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      <h1 id="top">6.5 Psychological support</h1>
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    <p> Many clinicians will tell you that breastfeeding is a confidence game. <br />Prof Hartmann in his studies of breast growth and development from preconception to weaning noted one woman in their study had no breast changes during her pregnancy. She went on to successfully breastfeed her baby. Prof Hartmann commented that she was successful because no one at any time suggested to her that she might have a problem. <br />Similarly a woman who exclusively breastfed her triplets for 6 months said that she did it because no one told her she might not be able to, and that had it been suggested she probably wouldn't have had the confidence to even try. </p>
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      <div class="section" id="Maternal_self-confidence_and_self-efficacy"><h2>Maternal self-confidence and self-efficacy</h2>
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      <p> Researchers confirm self-confidence and self-efficacy to be major predictors of breastfeeding success. Women studied in Denmark,<sup><a href="#note1">1</a></sup> USA,<sup><a href="#note2">2</a>,</sup><sup><a href="#note3">3</a></sup> Australia,<sup><a href="#note4">4</a>,</sup><sup><a href="#note5">5</a></sup> New Zealand<sup><a href="#note6">6</a></sup> and Canada<sup><a href="#note7">7</a></sup> have all found mothers who have confidence in their ability to breastfeed and mothers with high breastfeeding self-efficacy significantly more likely to breastfeed. </p>
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      <div class="section" id="Influencing_self-confidence_and_self-efficacy"><h2>Influencing self-confidence and self-efficacy</h2>
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      <p> A lack of education about breastfeeding was identified by several of the researchers mentioned above. </p>
      <p class="listTitle">Breastfeeding education needs to be included as a part of</p>
      <ul foot="to ensure mothers have an excellent understanding of all the relevant factors.">
        <li>community awareness programs,</li>
        <li>prenatal classes,</li>
        <li>prenatal health care provider visits, and</li>
        <li>postnatally</li>
      </ul>
      <p> Health professional attitudes and actions in regard to breastfeeding significantly influences mothers. At 12 weeks postpartum mothers are much more likely to be breastfeeding if they reported having received encouragement from their clinician to breastfeed<sup><a href="#note2">2</a></sup>. Health care professionals can also have a negative influence if their lack of knowledge results in inaccurate or inconsistent advice. Some hospital routines are also potentially detrimental to breastfeeding<sup><a href="#note7">7</a></sup>. Blyth et al (2002)<sup><a href="#note5">5</a></sup> recommend integrating self-efficacy enhancing strategies, improving the quality of healthcare delivered and increasing a new mother's confidence in her ability to breastfeed. </p>
      <p> Support from the mother's partner or a nonprofessional greatly increases the likelihood of positive breastfeeding behaviors<sup><a href="#note7">7</a></sup>. </p>
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    <div class="captionBox"><img width="418" height="534" src="images/WIC_Father_support_poster.jpg" alt="Never underestimate the role of the father in supporting breastfeeding." /><p>Never underestimate the role of the father in supporting breastfeeding. <br />&copy; WIC program, USA</p></div>
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			Be aware at all times of how your seemingly innocent comments and actions can affect maternal confidence. For example: mothers have reported losing self-confidence to breastfeed from staff commenting about their 'flat' nipples, or small breasts, or red hair, or fair skin, or ability to hold the baby. Impatience is another factor identified by mothers trying to learn a new skill. Taking the baby from the mother and having him/her settle immediately demonstrates to a mother her lack of skill, and perhaps to an anxious mother, that the baby may 'prefer' someone else.
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			With such short hospital stays it's important for the mother to assume all care of her infant as soon as she is physically able to, with nurses or midwives available to coach her when needed, providing positive feedback at every opportunity.
