Evaluation of Two Midwife-Supported Breastfeeding Positions After Cesarean: A Pilot Randomized Controlled Study

Abstract

Objective:

This study aimed to compare the effectiveness of two different breastfeeding positions (routine cradle hold and modified football hold) with midwife support during the first breastfeeding session after cesarean section. The modified football hold is defined as an innovative position designed to increase maternal comfort and support effective breastfeeding by protecting the incision site.

Method:

The study is a randomized controlled, exploratory pilot study conducted at a public hospital in Türkiye between July 2021 and January 2022. The study included 90 postpartum women in total (45 in the experimental group and 45 in the control group). The groups were randomized using the block randomization method. The experimental group received a modified football hold with midwife support, while the control group received a routine cradle hold. The “Mother and Newborn Information Form” and the “Infant Breastfeeding Assessment Tool (IBFAT)” were used as data collection tools.

Findings:

The sociodemographic and obstetric characteristics of the experimental and control groups did not differ significantly (p > 0.05). In the experimental group, breastfeeding satisfaction was significantly higher (very satisfied: 68.9%; control: 22.5%) (p < 0.001). There was a statistically significant difference (p < 0.001) between the experimental group’s mean IBFAT scores of 9.48 ± 1.85 and the control group’s 5.95 ± 2.09. The effect size (Cohen’s d = 1.78) was determined to be large.

Conclusion:

During the first breastfeeding session following a cesarean section, the modified football hold was found to be an effective method for increasing maternal satisfaction and promoting breastfeeding success. The effectiveness of breastfeeding and mother–baby bonding is thought to be enhanced by midwives’ use of it in clinical settings. Nevertheless, further research using larger sample sizes and in various centers is required to validate the efficacy of this method.

Keywords

breastfeeding positions cesarean section midwife support

Introduction

Breast milk is a unique food because it helps a baby grow and develop throughout the first 6 months of life, lowers the risk of infection, boosts immunity, and promotes neurodevelopment.^1,2 International health organizations advise initiating breastfeeding within the first hour after birth, providing exclusive breastfeeding for the first 6 months, and continuing breastfeeding with appropriate supplemental foods from the sixth month until at least 2 years of age.^3–5 Starting breastfeeding early after birth, skin-to-skin contact, and correct positioning facilitate effective feeding, accelerate milk production, and ensure that breastfeeding is sustained.^6–9

Cesarean section rates have increased significantly worldwide over the past decade. According to a global analysis by Zaigham et al., one in three babies born in 2030 is expected to be delivered via cesarean section.¹⁰ WHO data indicate that the global cesarean rate was 21.1% between 2010 and 2018, and could reach 28.5% by 2030.¹¹ However, the rates are significantly higher in Türkiye, where the cesarean rate is 57.6%, one of the highest in OECD nations, according to the 2023 Health Statistics Yearbook.^12–13

These high rates complicate the early breastfeeding process after cesarean section; postoperative pain, sedation, delayed mobilization, and mother–infant separation negatively affect effective breastfeeding and bonding.^14–19 Therefore, the midwife plays a crucial role throughout this time. The midwife helps the baby latch onto the breast, helps maintain safe skin-to-skin contact between mother and baby, and ensures proper positioning by taking into account the mother’s pain and fatigue with one-on-one professional support in the early stages.^7,9,16–22 A study conducted in Türkiye found that the duration of first contact and initiation of breastfeeding was long, while the rate of formula milk use was high. These findings emphasize the importance of practical midwife support after caesarean section.²³

Studies in the literature extensively report the advantages and limitations of breastfeeding positions for maternal comfort and infant feeding after cesarean section.^24,25 However, there is a need for systematic evaluation of innovative positions that aim to both increase maternal comfort and facilitate effective breastfeeding in the post-cesarean period. The modified football hold, first described and implemented in this study, was developed to effectively facilitate the first breastfeeding after cesarean section. No studies in the literature have directly examined the effect of position selection with the midwife’s active role on breastfeeding outcomes during the first breastfeeding after caesarean section. In this context, this study aims not only to compare current care practices but also to scientifically evaluate the modified football hold position. It is expected that the findings will provide an evidence-based basis for clinical care protocols for midwife-led position selection after cesarean section and contribute to the literature on a new breastfeeding position. This study aims to compare the effectiveness of two different breastfeeding positions (routine cradle hold and developed modified football hold) with midwife support in the first breastfeeding after cesarean section.

