The Influence of Perinatal Education on Breastfeeding Decision and Duration


  • Corina Zugravu University of Medicine and Pharmacy Bucharest; National Institute of Public Health, Bucharest
  • Michaela Iuliana Nanu Alessandrescu-Rusescu” National Institute for Mother and Child Care, Bucharest
  • Florentina Moldovanu Alessandrescu-Rusescu” National Institute for Mother and Child Care, Bucharest
  • Oana Cristina Arghir "Ovidius” University of Constanta
  • Cristina Maria Mihai "Ovidius” University of Constanta
  • Marina Ruxandra O?elea University of Medicine and Pharmacy Bucharest
  • Simona Claudia Cambrea "Ovidius” University of Constanta



Perinatal education, rooming in, birth delivery.


Objectives: to evaluate factors influencing breastfeeding duration in an integrative model, considering both the organization of medical care and the perinatal education.

Methods: We conducted a cross sectional study with data collected in a face to face interview of 1,008 mothers with children aged between 9 and 14 months The questionnaire focused on the main characteristics of a Mother-Baby Friendly Hospital initiative and the type of perinatal education received by pregnant women. Correlation and partial correlation tests, non-parametric tests and classification tests were applied. Data were processed in SPSS 12.0 software.

Results: The positive effects of Mother Baby Friendly Hospitals Organization initiative organization were confirmed. However, the main differentiator for breastfeeding duration was the level of formal education of pregnant mothers and the active seeking of perinatal education (r = 0.22, p< 0.001). The perinatal counseling was correlated with breastfeeding duration only for the subgroup participating to structured, dedicated time slot apart from the regular medical consultation (r = 0.079; p = 0.014), independently of mother’s age, education, residence, time to first breastfeeding contact, type of birth delivery and rooming in. Our results support a broader approach to perinatal education than medical counseling during pregnancy to increase the voluntary participation of future mothers to the perinatal educational programs.

Conclusion: As mothers’ motivation to maintain the optimum duration of breastfeeding is a determinant factor, an earlier and sustained educational process, before pregnancy and after birth delivery, is necessary in order to create a general favorability for exclusive breastfeeding.


