Factors Predicting Intention to Exclusive Breastfeeding among Mothers with Elective Cesarean Section at a Private Hospital, Bangkok Metropolis

Main Article Content

Sitanan Wannasen
Siriwan Sangin
Piriya Suppasri


Purpose: To study the intention to exclusive breastfeeding and the factors predicting the intention to exclusive breastfeeding among mothers with elective cesarean sections at a private hospital, Bangkok Metropolis.

Design: Correlational predictive design.

Methods: The sample was 150 mothers with elective cesarean section who were admitted to a private hospital, Bangkok Metropolis. Data were collected using demographic and obstetrics questionnaire, the Breastfeeding Intention Questionnaire, the Breastfeeding Attitude Questionnaire, the Breastfeeding Subjective Norm Questionnaire, and the Breastfeeding Perceive Behavioral Control Questionnaire. Data were analyzed by descriptive statistics and stepwise multiple regression analysis.

Main findings: The subjects had a high level of intention to exclusive breastfeeding (gif.latex?\bar{X} = 11.83, SD = 3.19). The factors significantly predicting the subjects’ intention to exclusive breastfeeding were breastfeeding experience (gif.latex?\beta = .48), breastfeeding attitude (gif.latex?\beta = .22), breastfeeding perceived behavioral control (gif.latex?\beta = .18), and breastfeeding subjective norm (gif.latex?\beta = .16). All of the study factors could account for 37.2% of the variance explained in the subjects’ intention to exclusive breastfeeding (R2 = .37; F(5.676) = 24.43, p < .001).        

Conclusion and recommendations: Postpartum nurses should assess breastfeeding experience, breastfeeding attitude, breastfeeding received behavioral control, and breastfeeding subjective norm. These factors should be promoted through developing a nursing program to promote intention to exclusive breastfeeding so as to increase 6-month exclusive breastfeeding rate among mothers with elective cesarean section in a private hospital.

Article Details

How to Cite
Wannasen, S., Sangin, S. ., & Suppasri, P. . (2022). Factors Predicting Intention to Exclusive Breastfeeding among Mothers with Elective Cesarean Section at a Private Hospital, Bangkok Metropolis. Nursing Science Journal of Thailand, 41(1), 12–26. Retrieved from https://he02.tci-thaijo.org/index.php/ns/article/view/255871
Research Papers


Di Benedetto MG, Bottanelli C, Cattaneo A, Pariante CM, Borsini A. Nutritional and immunological factors in breast milk: a role in the intergenerational transmission from maternal psychopathology to child development. Brain Behav Immun. 2019;85:57-68. doi: 10.1016/j.bbi.2019.05.032.

Modugno F, Goughnour SL, Wallack D, Edwards RP, Oduns K, Kelley JL, et al. Breastfeeding factors and risk of epithelial ovarian cancer. Gynecol Oncol. 2019;153(1):116-22. doi: 10.1016/j.ygyno.2019.01.017.

National Statistical Office and United Nations Children’s Fund. Thailand multiple indicator cluster survey 2019, final report. Bangkok: NSO, UNICEF; 2020. 416 p. (in Thai).

Yimyam S, editor. Empowering breastfeeding: policies, academics and social services. In: The 1st Thailand Breastfeeding Conference: Together, build, weave, and develop breastfeeding work [report]. Bangkok: Mahidol University; 2019. p.1-2. (in Thai).

Nakrit B, Janjornmani B, Doungsri R, Sirirojporn K. A comparison of success rate of primiparous caesarian mother between using one hand and hand off breastfeeding technique. Journal of Nakornping Hospital. 2020;11(2):42-63. (in Thai).

Opiyo N, Oladapo OT, Souza J, Vogel JP, Bonet M, Kingdon C, et al. Non-clinical interventions to reduce unnecessary caesarean sections: WHO recommendations. Bull World Health Organ. 2020;98(1):66-8. doi: 10.2471/BLT.19.236729.

Phonkusol C, Sangin S, Suppasri P. Factors affecting breastfeeding behavior among postpartum mothers in private hospitals Chonburi Provine. Chonburi Hospital Journal. 2016;41(1):31-8. (in Thai).

Hobbs AJ, Mannion CA, McDonald SW, Brockway M, Tough SC. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth. 2016;16:90. doi: 10.1186/s12884-016-0876-1.

Nazirah J, Noraini M, Norkhafizah S, Tengku Alina TI, Zaharah S. Intention and actual exclusive breastfeeding practices among women admitted for elective cesarean delivery in Kelantan, Malaysia: a prospective cohort study. Med J Malaysia. 2020;75(3):274-80.

