Number of Baby Friendly Hospital in Thailand 2017

Int J Womens Health. 2022; fourteen: 155–166.

Exclusive Breastfeeding Experiences of Thai Mothers in Metropolitan Bangkok

Chompoonut Topothai

¹International Health Policy Programme, Ministry of Public Health, Nonthaburi, 11000, Thailand

²Department of Wellness, Ministry of Public Health, Nonthaburi, 11000, Thailand

Thitikorn Topothai

¹International Wellness Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand

²Section of Health, Ministry of Public Health, Nonthaburi, 11000, Thailand

Rapeepong Suphanchaimat

¹International Wellness Policy Plan, Ministry building of Public Health, Nonthaburi, 11000, Thailand

³Department of Disease Control, Ministry building of Public Health, Nonthaburi, 11000, Thailand

Orratai Waleewong

¹International Health Policy Plan, Ministry of Public Health, Nonthaburi, 11000, Thailand

Weerasak Putthasri

⁴National Wellness Commission Office, Ministry building of Public Health, Nonthaburi, 11000, Thailand

Walaiporn Patcharanarumol

¹International Wellness Policy Program, Ministry of Public Wellness, Nonthaburi, 11000, Thailand

Viroj Tangcharoensathien

¹International Health Policy Program, Ministry building of Public Health, Nonthaburi, 11000, Thailand

Received 2021 Oct xv; Accepted 2022 January 12.

Abstract

Introduction

In 2019, but 14% of mothers in Thailand performed half dozen-calendar month sectional breastfeeding. This study sought to understand the pathways that mothers in Bangkok Metropolitan took to accomplish successful half-dozen-month sectional breastfeeding.

Methods

A total of 50 mothers living in Bangkok with children aged vi–12 months, who achieved and not achieved vi-month exclusive breastfeeding, were recruited for in-depth interviews during Feb to July 2020. Inductive thematic analysis of participants' viewpoints was applied for data analysis and interpretation.

Results

4 themes that contributed to six-month exclusive breastfeeding were i)  maternal breastfeeding self-efficacy;  ii)  back up provided by family members;  3)  engagement with and support from healthcare professionals; and iv)  employers' back up and workplace environments. Mothers with strong breastfeeding intentions and "perceived capability" to succeed at breastfeeding tended to prioritize breastfeeding and overcome and cope well with unforeseen breastfeeding challenges. Supportive family unit members, who were convinced of the benefits of breastfeeding, engaged in maternal controlling, and provided optimal support, contributed to successful exclusive breastfeeding. Health professionals were primal in supporting mothers throughout pregnancy until the postpartum menses. Lactating-mother-friendly working conditions, flexible working hours and enabling workplace environments, including the provision of breastfeeding breaks and a dedicate infinite for chest milk expression, were enabling factors for successful exclusive breastfeeding among working mothers.

Conclusion

We recommend that all mothers and their family members are fully informed and convinced of the benefit from breastfeeding and trained with practical skill during their visit to antenatal intendance clinics. These interventions aim to develop mothers' cocky-efficacy for breastfeeding and to prepare them to manage common breastfeeding challenges. Health professionals should provide regular follow-up and counseling sessions on breastfeeding practices to mothers and families throughout the lactating menses, especially working mothers for breastfeeding continuation after resume to work. Enhanced societal commonage actions such as breastfeeding-friendly policy in workplace, including breastfeeding break-time and corner, can create enabling environments for successful exclusive breastfeeding.

Keywords: breastfeeding, maternal-self efficacy, qualitative study, urban, Bangkok

Introduction

The Earth Health Organization (WHO) and the United Nation Children'due south Fund (UNICEF) recommend that infants should be initially breastfed within one hour subsequently birth, exclusively breastfed during the first six months, and go along to exist breastfed with appropriate complementary feeding for two years or across.¹ This recommendation is based on evidence confirming that chest-milk brings unequalled benefits to health and socio-economic outcomes for both mothers and children.² Breastfeeding protects babies from infection-related mortality such every bit pneumonia and diarrhea, reduces the risk of obesity and type-ii diabetes, and promotes cognitive development. Too, a longer duration of breastfeeding reduces incidence of breast and ovarian cancers and supports natural nascence command.³ The positive health impact for children and mothers results in a loftier return on investments in breastfeeding: approximately Usa$35 in return for every dollar of investment.⁴

