Does the Implementation of a Breastfeeding Educational Intervention affect First-Time Mother’s Confidence in Continuing Breastfeeding at Discharge?

By TANG Hoi Yan, Kathleen, RNM, BSN, MSN, IBCLC®, Maternity Department


The most common reasons cited by women for difficulty to choose exclusive or sustained breastfeeding can be attributed to lack self-confidence and self-efficacy. Mothers who delivered babies in Hong Kong Sanatorium & Hospital were more likely to initiate breastfeeding, but less likely to choose exclusive breastfeeding during hospitalization and discharge. And ineffective positioning and attachment, low breastfeeding rate therefore preventable if intervention change mother’s confidence level.

Purpose and Problem Statement

This study aimed to determine whether an in-hospital postpartum breastfeeding support service increase mothers confidence level and continues to breastfeed.

Implementation Plan

Using a related comparison group and a pre- and post-intervention design, in August 2018 in HKSH, 12 first-time mothers (experimental group) were selected to the in-hospital postpartum breastfeeding support service, which was standardized conducted by International Board Certified Lactation Consultants (IBCLCs) , focusing on effective positioning and attachment with the use of hands-off approach breastfeeding educational method.

Various confidence levels were assessed using a questionnaire with 5-likert scale, and breastfeeding rate were recorded during hospitalization, at discharge, and at one month after discharge.


Results showed that the in-hospital postpartum breastfeeding support service, with IBCLCs support and hands-off approach breastfeeding educational method, could improve mothers’ confidence at least 20% on various levels, including using different positions to breastfeed (average score from 2.75 to 3.917), proper latch on (average score from 3.417 to 4.167), and confidence to continue breastfeeding for 6 months (average score from 3.25 to 3.917).

Baseline on the ever breastfeeding rate during hospitalization in HKSH in 2016 was 97%, and at one month of age in Hong Kong's population was 78.2%. Following in-hospital postpartum breastfeeding support service, all mothers in the intervention group were continuous breastfeeding their babies at discharge date and after one month of age. Additionally, it led to a higher exclusive breastfeeding rate at discharge compared to usual care.

Recommendations and Next Steps

Although the exclusive breastfeeding rate of the intervention group at one month of age was lower than the Hong Kong's population in 2016, it was higher than those in the intervention group at discharge. The study has shown that in-hospital postpartum breastfeeding support service, conducted by IBCLCs and using hands-off approach, can increase mothers' confidence in continuous breastfeeding relevant to the immediate postpartum period and extend to one month of age. It is, therefore, applicable to all mothers, and could be an effective way of improving the ability of mothers to begin and continue to breastfeed successfully. Furthermore, a lactation team would be recommended to improve and provide continuous postpartum breastfeeding support service, not only for in-patient, but also extend to out-patient and follow up lactation support service.