WIC-Based Interventions to Promote Breastfeeding Among African-American Women in Baltimore: Effects on Breastfeeding Initiation and Continuation Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study. Costs and effectiveness of community postnatal support workers: randomised controlled trial Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial Design of an intervention addressing multiple levels of influence on dietary and activity patterns of low-income, postpartum women. Lactation counseling increases breast-feeding duration but not breast milk intake as measured by isotopic methods. Factors associated with perceived insufficient milk in a low-income urban population in Mexico. Breastfeeding training for health professionals and resultant changes in breastfeeding duration. Counselling on breastfeeding: assessing knowledge and skills. Breast-feeding counselling in a diarrhoeal disease hospital. ABFAB. Attachment to the breast and family attitudes to breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the initiation and duration of breastfeeding: a randomised controlled trial [ISRCTN21556494] Effect of a lactation nurse on the success of breast-feeding: a randomised controlled trial. Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia. Randomized trial of breastfeeding support in very low-birth-weight infants. Evaluation of an information booklet on breastfeeding duration: a clinical trial. The effect of volunteer home visitation for adolescent mothers on parenting and mental health outcomes: a randomized trial. Home and videotape intervention delays early complementary feeding among adolescent mothers. Breast-feeding promotion in a diarrhoea programme in rural communities. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study Infant feeding and subsequent risk of atopic eczema. The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial A breast feeding education and promotion program: Effects on knowledge, attitudes, and support for breast feeding Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Evaluation of a community-based intervention to increase breastfeeding prevalence. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding Effect of breastfeeding education on the feeding pattern and health of infants in their first 4 months in the Islamic Republic of Iran. A randomized trial of two public health nurse follow-up programs after early obstetrical discharge: an examination of breastfeeding rates, maternal confidence and utilization and costs of health services. The effect of postpartum lactation counseling on the duration of breast-feeding in low-income women. Breast-feeding training for health professionals and resultant institutional changes. The Effects of In-Hospital Lactation Education on Breastfeeding Practice Depot-medroxyprogesterone acetate (DMPA) and risk of endometrial cancer. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Randomized trial of postpartum care after hospital discharge. A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. A PROSPECTIVE STUDY OF INDIVIDUAL COURSES OF BREAST FEEDING A randomized trial of a program of early postpartum discharge with nurse visitation. Clinical support can make the difference in exclusive breastfeeding success among working women. Breastfeeding peer support: maternal and volunteer perceptions from a randomized controlled trial. Breast milk and neonatal necrotising enterocolitis Effect of Peer Counselors on Breastfeeding Initiation, Exclusivity, and Duration Among Low-income Urban Women Influences on breast-feeding by lower-income women: an incentive-based, partner-supported educational program. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial Assessment of a structured in‐hospital educational intervention addressing breastfeeding: a prospective randomised open trial Commercial discharge packs and breast-feeding counseling: effects on infant-feeding practices in a randomized trial. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial The effect of peer support on breast-feeding duration among primiparous women: a randomized controlled trial. Home versus hospital breastfeeding support for newborns: a randomized controlled trial. Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials Effects of home visits and telephone contacts on breastfeeding compliance in Taiwan. Lactation nurse increases duration of breast feeding. A randomized, controlled trial to measure the frequency of use of a hospital telephone line for new parents. Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. Breast-feeding in a low-income population. Program to increase incidence and duration. Smoking relapse and early weaning among postpartum women: is there an association? The Effect of Individualized Professional Support on Duration of Breastfeeding: A Randomized Controlled Trial Postpartum positioning and attachment education for increasing breastfeeding: a randomized trial. Nursing intervention to increase the duration of breastfeeding. From bioactive substances to research on breast-feeding promotion. Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding. The effect of a culture-specific education program to promote breastfeeding among Vietnamese women in Sydney. Effect of the maternity ward system on the lactation success of low-income urban Mexican women. Factors related to breastfeeding duration. Postnatal home visits in teenage mothers: a randomised controlled trial