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            <td class="body"><img src="design/tip.png" class="icon" alt="" /><h3>Think positive. Sound positive.</h3>
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      <p>It's the little things that count.</p>
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      <div class="section" id="What_should_I_remember_"><h2>What should I remember? </h2>
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        <ul>
          <li>Never say 'never'</li>
          <li>Health professional encourgement is vital to maternal self-confidence</li>
          <li>Include the father or mother's support people in education</li>
          <li>Encourage independence in baby care, with help when required</li>
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      <div class="section" id="Self-test_Quiz"><h2>Self-test Quiz</h2>
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      <div id="footnotes">
        <h3>Notes</h3>
        <ol>
          <li id="note1"><a href="references.html#kron04" title="See full details">#</a> Kronborg H et al. (2004) The influence of psychosocial factors on the duration of breastfeeding</li>
          <li id="note2"><a href="references.html#tave03" title="See full details">#</a> Taveras EM et al. (2003) Clinician support and psychosocial risk factors associated with breastfeeding discontinuation</li>
          <li id="note3"><a href="references.html#chez03" title="See full details">#</a> Chezem J et al. (2003) Breastfeeding knowledge, breastfeeding confidence, and infant feeding plans: effects on actual feeding practices</li>
          <li id="note4"><a href="references.html#cree03" title="See full details">#</a> Creedy DK et al. (2003) Psychometric characteristics of the breastfeeding self-efficacy scale: data from an Australian sample</li>
          <li id="note5"><a href="references.html#blyt02" title="See full details">#</a> Blyth R et al. (2002) Effect of maternal confidence on breastfeeding duration: an application of breastfeeding self-efficacy theory</li>
          <li id="note6"><a href="references.html#voge99" title="See full details">#</a> Vogel A et al. (1999) Factors associated with the duration of breastfeeding</li>
          <li id="note7"><a href="references.html#denn02" title="See full details">#</a> Dennis CL (2002) Breastfeeding initiation and duration: a 1990-2000 literature review</li>
        </ol>
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      <h1>Breastfeeding Essentials</h1>
      <ol>
        <li>1.0 <a href="topic_1-0.html">Why Breastfeeding is Important</a><ol><li>1.1 <a href="topic_1-1.html">Biochemistry</a></li><li>1.2 <a href="topic_1-2.html">Immunology</a></li><li>1.3 <a href="topic_1-3.html">Relative risks</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Communication Skills</a><ol><li>2.1 <a href="topic_2-1.html">Non-verbal</a></li><li>2.2 <a href="topic_2-2.html">Listening skills</a></li><li>2.3 <a href="topic_2-3.html">Building confidence</a></li><li>2.4 <a href="topic_2-4.html">An example</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Pregnancy Care</a><ol><li>3.1 <a href="topic_3-1.html">The feeding decision</a></li><li>3.2 <a href="topic_3-2.html">The barriers</a></li><li>3.3 <a href="topic_3-3.html">Physical preparation</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">The Birth Experience</a><ol><li>4.1 <a href="topic_4-1.html">The first hours</a></li><li>4.2 <a href="topic_4-2.html">Labor interventions</a></li><li>4.3 <a href="topic_4-3.html">Postnatal interventions</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Breastfeeding the Baby</a><ol><li>5.1 <a href="topic_5-1.html">Positioning Principles</a></li><li>5.2 <a href="topic_5-2.html">Breastmilk transfer</a></li><li>5.3 <a href="topic_5-3.html">Assessing breastfeeding</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">A time to learn</a><ol><li>6.1 <a href="topic_6-1.html">Practical skills</a></li><li>6.2 <a href="topic_6-2.html">Breastfeeding messages</a></li><li>6.3 <a href="topic_6-3.html">Normal growth</a></li><li>6.4 <a href="topic_6-4.html">Sleep</a></li><li class="current">6.5 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_6-5.html">Psychological support</a></li><li>6.6 <a href="topic_6-6.html">Discharge planning</a></li></ol></li>
        <li>7.0 <a href="topic_7-0.html">Infant Challenges</a><ol><li>7.1 <a href="topic_7-1.html">Late preterm infant; Non-latching</a></li><li>7.2 <a href="topic_7-2.html">Hypoglycemia; Jaundice</a></li><li>7.3 <a href="topic_7-3.html">Supplementation</a></li><li>7.4 <a href="topic_7-4.html">Crying baby</a></li><li>7.5 <a href="topic_7-5.html">Inadequate weight gain</a><ol><li>7.5.1 <a href="topic_7-5-1.html">Feeding-line device at the breast</a></li><li>7.5.2 <a href="topic_7-5-2.html">Cup feeding</a></li><li>7.5.3 <a href="topic_7-5-3.html">Finger Feeding</a></li><li>7.5.4 <a href="topic_7-5-4.html">Bottle feeding</a></li></ol></li></ol></li>
        <li>8.0 <a href="topic_8-0.html">Maternal Challenges</a><ol><li>8.1 <a href="topic_8-1.html">Engorgement</a></li><li>8.2 <a href="topic_8-2.html">Nipple Pain</a></li><li>8.3 <a href="topic_8-3.html">Breast Problems</a></li><li>8.4 <a href="topic_8-4.html">Insufficient breastmilk</a></li><li>8.5 <a href="topic_8-5.html">Medical, Surgical Issues</a></li></ol></li>
        <li>9.0 <a href="topic_9-0.html">Promotion, Protection and Support</a><ol><li>9.1 <a href="topic_9-1.html">The International Code of Marketing of Breastmilk Substitutes</a></li><li>9.2 <a href="topic_9-2.html">The Baby Friendly Initiative</a></li><li>9.3 <a href="topic_9-3.html">Young Child Feeding</a></li><li>9.4 <a href="topic_9-4.html">Local initiatives</a></li><li>9.5 <a href="topic_9-5.html">Infant feeding in emergencies</a></li></ol></li>
        <li>10.0 <a href="topic_10-0.html">Closing session</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
        <li class="appendix"> <a href="full.html">Print version</a></li>
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