How Can You Improve Outcomes By Supporting A Family’s Breastfeeding Self-Efficacy?

Self-efficacy—most of us have heard the term. Similar to self-confidence, self-efficacy is the feeling you have when you see yourself as capable of accomplishing a goal, and you are pretty certain that you can succeed.

You probably know intuitively that your client’s self-efficacy about breast- or chestfeeding is an important component of their success. But there’s numerical evidence to show that it may be even more important than we thought.

A 2017 study in the Journal of Human Lactation suggests that a person’s confidence in their breastfeeding success can have a marked impact on their actual success—and that the right interventions can significantly increase that all-important sense of self-assurance.

In the first investigation of its kind on this topic, Interventions to Improve Breastfeeding Self-Efficacy and Resultant Breastfeeding Rates: A Systematic Review and Meta-Analysis looked at the data from 11 previously published studies. Each had measured Breastfeeding Self-Efficacy (BSE), a numerical score indicating confidence, before and after breastfeeding interventions. Studies had then compared changes in BSE to breastfeeding rates at particular points postpartum.

Researchers grouped the data from the 11 studies’ control groups and intervention groups to compare results.

Overall, intervention groups had Breastfeeding Self-Efficacy scores 4.86 points higher than control groups.

But that’s not all. Researchers found that for every 1-point increase in the mean BSE score between groups, the odds of exclusive breastfeeding went up by 10 percent.

“We wanted to ask, ‘Is BSE a theory that means something for breastfeeding outcomes?” says Meredith (Merilee) Brockway, PhD, RN, IBCLC, a post-doctoral researcher at the University of Manitoba and the study’s lead author. “And the answer is yes. If we can improve a person’s BSE, we will see significantly improved breastfeeding rates.”

What is BSE?

About 20 years ago, researchers in human lactation created the term “Breastfeeding Self-Efficacy,” or BSE, to describe an individual’s degree of confidence in their ability to successfully nurse their child. A scale (the Breastfeeding Self-Efficacy Scale) was created to measure it, and was later refined to the Breastfeeding Self-Efficacy Scale Short Form, or BSES-SF. The concept has been used in many studies. However, until Brockway’s study, no one had measured whether BSE could be changed—or whether changing it enhanced breastfeeding success.

What Shapes BSE?

Some people enter their lactation journey full of confidence, some full of doubt. Most are somewhere in the middle. What creates the difference? Factors fall into four domains.

  • Previous accomplishments. Has this person breast- or chestfed before? What was that experience like?
  • Vicarious experience. Who else’s lactation journey have they seen? How did it go?
  • Verbal persuasion. Messages about the likelihood of success from important others in the person’s social sphere, like friends, family, and physicians, are key.
  • Physiological/affective status. How is the person feeling, physically and mentally? A traumatic birth, fatigue, depression, or anxiety can all effect BSE.

What Does this Mean for You?

Since BSE is an important predictor of success, how can lactation support professionals apply this concept in their work with families? Brockway has several suggestions.

Keep BSE on your radar. Remember that confidence in one’s ability, not just actual factors affecting ability, determines success.

Assess your client’s BSE. Ask questions in each of the four domains,” Brockway suggests. “What are their previous experiences? Vicarious experiences? What messages are they receiving from important others? What are they experiencing, mentally and physically, that might be impacting their confidence? If you notice red flags in a category, recognize that this client may have lower confidence in their ability to succeed, and that’s where you can augment your work for this family.”

Maintain continuity of care. Some studies the meta-analysis intervened in the hospital, others in the community, and others in both locations—with overwhelming evidence that interventions need to extend over both settings. When interventions only took place in the hospital, BSE scores only increased an average of 0.16 points. When they took place in the community after discharge, scores went up 0.84 points. But when an intervention spanned both settings, BSE jumped 5.37 points. “If you just end the work in the hospital, it is not fine,” Brockway says. “The person goes home and is on their own, and what are they to do? There has to be a transition where they keep contact. It’s very important.”

Understand How BSE Creates Success. From previous work on the concept of self-efficacy in general, we get a glimpse into why a person with higher BSE is more likely to meet their breast- or chestfeeding goals. It turns out that self-efficacy is what allows us to navigate obstacles that come up on the path to our goal. And since almost no one’s lactation journey is obstacle-free, that ability is critical to sustained success.

“When you build up someone’s BSE, you empower them,” Brockway concludes. “When you increase their self-efficacy, you launch them—you give them the eventual ability to operate successfully long-term on their own. So when that person hits an obstacle—sore nipples, a growth spurt, a sleep regression—they don’t think, ‘I’m failing at this.’ They think, ‘Okay, this is good. I can get through this, and I’m still doing well.”

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