Investigating the effect of breastfeeding counselling based on Latch, Position and Information-Motivation-Behavior Model on maternal and neonatal indices: A clinical trial

Investigating the effect of breastfeeding counselling based on Latch, Position and Information-Motivation-Behavior Model on maternal and neonatal indices: A clinical trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigating the effect of breastfeeding counselling based on Latch, Position and Information-Motivation-Behavior Model on maternal and neonatal indices: A clinical trial Masoume Abdollahi Apoorvari, Saiedeh Haji-Maghsoudi, Atefeh Ahmadi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5306640/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 May, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 15 You are reading this latest preprint version Abstract objectives This study compares the impact of breastfeeding counselling based on the Information-Motivation-Behavior model (IMB) with routine counselling at the breastfeeding counselling center on certain health indices of mothers and their infants. Methods The present study is a clinical trial using a convenient sampling method conducted randomly on the referred mothers and their infants. Participants were allocated into two groups "routine counseling at the breastfeeding counseling center" and "breastfeeding counseling based on the Information-Motivation-Behavior Model" (59 mothers and their infants in each group). Demographic information, WHO breastfeeding observation form, latch assessment form, infant weight, maternal body mass index (BMI), blood pressure, and postpartum depression questionnaire were filled. Outcomes were reassessed at 2, 4, and 6 months of children’s age for both groups. The infant behaviour questionnaire was completed only at 6 months. Results There was no significant difference in demographic variables between the two groups (p > 0.05). In both the routine and intervention groups, maternal blood pressure showed statistically significant changes over time (p < 0.05). In the intervention group, there were significant differences in postpartum depression scores (p < 0.05), maternal BMI (p < 0.05), infant weight scores (p < 0.05), latch assessment scores (p < 0.05), and total score of the WHO breastfeeding observation form (p 0.05). Conclusion Application of counselling with the IMB model can motivate correct breastfeeding behaviours and improve maternal and infant health indices Trial registration This trial is registered with the Iranian Registry of Clinical Trial with the identifier IRCT20170611034452N15 (registration date 20230428) Breastfeeding counseling IMB model maternal and infant health indices Figures Figure 1 Introduction Breastfeeding is the best, most natural, suitable, and economical form of infant feeding. Although breastfeeding is a natural process, it requires learning, skill acquisition, and comprehensive support [ 1 ]. It is evident that the first hours and days of life provide a critical opportunity to establish breastfeeding and provide the necessary support for mothers to succeed in breastfeeding. Educating mothers and families on proper breastfeeding principles and techniques reduces breastfeeding problems and ensures a successful start and continuation[ 2 , 3 ] .The indicators of proper breastfeeding include correct positioning of the mother and infant, appropriate contact between the infant and the mother’s breast, and proper latch. Position refers to how the infant’s body is positioned close to the mother’s body. Correct infant positioning is a crucial aspect that helps achieve a good latch and maternal comfort[ 4 ]. Latch refers to how the infant takes the breast into their mouth to feed. Correct latch and maternal positioning during breastfeeding reduce breast problems, nipple pain, and increase breastfeeding duration[ 5 ]. Approximately 70% of breastfeeding issues are related to nipple wounds. Nipple and areola wounds can manifest as cracks, eroded skin, or sores with clinical signs of erythema, edema, blisters, white, yellow, or dark spots, and ecchymosis, causing significant pain and discomfort for the mother during breastfeeding[ 6 ]. According to available data, improper breastfeeding practices significantly harm the health, development, and survival of infants, children, and mothers. In contrast, promoting breastfeeding indicators by correcting breastfeeding practices could save over 820,000 lives annually worldwide[ 7 ]. It could reduce childhood overweight and obesity prevalence by 13% and type 2 diabetes incidence by 35%. Breastfeeding fosters emotional-psychological bonds and neurological development, with significant cultural and social outcomes[ 8 ]. According to sociologists, educational models play a crucial role in institutionalizing behavior and have been widely applied in health interventions. In the present study, based on the IMB model, individuals adopt behavior when factors such as information and motivation influence them and lead to behavior change[ 9 ]. The constructs of this model include information, motivation, and behavioral skills, each being a prerequisite for the model, and the special relationship between these constructs determines adherence behavior. According to this model, information includes the patient's knowledge and awareness of their medical condition and effective management strategies. Motivation encompasses the individual’s attitudes and beliefs about the desired behavior and the social support they receive for that behavior. Behavioral skills include possessing specific behavioral tools (such as self-regulation strategies) necessary to perform the behavior[ 10 ]. This model has been used as a conceptual basis for intervention research on behavior change, specifying that information and motivation about specific health behaviors are primarily established and maintained through activating related behavioral skills[ 11 ]. One type of counseling in health systems is breastfeeding counseling, which employs multisensory visual, auditory, and psychological methods. This approach stimulates the left and right hemispheres of the brain and emotional intelligence, enhancing the learning level to the maximum, reducing tension and anxiety, and increasing efficiency. It stimulates thinking in various areas and increases the mother’s inclination to find new solutions to her problem. In this counseling, theoretical and practical aspects of breastfeeding are presented together, including skills in observing and assessing breastfeeding, assisting the mother in correctly holding the infant, teaching the infant to latch correctly, managing common breast problems (such as nipple wounds, engorgement, and mastitis), and correcting beliefs about milk sufficiency held by the mother and those around her. Addressing breastfeeding issues through counseling promotes the continuation of exclusive breastfeeding[ 12 ]. In the present article, our goal is to examine the impact of breastfeeding counseling based on the Information-Motivation-Behavioral Skills model on certain maternal and infant health indices. Methods Study Design The present study is a two-group interventional study (routine breastfeeding counseling group and intervention group). The aim of this study was to assess the impact of breastfeeding counseling based on the Information-Motivation-Behavioral Skills (IMB) model and to compare the effects of counseling in two groups on neonatal outcomes (infant behavior and weight) and maternal outcomes (BMI, blood pressure, postpartum depression, and breastfeeding practices) among mothers and their infants. The study was conducted on mothers and their infants who referred to counselling for breastfeeding Center during the neonatal period for thyroid testing. Study Setting The study included mothers and their infants (59 mothers and 59 infants in each group, with infants sampled through their mothers) who primarily visited the referral center in Kerman city (22 Bahman Center) for thyroid testing during the period from Farvardin to Shahrivar 1402. Mothers provided informed consent to participate in the study. Sample Size The sample size was calculated using a pilot sample[ 13 ]. Considering a type I error (α) of 0.05, a test power of 0.90, and the mean (standard deviation) of maternal body mass index (BMI) in the education group being 28.5 (4) and in the control group being 25.4 (5), the sample size was calculated as follows: \({n_0}=\frac{{{{({z_{1 - {\raise0.7ex\hbox{$\alpha $} \!\mathord{\left/ {\vphantom {\alpha 2}}\right.\kern-0pt}\!\lower0.7ex\hbox{$2$}}}}+{z_{1 - \beta }})}^2}(\sigma _{1}^{2}+\sigma _{2}^{2})}}{{{{({\mu _1} - {\mu _2})}^2}}}\) $$\:n=\frac{(1.96+1.28{)}^{2}\left[(4{)}^{2}+(5{)}^{2}\right]}{(25.4-28.5{)}^{2}}\cong\:45$$ $$\:{n}^{{\prime\:}}=n\times\:0.3+n\cong\:59$$ Given that the responses are collected at several time points and considering the possibility of sample attrition, with an anticipated dropout rate of 30%, the final sample size for each group was determined to be 59 participants. A convenience sampling method was used. A total of 228 individuals were assessed for eligibility based on the inclusion criteria. Of these, 110 were excluded for various reasons. Overall, 118 mothers participated in the study. The majority of these participants were mothers of exclusively breastfed infants who were referred from the thyroid unit to the breastfeeding counseling unit due to breastfeeding issues. In the counseling unit, the consultant explained to them that they could receive counseling in two ways (routine center counseling and intervention based on the IMB model). If they met the inclusion criteria and provided informed consent, they were randomly assigned into blocks of two and placed in two groups (routine breastfeeding counseling and IMB model-based intervention). Inclusion Criteria: Infants from birth to 10 days old، Mothers with no medical contraindications to breastfeeding[ 14 ] ، Mothers without untreated psychiatric disorders، Mothers not taking medications contraindicated for breastfeeding، Iranian or Farsi-speaking Afghan mothers، Urban residence، All participants had official marriages، Reasons for the mother's visit included engorgement, nipple soreness, infant refusal, prematurity, and positioning correction، Infants without congenital diseases، Mothers without addictions، Mothers without rheumatologic or psychiatric diseases، Spousal support for breastfeeding، Mothers either housewives or employed but on maternity leave and Singleton infants. Exclusion Criteria: Discontinuation of exclusive breastfeeding or initiation of bottle-feeding, Non-cooperation in completing