Impact of Breastfeeding Knowledge, Attitude, and Barriers on Breastfeeding Practice among Twin Mothers

Jae In Shim; Sook Jung Kang

doi:10.4069/kjwhn.2017.23.2.89

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Shim and Kang: Impact of Breastfeeding Knowledge, Attitude, and Barriers on Breastfeeding Practice among Twin Mothers

Original Article

Korean Journal of Women Health Nursing 2017; 23(2): 89-98.

Published online: 27 June 2017

DOI: https://doi.org/10.4069/kjwhn.2017.23.2.89

Impact of Breastfeeding Knowledge, Attitude, and Barriers on Breastfeeding Practice among Twin Mothers

Jae In Shim, Sook Jung Kang

College of Nursing, Ewha Womans University, Seoul, Korea.

Corresponding author: Kang, Sook Jung. College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-2882, Fax: +82-2-3277-2850, sookjungkang@ewha.ac.kr

Received 21 January 2017 Revised 14 March 2017 Accepted 17 March 2017

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to identify effects of breastfeeding knowledge, attitude, and barriers on breastfeeding practice on twin mothers and to provide basic data for successful breastfeeding for twins.

Methods

Participants were 151 mothers with two to twelve months-old twins. Data were collected from online support groups by an online survey.

Results

Mean score for breastfeeding knowledge was 18.34±4.63, for breastfeeding attitude was 3.61±0.51, and for barriers to breastfeeding was 13.35±1.08. The breastfeeding practice rate was 27.8% when twins were two months old. The breastfeeding knowledge was significantly different depending on mother's occupation, number of children, utilization of postpartum caretaker, and age of the children. There were significant differences in the breastfeeding attitude depending on gestational week of twins, planned length of the breastfeeding, and decision period for the breastfeeding. The practice of the breastfeeding was significantly different depending on the number of children. Factors influencing the breastfeeding practice were the breastfeeding attitude (p<.05), age of mother (p<.01), and the number of children (p<.01).

Conclusion

An educational program and expert-led supportive system that is designed for twins are necessary, and they need to be included in prenatal care in order to have positive attitude for the breastfeeding as well as to breastfeed successfully.

Keywords: Twins, Breastfeeding, Knowledge, Attitude, Practice

Figures and Tables

Figure 1

Breastfeeding practice.

Table 1

Characteristics of Participants (N=151)

Characteristics	Categories	n (%)	M±SD
Age (yr)	19~29	29 (19.2)	32.27±3.68
	30~34	79 (52.3)
	35~40	43 (28.5)
Educational level	High school	21 (13.9)
	College	34 (22.5)
	Graduate school	96 (63.6)
Occupation	Yes	74 (49.0)
Occupation	No	77 (51.0)
Number of children	2	125 (82.8)
Number of children	≥3	26 (17.2)
Postpartum caregiver	Mother	81 (53.6)
	Mother-in-law	25 (16.6)
	Postpartum caretaker	86 (57.0)
	Other	31 (20.5)
Receiving fertility therapy	Yes	89 (58.9)
Receiving fertility therapy	No	62 (41.1)
Age of child(month)	2~4	70 (46.4)	5.76±3.28
	5~9	49 (32.5)
	10~12	32 (21.2)
Gestational week of child	<35	35 (23.2)
Gestational week of child	≥35	116 (76.8)
Mother's thought about ideal period of breastfeeding (month)	1~5	17 (11.3)	9.32±4.49
	6~10	61 (40.4)
	11~24	73 (48.3)
Decision period for breastfeeding	Prenatal	107 (70.9)
	During pregnancy	19 (12.6)
	Postpartum	25 (16.6)
Receiving breastfeeding education	Yes	96 (63.6)
Receiving breastfeeding education	No	55 (36.4)
Receiving breastfeeding education for twins (n=96)	Yes	29 (29.6)
Receiving breastfeeding education for twins (n=96)	No	68 (66.3)
Motivated to breastfeed from	Family	21 (13.9)
	Myself	112 (74.2)
	Other^†	18 (11.9)
Difficult period for breastfeeding (week)	≤1	80 (53.0)
	2~4	54 (35.8)
	≥5	17 (11.3)
Source of support & information for breastfeeding	Internet	42 (27.8)
	Mother	32 (19.9)
	Health care team	20 (13.2)
	Husband	19 (12.6)
	Books	5 (3.3)
	Other	35 (23.2)

†Health care providers, media etc.

