The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial. [Educational intervention on breastfeeding promotion to the Family Health Program team]. Nursing intervention to increase the duration of breastfeeding. Comparison of the effect of two systems for the promotion of exclusive breastfeeding. Evaluating the effect of a breastfeeding consultant on the duration of breastfeeding. Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial. Effect of intervention to improve breastfeeding technique on the frequency of exclusive breastfeeding and lactation-related problems. Effects of home visits and telephone contacts on breastfeeding compliance in Taiwan. Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Factors related to breastfeeding duration. Home breastfeeding support by health professionals: findings of a randomized controlled trial in a population of Italian women. The effect of a postnatal education and support program on breastfeeding among primiparous women: a randomized controlled trial. Effect of early postnatal breastfeeding support: a cluster-randomized community based trial. [Controlled study of a regular telephone support program given by volunteers on the establishment of breastfeeding]. Training peer counselors to promote and support exclusive breastfeeding in Bangladesh. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding. Effectiveness of home-based peer counselling to promote breastfeeding in the northeast of Brazil: a randomized clinical trial. A breast-feeding promotion and support program a randomized trial in The Netherlands. Home versus hospital breastfeeding support for newborns: a randomized controlled trial. Effect of an extended midwifery postnatal support programme on the duration of breast feeding: a randomised controlled trial. A pilot randomized controlled trial of a breastfeeding self-efficacy intervention with primiparous mothers. [Promotion of breast-feeding in urban localities of southern Brazil: a randomized intervention study]. Lactation nurse increases duration of breast feeding. The influence of additional information, advice and support on the success of breast feeding in working class primiparas. Costs and effectiveness of community postnatal support workers: randomised controlled trial. Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding. [Promotion of breastfeeding: the importance of pediatricians with specific training]. Postnatal home visits in teenage mothers: a randomised controlled trial. A prospective study of individual courses of breast feeding. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Effectiveness of exclusive breastfeeding promotion in low-income mothers: a randomized controlled study. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. Randomized, controlled trial of a prenatal and postnatal lactation consultant intervention on duration and intensity of breastfeeding up to 12 months. Randomized trial of postpartum care after hospital discharge. Does continuity of care by well-trained breastfeeding counselors improve a mother's perception of support? Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia. The effect of individualized professional support on duration of breastfeeding: a randomized controlled trial. Lactation counseling increases exclusive breast-feeding rates in Ghana. Effect of breastfeeding education on the feeding pattern and health of infants in their first 4 months in the Islamic Republic of Iran. Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs. Assignment to a hospital-based breastfeeding clinic and exclusive breastfeeding among immigrant Hispanic mothers: a randomized, controlled trial. Lactation counseling increases breast-feeding duration but not breast milk intake as measured by isotopic methods. Differential response to an exclusive breastfeeding peer counseling intervention: the role of ethnicity. Maternal dietary counseling in the first year of life is associated with a higher healthy eating index in childhood. The effect of postpartum lactation counseling on the duration of breast-feeding in low-income women. Effectiveness of policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial. The effect of postnatal breastfeeding education/support offered at home 3 days after delivery on breastfeeding duration and knowledge: a randomized trial. Effect of postnatal home visits on maternal/infant outcomes in Syria: a randomized controlled trial. A randomized controlled community-based trial to improve breastfeeding rates among urban low-income mothers. The effect of peer support on breast-feeding duration among primiparous women: a randomized controlled trial.
Peer support may improve breastfeeding rates but the evidence is inconclusive. Previous studies and reviews recommend trials in different healthcare settings.
                To test if a specified programme of peer support affects the initiation and/or the duration of breastfeeding.
                A two-group randomised controlled trial of peer support for breastfeeding with evaluation of breastfeeding initiation and duration on an intention-to-treat basis.
                General practice in Ayrshire, Scotland.
                Following informed consent, 225 women at 28 weeks gestation were allocated to control or peer support group by post-recruitment concealed allocation. All peer support and control group mothers received normal professional breastfeeding support. Additionally, those in the peer support group still breastfeeding on return home from hospital had peer support until 16 weeks.
                Thirty-five of the 112 (31%) women in the peer support group were breastfeeding at 6 weeks compared to 33/113 (29%) in the control group, a difference of 2% (95% confidence interval = -10% to 14%). The median breastfeeding duration for all women in the peer support group was 2 days compared to 1 day for the control group and the Kaplan-Meier survival plot shows the peer support group overall breastfeeding slightly longer than the control group, with no statistically significant difference by logrank test (P = 0.5). The median breastfeeding duration among primagravidae in the peer support group was 7 days, compared to 3 days for the control group. Among women who started to breastfeed the medians were 72 days in the peer support group and 56 days in the control group. These differences were not statistically significant.
                Peer support did not increase breastfeeding in this population by a statistically significant amount. Breastfeeding Friendly Primary Care Initiative comprises educational activities focused on primary care units. The To evaluate the effectiveness of a strategy on breastfeeding promotion to the Family Health Program team.
                A controlled intervention study was performed with 20 family health care teams randomly selected into intervention and control group in Montes Claros, Southeastern Brazil, in 2006. The teams randomly selected into intervention and control group, and the intervention group took part in a 24-hour training program on breastfeeding promotion for health providers, modeled on the Baby-Friendly Hospital Initiative. It was emphasized health provider's support for breastfeeding and management of major lactation problems. The control group received routine breastfeeding training. Mothers of all children under two cared by the teams were interviewed at home before (n=1,423) and 12 months after the intervention (n=1,491) and answered questions about breastfeeding practices. Survival curves of breastfeeding were plotted and compared for both time points studied using the log rank test.
                There was a significant increase in exclusive breastfeeding after the educational activities for the Family Health Program teams. Survival curves of exclusive breastfeeding at the fi rst time point studied showed no statistical significance difference between the groups by log rank test (p=0.502). After the intervention, survival curves of exclusive breastfeeding were significantly different by the log rank test (p=0.001).
                The training of Family Health Program teams as proposed by the Baby-Friendly Hospital Initiative proved to be an effective, low-cost strategy for raising awareness among health providers, providing consistent information, and assuring the required support to mothers with breastfeeding issues. nan Promotion of breastfeeding is an important child-survival intervention, yet little is known about which promotional strategies are the most effective. We aimed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil--a hospital-based system and the same system combined with a programme of home visits.
                In February, 2001, maternity staff from two hospitals in Pernambuco, Brazil, were trained according to the Baby-Friendly Hospital Initiative (BFHI). In a randomised trial between March and August, 2001, 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding (n=175) or no home visits (n=175). Breastfeeding practices were studied on days 1, 10, 30, 60, 90, 120, 150, and 180 by researchers unaware of group allocation. The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months. Analyses were by intention to treat.
                The hospital-training intervention achieved a high rate (70%) of exclusive breastfeeding in the hospitals, but this rate was not sustained at home and at 10 days of age only 30% of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10-180 differed significantly (p<0.0001), with a mean aggregated prevalence of 45% among the group assigned home visits compared with 13% for the group assigned none.
                The BFHI achieves high rates of exclusive breastfeeding in hospital; however, in Brazil at least, the rates fall rapidly thereafter. Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed. A combination of promotional systems (hospital-based and in the community) is needed. nan To investigate whether antenatal breast feeding education alone or postnatal lactation support alone improves rates of exclusive breast feeding compared with routine hospital care.
                Randomised controlled trial.
                A tertiary hospital in Singapore.
                450 women with uncomplicated pregnancies.
                Primary outcomes were rates of exclusive breast feeding at discharge from hospital and two weeks, six weeks, three months, and six months after delivery. Secondary outcomes were rates of any breast feeding.