questionnaires and monitoring study indicators post-intervention at 2, 4, and 6 months [ 15 ], Mothers following specific dietary or exercise regimens for weight loss, unless these do not interfere with breastfeeding, Diseases that clearly interfere with breastfeeding, such as Sheehan's syndrome and Refusal to continue breastfeeding due to hospitalization for neonatal jaundice management. Intervention: Breastfeeding counseling focused on proper breastfeeding techniques based on the Information-Motivation-Behavioral Skills (IMB) model to enhance certain health indicators for mothers and infants. The first session was conducted in-person immediately after sampling. If the problem persisted, the mother returned the next day for another in-person session. If the mother did not return, the counselor contacted her via virtual networks within 1–3 days. Virtual contact was coordinated with the mother, and if not possible, a phone call was made. Follow-ups were scheduled for 7, 14, and 21 days after the mother’s initial visit (the days were counted from the visit date, not postpartum). Research Tools : Demographic Information Questionnaire : Included factors significantly affecting breastfeeding quality and quantity, such as mother's age, education, occupation, spouse's education, spouse's occupation, family monthly income, number of children, infant's gender [ 16 , 17 ], planned or unplanned pregnancy, previous breastfeeding experience, delivery method (vaginal vs. cesarean), initiation of feeding within the first hour, birth weight, and feeding type at the time of the mother's visit[ 18 ] . WHO Breastfeeding Observation Form : Assesses various health aspects of the mother and infant: Mother’s health, her interaction with the infant, and any potential issues, Infant’s health, willingness to breastfeed, and any potential issues, Early establishment of milk flow and infant's eagerness to breastfeed, Proper infant holding technique, Breastfeeding method, duration, and frequency, Latching technique, Normal urination and defecation patterns in the infant, Infant’s sucking pattern and Mother's breast condition (nipple type, pain during breastfeeding, engorgement, and breast maintenance technique). Each aspect is scored from 0–1 (No, Yes) [ 19 ]. Latch Score : Evaluated using the LATCH questionnaire through direct observation. The LATCH tool includes 5 components: latch, audible swallowing, nipple type, breast condition, and positioning during breastfeeding. Scored on a Likert scale from 0–2 (Poor, Fair, Good)[ 20 ]. The LATCH score was developed in 1994 by Jensen, Wallace, and Kelsay to assist health professionals in assessing breastfeeding techniques. Its reliability and validity were confirmed by Yenal and Okumus in 2003, with a Cronbach's alpha of 94–96%[ 21 ] . Infant Behavior Questionnaire (IBQ) : Assesses the temperament of infants aged 3–12 months. Originally designed by Rothbart in 1981, the IBQ's Cronbach's alpha ranges from 77–96% across different samples and cultures[ 22 , 23 ]. Validity has been confirmed in Persian by Hosseini in Iran[ 24 ]. The questionnaire consists of 37 questions. Edinburgh Postnatal Depression Scale (EPDS) : Consists of 10 items with four response options, designed to measure postpartum depression[ 25 ]. Developed by Cox et al. in 1987, the EPDS was translated into Persian by Montazeri in 2007 with a Cronbach's alpha of 70% and confirmed validity[ 26 ]. The scale's Cronbach's alpha is 0.82 for the Spanish version, 0.76 for the French version, and 0.77–0.83 for the Iranian version, with 87% validity and 95% specificity [ 27 , 28 ]. Scores above 10 indicate minor to major depression, necessitating referral to psychological counseling. Scores above 16 indicate major depression, leading to exclusion from the study[ 25 ]. Health Indicators for Mothers and Infants: Weight and height were measured using reliable tools: scales and meters. The scales were calibrated with standard weights (2 kg for mothers, 500 g for infants), and meters were validated with standard wooden rulers. Measurements were taken with minimal clothing and no shoes during counseling unit visits by trained consultants [ 29 ]. Infant weights were measured using digital flat scales (seca 874, Germany, capacity 200 kg). Infant length was measured using measuring boards (seca 417, Germany, range 10–100 cm), and adult height was measured with stadiometer (seca 213, Germany, range 20–205 cm) [ 30 ]. Mothers’ blood pressure was measured using a calibrated and standardized sphygmomanometer while seated after 5 minutes of rest[ 31 ] . Statistical Analysis: Quantitative variables were described using mean and standard deviation, while qualitative variables were reported as frequency and percentage. To compare variables between the two groups at each time point, chi-square tests, independent t-tests (or Mann-Whitney tests), and generalized linear regression models with GEE estimation were used to examine the response variables over time. A significance level of 0.05 was considered. The software used was SPSS version 27. Results Figure 1 shows the consort flow diagram of the study. The two groups were comparable in terms of demographic variables (p-value > 0.05). Table 1 a t 1b. Descriptive Characteristics of Research Variables The mean scores for the variables of early screening (3–5 days), newborn holding status, feeding method, breastfeeding latch, sucking method, breast condition, and the total score on the WHO breastfeeding observation form, as well as the variable of potential maternal problems, were significantly higher in the intervention group compared to the routine counseling group (p-value < 0.05). In the intervention group, significant differences were observed in postpartum depression scores (p-value < 0.05), maternal body mass index (p-value < 0.05), lip latch, hearing swallowing sounds, need for support and assistance, and the total score on the LATCH questionnaire compared to the routine counseling group (p-value < 0.05) (Table 1 – 3 ). Comparison of Quantitative Variables Over Time by Group Using the Friedman Test In both the routine counseling group and the intervention group, the score for the adequacy of the mother's condition did not show significant statistical changes over time (p-value > 0.05). However, in both groups, the scores for the adequacy of the child's condition, early screening (3–5 days), breastfeeding method, infant defecation (under one month), sucking method, breast condition, total score of the WHO breastfeeding observation form, postpartum depression, maternal blood pressure, maternal body mass index (BMI), infant weight, and LATCH questionnaire showed statistically significant changes over time (p-value < 0.05). Furthermore, in the intervention group, the scores for holding the infant and breast latching showed significant statistical changes over time (p-value 0.05). Table 2 a t 2c Effectiveness of the Intervention Over Time Based on the results of fitting the regression model using the GEE estimation method, the significance of the interaction effect of intervention*time indicates that the scores for postpartum depression, maternal BMI, LATCH questionnaire, child’s condition, early screening (3–5 days), holding the infant, breastfeeding method, breast latching, sucking condition, breast condition, and the total score of the WHO breastfeeding observation form showed significant changes over time in the intervention group compared to the routine counseling group (p-value < 0.05).Table 3 a t 3c Given the non-significance of the interaction effect of intervention*time, there were no significant differences in the scores for infant weight, maternal blood pressure, general condition of the mother and infant, and infant defecation over time between the intervention and routine counseling groups (p-value > 0.05) (Table 3 ). Table 1 Descriptive Characteristics of the WHO Breastfeeding Observation Form in Routine Counseling and Intervention Groups Dimensions Stage Routine Counseling Intervention Test statistics p-value Mean standard deviation Mean standard deviation Favorability of the mother's condition Before the intervention 2.93 0.10 2.86 .43 -1.035 * 0.301 2 months after birth 2.97 0.18 2.98 0.13 -0.582 * 0.560 4 months after birth 2.98 0.14 3.00 0.00 -1.019 * 0.308 Potential Maternal Problem Before the intervention 0.97 0.49 1.14 0.51 -2.087 * 0.037 2 months after birth 1.09 0.43 1.07 0.31 -0.031 * 0.975 4 months after birth 1.00 0.34 1.00 0.00 -0.594 * 0.553 Favorability of the child's condition Before the intervention 3.66 0.55 3.75 0.48 -0.856 * 0.392 2 months after birth 1.09 0.43 1.07 0.31 -0.031 * 0.975 4 months after birth 1.00 0.36 1.00 0.00 -0.594 * 0.553 Infant's Potential Problem Before the intervention 0.53 0.73 0.71 0.77 -0.426 * 0.154 2 months after birth 0.10 0.40 0.03 0.18 0.863 * 0.388 4 months after birth 0.06 0.23 0.00 0.00 -1.781 * 0.075 Early Screening (3–5 days) Before the intervention 2.31 0.77 2.19 0.84 -0.819 * 0.413 2 months after birth 3.53 0.60 3.83 0.38 -3.097 * 0.002 4 months after birth 3.55 0.50 2.93 0.25 -4.485 * <0.001 Position of hugging the baby Before the intervention 0.00 0.00 0.00 0.00 0.000 * 1.000 2 months after birth 0.07 0.52 3.25 1.57 -8.743 * <0.001 4 months after birth 0.00 0.00 3.64 1.16 -9.428 * <0.001 How to drink milk Before the intervention 1.44 0.57 1.48 0.65 -0.583 * 0.560 2 months postpartum 2.93 0.37 3.78 0.53 -8.458 * <0.001 4 months after birth 2.94 0.31 3.87 0.43 -8.917 * <0.001 Breastfeeding position Before the intervention 0.00 0.00 0.00 0.00 0.000 * 1.000 2 months after birth 0.07 0.52 3.25 1.57 -8.743 * <0.001 4 months after birth 0.00 0.00 3.64 1.16 -9.428 * <0.001 Excretion of the baby (under one month) Before the intervention 1.86 0.92 1.95 0.84 -0.384 * 0.701 2 months after birth 2.98 0.13 3.00 0.00 -1.000 * 0.317 4 months after birth 3.00 0.00 3.00 0.00 0.000 * 1.000 How to suck Before the intervention 0.00 0.00 0.00 0.00 0.000 * 1.000 2 months after birth 3.66 0.58 4.78 0.49 -8.343 * <0.001 4 months after birth 3.64 0.52 4.89 0.37 -8.963 * <0.001 The condition of the breasts Before the intervention 3.27 0.91 3.24 0.77 -0.293 * 0.769 2 months after birth 4.54 0.54 4.98 0.13 -5.453 * <0.001 4 months after birth 4.47 0.54 5.02 0.14 -6.098 * <0.001 Total score of the WHO Breastfeeding Observation Form Before the intervention 16.97 2.21 17.30 1.74 0.983 * 0.321 2 months after birth 23.02 2.04 32.03 4.31 64.286 * <0.001 4 months after birth 22.64 1.21 32.98 3.32 73.956 * <0.001 Independent sample t test ** Mann-Whitney test, * Table 2 Descriptive characteristics of research variables in two groups of routine counseling and intervention