International Journal of Caring Sciences January-April 2018 Volume 11 | Issue 1| Page 225

Original Article

Factors Affecting Mothers' Breastfeeding

Seval Keloglan, PhD, BSN

Assistant Professor, Amasya University, Faculty of Health Sciences, Nursing Department

Asli Yilmaz, MSc

Lecturer, Amasya University, Faculty of Health Sciences, Nursing Department

Kenan Gumus, PhD, BSN, Assistant Professor

Amasya University, Faculty of Health Sciences, Nursing Department

Correspondence: Keloglan Seval, Assistant Professor, Amasya University, Faculty of Health Sciences,
Nursing Department E- mail: [email protected]

Abstract
Background: Breastfeeding is crucial for the baby to grow healthfully. Factors affecting breastfeeding should
be recognized in order to support it and provide effective breastfeeding counseling. This research was conducted
as a descriptive study.
Objective: to investigate the factors affecting the breastfeeding status of the postpartum mothers.
Methodology: The universe of the research consists of mothers giving birth at Amasya University Sabuncuoglu
Serefeddin Education Research Hospital. A total of 51 mothers who gave birth and stayed in the postpartum
service in the same constitution between June-December 2016, fit the sample criteria and volunteered to
participate in the study. LATCH breastfeeding diagnostic tool was used in the research. SPSS 22 package
program was used to evaluate data.
Results: LATCH scale average score was 8.76 ± 1.46 (min=3, max=10). %68.6 of the mothers gave birth with
C-section. When the first breastfeeding period after birth was evaluated, %37.3 (n=19) of the mothers stated that
they fed the baby within the first half hour, %62.7 (n=32) stated that they fed within 30 mins-1 hour period. A
significant relationship was found between the LATCH breastfeeding score and mother having breastfeeding
experience (p=0.01). The lowest average score from the LATCH scale items was from the "comfort
breast/nipple" item with an average score of 0.196 ± 0.448. %82.4 (n=42) of the mothers stated that they used
medication during pregnancy and no significant relationship was found between medication use and LATCH
score (p>0.05).
Conclusion: As a result of the study, age, education level and gender of the baby were determined as factors
which do not affect breastfeeding. It was also detected that breastfeeding the baby within the first half hour is
not common, the lowest scale score was taken from the "comfort breast/nipple" item and nipple pain and sunken
breast make breastfeeding difficult for mothers.
Keywords: Mothers, Counseling, Breastfeeding

Introduction cells (Aslan and Dinc, 2015). Inadequate

micronutrient intake during pregnancy may lead
Breastfeeding up to the end of two years is
to abort or stillbirth, birth defects, preterm baby,
recommended because of its physiological and
small baby according to the gestational age in
psychological benefits (Sahin and Ertekin, 2017).
early period; and death, differences in growth
Breast milk provides both nutrition and
and development and cardiometabolic,
immunity required for the baby's growth and
pulmonary or neurologic defects in late periods
development in the first months (Elad et al.,
(Germand et al., 2016).
2014). Besides being an excellent nutritional
source for the growing baby, breast milk also Breastfeeding is strongly encouraged by many
protects babies from the infections since it communities. Not just for the newborn, benefits
includes antibodies, cytokines, growth factos, of starting breastfeeding at the earliest possible
antimicrobial substances and specific immune postpartum time for the mother is also well

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International Journal of Caring Sciences January-April 2018 Volume 11 | Issue 1| Page 226