However, globally simply 44% of infants younger than six months of age are currently exclusively breastfed.^v This is despite the global breastfeeding target aiming to reach a minimum of 50% exclusive breastfeeding (EBF) in the first six months by 2025 and 70% past 2030.⁴ Among Southeast Asian countries,⁵ Thailand performed poorly with the everyman rates of EBF of infants under 6 months old, at 14% in 2019.^vi

Bear witness confirms that the decision to breastfeed is complex and influenced by several personal and environmental determinants.^7–eleven At a personal level, written report shows that cocky-efficacy has positive correlation with successful EBF and is establish to exist a strong predictor of breastfeeding duration in first-fourth dimension Australian and Chinese mothers;^{12 , xiii} cocky-efficacy refers to the confidence of a person in their capacity to undertake behaviors which atomic number 82 to desired outcomes.^fourteen Other personal-level factors are maternal historic period, teaching, income, breastfeeding intention, by experience of EBF, and the mother-infant relationship. Ecology factors as well play an important role; these are family and customs support, supports and communication from health professionals. Likewise, work and workplace surround, marketing past formula milk companies and sure cultural beliefs can hamper breastfeeding efforts.^{7 , 9 , xv–20}

Prior studies take identified multiple determinants of breastfeeding among Thai mothers. Mothers with higher socioeconomic status, higher breastfeeding knowledge and intention to breastfeed and prior experiences of successful EBF are more likely to accomplish EBF than mothers without these attributes. Moreover, mothers who receive acceptable support from family members, communication and support from wellness professional seem to accomplish better EBF outcomes. In contrast, working conditions, and advertisements and active marketing by formula industries have been identified as barriers for initiation and continuation of breastfeeding.^21–25

Although prior studies identify the enablers of and barriers to breastfeeding practice, they accept yet to examine how these determinants interlink and how these links influence EBF. The qualitative evidence on the pathways that mothers take to achieve EBF is still lacking. Thus, this study sought to empathize how Thai mothers in urban metropolitan areas initiate and sustain EBF for six months and how breastfeeding challenges are addressed. Nosotros chose Bangkok as a study site as it has consistently low EBF rates^26–28 and loftier urbanization, and most mothers appoint in labor force which adds more difficulties and stress on lactating mothers.²⁹ Findings from this written report not only fill the knowledge gap in the Thai literature, but also support EBF for mothers living in Metropolitan areas in other low- and middle-income countries (LMICs).

Materials and Methods

Setting and Study Design

This written report employed a qualitative primary data collection. We selected Bangkok, with a high population density, as the study site.³⁰

Participant Pick and Recruitment

Participants were healthy mothers, living in Bangkok, having the concluding child aged vi–12 months; selected in gild to assess maternal experiences and the outcomes of EBF.

The plan was to recruit 40 participants, one-half who were successful at half dozen-month EBF, and the other half with EBF of less than half-dozen months, with an equal remainder betwixt working and not-working mothers. Participants were recruited when they took their babies for wellness check-ups and routine immunizations at the well-child clinic of the Metropolitan Health and Health Institution in Bangkok. The research team approached the mothers while they were waiting at the clinic reception. We briefly informed them about the project, methods of data collection, and the confidentiality of data. After agreeing to participate in the report, an interview session was appointed.

Information Collection

Data collection was conducted between Feb and July 2020. The outset author (C.T.) conducted an in-depth interview to capture breastfeeding practices and experiences by each participant, while the 2nd author (T.T.) attended the interview sessions to take audio recording. Information from in-depth interview such as birth weight and child'due south growth were triangulated using maternal and child health records. Though the initial programme aimed for 40 participants, we recruited fifty participants; 32 participated in the contiguous interview on site immediately after they had finished their kid'south wellness check-up in a private room in the well-child clinic. The remaining 18 participants chose for a telephone interview, which was arranged at their convenience.

