背景：母乳是嬰兒在出生後6個月內最佳主要營養來源，母乳哺育對母嬰健康與社會經濟效益有許多好處。親善措施已知與母乳哺育有正向關係，近年臺灣已有近八成新生兒出生於母嬰親善認證醫療院所，6個月內母乳哺育率卻不升反降，過去研究發現母乳哺育自我效能與社會支持乃是影響母乳哺育的重要因素，然而影響母乳哺育之因素眾多且彼此間的關係複雜，產後不同時期之母乳哺育相關因素亦可能不同，為了延續母乳哺育期，值得長期追蹤產後不同時期母親之親善經驗、母乳哺育自我效能與母乳哺育行為間之關係，作為擬定產後各階段母乳哺育照護措施之參考。
目的：探討母親生產後各時期（住院期間、嬰兒出生後滿1個月、2個月、4個月、6個月）之親善經驗、母乳哺育自我效能與該時期母乳哺育行為的關係，並探討各時期母乳哺育的相關因素、與嬰兒出生後滿4個月及6個月母乳哺育行為之決定因素。
方法：本研究採長期追蹤之世代研究設計，研究對象為於台灣南部母嬰親善機構生產且育有健康足月新生兒之產婦，排除條件為產後有合併症需住院治療之母嬰，以結構式問卷收集研究對象在產後各時期之親善經驗、母乳哺育自我效能與母乳哺育行為，並分析嬰兒出生後滿4個月及6個母乳哺育行為之決定因素。
結果：本研究共招募170名產婦，共155名產婦在產後滿6個月完成5次問卷追蹤，流失率為9%。嬰兒出生後滿6個月之哺育方式有10.3%為純母乳哺育、45.2%為母乳及配方奶混和哺育、44.5%為採配方奶哺育，研究結果顯示產後住院期間至滿6個月之各時期較高分的親善經驗及較佳的母乳哺育自我效能均與純母乳哺育有關聯。廣義估計方程式分析顯示控制時間因素後，相較於採用配方奶哺育者，較高分的親善經驗(Odds Ratio 1.68, 95% CI 1.47,-1.91.06, p < .001)及較佳的母乳哺育自我效能(Odds Ratio 1.13, 95% CI 1.09-1.17, p < .001)為產後住院期間至滿6個月內純母乳哺育的主要因素。嬰兒出生後滿4個月時採純母乳哺育的決定因素為產婦有較長的母乳哺育意圖、產後5-24小時開始母乳哺育、4個月時有較高的母乳哺育親善經驗總分與較佳的母乳哺育自我效能。嬰兒出生後滿6個月時採總母乳哺育的決定因素為產婦有較長的母乳哺育意圖、6個月時有較高的母乳哺育親善經驗總分與較佳的母乳哺育自我效能。多元邏輯斯迴歸分析結果顯示在住院期間的因素中，母乳哺育意圖大於6個月以上與住院時有較佳的母乳哺育自我效能為出生後滿4個月仍採純母乳哺育的預測因子；母乳哺育意圖大於6個月以上與住院時有較佳的母乳哺育自我效能為出生後滿6個月採總母乳哺育的預測因子，而住院期間之母乳哺育親善經驗並非出生後滿4個月與6個月時母乳哺育行為的預測因子。多變量Cox迴歸分析顯示6個月內終止母乳哺育的危險因子為產後住院期間之母乳哺育意圖小於4個月(HR = .40- .14)與母乳哺育自我效能(HR = .98)。
結論：母乳哺育親善措施的延續與保持較佳的母乳哺育自我效能乃滿4個月純母乳哺育與滿6個月總母乳哺育之決定因素，而住院期間的母乳哺育意圖及母乳哺育自我效能則為預測6個月內母乳哺育期之重要因子，健康照護專業人員應可據母乳哺育意圖及母乳哺育自我效能評估其6個月內母乳哺育期，並在產後不同階段延續母乳哺育親善措施與提供互動式介入措施，以促進並延長母乳哺育期至6個月。

Background: Breast milk is the best and optimal source of nutrition for infants in the first 6 months of life. Breastfeeding is beneficial to maternal/neonatal health and social efficiency. In recent years, around 80% newborn’s births occurred in Baby Friendly accredited facilities in Taiwan. The trend of exclusive breastfeeding rate among infants of 1–6 months of age decreased from 2012 to 2018. Previous studies have shown that Baby-Friendly practice and breastfeeding efficacy are associated with the rates of breastfeeding. The related factors of breastfeeding are complicated and also varied over time in different postpartum periods. In order to prolong breastfeeding duration, it is necessary to investigate the relationship among the experience of breastfeeding-friendly practice, breastfeeding self-efficacy, and breastfeeding behavior for each postpartum period to find interventions of each postpartum stage for improving and sustain breastfeeding duration for 6 months.
