Factors associated with breastfeeding continuation for 12 months or more among working mothers in a general hospital

Mendes, Michele Saraiva; Schorn, Monique; Santo, Lilian Cordova do Espírito; Oliveira, Luciana Dias; Giugliani, Elsa Regina Justo

doi:10.1590/1413-812320212611.12882020

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FREE THEMES • Ciênc. saúde coletiva 26 (11) • Nov 2021 • https://doi.org/10.1590/1413-812320212611.12882020 copy

Factors associated with breastfeeding continuation for 12 months or more among working mothers in a general hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to identify factors associated with breastfeeding continuation for at least 12 months among working mothers in a hospital in the south of Brazil. We conducted a cross-sectional study, interviewing 251 women who breastfed after returning to work. Eligibility criteria included non-twin biological children aged between 12 and 36 months and the absence of an illness (mother and/or child) that could affect breastfeeding. The association between breastfeeding continuation and the exposure variables was tested using Poisson multivariate regression. Only one work-related variable showed a significant association with the outcome. Working only during the day increased the prevalence of BF continuation for at least 12 months by 37%. The following non-work-related factors showed a positive association with the outcome: mothers without a college degree; mothers with at least 12 months’ prior breastfeeding experience; child not given milks other than breast milk when the mother returned to work, and not using a pacifier. The following variables showed a negative association with the outcome: older maternal age; older gestational age; mother receiving support from the child’s caregiver; and mother receiving professional breastfeeding support. Non-work-related factors had a greater influence on breastfeeding continuation for at least 12 months among working mothers.

Key words:
Breastfeeding; Working mothers; Risk factors

Variables		n (%)
Sociodemographic characteristics
	Average age+SD (years)	35 + 3.7
	College degree	149 (59.4)
	Mother’s skin color white	213 (84.9)
	Living with partner	234 (93.2)
	Living with mother	9 (3.6)
	Child sex female	110 (43.8)
Obstetric history
	Primiparous	146 (58.2)
	Antenatal care	251 (100.0)
	Private antenatal care	238 (94.8)
	Private delivery	210 (83.3)
	Average gestational age+SD (weeks)	38.2 + 1.7
	Cesarean delivery	206 (82.1)
	Intention to breastfeed for at least 12 months	235 (93.0)
	Intention to breastfeed after return to work	244 (97.2)
Breastfeeding
	Breastfeeding within the first hour of life	150 (59.8)
	Prior experience of breastfeeding for at least 12 months	46 (18.3)
	Breastfeeding for at least 12 months	156 (62.3)
	Exclusive breastfeeding on discharge from the maternity clinic	215 (85.7)
	Received breastfeeding support from partner	232 (92.4)
	Received breastfeeding support from child´s caregiver	203 (80.9)
	Received professional breastfeeding support	177 (70.5)
	Child given milks other than breast milk when the mother returned to work	238 (94.8)
	Used a pacifier	161 (64.1)

Variables		n	%
Mother’s position/function
	Patient care	198	78.9
	Administrative	19	7.6
	Other	34	13.5
Work shift
	Daytime	186	74.1
	Night/both	65	25.9
Working week (hours)* - Median (SD)		35,5 (5,3)
Breastfeeding during work
	Yes	56	22.3
	No	195	77.7
Use of human milk bank
	Yes	86	34.3
	No	165	65.7
Use of the services of lactation consultant
	Yes	25	10.0
	No	226	90.0
Breastfeeding support from work colleagues
	Yes	150	59.8
	No	101	40.2
Perception of difference in support between male and female colleagues
	Women provide more support	49	19.5
	Men provide more support/no difference	202	80.5
Breastfeeding agreement with employer
	Yes	50	19.9
	No	201	80.1
Guidance on continuing breastfeeding after return to work provided by the organization
	Yes	63	25.1
	No	188	74.9
Knowledge of the existence of a human milk bank in the hospital
	Yes	178	70.9
	No	73	29.1
Knowledge of the existence of a lactation consultant in the hospital
	Yes	65	25.9
	No	186	74.1
Knowledge of entitlement to take 1 hour off work each day for breastfeeding
	Yes	226	90.0
	No	25	10.0
Milk expression during work
	Yes	94	37.5
	No	157	62.5
Use of the hospital crèche
	Yes	58	23.1
	No	193	76.9
Use of expressed milk in the crèche
	Yes	6	2.4
	No	245	97.6
Breastfeeding in the crèche
	Yes	34	13.5
	No/did not use the crèche	217	86.5
Feeling of work overload in conciliating breastfeeding and work
	Yes	152	60.6
	No	99	39.4
Perception that work performance is negatively affected by breastfeeding
	Yes	58	23.1
	No	193	76.9