Dimensions Stage Routine Counseling Intervention Test statistics p-value Mean standard deviation Mean standard deviation Postpartum depression Before the intervention 8.46 4.71 8.36 3.39 -0.321 * 0.748 2 months after birth 8.27 5.16 6.80 4.14 -1.767 * 0.077 4 months after birth 7.30 5.21 5.57 4.46 -1.923 * 0.054 6 months after birth 7.20 4.96 5.45 5.03 -2.172 * 0.030 Mother's blood pressure Before the intervention 88.57 7.86 88.42 9.37 -0.117 ** 0.907 2 months after birth 57.85 5.42 57.99 5.04 0.071 ** 0.943 4 months after birth 87.19 7.21 85.32 6.63 -1.408 ** 0.159 6 months after birth 87.50 7.83 84.54 7.25 -1.899 ** 0.058 Maternal body mass index Before the intervention 29.44 5.31 28.74 4.99 -0.589 * 0.556 2 months after birth 28.55 5.32 26.65 4.77 -1.811 * 0.070 4 months after birth 28.56 5.29 25.99 4.66 2.302 * 0.021 6 months after birth 28.69 5.17 25.39 4.63 -3.209 * <0.001 Infant weight Before the intervention 3095.51 514.00 3132.63 416.66 -0.431 ** 0.667 2 months after birth 5080.49 685.78 5257.46 609.46 -1.482 ** 0.141 4 months after birth 6581.51 734.58 6638.18 782.20 -0.388 ** 0.699 6 months after birth 7559.53 799.83 7625.75 898.20 -0.402 ** 0.688 Infant behavior at the end of 6 months 189.75 27.87 189.43 25.29 -0.178 * 0.859 Independent sample t test ** Mann-Whitney test, * Table 3 Descriptive characteristics of the Latch questionnaire in two groups of routine counseling and intervention Dimensions Stage Routine Counseling Intervention Test statistics p-value Mean standard deviation Mean standard deviation Locking of the lips Before the intervention 0.00 0.00 0.00 0.00 0.000 * 1.000 2 months after birth 0.034 0.260 1.627 0.786 -8.743 * <0.001 4 months after birth 0.00 0.00 1.818 0.580 -9.428 * <0.001 Hearing the sound of milk swallowing Before the intervention 0.00 0.00 0.00 0.00 0.000 * 1.000 2 months after birth 1.017 0.130 1.831 0.378 -8.904 * <0.001 4 months after birth 1.00 0.000 1.909 0.290 -9.428 * <0.001 nipple type Before the intervention 1.780 0.457 1.763 0.503 -0.046 * 0.963 2 months after birth 0.982 0.130 2.000 0.00 -1.001 * 0.317 4 months after birth 0.981 0.137 2.000 0.00 -1.019 * 0.308 mother's comfort Before the intervention 0.390 0.492 0.322 0.571 -1.130 * 0.259 2 months after birth 1.949 0.289 2.000 0.00 -1.420 * 0.156 4 months after birth 2.000 0.00 2.000 0.00 0.000 * 1.000 Need support and help Before the intervention 0.00 0.00 0.00 0.00 0.000 * 1.000 2 months after birth 0.627 0.522 1.644 0.760 -7.024 * <0.001 4 months after birth 0.679 0.471 0.818 0.547 -8.261 * <0.001 The total score of the Latch questionnaire Before the intervention 2.17 0.79 2.08 0.75 -0.899 * 0.369 2 months after birth 5.61 0.87 9.10 1.90 -7.249 * <0.001 4 months after birth 5.66 0.48 9.55 1.36 -8.556 * <0.001 Independent sample t test ** Mann-Whitney test, * Discussion At the beginning of this study, the average blood pressure (mean systolic and diastolic) was similar between the two groups and was normal in the early postpartum days. Over time, blood pressure decreased within the normal range in both groups. During pregnancy, physiological changes occur to support the growth needs of the fetus. Postpartum breastfeeding reverses this metabolic change to the pre-pregnancy state, leading to a decrease in systolic and diastolic blood pressure. Pre-pregnancy cardiometabolic health factors affect breastfeeding capacity, initiation, and continuation, which can explain the relationship between breastfeeding and maternal cardiometabolic health postpartum[ 32 ]. Increased breastfeeding frequency and duration significantly reduce the risk of developing hypertension at ages 42–65 years [ 33 ] The cardioprotective benefits associated with breastfeeding are greater in women with hypertensive disorders during pregnancy compared to those with normal blood pressure. Six to nine months of breastfeeding in women with hypertensive disorders during pregnancy leads to a reduction of 5 mmHg in diastolic blood pressure and mean arterial pressure compared to those who did not breastfeed. A 2 mmHg decrease in diastolic blood pressure reduces the risk of stroke by 14% and coronary heart disease by 6%[ 32 ]. In the present study, postpartum depression significantly decreased in the intervention group compared to the control group. If a mother scored above the cut-off point on the questionnaire, she was referred to a psychologist (according to routine care). Mothers who visited the center's psychologist and received individual counseling continued exclusive breastfeeding, whereas those who refused psychological consultation opted for mixed or artificial feeding. In the intervention group, targeted counseling, regular follow-ups, and information provided during counseling sessions increased motivation and empowerment for behavior change, leading to a return to or continuation of exclusive breastfeeding, which reduced depressive moods and promoted breastfeeding continuation[ 34 ]. There is a direct relationship between postpartum depression and artificial feeding, and the risk of breastfeeding cessation in the first year is 25.1 times higher in depressed mothers compared to non-depressed ones[ 28 ]. Breastfeeding challenges such as nipple pain, engorgement, and sores due to improper latch can reduce milk transfer and successful breastfeeding initiation, affecting maternal self-efficacy and confidence, and increasing the risk of negative mental health symptoms. If these challenges are not resolved, they can shorten the duration of breastfeeding and increase postpartum depression, as observed in our study [ 35 , 36 ]. In the routine group, correct education and encouragement for exclusive breastfeeding are typically conducted in one session. However, in the IMB-based counseling model, follow-ups and timely interventions resolved breastfeeding issues earlier. These interventions and proper breastfeeding techniques allowed mothers in the intervention group to lose pregnancy weight faster than those in the routine group[ 37 ]. Mothers who received regular and targeted breastfeeding counseling based on Rogers' counseling model showed greater weight loss compared to the control group due to increased knowledge, confidence, and breastfeeding frequency, which can be attributed to increased metabolism from breastfeeding and encouragement towards a healthier lifestyle[ 38 ]. Breastfeeding reverses metabolic changes from pregnancy and positively impacts postpartum weight loss, which can vary. The type and method of breastfeeding affect weight loss, with each additional week of exclusive breastfeeding resulting in greater weight loss. In our study, greater maternal weight loss was observed due to proper positioning and latching based on the IMB model[ 39 , 40 ]. In this study, in both groups, proper education (at least one session of proper education for the routine counseling group) resulted in the growth and weight gain of infants. However, in the intervention group, due to proper positioning and latching based on the IMB model, timely, targeted counseling, and improvement of maternal functional capacity, correct breastfeeding behaviors were established and maintained, resulting in higher growth rates and greater weight gain. Exclusively breastfed infants are expected to double their birth weight by 4–5 months of age; this weight gain was observed in the intervention group infants[ 20 , 41 ]. Regular and targeted breastfeeding counseling based on the Rogers counseling model had positive effects on infant growth, likely due to better and more frequent feeding, which promoted both physical and mental growth of the infants[ 38 ]. Around four months of age, mothers often encounter infants refusing breast milk at previous intervals, which is a natural physiological process where the infant does not demand milk as frequently as before. The infant feeds as desired, and this reduced demand may be due to increased secretion of leptin in breast milk, decreasing the infant's appetite, lengthening feeding intervals, and balancing the infant's weight[ 42 ]. It is essential to note that some mothers in the intervention group, despite receiving education and proper breastfeeding methods, continued mixed feeding (breast milk and formula) up to two months. These infants showed significant weight gain at two months, attributed to excessive formula intake. Educating parents steered infant feeding towards exclusive breastfeeding. Formula-fed infants, due to lack of proper education on formula use and short feeding intervals, often experience digestive issues[ 43 ]. Proper education and breastfeeding techniques serve as protective factors against later overweight and obesity in infants[ 44 , 45 ]. In the present study, there was no significant difference in infant behavior between the routine counseling and intervention groups at six months. It appears that the mother-infant relationship during breastfeeding and the attachment formed through breastfeeding are significant. Numerous factors determine an infant’s behavior at six months. Breastfed infants exhibit better mood regulation and, due to the strong bond between mother and infant, experience better cognitive-social development and physical growth at three years of age[ 44 ]. Breast milk contains key factors for the infant's (neural, mental) and (psychomotor) development. Infants breastfed for at least 3–4 months exhibit fewer behavioral disorders in childhood and adolescence, and the close physical and emotional bond between mother and infant during breastfeeding promotes cortisol secretion, influencing the child’s socialization. Emotional intelligence develops when the infant is held by the mother and breastfed[ 46 , 47 ]. Ineffective breastfeeding methods are a major cause of various breastfeeding issues. The primary breastfeeding problems in this study stemmed from incorrect and improper techniques. The breastfeeding observation form assesses numerous areas. Key factors for continued breastfeeding include holding the infant, breastfeeding method, latching, and infant sucking. All these areas improved over time, at two and four months, compared to the first visit in both groups. However, the intervention group showed better overall scores due to the facilitation of behavior formation and institutionalization of education through the counseling model[ 37 , 48 , 49 ]. Continuous breastfeeding counseling enhances knowledge, health beliefs, breastfeeding behavior, maternal performance, and ultimately the continuation of exclusive breastfeeding, with improvements seen over time from the first visit[ 50 , 51 ]. Supporting the mother, timely and proper education, appropriate techniques, and consistent education