Edwards M E, Jepson R G, McInnes R J
Centre for Public Health and Population Health Research, Faculty of Health Sciences and Sport, Pathfoot Building, University of Stirling, Scotland FK9 4LA, UK.
Scottish Collaboration for Public Health Research and Policy (SCPHRP), 20 West Richmond Street, Edinburgh, Scotland EH8 9DX, UK.
Midwifery. 2018 Feb;57:8-17. doi: 10.1016/j.midw.2017.10.013. Epub 2017 Oct 20.
to explore women's and midwives' expectations, knowledge and experiences of breastfeeding initiation using Social Cognitive Theory.
a qualitative study using focus group discussions and individual interviews. Breastfeeding initiation was defined for this study as a process within the first 48hours after birth. Data were analysed using qualitative inductive analysis then further deductive analysis using Social Cognitive Theory (SCT).
a purposefully selected sample of primigravid antenatal and postnatal women (n=18) and practising midwives (n=18) from one Health Board area in Scotland.
attachment of the baby to the breast at birth was hindered by sleepy babies and the busy unfamiliar hospital environment. These resulted in mothers struggling to maintain their motivation to breastfeed and to develop low self-efficacy. Instinctive attachment was rare. Midwives who considered it was normal for babies to be sleepy and unable to attach or feed at birth did not facilitate instinctive baby behaviour. Midwives sometimes experienced lack of autonomy and environmental circumstances that made women centred care difficult. Furthermore caring for high numbers of women, dependent on their help, resulted in reduced self-efficacy for providing effective breastfeeding support.
interviewing both women and midwives specifically about initiation of breastfeeding has allowed for deeper insights into this critical period and enabled a comparison between the data obtained from mothers and midwives. The findings suggest that instinctive attachment is not an expectation of either mothers or midwives and results in a loss of breastfeeding confidence in both.
to facilitate initiation there is a need for more research to develop appropriate maternal and midwifery skills, and make changes to the cultural environment in hospitals. Social Cognitive Theory could be used as a framework in both the antenatal and immediate postnatal period to develop strategies and materials to increase women's and midwives' self-efficacy specifically in initiation.
运用社会认知理论探讨女性和助产士对母乳喂养启动的期望、知识及经历。
采用焦点小组讨论和个体访谈的定性研究。本研究将母乳喂养启动定义为出生后48小时内的一个过程。数据先采用定性归纳分析，然后运用社会认知理论（SCT）进行进一步的演绎分析。
从苏格兰一个健康委员会区域有目的地选取了初产妇（n = 18）和执业助产士（n = 18）作为样本。
出生时婴儿嗜睡以及医院环境繁忙且陌生，阻碍了婴儿与乳房的接触。这导致母亲们难以维持母乳喂养的动力，自我效能感较低。本能的接触很少见。认为婴儿出生时嗜睡且无法接触乳房或进食是正常现象的助产士，并未促进婴儿的本能行为。助产士有时会缺乏自主权，且环境因素使得以女性为中心的护理变得困难。此外，照顾大量依赖她们帮助的女性，导致提供有效母乳喂养支持的自我效能感降低。
专门针对女性和助产士进行母乳喂养启动方面的访谈，能够更深入地洞察这一关键时期，并对从母亲和助产士处获得的数据进行比较。研究结果表明，本能接触并非母亲或助产士的期望，且会导致双方母乳喂养信心的丧失。
为促进母乳喂养启动，需要开展更多研究以培养适当的产妇和助产士技能，并改变医院的文化环境。社会认知理论可在产前和产后即刻用作框架，以制定策略和材料，特别是在母乳喂养启动方面提高女性和助产士的自我效能感。
