What self-efficacy looks like in breastfeeding
Breastfeeding self-efficacy refers to a parent’s confidence that they can breastfeed successfully. It is one of the strongest predictors of breastfeeding duration and exclusivity, and importantly, it can be strengthened through support.
To measure this, researchers developed the Breastfeeding Self-Efficacy Scale (BSES) and a shorter, easier-to-use version known as the BSES-SF (Short Form). These tools assess how confident a parent feels about their ability to feed and allow professionals to track how different types of support influence confidence and outcomes over time.
Why self-efficacy matters for outcomes
Higher self-efficacy is consistently associated with longer breastfeeding duration and exclusivity. A number of meta-analyses and updated reviews show that parents who receive self-efficacy-focused interventions are more likely to still be breastfeeding one to two months postpartum, with benefits that persist when ongoing support is provided.
What boosts breastfeeding self-efficacy
The strongest gains come from support that is timely, practical, and confidence-building.
Postnatal support has greater impact on self-efficacy than education alone in pregnancy, particularly when delivered in the first days and weeks.
Skin-to-skin and protected early initiation help parents see small wins, which directly build confidence. Recent evidence reinforces this. The March 2025 report from NHS Digital shows uptake of skin-to-skin contact within one hour of birth in England for babies born at ≥37 weeks. NHS England Digital The updated 2025 Cochrane Collaboration review found that infants who had immediate skin-to-skin with mother were more likely to breastfeed exclusively at one month, and recommended making skin-to-skin the global standard of care. Cochrane
Partner and social support are key. Trials using partner involvement and tailored messaging show improvements in both breastfeeding self-efficacy and maternal mood.
What gets in the way
Two barriers tend to show up in practice:
Turning guidance into deadlines. For example, skin-to-skin and early feeding support are recommended, but when staff interpret this as “must feed by one hour or else” the result is often early supplementation with formula for babies who are simply taking their time. That undermines self-efficacy and milk supply.
Information without coaching. Giving handouts or advice alone rarely shifts belief. Confidence grows when parents experience measurable progress, reflect on it, and are supported to take the next actionable step.
Measuring self-efficacy to tailor support
The BSES-SF is a short, validated instrument suitable for clinical and community settings. It helps identify parents who may benefit from targeted confidence-building and gives teams a way to evaluate whether their support is working.
Coaching moves that build self-efficacy
These link directly to our work in the Advanced Perinatal Coaching Skills Certification:
Elicit recent wins. Ask: “What went a little better today than yesterday?” Recognising progress strengthens mastery experiences.
Normalise the learning curve. Reframe early challenges as part of the process rather than signs of failure.
Coach the next specific action. Agree one small, practical goal before the next contact. Follow up to reflect progress.
Use guided practice. Help the parent do the positioning, try the latch, and reflect on how it felt under your coaching.
Enlist partner support. Give partners concrete roles that reinforce the parent’s capability rather than replace it.
Avoid unnecessary supplementation. Offer formula only when clinically indicated, not because of a perceived “deadline”. Skin-to-skin and feeding support should be maximised. The recent Cochrane review frames skin-to-skin as standard practice. Cochrane
Antenatal versus postnatal: where to focus
While antenatal education is useful, the strongest improvements in self-efficacy and feeding behaviour happen when structured support continues into the postnatal period and is timely. Updated reviews show that skilled breastfeeding support improves both any and exclusive breastfeeding up to six months.
Quick checklist for practitioners
Protect uninterrupted skin-to-skin contact and support early feeding without imposing a strict deadline.
Use a simple confidence tool such as the BSES-SF to identify needs.
Focus on one actionable goal per contact with follow-up.
Involve partners with defined supportive roles.
Do not recommend formula for a healthy baby simply because feeding hasn’t happened within a specified time. Assess and support first.
Use the NHS Digital skin-to-skin contact data to benchmark local practice and plan improvements. NHS England Digital
How this connects to coaching skills
In the Advanced Perinatal Coaching Skills Certification we teach practitioners how to build self-efficacy in real time. Through reflective listening, strength-based questioning, structured debriefs and action-planning, you learn how to transform “I can’t” into “I’m doing this” for parents — and that shift underpins better outcomes.
References
- Bandura A. Self-Efficacy: The Exercise of Control. W. H. Freeman; 1997.
- Dennis C-L. The Breastfeeding Self-Efficacy Scale: psychometric assessment of the short form. Research in Nursing & Health. 2003;26(4):256–264.
- Brockway M, et al. Interventions to improve breastfeeding self-efficacy: systematic review. 2017; DOI: 10.1097/01.mss.0000517901.16471.88
- Patnode CD, et al. Interventions to support breastfeeding: updated evidence review. JAMA. 2025; DOI: 10.1001/jama.2024.27267
- NHS Digital. Skin-to-skin contact by delivery method from the Maternity Services Data Set: England, Jan-Dec 2023 and Jan-Dec 2024. 17 March 2025. Available at: https://digital.nhs.uk/
supplementary-information/ 2025/skin-to-skin-contact-by- delivery-method-from-the- maternity-services-data-set NHS England Digital
- Cochrane Collaboration. Strong evidence supports skin-to-skin contact after birth as standard care. 2025. Available at: https://www.cochrane.org/
about-us/news/strong-evidence- supports-skin-skin-contact- after-birth-standard-care Cochrane
