Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy Incentive-based Intervention to Maintain Breastfeeding Among Low-income Puerto Rican Mothers Theory of Planned Behavior-Based Models for Breastfeeding Duration Among Hong Kong Mothers Coparenting Breastfeeding Support and Exclusive Breastfeeding: A Randomized Controlled Trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs Does telephone lactation counselling improve breastfeeding practices? A randomised controlled trial. Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation. Supporting breastfeeding In Local Communities (SILC) in Victoria, Australia: a cluster randomised controlled trial ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions The effect of postpartum lactation counseling on the duration of breast-feeding in low-income women. The Effects of In-Hospital Lactation Education on Breastfeeding Practice Influence of counseling sessions on the prevalence of breastfeeding in the first year of life: a randomized clinical trial with adolescent mothers and grandmothers. Evaluation of a theory of planned behaviour-based breastfeeding intervention in Northern Irish schools using a randomized cluster design. Commercial discharge packs and breast-feeding counseling: effects on infant-feeding practices in a randomized trial. The effect of peer support on breast-feeding duration among primiparous women: a randomized controlled trial. Effects of a breastfeeding empowerment programme on Korean breastfeeding mothers: a quasi-experimental study. Prenatal and postpartum focus groups with primiparas: breastfeeding attitudes, support, barriers, self-efficacy, and intention. The Effect of Interactive Web-Based Monitoring on Breastfeeding Exclusivity, Intensity, and Duration in Healthy, Term Infants After Hospital Discharge. Why some women do not breast feed: bottle feeding and fathers' role. Exclusive breastfeeding increased by an internet intervention. Latent protective effects of breastfeeding on late childhood overweight and obesity: a nationwide prospective study. Effect of an extended midwifery postnatal support programme on the duration of breast feeding: a randomised controlled trial. The Effect of Individualized Professional Support on Duration of Breastfeeding: A Randomized Controlled Trial Promoting Exclusive Breastfeeding for 4-6 Months in Honduras: Attitudes of Mothers and Barriers to Compliance Postpartum positioning and attachment education for increasing breastfeeding: a randomized trial. A randomized controlled community-based trial to improve breastfeeding rates among urban low-income mothers. The effect of a postnatal education and support program on breastfeeding among primiparous women: a randomized controlled trial. Does parental breastfeeding knowledge increase breastfeeding rates? Effectiveness of a theory-based breastfeeding promotion intervention on exclusive breastfeeding in China: A randomised controlled trial.
OBJECTIVE : To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory ( URTI ) , lower respiratory ( LRTI ) , and gastrointestinal tracts ( GI ) in infancy . METHODS : This study was embedded in the Generation R Study , a population -based prospect i ve cohort study from fetal life onward in the Netherl and s. Rates of breastfeeding during the first 6 months ( never ; partial for < 4 months , not thereafter ; partial for 4–6 months ; exclusive for 4 months , not thereafter ; exclusive for 4 months , partial thereafter ; and exclusive for 6 months ) and doctor-attended infections in the URTI , LRTI , and GI until the age of 12 months were assessed by question naires and available for 4164 subjects . RESULTS : Compared with never-breastfed infants , those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI , LRTI , and GI until the age of 6 months ( adjusted odds ratio [ aOR ] : 0.65 [ 95 % confidence interval ( CI ) : 0.51–0.83 ] ; aOR : 0.50 [ CI : 0.32–0.79 ] ; and aOR : 0.41 [ CI : 0.26–0.64 ] , respectively ) and of LRTI infections between the ages of 7 and 12 months ( aOR : 0.46 [ CI : 0.31–0.69 ] ) . Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer . Partial breastfeeding , even for 6 months , did not result in significantly lower risks of these infections . CONCLUSIONS : Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants . Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months , but preferably 6 months , in industrialized countries The study provides a proof-of-concept that monthly financial incentives contingent on observed breastfeeding increased breastfeeding rates through 6-month postpartum among low-income Puerto Rican mothers . BACKGROUND AND OBJECTIVE : Despite maternal and child health benefits , breastfeeding rates are relatively low among low-income Puerto Rican mothers . This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) services only among Puerto Rican mothers . METHODS : A r and omized , 2-arm parallel-group design , from February 2015 through February 2016 . Half of the r and omized participants received monthly financial incentives contingent on observed breastfeeding for 6 months ( Incentive ) , and the other half received usual WIC services only ( Control ) . Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled .  Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from $ 20 to $ 70 for a total possible of $ 270 . RESULTS : The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group ( 89 % vs 44 % , P = .01 at 1 month ; 89 % vs 17 % , P < .001 at 3 months ; 72 % vs 0 % , P < .001 at 6 months ) . No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes ( ie , weight , emergency department visits ) . CONCLUSIONS : Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers ; however , no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes . Larger-scale studies are warranted to examine efficacy , implementation potential , and cost-effectiveness Background The theory of planned behavior ( TPB ) has been used to explain breastfeeding behaviors in Western cultures . Theoretically-based investigations in other groups are sparse . Objective To evaluate cross-cultural application of TPB-based models for breastfeeding duration among new mothers in Hong Kong . Method First-time breastfeeding mothers ( N = 209 ) with healthy newborns provided self-reports of TPB predictor variables during postpartum hospitalization and information about breastfeeding experiences at 1 , 3 , 6 , 9 , and 12 months postdelivery or until they weaned . Three predictive models were proposed : ( a ) a strict interpretation of the TPB with two added proximal predictors of breastfeeding duration ; ( b ) a replication with modification of the TPB-based model for more fully employed breastfeeding mothers from a previous study ( Duckett et al. , 1998 ) ; and ( c ) a model that posited perceived control ( PC ) as a mediating factor linking TPB motivational variables for breastfeeding with breastfeeding intentions and behavior . LISREL was used for the structural equation modeling analyses . Results Explained variance in PC and duration was high in all models . Overall fit of the strict TPB model was poor ( GOFI = 0.85 ) . The  TPB  for breastfeeding employed women and the PC-mediated models fit equally well ( GOFI = 0.94 ; 0.95 ) and residuals were small ( RMSR = 0.07 ) . All hypothesized paths in the PC-mediated model were significant ( p < .05 ) ; explained variance was 0.40 for perceived control and 0.36 for breastfeeding duration . Discussion Models were interpreted in light of the TPB , previous findings , the social context for breastfeeding in Hong Kong , and statistical model-building . Cross-cultural measurement issues and the need for prospect i ve design s are continuing challenges in breastfeeding research OBJECTIVE : To evaluate the effectiveness of a coparenting intervention on exclusive breastfeeding  among primiparous mothers and fathers . METHODS : A r and omized controlled trial was conducted in a large teaching hospital in Toronto , Canada . Couples were r and omized to receive either  usual care ( n = 107 ) or a coparenting breastfeeding support intervention ( n = 107 ) . Follow-up of exclusive breastfeeding and diverse secondary outcomes was conducted at 6 and 12 weeks postpartum . RESULTS : Significantly more mothers in the intervention group than in the control group continued to breastfeed at 12 weeks postpartum ( 96.2 % vs 87.6 % , P = .02 ) . Although proportionately more mothers in the intervention group were exclusively breastfeeding at 6 and 12 weeks , these differences were not significant . Fathers in the intervention group had a significantly greater increase in breastfeeding self-efficacy scores from baseline to 6 weeks postpartum compared with fathers in the control group ( P = .03 ) . In addition , significantly more mothers in the intervention group than in the control group reported that their partners provided them with breastfeeding help in the first 6 weeks ( 71 % vs 52 % , P = .02 ) and that they were satisfied with their partners ’ involvement with breastfeeding ( 89 % vs 78.1 % , P = .04 ) . Mothers in the intervention group were also more satisfied with the breastfeeding information they received ( 81 % vs 62.5 % , P < .001 ) . CONCLUSIONS : The significant improvements in breastfeeding duration , paternal breastfeeding self-efficacy , and maternal perceptions of paternal involvement and assistance with breastfeeding suggest that a coparenting intervention involving fathers warrants additional investigation Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background . 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 practice s during routine preventive visits . However , robust scientific evidence based on r and omized , controlled trials is currently lacking . Objective . 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 . Design . The study was a prospect i ve , r and omized , parallel-group , open trial . Setting . Participants were recruited at a level 3 maternity facility , with an average of 2000 births per year , in France . Participants . A total of 231 mothers who had delivered a healthy singleton infant ( gestational age : ≥37 completed weeks ) and were breastfeeding on the day of discharge were recruited and r and omized ( 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 . Intervention . 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 , m and atory 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 . Outcome Measures . 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 . Results . 