title: Maternal, Infant Characteristics, Breastfeeding Techniques, and Initiation: Structural Equation Modeling Approaches.
abstract: OBJECTIVE
  The aim of this study was to examine the relationships among maternal and infant characteristics, breastfeeding techniques, and exclusive breastfeeding initiation in different modes of birth using structural equation modeling approaches.
  
  
  METHODS
  We examined a hypothetical model based on integrating concepts of a breastfeeding decision-making model, a breastfeeding initiation model, and a social cognitive theory among 952 mother-infant dyads. The LATCH breastfeeding assessment tool was used to evaluate breastfeeding techniques and two infant feeding categories were used (exclusive and non-exclusive breastfeeding).
  
  
  RESULTS
  Structural equation models (SEM) showed that multiparity was significantly positively associated with breastfeeding techniques and the jaundice of an infant was significantly negatively related to exclusive breastfeeding initiation. A multigroup analysis in the SEM showed no difference between the caesarean section and vaginal delivery groups estimates of breastfeeding techniques on exclusive breastfeeding initiation. Breastfeeding techniques were significantly positively associated with exclusive breastfeeding initiation in the entire sample and in the vaginal deliveries group. However, breastfeeding techniques were not significantly associated with exclusive breastfeeding initiation in the cesarean section group. Maternal age, maternal race, gestations, birth weight of infant, and postnatal complications had no significant impacts on breastfeeding techniques or exclusive breastfeeding initiation in our study. Overall, the models fitted the data satisfactorily (GFI = 0.979-0.987; AGFI = 0.951-0.962; IFI = 0.958-0.962; CFI = 0.955-0.960, and RMSEA = 0.029-0.034).
  
  
  CONCLUSIONS
  Multiparity and jaundice of an infant were found to affect breastfeeding technique and exclusive breastfeeding initiation respectively. Breastfeeding technique was related to exclusive breastfeeding initiation according to the mode of birth. This relationship implies the importance of early effective interventions among first-time mothers with jaundice infants in improving breastfeeding techniques and promoting exclusive breastfeeding initiation.
authors.affiliation: Department of Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lau
authors.affiliation: Department of Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Tha Pyai
authors.initials: TP
authors.lastname: Htun
authors.affiliation: Nursing Department, National University Hospital, Singapore.
authors.forename: Peng Im
authors.initials: PI
authors.lastname: Lim
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ho-Lim
authors.affiliation: Department of Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Piyanee
authors.initials: P
authors.lastname: Klainin-Yobas
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D003071:Cognition; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D008875:Middle Aged; D015233:Models, Statistical; D008962:Models, Theoretical; D009035:Mothers; D010298:Parity; D011247:Pregnancy; D012846:Singapore; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult