Breastfeeding Initiation and Duration in First-Time Mothers: Exploring the Impact of Father Involvement in the Early Post-Partum Period

Abstract

Background: The early post-partum period is a crucial time for breastfeeding support. Mothers who have physical and emotional support during this period are more likely to be successful in breastfeeding. This study examined the relationship between father involvement and support for breast feeding initiation and duration in first-time mothers.

Methods: Overall, 146 women who attended a childbirth education class or breastfeeding course at BABS were asked to fill out the Childbirth Experiences Survey, which explored key topics such as (1) breastfeeding initiation, (2) early post-partum breastfeeding, (3) breastfeeding plan, (4) post-partum breastfeeding support and (5) breast feeding duration. This was a voluntary self-reported ques­tionnaire. The surveys were completed by the mothers during the post-partum period.

Results: 45.9% (n=67) of mothers received helped from their husband or part­ner with breastfeeding while in the hospital, while 54.1% (n=79) of mothers did not receive support from their partners. Mothers who received early post-par­tum breastfeeding support were more likely to continue breastfeeding after leaving the hospital.

Conclusion: First-time mothers who identified as having breastfeeding support from their partners, the infant’s father, during the early post-partum period were more likely to initiate breastfeeding and had longer breastfeeding durations.

Introduction

Decisions regarding how an infant is nourished are often complex with various social, psychological, emotional, and environmental factors impacting whether an infant is breast fed or bottle-fed.¹ Even though research has suggested that paternal involvement is likely to affect infant mortality through the mother’s well-being and support, efforts to reduce infant mortality in the United States have failed to incorporate fathers.² Father involvement in pregnancy is a relatively new research focus and much of what is known about the transition to fatherhood is gleaned from relatively older studies that focused on how couples become parents and negotiate their new father and mother roles.³ Research focusing on the fathers’ involvement in pregnancy and birth outcomes has been over looked and most studies focus primarily on the mother, despite findings that indicate that the role of the father has been identified as one of the strongest influences on the success of breast feeding among mothers in the United States.⁴

Many factors influence breastfeeding initiation and duration. In the U.S. the percent of infants who begin breastfeeding is high at 77% however there is concern that infants are not being breastfed for as long as recommended. Of infants born in 2010, 48% were breastfeeding at 6 months and only 27% were breastfeeding at 12 months.⁵ Despite the high rates of initiation, duration rates decrease as the child gets older. In the Healthy People 2020 Report, target goals were set to increase the proportion of infants who are breast fed at 6 months to 60.6%, and to increase the proportion of infants who are breastfed at 12 months to 34.1%.⁶ While there have been studies investigating the barriers to breastfeeding duration, they have not focused on the impact that father support has on breastfeeding duration in first-time mothers.^1,7

Support from the infant’s father through active participation in the breastfeeding decision, together with a positive attitude and knowledge about the benefits of breastfeeding, has been shown to have a strong influence on the initiation and duration of breastfeeding.^1,8 The most significant factor for mothers to initiate bottle-feeding was the mother’s perception of the father’s attitude.¹ Kessler et al., reported that in a group of 133 women, 71% were influenced by the infant’s father and 29% by the maternal grandmother.⁹

Previous research indicates that the early post-partum period is a critical time for establishing and supporting breastfeeding. Enhancing social support is one of the main strategies identified for increasing breastfeeding rates, especially in first-time mothers. To explore the influence that social support, specifically that of the male partner, has on first-time mothers’ breastfeeding initiation and duration we conducted a survey to assess the level of father involvement and support in the early post partum period as well as their participation in the breastfeeding decisions.

Materials and Methods

Participants

A convenience sample of first-time mothers was recruited from the Bloomington Area Birth Services (BABS) in Monroe County, Indiana from January 2009 to January 2013. The inclusion criteria for this study consisted of any first-time mother who had given birth between January 2009 and January 2013 and completed the breastfeeding component of the Childbirth Experiences Survey. Mothers voluntarily filled out this survey during the post-partum period. All mothers that participated had a baby within the last 12 months. A total of 294 women completed the Childbirth Experiences Survey, yet only 146 met eligibility criteria for this study. Participants were made fully aware that participating in the survey was completely voluntary. The study was approved by the Indiana University Institutional Review Board.

Data Collection

A self-administered questionnaire was used in this study. The survey instrument included demographics such as age, marital status, ethnicity and race. Items to assess breastfeeding initiation, early post-partum breastfeeding, breastfeeding plans, post-partum breastfeeding support, and breastfeeding duration were also included. The instrument format incorporated dichotomous, categorical, ordinal, and scale items as well as open-ended questions.

Statistical Analysis

Data were analyzed using SPSS statistical software version 21. This software was used for descriptive statistics where data is shown as percentages, means, and standard deviations to show demographic information. T-tests and chi-square tests were used to identify associations between breastfeeding initiation, breastfeeding duration, and breastfeeding support. Frequency distributions were used to test normality for each of these variables.

Ethical Issues

The proposal of this study was approved by review board of Indiana University School of Public Health.