We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7 - 10 days among African-American WIC participants . Of the 242 women with complete data , 48 % initiated breastfeeding , but only 31 % were still breastfeeding at 7 - 10 days . Initiation was associated with cesarean delivery , infant feeding instruction , no artificial milk discharge pack , attending the peer counselor only-intervention site , and intention to breastfeed . Continuation was influenced by infant feeding instruction , no artificial milk discharge pack , and intention to breastfeed . Overall , trends toward a positive impact of the breastfeeding promotion activities were evident but weak , and largely gone by 7 - 10 days postpartum OBJECTIVE --To study the effect of early diet on the development of allergic reactions in infants born preterm . DESIGN --Two r and omised prospect i ve trails . In trail A infants were r and omly allocated banked donor milk or preterm formula as their sole diet or ( separately r and omised ) as a supplement to their mother 's expressed breast milk . In trial B infants were allocated term or preterm formula . A blind follow up examination was done 18 months after the expected date of birth . SETTING --Neonatal units of hospitals in Cambridge , Ipswich , King 's Lynn , Norwich , and Sheffield . Outpatient follow up . PARTICIPANTS --777 Infants with a birth weight less than 1850 g born during 1982 to 1984 . MAIN OUTCOME MEASURES --Development of eczema , allergic reactions to food or drugs , and asthma or wheezing by nine and 18 months after term . Whenever possible the observations were confirmed by rechallenge or clinical examination . RESULTS --At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial . In the subgroup of infants with a family history of atopy , however , those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions ( notably eczema ) by 18 months ( odds ratio 3.6 ; 95 % confidence interval 1.4 to 9.1 ) . CONCLUSIONS --Feeding neonates on formulas based on cows ' milk , including those with a high protein content , did not increase the overall risk of allergy . Nevertheless , in the subgroup with a family history of atopy early exposure to cows ' milk increased the risk of a wide range of allergic reactions , especially eczema Abstract Objectives : To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives . Design : R and omised controlled trial with six month follow up . Setting : Recruitment in a university teaching hospital and care provided in women 's homes . Participants : 623 postnatal women allocated at r and om 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 . Results : 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 £ 635 for the intervention group and £ 456 for the control group ( P=0.001 ) . At six months figures were £ 815 and £ 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 . Conclusions : 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 BACKGROUND Most mothers breastfeed in Bangladesh , but they rarely practise exclusive breastfeeding . Hospital-based strategies for breastfeeding promotion can not reach them because about 95 % have home deliveries . We postulated that with the intervention of trained peer counsellors , mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months . METHODS 40 adjacent zones in Dhaka were r and omised to intervention or control groups . Women were enrolled during the last trimester of pregnancy between February and December , 1996 . In the intervention group , 15 home-based counselling visits were scheduled , with two visits in the last trimester , three early postpartum ( within 48 h , on day 5 , between days 10 and 14 ) , and fortnightly thereafter until the infant was 5 months old . Peer counsellors were local mothers who received 10 days ' training . FINDINGS 363 women were enrolled in each group .  Peer counselling significantly improved breastfeeding practice s. For the primary outcome , the prevalence of exclusive breastfeeding at 5 months was 202/228 ( 70 % ) for the intervention group and 17/285 ( 6 % ) for the control group ( difference=64 % ; 95 % CI 57%-71 % , p>0.0001 ) . For the secondary outcomes , mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods . At day 4 , significantly more mothers in the intervention group breastfed exclusively than controls . INTERPRETATION Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding . We recommend incorporation of peer counsellors in mother and child health programmes in developing countries Low-income , multi-ethnic women are at elevated risk for obesity and chronic diseases , yet influences at different levels may act as barriers to changing risk behaviors . Following the birth of a child , childrearing and social isolation can exacerbate these influences . The social ecological framework integrates behavior-change strategies at different levels , providing a strong theoretical base for developing interventions in this high-risk population . The primary purpose of this r and omized controlled trial is to test the efficacy of an educational model delivered by community-based paraprofessionals in improving diet , activity and weight loss  among new mothers over a 12-month postpartum period and a 6-month maintenance period . This model fosters institutional change to support behavior changes influenced at intrapersonal and interpersonal levels , through collaboration with federal programs for low-income families : the Special Supplemental Food Program for Women , Infants and Children ( WIC ) , and the Exp and ed Food and Nutrition Education Program ( EFNEP ) . Participants are r and omized to the Usual Care , e.g. WIC nutrition and breastfeeding education , or Enhanced EFNEP intervention arm , consisting of Usual WIC Care plus a sustained , multi-component intervention including home visits , group classes and monthly telephone counseling . If shown to be efficacious , this program