Factors influencing breastfeeding in parturients admitted to intensive care unit / 中华围产医学杂志

ABSTRACT

Objective:To investigate and analyze the factors influencing breastfeeding in parturients admitted to intensive care unit (ICU).Methods:A cross-sectional survey was conducted on parturients from the ICU of Maternal and Child Health Hospital of Hubei Province from March 1 to August 31, 2020, whose delivery information and reasons for ICU admission were retrieved from the electronic medical record system. Breastfeeding Self-Efficacy Scale (BSES), Emotion Regulation Scale (ERS), and Edinburgh Postnatal Depression Scale (EPDS) scores were assessed between postpartum day 3-7. Half a year after delivery, basic information about the parturients, sources of available breastfeeding knowledge, and breastfeeding data were surveyed through Wenjuanxing, an online questionnaire platform. Wilcoxon test, t-test, Chi-square test (or calibration Chi-square, or Fisher's exact test), trend test, and binary logistic regression were adopted for statistical analysis. Results:A total of 138 parturients were enrolled and divided into the breastfeeding group ( n=117) and bottle-feeding group ( n=21). Both mixed feeding and exclusive breastfeeding women were eligible for the breastfeeding group, which were further classified as subgroup A (breastfeeding ≥6 months, n=67) and subgroup B (breastfeeding <6 months, n=50). A higher breastfeeding rate was observed in parturients with good or excellent postpartum appetite ["average", "good" and "excellent" in both groups were 21.4%(25/117), 59.8%(70/117) and 18.8%(22/117) vs 85.7%(18/21), 14.3%(3/21) and 0.0%(0/21), χ2=27.29], adequate daily sleep [defined as ≥ 6 hours per day, 87.2%(102/117) vs 57.2%(12/21), χ2=10.99], higher BSES [107.00(92.00-122.00) vs 55.00(50.00- 68.50), Z=6.41], and ERS score [52.00(45.50-59.00) vs 38.00(27.05-42.50), Z=5.05], and access to breastfeeding knowledge through hospital education [59.0%(69/117) vs 4.8%(1/21), χ2=18.82] and self-study [62.4% (73/117) vs 33.3% (7/21), χ2=6.17] (all P<0.05). At the same time, those who had postpartum hemorrhage [18.8% (22/117) vs 42.9% (9/21), χ2=5.91], pregnancy complicated by heart disease [5.1% (6/117) vs 23.8% (5/21), χ2=8.47], and EPDS score≥13 [13.7% (16/117) vs 61.9% (13/21), χ2=24.95] had a lower breastfeeding rate (all P<0.05). Patients with good postpartum appetite ["average", "good" and "excellent" in both groups were 7.5%(5/67), 68.7%(46/67) and 23.9%(16/67) vs 40.0%(20/50), 48.0%(24/50)and 12.0%(6/50), χ2=13.96], adequate daily sleep [94.0% (63/67) vs 78% (39/50), χ2=6.57], higher BSES [115.00(106.00-131.00) vs 92.50 (68.00-104.00), Z=6.29], and ERS score [57.00(54.00-60.00) vs 45.50(38.00-50.00), Z=7.80] accounted for a higher proportion in subgroup A, while those with insufficiency lactation [41.8% (28/67) vs 76.0% (38/50), χ2=13.63], postpartum hemorrhage [9.0% (6/67) vs 32.0% (16/50), χ2=9.96], and EPDS score≥13[7.5%(5/67) vs 22.0%(11/50), χ2=5.13] accounted for lower proportion (all P<0.05). Multivariate logistic regression analysis showed that good postpartum appetite ( OR=8.016, 95% CI 1.908-33.679; OR=2.227, 95% CI 1.059-4.682) and adequate hospital breastfeeding education ( OR=30.013, 95% CI 3.022-298.047; OR=2.596, 95% CI 1.035-6.512) were the promoting factors for both breastfeeding and duration more than six months, while EPDS score≥13 ( OR=0.179, 95% CI 0.044-0.720) was a hindering factor for its ibreastfeeding and insufficient lactation ( OR=0.230, 95% CI 0.091-0.582), and postpartum hemorrhage ( OR=0.288, 95% CI 0.087-0.947) were barriers to breastfeeding ≥6 months. Conclusions:Appetite, sleep, access to the knowledge of breastfeeding, maternal complications, family support, and emotion can affect the rate and duration of breastfeeding in parturients admitted to ICU, for whom early assessment of basic information, active treatment of complications, breastfeeding education, and guidance from health professionals, and more family and social support can be helpful.