Each interview lasted for an average of threescore minutes. At the starting time of each interview, written consent was obtained. The telephone interview took longer than the face-to-face interview due to an all-encompassing introduction of the project, objectives, and confirmation of the participant'southward privacy.

The researchers developed the semi-structured interview guide based on a review of literature, the interview guide was assessed by three independent Thai breastfeeding experts as part of the validity cheque. The interview questions were conducted in Thai. These included: ane) What practise y'all recollect about breastfeeding?; 2) During pregnancy, did you have any concerns or plans about breastfeeding?; iii) After delivery, how did y'all initiate breastfeeding? How did yous breastfeed your child?; 4) Have yous ever faced breastfeeding difficulties?; five) How do you manage breastfeeding problems or difficulties?; and 6) For working mothers, how do y'all bargain with breastfeeding when returning to work? Is at that place any support at your workplace?

Participants were interviewed according to the interview guide, and were allowed to spend more time talking about topics they perceived to be of import such as topics related to breastfeeding and parenthood, experiences of being a "working women", or the beliefs and civilisation of their families. Compensation of The states$17 was offered to each participant at the end of the interview. The interview's records were transcribed verbatim for analysis. Field notes and observations were also collected by researchers.

Data Analysis

Inductive thematic analysis was applied as information technology allows researchers to understand the viewpoints and experiences of mothers without trying to fit any preconceived frames. 2 researchers (C.T. and T.T.) began the analysis by thorough reading and familiarization of the verbatim transcription, and cantankerous-checked the transcripts with field notes for accuracy and consistency. Then, they made notes on key points that emerged from the reading and independently generated initial codes from the transcribed text without specific focus. Then, all relevant codes were collated and clustered into initial themes. Subsequently, researchers had a discussion to review and refine the initial themes, to clarify the meaning of each theme, and to avert duplication across themes.³¹ Finally, iv themes emerged from this written report.

Results

Of the full 50 mothers who participated in this study, 62% had their first baby and first breastfeeding experiences, 74% had at least a high-school degree, 66% achieved 6-month EBF, and 34% proficient for a shorter duration. Around 74% of participants were employed with an average monthly income of 15,000 THB (effectually United states$ 500 at an exchange rate 30 THB) run into Table 1.

Table 1

Participants' Socio-Demographic Profiles by 6-Month EBF Outcome

Variables	All Participants	Six-Calendar month EBF Mothers (%)	Non-Six-Month EBF Mothers (%)
In full
Number	50	33 (66)	17 (34)
Age
Median (IQR)	31.5 (x)	34 (eight)	29 (12)
Historic period grouping
<31.5 years	25	xiii (52)	12 (48)
≥31.5 years	25	20 (80)	5 (twenty)
Education level
Secondary schoolhouse or below	21	12 (57)	nine (43)
Diploma/ Available caste or in a higher place	29	21 (72)	8 (28)
Employment
Working mother	37	24 (65)	thirteen (35)
Housewife	thirteen	ix (69)	4 (31)
Maternal income
Median (IQR)	15,000 (27,000)	15,000 (45,000)	15,000 (xx,000)
Maternal income range
<xv,000 Baht/month	24	16 (67)	eight (33)
≥fifteen,000 Baht/month	26	17 (65)	9 (35)
Household income
Median (IQR)	twoscore,000 (83,000)	50,000 (113,000)	30,000 (22,000)
Household income range
<xl,000 Baht/month	24	fourteen (58)	10 (42)
≥40,000 Baht/month	26	19 (73)	seven (27)

Four major themes emerged from the study; i) maternal breastfeeding self-efficacy; ii) support provided by family members, iii) engagement with and support from healthcare professionals and iv) employers' back up and workplace environments particularly for working mothers, run across Table 2.

