In Situ Simulation in Prenatal Breastfeeding Education: A Pilot Study

Abstract

Spanish

Background:

Breastfeeding education should be initiated during pregnancy. Simulation is an effective educational technique that has been little explored in the context of prenatal education.

Research Aim:

To evaluate the feasibility and effectiveness of an in situ simulation scenario about breastfeeding, as a prenatal educational intervention at home, on breastfeeding self-efficacy and related outcomes.

Methods:

This was a nonrandomized pilot intervention study with pre-test/post-test, conducted from October 2022 to November 2023. Pregnant people who received a home visit that provided an in situ simulation scenario entitled “Breastfeeding the Newborn” during prenatal care (n = 20) were compared to those who received only routine guidance (n = 20). Breastfeeding self-efficacy scores, exclusive breastfeeding rates, and difficulties in breastfeeding 2 months after delivery were evaluated and compared.

Results:

In the intragroup comparisons, a significant increase in breastfeeding self-efficacy scores was found among simulation participants (p < 0.01). Most participants were exclusively breastfeeding (n = 12, 60%) and reported no difficulties (n = 11, 55%) 2 months after delivery. However, no significant differences were found between groups. The findings also demonstrated the feasibility of implementing the in situ simulation scenario “Breastfeeding the Newborn” during the prenatal period.

Conclusions:

This pilot study supports the potential of in situ simulation as an educational approach for prenatal breastfeeding promotion. Further research with larger samples and extended follow-up is recommended to explore its impact on breastfeeding outcomes.

Keywords

breastfeeding Breastfeeding Self-Efficacy Scale (BSES & BSES-SF)educational intervention health education lactation education pilot study prenatal education primary health care self-efficacy simulation training

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References

Abuidhail

Mrayan

Jaradat

(2019). Evaluating effects of prenatal web-based breastfeeding education for pregnant mothers in their third trimester of pregnancy: Prospective randomized control trial. Midwifery, 69, 143–149. https://doi.org/10.1016/j.midw.2018.11.015

Agrina

Sabrian

F., Zulfitri

Herlina

Arneliwati

Dewi

A. P

. (2019). The effectiveness of simulation health education to mother breastfeeding skill between two groups in rural area of Riau, Indonesia. Enfermería Clínica, 29(Suppl. 1), 9–12. https://doi.org/10.1016/j.enfcli.2018.11.006

Axelrod

Ezra

H. L.

Galler

Nir

Ofir

Barkai

Sivan

Mazaki-Tovi

Tsur

(2025). Hybrid remote and in-clinic maternal-fetal surveillance for women with gestational diabetes: A prospective pilot study. International Journal of Gynecology & Obstetrics, 170(1), 430–438. https://doi.org/10.1002/ijgo.16148

Babakazo

Bosonkie

Mafuta

Mvuama

Mapatano

M.-A.

(2022). Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa. PLoS One, 17(10), Article e0275477. https://doi.org/10.1371/journal.pone.0275477

Bandura

(1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191

Barroso

Teixeira

A. B.

Pazin-Filho

Miranda

C. H.

(2023). In-situ simulation of cardiac arrest in ventricular fibrillation for professional nursing training. Medicina (Ribeirão Preto), 56(1), Article e-198580. https://doi.org/10.11606/issn.2176-7262.rmrp.2023.198580

Bitencourt

M. B. S. V.

Soratto

M. T.

(2024). O papel do enfermeiro frente às dificuldades na amamentação no puerpério. Revista Inova Saúde, 14(6), 141–158. https://doi.org/10.18616/inova.v14i6.6747

Buckland

Hector

Kolt

G. S.

Fahey

Arora

(2020). Interventions to promote exclusive breastfeeding among young mothers: A systematic review and meta-analysis. International Breastfeeding Journal, 15, Article 102. https://doi.org/10.1186/s13006-020-00340-6

Camargo

B. T. S.

(2025). Assistência de enfermagem no aleitamento materno [Nursing care in breastfeeding]. Editora Senac São Paulo.

10.

Chaves

A. F. L.

Ximenes

L. B.

Rodrigues

D. P.

Vasconcelos

C. T. M.

Monteiro

J. C. S.

Oriá

M. O. B.

(2019). Telephone intervention in the promotion of self-efficacy, duration and exclusivity of breastfeeding: Randomized controlled trial. Revista Latino-Americana de Enfermagem, 27, Article e3140. https://doi.org/10.1590/1518-8345.2777-3140

11.

