Study setting and selection of participants

NGT group sessions included participants from three of the four tertiary hospitals (University Maternity Hospital Limerick, University Hospital Galway and Rotunda Maternity Hospital Dublin) in the Republic of Ireland, where participants in our previous qualitative study [33] had been recruited. Eligibility criteria employed purposive snowball sampling methods [45] to selectively recruit participants who had participated in the previous qualitative study. From this pool, six postnatal mothers (n = 6) and four lactation consultants/midwives (n = 4) were purposefully selected to participate in the NGT sessions. The sample size was guided by the methodological requirements of the NGT, which favours small, purposive groups to enable meaningful participation and consensus-building. While not statistically representative, the sample was appropriate for the study’s aim of generating stakeholder-informed, prioritized recommendations [46,47].

Recruitment

Recruitment for NGT group sessions took place between March 2024 and May 2024. The principal investigator (PI) provided the Participant Information Leaflet (PIL) to all potential participants, including postnatal mothers and lactation consultants who had previously participated in our previous qualitative study [33]. The PIL contained detailed information on the study’s purpose, features, and the PI’s contact information. Establishing direct access to participants was facilitated through their involvement in our previous qualitative study. This prior engagement ensured familiarity and rapport between the researchers and participants, fostering trust critical for meaningful and authentic contributions in the current study. By leveraging this established connection, the study recruited participants with relevant experience and insights, enhancing the depth and quality of the data gathered. Six postnatal mothers (n = 6) and four lactation consultants/midwives (n = 4) participated in the study. Written informed consent was obtained from all participants before data collection. Additionally, verbal consent was reconfirmed immediately before the NGT sessions as an added ethical measure. The respective ethics committees approved this dual consent process.

Patient and public involvement (PPI)

To ensure that the study remained relevant and responsive to the needs of those it directly impacted, a Patient and Public Involvement (PPI) group was established [48,49]. This group consisted of a deputy director of midwifery, a midwife, and a lactation consultant, all of whom had experience in prenatal breastfeeding education. The PPI group advised on the design and content of the discussion guide for the NGT group sessions (S1 File), using insights and feedback gathered from our previous qualitative study with postnatal mothers and healthcare professionals. This collaborative design ensured that the topics explored during the NGT sessions were firmly rooted in the perspectives, priorities, and concerns expressed by the participants in our previous qualitative study [33].

Through their contributions, the PPI advisors helped shape the study’s direction and focus, ensuring that the final prioritized recommendations would be both meaningful and actionable for the community of mothers, healthcare providers, and other stakeholders in prenatal breastfeeding education. We documented the details of the PPI group, including their contributions and impact on the study, in accordance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) (S2 Table).

Data collection

The NGT process began with participants independently generating ideas, which were then shared with the group using a structured round-robin format to ensure equal opportunity for contribution. This was followed by a focused discussion and clarification phase, leading to a final ranking exercise to identify the most preferred options. NGT is widely valued for its ability to encourage creative input, reduce the risk of group-think, and support structured consensus-building [34]. Nonetheless, the method presents limitations, including being time-consuming, potentially restricting open dialogue, and the risk of facilitator influence. To mitigate these challenges, the principal investigator maintained active engagement with participants, skillfully guided discussions, and fostered an environment conducive to constructive consensus-building.

Data were collected through two online sessions conducted via Microsoft Teams, held approximately three weeks apart. One session was held with postnatal mothers and the other with healthcare professionals, each lasting approximately three and a half hours. The PI expertly guided the discussion sessions, using a discussion guide tailored to each session (S1 File).

Data collection for this study followed the NGT process (Fig 1), designed to refine and prioritize recommendations from our previous qualitative study [31]. The first online session was conducted with postnatal mothers (n = 6), followed by a second session with healthcare professionals (n = 4), each contributing to a structured refinement and evaluation of the recommendations. Before the session, postpartum mother participants (n = 6) received recommendations from our previous qualitative study [33]. Each mother independently assessed and ranked the recommendations, encouraging personal reflection while reducing potential influence from group dynamics. This confidential ranking process was done using a voting card (S2 File), allowing participants to express their priorities without external pressure.