Variables		Sample (n=251)		BF Prevalence≥12m	PR_c (IC95%)	p	PR_a (IC95%)	p
Variables		n	%	%
Distal Block
Maternal age(years)* - Average (SD)		35.7 (3.7)	-	-	0.97 (0.95-0.99)	0.024	0.97 (0.95-0.99)	0.021
Mother has college degree
	Yes	149	59.4	56.4	1.00		1.00
	No	102	40.6	70.6	1.25 (1.04-1.51)	0.020	1.23 (1.02-1.48)	0.033
Prior experience of breastfeeding
	<12 months	53	21.1	49.1	0.79 (0.59-1.07)	0.132	0.81 (0.60-1.08)	0.152
	≥12 months	46	18.3	78.3	1.27 (1.04-1.54)	0.019	1.32 (1.07-1.63)	0.008
	No experience	152	60.6	61.8	1.00		1.00
Intermediate Block
Antenatal care
	Public	13	5.2	84.6	1.39 (1.08-1.79)	0.011	1.03 (0.67-1.60)	0.883
	Private	238	94.8	60.9	1.00		1.00
Intention with regard to breastfeeding duration
	≥12months	235	93.6	64.3	2.06 (0.99-4.28)	0.054	1.79 (0.88-3.64)	0.107
	<12 months	16	6.4	31.3	1.00		1.00
Intention to breastfeed after return to work
	Yes	244	97.2	63.1	2.21 (0.68 - 7.16)	0.186	1.53 (0.49-4.79)	0.470
	No/Maybe	7	2.8	28.6	1.00		1.00
Delivery
	Public	41	16.3	73.2	1.22 (0.98-1.51)	0.071	1.15 (0.88-1.49)	0.305
	Private	210	83.3	60.0	1.00		1.00
Type of delivery
	Vaginal	45	17.9	73.3	1.23 (0.99-1.51)	0.054	1.13 (0.89-1.42)	0.312
	Cesarean	206	82.1	59.7	1.00		1.00
Gestational age (weeks)* - Average (SD)		38.2 (1.7)	-	-	0.95 (0.91-0.99)	0.035	0.93 (0.88-0.97)	0.003
Sex of child
	Female	110	43.8	70.0	1.25 (1.03-1.51)	0.022	1.17 (0.97-1.42)	0.106
	Male	141	56.2	56.0	1.00		1.00
EBF upon discharge from maternity clinic
	Yes	215	85.7	64.7	1.37 (0.96-1.96)	0.087	1.39 (0.97-1.98)	0.069
	No	36	14.3	47.2	1.00		1.00
Proximate Block
Duration of EBF (days)* - Median (P25-P75)		150 (90-180)	-	-	1.002 (1.001-1.004)	0.007	1.001 (1.000-1.003)	0.126
Use of milks other than breast milk when mother returned to work
	Yes	238	94.8	60.1	1.00		1.00
	No	13	5.2	100	1.66 (1.50-1.85)	<0.001	1.36 (1.06-1.74)	0.016
Breastfeeding support from child caregiver
	Yes	203	80.9	60.1	0.85 (0.69-1.05)	0.131	0.77 (0.61-0.97)	0.027
	No/parents are the child’s sole caregiver	48	19.1	70.8	1.00		1.00
Professional breastfeeding support
	Yes	177	70.5	58.8	0.84 (0.69-1.01)	0.069	0.78 (0.64-0.94)	0.008
	No	74	29.5	70.3	1.00		1.00
Using a pacifier
	Yes	161	64.1	56.5	1.00		1.00
	No	90	35.9	72.2	1.28 (1.06-1.54)	0.010	1.29 (1.07-1.54)	0.006
Mother’s position/function in the hospital
	Care	198	78.9	63.1	1.26 (0.89-1.80)	0.195	1.33 (0.98-1.81)	0.063
	Support	19	7.6	73.7	1.47 (0.96-2.27)	0.077	1.41 (0.92-2.17)	0.116
	Administrative	34	13.5	50.0	1.00		1.00
Shift
	Daytime	186	74.1	66.7	1.35 (1.04-1.77)	0.026	1.37 (1.05-1.77)	0.019
	Night/both	65	25.9	49.2	1.00		1.00
Expression of breast milk during work
	Yes	94	37.5	68.1	1.16 (0.96-1.41)	0.123	1.05 (0.87-1.26)	0.605
	No	157	62.5	58.6	1.00		1.00
Breastfeeding support from work colleagues
	Yes	150	59.8	66.0	1.17 (0.95-1.44)	0.137	1.20 (0.99-1.46)	0.070
	No	101	40.2	56.4	1.00		1.00
Guidance from organization on breastfeeding continuation after return to work
	Yes	63	25.1	69.8	1.17 (0.96-1.43)	0.120	1.17 (0.96-1.43)	0.124
	No	188	74.9	59.6	1.00		1.00
Use of the hospital crèche
	Yes	58	23.1	72.4	1.23 (1.01-1.49)	0.043	0.95 (0.68-1.35)	0.785
	No	193	76.9	59.3	1.00		1.00
Breastfeeding in the crèche
	Yes	34	13.5	76.5	1.28 (1.03-1.58)	0.027	1.13 (0.80-1.61)	0.493
	No/did not use crèche	217	86.5	59.9	1.00		1.00
Perceptions of difficulty of breastfeeding upon returning to work
	Easy/very easy	38	15.1	76.3	1.32 (1.05-1.66)	0.019	1.14 (0.87-1.49)	0.332
	Neither easy nor hard	82	32.7	62.2	1.07 (0.86-1.34)	0.541	1.02 (0.83-1.26)	0.852
	Difficult/very difficult	131	52.2	58.0	1.00		1.00

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[1] Collaborations

MS Mendes contributed at all stages, from data collection, tabulation, analysis and writing. M Schorn contributed to the stages of data collection, tabulation and analysis. LC Espírito Santo contributed to the orientation for: data collection, analysis, writing and design of the study. LD Oliveira contributed to the guidance for: data collection, analysis, writing and design of the study. ERJ Giugliani contributed to the guidance for: data collection, analysis, writing and design of the study.