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 ) . Conclusions . Although we can not 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 aim ing to support breastfeeding should involve primary care physicians BACKGROUND Exclusive breastfeeding rates in Malaysia remains low despite the implementation of the Baby Friendly Hospital Initiative ( BFHI ) policy in government hospitals . It has been suggested that any form of postnatal lactation support will lead to an increase in exclusive breastfeeding rates . OBJECTIVE To study the effectiveness of telephone lactation counselling on breastfeeding practice s. DESIGN Single blinded , r and omised controlled trial ( RCT ) . SETTING Maternity wards in a public hospital in Kuala Lumpur , Malaysia . PARTICIPANTS 357 mothers , each of whom had delivered a full term , healthy infant via spontaneous vaginal delivery . METHODS Mothers were followed up for 6 months . The intervention group ( n=179 ) received lactation counselling via telephone twice monthly by certified lactation counsellors in addition to receiving the current conventional care of postnatal breastfeeding support . The control group ( n=178 ) received the current conventional care of postnatal breastfeeding support . Definitions of breastfeeding practice s were according to World Health Organization ( WHO ) definitions . Participants answered a self-administered question naire during recruitment and were later followed up at one , four and 6-month intervals during the postpartum period via a telephone-based question naire . RESULTS At 1 month , a higher percentage of mothers in the intervention group practice d exclusive breastfeeding , compared to the control group ( 84.3 % vs. 74.7 % , OR 1.825 95 % , p=0.042 , CI=1.054 , 3.157 ) . At 4 and 6 months postpartum , similar percentages of mothers from the two groups practice d exclusive breastfeeding ( 41.98 % vs. 38.99 % ; 12.50 % vs. 12.02 % , no significant differences , both p>0.05 ) . Slightly higher numbers of mothers in the control group had completely stopped breastfeeding at the 1 , 4 and 6 month marks , compared to the intervention group ( 7.4 % vs. 5.4 % ; 12.6 % vs. 9.9 % ; 13.9 % vs. 9.4 % ; all p>0.05 ) . The reason cited by most mothers who had completely stopped breastfeeding during the early postpartum period was a low breast milk supply , while returning to work was the main reason for stopping breastfeeding later in the postpartum period . CONCLUSIONS Telephone lactation counselling provided by certified lactation counsellors from the nursing profession was effective in increasing the rate of exclusive breastfeeding for the first postpartum month but not during the 4 and 6month postpartum intervals OBJECTIVE To determine the impact of immigration status as well as race/ethnicity and social and economic factors on  breastfeeding initiation . DESIGN Cohort . SETTING Multisite group practice in eastern Massachusetts . PARTICIPANTS One thous and eight hundred twenty-nine pregnant women prospect ively followed up in Project Viva . MAIN OUTCOME MEASURE Whether the participant breastfed her infant . RESULTS The overall breastfeeding initiation rate was 83 % . In multivariate models that included race/ethnicity and social , economic , and demographic factors , foreign-born women were more likely to initiate breastfeeding than US-born women ( odds ratio [ OR ] , 3.2 [ 95 % confidence interval ( CI ) , 2.0 - 5.2 ] ) . In models stratified by both race/ethnicity and immigration status , and further adjusted for whether the mother herself was breastfed as an infant and the mother 's parents ' immigration status , US-born and foreign-born black and Hispanic women initiated breastfeeding at rates at least as high as US-born white women ( US-born black vs US-born white women , OR , 1.2 [ 95 % CI , 0.8 - 1.9 ] , US-born Hispanic vs US-born white women , OR , 1.1 [ 95 % CI , 0.6 - 1.9 ] , foreign-born black vs US-born white women , OR , 2.6 [ 95 % CI , 1.1 - 6.0 ] , and foreign-born Hispanic vs US-born white women , OR , 1.8 [ 95 % CI , 0.7 - 4.8 ] ) . Calculations of predicted prevalences showed that , for example , the 2.6-fold increase in odds for the foreign-born black vs US-born white women translated to an increase in probability of approximately 1.4 . Higher maternal education and household income also predicted higher initiation rates . CONCLUSIONS Immigration status was strongly associated with increased breastfeeding initiation in this cohort , implying that cultural factors are important in the decision to breastfeed . Immigrants of all races/ethnicities initiated breastfeeding more often than their US-born counterparts . In addition , US-born minority groups initiated breastfeeding at rates at least as high as their white counterparts , likely due in part to high levels of education and income as well as to access to a medical care system that explicitly supports breastfeeding Objectives Breastfeeding has significant health benefits for mothers and infants . Despite recommendations from the WHO , by 6 months of age 40 % of Australian infants are receiving no breast milk . Increased early postpartum breastfeeding support may improve breastfeeding maintenance . 