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Fig 1. NGT Process.

https://doi.org/10.1371/journal.pone.0328542.g001

Before the Session

During the session

Before the session

During the session

Data analysis

A modified version of the scoring system developed by [50] was used to prioritize recommendations for integration into Ireland’s prenatal breastfeeding education, in alignment with the WHO’s 10 Steps to Successful Breastfeeding. Each postnatal mother ranked the recommendations using a descending scale from 5 (highest priority) to 1 (lowest). Aggregate scores were calculated to determine group priorities, with ties resolved by the frequency of votes. Recommendations with cumulative scores between 25 and 30 were classified as high priority (S3 Table).

Subsequently, healthcare professionals assessed these prioritized recommendations based on their feasibility of integration into the current prenatal breastfeeding education framework. Each recommendation was scored on a 5-to-1 descending scale, with higher scores reflecting greater feasibility. Recommendations scoring between 18 and 20 were considered feasible (S4 Table). Additionally, healthcare professionals critically evaluated how each recommendation aligned with the WHO’s 10 Steps to Successful Breastfeeding (Table 1). All data from the NGT sessions were transcribed and anonymized to ensure participant confidentiality. The transcripts were then imported into NVIVO (Version 14; QSR, 2024) for data management and coding. Qualitative content analysis [51,52] was employed, combining inductive and deductive coding to capture emerging ideas and align them with predefined study domains that align with the study’s objectives and recommendations generated in our previous qualitative study [33]. The principal investigator (PI) conducted multiple readings of the transcripts to ensure a deep understanding of participants’ responses and the ideas generated during the sessions. The PI conducted initial coding, followed by collaborative discussions with AG and CO, experienced in qualitative content analysis, to review, refine, and agree upon the emergent themes. Particular emphasis was placed on consensus statements, which served as a basis for identifying key priorities.

Additionally, Ritchie’s Framework Analysis [53] explored these prioritized recommendations in greater depth. A matrix (S5 Tables) was developed to chart responses across the two groups (postnatal mothers and healthcare professionals), mapping how participants explained or justified their choices. This approach facilitated the structured summarization of predefined themes while accommodating emergent concepts arising during the sessions. The analysis followed a five-stage process encompassing familiarization, identifying a thematic framework, indexing, charting, and mapping/interpretation. Although the framework analysis followed the five established stages, the charting stage was intentionally repeated (S5 Tables). This iterative step was taken to verify the accuracy and consistency of data categorization across both stakeholder groups. Re-engaging with the charting process allowed for refinement of the matrix entries and ensured that the summaries retained their contextual depth while remaining analytically coherent.

Ethical approval

Ethical approval was obtained from the HSE Research Ethics Committees of three tertiary hospital sites in the Republic of Ireland (Reference Numbers: University Maternity Hospital Limerick- REC Ref: 119/2021, Rotunda Maternity Hospital Dublin-REC-2021–027, University Hospital Galway-Ref: C.A. 2718), and all procedures followed the Declaration of Helsinki regulations [54].

Participant characteristics (healthcare professionals and postnatal mothers)

The demographic characteristics of all study participants (n = 10) are presented in Table 2. All four healthcare professionals were female and employed in the maternity units across the selected research sites, where they directly provided prenatal breastfeeding education. All had also participated in the previous qualitative phase of this research. Two participants were dual-qualified as midwives and lactation consultants, while the remaining two identified solely as lactation consultants. Their ages ranged from 36 to 48 years (mean age = 42). Most were of Irish ethnicity (n = 3; 75%), with one identifying as being from another white ethnic background (n = 1; 25%). All were affiliated with either the Nursing and Midwifery Board of Ireland (NMBI) or the Association of Lactation Consultants in Ireland. Educational qualifications ranged from a bachelor’s degree (n = 1; 25%) to a master’s degree (n = 3; 75%). Their professional experience in healthcare roles spanned 5–6 years, with a mean of 5.5 years.

The postnatal mothers were between 24 and 42 (mean age, 33). The majority of postnatal mothers were cohabiting (n = 4; 66.67%), while the remainder were married (n = 2; 33.33%). In terms of ethnic background, three identified as Irish (50%), one as Black (Irish, African) (16.67%), and two as Asian (Indian) (33.33%). The education status of postnatal mothers ranged from a degree level (n = 1; 16.67%), postgraduate degree (n = 1; 16.67%), second-level education (Leaving Certificate) (n = 2; 33.33%) to Junior Certificate (n = 2; 33.33%). Three postnatal mothers (50%) reported being in full-time employment, two (33.33%) were unemployed, and one (16.67%) chose not to disclose her employment status. Two postnatal mothers (n = 2; 33.33%) identified as Primiparous (first-time mothers), while four mothers (n = 4; 66.67%) identified as Multiparous (Mothers with previous pregnancies).