Materials and Methods

This study was developed as an exploratory pilot study utilizing a randomized controlled design to assess the effects of two different breastfeeding positions—the modified football hold and the cradle hold—implemented with midwife support throughout the post-cesarean period on breastfeeding outcomes. Between July 2021 and January 2022, the study was carried out in the obstetrics and gynecology department of a public hospital in Türkiye.

Sample size

In the study, mothers were divided into two groups in a 1:1 ratio: the midwife-assisted cradle hold (control group, n = 45) and the midwife-assisted modified football hold (experimental group, n = 45). Block randomization was used to ensure balance in group numbers. Variable block sizes were used to ensure balance in group distribution and to reduce predictability. Block sizes were determined as 4 and 6, and block orders were randomly arranged on the computer. Medium-sized blocks (6) decreased the chance of guessing, whereas small blocks (4) enabled quick group number balancing. The randomization list was prepared before the study began, and allocation confidentiality was ensured by sequentially numbered, opaque, and sealed envelopes (SNOSE method). For each postpartum woman who met the study’s inclusion criteria and provided written consent, the next envelope was opened immediately before the first breastfeeding session. The intervention was administered by the researcher conducting the study; the postpartum woman was not informed of her group placement (single-blind design) (Fig. 1). Because this was an exploratory pilot study, we did not perform a formal a priori power calculation. A total sample of 90 mothers (45 per group) was judged to be feasible in our setting and sufficient to test the procedures of the trial and to obtain preliminary information on effect sizes and variability that could guide the sample size of a future larger study.

FIG. 1.

Study design.

Intervention

In the experimental group, the intervention was performed using a modified football hold position with midwife support during the first breastfeeding after a caesarean section. In this modified football hold position, the mother was lying comfortably in a supine position with her head slightly elevated on a pillow. The baby was placed along the mother’s longitudinal axis, with the feet directed towards the mother’s shoulder on the side of the breastfeeding breast and the head positioned at the level of the nipple. During breastfeeding, the midwife gently cradled the baby’s head with one hand and guided it towards the breast, while using the other hand to support the baby’s hips and back to maintain stability. The baby was held away from the mother’s abdomen and incision so that she could breastfeed without extra discomfort (Fig. 2).In the control group, the cradle hold position was applied with midwife support as part of routine care during the first breastfeeding after caesarean section (Fig. 3). In this position, the mother was positioned in a semi-sitting or upright sitting position; the baby was placed on her lap parallel to her body, and the head was supported by the mother’s inner elbow. The mother’s other hand supported the baby’s back and hips. The midwife helped the mother maintain the correct position, ensured that the baby’s head and neck were aligned with the breast, and provided support to ensure effective breastfeeding.

FIG. 2.

Modified football hold breastfeeding position with midwife support. Reference: Authors’ own illustration.

FIG. 3.

Cradle hold breastfeeding position with midwife support.³⁶

The implementation process and assessments were standardized. The first breastfeeding session after birth lasted approximately 20 minutes and continued until breastfeeding effectiveness was achieved. A single midwife conducted positioning practices, and environmental and equipment conditions were kept constant.

Data collection method and process

Data were collected using face-to-face interviews with mothers who volunteered to participate in the study and met the inclusion criteria. Participants were first provided with verbal and written information about the purpose, scope, process, and principles of voluntariness of the study, and their written consent was obtained. The “Mother and Newborn Information Form” and the “Infant Breastfeeding Assessment Tool (IBFAT)” were used as data collection tools. The Mother and Newborn Information Form, which included sociodemographic and obstetric characteristics and information about the newborn, was prepared by the researchers based on a literature review.^26,27

Infant Breastfeeding Assessment Tool

The IBFAT, developed by Mary Kay Matthews in 1988, is a measure designed to assess the breastfeeding behavior of newborns in the early postpartum period. Its Turkish validity and reliability study was conducted by Odabaşı and Demirci (2017).²⁸ A 4-item scoring system (0–12) is used to classify breastfeeding adequacy; scores of 0–6 indicate inadequate breastfeeding, scores of 7–9 indicate moderate breastfeeding, and scores of 10–12 indicate effective breastfeeding. Cronbach’s Alpha was used to evaluate the scale’s reliability, and the results showed that the scale had a high level of internal consistency (α = 0.92). The Cronbach’s Alpha coefficient for the scale in this study was determined to be 0.90.