Purpose: To explore the relationship among experience of breastfeeding-friendly practice, breastfeeding self-efficacy, and breastfeeding behavior in different periods after childbirth of hospitalization, at 1, 2, 4, and 6 months of infants’ age, and to identify the determinant factors of breastfeeding behaviors at 4 and 6 months after childbirth.
Methods: This study was a longitudinal cohort. The participants were mothers who gave birth to healthy newborns in two Baby-Friendly hospitals at Southern Taiwan. Mothers or infants having serious medical conditions that prevent the mothers from breastfeeding or needed to be hospitalized were excluded. Data were collected by a self-developed questionnaire on the experience of breastfeeding-friendly practice, the Chinese version of the Breastfeeding Self-efficacy Scale-Short Form (BSES-SF), and the Chinese version of the Breastfeeding Social Support Scale.
Results: A total of 170 mothers were recruited. Finally, 155 completed the questionnaires 5 times within 6 months with the attrition rate of 9%. The rate of exclusive breastfeeding declined over time after birth and dropped to10.3% at 6 months. High score of experience of breastfeeding-friendly practice and breastfeeding self-efficacy were associated with exclusive breastfeeding in each period after childbirth (hospitalization, at 1, 2, 4, and 6 months of infants’ age). After adjusting time factors, the generalized estimating equation model showed that the main factors of exclusive breastfeeding were experience of breastfeeding friendly practice (Odds Ratio 1.68, 95% CI 1.47,-1.91.06, p < .001) and breastfeeding self-efficacy (Odds Ratio 1.13, 95% CI 1.09-1.17, p < .001). The determinant factors of exclusive breastfeeding at 4 months were longstanding breastfeeding intention during hospitalization, the high score of experience of breastfeeding friendly practice at 4 months, and the high score of self-efficacy at 4 months. The determinant factors of any breastfeeding at 6 months were longstanding breastfeeding intention for over 6 months, the high score of experience of breastfeeding friendly practice at 6 months, and the high score of self-efficacy at 6 months. The results of multinomial logistic regression models showed that the in-hospital predictors of exclusive breastfeeding at 4 month were the intention of longstanding breastfeeding for over 6 months, initiation of breastfeeding within 5-24 hours after birth, and the high score of self-efficacy during hospitalization. The longstanding breastfeeding intention for over 6 months and the high score of breastfeeding self-efficacy during hospitalization in the maternity hospital stay were significant predictors of any breastfeeding at 6 months. The score of experience of breastfeeding friendly practice in hospitalization was not predictor of breastfeeding at 4 and 6 months after childbirth. Multivariate cox regression analysis showed that only breastfeeding intention (HR = .40 - .14) and in-hospital breastfeeding self-efficacy (HR = .98) were significant in-hospital risk factors that contributed to the breastfeeding duration in 6 months after childbirth.
Conclusions: The continuation of the experience of breastfeeding friendly practice and the maintenance of better breastfeeding self-efficacy were the determinants of exclusive breastfeeding at 4 months and any breastfeeding at 6 months. Longstanding breastfeeding intention for over 6 months and the high score of self-efficacy are in-hospital predictors of exclusive breastfeeding at 4 month and any-breastfeeding at 6 months. Breastfeeding intention and breastfeeding self-efficacy could be used to pre-estimate the breastfeeding behavior within six months. Based on the results of our study, healthcare professionals should provide breastfeeding friendly interventions and interactive intervention to support breastfeeding at different stages based on the individual pre-estimated results and the mother's informed plan.

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