Key recommendations and consensus outcomes from the NGT sessions

The NGT sessions systematically evaluated 20 recommendations from our previous qualitative study [33] (S3 Table). These recommendations, which sought to enhance prenatal breastfeeding education classes, were organized around six guiding questions that structured the group discussions and facilitated prioritization: 1) What do you think would have best prepared you for breastfeeding, considering the need for a balanced approach that addresses both the benefits and challenges, including the mental and emotional aspects like postpartum depression and the frustrations when things don’t go as planned? 2) Given your suggestions—such as using a pre-class survey, offering one-on-one support, implementing a feedback system, and incorporating real-life stories—which interactive strategy would you prioritize to make the classes more engaging? 3) What digital tools or platforms could enhance the learning experience, considering suggestions like virtual reality for hands-on techniques, discussion breakout rooms, and chat boxes for real-time dialogue? 4) How can we ensure more consistent and accurate information delivery in prenatal breastfeeding education, given that participants experienced frustration, confusion, and stress due to inconsistent advice? 5) How important do you think partner participation is in improving the effectiveness of breastfeeding classes? 6) Would you consider including practical advice on “breastfeeding in public”-specifically within the Irish context —as a priority for future prenatal breastfeeding education sessions? (S3 Table).

Seven recommendations emerged as the top priorities from the initial 20 recommendations (Table 3). Subsequently, these seven priorities were presented during the NGT session with healthcare professionals to evaluate their feasibility and alignment with the WHO’s 10 Steps to Successful Breastfeeding (S4 Table).

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Table 3. Prioritized Recommendations from Postnatal Mothers.

https://doi.org/10.1371/journal.pone.0328542.t003

Emergent themes

The findings were analyzed in a structured and rigorous manner to distill core themes and consensus statements from both groups. This involved synthesizing postnatal mothers’ educational priorities and comparing them to the feasibility assessments provided by healthcare professionals. This approach entailed carefully triangulating the mothers’ consensus priorities with the healthcare professional’s feasibility evaluations, particularly noting alignment with the WHO’s 10 steps to successful breastfeeding. Areas of divergence and discordance were also examined to reveal subtle differences in perspectives that could guide further refinement of breastfeeding education practices. Therefore, the following sections present the findings and direct quotes to provide a grounded understanding of participant priorities. The S6 Table also provides a summary of the findings.

1. Balanced Prenatal Breastfeeding Education with Emphasis on Mental and Emotional Preparedness (Normalising Frustration and Self-Doubt)

Consensus Priority from Postnatal Mothers: Postnatal mothers consistently prioritized a balanced approach to breastfeeding education, emphasizing the need for holistic preparation that includes both the benefits of breastfeeding and its potential challenges; “If I had known more about the ups and downs, I would not have been so shocked when things got tough” (M1). Many felt caught off guard by postpartum difficulties, particularly the frustration and doubts that arose when breastfeeding did not go as expected. This realistic framing was seen as essential for setting accurate expectations and offering reassurance.

The mothers emphasized the emotional and mental toll associated with breastfeeding: “I was not expecting to feel so overwhelmed. If they’d covered that more in the classes, I think I’d have been a bit more prepared” (M3). They spoke of the “mental load” and persistent “doubts,” often intensified by the lack of open discussion during classes. Many felt that postpartum support and reassurance could better prepare them for the emotional complexities of breastfeeding. They also expressed the need for prenatal classes to acknowledge and normalize common frustrations and self-doubt: “It would’ve been helpful if they’d talked more about how common those doubts are” (M6). The mothers wanted reassurance that such challenges are typical—and that they are not alone.

Feasibility of Implementation by Healthcare Professionals Healthcare professionals agreed that a more balanced approach is feasible to implement, particularly within the WHO Step 3 framework, which covers the benefits and management of breastfeeding. They noted that this addition could be seamlessly integrated, enhancing current messaging; “Adding a bit about the challenges wouldn’t be too hard, right? It’s just about tweaking what we’re already doing, nothing too drastic” (LCC1). Other healthcare professionals echoed this sentiment, emphasizing that mothers would benefit from a realistic portrayal that balances encouragement with honesty. This approach combines the benefits of breastfeeding with an in-depth examination of its challenges and complexities.