The Mother and Newborn Information Form was completed by the researcher directly. The IBFAT form was given to the mother immediately after the application was completed. To ensure that mothers could complete the scale correctly and consistently, the purpose of the scale, the meaning of the items, and the scoring method were explained to them in a standard explanatory text before they were included in the study. The mother was not intervened during the assessment; the same standardized explanation was repeated only when there were any points of uncertainty. Thus, the researcher effect was minimized during the assessment process, and the objectivity of the measurement was preserved. After data collection, the item scores were entered into SPSS 30.0 software program and total IBFAT scores for each mother were calculated within the statistical software for group comparisons. The flow chart of the study is presented in Figure 1. The entire data collection process was conducted by the same researcher, eliminating any practitioner differences. Data were collected in quiet, distraction-free, and temperature-optimized rooms, respecting the privacy of mothers and infants.

Ethical consideration

Ethical approval was obtained for the research from the Health Sciences Ethics Committee of a public university (approval number/date: 20.478.486/24.07.2019). Written institutional permission (approval number/date: 38006-02/09/2019) was obtained from the relevant healthcare institution before the study began.

All mothers participating in the study were provided with verbal and written information about the purpose, scope, procedures to be performed, potential benefits, and principles of voluntariness. Participants were informed that they could withdraw from the study at any time and that this would not affect the care services they would receive. Written informed consent was obtained from all participants. No personally identifiable information (name, contact details, specific location information) was collected or shared. Data were coded and stored securely, accessible only to the research team. Findings were presented collectively in a manner that did not allow the identification of any participant.

Data collections

The data were analyzed using descriptive statistics, including mean, standard deviation, minimum (min)–maximum (max) values, and percentages. The chi-square test or, where appropriate, the Fisher–Freeman–Halton exact test was used to determine the difference between the sociodemographic and obstetric characteristics of the experimental and control groups. The Mann–Whitney U test was used for group comparisons of continuous variables (age, gestational age, newborn weight, etc.) as the assumption of normal distribution was not met.

The Mann–Whitney U test was used to evaluate group differences in the primary outcome measure, IBFAT total scores. Maternal satisfaction with the breastfeeding position (very satisfied, satisfied, not very satisfied, not satisfied) was analyzed as a categorical variable and compared between the two groups using the chi-square test. The SPSS 30.0 software program was used for all statistical analyses, and a p value of <0.05 was regarded as statistically significant.

Findings

A total of 90 postpartum women participated in this study: 45 were in the experimental group, and 45 were in the control group. No postpartum women refused to participate in the study.

Table 1 presents the sociodemographic and obstetric characteristics of the mothers in the experimental and control groups. The mean age of the mothers in the experimental group was 28.00 ± 5.13 (min = 19, max = 39) years, while the mean age of the mothers in the control group was 27.06 ± 4.00 (min = 20, max = 38) years. When the educational backgrounds were examined, 48.9% of the mothers in the experimental group were primary school graduates, 40.0% were high school graduates, and 11.1% were university graduates; in the control group, these rates were 60.0%, 35.6%, and 4.4%, respectively. In terms of family type, 75.6% of the mothers in the experimental group had a nuclear family and 24.4% had an extended family structure; in the control group, these rates were 71.1% and 28.9%, respectively. When employment status was evaluated, 35.6% of mothers in the experimental group were employed, and 64.4% were unemployed; in the control group, 34.4% were employed, and 65.6% were unemployed. In terms of economic status, 82.2% of mothers in the experimental group reported that their income and expenses were equal, and 17.8% reported that their income was less than their expenses, while in the control group, 84.4% reported that their income and expenses were equal, 11.1% reported that their income was less than their expenses, and 4.4% reported that their income was more than their expenses.

Table 1.