2 community-based interventions to increase breastfeeding duration in local government areas ( LGAs ) in Victoria , Australia , were implemented and evaluated . Design 3-arm cluster r and omised trial . Setting LGAs in Victoria , Australia . Participants LGAs across Victoria with breastfeeding initiation rates below the state average and > 450 births/year were eligible for inclusion . The LGA was the unit of r and omisation , and maternal and child health centres in the LGAs comprised the clusters . Interventions Early home-based breastfeeding support by a maternal and child health nurse ( home visit , HV ) with or without access to a community-based breastfeeding drop-in centre ( HV+drop-in ) . Main outcome measures The proportion of infants receiving ‘ any ’ breast milk at 3 , 4 and 6 months ( women 's self-report ) . Findings 4 LGAs were r and omised to the comparison arm and provided usual care ( n=41 clusters ; n=2414 women ) ; 3 to HV ( n=32 clusters ; n=2281 women ) ; and 3 to HV+drop-in ( n=26 clusters ; 2344 women ) . There was no difference in breastfeeding at 4 months in either HV ( adjusted OR 1.04 ; 95 % CI 0.84 to 1.29 ) or HV+drop-in ( adjusted OR 0.92 ; 95 % CI 0.78 to 1.08 ) compared with the comparison arm , no difference at 3 or 6 months , nor in any LGA in breastfeeding before and after the intervention . Some issues were experienced with intervention protocol fidelity . Conclusions Early home-based and community-based support proved difficult to implement . Interventions to increase breastfeeding in complex community setting s require sufficient time and partnership building for successful implementation . We can not conclude that additional community-based support is ineffective in improving breastfeeding maintenance given the level of adherence to the planned protocol . Trial registration number ACTRN12611000898954 ; Results Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies 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 r and omized 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 The effectiveness of an in-hospital lactation education session on breastfeeding duration and satisfaction among postpartum women was investigated . In equal number , a total of 150 women were r and omly assigned to a st and ardized curriculum ( experimental group ) or a routine-care control group . No differences were found between the groups regarding breastfeeding duration , mother 's satisfaction level , or her perceived support . Item-scale analyses , however , were promising ( a=0 . 77 ) and a preliminary factor analysis suggested three underlying subscales : professional encouragement , satisfaction , and familial relationships . Based on a stepwise , multiple regression analysis three variables were related to length of breastfeeding experience , that is , level of satisfaction , educational level of the mother , and expected length of breastfeeding . Implication s of these results toward lactation education programs and further scale development are discussed BACKGROUND Adolescent mothers living with their mothers may be at greater risk of early weaning . This study aims to assess the influence of a breastfeeding promotion strategy directed at adolescent mothers living with their mothers on the prevalence of breastfeeding in the first year of life . METHOD A r and omized clinical trial with 323 adolescent mothers . Participants were divided into two groups : those who lived with their mothers and those who did not . Participants were r and omly assigned to control or intervention groups . Intervention consisted of breastfeeding counseling sessions held at the maternity ward and at home ( at 7 , 15 , 30 , 60 , and 120 days postpartum ) . The intervention effect was assessed by comparing survival curves for breastfeeding in the first 12 months of life . RESULTS The risk of weaning before 12 months of age was significantly lower in the intervention group for adolescent mothers not living with their mothers ; whereas the risk was not statistically different between intervention and control groups for those living with their mothers . CONCLUSIONS The positive influence of systematic counseling sessions on the prevalence of breastfeeding in the first year of life was significant for adolescent mothers . Living with their mothers reduced such influence OBJECTIVE The aim of this research was to evaluate the effectiveness of a school-based intervention design ed to enhance  young people 's motivations to breastfeed .  DESIGN A cluster r and omized controlled trial was conducted involving 50 post- primary schools from across Northern Irel and . However , dropout and exclusion criteria utilized for the current study result ed in an effective sample size of 42 schools . METHODS The intervention was delivered in two 35-min classroom sessions targeting those beliefs identified by the theory of planned behaviour ( TPB ) as significant in predicting motivation to breastfeed . Question naires incorporating the key components of the TPB were administered to all intervention and control schools at baseline , 1 and 6 months post-intervention . Multi-level modelling was used to analyse the data . RESULTS Findings suggest that the intervention was effective in that it increased females ' intentions to breastfeed , exp and ed their knowledge and led to more