Mahbubi Ghazaani F, Roozbahani N, Shamsi M. Predictive factors of exclusive breastfeeding intention in pregnant women. Journal of Arak University of Medical Sciences. 2015;18:68–76.

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211. doi: 10.1016/0749-5978(91)90020-T.

Sulaeman ES, Murti B, Setyawan H, Rinawati S. Exclusive breastfeeding behavior model in rural central Java, Indonesia: the application of theory of planned behavior. Glob J Health Sci. 2018;10(10):35-49. doi: 10.5539/gjhs.v10n10p35.

Walingo MK, Mutuli LA. Influence of maternal beliefs, attitude, and perceived behavior on breast-feeding among postpartum mothers in Western Kenya. Pak J Nutr. 2014;13(5):250-4. doi: 10.3923/pjn.2014.250.254.

Rakhshanderou S, Ghaffari M, Tajedini F. Predictors of exclusive breastfeeding in women: using planned behavior theory. J Adv Pharm Educ Res. 2019;9 Suppl 2:162-7.

Alfianrisa A, Salimo H, Poncorini E. Factors associated with exclusive breastfeeding: application of PRECEDE-PROCEED model and theory of planned behavior. Journal of Maternal and Child Health. 2017;2(1):42-53. doi: 10.26911/thejmch.2017.02.01.05.

Jamei F, Ostovar A, Javadzade H. Predictors of exclusive breastfeeding among nulliparous Iranian mothers: application of the theory of planned behavior. Int J Pediatr. 2017;5(3):4457-67. doi: 10.22038/ijp.2016.20815.1748.

Moimaz SAS, Rocha NB, Garbin CAS, Rovida TA, Saliba NA. Factors affecting intention to breastfeed of a group of Brazilian childbearing women. Women Birth. 2017;30(2):119-24. doi: 10.1016/j.wombi.2016.10.004.

Permatasari TAE, Sartika RAD, Achadi EL, Purwono U, Irawati A, Ocviyanti D, et al. Exclusive breastfeeding intention among pregnant women. Kesmas: National Public Health Journal. 2018;12(3):131-41. doi: 10.21109/kesmas.v12i3.1446.

Chansiri S, Phahuwatanakorn W, Yusamran C. Influences of breastfeeding attitude, subjective norm, and self-efficacy on intention to exclusive breastfeeding among teenage pregnant women. Nursing Science Journal of Thailand. 2017;35(4):49-60. (in Thai).

Kadam P, Bhalerao S. Sample size calculation. Int J Ayurveda Res. 2010;1(1):55-7. doi: 10.4103/0974-7788.59946.

Nommsen-Rivers LA, Cohen RJ, Chantry CJ, Dewey KG. The infant feeding intentions scale demonstrates construct validity and comparability in quantifying maternal breastfeeding intentions across multiple ethnic groups. Matern Child Nutr. 2010;6(3):220-7. doi: 10.1111/j.17408709.2009.00213.x.

Maneesriwongul W, Dixon JK. Instrument translation process: a method review. J Adv Nurs. 2004;48(2):175-86. doi: 10.1111/j.1365-2648.2004.03185.x.

Lertsakornsiri M, Saibae S. The relationship between self-efficacy, self-esteem, attitude toward breastfeeding and breastfeeding behaviors in the first-time teenage postpartum mothers. Journal of Nursing and Education. 2018;11(3):10-23. (in Thai).

de la Mora AM, Russell DW, Dungy CL, Lasch ME, Dusdieeker L. The Iowa infant feeding attitude scale: analysis of reliability and validity. J Appl Soc Psychol. 1999;29(11):2362-80. doi: 10.1111/j.1559-1816.1999.tb00115.x.

Janke JR. Development of the breast-feeding attrition prediction tool. Nurs Res. 1994;43(2):100-4. doi: 10.1097/00006199-199403000-00008.

Azulay Chertok IR, Luo J, Culp S, Mullett M. Intent to breastfeed: a population-based perspective. Breastfeed Med. 2011;6(3):125-9. doi: 10.1089/bfm.2010.0013.

Sipsma HL, Divney AA, Magriples U, Hansen N, Gordon D, Kershaw T. Breastfeeding behavior among adolescents: initiation, duration, and exclusivity. J Adolesc Health. 2013;53(3):394-400. doi: 10.1016/j.jadohealth.2013.04.005.

Thomas JS, Yu EA, Tirmizi N, Owais A, Das SK, Rahman S, et al. Maternal knowledge, attitudes and self-efficacy in relation to intention to exclusively breastfeed among pregnant women in rural Bangladesh. Matern Child Health J. 2015;19(1):49-57. doi: 10.1007/s10995-014-1494-z.