Table ii

Four Themes and Subcategory

Themes	Sub-Category
Maternal breastfeeding self-efficacy	Perception of mothers towards breastfeeding
	Having a plan and well prepared for breastfeeding
	Ensuring acceptable chest-milk supply and storage
	Perseverance to EBF through overcoming difficulties related to breastfeeding
Support provided by family members	Husband's level of commitment
	Role of family members
Engagement with and support from healthcare professionals	Taking advice of health professionals into consideration
	Quality and intensity of postal service-natal health professional person supports
Employers' back up and workplace environments	Overcoming breastfeeding difficulties due to job characteristics
	Coping with unfriendly workplace environs

Theme i: Maternal Breastfeeding Self-Efficacy

All mothers, regardless of the breastfeeding outcomes, had positive perceptions towards breastfeeding and intended to breastfeed their babies for some elapsing. This was reflected in a serial of actions, such as planning and grooming for breastfeeding, ensuring acceptable breast-milk supply and storage, and solving breastfeeding difficulties. This theme is demonstrated beneath.

Perception of Mothers Towards Breastfeeding

Most participants perceived breastfeeding as the best nutrition for their babies. During pregnancy, almost all mothers developed their intention to breastfeed for a certain duration, ranging from six months to as long as possible, although some mothers (7 out of fifty) had concerns and low confidence near breastfeeding due to breast problems.

I intended to go along breastfeeding to 2 years or as long every bit possible. I did non desire him (my babe) to be fed by formula milk because I know well that chest-milk is the best. - 35 years old, private sector employee, 6-month EBF mother.

The intention to consummate EBF however changed in accordance with real breastfeeding experiences. Mothers who were able to breastfeed properly or overcome all breastfeeding problems, such every bit poor latching or inadequate breastmilk supply, gained more conviction and committed to sustain EBF upwardly to 6 months or longer. Furthermore, mothers who regarded breastfeeding as a superlative priority over personal convenience and always spared acceptable time for breastfeeding were likely to sustain EBF for a longer period.

My office is very strict with breastfeeding suspension-time. I was allowed to do breast-milk pumping simply at 9.xxx, 12.30, and fifteen.30. So, I kept having luncheon in the role every twenty-four hours in order to have time for pumping. My friend who previously did breast-milk pumping decided to stopped pumping and get out for lunch.- 36 years old, private sector employee, half dozen-month EBF mother.

In contrast, mothers who were unable to solve their breastfeeding issues, tended to feel uncomfortable with continuing EBF, and decided to wean sooner than expected. Those who were overwhelmed by work or earning stopped EBF before than expected.

I myself take care of him [her son], exercise housework, do everything and I cannot exercise information technology [breastfeeding] in parallel. I must choose what I can practise. I e'er think that breastfeeding is fourth dimension-consuming and takes much of my time especially when I wish to finish my job and consummate all the bakery orders. I earn a living from this work.- 29 years old, self-employed, non- half dozen-calendar month EBF mother.

Having a Program and Well Prepared for Breastfeeding

Common practices included searching for information, visiting lactation clinics and attending breastfeeding counseling. Planning in accelerate helps mothers to meliorate empathise, have essential breastfeeding skills and know where to seek breastfeeding support after delivery. First-time mothers who prepared breastfeeding in advance had more confidence in their breastfeeding capability. Near working mothers began to plan for EBF during the first month after delivery.

With my first child, I reviewed many books and (internet) pages nearly breastfeeding, I read details into all the topics every bit I have no experience.- 33 years old, public sector employee, six-calendar month EBF mother.

Around 15 days before I resumed piece of work, I fix a schedule for chest-milk expression at dwelling house as if I were back at work with all the equipment prepared. I bought a new set of dresses, all of them were nursing dresses.- 33 years onetime, public sector employee, 6-month EBF mother.

Ensuring Adequate Breast-Milk Supply and Storage

Mothers' perceived sufficient breast-milk supply is a critical factor for EBF. Successful six-calendar month EBF mothers revealed that they breastfed the baby as early as possible immediately after nascence and had less concern near their breast-milk supply. The majority of respondents judged chest-milk capability by good and long sleeping hours and enough monthly weight gain of babies. Effective latch-on is an important skill that enabled mothers to provide feeding at the breast and foster their confidence that their babies were sufficiently breastfed. In dissimilarity, mothers who failed to feed at the chest had to do breast-milk pumping around the clock; this tiring situation pushed them to reconsider EBF goals.

