International Breastfeeding Journal · Published 2025-12-10 · DOI 10.1186/s13006-025-00794-6
Abstract Background Delayed onset of lactogenesis (DOL) is a significant barrier to successful breastfeeding, particularly for women experiencing mother–infant separation due to preterm birth or neonatal complications. This separation disrupts crucial early breastfeeding triggers. Understanding maternal knowledge, attitude, and practice (KAP) toward DOL is essential for improving outcomes. However, few studies have explored this relationship, especially in China where such separation is common. This study aimed to investigate the KAP toward DOL among postpartum women experiencing mother–infant separation and to examine the associations between these dimensions. Methods This multicenter cross-sectional survey was conducted in 11 tertiary hospitals in China from June to December 2023. We included 528 mothers over 20 years old who intended to breastfeed and experienced mother–infant separation requiring NICU admission. We assessed KAP toward DOL using a validated, self-designed questionnaire. Data were collected at or beyond 72 h postpartum, allowing participants to reflect on their early lactation experience. Results A total of 528 valid questionnaires were analyzed (mean age: 30.08 ± 5.14 years), with 321 individuals (60.8%) suffering from DOL. The mean scores for knowledge, attitude, and practice were 14.02 ± 5.04 (range: 0–26), 15.38 ± 5.02 (range: 6–30), and 27.73 ± 8.98 (range: 9–45), respectively. Multivariate logistic regression showed that a positive attitude (OR 1.37; 95% CI 1.29, 1.45), premature birth (OR 1.79; 95% CI 1.13, 2.83), and mother–infant separation for 1–3 days (OR 2.39; 95% CI 1.31, 4.37) or 4–7 days (OR 2.49; 95% CI 1.36, 4.54) were independently associated with breastfeeding practice. A structural equation model (SEM) confirmed that attitude significantly influenced practice (β = 0.90, P < 0.001). Conclusions Our findings underscore the importance of fostering positive maternal attitudes through structured lactation support from healthcare providers. Healthcare systems should implement targeted counseling and consider evaluating motivational interviewing as a strategy to enhance breastfeeding practices among mothers with infants in the NICU, thereby improving adherence to recommendations and reducing the incidence of DOL. Clinical trial number Not applicable.
Abstract from DOAJ. Public domain (CC0 1.0).
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