While the healthcare professionals recognized the critical importance of emotional support, they discussed the need to gradually incorporate this focus, potentially in Step 5, which supports mothers with breastfeeding initiation and provides ongoing support; “If we’re looking at what’s easiest to implement first… the emotional support could come later as part of ongoing care” (LCC4). This phased approach suggests a feasible strategy for incorporating emotional preparedness into the breastfeeding framework without overwhelming the existing framework for breastfeeding education. Additionally, healthcare professionals strongly supported normalizing discussions on common struggles in the classes, which could help mothers feel more supported; “We need to normalize those struggles a bit more, so they don’t feel like they’re on their own” (LCC3).

Alignment with Key Stages of WHO’s 10 Steps to Successful Breastfeeding Healthcare professionals agreed that this recommendation aligns most directly with Step 3 of the WHO’s 10 Steps to Successful Breastfeeding, which focuses on informing mothers about the benefits and management of breastfeeding. They emphasized that incorporating a balanced and realistic educational approach within this step would enable mothers to understand breastfeeding comprehensively, including its advantages and common emotional and practical challenges. This would help foster realistic expectations, emotional preparedness, and resilience during the postpartum period. In addition, the priority was also seen as closely related to Step 5, which centres on supporting mothers with breastfeeding initiation. Healthcare professionals agreed that integrating structured discussions around emotional and mental wellbeing at this stage would be critical in helping mothers cope with early frustrations, normalizing self-doubt, and reinforcing support during the critical initiation phase. Steps 3 and 5 collectively offer a structured, evidence-informed foundation for integrating this recommendation into Ireland’s prenatal breastfeeding education framework.

Developing a holistic and balanced curriculum

A key recommendation emerging from this study is the need to revise existing prenatal breastfeeding education to adopt a more holistic and balanced curricular approach. Current materials often focus predominantly on the biological and nutritional benefits of breastfeeding, inadvertently portraying an idealized version of the experience. Participants highlighted the absence of content that adequately prepares mothers for the psychological and emotional complexities they may encounter during the postpartum period.

To address this, prenatal breastfeeding educational resources should be redeveloped to reflect a nuanced and realistic portrayal of breastfeeding, emphasizing not only its advantages but also its common challenges and complexities. Furthermore, incorporating real-life scenarios and shared experiences can help the mothers set realistic expectations, enhance emotional preparedness, and build psychological resilience. This recommendation aligns with WHO Step 3, which emphasizes equipping mothers with knowledge about the benefits and management of breastfeeding. Consequently, training modules for healthcare educators should be updated to integrate this broader perspective, ensuring coherence and consistency in delivery across clinical and community-based educational settings.

The analytical rationale for this revision is grounded in both this study’s findings and existing literature. By addressing the tendency of current programs to idealize breastfeeding, this approach helps prevent the mismatch between expectation and lived experience that often contributes to maternal frustration and diminished confidence in the early postpartum period. A realistic curriculum that balances enthusiasm with authenticity fosters greater maternal self-assurance and enhances preparedness, ultimately supporting a more sustained and satisfying breastfeeding experience [65–67].

Introducing emotional and mental health preparedness strategies

Another significant recommendation centres on integrating emotional and mental health preparedness within the structure of prenatal breastfeeding education. While existing curricula frequently prioritize physiological techniques and nutritional guidance, they often neglect the psychological demands associated with breastfeeding. This omission leaves many mothers under prepared for the emotional complexities, frustrations, and self-doubt that can arise, particularly during the early postpartum period.

To address this deficit, it is recommended that targeted modules be developed and embedded within prenatal classes, explicitly designed to address the mental and emotional dimensions of breastfeeding. These modules should incorporate facilitated discussions, interactive role-playing exercises, and structured, evidence-based resources to foster open dialogue around emotional struggles. Creating a space in which mothers can articulate concerns and normalize common experiences, such as fatigue, anxiety, or feelings of inadequacy, may mitigate the stigma surrounding emotional distress and provide early strategies for coping.

This initiative can be incorporated into WHO Step 5, which focuses on supporting mothers during breastfeeding initiation. A phased implementation approach is advised, whereby foundational emotional literacy is introduced in the early stages of pregnancy, followed by more comprehensive support strategies as the due date approaches. Such progressive layering ensures that mothers are not overwhelmed while receiving the critical tools necessary for emotional resilience.