Chetwynd

Demirci

Yourkavitch

(2025). Breastfeeding measurement - Considerations when measuring exclusive breastfeeding. Journal of Human Lactation, 41(1), 22–25. https://doi.org/10.1177/08903344241305669

12.

Cocks

Torgerson

D. J.

(2013). Sample size calculations for pilot randomized trials: A confidence interval approach. Journal of Clinical Epidemiology, 66(2), 197–201. https://doi.org/10.1016/j.jclinepi.2012.09.002

13.

Dennis

C. L.

Faux

(1999). Development and psychometric testing of the breastfeeding self-efficacy scale. Research in Nursing & Health, 22(5), 399–409. https://doi.org/10.1002/(sici)1098-240x(199910)22:5%3C399::aid-nur6%3E3.0.co;2-4

14.

Dodou

H. D.

Chaves

A. F.

Pinho

M. A.

Lopes

B. B.

Silva

B. G.

Rodrigues

D. P.

Monteiro

J. C. S.

Oriá

M. O. B.

(2023). Effects of a telephone educational intervention on breastfeeding: A clinical trial. Acta Paulista de Enfermagem, 36, Article eAPE01101. https://doi.org/10.37689/acta-ape/2023AO011011

15.

Dodt

R. C. M.

(2008). Aplicação e validação da breastfeeding self-efficacy scale-short form (BSES-SF) em puérperas [Application and Validation of Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF) in postnatal mothers] [Master’s thesis, Federal University of Ceará]. UFC Institutional Repository. https://repositorio.ufc.br/handle/riufc/2018

16.

Dodt

R. C. M.

Ximenes

L. B.

Almeida

P. C.

Oriá

M. O. B.

Dennis

C. L.

(2012). Psychometric and maternal sociodemographic assessment of the breastfeeding self-efficacy scale - short form in a Brazilian sample. Journal of Nursing Education and Practice, 2(3), 66–73. https://doi.org/10.5430/jnep.v2n3p66

17.

Fernandes

H. R. M.

(2020). Educação em saúde para gestantes: Experiência da implementação de um grupo de gestantes [Health education for pregnant women: Experience of the implementation of a group of pregnant women]. Revista Interdisciplinar em Saúde, 7(1), 1608–1621. https://doi.org/10.35621/23587490.v7.n1.p1608-1621

18.

Gianni

M. L.

Bettinelli

M. E.

Manfra

Sorrentino

Bezze

Plevani

Cavallaro

Raffaeli

Crippa

B. L.

Colombo

Morniroli

Liotto

Roggero

Villamor

Marchisio

Mosca

(2019). Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients, 11(10), Article 2266. https://doi.org/10.3390/nu11102266

19.

Grabowski

Anderson

O. S.

Zielinski

Scott

Hammer

Bassil

Chuisano

S. A.

Sadovnikova

(2020). Midwifery students better approximate their self-efficacy in clinical lactation after reflecting in and on their performance in the LactSim OSCE. Advances in Simulation, 5, Article 28. https://doi.org/10.1186/s41077-020-00143-z

20.

Graminha

P. M. F.

Góes

F. S. N.

Fonseca

L. M. M.

Camargo

R. A. A.

Silva

F. C.

Lima

V. F.

(2020). Comunicação e amamentação: Simulação clínica para educação em enfermagem [Communication and breastfeeding: Clinical simulation for nursing education]. Revista Recien - Revista Científica de Enfermagem, 10(32), 164–174. https://doi.org/10.24276/rrecien2020.10.32.164-174

21.

INACSL Standards Committee. (2021). Onward and upward: Introducing the Healthcare Simulation Standards of Best Practice^TM. Clinical Simulation in Nursing, 58, 1–4. https://doi.org/10.1016/j.ecns.2021.08.006

22.

Kehinde

O’Donnell

Grealish

(2023). The effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum: A systematic review. Midwifery, 118, Article 103579. https://doi.org/10.1016/j.midw.2022.103579

23.

Koukourikos

Tsaloglidou

Kourkouta

Papathanasiou

I. V.

Iliadis

Fratzana

Panagiotou

(2021). Simulation in clinical nursing education. Acta Informatica Medica, 29(1), 15–20. https://doi.org/10.5455/aim.2021.29.15-20

24.

Lojander

Axelin

Niela-Vilén

(2024). Breastfeeding exclusivity, difficulties, and support in the first days after hospital discharge: A correlational study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 296, 76–82. https://doi.org/10.1016/j.ejogrb.2024.02.029

25.