While non-working mothers continued to feed at the breast, most working mothers began to express chest-milk using either a manual or electrical pump during maternity exit and cumulated a large stock of chest-milk for the baby. Some working mothers who started breastmilk pumping and breast-milk-bottle-feeding as early as less than i month due to a shorter menstruum of motherhood exit faced several negative consequences, such as breast refusal, duct obstruction, and insufficient breastmilk supply. Mothers who took a full 3-months or longer maternity leave were more than likely to filibuster breast-milk-pumping and they subsequently continued breastfeeding with fewer issues.

I started pumping chest-milk seriously when my child reached 2 months old considering I had to go to work when he turned iii months. Previously, I just breastfed him. I just wanted to make sure that I had plenty chest-milk stock for him- 24 years sometime, private sector employee, six-month EBF female parent.

Perseverance to EBF Through Overcoming Difficulties Related to Breastfeeding

Virtually all mothers had experienced some breastfeeding difficulties, ranging from very mild to severe, either due to concrete or mental causes. Difficulties arose at early postpartum and afterward returning to work. Common concrete issues such as poor latching, nipple confusion, and perceived bereft milk supply were coped by "trial and fault" solutions, seeking data from net and peer support from friends or health intendance workers. Unresolved physical or psychological stresses resulted in shorter than 6 months EBF. Perseverance fosters self-efficacy; as mothers with successful vi-month EBF tried multiple solutions without distorting the original EBF intention, even though they had to merchandise off with other benefits.

I could not get my child to latch on since the outset twenty-four hours, so he cried a lot and refused to be fed at the breast, this was so stressful. I tried to solve it past practicing and practicing and practicing latch-on while giving the infant a bottle feed in parallel. Later one day, I could practise it – 38 years erstwhile, private sector employee, 6-month EBF mother.

Theme 2: Support Provided by Family Members

Married man's Level of Delivery

All mothers who achieved half dozen-calendar month EBF regarded their husbands as important primary supporters. Husbands gained cognition from counseling sessions at antenatal or lactation clinics. Recognizing the importance of breastfeeding, husbands supported every critical step and protected the infants from early on introduction of complementary food or breast-milk substitutes, which were attempted more often than not by grandparents. Below are ii EBF examples: one successful and ane unsuccessful.

After delivery, my son was in the nursery for 6 hours. My husband was the one who kept asking the nurse to bring my son to me to initiate breastfeeding … otherwise I would have had to wait longer. He highly supports breastfeeding, I would say.- 35 years old, individual sector employee, 6-month EBF mother.

I was not supported by my family unit at all. Anybody wanted me to feed my kid with formula. My hubby told me that there was no problem if I had no milk, we could feed her with formula. He did not want me to feel stress because of breastfeeding, only he did not know that this kind of response made me get worse and experience more stress considering I had a strong intention to breastfeed my kid.- thirty years old, public sector employee, non-6-month EBF mother.

Role of Family unit Members

Family members can be encouraging and discouraging and the latter experienced needs to be well managed. Common EBF back up provided past family members was giving mental support or taking care of the infant while the mother took a rest or had some other duty to fulfil. Mothers who received criticism from family unit members, such as receiving questions every bit to why breast-fed babies gained less weight, lost confidence and discontinued EBF earlier than expected.

My brother was my main back up. When I was significant, my female parent and my sister told me that our families inherited no-milk production genes and I would accept no chest-milk, but my brother disagreed with this thought. He kept cheering me upwardly and told me that fifty-fifty my-sister-in-law who was very slim, had enough chest-milk so I would accept breast-milk equally well… - 45 years quondam, cocky-employed, 6-month EBF mother.

My mother-in-law told me to feed my kid with formula milk in parallel with breast-milk when he was two months one-time. I did not want to feed him with formula but I could not convince her. When my baby reached 4 months quondam, my mother-in-law once more fed him with assistant despite my request for EBF to six months.- 22 years old, unemployed, non-vi-month EBF mother.

Theme 3: Engagement with and Support from Healthcare Professionals

Taking Communication of Wellness Professionals into Consideration

Gratuitous parental classes for pregnant women, husbands and family unit members during antenatal care played a pivotal role in empowering self-efficacy, conviction and intention for six-month EBF.

