The Effect of a Multi-Component Breastfeeding Support Program on Breastfeeding Self-Efficacy and Mother-Infant Bonding in Mothers Following Cesarean Section

This study tests a breastfeeding support program for mothers who give birth by cesarean section. The purpose of the study is to see whether the program helps mothers feel more confident about breastfeeding and improves mother-baby bonding.

Study Overview

• Status: Recruiting
• Conditions: Primigravida Women; Breastfeeding Self-Efficacy; Breastfeeding Consultancy Training; Mother-Infant Attachment
• Intervention / Treatment: Behavioral: Breastfeeding Support Program

Detailed Description

Cesarean delivery may negatively affect early breastfeeding initiation, maternal mobility, skin-to-skin contact, and early mother-infant interaction due to postoperative pain, delayed mobilization, and surgical recovery. These factors may reduce maternal confidence in breastfeeding and adversely influence early mother-infant bonding. Therefore, structured and continuous professional breastfeeding support during the early postpartum period is critically important, particularly for mothers who deliver via cesarean section.

Breastfeeding self-efficacy, based on Bandura's Social Cognitive Theory, refers to a mother's belief in her ability to successfully perform and sustain breastfeeding. Higher breastfeeding self-efficacy has been associated with longer breastfeeding duration, more effective coping with breastfeeding difficulties, and stronger mother-infant bonding. In addition, oxytocin released during breastfeeding supports both milk ejection and emotional attachment, reinforcing the psychobiological relationship between effective breastfeeding and bonding processes.

This experimental study is designed as a pretest-posttest control group trial to evaluate the effectiveness of a multi-component breastfeeding support program during the early postpartum period. The study will be conducted at the Obstetrics Service and Lactation Counseling Clinic of Sivas Cumhuriyet University Training and Research Hospital between February 20, 2026 and August 30, 2026.

Intervention Process (Experimental Group)

The intervention consists of two structured phases:

1. Early In-Hospital Support (First 48 Hours)

   Mothers in the experimental group will receive individualized breastfeeding education and hands-on guidance provided by the researcher. The intervention includes positioning techniques, effective latch support, milk expression methods, management of common breastfeeding problems, and strengthening of skin-to-skin contact and rooming-in practices. Breastfeeding behavior will be observed and supported regularly during the first 48 hours postpartum.

   To enhance accessibility to educational content, QR code-supported digital materials will be provided. This will allow mothers to review educational materials when needed.

   Additionally, to increase breastfeeding motivation and encourage breastfeeding in social settings, supportive gift packages will be prepared. These packages will include a breastfeeding cover and convey the message that mothers can breastfeed their babies confidently in any environment. This approach aims to strengthen maternal confidence in breastfeeding outside the home.

2. Post-Discharge Follow-Up (First 4 Weeks)

After discharge, mothers in the experimental group will receive structured daily supportive and motivational text messages for 28 days. These messages are developed in accordance with current evidence-based breastfeeding and postpartum care guidelines and address breastfeeding management, milk physiology, maternal self-efficacy, bonding, and psychosocial well-being.

In addition, individualized telephone counseling sessions will be conducted on postpartum day 15 and at the end of the first month. These calls aim to assess breastfeeding progress, provide personalized problem-solving support, and reinforce maternal breastfeeding confidence.

Control Group

Mothers in the control group will continue to receive routine postpartum care and standard breastfeeding counseling provided by the hospital. No additional intervention, motivational messaging, structured education program, or supportive materials will be provided to the control group.

Outcome Measures

The primary outcome measures are the changes in breastfeeding self-efficacy and mother-infant bonding scores between baseline and the fourth postpartum week.

In addition, early postpartum breastfeeding effectiveness will be evaluated.

Statistical analyses will be performed using SPSS software. Parametric or non-parametric tests will be applied according to data distribution characteristics. Effect sizes will be calculated and reported to determine the magnitude of the intervention effect.

This study aims to provide evidence on the effectiveness of structured and tele-support-enhanced breastfeeding programs for mothers who undergo cesarean delivery and to contribute to the development of sustainable postpartum breastfeeding support models.

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: shabnam Behnam Makouei, Master's Student; Phone Number: +90 552 828 5168; Email: shabnambehnam.bm@gmail.com
• Study Contact Backup: Name: Prof. Dr. Nilüfer Tuğut, PhD; Phone Number: +90 532 775 48 28; Email: nlfrtugut@gmail.com

Study Locations

• Turkey (Türkiye)
  • Merkez
    • Sivas, Merkez, Turkey (Türkiye), 58030
      • Recruiting
      • Sivas Cumhuriyet University Hospital
      • Contact: Prof. Dr. Nilüfer Tuğut, PhD; Phone Number: +90 532 775 48 28; Email: nlfrtugut@gmail.com
      • Contact: Shabnam Behnam Makouei, master; Phone Number: +90 552 828 5168; Email: nlfrtugut@gmail.com
      • Principal Investigator: shabnam behnam makouei, MSc (Master of Science)
      • Principal Investigator: Nilüfer Tuğut, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