                Compared with women who received routine care, women in the postnatal support group were more likely to breastfeed exclusively at two weeks (relative risk 1.82, 95% confidence interval 1.14 to 2.90), six weeks (1.85, 1.11 to 3.09), three months (1.87, 1.03 to 3.41), and six months (2.12, 1.03 to 4.37) postnatally. Women receiving antenatal education were more likely to breast feed exclusively at six weeks (1.73, 1.04 to 2.90), three months (1.92, 1.07 to 3.48), and six months (2.16, 1.05 to 4.43) postnatally. The numbers needed to treat to achieve one woman exclusively breast feeding at six months were 11 (6 to 80) for postnatal support and 10 (6 to 60) for antenatal education. Women who received postnatal support were more likely to exclusively or predominantly breast feed two weeks after delivery compared with women who received antenatal education (1.53, 1.01 to 2.31). The rate of any breastfeeding six weeks after delivery was also higher in the postnatal support group compared with women who received routine care (1.16, 1.02 to 1.31).
                Antenatal breast feeding education and postnatal lactation support, as single interventions based in hospital both significantly improve rates of exclusive breast feeding up to six months after delivery. Postnatal support was marginally more effective than antenatal education.
                Clinical Trials NCT00270920 [ClinicalTrials.gov]. This randomized clinical trial compared frequencies of exclusive breastfeeding and lactation-related problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward, and 137 controls. The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days (79.7% vs 82.5%, respectively) and 30 days (60.8% vs 53.3%). There was no difference between groups in the frequency of sore nipples at 7 and 30 days, in breast engorgement and mastitis, and in the quality of breastfeeding technique at 30 days. Therefore, a single intervention at maternity was not sufficient to improve breastfeeding technique, increase exclusive breastfeeding rates, and reduce the incidence of breastfeeding problems during the first month. The purpose of this quasi-experimental study was to test the effects of home visits and telephone contacts on mothers' compliance to breastfeeding in Taiwan. A total of 180 mothers was assigned to three groups: home visit, telephone contact, and control. No significant differences were found between groups. However, multiparas showed a significantly longer duration of breastfeeding and a more positive experience of breastfeeding than primiparas. The best subsets to predict breastfeeding duration were level of breastfeeding easiness and a home visit, which accounted for 20% of the total variance. Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. The effect of breastfeeding counselling by peer counsellors was assessed in Africa.
                24 communities in Burkina Faso, 24 in Uganda, and 34 in South Africa were assigned in a 1:1 ratio, by use of a computer-generated randomisation sequence, to the control or intervention clusters. In the intervention group, we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers. The data gathering team were masked to the intervention allocation. The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks. Country-specific prevalence ratios were adjusted for cluster effects and sites. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00397150.
                2579 mother-infant pairs were assigned to the intervention or control clusters in Burkina Faso (n=392 and n=402, respectively), Uganda (n=396 and n=369, respectively), and South Africa (n=535 and 485, respectively). The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 (79%) of 392 and 139 (35%) of 402, respectively, in Burkina Faso (prevalence ratio 2·29, 95% CI 1·33-3·92); 323 (82%) of 396 and 161 (44%) of 369, respectively, in Uganda (1·89, 1·70-2·11); and 56 (10%) of 535 and 30 (6%) of 485, respectively, in South Africa (1·72, 1·12-2·63). The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 (77%) and 94 (23%), respectively, in Burkina Faso (3·27, 2·13-5·03); 305 (77%) and 125 (34%), respectively, in Uganda (2·30, 2·00-2·65); and 41 (8%) and 19 (4%), respectively, in South Africa (1·98, 1·30-3·02). At 24 weeks, the prevalences based on 24-h recall were 286 (73%) in the intervention cluster and 88 (22%) in the control cluster in Burkina Faso (3·33, 1·74-6·38); 232 (59%) and 57 (15%), respectively, in Uganda (3·83, 2·97-4·95); and 12 (2%) and two (<1%), respectively, in South Africa (5·70, 1·33-24·26). The prevalences based on 7-day recall were 279 (71%) in the intervention cluster and 38 (9%) in the control cluster in Burkina Faso (7·53, 4·42-12·82); 203 (51%) and 41 (11%), respectively, in Uganda (4·66, 3·35-6·49); and ten (2%) and one (<1%), respectively, in South Africa (9·83, 1·40-69·14). Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 (5%) and 36 (9%), respectively, in Burkina Faso (0·57, 0·27-1·22); 39 (10%) and 32 (9%), respectively, in Uganda (1·13, 0·81-1·59); and 45 (8%) and 33 (7%), respectively, in South Africa (1·16, 0·78-1·75). The prevalence at age 24 weeks in the intervention and control clusters was 26 (7%) and 32 (8%), respectively, in Burkina Faso (0·83, 0·45-1·54); 52 (13%) and 59 (16%), respectively, in Uganda (0·82, 0·58-1·15); and 54 (10%) and 33 (7%), respectively, in South Africa (1·31, 0·89-1·93).
                Low-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings.
                European Union Sixth Framework International Cooperation-Developing Countries, Research Council of Norway, Swedish International Development Cooperation Agency, Norwegian Programme for Development, Research and Education, South African National Research Foundation, and Rockefeller Brothers Foundation.
                Copyright © 2011 Elsevier Ltd. All rights reserved. Exclusive breastfeeding is recommended worldwide but not commonly practised. We undertook a randomised controlled study of the efficacy of home-based peer counselling to increase the proportion of exclusive breastfeeding among mothers and infants residing in periurban Mexico City.
                Two intervention groups with different counselling frequencies, six visits (44) and three visits (52), were compared with a control group (34) that had no intervention. From March, 1995, to September, 1996, 170 pregnant women were identified by census and invited to participate in the study. Home visits were made during pregnancy and early post partum by peer counsellors recruited from the same community and trained by La Leche League. Data were collected by independent interview. Exclusive breastfeeding was defined by WHO criteria.
                130 women participated in the study. Only 12 women refused participation. Study groups did not differ in baseline factors. At 3 months post partum, exclusive breastfeeding was practised by 67% of six-visit, 50% of three-visit, and 12% of control mothers (intervention groups vs controls, p<0.001; six-visit vs three-visit, p=0.02). Duration of breastfeeding was significantly (p=0.02) longer in intervention groups than in controls, and fewer intervention than control infants had an episode of diarrhoea (12% vs 26%, p=0.03).
                This is the first reported community-based randomised trial of breastfeeding promotion. Early and repeated contact with peer counsellors was associated with a significant increase in breastfeeding exclusivity and duration. The two-fold decrease in diarrhoea demonstrates the importance of breastfeeding promotion to infant health. The purpose of this study was to discover factors related to breastfeeding duration. Of the 131 women who volunteered to complete questionnaires at one, three and six months postpartum, 46 provided baseline data, and 37 and 48 (randomly assigned) constituted low and high intervention groups respectively. Comparisons were made between breastfeeding and bottle feeding. Factors shown at three and six months to be related to duration of breastfeeding at the p < .05 level were: identified high risk factors in labor and delivery, admission of the infant to the intensive care nursery, and length of mother's and/or infant's hospitalization. The three months' data also showed a significant relationship between spontaneous births and `breastfeeding only'. No positive relationship was found between breastfeeding duration and support from nursing staff. The results suggest that when mothers and infants experience intrapartum high risk factors, delivery by cesarean section and long hospital stay, the mothers are likely to stop breastfeeding early. We conducted a randomized controlled trial to assess the effectiveness of a support intervention delivered by health professionals to increase the rate and duration of breastfeeding.
                A randomized controlled intervention study was conducted in the period 2000-2001 among 605 mothers who had given birth in a public maternity ward located in the city of Rome, Italy. The intervention consisted of a home visit by a midwife from the maternity ward of the hospital. The outcome of the study was the infant's feeding habits, assessed by a 24-h recall. The effect of the intervention on the duration of breastfeeding was estimated by the Kaplan-Meier method and by the Cox multivariate regression model.