I was not confident nigh breastfeeding considering I was an older mother who had a loftier-risk pregnancy. I believed I could not exclusively breastfeed my child for a long duration; as the beginning and 2d child were breastfed for very short period. However, subsequently attending parental class here, I received useful communication from the nurses and doctors. They motivated me to try my best … They inspired me to continue breastfeeding.- 42 years sometime, private sector employee, 6-calendar month EBF female parent.

Quality and Intensity of Post-Natal Health Professional person Support

Mothers who accessed quality professional support such equally face up-to-face training on latching and positioning, observing baby's hunger cue, breastmilk-production stimulation technique, and screening for tongue-necktie were able to initiate breastfeeding and go along EBF confidently.

The nurse brought me my girl presently after delivery to initiate breastfeeding, about 1.five hours … Every time the nurses came to my room, they taught and advised me on breastfeeding, and sometimes the nurses shared their experiences of breastfeeding. … The doctor was likewise very not bad on breastfeeding promotion. She brought many breastfeeding teaching-materials into my room to teach me and my husband.- 35 years old, self-employed, vi-calendar month EBF female parent.

My starting time child had tongue-tie so he could not latch on properly. Luckily, my admission was extended to seven days and I was trained by lactation nurses. I learnt how to practice breastfeeding correctly there, the lactation nurse shared many useful tips that were tailored to my problems- 36 years former, public sector employee, 6-month EBF mother.

My father-in-law believes that breast-milk is not useful for the infant aged over six months. I solved this problem by taking both my father- and mother-in-law to see the doctor at the well-child clinic when my kid went for vaccination at six months. I pretended to ask the doctor for how long should I proceed breastfeeding? Is breast-milk still useful from at present on? And the physician said yes, of form I should continue breastfeeding as long equally possible. This tactic worked very well.- 33 years old, public sector employee, 6-month EBF mother.

Theme 4: Employers' Support and Workplace Environments

Near working mothers felt some sense of inconvenience for being lactating mothers while being back at work. This perception was influenced by item chore characteristics and unsupportive workplace environments. The coping strategies were to ensure adequate time and to seek proper infinite for breastmilk pumping and storage.

Overcoming Breastfeeding Difficulties Due to Task Characteristics

Maternal working atmospheric condition, task characteristics, and positions were raised by the participants equally major factors contributing to their EBF continuation. Mothers working in office-based settings with flexible working hours could amend design their breastfeeding pause times than those working in service-based settings or on manufactory product-lines. Working mothers holding a high position can manage their working hours and have admission to private spaces for breastmilk pumping. Self-efficacy, perseverance and adaptation are key factors for successful six-month EBF amidst working mothers.

When I resumed work as a street nutrient vendor, there was no one to heighten my kid at dwelling house, I bought the baby with me, and stop working every time he felt hungry. I found corners on the street and fed him at breast. Information technology was not convenient but I had to exercise it.- 28 years former, self-employed, 6-month EBF mother.

Coping with Unfriendly Workplace Surroundings

Coping mechanisms by working mothers in unsupportive workplace environments include adjusting lifestyles, ignoring poor attitudes of co-workers and managers, or even changing their jobs in order to sustain six-month EBF. Mothers needed to prepare their ain personal gadgets, nursing covers, ice packs and cool boxes for breastmilk storage. Some working mothers, who were criticized past their bosses and co-workers for breastfeeding every bit this meant they could not fulfil job duties as a issue, decided to express breastmilk while working at their desks or workstation. Simply mothers with potent cocky-efficacy and adequate breastmilk supply could sustain EBF to 6 months or beyond.

It was non convenient at my workplace for pumping breast milk because information technology was a furniture outlet located in a section store. There was no fridge and no individual space in the office. I had to bring my own icepack every single day to freeze the expressed chest milk. Although there was a parent room (in the section store), it was too far away.- 36 years quondam, individual sector employee, half-dozen-month EBF mother.

