The Effects of Spousal Participation in Breastfeeding Interventions at Different Perinatal Stages on Mothers' Coparenting Cognition and Infant Feeding Patterns: A Prospective Quasi-Experimental Study
Phase: NA
Conditions: Breast Feeding, Social Support, Coparenting
Sponsor: Sichuan University

Effects of Perinatal Paternal Involvement in Breastfeeding
Support on Maternal Self-Efficacy and Coparenting
Outcomes
February 25, 2026

1. Study Design and Setting
This study was designed as a non-randomized parallel controlled trial conducted at a
tertiary maternity hospital in Shaanxi Province, China. Pregnant women and their
partners who attended antenatal care or delivered at the study hospital between
August 20 and October 20, 2025 were consecutively recruited.
The intervention period covered the entire perinatal continuum, extending from
14 weeks of gestation to 24 weeks postpartum, in alignment with the structured
intervention framework illustrated in Figure 1.
Figure1. Schematic Diagram of the Study Design and Participant Grouping.
2. Participants
2.1 Inclusion Criteria
Participants were eligible for inclusion if they met all of the following criteria:

Married couples, with gestational age between 12 - 14 weeks at enrollment for
Groups A and B;

Planned discharge within 48 hours after delivery;

Mothers and partners expected to cohabit for ≥6 months postpartum;

Gestational age at delivery ≥37 weeks;

No diagnosed psychiatric disorders in either partner;


Voluntary participation with written informed consent from both mother and
partner;

Neonates with Apgar scores ≥8 at 1, 5, and 10 minutes after birth.
2.2 Exclusion Criteria

Maternal diagnosis of infectious diseases (e.g., HIV, hepatitis B);

Withdrawal from the study at any stage;

Failure to complete required questionnaires;

Loss to follow-up during the study period;

Concurrent participation in other interventional studies;

Major fetal anomalies.
3. Group Allocation and Intervention Characteristics
Participants were assigned to one of four groups according to the timing and extent of
paternal involvement in breastfeeding interventions, as illustrated in Figure 1.
Group A: Antenatal–Postpartum Paternal Involvement Group
Both mothers and their partners participated jointly in breastfeeding interventions
throughout all key perinatal stages, from 14 weeks of gestation to 24 weeks
postpartum.
Interventions comprised:

Antenatal breastfeeding education during mid-pregnancy (14–27⁺⁶ weeks) and
late pregnancy (28–37⁺⁶ weeks);

Implementation
of
the
“three
early
practices”
during
parturition
(early
skin-to-skin contact, early suckling, and early initiation of breastfeeding);

Structured breastfeeding guidance and skills training provided to both mothers
and partners during the early postpartum period (1–48 hours);


Continued breastfeeding support during the late postpartum period (48 hours to
24 weeks postpartum), including educational materials, digital resources, and
scheduled follow-up for both partners.
Group B: Antenatal Paternal Involvement Group
Both mothers and their partners jointly participated in breastfeeding interventions
during pregnancy only, from 14 weeks of gestation until delivery.
Interventions included:

Antenatal breastfeeding education during mid- and late pregnancy;

Implementation of the “three early practices” during parturition.

Postpartum breastfeeding support was provided only to mothers, without
mandatory partner involvement.
Group C: Postpartum Paternal Involvement Group

Breastfeeding interventions before delivery were provided exclusively to
pregnant women.

During pregnancy, mothers received antenatal breastfeeding education without
partner participation;

During parturition, the “three early practices” were implemented;

From delivery through 24 weeks postpartum, both mothers and their partners
jointly participated in breastfeeding interventions identical to the postpartum
components of Group A.
Group D:

Mothers did not receive antenatal breastfeeding education at the study hospital.

During parturition, the “three early practices” were implemented;

From
delivery
through
24
weeks
postpartum,
mothers
received
routine
breastfeeding guidance consistent with standard clinical care;


Partner participation in breastfeeding interventions was not required.
4. Intervention Procedures
4.1 Antenatal Interventions
4.1.1 Mid-Pregnancy (14–27⁺⁶ weeks)
Mothers and their partners in Groups A and B received breastfeeding educational
booklets and jointly viewed a 10-minute educational video, aiming to establish
foundational breastfeeding knowledge and foster positive breastfeeding attitudes.
4.1.2 Late Pregnancy (28–37⁺⁶ weeks)
Mothers and partners in Groups A and B jointly viewed a 45-minute breastfeeding
skills video, which covered breastfeeding positions, latch techniques, milk expression
methods, and precautionary measures. Completion of the session was confirmed by
investigators and recorded in the Maternal and Child Health Handbook.
4.2 Intrapartum Intervention
All
participants
received
standardized
intrapartum
breastfeeding
support
in
accordance with the hospital’s Perinatal Breastfeeding Clinical Pathway, including
implementation of the “three early practices” (early skin-to-skin contact, early
suckling, and early initiation of breastfeeding) immediately after birth.
4.3 Early Postpartum Interventions (1–48 hours)
At 6, 24, and 48 hours postpartum: in Groups A and C, breastfeeding education and
practical skills training were provided to both mothers and their partners; in Groups B
and D, the same interventions were provided only to mothers, without mandatory
partner involvement.
4.4 Late Postpartum Interventions (48 hours to 24 weeks)
A Breastfeeding
Activity
Record
Handbook,
developed
based
on Jennifer’s
theoretical framework, was used to document breastfeeding goals, partner support,
maternal and infant characteristics, and partner involvement in maternal and infant

