Measuring the Milk of Confidence: A Review of Two Breastfeeding Self-Efficacy Scales

Background: While U.S. breastfeeding rates have recently improved, rates after initiation significantly decline. Therefore, there is a growing focus on modifiable factors that could increase breastfeeding exclusivity and duration. One such influence is a mother's level of self-efficacy. The Breastfeeding Self-Efficacy Scale (BSES) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) are the most consistently used measures of breastfeeding self-efficacy. The objective of this review was to examine how these scales have been administered, and the associated results, in order to identify promising ways to augment breastfeeding self-confidence. Methods: Article searches used Web of Science and PubMed databases. Forty relevant and timely studies were identified, all of which reported using the BSES or BSES-SF as instruments and focused on outcomes of breastfeeding self-efficacy. Results: Existing research supported the reliability and validity of the BSES and BSES-SF, as well as the benefits of using these scales to predict breastfeeding duration and exclusivity. In addition, studies showed that these scales can be used in an intervention context as affirmative sources of verbal persuasion to improve a mother's self-evaluation. Conclusions: This review confirmed the use of the BSES and BSES-SF to assess maternal self-confidence, not only as predictors of breastfeeding success, but also as techniques to increase self-efficacy. Future research should focus on measurement consistency and more diverse samples. Altering social norms to include a focus on maternal confidence could also generate a positive impact on breastfeeding outcomes.