                According to intention-to-treat analysis, there was no significant difference between the intervention and the control group, after controlling for confounding factors (hazard ratio (HR) 1.04; 95% confidence interval (95% CI): 0.85-1.26). The duration of breastfeeding was shorter (HR 1.61; 95% CI: 1.13-2.31) for women in the intervention group who refused the obstetric visit.
                Our study shows that an early home support programme delivered by health professionals was not effective in increasing breastfeeding initiation and duration. Women's traditional way of breastfeeding has altered in Jordan with rates declining in recent years.
                The objectives of this study were to test whether the introduction of an educational program supporting breastfeeding would increase the proportion of women who breastfed fully to six months, improve the women's level of breastfeeding knowledge, and decrease the proportion of infants admitted to hospitals due to gastrointestinal illnesses.
                A randomized controlled trial was conducted in 90 primiparous women who had given birth to a healthy, full term, singleton baby at two hospitals in the southern region of Jordan. Women were randomly allocated to either the intervention group (n=45), in which they were offered a one-to-one postnatal educational session and follow-up phone calls at two months and four months postpartum, or the control group (n=45), in which they received routine postnatal care. The primary outcomes were the proportion of women fully breastfeeding their babies at six months and the women's level of breastfeeding knowledge at six months postpartum.
                The postnatal education and support program significantly improved breastfeeding knowledge measured by differences between mean pre- and post-test scores. This was statistically significant for the intervention group (p<0.001) but was not significant for the control (p=0.23). The proportion of women fully breastfeeding their babies at 6 months was not found to be statistically significantly different between the intervention group (39%) and the control group (27%), percentage difference=12% (95% confidence interval [-9% to 30%], Chi squared: χ(2)=3.54, p>0.05).
                Although the postnatal education and support program improved breastfeeding knowledge among women in the study, this increase in knowledge did not translate to an increase in the duration of full breastfeeding to six months.
                Copyright © 2011 Elsevier Ltd. All rights reserved. To assess the impact of a supportive intervention on the duration of breastfeeding.
                A community based cluster-randomized trial in Western Denmark.
                Fifty-two health visitors and 781 mothers in the intervention group, and 57 health visitors and 816 mothers in the comparison group. Intervention: Health visitors in the intervention group received an 18-h course. The intervention addressed maternal psychosocial factors and consisted of 1-3 home visits during the first 5 weeks post-partum. Health visitors in the comparison group offered their usual practice. Main outcome measure: Duration of exclusive breastfeeding during 6 months of follow-up.
                Mothers in the intervention group had a 14% lower cessation rate (HR = 0.86 CI: 0.75-0.99). Similar results were seen for primipara, and multipara with previously short breastfeeding experience. Mothers in the intervention group received their first home visit earlier, had more visits and practical breastfeeding training within the first 5 weeks. Babies in the intervention group were breastfed more frequently, fewer used pacifiers, and their mothers reported more confidence in not knowing the exact amount of milk their babies had received when being breastfed.
                Home visits in the first 5 weeks following birth may prolong the duration of exclusive breastfeeding. Postnatal support should focus on both psychosocial and practical aspects of breastfeeding. Mothers with no or little previous breastfeeding experience require special attention. The goal of this controlled trial was to evaluate the impact of a volunteer telephone support program on the ability of the mothers to reach their breastfeeding objectives and to reduce the number of difficulties while nursing. Two hundred expectant women were randomly assigned to two groups. The first group received the usual services from the professionals and the second had the extra service from a trained volunteer. By comparing the proportions of women still breastfeeding at each month, the present study showed that this type of support was ineffective in meeting the objectives. The gap between the intended length of breastfeeding and the duration achieved was equally large in both groups. Only 30% breastfed for the length of time envisaged during pregnancy. Strategies to increase the effectiveness of this type of service are suggested. Exclusive breastfeeding is rare in Bangladesh. About 90% of women have home deliveries, so the Baby-Friendly Hospital Initiative has no mechanism to reach them. Mother support groups do not exist, and community health workers do not have time to promote and support exclusive breastfeeding. To provide this kind of support at the community level, an area in Dhaka was selected for a peer-counseling intervention program. Using certain selection criteria, 1 woman from each community was trained as a peer counselor. The training was based on the World Health Organization/United Nations International Children's Emergency Fund 40-hour breastfeeding counseling course and related books. Counseling skills were taught using demonstrations and role play, followed by practical training in the project area. The intervention was very successful, as 70% of the mothers in the project area breastfed their infants exclusively for 5 months compared to only 6% in the control area. The authors describe the peer counseling training, strategies used for peer counseling visits, and lessons learned. Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries.
                To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants.
                The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996-December 1997 with a 1-year follow-up.
                Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.
                A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up.
                Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies.
                Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups.
                Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P =.01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28).
                Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding. To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding.
                Randomised controlled trial.
                32 general practices in London and south Essex.
                720 women considering breast feeding.
                Primary outcome was prevalence of any breast feeding at six weeks. Secondary outcomes were the proportion of women giving any breast feeds, or bottle feeds at four months, duration of any breast feeding, time to introduction of bottle feeds, and satisfaction with breast feeding.
                Offering support in breast feeding did not significantly increase the prevalence of any breast feeding to six weeks (65% (218/336) in the intervention group and 63% (213/336) in the control group; relative risk 1.02, 95% confidence interval 0.84 to 1.24). Survival analysis up to four months confirmed that neither duration of breast feeding nor time to introduction of formula feeds differed significantly between control and intervention groups. Not all women in the intervention group contacted counsellors postnatally, but 73% (123/179) of those who did rated them as very helpful. More women in the intervention group than in the control group said that their most helpful advice came from counsellors rather than from other sources.
                Women valued the support of a counsellor in breast feeding, but the intervention did not significantly increase breastfeeding rates, perhaps because some women did not ask for help. To evaluate the effectiveness of home-based peer counselling to increase breastfeeding rates for unfavourably low birthweight babies.
                Randomized clinical trial carried out in maternity hospitals and households in Fortaleza, one of the regions in Brazil with very low income; 1003 mothers and their newborns were selected in eight maternity hospitals. Newborns needed were healthy and weighed less than 3000 g.
                Breastfeeding counselling, conducted by lay counsellors from the community, during home visits carried out on days 5, 15, 30, 60, 90 and 120 after birth.
                Feeding methods in the fourth month of life.
                The intervention increased exclusive breastfeeding (24.7% vs 19.4%; p=0.044), delayed the introduction of formula and increased the time infants substituted breastfeeding to bottle milk (bottle milk 33.4% in the control group and 20.1% in the intervention group; p=0.00002). When comparing the frequency of artificial breastfeeding versus all other forms of breastfeeding (exclusive+predominant+partial), the intervention increased breastfeeding rates in 39% (RR=0.61; CI 95%: 0.50-0.75); 15% of children were free from artificial feeding (absolute risk reduction). The number of families to be visited to avoid one child receiving artificial feeding (NNT) was 7 (CI 95%: 5-13).
                Breastfeeding counselling, promoted by lay counsellors, can impact favourably on exclusive breastfeeding rates and contribute to delaying the utilization of milk formula and weaning. The intervention has great application potential because most cities in the northeast of Brazil count on community health workers that could do the counselling. In the Netherlands, the initiation rate of breast-feeding (BF) was 80% in 2002, but only 35% of the mothers continued to breast-feed for 3 months. This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding.
                A cluster-randomized intervention trial was used. Ten child health care centers in three regions of the home health care were randomly allocated to the program or usual care. Elements in the program were health counseling, measures to enhance cooperation, early signaling of breast-feeding problems and continuity of care, and lactation consultancy. Pregnant mothers who applied for home health care in the intervention or usual care regions were enrolled and were followed up from pregnancy until 6 months postpartum (n = 683). The primary outcome measure was the continuation of breast-feeding until at least 3 months.