Machado

P. Y.

Silveira-Monteiro

C. A.

Fonseca

N. S. M.

Gomez-Sponholz

F. A.

Ribeiro

P. M.

Calheiros

C. A. P.

Franco

A. P. M. M. L.

Freitas

P. S.

(2023). Orientações sobre amamentação para gestantes do pré-natal na atenção primária à saúde [Guidelines on breastfeeding for pregnant women during prenatal care in primary health care]. Arquivos de Ciências da Saúde da UNIPAR, 27(7), 3862–3879. https://doi.org/10.25110/arqsaude.v27i7.2023-040

26.

Medeiros

L. P.

Sena

J. F.

Rodrigues

M. I.

Nascimento

R. M.

Fonseca

L. M. M.

Costa

I. K.

(2023). Virtual simulation on breastfeeding and nipple-areolar lesions: Prototype development and validation. Acta Paulista de Enfermagem, 36, Article eAPE02502. https://doi.org/10.37689/acta-ape/2023AO025022

27.

Ministério da Saúde. (2017). Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS) (Portaria nº 2.436, de 21 de setembro de 2017) [Approves the National Primary Health Care Policy, establishing revised guidelines for the organization of Primary Health Care within the Unified Health System (UHS) (Ordinance No. 2,436, September 21, 2017)]. Ministério da Saúde. https://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prt2436_22_09_2017.html

28.

Moura

R. M. G.

Neto

U. R. M.

(2020). As tecnologias educacionais em saúde na promoção e proteção do aleitamento materno [Health educational technologies in the promotion and protection of breastfeeding]. Revista Eletrônica Acervo Saúde, 12(10), Article e5058. https://doi.org/10.25248/reas.e5058.2020

29.

Natarelli

T. R. P.

Campbell

S. H.

Mello

D. F.

Moreno

A. I. P.

Fonseca

L. M. M.

(2025). Simulated scenario for promoting breastfeeding in primary health care. Acta Paulista de Enfermagem, 38, Article eAPE0002852i. https://doi.org/10.37689/acta-ape/2025AO0002852i

30.

Nickson

(2020). In situ simulation. Life in the fast lane. https://litfl.com/in-situ-simulation/

31.

North

Gao

Allen

Lee

A. C. C.

(2022). Breastfeeding in a global context: Epidemiology, impact, and future directions. Clinical Therapeutics, 44(2), 228–244. https://doi.org/10.1016/j.clinthera.2021.11.017

32.

Öztürk

Ergün

Özyazıcıoglu

(2021). Effect of antenatal educational intervention on maternal breastfeeding self-efficacy and breastfeeding success: A quasi-experimental study. Revista da Escola de Enfermagem da USP, 56, Article e20210428. https://doi.org/10.1590/1980-220X-REEUSP-2021-0428

33.

Polit

D. F.

Beck

C. T.

(2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.

34.

Pommeret-de Villepin

Barasinski

Rigourd

. (2022). Initiating and supporting breastfeeding: Guidelines for interventions during the perinatal period from the French National College of Midwives. Journal of Midwifery & Women’s Health, 67(S-1), S56–S73. https://doi.org/10.1111/jmwh.13420

35.

Roth

M. C.

Humphreys

K. L.

King

L. S.

Gotlib

I. H.

Robakis

T. K.

(2021). Breastfeeding difficulties predict mothers’ bonding with their infants from birth to age six months. Maternal and Child Health Journal, 25(5), 777–785. https://doi.org/10.1007/s10995-020-03036-9

36.

Scime

N. V.

Metcalfe

Nettel-Aguirre

Nerenberg

Seow

C. H.

Tough

S. C.

Chaput

K. H.

(2023). Breastfeeding difficulties in the first 6 weeks postpartum among mothers with chronic conditions: A latent class analysis. BMC Pregnancy and Childbirth, 23, Article 90. https://doi.org/10.1186/s12884-023-05407-w

37.

Shafaei

F. S.

Mirghafourvand

Havizari

(2020). The effect of prenatal counseling on breastfeeding self-efficacy and frequency of breastfeeding problems in mothers with previous unsuccessful breastfeeding: A randomized controlled clinical trial. BMC Women’s Health, 20, Article 94. https://doi.org/10.1186/s12905-020-00947-1

38.

