Factors Influencing Exclusive Breastfeeding During the Postpartum Period: A Mixed-Methods Study

Abstract

Background/Objectives: Breastfeeding is essential to maternal and child health, and multiple factors influence its success. This study examined the factors associated with breastfeeding type among infants aged 0 to 12 weeks. Methods: A mixed-methods study, employing a convergent design, was conducted in the rooming in unit of a hospital in Espírito Santo, Brazil. A total of 296 mothers of neonates ≥ 34 weeks participated in both the quantitative and qualitative phases. The qualitative phase involved semi-structured interviews conducted in the hospital setting. In the quantitative phase, data were collected via telephone in three waves (on days 14, 40, and 90 postpartum), critical moments for establishing and maintaining breastfeeding, analyzing sociodemographic factors (age, education, marital status, number of pregnancies), clinical factors (gestational age, mode of delivery, milk production) and support factors (social and hospital). Descriptive statistical analysis and binomial and multinomial logistic regression models were used, conducted in R 4.3.3 software. The qualitative and quantitative findings were integrated through simultaneous incorporation and presented in a joint display. Results: The analysis showed that although most mothers had high adherence to prenatal care, breastfeeding counseling was insufficient. In addition to the type of delivery and immediate skin-to-skin contact, other factors were also found to be relevant to maintaining exclusive breastfeeding. Higher maternal education and a greater number of pregnancies were associated with better breastfeeding practices, albeit with variations in statistical significance. Support received during hospitalization, especially from the healthcare team, also emerged as a central element in the qualitative reports, reinforcing its role as a protective factor for continued breastfeeding. Early formula use within the first 48 h was identified as a barrier to initiating and maintaining breastfeeding. Conclusions: The duration and maintenance of exclusive breastfeeding varied over time, depending on factors such as the number of prenatal appointments, education level, number of pregnancies, mode of delivery, immediate skin-to-skin contact, and, most importantly, the use of formula in the first 48 h. The early introduction of formula in maternity wards represented a significant obstacle to breastfeeding, reinforcing the importance of integrated public policies and multidisciplinary initiatives that promote breastfeeding from birth.

Keywords: breastfeeding; labor and delivery; postpartum period; prenatal education.