My new office gave me a college salary just they were so strict and I had no interruption time to practise chest-milk pumping. It was non convenient to express breast-milk so I stopped breastfeeding four months afterward delivery- 20 years old, individual sector employee, non-6-calendar month EBF female parent.

Discussion

The inductive synthesis of the findings is summarized in Effigy 1. Though maternal self-efficacy is a primary contributing factor to successful EBF, healthcare professionals, family members, employers and the workplace environs besides play important enabling secondary factors. This study confirms findings from prior a global review,⁷ international studies,^{7 , 32 , 33} and Thai literature.^{23 , 25}

Context, actors, maternal cocky-efficacy and breastfeeding outcomes.

When mothers realize breastfeeding as their ultimate responsibility, they experience empowered and adamant. The Theory of Planned Behavior suggests that mothers who accept positive attitudes towards breastfeeding and positive norms which value EBF are more probable to develop strong intentions to breastfeed. Due to these stiff intentions, mothers prioritize breastfeeding over other activities and discover means to overcome all foreseeable and unforeseen difficulties.^{34 , 35} Successful coping experiences non only help mothers to detect their ability to breastfeeding which is a fundamental attribute of breastfeeding self-efficacy; it in turn fosters self-determination towards a successful EBF.^36–39 Therefore, empowering mothers to develop breastfeeding intentions and self-efficacy and equip them with necessary technical skills such as latching and the positioning of the baby are disquisitional for successful EBF.^{7 , 24 , 40}

This written report confirms the critical office of wellness professionals in providing support at all stages, from pregnancy to delivery and post-partum and across. Healthcare professionals should aim to strengthen mothers' intrinsic motivation towards EBF from early pregnancy onwards, while intrinsic motivation includes desire for self-control, concerns about baby'due south wellness and concerns almost mother's health.⁴¹ After delivery, self-efficacy should be equipped by technical skill provided by healthcare professionals such as immediate breastfeeding initiation, correct latching and positioning, and assessment of baby'due south hunger cue and breastmilk supply. Prove shows that poor-latching and insufficient breastmilk supplies are common reasons for EBF discontinuation.^{23 , 25 , 40 , 42}

Despite health professionals' disquisitional roles, existing breastfeeding back up for Thai mothers, particularly during the early mail service-partum period, is all the same inadequate and needs significant reform;^{43 , 44} only vii.seven% of infants in Thailand were put to the female parent's breast after birth and simply 34% were initially breastfed within an hour subsequently birth in 2019.⁶ Inadequate breastfeeding follow-upwardly is a consequence of a shortage of lactation counselors and other competing responsibilities.^{44 , 45} Health professionals in all hospitals including those taking function in the Babe-Friendly-Hospital-Initiative should have adequate training on breastfeeding counseling and problem-solving skills.^45–47 The village wellness volunteers should be trained on bones breastfeeding counseling and engage in the community-based breastfeeding supporting organization.⁴⁸ Other skills across clinical skills have yet to improve specially empowering mothers and strengthening mothers' intrinsic motivation; both of which atomic number 82 to breastfeeding self-efficacy and successful EBF. Healthcare professionals can exist empowered through trainings such every bit goal setting, action planning, and enhanced self-awareness and confidence.⁴⁹ Their internalized experiences of "empowerment" tin be used to empower significant women.

Sustained breastfeeding either at the breast or chest-milk pumping requires time commitment and try. Mothers with no or little support might not be able to sustain breastfeeding, particularly single- or working- mothers. Hence, family members are great supporters in several ways. In contrast, family members can exist an obstacle for EBF, for example some grandparents feed water and complementary food to infants prior to six months one-time.^{23 , 25} For cultural reasons, decisions made by other family members are sometimes across the mother power of negotiation. Thus, family members should be educated on the benefits of breastfeeding and the supportive role they play.²² Policy makers should also advocate positive societal attitudes towards breastfeeding and promote six-month EBF.⁵⁰

There is still a limited political window of opportunity for maternity exit extension from the current three months to six months, which would facilitate successful six-calendar month EBF. Extending maternity leave to vi months is non-palatable for employers and create worry among mothers for economical and job security reasons.⁵¹ Therefore, breastfeeding-friendly workplaces can exist a applied solution from both employers' and employees' perspectives. These low cost interventions include provisions of acceptable breastfeeding suspension time, a lactation corner and refrigerator for breast-milk expression.⁵²

This written report has some limitations. First, at that place was selection bias as the participants were recruited from the Metropolitan Health and Wellness Institution. Participants in this report, having been exposed to wellness facilities that promote breastfeeding, tin have positive bias in favor of breastfeeding. Also, there was no recruitment of mothers who are not able to attend the public health facilities (most of them are the less well-off) or mothers who visited private facilities (more often than not wealthy mothers).