                The 3-month breast-feeding rate was 32% in the intervention and 38% in the control groups (OR = 0.79, 95% CI = 0.58-1.08).
                The program was not effective. We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program, such as the categories of caregivers involved and the number and duration of contacts after parturition. The advantages of breastfeeding have been well established for both mothers and their infants. Existing research reports equivocal effects of early discharge and postpartum home care on breastfeeding success. The purpose of this study was to compare the effects of breastfeeding support offered in hospital and home settings on breastfeeding outcomes and maternal satisfaction for mothers of term and near-term newborns who experienced standard or early discharge.
                In a randomized controlled trial with prognostic stratification for gestational age, 101 term and 37 near-term (35-37 weeks' gestational age) mother-newborn pairs were randomized to either a standard care group (standard care and standard length of hospitalization) or an experimental group (standard hospital care with early discharge and home support from nurses who were certified lactation consultants). Data collection occurred before randomization, at discharge from hospital, and from 5 to 12 days postpartum. Primary outcomes included breastfeeding rates and maternal satisfaction.
                More mothers of term newborns in the experimental group were breastfeeding exclusively at follow-up (p = 0.02) compared with the control group. No significant breastfeeding differences occurred among mothers with near-term newborns in the experimental and standard care groups.
                In-home lactation support appears to facilitate positive breastfeeding outcomes for mothers of term newborns. This may also be a beneficial model of postpartum care for mothers of near-term newborns; however, further research is required. The findings suggest implications for health caregivers and policy makers with respect to postpartum lactation and health care services. to evaluate the effects of an extended midwifery support (EMS) programme on the proportion of women who breast feed fully to six months.
                randomised controlled trial.
                large public teaching hospital in Australia.
                849 women who had given birth to a healthy, term, singleton baby and who wished to breast feed.
                participants were allocated at random to EMS, in which they were offered a one-to-one postnatal educational session and weekly home visits with additional telephone contact by a midwife until their baby was six weeks old; or standard postnatal midwifery support (SMS). Participants were stratified for parity and tertiary education.
                the main outcome measures were prevalence of full and any breast feeding at six months postpartum.
                there was no difference between the groups at six months postpartum for either full breast feeding [EMS 43.3% versus SMS 42.5%, relative risk (RR) 1.02, 95% confidence interval (CI) 0.87-1.19] or any breast feeding (EMS 63.9% versus SMS 67.9%, RR 0.94, 95%CI 0.85-1.04).
                the EMS programme did not succeed in improving breast-feeding rates in a setting where there was high initiation of breast feeding. Breast-feeding rates were high but still fell short of national goals.
                continuing research of programmes designed to promote breast feeding is required in view of the advantages of breast feeding for all mothers and babies.
                Copyright 2008 Elsevier Ltd. All rights reserved. To pilot test a newly developed breastfeeding self-efficacy intervention.
                Pilot randomized controlled trial (RCT).
                An acute care hospital located in Northwestern Ontario that is the sole provider of maternity care for the city and referral center for the region.
                One-hundred-and-fifty primiparous women intending to breastfeed their healthy, term, singleton infant.
                A standardized, individualized nursing intervention protocol was designed and administered to increase mothers' breastfeeding self-efficacy. Participants were randomly allocated to the intervention group or control group using sealed, opaque envelopes. Participants in the intervention group received three individualized, self-efficacy enhancing sessions with the researcher: two in-hospital and one by telephone. Participants in the control group received standard in-hospital and community care.
                Feasibility, compliance, and the acceptability of the breastfeeding self-efficacy intervention. Other outcomes assessed were breastfeeding self-efficacy, duration, and exclusivity.
                Findings suggest that the intervention was feasible; there was a high degree of protocol compliance, and the majority of mothers reported that the intervention was beneficial. Mothers in the intervention group had higher rates of breastfeeding self-efficacy, duration, and exclusivity at 4 and 8 weeks postpartum. However, the differences between groups were not statistically significant.
                The pilot RCT provided valuable information in examining the feasibility of the trial design and intervention.
                © 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. A randomized intervention trial to promote breast-feeding was carried out in southern Brazil. A group of 450 mothers and babies was visited at home 5, 10 and 20 days after birth and compared to a non-visited control group of the same size. Ninety-two per cent of the families visited received the three home visits planned. The evaluation of breast-feeding patterns and reasons for weaning took place 6 months after birth for both groups. Ninety-four per cent of the group visited and 92% of the non-visited controls group were traced on the occasion of the assessment. The intervention increased the duration of breast-feeding (median duration of 120 days in the group visited and 105 days in the controls; p = 0.03) and delayed the introduction of milk bottles (median age of introduction of 90 days in the group visited and 60 days in the controls; p = 0.01). Causes of weaning were classified as underlying, intermediate and immediate. The most common underlying cause of weaning was "the baby cried too much", which suggests that mothers should be taught about normal patterns of infant behaviour in the first weeks of life, particularly the need for crying, and the fact that this not necessarily reflects hunger. In a randomised controlled trial a lactation nurse assisted mothers during the early weeks after parturition both in hospital and at home. All mothers who started breast feeding were entered into the trial. The lactation nurse significantly extended duration in the study group compared with controls, particularly during the first four weeks and among women of lower social class. A sample of 38 white working class primiparas intending to breast feed were alternately assigned to either an experimental or control group during the last trimester of pregnancy. All women were visited at home antenatally for a structured interview on their attitudes towards and information on breast feeding. The experimental group were visited twice before the birth, seen within the first 5 days in hospital, and visited immediately after they returned home, to enable the provision of information, advice and support regarding breast feeding. All women were seen again at 3 months postpartum. There was a significant difference between the two groups in level of breast feeding success, and explanations for this effect are put forward in terms of the experimental intervention components. To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives.
                Randomised controlled trial with six month follow up.
                Recruitment in a university teaching hospital and care provided in women's homes.
                623 postnatal women allocated at random to intervention (311) or control (312) group. Intervention: Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker. Main outcome measure: General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs.
                At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were pound 635 for the intervention group and pound 456 for the control group (P=0.001). At six months figures were pound 815 and pound 639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits.
                There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service. To evaluate the relative effects introducing motivational videotapes and/or peer counseling in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics serving African-American women have on breast-feeding duration.
                Experimental intervention study. Pregnant women were enrolled at or before 24 weeks gestation and were followed up until postpartum week 16. Women were interviewed at enrollment, 7 to 10 days, 8 weeks, and 16 weeks postpartum. SUNJECTS/SETTING: One hundred fifteen African-American WIC participants who initiated breast-feeding and who had been enrolled in 1 of 4 clinics.
                Two-by-two factorial design, in which 4 clinics were randomly assigned to receive either no intervention, a motivational video package intervention, a peer-counseling intervention, or both interventions.
                Breast-feeding duration in weeks and relative risk ratios for breast-feeding cessation before 16 weeks postpartum.
                Contingency table analysis, including chi2 tests and log-rank tests; multivariate analysis using Cox proportional hazards regression analysis.
                A higher proportion of women were breast-feeding at 8 and 16 weeks postpartum in the intervention clinics than in the control clinic. The proportion of women reporting breast-feeding declined at 8 and 16 weeks postpartum, but the rate of decline was slower in the 3 intervention clinics than in the control clinic. Being younger than 19 years of age or older than 25 years of age, having a male infant, and returning to work or school all negatively affected breastfeeding duration, whereas previous breast-feeding experience positively influenced breast-feeding duration.
