Knowledge, attitude, and practice of breastfeeding among mothers experiencing maternal-infant separation: a cross-sectional study

Objective Maternal-infant separation hinders breastfeeding and may reduce breastfeeding success. This study investigated breastfeeding-related knowledge, attitudes, and practices (KAP) among mothers who experienced separation. Methods A cross-sectional study using a self-administered KAP questionnaire was conducted in Shanxi Bethune Hospital from November to December 2024. Results A total of 513 mothers were included (effective response rate of 96.4%); 52.63% used mixed feeding and 68.76% were within 42 days postpartum. Median (interquartile ranges) scores for knowledge, attitude, and practice were 23 (22–25), 35 (32–37), and 44 (40–47), respectively. Most mothers (68.97%) reported that separation affected breastfeeding, and work environment (40.35%) and family support (38.40%) were major influencing factors. Spearman correlation analysis further revealed that knowledge was negatively correlated with attitude (r = −0.521, P < 0.001) and practice (r = −0.509, P < 0.001), whereas attitude was positively correlated with practice (r = 0.470, P < 0.001). In multivariable logistic regression analyses, vaginal delivery (OR = 0.624, 95% CI: 0.406–0.960) and completed maternal-infant separation (OR = 0.528, 95% CI: 0.340–0.821) were independently associated with knowledge level. Compared with those currently experiencing separation, participants who had completed separation demonstrated significantly more positive attitudes (OR = 1.815, 95% CI: 1.155–2.854) and practices (OR = 1.915, 95% CI: 1.219–3.007, P = 0.005). Conclusions Mothers experiencing maternal-infant separation demonstrated limited breastfeeding knowledge but maintained positive attitudes and proactive practices. Although causal inference cannot be established in this cross-sectional study, the unexpected negative correlations between knowledge and both attitude and practice suggest that higher knowledge may reflect reactive, problem-driven learning under separation-related stress rather than a linear progression from knowledge to behavior. Targeted breastfeeding support that reinforces existing motivation may improve outcomes. Longitudinal studies are needed to clarify these relationships.