Abstract
We would like to sincerely thank Saito and colleagues for sharing their valuable comments on our study entitled “Evaluation of Two Midwife-Supported Breastfeeding Positions After Cesarean: A Pilot Randomized Controlled Study.” We are grateful for the time they devoted to carefully reviewing our work, for their constructive comments, and for their contributions to advancing breastfeeding support following cesarean birth. We appreciate the opportunity to clarify the issues raised in their letter.
We thank the authors for their observation that the positive outcomes observed in the modified football hold group may have resulted from more intensive midwifery support rather than the breastfeeding position itself. However, we would like to emphasize that midwifery support was standardized across both study groups. In both groups, the breastfeeding position was implemented by the midwife after ensuring maternal comfort, and the level of maternal participation in the breastfeeding process was comparable. No group received more intensive physical support than the other. Therefore, we do not believe that the observed differences can be explained solely by variations in the level of professional support provided.
We agree with the authors regarding the importance of long-term breastfeeding outcomes. However, our study was designed as a pilot randomized controlled trial to evaluate the effectiveness and feasibility of two different midwife-supported breastfeeding positions during the first breastfeeding session after cesarean birth. Consequently, long-term outcomes were beyond the scope of the study. We believe that future studies with larger sample sizes and longer follow-up periods will make important contributions to this field, and we are planning further research in this direction. We would also like to emphasize our openness to scientific collaboration and the exchange of experiences. Should the authors be interested, we would be pleased to share our experiences, educational materials, and methodological approaches related to the breastfeeding positions used in our study.
We also thank the authors for highlighting the importance of neonatal safety. Ensuring neonatal safety was one of the primary priorities of our study. All breastfeeding procedures were conducted under the direct supervision of experienced midwives, and the infant’s positioning, airway patency, and overall condition were monitored throughout the breastfeeding session. No adverse events related to breastfeeding position were observed during the study period.
In this context, we would like to note that midwifery in Türkiye is an independent health profession requiring a four-year undergraduate education that includes comprehensive theoretical and clinical training in maternal, newborn, and breastfeeding care. Breastfeeding counseling, the application of breastfeeding positions, assessment of both mother and newborn, and safe breastfeeding practices are core components of midwifery education and clinical practice. Therefore, the interventions implemented in our study were consistent with routine midwife-supported care practices commonly used in our clinical setting.
We also recognize that breastfeeding support practices may vary across health care systems, clinical environments, and professional traditions. We believe that such diversity provides valuable opportunities for scientific exchange and contributes to the advancement of evidence-based breastfeeding care. Future multicenter and international studies evaluating breastfeeding positions and breastfeeding support practices across different countries and health care systems may strengthen the existing evidence base and improve the generalizability of findings. We, therefore, welcome international scientific collaborations in this area.
Finally, we appreciate the authors’ emphasis on the importance of not only appropriate breastfeeding positions but also qualified midwifery support in post-cesarean breastfeeding care. We fully agree with this perspective. The primary aim of our study was to support mothers during their initial breastfeeding experience following cesarean birth and to evaluate practices that may enhance breastfeeding success. We hope that our findings will contribute to the development of woman-centered and evidence-based breastfeeding care.
Once again, we thank the authors for their valuable contributions and constructive comments.
Sincerely,
Benay Oğuz
Nursen Bolsoy