2nd, there may be social desirability bias as mothers who failed to complete vi-month EBF may refrain from detailing their negative views or unsuccessful experiences. This bias was managed by building rapport and holding initial interviews with general open-ended questions, seeking descriptions of experiences from the prenatal, natal and post-natal period.

3rd, although literature suggests that market promotion of baby formula creates negative mental attitude towards breastfeeding practices;^{seven , 25 , 53} only very few of the 17 participants who did non achieve six-month EBF refer to this issue. Therefore, this issue was non included in the findings.

Lastly, to prevent researchers' confirmation bias, the researchers triangulated the interviewed information with other sources of information such as the records in the maternal and child health handbook.

Conclusion and Recommendations

This is the first study that examines the practical experiences and coping strategies in successful half-dozen-month EBF among mothers living in Bangkok. Cocky-efficacy and coping skills contribute to successful EBF. Still, support from family unit members, health professionals, employers besides equally societal collective actions are also key enabling factors.

We recommend that during prenatal period, health professionals should appraise the attitudes towards breastfeeding of pregnant women and their family unit members, encourage them to decide and set breastfeeding goals, and prepare them with necessary skills; all of which aims to create or strengthen mothers' cocky-efficacy for breastfeeding. During post-natal menses, regular follow-up and counseling session on breastfeeding exercise, and trouble-solving techniques is strongly recommended for health professional working in all well-child clinics. Policy makers should monitor and evaluate the performance of health facilities to ensure compliance with the x steps to successful breastfeeding. Breastfeeding-friendly policy in workplaces, such as breastfeeding room and break-time, should exist further promoted with appealing incentives to employers. This is especially important as Thai women have high level of labor strength participation, 45% of total labor force in 2019.⁵⁴ Further implementation research on applied interventions that empowers self-efficacy and boost confidence amidst kickoff-time and working mothers are encouraged. Such understanding may pave the fashion to meliorate half dozen-month EBF coverage in Thailand.

Acknowledgments

We admit staff members at the Metropolitan Health and Wellness Institution who facilitated the recruitment of sample mothers and provided a quiet room for in-depth interviews. We give thanks all participants for sharing their practical experiences in managing EBF. Articulation funding back up from (1) the Thai Health Promotion Foundation through the Food and Nutrition Policy for Wellness Promotion, International Wellness Policy Foundation (Contract No. 62-00-0144); (ii) Thailand Scientific discipline Inquiry and Innovation (TSRI) for the Senior Research Scholar on Health Policy and Organisation Research (Contract No. RTA6280007); and (iii) the Capacity Building on Wellness Policy and Systems Enquiry program (HPSR Fellowship) under cooperation between Bank for Agriculture and Agronomical Co-operatives (BAAC), National Health Security Office (NHSO) and International Health Policy Program Foundation (IHPF) are highly appreciated.

Abbreviation

EBF, exclusive breastfeeding.

Ideals Blessing and Informed Consent

All respondents signed informed consent prior to participation in the study. The informed consent included publication of anonymous responses. This study received ideals approval from the Found for Development of Homo Inquiry Protection in Thailand (IHRP letterhead: 127/2563) which is a recognized agency that conform to the Announcement of Helsinki, Belmont Report, CIOMS Guidelines and ICH-GCP Guidelines.

Writer Contributions

All authors fabricated a significant contribution to the work, ranging from the conception, study design, execution, acquisition of data, assay and interpretation. All authors took part in drafting, revising or critically reviewing the article; gave final approving of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be answerable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8842719/

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