known. However, according to the Turkey participate are the criteria of exclusion from the
Population Health Research results (Hacettepe study.
University Institute of Population Studies),
LATCH breastfeeding diagnostic tool, of which
breastfeeding rate within 1 hour after birth is
the Turkish reliability was studied by Yenal and
%49.9 and breastfeeding rate within 1 day is
Okumus (2003), was used in the research.
%70.2. Mother thinking that her milk is not
Requisite permission to use the scale was
enough, delicate nipples, lack of adequate
obtained via e-mail. The measurement tool
draining, oedema formation, obstruction due to
consists of five evaluation criteria. LATCH
the diminished lymphatic drainage, nipple chaps
consists of the first letters of the English
and plain nipple are among the problems faced
equivalents of these criteria. These criteria are:
during breastfeeding (Mathur and Dhingra,
2014). Providing counseling about the problems L: Latch on breast, A: Audible swallowing,
faced in this process raises the breastfeeding rate T: Type of nipple, C: Comfort breast/nipple,
(Çaka et al., 2017). Healthcare professionals are H: Hold/help
the most important people to support mother Each item is evaluated between 0-2 points and
during the postpartum period. Therefore, one of the total score is 10.
the responsibilities of nurses' about breastfeeding
is the evaluation of breastfeeding. In this way, Descriptive data form consists of two sections.
problems can be detected early and interruption First section includes 5 questions about mother's
of breastfeeding can be prevented. sociodemographic characteristics, last menstrual
date and the gender of the baby. Second section
Research Question consists of 8 questions about form of birth,
Do the descriptive factors related to mothers and APGAR score regarding breastfeeding status and
babies affect LATCH average scores? the baby and information about weight, height
etc. APGAR score, weight, height and the head
Methodology
circumference of the baby are obtained from the
Aim mother's patient file. Pretesting of the draft
survey form was conducted and its deficiencies
Our aim with this research is to evaluate
were corrected. Surveys used for pretesting are
breastfeeding in order to support successfull
not included in the study.
breastfeeding and examine the factors affecting
it. Data were collected at the postpartum clinics.
LATCH diagnosis form was filled in by the
Study design
researcher within the first 48 hours.
This research was conducted as a descriptive Breastfeeding of each mother was observed and
study in order to investigate the factors affecting the appropriate situation was marked in
the breastfeeding status of the postpartum accordance with the breastfeeding observation.
mothers. Universe of the research consists of Gathering the data lasted approximately 15-20
mothers giving birth at Amasya University mins for each mother. Requisite permission to
Sabuncuoglu Serefeddin Education Research conduct the research was obtained from the
Hospital, which is a baby-friendly hospital. A Amasya University ethical board and from the
total of 51 mothers who gave birth June- institution where the research is conducted.
December 2016 and stayed in the postpartum Informed consent was obtained from the
service in the same constitution, fit the sample participants who accepted to be involved in the
criteria and volunteered to participate in the research.
study were chosen by improbable sampling
Data Analysis
method. Criteria to be involved in the study are;
being in the term period (38 weeks or more), Dependent variables of the research is
being healthy, having no chronical disease determined as the score obtained from the
preventing breastfeeding and being volunteered breastfeeding diagnosis tool and the independent
to participate in the study for women and having variables are determined as the age of mother,
5 min APGAR score 7 or above and having no education level, gender of the baby, mother's
congenital anomalies for babies. Premature birth, chronical diseases, mother's experience, usage of
a situation preventing mother or baby to nourishment other than breast milk. SPSS 22
breastfeed and mother's unwillingness to (Statistical Package for Social Sciences) were
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International Journal of Caring Sciences January-April 2018 Volume 11 | Issue 1| Page 227

