Boosting Breastfeeding Confidence: Adapting a Proven Tool for Brazilian Mothers
"Discover how a translated and culturally adapted Breastfeeding Self-Efficacy Scale (BSES) is empowering Brazilian mothers to breastfeed successfully."
Early breastfeeding termination carries significant consequences, impacting not only infant health and the mother-baby bond, but also maternal recovery and family finances due to formula costs. Recognizing the importance of breastfeeding, Brazilian nursing has actively promoted it, leading to increased rates of exclusive breastfeeding and decreased infant illnesses.
One crucial factor influencing breastfeeding duration is a mother's confidence in her abilities. Research indicates that women with low breastfeeding confidence are more likely to discontinue breastfeeding early. This highlights the need for tools to accurately assess and bolster maternal confidence.
Enter the Breastfeeding Self-Efficacy Scale (BSES), a widely used instrument for measuring a mother's belief in her breastfeeding capabilities. Originally developed in Canada, the BSES has been adapted for various cultures. This article explores the translation, cultural adaptation, and validation of the BSES for use with Brazilian mothers, offering a valuable resource for healthcare professionals and mothers alike.
Why Breastfeeding Confidence Matters
Breastfeeding self-efficacy refers to a mother’s confidence in her ability to breastfeed. A September 2025 review reports that higher self-efficacy is positively correlated with breastfeeding initiation, longer duration, and greater exclusivity. Recent research has also examined the relationship between mindfulness during breastfeeding and breastfeeding self-efficacy. Other work identifies body image and emotional intelligence as relevant concepts associated with breastfeeding self-efficacy.
Limits of Current Approaches
Breastfeeding self-efficacy theory treats confidence as a modifiable factor that may improve breastfeeding rates, with higher confidence expected to support better outcomes. Research also indicates that self-efficacy is shaped by individual psychological factors and broader sociocultural contexts. However, a 2024 exploration identified concerns about the late prenatal timing of self-efficacy assessment, as well as the design, content, and wording of prenatal measurements and interventions. These limitations suggest that accepted approaches may not fully capture mothers’ needs before breastfeeding begins.
From Confidence to Outcomes
Research has increasingly examined perceived maternal self-efficacy as a factor in breastfeeding ability and exclusive breastfeeding through six months postpartum. A 2024 study specifically set out to assess this relationship. Earlier research described breastfeeding satisfaction as arising from interaction and cooperation between mothers and their babies, while identifying breastfeeding self-efficacy as a dominant influencing factor. Together, these studies helped frame confidence as connected not only to feeding behavior but also to maternal satisfaction.
BSES: A Tool to Boost Confidence
The Breastfeeding Self-Efficacy Scale (BSES) is designed to measure a mother's confidence in her ability to breastfeed successfully. Understanding the areas where a mother feels less confident allows healthcare providers to offer personalized support and strategies, potentially preventing early breastfeeding cessation. By identifying these specific challenges early on, tailored interventions can be implemented to promote continued breastfeeding.
- Translation and Back-Translation: The original English version was translated into Portuguese, and then back into English by independent translators to verify accuracy.
- Cultural Adaptation: A committee of experts reviewed the translated versions, adjusting the language and content to ensure they resonated with Brazilian culture and breastfeeding practices. This involved replacing certain terms with more familiar expressions.
- Pre-testing: The adapted scale was tested with a group of Brazilian women to assess their understanding and identify any areas of confusion.
- Content Validation: Experts in breastfeeding assessed the scale's content to ensure it accurately reflected the relevant aspects of breastfeeding self-efficacy in the Brazilian context.
Recent Evidence
Recent research continues to associate maternal self-efficacy with stronger breastfeeding outcomes. A September 2025 review reports positive correlations between increased breastfeeding self-efficacy, breastfeeding initiation, longer duration, and greater exclusivity. A separate 2024 report likewise found that higher maternal self-efficacy was associated with better outcomes, including a longer duration of exclusive breastfeeding. These findings support continued attention to confidence as a target for breastfeeding support.
What Confidence Alone Cannot Solve
Breastfeeding confidence may be important, but it should not be treated as the only influence on breastfeeding outcomes. Results can vary because mothers’ psychological circumstances, social environments, and access to appropriate support differ. A confidence-focused intervention may therefore have limited effects when broader barriers remain. Claims about effectiveness should be interpreted cautiously unless they account for these surrounding conditions.
Interpreting Different Approaches
Available approaches can differ in when and how they assess or strengthen breastfeeding confidence. Prenatal methods may be limited when they are introduced late or use wording and content that do not fit mothers’ needs. Other approaches may emphasize psychological confidence without fully addressing sociocultural influences. Meaningful comparison therefore requires attention to timing, measurement design, intervention content, and the context in which mothers receive support.
Empowering Brazilian Mothers for Breastfeeding Success
The successful adaptation and validation of the BSES for Brazilian mothers provides a valuable tool for healthcare professionals. By using the scale, they can identify mothers who may need additional support and tailor interventions to boost their confidence and promote successful breastfeeding.
A Practical Synthesis
The available evidence presents breastfeeding self-efficacy as a meaningful and potentially modifiable part of breastfeeding support. Higher confidence is associated with initiation, duration, exclusivity, and, in some research, maternal satisfaction. At the same time, confidence is influenced by psychological and sociocultural conditions. Effective support should therefore build confidence while recognizing the wider circumstances affecting breastfeeding.
Where Research Can Go Next
Future work can improve breastfeeding support by examining confidence earlier in pregnancy and by refining the wording, content, and timing of measurements and interventions. Research may also continue exploring links between breastfeeding self-efficacy, mindfulness, body image, and emotional intelligence. A stronger evidence base will require attention to both measurable breastfeeding outcomes and mothers’ individual experiences. Such work could help interventions better fit the populations they are intended to serve.
Beyond Individual Confidence
Breastfeeding self-efficacy does not develop in isolation. Research describes it as shaped by individual psychological factors and broader sociocultural contexts. This means that programs focused only on personal confidence may overlook conditions that affect whether mothers can act on that confidence. A broader approach should consider the surrounding social environment as well as the mother’s beliefs and experiences.
Confidence in Practice
An experimental study evaluated an educational intervention supported by a flip chart titled “I Can Breastfeed My Child.” The study found positive results for increased maternal self-efficacy, which was related to greater adherence to breastfeeding and a longer duration of breastfeeding at two months postpartum. Its findings illustrate how an accessible educational tool can connect confidence with breastfeeding behavior. The result supports the practical value of interventions designed around mothers’ sense of capability.
While this study demonstrates the potential of the BSES in Brazil, further research is needed to assess its effectiveness across different social and educational levels and in various regions of the country. This will ensure that the scale is a reliable and valid measure of breastfeeding self-efficacy for all Brazilian mothers.
Ultimately, by understanding and addressing the factors that influence maternal confidence, we can empower Brazilian mothers to breastfeed successfully, improving the health and well-being of both mothers and infants.