[1] Cai X, Wardlaw T, Brown DW. Global trends in exclusive breastfeeding. Int Breastfeed J 2012; 7(1): 12.
[2] Ryan AS, Wenjun Z, Acosra A. Breastfeeding continues to increase into the new millenium. Pediatrics 2002; 110(6): 1103-1109.
[3] Organization for Economic Co-operation and Development (OECD) Breastfeeding Rates. OECD Family Database CO1.5. Paris: Social Policy Division, Directorate of Employment, Labour and Social Affairs, OECD; 2011.
[4] Nuzrina R, Roshita A, Basuki DN. Factors affecting breastfeeding intention and its continuation among urban mothers in West Jakarta; a follow up qualitative study using critical point contact for breastfeeding. Asia Pac J Clin Nutr 2016; 25(Suppl 1): S43-S51.
[5] Singletary N, Chetwynd E, Goodell LS, Fogleman A. Stakeholder views of breastfeeding education in schools: a systematic mixed studies review of the literature. Int Breasfeed J 2016; 12(1): 14.
[6] Grassley JS, Connor KC, Bond L. Game-based online antenatal breesfeeding education: A pilot. Appl Nurs Res 2017; 33: 93-95.
[7] Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M. Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database of Systematic Reviews 2012; 12: Art. No: CD006425.
[8] Costanian C, Macpherson AK, Tamim H. Indequate prenatal care use and breastfeeding practices in Canada: a national survey of women. BMC Pregnancy and Childbirth 2016; 16: 100.
[9] Demirci JR, Bogen, DL, Holland C, et al. Characteristics of Breastfeeding Discussions at the Initial Prenatal Visit. Obstet Gynecol 2013; 122(6): 1263-1270.
[10] Gavine A, MacGillivray S, Renfrew MJ, Siebelt L, Haggi H, McFadden A. Education and training of healthcare staff in knowledge, attitudes and skills needed to work effectively with breastfeeding women: a systematic review. Intl Breastfeed J 2016; 12: 6.
[11] Lange A, Nautsch A, Weitmann K, Ittermann T, Heckmann M. Breastfeeding motivation in Pomerania: Survey of neona-tes in Pomerania (SNiP-Study). Int Breastfeed J 2016; 2: 3.
[12] Tavoulari EF, Benetou V, Vlastarakos PV, Andriopoulou E, Kreatsas G, Linos A. Factors affecting breast-feeding initiation in Greece: what is important? Midwifery 2015; 31(2): 323-331.
[13] Mirowsky J, Ross CE. Education, learned effectiveness and health. London Rev Educ 2005; 3(3): 205-220.
[14] Romano AM. A Changing Landscape: Implications of Pregnant Women's internet Use for Childbirth Educators. J Perinat Educ 2007; 16(4): 18-24.
[15] Sayakhot P, Carolan-Olah M. Internet use by pregnancy women seeking pregnancy-related information: a systematic review. BMC Pregnancy and Childbirth 2016; 16(1): 1-10.
[16] Kennedy RAK, Mullaney L, Reynolds CME, Cawley S, McCartney DMA, Turner MJ. Preferences of women for web-based nutritional information in pregnancy. Public Health 2016; 143(2): 71-77.
[17] Song FW, West JE, Lundy L, Dahmen NS. Women, Pregnancy, and Health Information Online: The Making of Informed Patients and Ideal Mothers. Gend Soc 2012; 226(5): 773-98.
[18] Ho Y-J, McGrath J. Predicting Breastfeeding Duration Related to Maternal Attitudes in a Taiwanese Sample. J Perinat Educ 2011; 20(4): 188-199.
[19] Kim C, Draska M, Hess ML, Wilson EJ, Richardson CR. A web-based pedometer program in women with recent histories of gestational diabetes. Diabet Med 2012; 29(2): 278-283.
[20] Price SM, Bonilla E, Zador P, Levis DM, Kilgo CL, Cannon MJ. Educating women about congenital cytomegalovirus: assessment of health education materials through a web-based survey. BMC Women's Health 2014; 14: 144.
[21] Fredriksen EH, Harris J, Moland KM. Web-based discussions forums on pregnancy complaints and maternal health literacy in Norway. J Med Internet Res 2016; 18(5): e113.
[22] Lauria L, Spinelli A, Grandolfo M. Prevalence of breastfeeding in Italy: a population based follow-up study. Ann Ist Super Sanita 2016; 52(3): 457-461.
[23] Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarian birth: a systematic review and meta-analysis of world literature. Am J Clin Nutr 2012; 95(5): 1113-1135.
[24] Alzaheb R. Factors influencing Exclusive Breastfeeding in Tabuk, Saudi Arabia. Clin Med Insights Pediatr 2017; 11: 1-8.
[25] Biro, MA, Yelland JS, Briwn SJ. Who is holding the baby? Women's experiences of contact with their baby immediately after birth: An Australian population-based survey. Women Birth 2015; 28(4): 317-322.
[26] Tur?i? Škledar M, Miloševi? M. Breastfeeding and time of complementary food introduction as predictors of obesity in children. Cent Eur J Public Health 2015; 23(1): 26-31.
[27] Beake S, Pellowe C, Dykes F, Schmied V, Bick D. A systematic review of structured compared to non-structured breastfeeding programmes to support the initiation and duration of exclusive and any breastfeeding in acute and primary health care settings. Mat Child Nutr 2012; 8(2): 141-161.
[28] Brodribb W, Kruske S, Miller YD. Baby-friendly hospital accreditation, in-hospital care practices and breastfeeding. Pediatrics 2013; 131(4): 685-692.
[29] Nanu M, Moldovanu F, Stativa E, Stoicescu S, Novak C. Efficiency of interventions related to child nutrition under 2 years of old included in the national programs. (Evaluarea eficien?ei interven?iilor incluse în programele na?ionale privind nutri?ia copiilor sub 2 ani). 2011; Bucharest: IOMC-UNICEF.
[30] Cattaneo AB. Effectiveness of the Baby Friendly Community Initiative in Italy: a non-randomised controlled study. BMJ Open 2016; 6: e010232.
[31] Fewtrell M, Bronsky J, Campoy C, et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017; 64(1): 119-132.
[32] Man L, Man A, Ma?rginean CO, Pitea AM, Baghiu MD. The relationship between micronutrients and anthropometric measurements in malnourished children. Rev Romana Med Lab 2014; 22(4): 459-470.
[33] MAL-ED Network Investigators. Relationship between growth and illness, enteropathogens and dietary intakes in the first 2 years of life: findings from the MAL-ED birth cohort study. BMJ Global Health 2017; 2(4): e000370.
[34] Horta BL, de Sousa BA, de Mola CL.Breastfeeding and neurodevelopmental outcomes. Curr Opin Clin Nutr Metab Care 2018.
[35] Bosch AATM, de Steenhuijsen Piters WAA, van Houten MA, et al. Maturation of the Infant Respiratory Microbiota, Environmental Drivers, and Health Consequences. A Prospective Cohort Study. Am J Respir Crit Care Med 2017; 196(12): 1582-1590.






General Articles