used to evaluate data. Descriptive characteristics between LATCH breastfeeding score and having
of the data was evaluated as number, percentage experience on breastfeeding (p=0.010). A 68.6%
and average. For statistical analysis, reliability (n=35) of the mothers gave birth by C-section.
level was evaluated by using cronbach alpha When the first breastfeeding period after labor
coefficient and was found 0.710. Non-parametric was evaluated, 37.3 % (n=19) of the mothers
tests were used for analysis since the scale does stated that they fed the baby within the first half
not fit the normal distribution. The statistical hour, %62.7 (n=32) stated that they fed within 30
significance level was accepted as p<0.05. mins-1 hour period. It was stated that 21.6%
(n=11) of the babies were formula-fed during
Results
their stay at the clinic. 56.9 % (n=29) of the
Average age of the mothers who participated in mothers stated that they don't have a problem
the study is 27.54 ± 5.33. A 54.9% (n=28) of complicating the breastfeeding process. Among
them are primary school graduates and 68.6 % the mothers who stated that they have a problem
(n=35) of them are within the first 24 hours after complicating breastfeeding process, 25.5 %
labor. Descriptive factors regarding mother are (n=13) of them stated that they have breast
given at Table 1. When information about babies problems (sunked breast, nipple pain).
are examined, it is detected that average weight Information on other factors affecting the
is 3362.01 ± 378.20 grams, average height is breastfeeding status are given at Table 4.
50.03±0.63 cm, average head circumference is
Discussion
34.4 ± 1.22 cm and %58.8 of them are girls. First
minute APGAR score average was detected as It is recommended by World Health Organisation
9.74 ±0.44 (min=9 max=10) and 5th minute (WHO) and United Nations International
APGAR score average was detected as 9.92 Children's Emergency Fund (UNICEF) (2009) to
±0.27 (min=9 max=10). start breastfeeding within the first half hour after
labor. As a result of the study, it was detected
The Cronbach's Alpha coefficient of LATCH
that breastfeeding within the first half hour is not
breastfeeding diagnosis tool was 0.710 in
common. It was detected that %37.3 of the
accordance with the data gathered within the
mothers start breastfeeding within the first half
score of research.
hour and %62.7 of them started within 30mins-
LATCH breastfeeding diagnosis tool and 1hour.
subscale average scores are given at Table 2.
According to the Turkey Population Health
LATCH scale average score were found 8.76 ±
Research data, %50 of the babies started
1.46 (min=3, max=10). A 86.3 % (n=44) of the
breastfeeding within the first 1 hour after labor
mothers stated that they don't have a chronical
(HUNEE, 2014). Although UNICEF (2014)
disease and %82.4 (n=42) stated that they used
stated that the ratio of starting breastfeeding
medication during pregnancy. Medication usage
within the first hour after labor is %43
during pregnancy was investigated in order to
worldwide and %53 among underdeveloped
evaluate its affects on the breastfeeding success.
countries; using different descriptions, timings
A 82.4 % (n=42) of the mothers stated that they
and different data collecting methods makes it
used medication regularly during pregnancy. No
difficult to compare countries' breastfeeding
significant relationship was found between the
ratios (Earle, 2002).
LATCH score and the usage of iron supplements
or fish oil (p>0.05). Distribution of the LATCH Also, while no significant relationship was found
average scores and using medication during between the LATCH scale score and the
pregnancy is given at Table 3. breastfeeding time within the scope of the
research, in a study conducted by Gercek et al.,
It was detected that 64.7% (n=33) of the mothers
LATCH score was found significantly higher
had training on breastfeeding during their
among those who started breastfeeding within
pregnancy. A 66.7% (n=34) of the mothers
the first 30 minutes.
stated that they have breastfeeding experience
and a significant relationship was detected

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International Journal of Caring Sciences January-April 2018 Volume 11 | Issue 1| Page 227

Table 1. Distribution of the Descriptive Factors Regarding the Mother (N=51)

Characteristics N %
Education Level
Primary School 28 54.9
Highschool 12 23.5
University 11 21.6
Age
26 and below 23 45.1
27 and above 28 54.9
How many hours has it been
since labor?
24 hours 35 68.6
24-48 hours 16 31.4

Table 2. LATCH Breastfeeding Diagnosis Tool and Subscale Average Scores

Scale Criteria
± SD
L: Latch on breast 1.882 ±0.381*
A: Audible swallowing 1.823±0.385
T: Type of nipple 1.862±0.490
C. Comfort breast/nipple 0.196 ±0.448**
H: Hold/Help 1.411±0.697
Total 8.764±1.464
*Mininum average, **Maximum average

Table 3. Comparison of the LATCH mean Scores and Medication Usage i Pregnancy (N= 42)*
n % LATCH Test and p
score ± SD
Medication Usage
Yes 42 82.4 8.66±0.23 Z:-1.204
No 9 17.6 9.22±0.36 p:0.229
Iron
Yes 32 62.7 8.46±0.29 Z:-1.430
No 10 19.6 9.30±0.21 p:0.153
Vitamin
Yes 25 49 8.76±0.30 Z:-0.395
No 17 33.3 8.52±0.38 p:0.692
Fish Oil
Yes 5 9.8 9.20±0.20 Z:-0,537
No 37 72.5 8.59±0.26 p:0.591

*More than one options were marked.