Sociodemographic and Obstetric Characteristics of Mothers

Mother’s characteristics	Experimental groupN (%)	Control groupN (%)	T/X²	p
Age
Mean ± SD	28.00 ± 5.13	27.06 ± 4.00	0.961	0.339
Education level
Primary education	22 (48.9)	27 (60.0)	1.914	0.379^a
High school	18 (40.0)	16 (35.6)
University	5 (11.1)	2 (4.4)
Family type
Nuclear family	34 (75.6)	32 (71.1)	0.227	0.634
Extended family	11 (24.4)	13 (28.9)	0.227	0.634
Employment status
Yes	16 (35.6)	15 (34.4)	0.049	0.824
No	29 (64.4)	59 (65.6)	0.049	0.824
Economic status
Income exceeds expenses	0 (0.0)	2 (4.4)	2.706	0.388^a
Income equals expenses	37 (82.2)	38 (84.4)
Income less than expenses	8 (17.8)	5 (11.1)
Desired status of the pregnancy
Yes	35 (77.8)	37 (82.2)	0.278	0.598
No	10 (22.2)	8 (17.8)	0.278	0.598
Breastfeeding experience
Yes	25 (55.6)	19 (42.2)	1.601	0.206
No	20 (44.4)	26 (57.8)	1.601	0.206
Gestational age
Mean ± SD	38.17 ± 0.53	38.15 ± 0.52	0.200	0.842
Nipple condition
Normal	37 (82.2)	38 (84.4)	1.000^a	0.777
Deep	8 (17.8)	7 (15.6)	1.000^a	0.777

Fisher–Freeman–Halton Exact Test.

SD, standard deviation.

Depending on the desired status of the pregnancy, 77.8% of pregnancies in the experimental group were desired, while 22.2% were undesired; in the control group, 82.2% were desired, and 17.8% were undesired. In terms of breastfeeding experience, 55.6% of mothers in the experimental group had breastfeeding experience, while 44.4% were inexperienced; in the control group, 42.2% had breastfeeding experience, while 57.8% were inexperienced. The mean gestational age was 38.17 ± 0.53 (min = 37, max = 39) in the experimental group and 38.15 ± 0.52 (min = 37, max = 39) in the control group. When assessing nipple status, 82.2% of mothers in the experimental group had normal nipples and 17.8% had inverted nipples; in the control group, 84.4% had normal nipples and 15.6% had inverted nipples. No statistically significant differences were found between the groups in terms of age, educational status, family type, employment status, economic status, desired pregnancy status, breastfeeding experience, gestational age, and nipple characteristics (p > 0.05) (Table 1).

Table 2 presents the characteristics of the newborns of the mothers in the experimental and control groups, the mean time from caesarean section to the initiation of the first breastfeeding was 51.82 ± 10.19 minutes in the experimental group and 51.33 ± 9.37 minutes in the control group (p = 0.813). Time to first breastfeeding (minutes) was defined as the interval between the end of the caesarean section (completion of skin closure) and the start of the first breastfeed (sustained latch with visible sucking). In this study, the time to first breastfeeding, defined as the interval between the baby’s birth time and the start of the first breastfeed (sustained latch with visible sucking), was 51.82 ± 10.19 minutes in the experimental group and 51.33 ± 9.37 minutes in the control group (p = 0.813). The mean birth weights of the newborns were found to be similar, 3201.11 ± 328.12 g in the experimental group and 3167.77 ± 300.02 g in the control group (p = 0.616). When the gender distribution of the newborns was evaluated, 55.6% were female and 44.4% were male in the experimental group; 53.3% were female and 46.7% were male in the control group (p = 0.832). When the Apgar scores were examined, the mean 1st-minute Apgar score was found to be 8.35 ± 0.64 in the experimental group and 8.31 ± 0.63 in the control group (p = 0.742). The 5th-minute Apgar scores were 9.44 ± 0.58 in the experimental group and 9.40 ± 0.57 in the control group. No statistically significant differences were found between the groups in terms of time to first breastfeed, newborn weight, gender, 1st and 5th-minute Apgar scores, or nipple status (p > 0.05). In the experimental group, 4.4% of babies were in deep sleep, 17.8% were sleepy, 40.0% were quiet and awake, and 37.8% were actively crying; in the control group, these rates were 2.2%, 15.6%, 33.3%, and 48.9%, respectively. No statistically significant difference was found between the groups in terms of the infant’s state at the time of breastfeeding (p = 0.726).

Table 2.