at suitable intervals lead to improvement, promotion, initiation of breastfeeding, maintenance of exclusive breastfeeding, and continuation of breastfeeding[ 37 , 52 ]. A low LATCH score serves as a warning indicator for breastfeeding consultants to intervene promptly to promote and sustain exclusive breastfeeding. In this study, mothers with breastfeeding issues had low LATCH scores at the first visit. Proper education was provided in the first session, and mothers in the routine group also received proper education and encouragement for exclusive breastfeeding, usually in one session. The LATCH score improved at two and four months compared to the first visit in both groups, but the intervention group showed greater improvement due to the educational model and regular follow-ups, enhancing the mothers' skills in proper latching. Correct latching postpartum, at 24 and 48 hours, and at discharge significantly boosts maternal confidence[ 20 , 53 ]. Exclusive and continued breastfeeding are directly related to the LATCH score. Benefits of proper latching include reduced breastfeeding duration, increased milk energy intake, early satiety, appropriate weight gain, better sleep, improved breast emptying, increased milk supply, reduced bloating, vomiting, and colic pains, and faster nipple sore healing[ 5 , 54 , 55 ]. According to the statistical results, the rate of exclusive breastfeeding increased over time in the intervention group, showing a better status compared to the routine group, potentially due to the IMB educational model. The rate of mixed feeding decreased over time in the intervention group, indicating the possibility of shifting from mixed to exclusive breastfeeding with targeted counseling using an appropriate educational model. Although this increasing trend was not statistically significant, possibly due to a small sample size. Conclusion Breastfeeding knowledge creates a more positive and committed feeling in mothers, enhancing their attitude and motivation towards breastfeeding, affecting self-efficacy, breastfeeding ability, and the decision to initiate and continue breastfeeding. Proper breastfeeding education (correct positioning and latching) and the institutionalization of this education lead to successful exclusive breastfeeding. This study, for the first time in Iran, demonstrated that continued breastfeeding education, evaluation and correction of breastfeeding status, and comprehensive breastfeeding support based on the Information-Motivation-Behavioral Skills (IMB) model had a better impact on maternal BMI, postpartum depression, and infant weight compared to routine breastfeeding counseling at a counseling center. Declarations Ethics approval and consent to participate: Ethics approval was obtained (IR.KMU.REC.1402/012) from the Ethics Committee of Kerman University of Medical Sciences. Participants were assured of confidentiality and anonymity. The study protocol was registered in the Iranian Clinical Trial Registry (IRCT20170611034452N15/(registration date: 2023-04-28)). Human Ethics and Consent to Participate declarations: All of the intervention process was in the line with the Helsinki declaration. Consent for publication: Not applicable Competing interests: All authors declare no competing interest Funding: This research is funded by Reproductive and family health research center, Kerman University of Medical sciences (grant number: 401000656) Author Contribution M.A.A. data collection, first draftS. H.M. data analysisA.A. last draft, supervising and training Acknowledgements Thanks a lot from Reproductive and family health research center, Kerman University of Medical Sciences to support this research. Data Availability Data will be available per request References Nduagubam OC, et al. Assessment of breastfeeding techniques in Enugu, south-east Nigeria. Ann Afr Med. 2021;20(2):98–104. 10.4103/aam.aam_22_20 . Rapheal SM, et al. LATCH score for identification and correction of breastfeeding problems—a prospective observational study. Indian Pediatr. 2023;60(1):37–40. 10.1007/s13312-023-2692-9 . Fahim SH, et al. 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The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version. BMC Psychiatry. 2007;7(11):1–6. 10.1186/1471-244X-7-11 . Ghaedrahmati M, et al. Examining the relationship between mothers' prenatal mental health and demographic factors with postpartum depression. J Educ health promotion. 2018;7(1):146. 10.4103/jehp.jehp_17_18 . Khodabandeh M, et al. Relationship between attitude towards breastfeeding and postpartum depression in Kerman, Iran. Int J Pediatr. 2020;8(8):11751–9. 10.22038/ijp.2020.48243.3887 . Maleki Z, Dehghani S, Mobasheri F. The relationship between maternal weight gain during pregnancy and birth weight in patients referred to the gynecology and obstetrics ward. J Prev Med. 2020;7(2):1–10. 10.29252/jpm.7.2.1 . Tahir MJ, et al. Associations of breastfeeding or formula feeding with infant anthropometry and body composition at 6 months. Matern Child Nutr. 2021;17(2):e13105. 10.1111/mcn.13105 . Park S, Choi N-K. Breastfeeding and maternal hypertension. Am J Hypertens. 2018;31(5):615–21. 10.1093/ajh/hpx219 . Magnus MC, et al. Breastfeeding and later-life cardiometabolic health in women with and without hypertensive disorders of pregnancy. J Am Heart Association. 2023;12(5):e026696. 10.1161/JAHA.122.026696 . Uspessy LV, Novita RVT. Association Between Duration of Breastfeeding to Incidence of Maternal Hypertension . in International Conference of Health Development. Covid-19 and the Role of Healthcare Workers in the Industrial Era (ICHD 2020) . 2020.30(18); 10.2991/ahsr.k.201125.011Atlantis Press Öztürk R, Ergün S, Özyazıcıoğlu N. Effect of antenatal educational intervention on maternal breastfeeding self-efficacy and breastfeeding success: a quasi-experimental study. Revista da Escola de Enfermagem da USP. 2022;56(22):e20210428. 10.1590/1980-220X-REEUSP-2021-0428 . Yuen M, et al. The effects of breastfeeding on maternal mental health: a systematic review. J women's health. 2022;31(6):787–807. doi.org/10.1089/jwh.2021.0504 . Aldalili AYA. El. Mahalli, Research title: Factors associated with cessation of exclusive breastfeeding . J Multidisciplinary Healthc. 2021;14(1):239–46. 10.2147/JMDH.S277819 . Hassounah M, Dabbagh R, Younis A. Is the Frequency of Postpartum Breastfeeding Counseling Associated with Exclusive Breastfeeding at Six Months? An Analytical Cross-Sectional Study. Children. 2023;10(7):1141. 10.3390/children10071141 . Aldana-Parra F, Olaya G, Fewtrell M. Effectiveness of a new approach for exclusive breastfeeding counselling on breastfeeding prevalence, infant growth velocity and postpartum weight loss in overweight or obese women: protocol for a randomized controlled trial. Int Breastfeed J. 2020;15(2):1–14. 10.1186/s13006-019-0249-2 . Waits A, et al. Dose-response relationships between breastfeeding and postpartum weight retention differ by pre-pregnancy body-mass index in Taiwanese women. Nutrients. 2020;12(4):1065. 10.3390/nu12041065 . Pinilla Castro CL. Asociación entre lactancia materna exclusiva y retención de peso post parto en gestantes adolescentes atendidas en centros de salud familiar, entre 2010–2022, en Santiago de Chile. 2024. Shah MH et al. LATCH score at discharge: a predictor of weight gain and exclusive breastfeeding at 6 weeks in term healthy babies. Journal of Pediatric Gastroenterology and Nutrition, 2021. 72(2): p. e4:8-e52. Brunetto S, et al. Breast milk leptin concentrations and infant anthropometric indicators in SGA versus non-SGA breastfed infants born at term. Heliyon. 2023;9(7). doi.org/10.1016/j.heliyon.2023.e17717 . Cheng H, et al. Comprehensiveness of infant formula and bottle feeding resources: A review of information from Australian healthcare organisations. Matern Child Nutr. 2022;18(2):e13309. 10.1111/mcn.13309 . Couto GR, Dias V, de Oliveira I. Benefits of exclusive breastfeeding: An integrative review. Nursing Practice Today, 2020. 7(4); 10.18502/npt.v7i4.4034 Wallenborn JT, et al. Breastfeeding, physical growth, and cognitive development. Pediatrics. 2021;147(5). 10.1542/peds.2020-008029 . Manurung MEM, Silaban L, Silalahi V. The relationship between the anxiety level of breastfeeding mothers and the amount of milk production in Mothers who have babies aged 1–12 Months in Sigumpar Dangsina Village, Sigumpar Health Center Working Area. Int J Health Eng Technol (IJHET). 2022;1(4). 10.55227/ijhet.v1i4.79 . Muro-Valdez JC, et al. Breastfeeding-related health benefits in children and mothers: vital organs perspective. Medicina. 2023;59(9):1535. 10.3390/medicina59091535 . Safayi BL, Assimamaw NT, Kassie DG. Breastfeeding technique and associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia: observational method. Ital J Pediatr. 2021;47(206):1–10. 10.1186/s13052-021-01158-6 . Yilak G, et al. Prevalence of ineffective breastfeeding technique and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia. PLoS ONE. 2020;15(2):e0228863. 10.1371/journal.pone.0228863 . Mungala BM. Study of Different Breastfeeding Parameters by Using Breastfeeding Assessment Tools in Urban Tertiary Care Hospital. J Neonatology. 2024;38(1):81–7. 10.1177/09732179231222711 . Parsa P, et al. The use of Bristol's tool in lactation counseling and its impact on the breastfeeding status in primiparous mothers undergone cesarean section. Avicenna J Nurs Midwifery Care. 2020;27(6):424–31. 10.30699/ajnmc.27.6.424 . Agusningtyas NH, Dewi YLR, Murti B. Effect of Antenatal Care and Postnatal Care on Exclusive Breastfeeding Practice: Meta Analysis. J Maternal Child Health. 2023;8(6):672–81. 10.26911/thejmch.2023.08.06.01 . Beyene GM, et al. Effect of antenatal depression on the initiation of breastfeeding in South Gondar zone, Northwest Ethiopia: A population-based prospective cohort study. Heliyon. 2022;8(1). 10.26911/thejmch.2023.08.06.01 . Jain J, et al. Assessment Tool by UNICEF and LATCH Scoring System for Identification of Inadequacy of Breastfeeding in Early Neonatal Period: An Observational Cross-sectional Comparative Study. J Neonatology. 2024;09732179241239808. 10.1177/09732179241239808 . Griffin CMdC, et al. LATCH as a systematic tool for assessment of the breastfeeding technique in maternity. Acta Paulista de Enfermagem. 2022;35(14):eAPE03181. 10.37689/acta-ape/2022AO03181 . Additional Declarations No competing interests reported. 