                WIC-based peer counselor support and motivational videos can positively affect the duration of breast-feeding among African-American women. WIC nutritionists and other health professionals in contact with this population should expand their efforts toward promoting increased duration of breast-feeding. To study the factors involved in the maintenance of exclusive breastfeeding in healthy infants during the first 4 months of life, with emphasis on the role of pediatricians. Material and methods: A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba, state of Minas Gerais, Brazil. The babies were divided at random into three groups: G1, receiving advice from a multiprofessional breastfeeding team; G2, receiving advice from a pediatrician trained in breastfeeding; and G3, receiving advice from a pediatrician with no breastfeeding training. Group randomization was confirmed by analysis of variance. The factors involved in the type of feeding at 4 months were analyzed by the chi-square test, by analysis of variance and by multiple variable analysis.
                At the end of follow-up, Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding. In addition, the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 (p = 0.002). The use of a pacifier was negatively correlated with exclusive breastfeeding (p = 0.003). More maternal schooling increased the chance of exclusive breastfeeding at 4 months (p = 0.041).
                In this study, a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months. Teenage pregnancies are associated with negative socioeconomic effects. Our aim was to ascertain whether a postnatal home-visiting service for teenage mothers younger than age 18 years could reduce the frequency of adverse neonatal outcomes and improve knowledge of contraception, breastfeeding, and infant vaccination schedules in this parent group.
                We enrolled 139 adolescents, attending a teenage pregnancy clinic, in a randomised controlled trial. After completing an antenatal questionnaire designed to assess their knowledge of contraception, infant vaccination, and breastfeeding, we assigned participants to either receive five structured postnatal home visits by nurse-midwives (n=65) or not (n=71). Assessment interviews were done 6 months postpartum. Our primary endpoint was unadjusted difference in knowledge between groups, and incidence of predefined adverse neonatal outcomes. Analysis was by intention to treat.
                Three women withdrew before randomisation because of late fetal loss, 11 mothers withdrew because of adverse neonatal outcomes (adverse neonatal outcome was a primary endpoint, but resulted in withdrawal from the study for knowledge outcomes), and one left voluntarily. Follow-up data were, therefore, available for 124 teenagers. Postnatal home visits were associated with a reduction in adverse neonatal outcomes (intervention: 2; control: 9; relative risk 0.24, 95% CI 0.05-1.08), and a significant increase in contraception knowledge (mean difference 0.92, 95% CI 0.32-1.52). However, there was no significant increase in knowledge with respect to breastfeeding or infant vaccination schedules associated with the home visits.
                Postnatal home-visiting services by nurse-midwives reduce adverse neonatal events and improve contraception outcomes, but do not affect breastfeeding or infant vaccination knowledge or compliance. A prospective study of the course of breast feeding was carried out in 75 randomly selected women. Weekly interviews were performed from the day after delivery until the termination of breast feeding, but in no case for longer than 6 months. In each case a detailed analysis was made of the factors leading to transient lactation crises or to complete cessation of breast feeding. A second group of 71 mothers, also randomly selected, was interviewed in retrospect only, 6 months after delivery, and served as controls. Twenty-four weeks after delivery 47% of the mothers in the weekly interview group were still breast feeding. The corresponding figure in the control group was 38%. In both groups only few mothers terminated lactation for medical reasons, while about one fourth stopped for some other reason and about one half because of a combination of factors. Brief case reports are presented to illustrate how varying the factors were that threatened breast feeding. Breastfeeding can ameliorate some of the complex health issues faced by low-income families. Women who breastfeed and their infants have lower health care costs compared with those who formula feed. Increasing the duration of breastfeeding is recognized as a national priority, particularly for low-income women. This community-based randomized clinical trial involving low-income mothers compared usual care with an intervention comprising hospital and home visits, and telephone support by a community health nurse/peer counselor team for 6 months after delivery.
                Forty-one women were recruited after delivery of a full-term singleton infant and randomly assigned to intervention or usual care groups.
                Women receiving the community health intervention breastfed longer than the women receiving usual care. The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group. The intervention cost ($301/mother) was partially offset by cost savings on formula and health care.
                Community health nurse and peer counselor support can increase breastfeeding duration in low-income women, and has the potential to reduce total costs including the cost of support. To evaluate the effectiveness of a breastfeeding promotion program in the Women, Infant and Children (WIC) Supplemental Nutrition Program participants.
                This randomized clinical trial included 52 women in the intervention group who received one-to-one pre- and postnatal breastfeeding education and support from a lactation consultant. Women (n = 52) randomized to controls received standard breastfeeding services. Data regarding their infants' feeding (classified as exclusive, partial, and bottle) during the first 7 days, 1, 2, and 3 months of age were compared. Additionally, the mothers were surveyed to assess their knowledge, attitude, and beliefs regarding breastfeeding.
                Among the 104 enrolled women, 91 (87.5%) were Hispanic. Almost all the pregnant women had planned to breastfeed their infants. Although the majority of women reported breastfeeding their infants, 45.6% in the intervention group and 28.9% of controls practiced exclusive breastfeeding during the first 7 days. By 3 months, the rate of exclusive breastfeeding in the intervention and control groups had dropped to 13.9% and 10.5%, respectively. Parity, mode of delivery, previous experience with breastfeeding, rooming in, and return to work did not significantly affect the exclusive breastfeeding rate. Maternal knowledge, attitude, and beliefs regarding breastfeeding were comparable between the study groups at the baseline stage as well as 3 months postpartum.
                Participation in the proposed breastfeeding promotion program by the low-income mothers was associated with an insignificant increase in the exclusive breastfeeding rate during the first 3 postpartum months. Exclusive breastfeeding is recommended until age 6 months. We assessed the feasibility, effectiveness, and safety of an educational intervention to promote exclusive breastfeeding for this length of time in India.
                We developed the intervention through formative research, pair-matched eight communities on their baseline characteristics, and randomised one of each pair to receive the intervention and the other to no specific intervention. We trained health and nutrition workers in the intervention communities to counsel mothers for exclusive breastfeeding at multiple opportunities. We enrolled 1115 infants born in the 9 months after training-552 in the intervention and 473 in the control communities. Feeding at age 3 months, and anthropometry and of diarrhoea prevalence at age 3 months and 6 months were assessed. All analyses were by intention to treat.
                We assessed 483 and 412 individuals at 3 months in the intervention and control groups, respectively, and 468 and 412 at 6 months. At 3 months, exclusive breastfeeding rates were 79% (381) in the intervention and 48% (197) in the control communities (odds ratio 4.02, 95% CI 3.01-5.38, p<0.0001). The 7-day diarrhoea prevalence was lower in the intervention than in the control communities at 3 months (0.64, 0.44-0.95, p=0.028) and 6 months (0.85, 0.72-0.99, p=0.04). The mean weights and lengths, and the proportion with weight-for-height or height-for-age Z scores of 2 or less, at age 3 months and 6 months did not differ much between groups. Intervention effect on exclusive breastfeeding, diarrhoeal morbidity, and anthropometry at age 6 months in the low-birthweight subgroup was similar to that for all births.
                Promotion of exclusive breastfeeding until age 6 months in a developing country through existing primary health-care services is feasible, reduces the risk of diarrhoea, and does not lead to growth faltering. Recognizing that an expectant father may influence a mother's decision to breast- or formula-feed, we tested the effectiveness of a simple, educational intervention that was designed to encourage fathers to advocate for breastfeeding and to assist his partner if she chooses to breastfeed.
                We conducted a randomized controlled trial in which expectant fathers (n = 59) were assigned randomly to attend either a 2-hour intervention class on infant care and breastfeeding promotion (intervention) or a class on infant care only (control group). The classes, which were led by a peer-educator, were interactive and informal and utilized different media to create an accessible environment for participants. Couples were recruited during the second trimester from a university obstetrics practice.
