Breastfeeding self-efficacy as a mediator between sense of coherence and perception of milk supply among postpartum women: a cross-sectional study

Background Concerns about insufficient milk are a common reason for supplementation and breastfeeding cessation. The H&H Lactation Scale (HHLS) captures a broad maternal appraisal of lactation that includes confidence, perceived infant satiety, and satisfaction. We examined the cross-sectional association of sense of coherence with HHLS total and domain scores and estimated the indirect association through breastfeeding self-efficacy. Methods This single-center cross-sectional study included 255 women attending a routine one-month postpartum follow-up. Sense of coherence, breastfeeding self-efficacy, and perception of milk supply were measured using the SOC-13, BSES-SF, and Chinese-language HHLS, respectively. Analyses included hierarchical regression, domain-specific path models, and 5,000-resample bootstrap estimates under parsimonious and expanded adjustment specifications. Sensitivity analyses excluded women currently formula feeding. Results SOC was positively associated with BSES-SF and HHLS total scores. Adding BSES-SF increased explained variance in HHLS total score from 10.4 to 36.1%. The parsimonious indirect estimate was 0.187 (bootstrap 95% CI 0.097 to 0.299), and the expanded estimate was 0.044 (−0.002 to 0.108). Indirect associations were evident for HHLS Maternal confidence/commitment (0.086, 0.036 to 0.152) and satisfaction (0.102, 0.057 to 0.155), but not infant satiety (−0.001, −0.021 to 0.019). After excluding 48 women currently formula feeding, the corresponding estimates remained positive in both the parsimonious (0.199, 0.102 to 0.323) and expanded (0.061, 0.004 to 0.147) models. Conclusion Breastfeeding self-efficacy was related to mothers’ broader appraisal of lactation, particularly confidence and satisfaction, and the principal pattern remained among women who were currently breastfeeding. The findings did not extend to perceived infant satiety and do not establish temporal mediation. BSES-SF may complement, but should not replace, clinical assessment of lactation and infant intake.