favourable attitudes and perceptions of subjective norms . Notably , females ' knowledge increased more in secondary schools than in grammar schools irrespective of whether they were control or intervention schools . CONCLUSION The research has provided evidence to support the use of the TPB in the design and evaluation of an intervention to increase females ' intentions to breastfeed A r and omized controlled trial was conducted to evaluate two interventions for prolonging the duration of breast-feeding in a multiethnic sample of 343 low-income urban women . One intervention compared research breast-feeding bedside counseling by a trained counselor , who also made eight telephone calls during the first 3 months of the infant 's life , with the routine breast-feeding counseling provided in the hospital by nurses . The other intervention compared commercial discharge packs provided by formula companies with research discharge packs design ed to be consistent with the WHO Code of Marketing of Breastmilk Substitutes . When infants were 4 months old , a telephone interviewer unaware of treatment status contacted 95 % ( 324/343 ) of the women to determine the infants ' feeding and health histories . Compared with routine counseling , research counseling delayed the first introduction of solid foods to the infant 's diet ( P = .03 , one-tailed ) but did not exert a statistically significant effect on breast-feeding by 4 months ' postpartum . Women who received the research discharge pack , compared with those who received the commercial pack , were more likely to prolong exclusive breast-feeding ( P = .004 , one-tailed ) , to be partially breast-feeding at 4 months postpartum ( P = .04 , one-tailed ) , and to delay the daily use of solid foods in the infant 's diet ( P = .017 , one-tailed ) . Among the women who received research counseling , the research discharge pack was associated with lower rates of rehospitalization of infants than was the commercial pack ( 1 % v 14 % ; P = .014 , two-tailed ) . We conclude that in high-risk maternity population s , commercial discharge material s for breast-feeding women should be replaced by material s consistent with the WHO Code BACKGROUND 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 r and omized controlled trial to evaluate the effect of peer ( mother-to-mother ) support on breast-feeding duration among first-time breast-feeding mothers . METHODS We recruited 256 breast-feeding mothers from 2 semi-urban community hospitals near Toronto and r and omly 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 . RESULTS 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 . INTERPRETATION 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 OBJECTIVES This quasi-experimental study examined the effects of a new breastfeeding empowerment programme provided to post-partum mothers within 3 days of entering post-partum care centres on their breastfeeding empowerment , problems and practice rate . METHOD The study employed a non-equivalent control group non-synchronized design . Participants who conformed with the selection criteria were selected from two post-partum care centres affiliated with hospitals in a city in South Korea . Each of the two study groups included 30 participants . The breastfeeding empowerment programme comprised four 60-minute sessions , and was applied for 4 weeks to mothers in the experimental group . RESULTS The breastfeeding empowerment scores were higher in the experimental group than in the control group ( p=0.007 ) , and there were fewer breastfeeding problems in the former group ( p=0.012 ) and the breastfeeding rates were higher in the former group ( p=0.017 , 0.002 and 0.002 at 4 , 8 and 12 weeks post-partum , respectively ) . CONCLUSIONS These results indicate that the provision of breastfeeding empowerment programmes to help mothers to identify and solve problems by themselves can improve breastfeeding empowerment , problem and practice rates , and hence should be considered useful as a post-partum nursing intervention in clinical setting s. The effectiveness of the various components of the breastfeeding empowerment programme developed in this study should be verified in field trials INTRODUCTION The purpose of this study was to explore women 's prenatal attitudes , perception of support , anticipated barriers , facilitators , and breastfeeding self-efficacy beliefs and how their attitudes , beliefs , and perceptions of support changed as a result of their postpartum experiences . METHODS A prospect i ve , descriptive design with qualitative data collection methods was used for this study . Eight primiparas participated in prenatal and postpartum focus groups held in the conference room of a local school of nursing . One additional mother participated in individual interviews before and after giving birth at her request . RESULTS In the prenatal groups , the major themes included beliefs that breastfeeding benefits both the mother and baby , availability of support , looking toward the future , and uncertainty about what to expect with breastfeeding . In the postpartum groups , the major themes centered around the realization that breastfeeding was both easy and difficult , the importance and role of supportive others , receiving conflicting advice , having validating experiences , and modifying breastfeeding intention based on postpartum experiences . DISCUSSION Mothers need to be better educated for breastfeeding prenatally , and the information must be consistent , realistic , and evidence -based OBJECTIVE To determine whether a Web-based interactive breastfeeding monitoring system increased breastfeeding duration , exclusivity , and intensity as primary outcomes and decreased symptoms of postpartum depression as a secondary outcome . DESIGN Two-arm , r and omized controlled trial . SETTING Three hospitals in the Midwestern United States . PARTICIPANTS One hundred forty one ( 141 ) mother-newborn dyads were recruited before discharge . METHODS Postpartum women were r and omly assigned to the control or intervention groups . Women in the control group ( n = 57 ) followed the st and ard hospital protocol , whereas women in the intervention group ( n = 49 ) were given access to an online interactive breastfeeding monitoring system and were prompted to record breastfeeding and infant output data for 30 days . A follow-up online survey was sent to both groups at 1 , 2 , and 3 months to assess breastfeeding outcomes and postpartum depression . RESULTS For mothers and infants , there were no significant differences in demographics between groups . No significant differences in breastfeeding outcomes were found between groups at discharge ( p = .707 ) . A significant difference in breastfeeding outcomes was found between groups at 1 , 2 , and 3 months ( p = .027 , p < .001 , and p = .002 , respectively ) . Members of the intervention group had greater exclusive breastfeeding rates at 1 , 2 , and 3 months . By the end of the third month , 84 % of the intervention group was breastfeeding compared with 66 % of the control group . Postpartum depression symptom scores decreased for both groups at 1 , 2 , and 3 months ( control group : 4.9 ± 3.9 , 4.3 ± 4.9 , and 3.2 ± 3.9 , respectively ; intervention group : 4.7 ± 4.5 , 3.0 ± 3.4 , and 2.8 ± 3.6 , respectively ) . However , there was no significant difference between groups at 1 , 2 , and 3 months ( p = .389 , .170 , and .920 , respectively ) for depression . CONCLUSION The Web-based interactive breastfeeding monitoring system may be a promising intervention to improve breastfeeding duration , exclusivity , and intensity OBJECTIVE To explore women 's experiences and perceptions of baby feeding and to explore the explanations offered by women who choose to either breast or bottle feed . DESIGN A qualitative study , which was prospect i ve in design . Participants were interviewed three times : the first stage was between six and 14 weeks of pregnancy ; the second stage was between 34 and 39 weeks ; and the third stage was between six and 14 weeks after childbirth . PARTICIPANTS 19 participants were recruited to the study group via 12 antenatal clinics in Coventry , UK . FINDINGS AND DISCUSSION The data indicate that participants make baby-feeding decisions either prior to conception or early in the pregnancy . Findings also indicate that both breast and bottle feeders possessed knowledge of the benefits of breast feeding , but this did not seem to influence decision making . One of the most significant factors influencing the decision to bottle feed appears to be a desire for paternal involvement . CONCLUSIONS AND IMPLICATION S FOR PRACTICE To increase the incidence of breast feeding , health-care professionals should consider the need for preconceptual health promotion . The role of paternal involvement in baby-feeding decisions also needs to be acknowledged and men need to be included in breast-feeding promotion campaigns BACKGROUND Exclusive breastfeeding for 6 months is acknowledged universally as the optimal feeding method for infants in order to provide the greatest health and well-being gains for the infant and mother . Despite this , many women stop short of attaining this desired outcome for their infant . With the permeation of the Internet into most of society , the aim of this study was to evaluate the effect of a breastfeeding support Internet intervention on breastfeeding outcomes on women living in regional Western Australia . MATERIAL S AND METHODS A nested intervention design within a longitudinal cohort titled the Regional Infant Feeding Study examined the effect of an Internet support Web site on the infant feeding practice s of women living in regional Western Australia . RESULTS In total , 414 women participated in the Internet study and were r and omly assigned to the control group ( n=207 ) or the intervention group ( n=207 ) . Women enrolled in the intervention were significantly more likely to be exclusively breastfeeding at 6 months postpartum compared with control group participants . Those women experiencing breastfeeding problems were more likely to access the Internet . CONCLUSIONS This breastfeeding support intervention study demonstrated a positive effect on longer-term exclusive breastfeeding for those enrolled in the intervention group . Together with more traditional methods of support , the Internet provides another possible method for promoting positive long-term breastfeeding outcomes OBJECTIVE To investigate the latent effect of breastfeeding on  overweight and obesity in late childhood . METHODS Data on breastfeeding and child anthropometric measurements were collected annually from a nation-wide population -based prospect i ve cohort study in Japan ( 21,425 boys and 20,147 girls ) .  