The mediating role of comfort in the relationship between social support and breastfeeding self-efficacy among primiparous mothers after cesarean

Int J Gynaecol Obstet. 2026 Feb 24. doi: 10.1002/ijgo.70914. Online ahead of print.

ABSTRACT

OBJECTIVE: Postpartum comfort refers to the mother’s perceived physical, psychospiritual, and sociocultural well-being during the postpartum period. The present study examined the mediating role of postpartum comfort in the effect of perceived social support on breastfeeding self-efficacy among primiparous mothers who had undergone a cesarean delivery.

METHODS: This cross-sectional correlational study was conducted between June 2024 and June 2025 at a university hospital. Data were collected using self-report questionnaires completed by the mothers, including the maternal personal information form, the multidimensional scale of perceived social support (MSPSS), the breastfeeding self-efficacy scale-short form (BSES-SF), and the postpartum comfort scale (PCS). Higher scores indicate higher perceived social support, higher postpartum comfort, and greater breastfeeding self-efficacy. The data were analyzed using hierarchical regression analysis with the Statistical Package for the Social Sciences (SPSS) version 25.0.

RESULTS: In the present study which included 314 primiparous mothers, correlation analysis revealed a moderate positive relationship between total MSPSS and total BSES-SF scores (r = 0.357; P < 0.001), a weak positive relationship between total MSPSS and total PCS scores (r = 0.225; P < 0.001), and a strong positive relationship between total PCS and total BSES-SF scores (r = 0.703; P < 0.001). In the hierarchical regression analysis, Model 1 showed that social support significantly predicted breastfeeding self-efficacy and explained 12.8% of the variance (F_1,312 = 45.623; P < 0.001). In Model 2, when postpartum comfort was added, both variables remained significant predictors, and the explained variance increased to 53.6% (F_2,311 = 179.517; P < 0.001). The standardized effect of social support decreased from β = 0.357 to β = 0.210. The Sobel test (z = 6.26; P < 0.001) confirmed the partial mediating role of postpartum comfort.

CONCLUSION: A substantial part of the effect of perceived social support on breastfeeding self-efficacy is explained by postpartum comfort. The findings indicate integrating strategies that enhance comfort and social support into policies and nursing practices can strengthen maternal-infant health and improve breastfeeding outcomes.

PMID:41732902 | DOI:10.1002/ijgo.70914