in the control group (P= 0.9). Twomonths after delivery, the total mean (SD) score of maternal self-efficacy in the intervention andcontrol groups was 38.10 (1.42) and 27.40 (3.43), respectively. Further, the total mean (SD)score of maternal self-efficacy four months after delivery was 37.57 (0.81) in the interventiongroup and 27.011 (3.37) in the control group [AMD:10.56, 95%CI: 9.46 to 11.67, P <0.001].The total mean (SD) score of breastfeeding self-efficacy in the intervention group increased from50.56 (2.35) during 10-15 days after birth to 62.86 (1.77) at two months and 64.2 (1.37) at fourmonths after birth and it changed from 44.26 (5.89) during 10-15 days after birth to 43 (6.93) attwo months and 39.13 (6.98) at four months after birth in the control group [AMD:20.41, 95%CI: 18.18 to 22.63, P<0.001].The mean (SD) weight of infants in the intervention group increased from 3134.33 (385.90) afterbirth to 5643.33 (793.04) at two months and 7276.66 (926.12) at four months after birth. Themean (SD) weight of infants in the control group enhanced from 3268.33 (464.88) after birth to5318.33 (639.83) at two months and 6736.66 (639.22) at four months after birth (AMD: 213.33,95% CI = -73.74 to 500.41, P = 0.142)Conclusion: In-home supportive counseling effectively influences the improvement ofbreastfeeding and maternal performance after CS. The findings of this study demonstrated thatthe acquisition of functional skills in mothers leads to increased self-confidence and improvedself-efficacy in caring for the baby over time. Also, increasing breatfeeding self-eeficacy leads toimprove breatfeeding performance. But it does not have a significant effect on the weight gain ofbabies.