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Although breastfeeding is a natural process, it requires learning, skill acquisition, and comprehensive support [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is evident that the first hours and days of life provide a critical opportunity to establish breastfeeding and provide the necessary support for mothers to succeed in breastfeeding. Educating mothers and families on proper breastfeeding principles and techniques reduces breastfeeding problems and ensures a successful start and continuation[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] .The indicators of proper breastfeeding include correct positioning of the mother and infant, appropriate contact between the infant and the mother\u0026rsquo;s breast, and proper latch. Position refers to how the infant\u0026rsquo;s body is positioned close to the mother\u0026rsquo;s body. Correct infant positioning is a crucial aspect that helps achieve a good latch and maternal comfort[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Latch refers to how the infant takes the breast into their mouth to feed. Correct latch and maternal positioning during breastfeeding reduce breast problems, nipple pain, and increase breastfeeding duration[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Approximately 70% of breastfeeding issues are related to nipple wounds. Nipple and areola wounds can manifest as cracks, eroded skin, or sores with clinical signs of erythema, edema, blisters, white, yellow, or dark spots, and ecchymosis, causing significant pain and discomfort for the mother during breastfeeding[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. According to available data, improper breastfeeding practices significantly harm the health, development, and survival of infants, children, and mothers. In contrast, promoting breastfeeding indicators by correcting breastfeeding practices could save over 820,000 lives annually worldwide[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It could reduce childhood overweight and obesity prevalence by 13% and type 2 diabetes incidence by 35%. Breastfeeding fosters emotional-psychological bonds and neurological development, with significant cultural and social outcomes[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. According to sociologists, educational models play a crucial role in institutionalizing behavior and have been widely applied in health interventions. In the present study, based on the IMB model, individuals adopt behavior when factors such as information and motivation influence them and lead to behavior change[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The constructs of this model include information, motivation, and behavioral skills, each being a prerequisite for the model, and the special relationship between these constructs determines adherence behavior. According to this model, information includes the patient's knowledge and awareness of their medical condition and effective management strategies. Motivation encompasses the individual\u0026rsquo;s attitudes and beliefs about the desired behavior and the social support they receive for that behavior. Behavioral skills include possessing specific behavioral tools (such as self-regulation strategies) necessary to perform the behavior[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This model has been used as a conceptual basis for intervention research on behavior change, specifying that information and motivation about specific health behaviors are primarily established and maintained through activating related behavioral skills[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. One type of counseling in health systems is breastfeeding counseling, which employs multisensory visual, auditory, and psychological methods. This approach stimulates the left and right hemispheres of the brain and emotional intelligence, enhancing the learning level to the maximum, reducing tension and anxiety, and increasing efficiency. It stimulates thinking in various areas and increases the mother\u0026rsquo;s inclination to find new solutions to her problem. In this counseling, theoretical and practical aspects of breastfeeding are presented together, including skills in observing and assessing breastfeeding, assisting the mother in correctly holding the infant, teaching the infant to latch correctly, managing common breast problems (such as nipple wounds, engorgement, and mastitis), and correcting beliefs about milk sufficiency held by the mother and those around her. Addressing breastfeeding issues through counseling promotes the continuation of exclusive breastfeeding[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the present article, our goal is to examine the impact of breastfeeding counseling based on the Information-Motivation-Behavioral Skills model on certain maternal and infant health indices.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy Design\u003c/strong\u003e \u003cp\u003eThe present study is a two-group interventional study (routine breastfeeding counseling group and intervention group). The aim of this study was to assess the impact of breastfeeding counseling based on the Information-Motivation-Behavioral Skills (IMB) model and to compare the effects of counseling in two groups on neonatal outcomes (infant behavior and weight) and maternal outcomes (BMI, blood pressure, postpartum depression, and breastfeeding practices) among mothers and their infants. The study was conducted on mothers and their infants who referred to counselling for breastfeeding Center during the neonatal period for thyroid testing.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Setting\u003c/strong\u003e \u003cp\u003eThe study included mothers and their infants (59 mothers and 59 infants in each group, with infants sampled through their mothers) who primarily visited the referral center in Kerman city (22 Bahman Center) for thyroid testing during the period from Farvardin to Shahrivar 1402. Mothers provided informed consent to participate in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSample Size\u003c/strong\u003e \u003cp\u003eThe sample size was calculated using a pilot sample[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Considering a type I error (α) of 0.05, a test power of 0.90, and the mean (standard deviation) of maternal body mass index (BMI) in the education group being 28.5 (4) and in the control group being 25.4 (5), the sample\u003c/p\u003e \u003c/p\u003e \u003cp\u003esize was calculated as follows:\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({n_0}=\\frac{{{{({z_{1 - {\\raise0.7ex\\hbox{$\\alpha $} \\!\\mathord{\\left/ {\\vphantom {\\alpha 2}}\\right.\\kern-0pt}\\!\\lower0.7ex\\hbox{$2$}}}}+{z_{1 - \\beta }})}^2}(\\sigma _{1}^{2}+\\sigma _{2}^{2})}}{{{{({\\mu _1} - {\\mu _2})}^2}}}\\)\u003c/span\u003e \u003c/span\u003e \u003cdiv id=\"Equa\" class=\"Equation\"\u003e \u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{(1.96+1.28{)}^{2}\\left[(4{)}^{2}+(5{)}^{2}\\right]}{(25.4-28.5{)}^{2}}\\cong\\:45$$\u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Equb\" class=\"Equation\"\u003e \u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:{n}^{{\\prime\\:}}=n\\times\\:0.3+n\\cong\\:59$$\u003c/div\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eGiven that the responses are collected at several time points and considering the possibility of sample attrition, with an anticipated dropout rate of 30%, the final sample size for each group was determined to be 59 participants. A convenience sampling method was used. A total of 228 individuals were assessed for eligibility based on the inclusion criteria. Of these, 110 were excluded for various reasons. Overall, 118 mothers participated in the study. The majority of these participants were mothers of exclusively breastfed infants who were referred from the thyroid unit to the breastfeeding counseling unit due to breastfeeding issues. In the counseling unit, the consultant explained to them that they could receive counseling in two ways (routine center counseling and intervention based on the IMB model). If they met the inclusion criteria and provided informed consent, they were randomly assigned into blocks of two and placed in two groups (routine breastfeeding counseling and IMB model-based intervention).\u003c/p\u003e \u003cp\u003eInclusion Criteria: Infants from birth to 10 days old، Mothers with no medical contraindications to breastfeeding[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] ، Mothers without untreated psychiatric disorders، Mothers not taking medications contraindicated for breastfeeding، Iranian or Farsi-speaking Afghan mothers، Urban residence، All participants had official marriages، Reasons for the mother's visit included engorgement, nipple soreness, infant refusal, prematurity, and positioning correction، Infants without congenital diseases، Mothers without addictions، Mothers without rheumatologic or psychiatric diseases، Spousal support for breastfeeding، Mothers either housewives or employed but on maternity leave and Singleton infants.\u003c/p\u003e \u003cp\u003eExclusion Criteria: Discontinuation of exclusive breastfeeding or initiation of bottle-feeding, Non-cooperation in completing questionnaires and monitoring study indicators post-intervention at 2, 4, and 6 months [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], Mothers following specific dietary or exercise regimens for weight loss, unless these do not interfere with breastfeeding, Diseases that clearly interfere with breastfeeding, such as Sheehan's syndrome and Refusal to continue breastfeeding due to hospitalization for neonatal jaundice management.\u003c/p\u003e \u003cp\u003eIntervention:\u003c/p\u003e \u003cp\u003eBreastfeeding counseling focused on proper breastfeeding techniques based on the Information-Motivation-Behavioral Skills (IMB) model to enhance certain health indicators for mothers and infants. The first session was conducted in-person immediately after sampling. If the problem persisted, the mother returned the next day for another in-person session. If the mother did not return, the counselor contacted her via virtual networks within 1\u0026ndash;3 days. Virtual contact was coordinated with the mother, and if not possible, a phone call was made. Follow-ups were scheduled for 7, 14, and 21 days after the mother\u0026rsquo;s initial visit (the days were counted from the visit date, not postpartum).\u003c/p\u003e \u003cp\u003e \u003cb\u003eResearch Tools\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDemographic Information Questionnaire\u003c/b\u003e: Included factors significantly affecting breastfeeding quality and quantity, such as mother's age, education, occupation, spouse's education, spouse's occupation, family monthly income, number of children, infant's gender [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], planned or unplanned pregnancy, previous breastfeeding experience, delivery method (vaginal vs. cesarean), initiation of feeding within the first hour, birth weight, and feeding type at the time of the mother's visit[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] .