Breastfeeding status ( exclusiveness and duration ) was assessed when the child was 6 months old . Mixed effects models were used to evaluate trajectories of body mass index ( BMI ) , together with overweight and obesity status , from 1.5 to 8 years of age . RESULTS  Mixed-fed boys and exclusively breastfed boys showed lower BMI as the main effect , as well as a slower increase of inclination in BMI as interaction term between feeding type and age , than exclusively formula-fed boys . Breastfed boys had lower BMI at the ages of 7 and 8 , in comparison with exclusively formula fed boys ( P = 0.002 and P < 0.001 , respectively ) . A similar association was found for girls , although the main effect of feeding type was not statistically significant . The analysis of breastfeeding duration had similar results . CONCLUSIONS Breastfeeding , even if partial or for short duration , has a latent protective effect against overweight and obesity in late childhood , especially for boys OBJECTIVE to evaluate the effects of an extended midwifery support ( EMS ) programme on the proportion of women who breast feed fully to six months . DESIGN r and omised controlled trial . SETTING large public teaching hospital in Australia . PARTICIPANTS 849 women who had given birth to a healthy , term , singleton baby and who wished to breast feed . INTERVENTION participants were allocated at r and om 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 st and ard postnatal midwifery support ( SMS ) . Participants were stratified for parity and tertiary education . MEASUREMENTS the main outcome measures were prevalence of full and any breast feeding at six months postpartum . FINDINGS 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 ) . CONCLUSIONS 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 . IMPLICATION S FOR PRACTICE continuing research of programmes design ed to promote breast feeding is required in view of the advantages of breast feeding for all mothers and babies Atrialwas conducted with 51women r and omly 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 Prospect i ve and retrospective data on maternal attitudes and obstacles to exclusive breastfeeding ( EBF ) were collected from Honduran mothers of low birthweight ( 1500 - 2500 g ) , term infants who were enrolled in an intervention study to compare infant outcomes in those who were r and omly assigned to breastfeed exclusively for either 4 or 6 months . Perceived advantages of EBF were that it was easier , more practical and economical , and result ed in better infant health and growth . Disadvantages included the perceived time dem and , concerns that the infant would accept solids less readily , and fears that breast milk alone was insufficient . The majority of study participants said that they would choose to EBF , particularly in the first few weeks , women who persevered became enthusiastic proponents of EBF . Messages to promote EBF need to target the entire community , not just mothers , and should focus on addressing common misconceptions and alerting women to potential problems before they occur BACKGROUND Although lactation experts suggest that a correct positioning and attachment technique reduces breastfeeding problems and enhances long-term breastfeeding , evidence from r and omized trials is lacking . The objective of this study was to evaluate the effect of postpartum positioning and attachment education on breastfeeding outcomes in first-time mothers . METHOD A r and omized trial was performed in a public hospital in Adelaide , South Australia , where 160 first-time mothers were r and omly allocated to receive either structured one-to-one education ( experimental group ) or usual postpartum care ( control group ) within 24 hours of birth . The primary outcome was breastfeeding at 6 weeks and 3 and 6 months postpartum ; other outcomes were nipple pain and trauma in hospital and at 6 weeks and 3 and 6 months , and satisfaction with breastfeeding . RESULTS No significant differences occurred in breastfeeding rates between the groups at each endpoint , although a trend in the direction of lower rates was seen at each endpoint in the experimental group . This group reported less nipple pain on days 2 ( p = 0.004 ) and 3 ( p = 0.04 ) , but this was not sustained on follow-up . No differences were observed in nipple trauma in hospital or in self-reported nipple pain and /or trauma at the three endpoints . Experimental group women were less satisfied with breastfeeding at 3 and 6 months postpartum when using a one-item measure ; however , a multiple-item measure showed no significant differences at the three endpoints . CONCLUSIONS The intervention did not increase breastfeeding duration at any assessment time or demonstrate any differences between the groups on secondary outcomes . The trend toward lower breastfeeding rates in the experimental group suggests a need for a larger trial to evaluate whether or nor postpartum positioning and attachment education may negatively