                Overall, breastfeeding was initiated by 74% of women whose partners attended the intervention class, as compared with 41% of women whose partners attended the control class (P = .02).
                Expectant fathers can be influential advocates for breastfeeding, playing a critical role in encouraging a woman to breastfeed her newborn infant. To determine whether an individualized, prenatal and postnatal, lactation consultant intervention resulted in increased cumulative intensity of breastfeeding up to 52 weeks.
                The randomized, nonblinded, controlled trial recruited women from prenatal care. Baseline prenatal interviews covered demographic data and breastfeeding experience, intention, and knowledge. Interviews at 1, 2, 3, 4, 6, 8, 10, and 12 months after birth collected data on weekly feeding patterns, infant illness, and infant health care use.
                Two community health centers serving low-income, primarily Hispanic and/or black women.
                The analytic sample included 304 women (intervention: n = 145; control: n = 159) with > or = 1 postnatal interview.
                Study lactation consultants attempted 2 prenatal meetings, a postpartum hospital visit, and/or home visits and telephone calls. Control subjects received the standard of care.
                Cumulative breastfeeding intensity at 13 and 52 weeks, based on self-reports of weekly feeding, on a 7-level scale.
                The intervention group was more likely to breastfeed through week 20 (53.0% vs 39.3%). Exclusive breastfeeding rates were low and did not differ according to group. In multivariate analyses, control subjects had lower breastfeeding intensity at 13 weeks (odds ratio [OR]: 1.90; 95% confidence interval [CI]: 1.13-3.20) and 52 weeks (OR: 2.50; 95% CI: 1.48-4.21). US-born control subjects had lowest breastfeeding intensity at 13 weeks (OR: 5.22; 95% CI: 2.43-11.22) and 52 weeks (OR: 5.25; 95% CI: 2.44-11.29). There were no significant differences in breastfeeding intensity among the US-born intervention, foreign-born intervention, and foreign-born control groups.
                This "best-practices" intervention was effective in increasing breastfeeding duration and intensity. Breastfeeding promotion should focus on US-born women and exclusive breastfeeding. Harmful effects of short postpartum hospital stays include dehydration and malnutrition of breastfed infants. These may be prevented by adequate breastfeeding frequency; however, rigorous research to determine the relative effectiveness of various follow-up strategies in supporting breastfeeding frequency is absent. This study addressed the question, "Is there a difference in breastfeeding frequency or infant weight gain for singleton infants discharged within 36 hours' postpartum who received either community nurse (home visit) or hospital nurse (clinic) follow-up?"
                A randomized, controlled trial was conducted at a university teaching hospital (3700 births/y) and affiliated community health centers. A consecutive sample of 586 healthy mother-infant pairs were recruited from January 1997 to September 1998 before discharge; 513 (87.5%) contributed data on 1 or more outcomes. Forty-eight-hour postpartum telephone contact and day 3 nurse contact in the home (experimental) or at the hospital (control) were provided. The main outcomes measured were breastfeeding frequency and infant weight gain assessed at 2 weeks' postpartum by maternal diary and weight at home by research assistants, masked to group allocation.
                No clinically important or statistically significant group differences were found in daily breastfeeding frequency (mean difference experimental minus control = 0.1 feeds [95% confidence interval: -0.1-0.3]) or daily rate of infant weight gain (-1.1 g [-2.5-0.3]) based on intention-to-treat analyses.
                Follow-up by nurses after short postpartum hospital stays, in either the home or a hospital-based clinic, of healthy infants discharged at <36 hours seems associated with satisfactory infant breastfeeding outcomes. Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care.
                Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales.
                Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both control groups.
                After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care, the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care. The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies, during a period of 42 days after delivery. Another aim was to compare the mothers', the midwife's, and the doctor's findings of prevalence of health problems at the end of the puerperium period.
                A randomised controlled trial was carried out. One group of mothers and their infants were randomly allocated to a home visiting group (Group A); the other group (Group B) was only visited at day 42.
                The study was carried out at the University Teaching Hospital (UTH) in Lusaka, the capital city of Zambia.
                A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant, as assessed by the attending midwife, were randomised to two groups. Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3, 7, 28, and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42.
                At day 42 an equal proportion (30%) of mothers in both groups perceived that they had health problems. The prevalence of infant health problems in Group B was significantly higher (p < 0.01) as perceived by mothers. There were more mothers in Group B (p < 0.01) perceiving insufficient milk production and giving supplementary feeding. At day 42, mothers in Group A (56%) took more actions than mothers in Group B (41%) to solve infant health problems (p < 0.03). In both groups the mothers' perceived own health problems, were significantly higher (p < 0.01) than those observed by the obstetrician and those observed by the midwife. The midwife found more infant health problems in Group B (p < 0.01) than in Group A and more infants with health problems in both groups compared with the paediatrician's findings (p < 0.01).
                There was a significant difference between the mothers' reported health problems and the health problems identified by the midwife and the doctors. The study shows that a midwife home visit and individual health education to mothers, reduce the prevalence of infant health problems, and enables the mother to more often take action when an infant health problem is identified. There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care. A trial was conducted with 51 women randomly assigned either to a conventional nursing care group or to an individualized professional support group to examine the effect of professional support on breastfeeding status at 4 weeks postpartum. All participants identified themselves as having no prior support. At 4 weeks postpartum, 17 out of 25 (68%) and 26 out of 26 (100%) women in the control and intervention groups, respectively, continued to breastfeed (P = .005). Results indicate that postpartum care augmented with individualized professional support commenced in the hospital and continued in the community significantly increases the duration of breastfeeding among women who identify themselves as being without support for the first month postpartum. Exclusive breast-feeding (EBF) rates remain low despite numerous health benefits associated with this behavior. We conducted a randomized trial on the effect of lactation counseling on EBF, which controlled for the Hawthorne effect while also varying the timing of the intervention. Pregnant women attending prenatal clinics in Tema were randomly assigned to 1 of 2 intervention groups (IG) or to a control group (C), as follows: 1) EBF support given pre-, peri-, and postnatally (IG1; n = 43); 2) EBF support given only peri- and postnatally (IG2; n = 44); or 3) nonbreast-feeding health educational support (C; n = 49) that had an equal amount of contact with lactation counselors. Two educational sessions were provided prenatally, and 9 home follow-up visits were provided in the 6-mo postpartum period. Infant feeding data were collected monthly at the participant's home. The 3 groups did not differ in sociodemographic characteristics. At 6 mo postpartum, 90.0% in IG1 and 74.4% in IG2 had exclusively breast-fed during the previous month. By contrast, only 47.7% in C were doing so (P = 0.008). Similarly, the percentage of EBF during the 6 mo was significantly higher (P = 0.02) among IG1 and IG2 (39.5%) than among C (19.6%). The 100% increase in EBF rates can be attributed to the lactation counseling provided. Additional prenatal EBF support may not be needed within a context of strong routine prenatal EBF education. This quasi-experimental study was conducted in Shiraz, the Islamic Republic of Iran, on 120 pairs of mothers and infants in a maternity hospital that had a rooming-in programme. All 59 mothers in the study group received breastfeeding education, face-to-face, after delivery and during follow-up for 4 months in the mother and child health (MCH) centre or in their homes; the remaining 61 mothers comprised the control group. Exclusive breastfeeding rates were significantly higher in the study group (54%) than in the control group (6.5%), but 5% and 18% of infants, respectively, in the study and control groups had stopped breastfeeding by the age of 4 months. The mean number of days of diarrhoea experienced by infants in the study group were significantly lower (P < or = 0.004) than in the control group. At the end of 4 months, the mean weight and length of the infants were significantly higher (both P < 0.05) in the study group than in the control group. The findings indicate that rooming-in is very important for promoting exclusive breastfeeding and that there is a need for continuous breastfeeding education of mothers. Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health, the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal. The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks. Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed, problems with the infant latching or suckling, and lack of individualized encouragement from their clinicians in the early postdischarge period. Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practices during routine preventive visits. However, robust scientific evidence based on randomized, controlled trials is currently lacking.
