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Breast milk is the most natural and suitable source of nutrition for newborns (Giglia & Binns, 2014) and breastfeeding can enhance maternal attachment to her newborn (Britton, Britton, & Gronwaldt, 2006). For newborns in the neonatal intermediate care unit after birth, exclusive and continued breastfeeding can be affected by factors such as mother-infant separation (Wang & Gau, 2013), infant’s health conditions (Huang, Lee, Gau, & Hang, 2007) and maternal anxiety (Lee, Lee, & Kuo, 2009; Meier, Engstrom, Patel, Jegier, & Bruns, 2010). Thus, providing support to mothers and preparing them to have adequate information related to the situations of the mother and the newborn during the early phase of the newborn’s admission are important (Kornides & Kitsantas, 2013; Wang & Gau, 2013). Past education programs and breastfeeding teaching in prenatal and postpartum periods often emphasized the importance of breastfeeding and general practice for mothers with healthy infants (Blixt, Martensson, & Ekstrom, 2014; Lin, Chien, Tai, & Lee, 2008; Meedya et al., 2014). Specific breastfeeding issues and related solutions were rarely provided to mothers with infants in the neonatal intermediate care unit. The purpose of this study is to evaluate the effectiveness of a breastfeeding education program on maternal breastfeeding knowledge, anxiety, attachment, perceived nursing support and one-month exclusive breastfeeding rate.
Methods:
A historical comparison study was designed. A total of 68 mothers whose newborns were admitted to the neonatal intermediate care unit after birth and planned to breastfeed participated. Thirty-four mothers in the comparison group received routine care; besides the routine care, 34 mothers in the intervention group received a breastfeeding program designed for these mothers. The breastfeeding program including 28 short modules were made and downloaded onto a tablet personal computer. Each module elaborated on a breastfeeding topic and provided video clips to show practice steps if necessary. During the mother’s 3-5 days stay on the postpartum unit, mothers could repeatedly watch every module or select topics related to her situation at her own pace. Maternal breastfeeding knowledge, situational anxiety, and attachment were measured at the newborn’s admission and discharge (or seventh day after admission). Perceived nursing support was measured at discharge and breastfeeding type was followed-up at one-month.
Results:
Compared to admission, mothers in both groups had increased breastfeeding knowledge, decreased anxiety, and greater attachment at discharge. After adjusting for newborn’s birth weight, mothers in the intervention group had better attachment to their newborns and perceived nurse support than mothers in the comparison group. The one month exclusive breastfeeding rate was significantly higher in the intervention group (61.8%) than the rate in the comparison group (35.3%). Mothers in the intervention were very satisfied with the educational program and provided positive feedback.
Conclusion:
Designing an intervention which provides informational, emotional, instrumental, and esteem support for the mother can effectively increase maternal attachment with her newborn during mother-newborn separation related to infant admission to a neonatal intermediate care unit and help to maintain exclusive breastfeeding at one month. An early breastfeeding education program is an important intervention for mothers of newborns in the neonatal intermediate care unit.