Results

We carried out descriptive analysis on all participants. All participants in this study were first-time mothers living in Indiana. Of the 146 participants, 88.4% (129) were married and 11.6% (17) were not married. Ages of participants (mothers) ranged from 19 years old to 40 years old with 17.1% (25) between the ages of 19-25, 39.1% (57) between the ages of 26-30, 32.2% (47) between the ages of 31-35, 6.8% (10) between the ages of 36-40, and 4.8% (7) did not provide an age. Participants also indicated their partners’ ages, which ranged from 20 years old to 44 years old. A full description of the demographic information is shown in Table 1.

Table 1. Demographic Characteristics of Sample .

Demographic Description	N	Percent of Total (n=146)
Mother’s Age (yr)
- 19-25	25	17.1
- 26-30	57	39.1
- 31-35	47	32.2
- 36-40	10	6.8
- Missing	7	4.8
Father’s Age (yr)
- 19-25	16	11.0
- 26-30	41	28.1
- 31-35	52	35.6
- 36-40	23	15.7
- 41-45	5	3.4
- Missing	9	6.2
Marital Status
- Married	129	88.4
- Not Married	17	11.6
Partner Breastfeeding Support
- Yes	67	45.9
- No	79	54.1

Participants were asked to indicate if their partner, the infant’s father, helped with breastfeeding during the first 48 hours after the child was born. The results indicate that 45.9% (n=67) of mothers received helped from their husband or partner with breastfeeding while in the hospital, while 54.1% (n=79) of mothers did not receive support from their partners (Table 1).

A Kruskal-Wallis test was conducted to determine whether breastfeeding duration differed between those women who received early post-partum support from their partners and those who did not. The prevalence of exclusive breastfeeding at 6 months was significantly higher among mothers who had involvement and support from the infants’ father during the early post-partum period (Figure 1). Of the 146 mothers who participated in this study, 97% (n=65) mothers who received early post-partum breastfeeding support from their partners continued breastfeeding after leaving the hospital, with 26% (n=17) of these mothers breastfeeding their child to at least 6 months of age (Fig. 1). Of the mothers that indicated that they did not receive breastfeeding help and support from their partner, 64% (n=51) continued breastfeeding after leaving the hospital, with 10.1% (n=8) mothers breastfeeding exclusively at 6 months (Fig. 1).

Fig. 1 .

Early-postpartum Father Involvement and Breastfeeding Duration

Discussion

Mother’s responses indicate that the father has an influential role in breastfeeding. These results indicate that the father plays an important role in breastfeeding outcomes of first-time mothers. Consistent with previous studies, these supportive actions remove stressors so that the mother is enabled to breastfeed successfully.^10,11 Based on these findings; it is recommended that breastfeeding promotion programs include a paternal component to their initiatives.

Despite the fact that many men want to be involved in their partner’s pregnancy, antenatal and perinatal care does not usually include information and training for the fathers as a priority.^8,12 Although some fathers do participate in the feeding choice, most studies have found that they are poorly informed about the advantages of breastfeeding.^13,14 Pregnancy has been described as a “teachable moment”, and expectant fathers are often open, available, and willing to learn and participate in prenatal visits, antenatal classes, as well as in childbirth.¹⁵ Previous studies indicate educating of fathers regarding the benefits of breastfeeding, as well as how to overcome barriers, would have a positive impact on the number of mothers choosing to breastfeed.¹ A randomized controlled trial showed that exposing expectant fathers to a 2-hour intervention class on infant care and breastfeeding promotion was successful in increasing breastfeeding initiation rates.¹⁶ Incorporating expectant fathers in breastfeeding courses will increase men’s involvement in pregnancy.

Men’s greater involvement at all stages of the pregnancy not only helps them support their partners but also gives the couple the opportunity to conceptualize and adapt to their family transition together.^7,17 The infant’s father should be involved in all discussions regarding the type of feeding that the infant will receive, whether they are in the physician’s office, prenatal classes, or in the delivery room.^1,18,19 Paternal involvement has been shown to have an effect on mothers’ health behaviors during their pregnancies, thus indirectly affecting pregnancy outcomes.²

Conclusion

Father involvement and support of breastfeeding during the early post-partum period may have a role in the initiation and duration of breastfeeding in first-time mothers. Results from previous studies have shown an association between support of breastfeeding by fathers and breastfeeding outcomes, however those who have examined the father’s influence have often asked the mother for her perspective on this role.¹⁰ This study confirms that paternal support promotes breastfeeding rates, specifically those in first-time mothers, yet this study is from the mother’s perspective. Research on the continued involvement of fathers and their perspectives on breastfeeding should be further explored.

Acknowledgements

We acknowledge the staff at the Bloomington Area Birth Services. Most importantly, we gratefully acknowledge the mothers who participated in this study. The authors received no financial support for the research, authorship, and/or publication of this article.

Competing interests

The authors declare no potential conflict of interest with respect to the research, authorship, and/or publication of this article.