Characteristics of Mothers’ Newborns

Newborn characteristics	Experimental groupN (%)	Control groupN (%)	T/X²	p
First breastfeeding time
Mean ± SD	51.82 ± 10.19	51.33 ± 9.37	0.237	0.813
Birth weights
Mean ± SD	3201.11 ± 328.12	3167.77 ± 300.02	0.503	0.616
Newborn gender
Female	25 (55.6)	24 (53.3)	0.045	0.832
Male	20 (44.4)	21 (46.7)	0.045	0.832
1st-minute Apgar score
Mean ± SD	8.35 ± 064	8.31 ± 0.63	0.330	0.742
5th-minute Apgar score
Mean ± SD	9.44 ± 0.58	9.40 ± 0.57	0.362	0.719
Baby’s condition before breastfeeding
Deeply asleep	2 (4.4)	1 (2.2)	1.314^a	0.726
Drowsy	8 (17.8)	7 (15.6)
Quiet and alert	18 (40.0)	15 (33.3)
Active crying	17 (37.8)	22 (48.9)

Monte Carlo Simülation.

When mothers’ breastfeeding satisfaction levels were evaluated, 68.9% of the mothers in the experimental group responded “very satisfied,” 31.1% responded “satisfied,” and none responded “not very satisfied” or “not satisfied.” In the control group, 22.5% of the mothers responded “very satisfied,” 42.2% responded “satisfied,” and 37.8% responded “not very satisfied,” with no “not satisfied” response. A statistically significant difference was found between the two groups in terms of breastfeeding satisfaction levels (p < 0.001; Table 3).

Table 3.

Mothers’ Breastfeeding Satisfaction Level

	Experimental groupN (%)	Control groupN (%)	X²	p
Mothers’ breastfeeding satisfaction level
Very satisfied	31 (68.9)	9 (22.5)	31.623^a	<0.001
Satisfied	14 (31.1)	19 (42.2)
Not very satisfied	0 (0.0)	17 (37.8)
Not satisfied	0 (0.0)	0 (0.0)

Monte Carlo Simülation.

Table 4 shows the mean total IBFAT scores for both groups. A statistically significant difference was found between the experimental and control groups in terms of IBFAT scores (p < 0.001). The mean total IBFAT score in the experimental group was 9.48±(1.85) (median = 10, interquartile range [IQR] = 3, min = 6, max = 12), while in the control group, this value was 5.95±(2.09) (median = 4, IQR = 4, min = 4, max = 9). The effect size (Cohen’s d = 1.78) was found to be quite high; together with its 95% confidence interval (%95 confidence interval: 2.70–4.36; Table 4), this indicates that the modified football hold position with midwife support significantly and strongly supported the first breastfeeding after caesarean section compared to the cradle hold position with midwife support.

Table 4.

Comparison of IBFAT Total Scores of Experimental and Control Groups

IBFAT total score	Mean ± SD	Median (IQR) (min, max)	U	p	Effect size(%95 CI)
Experimental group	9.48 ± 1.85	10 (3) (6,12)	253.000	<0.001	1.78 (2.70–4.36)
Control group	5.95 ± 2.09	4 (4) (4,9)	253.000	<0.001	1.78 (2.70–4.36)

%95 CI, %95 confidence interval; IBFAT, Infant Breastfeeding Assessment Tool; IQR, interquartile range; max; maximum; min, minimum.

Discussion

This study compared the modified football hold (experimental) with midwife support during the first breastfeeding after caesarean section with the cradle hold (control) with midwife support. The groups were similar in terms of sociodemographic and obstetric variables (p > 0.05). This balance enables a more reliable assessment of the impact of position differences on breastfeeding outcomes.

A review of the literature shows that breastfeeding support after a caesarean section enhances both breastfeeding success and the mother’s experience, helping with the continuation of breastfeeding.^22,29–33 Studies on breastfeeding positions suggest that adopting appropriate breastfeeding positions after a cesarean section^33,34 and receiving professional support^29,32 can increase maternal comfort and enhance the breastfeeding experience.

A study by Arora et al. revealed that participants experienced less pain in the L-shaped position compared to the side-lying position during breastfeeding after undergoing a cesarean section.³⁴ Puapornpong et al. found no difference in breastfeeding outcomes between the supine and side-lying positions after a cesarean section.³⁵ According to D’Souza et al., the side-lying posture promoted positive newborn feeding behaviors and enhanced maternal comfort during the post-cesarean period when compared to the cradle hold position.²⁴ A study by Wang et al. found that breastfeeding in the supine position reduced the risk of nipple pain and trauma.²⁵ Pehlivan and Demirel Bozkurt reported that the cradle hold position was preferred and improved breastfeeding outcomes compared to the football hold.³³ However, it also caused more pain at the incision site. The modified football hold evaluated in this study was found to be more effective because it was performed with midwife support and because a modified position protected the incision area, which may have increased breastfeeding effectiveness.