Table 2

Levels of Breastfeeding Knowledge, Breastfeeding Attitude, and Barriers to Breastfeeding (N=151)

Variables	Categories	M±SD	Range	Min	Max
Breastfeeding knowledge	Benefit to baby	5.68±2.25	0~9	0	9
	Benefit to mother	2.19±1.28	0~4	0	4
	Skill and solution	9.82±2.39	0~13	0	13
	Total	18.34±4.63	0~26	0	26
Breastfeeding attitude	Cognitive	4.21±0.62	0~5	1.40	5.0
	Emotional	3.42±0.73	0~5	1.67	5.0
	Behavioral	4.04±0.68	0~5	1.80	5.0
	Total	3.61±0.51	0~5	2.20	4.7
Barriers to breastfeeding		13.35±1.08	0~17	8.0	14.0

Table 3

Breastfeeding Knowledge, Breastfeeding Attitudes, and Barriers to Breastfeeding according to Characteristics of Participants (N=151)

Characteristics	Categories	n	Breastfeeding knowledge		Breastfeeding attitude		Barriers to breastfeeding
Characteristics	Categories	n	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Age (yr)	19~29	29	17.41±4.89	0.85 (.428)	3.63±0.66	0.08 (.927)	13.03±1.24	1.71 (.184)
	30~34	79	18.39±4.31		3.59±0.49		13.47±0.89
	35~40	43	18.86±5.05		3.62±0.42		13.35±1.27
Occupation	Yes	74	19.34±3.67	−2.67 (.009)	3.58±0.52	0.71 (.480)	13.31±0.98	0.45 (.657)
Occupation	No	77	17.38±5.25	−2.67 (.009)	3.64±0.50	0.71 (.480)	13.39±1.18	0.45 (.657)
Number of children	2	0125	18.00±4.81	−2.53 (.014)	3.61±0.53	0.34 (.736)	13.43±0.96	1.53 (.138)
Number of children	≥3	26	19.99±3.28	−2.53 (.014)	3.58±0.40	0.34 (.736)	12.96±1.51	1.53 (.138)
Postpartum caregiver	Yes	86	19.31±4.15	−3.06 (.003)	3.58±0.47	0.91 (.365)	13.29±1.02	0.78 (.434)
Postpartum caregiver	No	65	17.05±4.95	−3.06 (.003)	3.65±0.56	0.91 (.365)	13.43±1.17	0.78 (.434)
Age of child (month)	2~4^a	70	19.06±3.70	4.80 (.010) a, b>c	3.62±0.53	0.11 (.897)	13.30±1.11	0.39 (.679)
	5~9^b	49	18.73±4.76		3.61±0.50		13.33±1.26
	10~12^c	32	16.16±5.66		3.57±0.50		13.50±0.67
Gestational week of child	<35	35	19.63±4.27	1.90 (.060)	3.76±0.49	2.06 (.042)	13.43±0.70	0.48 (.631)
Gestational week of child	≥35	0116	17.95±4.69	1.90 (.060)	3.56±0.51	2.06 (.042)	13.33±1.18	0.48 (.631)
Receiving breastfeeding education	Yes	96	18.74±3.98	1.29 (.200)	3.58±0.46	−0.78 (.437)	13.48±0.87	−0.78 (.088)
Receiving breastfeeding education	No	55	17.64±5.57	1.29 (.200)	3.65±0.59	−0.78 (.437)	13.13±1.36	−0.78 (.088)
Planned length of breastfeeding	1~5^a	17	17.35±4.54	2.71 (.070)	3.31±0.61	3.40 a<c (.036)	12.59±1.97	2.08 (.138)
	6~10^b	61	17.54±4.44		3.62±0.50		13.36±0.86
	11~24^c	73	19.23±4.71		3.66±0.47		13.52±0.90
Decision period for breastfeeding	Prenatal^a	107	18.65±4.14	2.50 (.085)	3.71±0.44	5.75 a>c (.007)	13.50±10.93	2.79 (.076)
	During pregnancy^b	19	19.00±6.31		3.45±0.50		13.16±1.07
	Postpartum^c	25	16.48±4.93		3.31±0.64		12.84±1.52

Table 4

Factors Affecting Breastfeeding Practice

Variables	Categories	OR	95% CI
Breastfeeding attitude		2.434^*	1.110~5.370
Age of mother		0.866^**	0.779~0.963
Number of children	2		1
Number of children	≥3	4.836^**	1.854~12.612

OR=odds ratio; ^*p<.01, ^**p<.05.

Notes

This articles is a revision of the first author's master's thesis from Ewha Womans University.

Summary Statement

▪ What is already known about this topic?

In Korea, birth rate of twins is continuously increasing, and mothers of twins are having hard time both in initiating and continue breastfeeding their children.

▪ What this paper adds?

Among twin mothers of two-month old babies in this study, only 27.8% were breastfeeding. Factors influencing breastfeeding practice of twin mothers were the breastfeeding attitude, age of mother, and number of children.

▪ Implications for practice, education and/or policy

An educational program starting from prenatal care ineed to be developed and implemented to have optimal result of breastfeeding practice. Also an expert-led support system and educational program that is designed for twin mothers is needed.

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