This recommendation is grounded in evidence highlighting identified gaps in Ireland’s current prenatal education framework. Participants consistently reported a lack of acknowledgement of the emotional realities of breastfeeding in formal education settings. This concern is echoed in the broader literature, which affirms that psychological preparedness is positively associated with breastfeeding success and maternal mental health outcomes [68–70]. Embedding emotional and mental health content into prenatal curricula will ensure that breastfeeding education supports physical techniques and nurtures maternal well-being as a foundational element of postnatal care.

Enhancing personalization through pre-class surveys

A further recommendation centres on the development and integration of pre-class surveys as a means to personalize prenatal breastfeeding education. This approach responds to the growing recognition that expectant mothers enter educational settings with diverse backgrounds, prior knowledge, and individualized concerns, all influencing their engagement with and absorption of course content. Standardized delivery models may inadvertently overlook these variations, potentially diminishing the relevance and effectiveness of the educational experience.

To address this issue, targeted pre-class surveys are proposed. These instruments would collect key information about participants’ breastfeeding knowledge, specific concerns, and preferred learning styles. Facilitators could then use insights gleaned from these surveys to adapt the content, structure, and delivery of sessions to better align with the group’s identified needs. This personalized approach would transform the learning environment into one that is more responsive and inclusive. This strategy is directly aligned with WHO Steps 2 and 3, which emphasize the importance of effective staff training and the delivery of comprehensive breastfeeding education. To ensure successful implementation, facilitators would require training in interpreting and applying survey data, equipping them to make real-time instructional adjustments. It is also recommended that pilot testing be conducted in selected clinical or community-based settings to evaluate the survey mechanism’s usability, feasibility, and impact.

The analytical rationale underpinning this recommendation is firmly supported by evidence indicating that personalized education enhances participant engagement and optimizes knowledge retention. When learners perceive educational content as directly relevant to their circumstances, they are more likely to internalize key messages and apply them in practice [71,72]. As such, integrating pre-class surveys represents a pragmatic yet impactful strategy to elevate the quality and responsiveness of prenatal breastfeeding education.

Integrating storytelling and shared experiences

An additional recommendation from this study emphasizes the integration of structured storytelling and shared experiential learning within prenatal breastfeeding education. Mothers participating in the NGT sessions consistently underscored the transformative value of hearing first-hand accounts from others navigating the breastfeeding journey. Such narratives were viewed as emotionally validating and practically instructive, offering nuanced insights often absent from didactic or textbook-based content.

Encouraging participants to share personal breastfeeding experiences in a moderated, group-based setting fosters a culture of mutual support, emotional connection, and peer learning. These storytelling sessions can be further enhanced by utilizing data collected through pre-class surveys, enabling facilitators to identify common themes or concerns and structure discussions accordingly. This alignment ensures that the shared narratives address the specific anxieties and curiosities within the group, thereby maximizing their relevance and impact.

This strategy aligns with WHO Step 3, emphasizing the significance of comprehensive breastfeeding education and management. To effectively implement this recommendation, facilitators should receive training in group moderation techniques that foster psychological safety, inclusivity, and cultural sensitivity. Maintaining a supportive environment ensures participants feel empowered to share personal experiences without fearing judgment or dismissal.

The evidence-informed rationale for this approach is grounded in a substantial body of literature that highlights the pedagogical and Psychosocial benefits of storytelling in creating emotional connections, normalizing challenges, and boosting maternal confidence [59,73]. Additionally, shared experiential learning has been shown to reduce feelings of maternal isolation, which often intensify during the early postpartum period [33,60]. Consequently, integrating storytelling into prenatal education enriches the learning experience and fosters a stronger sense of community and emotional preparedness among participants [71].

Standardising breastfeeding guidance

This recommendation emphasizes the importance of consistency in breastfeeding education and clinical messaging among all healthcare professionals involved in maternal care. Participants in the study frequently reported discrepancies in the guidance received from different providers, which led to confusion, reduced confidence, and diminished trust in professional advice. Such inconsistencies, particularly during the early postpartum period, can undermine a mother’s sense of efficacy and stability in decision-making around infant feeding. To address this gap, the development of a standardized breastfeeding handbook for healthcare professionals is proposed. This resource should consolidate evidence-based guidance, practical strategies, and communication protocols, serving as a unifying reference for all prenatal and postnatal care staff. To ensure effective uptake, the handbook should be complemented by regular staff training and Mentorship programmes. These sessions would serve not only to reinforce adherence to the standardized content but also to provide a platform for discussing clinical updates and emerging best practices.

