EVALUATİON OF THE EFFECTİVENESS OF A MODEL-BASED HYPNOBREASTFEEDİNG EDUCATİON PROGRAM GİVEN TO PRİMİPAROUS PREGNANT WOMEN

Overview

This randomized controlled trial aimed to evaluate the effectiveness of an education program based on the Information-Motivation-Behavioral Skills (IMB) Model and grounded in the philosophy of hypnobreastfeeding provided to primiparous pregnant women.

Throughout her life, a woman experiences numerous physiological processes, one of the most significant of which is the breastfeeding period. Breastfeeding is the natural and normative method of infant feeding; however, it encompasses far more than nutrition alone. By influencing all vital life processes, breastfeeding lays the foundations of both physical and psychological health and establishes an instinctive, epigenetic connection between mother and infant. Breast milk and breastfeeding, which are regarded as the gold standard in infant nutrition, provide all essential nutrients and energy required to support infant growth and development. In addition to being easily digestible, breast milk has high bioavailability and constitutes a natural and optimal source of nutrition. Breast milk and breastfeeding offer numerous benefits for both infants and mothers. Breastfeeding strengthens the infant's immune system, supports brain development, contributes to the maturation of the respiratory system and immature intestines, and reduces the risk of allergic reactions. Furthermore, infants who are breastfed have a lower risk of developing obesity and diabetes later in life. The continuation of breastfeeding is mediated by various physical and biological changes that contribute to the multiple advantages breastfeeding provides to mothers. Lactation represents a unique biological phase characterized by hormonal regulation, suppression of reproductive functions, and metabolic adaptations. Breastfeeding is associated with a reduced risk of maternal anemia, osteoporosis, depression, and ovarian and breast cancers. Breast milk and breastfeeding have been identified as global health priorities within the World Health Organization's (WHO) 2030 Sustainable Development Goals. Consequently, breastfeeding-related strategies have gained increasing importance in national development agendas. The primary factors contributing to this emphasis include the widespread availability of infant formula due to technological advancements, shifts in lifestyle and cultural practices, and changes in economic conditions. Supporting and sustaining breastfeeding through policy initiatives is therefore essential to achieving sustainable development goals, as suboptimal breastfeeding practices negatively affect infant and child health in the short term and public health in the long term. Globally, while approximately 70% of infants are breastfed during the first year of life, this rate declines to 45% during the second year, indicating that sustained breastfeeding remains below desired levels worldwide. The WHO and the United Nations Children's Fund (UNICEF) recommend initiating breastfeeding within the first half hour after birth, exclusively breastfeeding for the first six months, and continuing breastfeeding alongside complementary feeding until at least two years of age and beyond. Despite these recommendations, WHO data indicate that a substantial proportion of newborns in many countries are still not breastfed within the first hour after birth. Between 2007 and 2014, only 36% of infants aged 0-6 months worldwide were exclusively breastfed, and this rate increased to 44% according to WHO data published in 2021. Although breastfeeding is a common practice in Türkiye, breastfeeding rates show a decline similar to global trends. The rate of breastfeeding within the first 24 hours after birth has been reported as 85.6%. According to the 2013 Türkiye Demographic and Health Survey (TDHS), 96% of infants were breastfed at some point during infancy; however, exclusive breastfeeding rates declined from 58% during the first two months to 10% by the fourth and fifth months. TDHS 2018 data revealed that although 98% of infants born within the preceding two years were breastfed, only 73% were breastfed within the first hour after birth, 86% within the first day, and 24% received supplementary feeding prior to breastfeeding. Exclusive breastfeeding rates declined with infant age, decreasing from 59% at 0-1 months to 45% at 2-3 months and 14% at 4-5 months. In Türkiye, declining breastfeeding rates have been attributed to maternal age, educational level, income status, availability of social support, obstetric factors, breastfeeding-related myths, and maternal health problems. Additionally, maternal feelings of inadequacy and lack of access to appropriate support when encountering breastfeeding difficulties adversely affect breastfeeding continuation. Psychological factors such as maternal perceptions of breastfeeding, self-confidence, breastfeeding motivation, and self-efficacy play a significant role in breastfeeding outcomes. Breastfeeding self-efficacy refers to a mother's belief in her ability to breastfeed her infant successfully. This belief influences whether a mother initiates breastfeeding, the effort she invests, and her thoughts and emotions related to breastfeeding. Mothers who do not perceive breastfeeding as valuable or who lack confidence in their ability to breastfeed are less motivated and more likely to discontinue breastfeeding early. Therefore, understanding maternal motivation-the driving force behind behavior-is essential for identifying the reasons underlying early breastfeeding cessation. Maternal motivation, a key determinant of breastfeeding self-efficacy, has been shown to influence maternal behaviors and exclusive breastfeeding practices during the first six months postpartum. Breastfeeding motivation is shaped by emotional state, attitudes toward breastfeeding, self-confidence, self-efficacy, and family and environmental factors. Consequently, pregnant women may experience ambivalence regarding breastfeeding. Motivational interviewing, frequently used to resolve ambivalence, aims to correct misconceptions, enhance motivation, and strengthen self-efficacy in breastfeeding practices. Studies have demonstrated that motivational interviewing improves breastfeeding self-efficacy, motivation, and exclusive breastfeeding duration. During pregnancy and the postpartum period, both pharmacological and non-pharmacological methods are employed to increase prolactin secretion and breast milk production. These methods support the continuation of breastfeeding. Non-pharmacological approaches include frequent breastfeeding or pumping, massage and compression, warm applications, acupuncture and acupressure, aromatherapy, music therapy, yoga, hypnobreastfeeding, oxytocin massage, and structured education and counseling. Hypnobreastfeeding is a mind-body approach that enhances bodily awareness, fosters self-compassion, increases maternal confidence, and emphasizes mother-infant cooperation while adopting an instinctive perspective focused on the natural process of breastfeeding. This philosophy incorporates relaxation, positive suggestions, breathing techniques, emotional regulation, stress reduction, and affirmative guidance related to the maternal role, thereby facilitating breastfeeding continuation. Although studies on hypnobreastfeeding remain limited, available evidence suggests that hypnobreastfeeding interventions increase breast milk volume, reduce anxiety, accelerate colostrum secretion, elevate prolactin levels, and enhance breastfeeding self-efficacy and motivation. Breastfeeding education and counseling are known to play a critical role in improving breastfeeding outcomes. Contemporary approaches emphasize structured, theory-based counseling models, one of which is the Information-Motivation-Behavioral Skills (IMB) Model. Developed by Fisher et al. in 1992, the IMB Model provides a robust theoretical framework for behavior change by addressing knowledge, motivation, and behavioral skills components. According to this model, deficiencies in any of these components may hinder the adoption of health-promoting behaviors. While studies grounded in the IMB Model have demonstrated effectiveness across various health behaviors, research integrating hypnobreastfeeding philosophy with the IMB Model in breastfeeding education is lacking. Nurses play a pivotal role in supporting and sustaining breastfeeding; thus, employing structured, model-based approaches supported by innovative philosophies is essential. The integration of hypnobreastfeeding philosophy with the IMB Model constitutes the originality and scientific value of the present study.