Revision of the Beginning Breastfeeding Survey: a cumulative assessment of breastfeeding.

Background and Purpose: Women use their cumulative breastfeeding experiences, in combination with other factors, to make their infant feeding decisions. This pilot study assessed the reliability and predictive validity of the revised Beginning Breastfeeding Survey-Cumulative (BBS-C). Methods: 25 women were recruited prenatally from a university hospital. The BBS-C was completed before hospital discharge. Infant feeding outcomes were measured at 1 and 3 months postpartum. Results: Participants were 17-40 years old, mostly married, Whites, and well-educated. Coefficient alpha was .92-.94. The BBS-C predicted an infant not receiving breast milk, not feeding from the breast, and receiving infant formula feedings. Conclusions: In this sample, the BBS-C had strong reliability and predictive validity. Further testing should assess reliability and predictive validity in a wider range of populations and settings.Keywords: breastfeeding; nursing assessment; postpartum period; psychometricsMost mothers in the United States (75%) begin breastfeeding immediately after birth, but by 6 months, only less than half of mothers are still breastfeeding (Centers for Disease Control and Prevention, 2007). Problems that cause women to give up on breastfeeding often start during the postpartum hospitalization (Taveras et al., 2003); and during the first 4 months of life, a peak in breastfeeding cessation occurs in the first week after birth (Ertem, Votto, & Leventhal, 2001). Therefore, it is critical that breastfeeding be adequately assessed and supported during the childbirth hospitalization because waiting 1 week or more after birth "is too late to intervene for many breastfeeding mothers" (Ertem et al., 2001, p. 546).During postpartum hospitalization in the United States, registered nurses are the primary providers of care (Association of Women's Health, Obstetric and Neonatal Nurses, 2010) and mothers want their support when breastfeeding (Gill, 2001). To encourage women to continue breastfeeding, registered nurses must be able to accurately identify breastfeeding problems and use interventions that alleviate or minimize those problems during the postpartum hospitalization. It is critical that nurses assess how the mother perceives breastfeeding and problems associated with breastfeeding because mothers have a closer view of their infants, can feel the movements of their infant's mouth, and can hear the faint sounds of swallowing and breathing (Nyqvist, Rubertsson, Ewald, & Sjoden, 1996). The purpose of this pilot study was to assess the preliminary psychometric properties of the Beginning Breastfeeding Survey-Cumulative (BBS-C), a revised version of the Beginning Breastfeeding Survey (BBS) that measures a mother's perception of all her breastfeeding experiences since giving birth, instead of measuring only a single breastfeeding episode.CONCEPTUAL FRAMEWORKMaslow's Hierarchy of Needs served as the conceptual framework for the original version of the BBS (Mulder & Johnson, 2010). Maslow's Hierarchy of Needs states that human behavior is motivated by five sequential levels of needs: physiologic, safety, love, esteem, and self-actualization (Maslow, 1943). Breastfeeding is a maternal behavior that can be motivated by a woman's need to provide physiological nourishment to her infant; to keep her infant safe from infection and chronic disease; to establish a loving, intimate relationship; to achieve self-confidence in a maternal role; or to become the best mother she can be. Alternatively, a mother can stop breastfeeding to protect herself from nipple pain and fatigue, feeling exposed and vulnerable, being accused of having a sexual relationship with her infant, or being a bad mother who does not provide enough nourishment to her infant. In either case, breastfeeding is motivated by maternal and infant needs; and assessing breastfeeding involves assessing how well a mother perceives that her and her infant's needs are being met by breastfeeding (Mulder & Johnson, 2010). …