Silva

C. C.

Natarelli

T. R. P.

Domingues

N. A.

Fonseca

L. M. M.

Melo

L. L.

(2022). Prebriefing in clinical simulation in nursing: Scoping review. Revista Gaúcha de Enfermagem, 43(spe), Article e20220067. https://doi.org/10.1590/1983-1447.2018.20220067.en

39.

Silva

N. M.

Queiroz

T. D. R.

Silva

A. B.

Vale

Silva

J. V.

Nascimento

E. G. C.

(2022). Health education for pregnant women in the family health strategy: Challenges and possibilities. Revista de Ciências Médicas e Biológicas, 21(2), 203–210. https://doi.org/10.9771/cmbio.v21i2.46713

40.

Skov

Deddens

Petersen

M. R.

Endahl

(1998). Prevalence proportion ratios: Estimation and hypothesis testing. International Journal of Epidemiology, 27(1), 91–95. https://doi.org/10.1093/ije/27.1.91

41.

Souza

B. F.

Marski

B. S. L.

Bonelli

M. A.

Ruiz

M. T.

Wernet

(2022). Solicitude in home visit of nurses in high-risk prenatal care: An experience report. Escola Anna Nery Revista de Enfermagem, 26, Article e20210328. https://doi.org/10.1590/2177-9465-EAN-2021-0328

42.

Souza

E. F. C.

Pina-Oliveira

A. A.

Shimo

A. K. K.

(2020). Effect of a breastfeeding educational intervention: A randomized controlled trial. Revista Latino-Americana de Enfermagem, 28, Article e3335. https://doi.org/10.1590/1518-8345.3081.3335

43.

Tseng

J. F.

Chen

S. R.

H. K.

Chipojola

Lee

G. T.

Lee

P. H.

Shyu

M. L.

Kuo

S. Y.

(2020). Effectiveness of an integrated breastfeeding education program to improve self-efficacy and exclusive breastfeeding rate: A single-blind, randomised controlled study. International Journal of Nursing Studies, 111, Article 103770. https://doi.org/10.1016/j.ijnurstu.2020.103770

44.

United Nations Children’s Fund. (2023). Breastfeeding. https://data.unicef.org/topic/nutrition/breastfeeding/

45.

Universidade Federal do Rio de Janeiro. (2021). Aleitamento materno: Prevalência e práticas entre crianças brasileiras menores de 2 anos (ENANI-2019) [Breastfeeding: Prevalence and practices of breastfeeding in Brazilian children under 2 years of age (ENANI-2019)]. https://enani.nutricao.ufrj.br/download/relatorio-4-aleitamento-materno/

46.

Villegas

Cianelli

Cerisier

Fernandez-Pineda

Jacobson

Lin

H. H.

Sanchez

Davenport

Zavislak

(2021). Development and evaluation of a telehealth-based simulation to improve breastfeeding education and skills among nursing students. Nurse Education and Practice, 57, Article 103226. https://doi.org/10.1016/j.nepr.2021.103226

47.

Webber

Wodwaski

Courtney

(2021). Using simulation to teach breastfeeding management skills and improve breastfeeding self-efficacy. The Journal of Perinatal Education, 30(1), 19–28. https://doi.org/10.1891%2FJ-PE-D-20-00013

48.

Wijnen-Meijer

Brandhuber

Schneider

Berberat

P. O.

(2022). Implementing Kolb′s experiential learning cycle by linking real experience, case-based discussion and simulation. Journal of Medical Education and Curricular Development, 9, Article 23821205221091511. https://doi.org/10.1177/23821205221091511

49.

World Health Organization, United Nations Children’s Fund. (2021a). The extension of the 2025 maternal, infant and young child nutrition targets to 2030. https://data.unicef.org/resources/extension-of-2025-maternal-infant-young-child-nutrition-targets-2030/

50.

World Health Organization, United Nations Children’s Fund. (2021b). Indicators for assessing infant and young child feeding practices: Definitions and measurement methods. https://www.who.int/publications/i/item/9789240018389

51.

Zimmerman

D. R.

Kaplan

Shoob

Freisthler

Toledano

Stein-Zamir

(2022). Breastfeeding challenges and support in a high initiation population. Israel Journal of Health Policy Research, 11, Article 31. https://doi.org/10.1186/s13584-022-00538-5

52.

Zulkarnaini

Hernita

Ardilla

(2023). The relationship between breastfeeding self-efficacy and the success of exclusive breastfeeding. Jurnal Ilmiah Keperawatan Orthopedi, 7(1), 1–7. https://doi.org/10.46749/jiko.v7i1.121

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