\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eWHO Breastfeeding Observation Form\u003c/b\u003e: Assesses various health aspects of the mother and infant: Mother\u0026rsquo;s health, her interaction with the infant, and any potential issues, Infant\u0026rsquo;s health, willingness to breastfeed, and any potential issues, Early establishment of milk flow and infant's eagerness to breastfeed, Proper infant holding technique, Breastfeeding method, duration, and frequency, Latching technique, Normal urination and defecation patterns in the infant, Infant\u0026rsquo;s sucking pattern and Mother's breast condition (nipple type, pain during breastfeeding, engorgement, and breast maintenance technique).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eEach aspect is scored from 0\u0026ndash;1 (No, Yes) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLatch Score\u003c/b\u003e: Evaluated using the LATCH questionnaire through direct observation. The LATCH tool includes 5 components: latch, audible swallowing, nipple type, breast condition, and positioning during breastfeeding. Scored on a Likert scale from 0\u0026ndash;2 (Poor, Fair, Good)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The LATCH score was developed in 1994 by Jensen, Wallace, and Kelsay to assist health professionals in assessing breastfeeding techniques. Its reliability and validity were confirmed by Yenal and Okumus in 2003, with a Cronbach's alpha of 94\u0026ndash;96%[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] .\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eInfant Behavior Questionnaire (IBQ)\u003c/b\u003e: Assesses the temperament of infants aged 3\u0026ndash;12 months. Originally designed by Rothbart in 1981, the IBQ's Cronbach's alpha ranges from 77\u0026ndash;96% across different samples and cultures[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Validity has been confirmed in Persian by Hosseini in Iran[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The questionnaire consists of 37 questions.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eEdinburgh Postnatal Depression Scale (EPDS)\u003c/b\u003e: Consists of 10 items with four response options, designed to measure postpartum depression[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Developed by Cox et al. in 1987, the EPDS was translated into Persian by Montazeri in 2007 with a Cronbach's alpha of 70% and confirmed validity[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The scale's Cronbach's alpha is 0.82 for the Spanish version, 0.76 for the French version, and 0.77\u0026ndash;0.83 for the Iranian version, with 87% validity and 95% specificity [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Scores above 10 indicate minor to major depression, necessitating referral to psychological counseling. Scores above 16 indicate major depression, leading to exclusion from the study[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eHealth Indicators for Mothers and Infants:\u003c/h2\u003e \u003cp\u003eWeight and height were measured using reliable tools: scales and meters. The scales were calibrated with standard weights (2 kg for mothers, 500 g for infants), and meters were validated with standard wooden rulers. Measurements were taken with minimal clothing and no shoes during counseling unit visits by trained consultants [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Infant weights were measured using digital flat scales (seca 874, Germany, capacity 200 kg). Infant length was measured using measuring boards (seca 417, Germany, range 10\u0026ndash;100 cm), and adult height was measured with stadiometer (seca 213, Germany, range 20\u0026ndash;205 cm) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Mothers\u0026rsquo; blood pressure was measured using a calibrated and standardized sphygmomanometer while seated after 5 minutes of rest[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] .\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eQuantitative variables were described using mean and standard deviation, while qualitative variables were reported as frequency and percentage. To compare variables between the two groups at each time point, chi-square tests, independent t-tests (or Mann-Whitney tests), and generalized linear regression models with GEE estimation were used to examine the response variables over time. A significance level of 0.05 was considered. The software used was SPSS version 27.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the consort flow diagram of the study. The two groups were comparable in terms of demographic variables (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea t 1b.\u003c/p\u003e\n\u003ch3\u003eDescriptive Characteristics of Research Variables\u003c/h3\u003e\n\u003cp\u003eThe mean scores for the variables of early screening (3\u0026ndash;5 days), newborn holding status, feeding method, breastfeeding latch, sucking method, breast condition, and the total score on the WHO breastfeeding observation form, as well as the variable of potential maternal problems, were significantly higher in the intervention group compared to the routine counseling group (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the intervention group, significant differences were observed in postpartum depression scores (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05), maternal body mass index (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05), lip latch, hearing swallowing sounds, need for support and assistance, and the total score on the LATCH questionnaire compared to the routine counseling group (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eComparison of Quantitative Variables Over Time by Group Using the Friedman Test\u003c/h3\u003e\n\u003cp\u003eIn both the routine counseling group and the intervention group, the score for the adequacy of the mother's condition did not show significant statistical changes over time (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, in both groups, the scores for the adequacy of the child's condition, early screening (3\u0026ndash;5 days), breastfeeding method, infant defecation (under one month), sucking method, breast condition, total score of the WHO breastfeeding observation form, postpartum depression, maternal blood pressure, maternal body mass index (BMI), infant weight, and LATCH questionnaire showed statistically significant changes over time (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, in the intervention group, the scores for holding the infant and breast latching showed significant statistical changes over time (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no significant statistical difference in infant behavior scores between the routine and intervention groups (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea t 2c\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness of the Intervention Over Time\u003c/h2\u003e \u003cp\u003eBased on the results of fitting the regression model using the GEE estimation method, the significance of the interaction effect of intervention*time indicates that the scores for postpartum depression, maternal BMI, LATCH questionnaire, child\u0026rsquo;s condition, early screening (3\u0026ndash;5 days), holding the infant, breastfeeding method, breast latching, sucking condition, breast condition, and the total score of the WHO breastfeeding observation form showed significant changes over time in the intervention group compared to the routine counseling group (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003ea t 3c\u003c/p\u003e \u003cp\u003eGiven the non-significance of the interaction effect of intervention*time, there were no significant differences in the scores for infant weight, maternal blood pressure, general condition of the mother and infant, and infant defecation over time between the intervention and routine counseling groups (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Characteristics of the WHO Breastfeeding Observation Form in Routine Counseling and Intervention Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRoutine Counseling\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTest statistics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFavorability of the mother's condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePotential Maternal Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFavorability of the child's condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInfant's Potential Problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEarly Screening (3\u0026ndash;5 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-4.485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePosition of hugging the baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-9.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHow to drink milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBreastfeeding position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-9.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eExcretion of the baby (under one month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHow to suck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eThe condition of the breasts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-5.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-6.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTotal score of the WHO Breastfeeding Observation Form\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e64.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73.956\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eIndependent sample t test\u003csup\u003e**\u003c/sup\u003eMann-Whitney test, \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive characteristics of research variables in two groups of routine counseling and intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRoutine Counseling\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003csup\u003eTest statistics\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePostpartum depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMother's blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e0.943\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMaternal body mass index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eInfant weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3095.