Factors associated with breastfeeding self-efficacy according to nipple types

Keywords: Breast Feeding; Maternal-Child Nursing; Postpartum Period; Nipples; Rooming-in Care.


Objective: to analyze factors associated with breastfeeding self-efficacy according to nipple types. Methods: cross-sectional study conducted with 60 mothers admitted to rooming-in. A questionnaire was used in addition to the application of the State-Trait Anxiety Scale and the Breastfeeding Self-Efficacy Scale. Results: the proportion of protruding and non-protruding nipples was 31 (51.6%) and 29 (48.3%), consecutively. The anxiety evaluated was higher in women with non-protruding nipples. While breastfeeding self-efficacy was higher in women with protruding nipples (p=0.027). Factors associated with breastfeeding according to nipple types were: difficulty in gripping (p=0.019), breastfeeding aid (p=0.003) and breastfeeding satisfaction (p=0.043). Conclusion: the Breastfeeding Self-Efficacy Scale score was higher in the group of women with protruding nipple promoting greater satisfaction during practice, while non-protruding women are related to difficulty in gripping, as well as the need for assistance during breastfeeding.


World Health Organization. Maternal, infant and young child nutrition. Comprehensive implementation plan on maternal, infant and young child nutrition: biennal report [Internet]. 2018 [cited Jun 10, 2019]. Available from: http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_22-en.pdf

Boccolini CS, Boccolini PMM, Monteiro FR, Venâncio SI, Giugliani ERJ. Tendência de indicadores do aleitamento materno no Brasil em três décadas. Rev Saúde Pública. 2017; 51:108. doi: https://doi.org/10.11606/S1518-8787.2017051000029

Arshad SM, Khani-Jeihooni A, Moradi Z, Kouhpayeh SA, Kashfi SM, Dehghan A. Effect of theory of planned behavior-based educational intervention on breastfeeding behavior in pregnant women in Fasa City, Iran. J Educ Community Health. 2017; 4(2):55-63.doi: https://doi.org/10.21859/jech.4.2.55

Duckett LJ. Commentary: “Validation of a theory of planned behavior-based questionnaire to examine factors associated with milk expression” by Y. K. Bai& L. M. Dinour. J Hum Lact. 2017; 33(4):666-9. doi: https://doi.org/10.1177/0890334417726306

Sipsma HL, Jones KL, Cole-Lewis H. Breastfeeding among adolescent mothers: a systematic review of interventions from high-income countries. J Hum Lact. 2015; 31(2):221-9. doi: https://doi.org/10.1177/0890334414561264

Karaçam Z, Sağlık M. Breastfeeding problems and interventions performed on problems: systematic review based on studies made in Turkey. Turk Pediatr Ars. 2018; 53(3):134-48. doi: https://doi.org/10.5152/TurkPediatriArs.2018.6350

Urbanetto PDG, Gomes GC, Costa AR, Nobre CMG, Xavier DM, Jung BC. Facilities and difficulties found by mothers to breastfeed. J Res Fundam Care Online. 2018; 10(2):399-405. doi: https://doi.org/10.9789/2175-5361.2018.v10i2.399-405

Biaggio AMB, Natalcio L, Spielberger CD. Desenvolvimento da forma experimental em português do IDATE. Arq Bras Psicol [Internet]. 1977 [citado 2019 jun. 18]; 29(3):31-44. Disponível em: http://bibliotecadigital.fgv.br/ojs/index.php/abpa/article/view/17827/16571

Dennis CL, Brennenstuhl S, Abbass-Dick J. Measuring Paternal Breastfeeding Self-Efficacy: A Psychometric Evaluation of the Breastfeeding Self-Efficacy Scale – Short Form among Fathers. Midwifery. 2018; 64:17-22. doi: https://doi.org/10.1016/j.midw.2018.05.005

Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Saúde da criança: aleitamento materno e alimentação complementar. Brasília: Ministério da Saúde; 2015.

Shiffman MA. Nipple-areolar complex reconstruction: principles and clinical techniques. Tustin Springer. 2018. doi: https://doi.org/10.1007/978-3-319-60925-6

Huang Y, Ouyang YQ, Redding SR. Previous breastfeeding experience and its influence on breastfeeding outcomes in subsequent births: a systematic review. Women Birth. 2019; 32(4):303-9. doi: https://doi.org/10.1016/j.wombi.2018.09.003

Margotti E, Epifanio M. Exclusive maternal breastfeeding and the Breastfeeding Self-efficacy Scale. Rev Rene. 2014; 15(5):771-9. doi: https://doi.org/10.15253/2175-6783.2014000500006

Yang X, Gao LL, Ip WY, Chan WCS. Predictors of breast feeding self-efficacy in the immediate postpartum period: a cross-sectional study. Midwifery. 2016; 41:1-8. doi: https://doi.org/10.1016/j.midw.2016.07.011

Castro e Carneiro LMM, Barbieri F, Moro ASS, Freitas HMB, Colomé JS, Backes DS. Breastfeeding women: risk factors for early weaning. Disciplinarum Scientia [Internet]. 2014 [citado 2019 ago. 28]; 15(2):239-48. Disponível em: https://periodicos.ufn.edu.br/index.php/disciplinarumS/article/view/1085/1028

Tan DJA, Lew JP, Jumhasan MB, Pang C, Sultana R, Sng BL. Investigating factors associated with success of breastfeeding in first-time mothers undergoing epidural analgesia: a prospective cohort study. Int Breastfeed J. 2018; 13(42):1-9. doi: https://doi.org/10.1186/s13006-018-0184-7

Froh EB, Hallowell S, Spatz DL. The use of technologies to support human milk & breastfeeding. J Pediatr Nur. 2015; 30(3):521-3.doi:https://doi.org/10.1016/j.pedn.2015.01.023

Hanna S, Wilson M, Norwood S. A description of breast-feeding outcomes among U.S. mothers using nipple shields. Midwifery. 2013; 29(6):616-21. doi: https://doi.org/10.1016/j.midw.2012.05.005

Schafer EJ, Campo S, Colaizy TT, Mulder PJ, Ashida S. Influence of experiences and perceptions related to breastfeeding one’s first child on breastfeeding initiation of second child. Matern Child Health J. 2017; 21(6):1288-96. doi: https://doi.org/10.1007/s10995-016-2228-1

Research Article