When compared to the control group, the experimental group’s mother satisfaction and IBFAT scores were noticeably higher. This implies that the modified football hold is a successful strategy for starting breastfeeding following a cesarean section when used with the active assistance of the midwife. In addition to providing a position comparison to the literature, this study emphasizes the beneficial breastfeeding experience of a novel application created with the active assistance of the midwife. Therefore, the use of the modified football hold with professional support in breastfeeding after caesarean section can be considered an innovative approach that could make significant contributions to clinical practice.

In the longer term, initiating breastfeeding in a more comfortable position that protects the incision area may help mothers breastfeed for a longer period and maintain breastfeeding more consistently by reducing early difficulties and discouragement. Because the first breastfeeding experience plays an important role in the continuation of breastfeeding, a successful experience may strengthen mothers’ sense of “I can do this,” thereby increasing their breastfeeding self-efficacy and confidence. In addition, feeling physically comfortable and supported during the first post-caesarean breastfeed may contribute to a more positive perception of the birth and early postpartum period. Finally, by facilitating skin-to-skin contact, the modified football hold position may also support the development of the mother–infant bond.

In addition, sociocultural characteristics of the setting may have influenced both women’s preferences for breastfeeding positions and their experiences. Concerns about modesty, expectations about resting after a caesarean, and the presence and involvement of family members may influence how comfortable women feel in different breastfeeding positions and how easy it is for them to maintain a latch. This may help explain why some mothers in our study found the modified football hold more acceptable. Although this study was conducted in a single-country context, the ergonomic principles of the modified football hold—providing better control of the newborn’s head, minimizing pressure on the abdominal incision, and facilitating skin-to-skin contact—are likely relevant in other maternity care settings. Additional research conducted in diverse cultural and organizational contexts could further clarify how sociocultural norms, institutional practices, and midwifery care models affect the implementation of this position and its impact on breastfeeding outcomes.

Conclusion

The modified football hold breastfeeding position may be an effective and practical method for the first breastfeeding after a cesarean section. When midwives use this position in clinical practice, it may lead to increased maternal satisfaction and better breastfeeding outcomes. Additionally, the modified football hold position may facilitate early skin-to-skin contact, allowing for breastfeeding with midwife support in the operating room. This support may enhance mother-baby bonding by increasing oxytocin release. Although evaluated in a single-country setting, the ergonomic principles of the modified football hold are not culture-specific and may be adapted to different clinical and cultural contexts, provided that local care routines and resources are taken into account. Therefore, the modified football hold can be considered a clinical approach with the potential to support breastfeeding success and contribute to the well-being of the mother and baby. More research conducted in different centers with larger and more diverse samples is needed to confirm these findings and strengthen the evidence for the effectiveness of this method. Future research should examine the effectiveness of this position in women who give birth vaginally and explore whether its benefits extend to different modes of delivery. Furthermore, its effectiveness should be examined over longer breastfeeding durations in order to determine whether early use of the modified football hold translates into improvements in breastfeeding exclusivity and continuation in the longer term.

Limitations

This study has some limitations. The study was conducted at a single center with a small sample size, limiting the generalizability of the results. Therefore, further studies are needed with larger samples and across centers. Because the interventions were implemented and evaluated by a single researcher/midwife, having the same researcher and practitioner may pose a risk of bias. Furthermore, breastfeeding was assessed using the IBFAT scale, which was completed independently by mothers, thus reducing researcher influence during the measurement process. As the study focused solely on the first breastfeeding after caesarean section, the findings cannot be directly generalized to mothers who had vaginal births.

Authors’ Contributions

B.O.: Conceptualization, methodology, data curation, formal analysis, investigation, resources, writing—original draft, writing—review and editing. N.B.: Conceptualization, methodology, supervision, project administration, formal analysis, writing—review and editing.

Footnotes

Acknowledgments

The authors would like to thank the administration of the hospital where this study was conducted for their support and all the mothers who voluntarily participated in the research. The authors also extend their gratitude to Muhammed Can Akyürek for his contribution to the illustration of the modified football hold breastfeeding position.

Funding Information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure Statement

The authors declare no conflict of interest.

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