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e514.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3132.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e416.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5080.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e685.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5257.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e609.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6581.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e734.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6638.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e782.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7559.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e799.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7625.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e898.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eInfant behavior at the end of 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e189.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.859\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eIndependent sample t test\u003csup\u003e**\u003c/sup\u003eMann-Whitney test, \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive characteristics of the Latch questionnaire in two groups of routine counseling and intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRoutine Counseling\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003csup\u003eTest statistics\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLocking of the lips\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-9.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHearing the sound of milk swallowing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.904\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-9.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003enipple type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003emother's comfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNeed support and help\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-7.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eThe total score of the Latch questionnaire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-7.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 months after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eIndependent sample t test\u003csup\u003e**\u003c/sup\u003eMann-Whitney test, \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAt the beginning of this study, the average blood pressure (mean systolic and diastolic) was similar between the two groups and was normal in the early postpartum days. Over time, blood pressure decreased within the normal range in both groups. During pregnancy, physiological changes occur to support the growth needs of the fetus. Postpartum breastfeeding reverses this metabolic change to the pre-pregnancy state, leading to a decrease in systolic and diastolic blood pressure. Pre-pregnancy cardiometabolic health factors affect breastfeeding capacity, initiation, and continuation, which can explain the relationship between breastfeeding and maternal cardiometabolic health postpartum[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Increased breastfeeding frequency and duration significantly reduce the risk of developing hypertension at ages 42\u0026ndash;65 years [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe cardioprotective benefits associated with breastfeeding are greater in women with hypertensive disorders during pregnancy compared to those with normal blood pressure. Six to nine months of breastfeeding in women with hypertensive disorders during pregnancy leads to a reduction of 5 mmHg in diastolic blood pressure and mean arterial pressure compared to those who did not breastfeed. A 2 mmHg decrease in diastolic blood pressure reduces the risk of stroke by 14% and coronary heart disease by 6%[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, postpartum depression significantly decreased in the intervention group compared to the control group. If a mother scored above the cut-off point on the questionnaire, she was referred to a psychologist (according to routine care). Mothers who visited the center's psychologist and received individual counseling continued exclusive breastfeeding, whereas those who refused psychological consultation opted for mixed or artificial feeding. In the intervention group, targeted counseling, regular follow-ups, and information provided during counseling sessions increased motivation and empowerment for behavior change, leading to a return to or continuation of exclusive breastfeeding, which reduced depressive moods and promoted breastfeeding continuation[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. There is a direct relationship between postpartum depression and artificial feeding, and the risk of breastfeeding cessation in the first year is 25.1 times higher in depressed mothers compared to non-depressed ones[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Breastfeeding challenges such as nipple pain, engorgement, and sores due to improper latch can reduce milk transfer and successful breastfeeding initiation, affecting maternal self-efficacy and confidence, and increasing the risk of negative mental health symptoms. If these challenges are not resolved, they can shorten the duration of breastfeeding and increase postpartum depression, as observed in our study [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the routine group, correct education and encouragement for exclusive breastfeeding are typically conducted in one session. However, in the IMB-based counseling model, follow-ups and timely interventions resolved breastfeeding issues earlier. These interventions and proper breastfeeding techniques allowed mothers in the intervention group to lose pregnancy weight faster than those in the routine group[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Mothers who received regular and targeted breastfeeding counseling based on Rogers' counseling model showed greater weight loss compared to the control group due to increased knowledge, confidence, and breastfeeding frequency, which can be attributed to increased metabolism from breastfeeding and encouragement towards a healthier lifestyle[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Breastfeeding reverses metabolic changes from pregnancy and positively impacts postpartum weight loss, which can vary. The type and method of breastfeeding affect weight loss, with each additional week of exclusive breastfeeding resulting in greater weight loss. In our study, greater maternal weight loss was observed due to proper positioning and latching based on the IMB model[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, in both groups, proper education (at least one session of proper education for the routine counseling group) resulted in the growth and weight gain of infants. However, in the intervention group, due to proper positioning and latching based on the IMB model, timely, targeted counseling, and improvement of maternal functional capacity, correct breastfeeding behaviors were established and maintained, resulting in higher growth rates and greater weight gain. Exclusively breastfed infants are expected to double their birth weight by 4\u0026ndash;5 months of age; this weight gain was observed in the intervention group infants[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegular and targeted breastfeeding counseling based on the Rogers counseling model had positive effects on infant growth, likely due to better and more frequent feeding, which promoted both physical and mental growth of the infants[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Around four months of age, mothers often encounter infants refusing breast milk at previous intervals, which is a natural physiological process where the infant does not demand milk as frequently as before. The infant feeds as desired, and this reduced demand may be due to increased secretion of leptin in breast milk, decreasing the infant's appetite, lengthening feeding intervals, and balancing the infant's weight[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is essential to note that some mothers in the intervention group, despite receiving education and proper breastfeeding methods, continued mixed feeding (breast milk and formula) up to two months. These infants showed significant weight gain at two months, attributed to excessive formula intake. Educating parents steered infant feeding towards exclusive breastfeeding. Formula-fed infants, due to lack of proper education on formula use and short feeding intervals, often experience digestive issues[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Proper education and breastfeeding techniques serve as protective factors against later overweight and obesity in infants[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, there was no significant difference in infant behavior between the routine counseling and intervention groups at six months. It appears that the mother-infant relationship during breastfeeding and the attachment formed through breastfeeding are significant. Numerous factors determine an infant\u0026rsquo;s behavior at six months. Breastfed infants exhibit better mood regulation and, due to the strong bond between mother and infant, experience better cognitive-social development and physical growth at three years of age[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Breast milk contains key factors for the infant's (neural, mental) and (psychomotor) development. Infants breastfed for at least 3\u0026ndash;4 months exhibit fewer behavioral disorders in childhood and adolescence, and the close physical and emotional bond between mother and infant during breastfeeding promotes cortisol secretion, influencing the child\u0026rsquo;s socialization. Emotional intelligence develops when the infant is held by the mother and breastfed[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIneffective breastfeeding methods are a major cause of various breastfeeding issues. The primary breastfeeding problems in this study stemmed from incorrect and improper techniques. The breastfeeding observation form assesses numerous areas. Key factors for continued breastfeeding include holding the infant, breastfeeding method, latching, and infant sucking. All these areas improved over time, at two and four months, compared to the first visit in both groups. However, the intervention group showed better overall scores due to the facilitation of behavior formation and institutionalization of education