3.1 The feeding decision
What is most influential?
Several studies have noted that women may decide on how they will feed their baby either before pregnancy or during the first trimester. These decisions are formed as a product of their demographics and the culture in which they live.
Demographic data, such as age, ethnicity, social class, education, etc may be used to predict feeding decisions. There is limited ability to change these factors.
Psychosocial variables, however, can also have a significant impact, and these can be targetted with education.
Researchers found that maternal attitudes are better predictors of feeding method than are sociodemographic factors, 1 and that a woman's prenatal intention was a stronger predictor than the standard demographic factors combined. 2 Fathers' attitudes also influence maternal decisions.3,4
In a study of women who were already breastfeeding 95.5% gave breastmilk as being better for the baby as the major reason they chose to breastfeed, with convenience for the mother another common reason. Another researcher 5 explored why both breastfeeding and artificial formula-feeding mothers chose their method of feeding. They found ...
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Mothers chose to feed artificial infant formula
- not because they embraced artificial infant formula-feeding, rather that they rejected breastfeeding
- found breastfeeding embarrassing
- feared the pain or discomfort
- felt it limits freedom and social life
- were concerned that the father would not be involved
- but acknowledged that human milk is better for the baby
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Mothers who chose to breastfeed had the following in common
- a positive attitude toward breastfeeding and human milk
- considered human milk to be healthier or 'better' for babies than artificial infant formula
- felt breastfeeding was more natural
- felt it resulted in better bonding or closeness with the baby
- and their self-confidence was linked to longer duration of breastfeeding
Both breastfeeding and artificial infant formula-feeding mothers felt that their chosen feeding method was the most convenient.
How can we influence the decision?
In the community
Community health promotion activities that present breastfeeding as a natural, healthy, and normal way to feed a baby can influence society opinion. As a member of that society the mother and her support people will also be influenced.

What can your hospital do?
- Becoming involved in
World Breastfeeding Week promotions, with displays not only at the hospital but in shopping precincts, libraries and other public places.
- Use social media avenues to connect with your community. What social media does your target-group use? Could your Unit have an official 'twitter' account, or a blog? Does your hospital have a Facebook account? If there are popular bloggers writing on parenting issues in your area could you write articles for them to post?
- Be prepared to make public statements whenever any topic about breastfeeding is raised in the media, eg breastfeeding in public, workplace reforms, etc. Make your hospital the 'go to' place whenever the media wants expert opinion on breastfeeding topics.
- Offer consultancy services to government departments that fund health promotion activities.
- What other ideas can you think of? Please share them in the General Forum.
Prenatal education
The attitude of the health care provider to breastfeeding strongly influences the pregnant woman's attitude. Women who are encouraged to breastfeed by their doctor, nurse or midwife are four times more likely to initiate breastfeeding than women who do not receive their encouragement. 6

Play your part...
This is an indication of the mother's respect for her health provider's opinion. The responsibility rests on your shoulders to be a positive influence on pregnant women at a time when they are so open to receiving information.
You have a very important role to play in encouraging a positive breastfeeding attitude.
If your health care district runs pre-conception classes this is an ideal opportunity to have a major influence on women and their partners.
Early in their pregnancy, and continue throughout pregnancy:
- Provide information about the recommended length of time to breastfeed exclusively (ie 6 months), and in total (up to 2 years and beyond). 7
Mothers who know the scientific recommendation are more likely to set that as their breastfeeding goal. - Include the mother's support people, particularly the father, but also the mother's mother and mother-in-law when giving education, both face-to-face and in classes. 8 9
Having their support for breastfeeding makes a significant difference to initiation and duration of breastfeeding. - Discuss how to provide breastmilk during times of separation.10 11 9
Feelings of being 'tied' to the baby, or not knowing how they could breastfeed when they return to the workforce, can cause some mothers to not begin breastfeeding or to wean very early. - Increase maternal confidence and self-efficacy. 12
Provide a supportive environment for breastfeeding in the hospital. Mothers say it is important that nurses discuss breastfeeding and watch them breastfeed. Having a Lactation Consultant review them also positively influences mothers' self-confidence.
Guilt and not breastfeeding
What should I remember?

- The factors which most influence a woman's infant feeding decision
- The prenatal circumstances which can positively influence maternal attitude towards breastfeeding
- Your role as a health professional in modelling a positive breastfeeding attitude to all women
- Be proactive - you will make a difference!
Self -test quiz
Notes
- # Dungy CI et al. (1994) Maternal attitudes as predictors of infant feeding decisions
- # Donath SM et al. (2003) Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study
- # Sencan I et al. (2013) Factors influencing breastfeeding duration: a survey in a Turkish population.
- # Freed GL et al. (1993) Effect of expectant mothers' feeding plan on prediction of fathers' attitudes regarding breast-feeding
- # Brodribb W et al. (2007) Identifying predictors of the reasons women give for choosing to breastfeed.
- # Lu MC et al. (2001) Provider encouragement of breast-feeding: evidence from a national survey
- # Wen LM et al. (2012) Awareness of breastfeeding recommendations and duration of breastfeeding: findings from the Healthy Beginnings Trial.
- # Tarrant RC et al. (2010) The prevalence and determinants of breast-feeding initiation and duration in a sample of women in Ireland.
- # Ismail TA et al. (2013) Intention of pregnant women to exclusively breastfeed their infants: The role of beliefs in the theory of planned behaviour.
- # Plewma P (2013) Prevalence and factors influencing exclusive breast-feeding in Rajavithi Hospital.
- # Ladomenou F et al. (2007) Risk factors related to intention to breastfeed, early weaning and suboptimal duration of breastfeeding.
- # Leahy-Warren P et al. (2013) Factors influencing initiation and duration of breast feeding in Ireland.