                The purpose of this study was to determine whether attending an early, routine, preventive, outpatient visit delivered in a primary care physician's office would improve breastfeeding outcomes.
                The study was a prospective, randomized, parallel-group, open trial.
                Participants were recruited at a level 3 maternity facility, with an average of 2000 births per year, in France.
                A total of 231 mothers who had delivered a healthy singleton infant (gestational age: > or =37 completed weeks) and were breastfeeding on the day of discharge were recruited and randomized (116 were assigned to the intervention group and 115 to the control group) between October 1, 2001, and May 31, 2002; 226 mother-infant pairs (112 in the intervention group and 114 in the control group) contributed data on outcomes.
                Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members, a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge, provision of the telephone number of a peer support group, mandatory routine, preventive, outpatient visits at 1, 2, 3, 4, 5, and 6 months of infant age, and 10 weeks of paid maternity leave (extended to 18 weeks after the birth of the third child). In addition to the usual predischarge and postdischarge support, the mothers in the intervention group were invited to attend an individual, routine, preventive, outpatient visit in the office of 1 of the 17 participating primary care physicians (pediatricians or family physicians) within 2 weeks after the birth. The participating physicians received a 5-hour training program on breastfeeding, delivered in 2 parts in 1 month, before the beginning of the study.
                The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks (defined as giving maternal milk as the only food source, with no other foods or liquids, other than vitamins or medications, being given). The secondary outcomes included any breastfeeding reported at 4 weeks, breastfeeding duration, breastfeeding difficulties, and satisfaction with breastfeeding experiences. Classification into breastfeeding categories reported at 4 weeks was based on 24-hour dietary recall.
                Ninety-two mothers (79.3%) assigned to the intervention group and 8 mothers (7.0%) assigned to the control group reported that they had attended the routine, preventive, outpatient visit in the office of 1 of the 17 primary care physicians participating in the study. Mothers in the intervention group were more likely to report exclusive breastfeeding at 4 weeks (83.9% vs 71.9%; hazard ratio: 1.17; 95% confidence interval [CI]: 1.01-1.34) and longer breastfeeding duration (median: 18 weeks vs 13 weeks; hazard ratio: 1.40; 95% CI: 1.03-1.92). They were less likely to report any breastfeeding difficulties (55.3% vs 72.8%; hazard ratio: 0.76; 95% CI: 0.62-0.93). There was no significant difference between the 2 groups with respect to the rate of any breastfeeding at 4 weeks (89.3% vs 81.6%; hazard ratio: 1.09; 95% CI: 0.98-1.22) and the rate of mothers fairly or very satisfied with their breastfeeding experiences (91.1% vs 87.7%; hazard ratio: 1.04; 95% CI: 0.95-1.14).
                Although we cannot exclude the possibility that findings might differ in other health care systems, this study provides preliminary evidence of the efficacy of breastfeeding support through an early, routine, preventive visit in the offices of trained primary care physicians. Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes. Multifaceted interventions aiming to support breastfeeding should involve primary care physicians. A randomized controlled trial is used to determine whether assigning mixed feeders to a breastfeeding clinic within 1 week postpartum will increase exclusive breastfeeding at 1 month among Hispanic immigrants. Subjects are eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 85% are monolingual Hispanic. Mothers (n = 522) of infants at low risk for hyperbilirubinemia are approached at bedside 20 to 48 hours after delivery and randomly assigned to treatment or control groups. Intent-to-treat analysis of feeding behavior at 4 weeks postpartum indicates that the intervention group is more likely to be exclusively breastfeeding (16.4% vs 10% in the control group, P = .03; adjusted odds ratio 1.87; 95% confidence interval, 1.07-3.26); that the incidence of formula supplementation does not differ between groups; and that the intervention group is less likely to supplement with water and tea (P < .002). The importance of exclusive breast-feeding in the first 6 mo of life is widely recognized, but most mothers still do not reach this goal. Several studies have shown that face-to-face lactation counseling is effective in increasing not only exclusive breast-feeding rates but also the total duration of breast-feeding. However, it is unclear whether counseling could increase breast milk intake. The purpose of this study was to evaluate the effect of lactation counseling on breast milk intake, assessed through the deuterium dilution method. This was a blind, randomized intervention trial of lactation counseling in a sample of 188 babies born in Pelotas, selected with the same criteria used for the WHO Multicentre Growth Reference Study (MGRS). The main outcomes were breast-feeding pattern and duration for all infants as well as breast milk intake for a subsample of 68 infants at the age of 4 mo. Mothers in the control group were almost twice as likely to stop breast-feeding by 4 mo as those in the intervention group (prevalence ratio 1.85; P = 0.04). Cox regression confirmed that the velocity of weaning was twice as high in the control group. Breast milk and total water intakes did not differ between the groups. The deuterium dilution technique proved to be a practical means of assessing breast milk intake. Lactation counseling reduced early weaning, but breast milk intake at 4 mo was not affected. The authors analyzed data from a trial assessing the efficacy of breastfeeding peer counseling (PC) for increasing exclusive breastfeeding (EBF) to (1) examine whether different ethnic groups responded differently to the intervention and (2) document the determinants of EBF. At 2 months postpartum, the prevalence of EBF in the intervention group was 11.4% among Puerto Ricans compared to 44.4% among non-Puerto Ricans (P = .008). Multivariate logistic regression analyses showed that women who had the intention prenatally to engage in EBF were more likely to do so and those whose mothers lived in the United States were less likely to engage in EBF at hospital discharge. At 2 months postpartum, mothers who were breastfed as children were more likely to engage in EBF, whereas non-Puerto Ricans had a significantly greater response to the intervention than Puerto Ricans (odds ratio, 6.40; 95% confidence interval, 1.45-28.33). There is a need for further studies to determine why different ethnic groups respond differently to EBF promotion interventions. Food preferences are established in early childhood and track later in life. Therefore, it is important to promote healthy feeding practices as early as possible. A randomized field trial was conducted with 500 mother-child pairs from a low-income area of São Leopoldo, State of Rio Grande do Sul, Brazil, to evaluate the impact of a nutritional intervention in the first year of life on the dietary quality of 3- to 4-y-old children. Mother-child pairs were randomized either to intervention and control groups and dietary counseling was provided for mothers in the intervention group during 10 home visits in the course of the first year of life. These visits were carried out by fieldworkers who counseled the mothers about the Ten Steps for Healthy Feeding from Birth to Two Years of Age, based on the WHO guidelines. Dietary intake was assessed at 3-4 y of age for 345 children using two 24-h food recalls. Overall diet quality was determined by the Healthy Eating Index. The prevalence of poor diet in the intervention group was lower compared with the control group [relative risk (RR) = 0.30; 95% CI = 0.13-0.71). The number of children who achieved the 75th percentile for the vegetable and fruit component score was higher in the intervention than in control group (RR = 1.95; 95% CI = 1.31-2.89 and RR = 1.49; 95% CI = 1.07-2.07, respectively). Such data provide evidence that dietary counseling for mothers during the first year of life improves the overall dietary quality of children in a low-income population. We investigated the effectiveness of a program of intensive postpartum support for low-income, breast-feeding women and identified potential predictors of prolonged breast-feeding in this population. Ninety-seven low-income women were randomized to receive intensive postpartum education and support for breast-feeding or to receive only the routine assistance provided by the obstetrical nurses. Both groups were telephoned 6 weeks post partum to determine the method of infant feeding then, and those still breast-feeding were contacted monthly until complete weaning had occurred. No significant difference in breast-feeding duration between the two groups was noted. There was no association between duration of nursing and race, marital status, or the need to return to work or school. Earlier age at introduction of supplement, younger maternal age, and participation in prenatal classes predicted breast-feeding duration by logistic regression. To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women.