through the counseling model[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Continuous breastfeeding counseling enhances knowledge, health beliefs, breastfeeding behavior, maternal performance, and ultimately the continuation of exclusive breastfeeding, with improvements seen over time from the first visit[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Supporting the mother, timely and proper education, appropriate techniques, and consistent education at suitable intervals lead to improvement, promotion, initiation of breastfeeding, maintenance of exclusive breastfeeding, and continuation of breastfeeding[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA low LATCH score serves as a warning indicator for breastfeeding consultants to intervene promptly to promote and sustain exclusive breastfeeding. In this study, mothers with breastfeeding issues had low LATCH scores at the first visit. Proper education was provided in the first session, and mothers in the routine group also received proper education and encouragement for exclusive breastfeeding, usually in one session. The LATCH score improved at two and four months compared to the first visit in both groups, but the intervention group showed greater improvement due to the educational model and regular follow-ups, enhancing the mothers' skills in proper latching. Correct latching postpartum, at 24 and 48 hours, and at discharge significantly boosts maternal confidence[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Exclusive and continued breastfeeding are directly related to the LATCH score. Benefits of proper latching include reduced breastfeeding duration, increased milk energy intake, early satiety, appropriate weight gain, better sleep, improved breast emptying, increased milk supply, reduced bloating, vomiting, and colic pains, and faster nipple sore healing[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the statistical results, the rate of exclusive breastfeeding increased over time in the intervention group, showing a better status compared to the routine group, potentially due to the IMB educational model. The rate of mixed feeding decreased over time in the intervention group, indicating the possibility of shifting from mixed to exclusive breastfeeding with targeted counseling using an appropriate educational model. Although this increasing trend was not statistically significant, possibly due to a small sample size.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBreastfeeding knowledge creates a more positive and committed feeling in mothers, enhancing their attitude and motivation towards breastfeeding, affecting self-efficacy, breastfeeding ability, and the decision to initiate and continue breastfeeding. Proper breastfeeding education (correct positioning and latching) and the institutionalization of this education lead to successful exclusive breastfeeding. This study, for the first time in Iran, demonstrated that continued breastfeeding education, evaluation and correction of breastfeeding status, and comprehensive breastfeeding support based on the Information-Motivation-Behavioral Skills (IMB) model had a better impact on maternal BMI, postpartum depression, and infant weight compared to routine breastfeeding counseling at a counseling center.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e Ethics approval was obtained (IR.KMU.REC.1402/012) from the Ethics Committee of Kerman University of Medical Sciences. Participants were assured of confidentiality and anonymity. The study protocol was registered in the Iranian Clinical Trial Registry (IRCT20170611034452N15/(registration date: 2023-04-28)). Human Ethics and Consent to Participate declarations: All of the intervention process was in the line with the Helsinki declaration.\u003c/p\u003e \u003ch2\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eAll authors declare no competing interest\u003c/p\u003e \u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research is funded by Reproductive and family health research center, Kerman University of Medical sciences (grant number: 401000656)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.A.A. data collection, first draftS. H.M. data analysisA.A. last draft, supervising and training\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThanks a lot from Reproductive and family health research center, Kerman University of Medical Sciences to support this research.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData will be available per request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNduagubam OC, et al. Assessment of breastfeeding techniques in Enugu, south-east Nigeria. Ann Afr Med. 2021;20(2):98\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/aam.aam_22_20\u003c/span\u003e\u003cspan address=\"10.4103/aam.aam_22_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRapheal SM, et al. 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Assessment Tool by UNICEF and LATCH Scoring System for Identification of Inadequacy of Breastfeeding in Early Neonatal Period: An Observational Cross-sectional Comparative Study. J Neonatology. 2024;09732179241239808. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/09732179241239808\u003c/span\u003e\u003cspan address=\"10.1177/09732179241239808\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriffin CMdC, et al. LATCH as a systematic tool for assessment of the breastfeeding technique in maternity. Acta Paulista de Enfermagem. 2022;35(14):eAPE03181. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.37689/acta-ape/2022AO03181\u003c/span\u003e\u003cspan address=\"10.37689/acta-ape/2022AO03181\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breastfeeding counseling, IMB model, maternal and infant health indices","lastPublishedDoi":"10.21203/rs.3.rs-5306640/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5306640/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eobjectives\u003c/h2\u003e \u003cp\u003eThis study compares the impact of breastfeeding counselling based on the Information-Motivation-Behavior model (IMB) with routine counselling at the breastfeeding counselling center on certain health indices of mothers and their infants.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe present study is a clinical trial using a convenient sampling method conducted randomly on the referred mothers and their infants. Participants were allocated into two groups \"routine counseling at the breastfeeding counseling center\" and \"breastfeeding counseling based on the Information-Motivation-Behavior Model\" (59 mothers and their infants in each group). Demographic information, WHO breastfeeding observation form, latch assessment form, infant weight, maternal body mass index (BMI), blood pressure, and postpartum depression questionnaire were filled. Outcomes were reassessed at 2, 4, and 6 months of children\u0026rsquo;s age for both groups. The infant behaviour questionnaire was completed only at 6 months.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was no significant difference in demographic variables between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In both the routine and intervention groups, maternal blood pressure showed statistically significant changes over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the intervention group, there were significant differences in postpartum depression scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), maternal BMI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), infant weight scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), latch assessment scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and total score of the WHO breastfeeding observation form (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared to the routine counselling group. There was no significant statistical difference in infant behaviour scores between the routine and intervention groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eApplication of counselling with the IMB model can motivate correct breastfeeding behaviours and improve maternal and infant health indices\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eThis trial is registered with the Iranian Registry of Clinical Trial with the identifier IRCT20170611034452N15 (registration date 20230428)\u003c/p\u003e","manuscriptTitle":"Investigating the effect of breastfeeding counselling based on Latch, Position and Information-Motivation-Behavior Model on maternal and neonatal indices: A clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 12:04:45","doi":"10.21203/rs.3.rs-5306640/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-17T12:30:34+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"218117718054783879690713088622792723763","date":"2024-12-16T10:15:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262048284255990672916261082722694909733","date":"2024-12-13T19:14:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-12T19:41:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221723388546439211412202664017334208387","date":"2024-12-12T09:16:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140360010476627909825559371904909969990","date":"2024-12-11T17:05:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333668187679067629856522859486025485182","date":"2024-11-18T19:59:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-15T00:31:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148580004029389202606138332110791889032","date":"2024-11-13T20:19:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49242938988365649405863676669878709831","date":"2024-11-12T20:49:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-12T15:48:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-28T11:00:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-26T05:56:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-26T05:54:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-10-21T18:54:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ea2ee2e-5063-4038-b582-f3f82469814f","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:11:28+00:00","versionOfRecord":{"articleIdentity":"rs-5306640","link":"https://doi.org/10.1186/s12884-025-07679-w","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-05-31 15:57:36","publishedOnDateReadable":"May 31st, 2025"},"versionCreatedAt":"2024-11-15 12:04:45","video":"","vorDoi":"10.1186/s12884-025-07679-w","vorDoiUrl":"https://doi.org/10.1186/s12884-025-07679-w","workflowStages":[]},"version":"v1","identity":"rs-5306640","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5306640","identity":"rs-5306640","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}