care. Mothers completed the handbook on a weekly basis.
Educational QR codes provided access to breastfeeding knowledge, practical
skills training, and frequently asked questions. Weekly telephone to assess
breastfeeding practices, infant growth, and breastfeeding-related challenges. A
moderated
WeChat
support
group,
providing
professional
consultation,
peer
interaction, and emotional support.
5. Indicator Definitions
Exclusive breastfeeding was defined as the provision of only breast milk to the infant,
with no additional liquids or solid foods, except for prescribed vitamins, minerals, or
medications, excluding water. Pregnancy complications included gestational diabetes
mellitus, gestational hypertension, hypothyroidism, hyperthyroidism, placenta previa,
and intrahepatic cholestasis of pregnancy.
6. Outcome Measures
The
primary
outcomes
were
maternal
breastfeeding
self-efficacy,
spousal
participation frequency, co–parenting perception, and feeding type (exclusive, mixed,
or formula) at 6, 12, and 24 weeks postpartum.
Breastfeeding self-efficacy was measured using the Breastfeeding Self-Efficacy
Scale–Short Form (BSES-SF) developed by Dennis. The scale contains 14 items rated
on a 5-point Likert scale (score range, 14–70); higher scores indicate stronger
self-efficacy (Cronbach’s α = 0.93). Co-parenting perception was assessed with the
Brief Co-parenting Relationship Scale (Brief-CRS), developed by Feinberg et al.. The
scale includes five domains–mutual support, affirmation, conflict, undermining, and
division of labor–with 14 items rated on a 7-point scale (0–6); higher total scores
indicate stronger co-parenting perception.
7. Quality Control
Obstetric nurses with continuous involvement in the study served as investigators.
After each outpatient session, they documented the participation of pregnant women

and their partners in breastfeeding activities. Departmental supervisors were trained
under the Breastfeeding Clinical Pathway to ensure uniformity in breastfeeding
education. Trained nurses delivered stage-specific interventions and conducted
follow-up assessments. During data collection, investigators maintained objectivity,
avoided leading questions, and adhered strictly to the survey protocol. Questionnaires
were reviewed for completeness and accuracy, and any errors or omissions were
corrected immediately. Data were entered using a double-entry system to minimize
transcription errors and ensure data integrity.
8. Statistical Analysis
All statistical analyses were performed with SPSS software, version 22.0 (IBM Corp.,
Armonk, NY), and data were entered and verified using Epidata version 3.0. A
two-sided P ≤0.05 was considered statistically significant. Assuming a national
exclusive breastfeeding rate of 30% and a projected 50% rate in the intervention
groups, 93 participants per group were needed for 80% power (α = 0.05). Allowing
for 15% attrition, the required sample was 107 per group (428 total). A total of 526
women were enrolled, and 481 completed the study (Group A, 133; Group B, 115;
Group C, 116; Group D, 117).
Each item was coded based on the frequency of participation during the past
week: 0 = no participation; 1 = occasional (1–2 times per week); 2 = frequent (3–5
times per week). Continuous variables were tested for normality using the
Kolmogorov–Smirnov test. Normally distributed data were summarized as means
with standard deviations, whereas non-normally distributed data were expressed as
medians with interquartile ranges. Categorical variables were described as frequencies
and percentages.
Comparisons between groups were performed using independent-sample t tests
or one-way analysis of variance (ANOVA) for continuous variables, with post hoc
pairwise comparisons when appropriate. Categorical variables were analyzed using
chi-square or Fisher’s exact tests, and ordinal or non-normally distributed data were

analyzed using nonparametric tests, including the Mann–Whitney U test or
Kruskal–Wallis test.
Changes in repeated measures over time, such as breastfeeding self-efficacy and
co-parenting scores at 6, 12, and 24 weeks postpartum, were assessed using
generalized linear models (GLMs). These models allowed for the evaluation of main
effects of group and time as well as group–time interactions, while adjusting for
potential confounding variables. Analyses were conducted on available data, and
sensitivity analyses were performed to assess the robustness of the findings.