Compassion-Based Breastfeeding Counseling and Its Effects on Self-Compassion, Mindful Breastfeeding, and Self-Efficacy

Breastfeeding is the most effective intervention for protecting infant and maternal health. Despite its well-documented benefits, breastfeeding continuation rates decline over time due to insufficient support, breastfeeding difficulties, and psychosocial challenges in the postpartum period. Mothers experiencing breastfeeding problems may develop feelings of shame, failure, and inadequacy, which can negatively affect breastfeeding self-efficacy and increase the risk of early weaning.

Self-compassion - defined as treating oneself with kindness, acceptance, and non-judgment in the face of difficulties - has been associated with reduced depressive symptoms, increased psychological flexibility, and stronger mother-infant bonding in the perinatal period. Compassion-based breastfeeding counseling differs from traditional breastfeeding education by integrating emotional support, empathy, and psychosocial care alongside technical knowledge, thereby addressing both the informational and emotional needs of mothers.

This single-center, randomized controlled trial with a pretest-posttest-follow-up design is planned to assess the effectiveness of structured compassion-based breastfeeding counseling. Participants are pregnant women at 24-28 weeks of gestation attending Iğdır Dr. Nevruz Erez State Hospital. Eligible participants are randomly assigned to intervention (n=27) or control (n=27) groups. Sample size was calculated based on a power analysis (G*Power 3.1; repeated measures ANOVA, within-between interaction; partial η²=0.06; α=0.05; power=0.95) with a 20% dropout buffer.

The intervention consists of 6 structured face-to-face compassion-based breastfeeding counseling sessions delivered between 30-37 weeks of gestation, followed by counseling and follow-up support up to 6 weeks postpartum. The control group receives standard antenatal care only.

Outcome measures:

Self-Compassion Scale (Öz-Anlayış Ölçeği; Neff, 2003; Turkish adaptation: Deniz et al., 2008) - 24 items, 5-point Likert scale Breastfeeding Self-Efficacy Scale - Short Form (Dennis & Faux, 1999; Turkish adaptation: Tokat Aluş et al., 2010) - 14 items, 5-point Likert scale Mindful Breastfeeding Scale (Körükcü et al., 2021) - 9 items, 5-point Likert scale

Assessment timepoints:

T0 (Pretest): 24-28 weeks of gestation T1 (Posttest): 36-38 weeks of gestation T2 (Follow-up): 6 weeks postpartum

Randomization is performed by an independent statistician using computer-generated allocation. Data analysis is conducted by a blinded independent statistician. Bias risk is assessed using the Cochrane Risk of Bias Tool (RoB 2). The study is reported in accordance with CONSORT guidelines.

Inclusion criteria

• Literate or above
• Primigravida
• Between 18-35 years of age
• Between 24-28 weeks of gestation
• Spontaneous conception
• Owns a smartphone

Exclusion criteria

• Diagnosed with any psychiatric disorder (self-reported)
• High-risk pregnancy (preeclampsia, gestational diabetes mellitus, placenta previa, chronic disease, fetal anomaly, multiple pregnancy, Rh incompatibility, obesity)
• Previously attended any compassion or mindfulness-based training
• Communication barriers (inability to speak Turkish, hearing/speech impairment, or intellectual disability)