This strategy aligns directly with WHO Step 2, which emphasizes the critical role of staff training in delivering high-quality breastfeeding support. In addition, establishing a review committee comprising clinical experts, educators, and service users is recommended. Such a body would be responsible for periodically evaluating and revising the handbook, ensuring that the material remains current, relevant, and responsive to the evolving needs of both providers and service users.

Substantial evidence supports the underlying rationale for this recommendation, indicating that inconsistent or conflicting advice erodes maternal confidence and may deter continued breastfeeding [74,75]. In contrast, standardizing the content and delivery of breastfeeding guidance fosters trust, clarity, and continuity of care, essential for maternal empowerment and positive breastfeeding outcomes [61,76]. Implementing a coherent educational framework thus represents a critical step toward enhancing the overall quality and reliability of breastfeeding support within the healthcare system.

Encouraging flexible partner involvement

This study’s salient recommendation was to integrate partner-focused education within prenatal breastfeeding programmes. Participants emphasized that partners’ presence and active support influence maternal experiences and breastfeeding outcomes. Despite this, current educational models often marginalize or overlook partners, failing to provide flexible or relevant avenues for their engagement. To address this oversight, it is recommended that flexible educational resources be developed, tailored to partners’ schedules and informational needs. These resources may include recorded sessions, online modules, and on-demand content, allowing partners to access materials at their convenience, regardless of work or care giving obligations. In addition to logistical flexibility, the content must be tailored to address partner support’s practical and emotional aspects, highlighting strategies for assisting with infant care, responding to maternal distress, and fostering a supportive home environment.

While participants recognize partner involvement as important, it does not align directly with the WHO’s Ten Steps to Successful Breastfeeding. Although aspects of support and education are addressed within the framework, there is currently no explicit provision for structured partner engagement in prenatal breastfeeding education. However, the empirical evidence supporting this recommendation is well-grounded in research linking partner involvement to breastfeeding success, maternal well-being, and the mitigation of postpartum stress [77,78]. Partners with the knowledge and confidence to support breastfeeding contribute to higher initiation and continuation rates. Moreover, flexible and inclusive educational formats help overcome participation barriers, ensuring that partners remain engaged even when constrained by time or distance [79,80]. By positioning partners as integral stakeholders in the breastfeeding journey, this approach reinforces a family-centreed model of care that promotes shared responsibility and sustained maternal support.

Addressing public breastfeeding challenges

The visibility of breastfeeding in public spaces continues to pose a complex challenge for many mothers, often intersecting with cultural norms, social stigma, and personal discomfort. Despite broader public health efforts to promote breastfeeding, social and environmental barriers persist, inhibiting mothers’ ability to feed confidently outside the home. Participants in this study strongly advocated for including targeted, practical guidance within prenatal education to address these challenges explicitly.

Therefore, prenatal breastfeeding programmes should incorporate scenario-based discussions and role-playing exercises to simulate public breastfeeding situations. These strategies enhance mothers’ practical preparedness and normalize public breastfeeding as socially acceptable and empowering. Additionally, facilitated group discussions should be embedded within the curriculum to provide a supportive platform for exploring cultural attitudes, personal discomfort, and strategies for self-advocacy. These dialogues allow participants to share concerns, challenge misconceptions, and build solidarity through peer learning. While this recommendation does not align directly with the WHO’s 10 Steps to Successful Breastfeeding, it can be effectively integrated into broader educational modules or included as a supplementary component of existing classes. Therefore, facilitators should receive training in cultural competence and inclusive communication to ensure sensitive and effective delivery, equipping them to navigate diverse perspectives and promote respectful dialogue [81].

The empirical basis for this recommendation is well-established. Research has consistently shown that public breastfeeding remains a source of anxiety for many mothers, often contributing to early discontinuation or restricted breastfeeding practices [82,83]. By equipping mothers with practical tools and culturally informed strategies, education can play a transformative role in dismantling stigma and reinforcing breastfeeding as a socially supported norm [80]. This approach enhances maternal confidence and contributes to broader public normalization, helping to shift the sociocultural landscape in favor of breastfeeding-friendly environments.