                Cluster randomised controlled trial with prospective mixed method embedded case studies to evaluate implementation processes.
                Primary care in Scotland.
                Pregnant women, breastfeeding mothers, and babies registered with 14 of 66 eligible clusters of general practices (localities) in Scotland that routinely collect breastfeeding outcome data.
                Localities set up new breastfeeding groups to provide population coverage; control localities did not change group activity.
                Primary outcome: any breast feeding at 6-8 weeks from routinely collected data for two pre-trial years and two trial years. Secondary outcomes: any breast feeding at birth, 5-7 days, and 8-9 months; maternal satisfaction.
                Between 1 February 2005 and 31 January 2007, 9747 birth records existed for intervention localities and 9111 for control localities. The number of breastfeeding groups increased from 10 to 27 in intervention localities, where 1310 women attended, and remained at 10 groups in control localities. No significant differences in breastfeeding outcomes were found. Any breast feeding at 6-8 weeks declined from 27% to 26% in intervention localities and increased from 29% to 30% in control localities (P=0.08, adjusted for pre-trial rate). Any breast feeding at 6-8 weeks increased from 38% to 39% in localities not participating in the trial. Women who attended breastfeeding groups were older (P<0.001) than women initiating breast feeding who did not attend and had higher income (P=0.02) than women in the control localities who attended postnatal groups. The locality cost was pound13 400 (euro14 410; $20 144) a year.
                A policy for providing breastfeeding groups in relatively deprived areas of Scotland did not improve breastfeeding rates at 6-8 weeks. The costs of running groups would be similar to the costs of visiting women at home.
                Current Controlled Trials ISRCTN44857041. The aim of this study was to determine the effects of breastfeeding education/support offered at home on day 3 postpartum on breastfeeding duration and knowledge.
                The study included a total of 60 women who gave birth at Zübeyde Hanım Maternity Hospital located in Aydın, Turkey. In addition to a standard breastfeeding education in the first few hours after delivery, which was provided to all women in this "baby-friendly initiative" (BFI) hospital, the mothers in the intervention group received breastfeeding education at home on day 3 postpartum from supporters.
                Both groups were comparable in terms of maternal and neonatal characteristics. The breastfeeding education/support offered during a home visit on day 3 postpartum was associated with a significant increase in the percentage of exclusively breastfed infants both at 2 weeks and 6 weeks, and at 6 months, and was also associated with a significant increase in exclusive breastfeeding and in total breastfeeding duration. In addition, increased breastfeeding knowledge scores were observed in the intervention group at 2 weeks and at 6 weeks after delivery, when compared with the respective scores in the control group.
                Breastfeeding education offered at home on day 3 postpartum was effective in increasing the breastfeeding duration and breastfeeding knowledge. Early postpartum home visiting is universal in many Western countries. Studies from developing countries on the effects of home visits are rare. In Syria, where the postpartum period is rather ignored, this study aimed to assess whether a community-based intervention of postnatal home visits has an effect on maternal postpartum morbidities; infant morbidity; uptake of postpartum care; use of contraceptive methods; and on selected neonatal health practices.
                A randomized controlled trial was carried out in Damascus. Three groups of new mothers were randomly allocated to receive either 4 postnatal home visits (A), one visit (B), or no visit (C).
                A total of 876 women were allocated and followed up.
                Registered midwives with special training made a one or a series of home visits providing information, educating, and supporting women.
                A significantly higher proportion of mothers in Groups A and B reported exclusively breastfeeding their infants (28.5% and 30%, respectively) as compared with Group C (20%), who received no visits. There were no reported differences between groups in other outcomes.
                While postpartum home visits significantly increased exclusive breastfeeding, other outcomes did not change. Further studies framed in a nonbiomedical context are needed. Other innovative approaches to improve postnatal care in Syria are needed. The purpose of this study was to assess whether providing a breastfeeding support team results in higher breastfeeding rates at 6, 12, and 24 weeks postpartum among urban low-income mothers.
                Design: A randomized controlled trial with mother-infant dyads recruited from 2 urban hospitals. Participants: Breastfeeding mothers of full-term infants who were eligible for Special Supplemental Nutrition Program for Women, Infants, and Children (n=328) were randomized to intervention (n=168) or usual-care group (n=160). Intervention: The 24-week intervention included hospital visits by a breastfeeding support team, home visits, telephone support, and 24-hour pager access. The usual-care group received standard care. Outcome Measure: Breastfeeding status was assessed by self-report at 6, 12, and 24 weeks postpartum.
                There were no differences in the sociodemographic characteristics between the groups: 87% were African American, 80% single, and 51% primiparous. Compared with the usual-care group, more women reported breastfeeding in the intervention at 6 weeks postpartum, 66.7% vs 56.9% (odds ratio, 1.71; 95% confidence interval, 1.07-2.76). The difference in rates at 12 weeks postpartum, 49.4% vs 40.6%, and 24 weeks postpartum, 29.2% vs 28.1%, were not statistically significant.
                The intervention group was more likely to be breastfeeding at 6 weeks postpartum compared with the usual-care group, a time that coincided with the most intensive part of the intervention.
                2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved. Most mothers stop breast-feeding before the recommended 6 months post partum. A systematic review showed that breast-feeding support programs by health care professionals did not substantially improve breast-feeding outcomes beyond 2 months post partum. We conducted a randomized controlled trial to evaluate the effect of peer (mother-to-mother) support on breast-feeding duration among first-time breast-feeding mothers.
                We recruited 256 breast-feeding mothers from 2 semi-urban community hospitals near Toronto and randomly assigned them to a control group (conventional care) or a peer support group (conventional care plus telephone-based support, initiated within 48 hours after hospital discharge, from a woman experienced with breast-feeding who attended a 2.5-hour orientation session). Follow-up of breast-feeding duration, maternal satisfaction with infant feeding method and perceptions of peer support received was conducted at 4, 8 and 12 weeks post partum.
                Significantly more mothers in the peer support group than in the control group continued to breast-feed at 3 months post partum (81.1% v. 66.9%, p = 0.01) and did so exclusively (56.8% v. 40.3%, p = 0.01). Breast-feeding rates at 4, 8 and 12 weeks post partum were 92.4%, 84.8% and 81.1% respectively among the mothers in the peer support group, as compared with 83.9%, 75.0% and 66.9% among those in the control group (p < or = 0.05 for all time periods). The corresponding relative risks were 1.10 (95% confidence interval [CI] 1.01-2.72) at 4 weeks, 1.13 (95% CI 1.00-1.28) at 8 weeks and 1.21 (95% CI 1.04-1.41) at 12 weeks post partum. In addition, when asked for an overall rating of their feeding experience, significantly fewer mothers in the peer support group than in the control group were dissatisfied (1.5% v. 10.5%) (p = 0.02). Of the 130 mothers who evaluated the peer support intervention, 81.6% were satisfied with their peer volunteer experience and 100% felt that all new breast-feeding mothers should be offered this peer support intervention.
                The telephone-based peer support intervention was effective in maintaining breast-feeding to 3 months post partum and improving satisfaction with the infant feeding experience. The high satisfaction with and acceptance of the intervention indicates that breast-feeding peer support programs, in conjunction with professional health services, are effective.
All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. Support is likely to be more effective in settings with high initiation rates, so efforts to increase the uptake of breastfeeding should be in place. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed. Support that is only offered reactively, in which women are expected to initiate the contact, is unlikely to be effective; women should be offered ongoing visits on a scheduled basis so they can predict that support will be available. Support should be tailored to the needs of the setting and the population group.