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. 2025 Sep:45:101127.
doi: 10.1016/j.srhc.2025.101127. Epub 2025 Jul 1.

The association between exclusive breastfeeding and quality of care and maternal factors in a tertiary maternity hospital in Finland: A cross-sectional study

Jaana Lojander  1 , Anna Axelin  2 , Aydin Tekay  3 , Seppo Heinonen  4 , Satu Polkko  3 , Laura Lehti  5 , Terhi Kolari  6 , Hannakaisa Niela-Vilén  2
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Free article

The association between exclusive breastfeeding and quality of care and maternal factors in a tertiary maternity hospital in Finland: A cross-sectional study

Jaana Lojander et al. Sex Reprod Healthc. 2025 Sep.
Free article

Abstract

Background: Mothers' perceptions of high-quality hospital care may improve breastfeeding outcomes, yet postnatal care in hospitals is often rated poorly by mothers, highlighting the need to focus on the quality and maternal perceptions of care, not just its provision. Fewer women exclusively breastfeed than intend to. The aim was to examine the association between exclusive breastfeeding, quality of care, and maternal factors based on maternal reports.

Methods: A cross-sectional study was conducted at a Finnish maternity hospital in 2022-2023. Data were collected through an online survey of mothers within 12 weeks of childbirth. Quality of care was measured by childbirth satisfaction, early breastfeeding initiation, family-centered care, maternal satisfaction with postnatal care, and breastfeeding support. Binary logistic regression analyzed associations between exclusive breastfeeding, quality of care, and maternal factors.

Findings: A total of n = 160 mothers participated. Lack of early breastfeeding initiation (OR 2.20, p = 0.05), inadequate breastfeeding support (OR 2.05, p = 0.05), lower family-centered care quality (OR 2.14, p = 0.04), primiparity (OR 2.94, p < 0.001), antenatal non-exclusive breastfeeding plan (OR 6.44, p < 0.0001), and lower parenting self-efficacy (OR 4.98, p < 0.0001) were associated with non-exclusive breastfeeding. The most significant predictor of non-exclusive breastfeeding was a lack of antenatal breastfeeding plan (OR 6.22) combined with lower parenting self-efficacy (OR 4.81).

Conclusion: Early breastfeeding initiation, support, and family-centered care were initially associated with breastfeeding outcomes; however, only the maternal factors-absence of antenatal breastfeeding plans and lower parenting self-efficacy-remained significantly associated with non-exclusive breastfeeding.

Keywords: Breastfeeding support; Exclusive breastfeeding; Postnatal care; Quality of care.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.