- Primiparous mothers who have completed pregnancy

Mothers who delivered by cesarean section (C/S)

Mothers in the early postpartum period

Mothers aged 18 years and older

Mothers who are exclusively breastfeeding

Mothers with healthy and stable infants

Mothers with no medical conditions that may interfere with breastfeeding

Mothers who can read and understand Turkish and complete the data forms

Exclusion Criteria:

• Mothers who experienced postpartum complications

Infants with severe health problems, congenital anomalies, or requiring intensive care

Infants hospitalized in neonatal intensive care unit

Mothers with medical or psychiatric conditions that prevent breastfeeding

Mothers with multiple pregnancies (twins, triplets, etc.)

Mothers who cannot attend follow-up visits during the study

Mothers without mobile phones

Mothers who received breastfeeding education during pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Group - Breastfeeding Support Program; Participants will be randomly assigned to two groups. The intervention group will receive a multi-component breastfeeding support program including breastfeeding education, counseling, practical breastfeeding support, follow-up support, motivational messages for 28 days, individualized counseling according to participants' needs, telephone follow-up on day 15, and final evaluation via telephone at the end of the month. Participants will also receive a gift package containing a breastfeeding apron with a QR code providing access to a breastfeeding education video, aiming to increase breastfeeding confidence and promote breastfeeding behavior.	Behavioral: Breastfeeding Support Program; In my thesis, the multi-component breastfeeding support program was applied to address a gap in the literature. Altay and Sarıalioğlu (2024, Breastfeeding Medicine, 19(12):947-956) showed that baby soothing training for primiparous mothers significantly improved maternal role perception, attachment, and breastfeeding self-efficacy (p<0.001). However, experimental studies simultaneously evaluating breastfeeding education, psychosocial support, video, message, telephone follow-ups, and individualized counseling are limited. Therefore, my study provides strong causal evidence using an experimental design. The sample size (n=100) is larger than many existing studies, and the study uniquely combines three measures: self-efficacy, bonding, and LATCH.
No Intervention: Control Group - Routine Postpartum Care; Control Group - Routine Postpartum Care: Participants in the control group will receive routine postpartum care provided by the hospital. No additional breastfeeding support intervention will be applied to this group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Breastfeeding Self-Efficacy Scale Mother-Infant Bonding Scale LATCH Breastfeeding Assessment Scale	Number of Participants Achieving Increased Scores in Breastfeeding Self-Efficacy (14-70, higher = better), LATCH (0-10, higher = better), and Mother-Infant Bonding (19-76, higher = stronger) at 4 Weeks After a Multicomponent Breastfeeding Support Program Following Cesarean Section.	Baseline (48 hours postpartum)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Breastfeeding Self-Efficacy Scale Mother-Infant Bonding Scale LATCH Breastfeeding Assessment Scale	Number of Participants Achieving Increased Scores in Breastfeeding Self-Efficacy (14-70, higher = better), LATCH (0-10, higher = better), and Mother-Infant Bonding (19-76, higher = stronger) at 4 Weeks After a Multicomponent Breastfeeding Support Program Following Cesarean Section	4 weeks postpartum follow-up

Collaborators and Investigators

• Sponsor: Cumhuriyet University

Publications and helpful links

General Publications

• Uzunkaya-Oztoprak P, Koc G, Ozyuncu O. The effect of Kinesio Taping on acute pain, breastfeeding behavior and comfort level in women with cesarean section: A randomized controlled trial. Niger J Clin Pract. 2023 Aug;26(8):1075-1084. doi: 10.4103/njcp.njcp_459_22.

Study record dates

Study Major Dates

• Study Start (Actual): February 20, 2026
• Primary Completion (Estimated): August 30, 2026
• Study Completion (Estimated): November 30, 2026

Study Registration Dates

• First Submitted: March 11, 2026
• First Submitted That Met QC Criteria: March 11, 2026
• First Posted (Actual): March 16, 2026

Study Record Updates

• Last Update Posted (Actual): March 25, 2026
• Last Update Submitted That Met QC Criteria: March 21, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Cesarean Section; Breastfeeding Support; Postpartum Period; Breastfeeding Self-Efficacy; Maternal-Infant Bonding
• Other Study ID Numbers: Sivas Cumhuriyet Univercity

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The study protocol, statistical analysis plan, and SPSS datasets may be shared upon reasonable request while ensuring the protection of participant confidentiality and personal identifying information.
• IPD Sharing Time Frame: Data will be collected from February 20, 2026, to August 30, 2026. Individual participant data and supporting documents will be available after publication of the study results for 5 years.
• IPD Sharing Access Criteria: Access to individual participant data and supporting documents will be available to qualified researchers, subject to approval of a data access request. Researchers may access de-identified datasets for scientific purposes after providing a research proposal and agreeing to data sharing and confidentiality conditions.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No