Breastfeeding self-efficacy in Italian mothers: the role of attachment, parental stress, and feeding practices

Background Breastfeeding self-efficacy, defined as a mother’s confidence in her ability to breastfeed, is a central psychological determinant of breastfeeding initiation, duration, and exclusivity. Although widely studied, fewer investigations have examined breastfeeding self-efficacy within an integrated framework that simultaneously considers contextual, experiential, and psychological factors. The present study aimed to identify the main predictors of breastfeeding self-efficacy in a large sample of Italian mothers. Methods This cross-sectional study included 500 Italian mothers who were currently breastfeeding, either formula-free or in combination with formula feeding. Data were collected through a web-based survey assessing sociodemographic characteristics, childbirth-related variables, feeding practices, and breastfeeding-related informational support. Standardized measures included the Breastfeeding Self-Efficacy Scale-Short Form, the Maternal Postnatal Attachment Scale, the Maternal Self-Efficacy Questionnaire, and the Parenting Stress Index–Short Form. Hierarchical multiple regression analyses were conducted to examine predictors of breastfeeding self-efficacy. Results Higher breastfeeding self-efficacy was significantly associated with formula-free breastfeeding, initiation of complementary feeding while breastfeeding was ongoing, older infant age, multiparity, and receipt of postpartum breastfeeding information from healthcare professionals. In addition, higher general maternal self-efficacy predicted higher breastfeeding self-efficacy, whereas greater parental stress predicted lower confidence. Feeding-related variables accounted for the largest incremental proportion of explained variance. Conclusions Breastfeeding self-efficacy emerges as a multidimensional construct shaped by feeding practices, experiential factors, and maternal psychological functioning. Interventions aimed at enhancing breastfeeding outcomes should integrate practical postpartum support with strategies addressing maternal confidence and stress regulation, particularly among first-time mothers.