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International Journal of Caring Sciences January-April 2018 Volume 11 | Issue 1| Page 228

Table 4. Comparison of the LATCH Average Scores with Individual Characteristics of Mothers
and Characteristics Regarding Infant Nutrition
Variable n % LATCH score Test and p

± SD

26 and below 23 45.1 8.34±1.96 Z: - 0.782

27 and above 28 54.9 9.10±0.73 0.434

Education Level

Primary School 28 54.9 9.07±1.18 x²: 3.738

High School 12 23.5 8.25±1.81 0.154

University 11 21.6 8.54±1.63

Time to Start Breastfeeding

Within first 30 mins 19 37.3 8.76±0.32 Z:0.134

30mins-1hour 32 62.7 8.78 ±0.26 0.893

Gender of the Baby

Girl 30 58.5 8.53±1.61 Z: -1.388

Boy 21 41.2 9.09±1.17 0.165

Experience

Yes 34 66.7 9.23 Z:-2.582

No 17 33.3 7.82 0.010

Chronical disease

Yes 7 13.7 9.42±0.53 Z:-1.247

No 44 86.3 8.65±1.53 0.213

Usage of formula

Yes 11 21.6 8.18±2.27 Z:-0.716

No 40 78.4 8.92±1.14 0.474

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The fact that the baby is physiologically more researches done in this field is needed. Although
ready for breastfeeding within the first 30 statistically not significant, the breastfeeding
minutes after labor is a facilitating factor for success score of the mothers with chronical
breastfeeding. We think that the result from our diseases were found higher than the scores of the
research is a result of the fact that only %37.3 of mothers who do not have chronical disease. This
the mothers started breastfeeding within the first result may be because of the individual factors
half hour. In this research, similar to Bostancı since it is a known fact that the chronical
and İnal's study (2015), no significant diseases are one of the major factors of
relationship was found between the LATCH pregnancy depression (Calık and Aktas, 2011).
score and age of mother and education level. At the same time, it is stated in literature that
Also, LATCH average scores show similarity mothers with depression are more worried about
(8.76±1.46). In this study, a significant breastfeeding (Annagur and Annagur, 2012). For
relationship was found between the LATCH this reason, mothers with chronical disease
scale score and experience in breastfeeding should be monitored closely in terms of
(p<0.05). Similar to that, in Kuçukoglu and breastfeeding.
Celebioglu's (2014) study, breastfeeding self-
Limitiations
efficacy of mothers were found higher among
those who have experience in breastfeeding. It Limitations of the study are that the research was
can be said that the experienced mothers have conducted at a single hospital, between certain
more advantage in breastfeeding and lack of dates and with a limited number of mothers.
experience may cause breastfeeding to be
Conclusion
interrupted.
As a result of the study, a significant relationship
Lowest score from the LATCH scale was was found between LATCH breastfeeding
obtained from the "comfort breast/nipple" item success score and experience in breastfeeding, no
with a score of 0.196 ± 0.448. In accordance with difference was found between other variables.
this finding, it was detected that %25.5 (n=13) of The lowest scale score was obtained from the
the mothers had problems about breasts (sunked "comfort breast/nipple" item. Furthermore, it was
breast, nipple pain). If the mother has nipple pain detected that breast pain is a factor which may
of her nipple is cracked, they should be told that cause breastfeeding to be interrupted. It should
this may be caused by misplacing the baby and it be taken care that the breastfeeding position is
may cause breastfeeding to be interrupted (Bilgin proper in order to avoid nipple damage. It was
and Potur, 2010; Leung, 2016; Li et al., 2008). detected that breastfeeding within the first half
During this process, efficient communication hour is not common. Considering the results of
techniques should be used to make mother feel the research and clinical observations,
confident and efficient counseling service applications should be made to encourage the
towards physiological problems should be mother to breastfeed properly.
provided.
Acknowledgements
Iron reinforcement to pregnant women is one of
the most common public health precautions The authors wish to acknowledge the
(Allen, 2000). According to the World Health contribution of the residents. Without their effort
Organization (2015), anemia prevalance among and support this study would not have been
pregnant women is %38.2 and in general possible.
approximately %50 of the anemia cases are due The research was carried out at Amasya
to iron deficiency. When the medication used by University Sabuncuoglu Serefeddin Educational
the mothers participated in the research was Research Hospital
examined, it was detected that %62.7 used iron
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