affect breastfeeding OBJECTIVE 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 . METHODS DESIGN A r and omized 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 r and omized 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 st and ard care . OUTCOME MEASURE Breastfeeding status was assessed by self-report at 6 , 12 , and 24 weeks postpartum . RESULTS 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 . CONCLUSIONS 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 INTRODUCTION Women 's traditional way of breastfeeding has altered in Jordan with rates declining in recent years . OBJECTIVE 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 . METHODS A r and omized 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 r and omly 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 . RESULTS 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 ) . CONCLUSIONS 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 OBJECTIVE Although improving mothers ' knowledge about breastfeeding can increase rates and duration of breastfeeding , little is known about the influence of fathers ' knowledge . The purpose of this study was to assess the knowledge of mothers and fathers about breastfeeding before and after receiving  postpartum advice  and its relationship to the frequency of breastfeeding . METHODS A clinical trial was performed with mothers and fathers of normal children born at the Hospital de Clínicas de Porto Alegre , Brazil , between July 1994 and March 1995 . The study intervention consisted of postpartum advice supplied by means of a video film discussing basic topics of breastfeeding , an explanatory leaflet , and open discussion after viewing the video .  The first 208 couples comprised the control group , the next 197 comprised experimental group 1 , and the remaining 196 comprised experimental group 2 . Immediately after delivery , mothers and fathers in the three groups answered a test on breastfeeding knowledge ; they completed the same test at the end of the first month . All families received home visits at the end of the first , second , fourth , and sixth months , or until breastfeeding ceased . Logistic regression was used to evaluate the association between the mothers ' and fathers ' knowledge and frequency of breastfeeding . RESULTS Postpartum advice increased the breastfeeding knowledge of mothers and fathers . The mothers with the highest level of knowledge had a 6.5 times higher chance of exclusively breastfeeding at the end of the third month , and 1.97 times higher chance of continuing breastfeeding to the end of the sixth month compared with other mothers . The fathers ' knowledge also significantly influenced breastfeeding rates . The children whose fathers knew more had a 1.76 higher chance of being exclusively breastfed at the end of the first month , and 1.91 higher chance of receiving maternal milk at the end of the third month . CONCLUSION A simple , inexpensive strategy can increase the level of breastfeeding knowledge of mothers and fathers and , consequently , have a positive impact on the frequency of breastfeeding OBJECTIVE To investigate the effectiveness of a design ed intervention programme on the promotion of exclusive breast feeding during 6 months post partum among Chinese primiparous women , based on the theory of planned behaviour . DESIGN R and omised controlled trial . SETTING A tertiary hospital in Shanghai , China . PARTICIPANTS Chinese primiparous women who were able to breastfed their babies and companied by either husb and or mothers . INTERVENTION Participants were r and omly divided into the intervention and control group . On the basis of the theory of planned behaviour , mothers in the intervention group received the TPB-based intervention programme , including individual instruction , group education and telephone counselling , whereas both the intervention and control group continued to receive routine nursing care . MEASUREMENTS AND FINDINGS Data were collected between October 2013 and June 2014 . Initially , 352 participants were included . However , 67 of them dropped out or were lost to follow-up . Finally , 285 participants were included into the analysis , including 157 participants in the intervention group and 128 participants in the control group . Though some bias might exist , rates of exclusive breast feeding were consistently and significantly higher in the intervention group than the control group at 3 days ( 40.1 % versus 10.9 % , P<0.001 ) , 6 weeks ( 57.3 % versus 29.7 % , P<0.001 ) , 4 months ( 56.7 % versus 15.6 % , P<0.001 ) and 6 months post partum ( 42.0 % versus 10.2 % , P<0.001 ) . CONCLUSION AND IMPLICATION S The TPB-based breast-feeding promotion intervention is effective in improving exclusive breast-feeding rates in primiparous women . Although the current intervention that provides continued support during the hospitalisation and follow-up at home , problems remains in the workplaces
ABSTRACT The benefits of exclusive breastfeeding are well documented , yet few women adhere to recommendations .
We report the Behaviour Change Techniques ( BCTs ) within interventions trialled internationally after pregnancy to promote exclusive and mixed breastfeeding as well as evidence of effectiveness .