will be readily sustainable through existing federal agencies 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 , r and omized 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 sub sample 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 Survival analysis and logistic regression were used to identify factors associated with the onset of perceived insufficient milk among 165 healthy mothers who planned to breast-feed and gave birth by vaginal delivery , without complications , to a healthy term infant in either a nursery ( n = 58 ) or a rooming-in-hospital where formula supplementation was not allowed ( n = 107 ) . Women were interviewed in the hospital and at 1 wk , 2 mo and 4 mo postpartum . Women from both hospitals were similar in socioeconomic , demographic , anthropometric , previous infant feeding experience and prenatal care variables . Eighty percent of the women reported perceived insufficient milk at some point during the study . The cue interpreted most often as indicating insufficient milk was the crying of the infant . Multivariate analyses indicated that lack of confidence in breast-feeding , delayed onset of milk production , maternal education , multiparity , sore nipples , early introduction of formula to the previous child and mother breast-fed as a child were significantly associated ( P < 0.05 ) with perceived insufficient milk . Among women who reported perceived insufficient milk before 1 wk , breast-feeding confidence and maternal education interacted with the hospital in which they delivered CONTEXT Promotion of breastfeeding in Brazilian maternity hospitals . OBJECTIVE To quantify changes in the breastfeeding duration among mothers served by hospitals exposed to the Wellstart-SLC course  , comparing them with changes among mothers attended by institutions not exposed to this course . DESIGN R and omized Institutional Trial . SETTING The effects of training on breastfeeding duration was assessed in eight Brazilian hospitals assigned at r and om to either an exposed group ( staff attending the Wellstart-SLC course ) or a  control group .  SAMPLE For each of the eight study hospitals , two cohorts of about 50 children were visited at home at one and six months after birth . The first cohort ( n = 494 ) was composed of babies born in the month prior to exposure to the Wellstart-SLC course , and the second cohort ( n = 476 ) was composed of babies born six months subsequent to this exposure . MAIN MEASUREMENTS Kaplan-Meier curves were plotted to describe the weaning process and log-rank tests were used to assess statistical differences among survival curves . Hazard ratio ( HR ) estimates were calculated by fitting Cox proportional hazard regression models to the data . RESULTS The increases in estimated , adjusted rates for children born in hospitals with trained personnel were 29 % ( HR = 0.71 ) and 20 % ( HR = 0.80 ) for exclusive and full breastfeeding , respectively . No changes were identified for total breastfeeding . CONCLUSION This r and omized trial supports a growing body of evidence that training hospital health professionals in breastfeeding promotion and protection results in an increase in breastfeeding duration Reported are the results of a r and omized controlled trial to assess the effectiveness of the WHO/UNICEF 40-hour course " Breastfeeding counselling : a training course " . The course was conducted in a maternity hospital which provides care to a low-income population in a metropolitan area in São Paulo , Brazil . Health workers from 60 health units were r and omly assigned to be either participants ( 20 ) or controls ( 40 ) , and their breastfeeding knowledge and skills were assessed before and immediately after the course , as well as 3 months later . Immediately after the course the participants ' knowledge of breastfeeding had increased significantly compared to controls . Both their clinical and counselling skills also improved significantly . When assessed 3 months later , the scores remained high with only a small decrease . The implementation of the course was also evaluated . The methods used were participatory observation , key interviews and focus group discussion . In the 33 sessions of the course , the average score was 8.43 out of 10 . Scores were highest for content and methodology of the theory sessions , and lowest for " use of time " , " clinical management of lactation " , and " discussion of clinical practice " .  " Breastfeeding counselling : a training course " therefore effectively increases health workers ' knowledge and their clinical and counselling skills for the support of breastfeeding . The course can be conducted adequately using the material and methodology proposed , but could be more satisfactory if the time allocated to exercises and clinical practice sessions were increased Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea , so that they could start exclusive breast-feeding during their hospital stay . Infants ( n = 250 ) up to 12 weeks of age were r and omized to intervention and control groups . Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education . During follow-up at home by the counsellors a week later , only the mothers in the intervention group were counselled . All the mothers were evaluated for infant feeding practice s at home two weeks after discharge . Among the 125 mother-infant pairs in each group , 60 % of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6 % in the control group ( P < 0.001 ) ; two weeks later , these rates rose to 75 % and 8 % in the intervention and control groups , respectively ( P < 0.001 ) . However , 49 % of mothers in the control group reverted back to bottle-feeding compared with 12 % in the intervention group ( P < 0.001 ) . Thus , individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home . Maternal and child health facilities should include lactation counselling as an integral part of their programme to improve infant feeding practice Background It has proven difficult to reach World Health Organization ( WHO ) recommendations that infants be exclusively breastfed from birth to six months of age [ 1 , 2 ] , yet there is limited knowledge about interventions that are effective in increasing breastfeeding initiation and duration . Particularly lacking is evidence about how to maintain breastfeeding rates in countries which already have a high initiation of breastfeeding . This study aims to determine whether mid-pregnancy breastfeeding education  , with a focus on either attitudes to breastfeeding or on technical aspects of breastfeeding , has an effect on rates of breastfeeding initiation and duration . Secondary aims of the study are to : explore what factors might affect the duration of breastfeeding and evaluate the interventions from the participant and childbirth facilitator perspectives . Methods / Design A r and omised controlled trial ( RCT ) design will be used . Women having their first baby , and planning to give birth as public patients at the Royal Women 's Hospital ( RWH ) , Melbourne , will be approached at 18–20 weeks of pregnancy and invited to participate in the study . Participants will be r and omly allocated to a control group or one of two group interventions : a previously design ed and trialled tool to teach practical aspects of breastfeeding or an exploration of family attitudes to breastfeeding . The latter was developed and piloted by the investigators in conjunction with the group facilitators , prior to trial commencement . The interventions are planned to take place at 20–25 weeks . Data will be collected by question naire at recruitment , at interview in hospital after the birth and by telephone interview six months later . Medical/obstetric outcomes will be obtained from the medical record . The sample size ( 972 ) was calculated to identify an increase in breastfeeding initiation from 75 to 85 % and an increase from 40 to 50 % in breastfeeding at six months An evaluation of a  lactation nurse  by means of a r and omised controlled trial is described . The lactation nurse was employed to assist , support , and encourage mothers during the early weeks after parturition in hospital and at home . All mothers who breast-fed at least once were entered into the trial . Altogether 649 mothers were interviewed 12 months later to establish the duration of breast-feeding and to enquire after practice s of and attitudes towards infant feeding . The lactation nurse significantly extended the duration of breast-feeding , particularly during the first four weeks and among women of lower social class . Although she did not reduce problems or change practice s significantly , all the trends were consistently in the right direction . Mothers in the experimental group were more satisfied with the help they received than were mothers in the control group . It seems likely that the lactation nurse by consistent advice , assistance , support , and encouragement enabled mothers to cope more successfully with difficulties and that this led to significantly fewer ending breast-feeding prematurely STUDY OBJECTIVES : 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 . DESIGN : A r and omised controlled trial was carried out . One group of mothers and their infants were r and omly allocated to a home visiting group ( Group A ) ; the other group ( Group B ) was only visited at day 42 . SETTING : The study was carried out at the University Teaching Hospital ( UTH ) in Lusaka , the capital city of Zambia . PARTICIPANTS : 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 r and omised 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 . MAIN RESULTS : 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 ) . CONCLUSIONS : 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 OBJECTIVE To determine if supplementary structured breastfeeding counseling ( SSBC ) for both parents compared with conventional hospital breastfeeding support ( CHBS ) improves the duration of breastfeeding in very low-birth-weight infants up to 1 year old . DESIGN R and omized trial with longitudinal follow-up of infants at term , and ages 1 , 3 , 6 , and 12 months ( infant ages corrected for prematurity ) . SETTING A tertiary-level neonatal intensive care unit ( NICU ) and geographically defined region in central -west Ontario , Canada . PARTICIPANTS Parents of infants with a birth weight less than 1500 g , who planned to breastfeed . INTERVENTIONS The SSBC consisted of viewing a video on breastfeeding for preterm infants ; individual counseling by the research lactation consultant ; weekly personal contact in the hospital ; and frequent postdischarge contact through the infants ' first year or until breastfeeding was discontinued . The CHBS group had st and ard breastfeeding support from regular staff members confined to the period of hospitalization in the NICU . MAIN OUTCOME MEASURE Duration of breastfeeding . RESULTS At study entry , there were no statistically significant differences in major demographic characteristics between groups . The mean duration of breastfeeding was 26.1 weeks ( SD = 20.8 ; median , 17.4 ) in the SSBC group and 24.0 weeks ( SD = 20.5 ; median , 17.4 ) in the CHBS group ( not statistically significant ) . CONCLUSIONS Long-term breastfeeding counseling of parents of very low-birth-weight infants in this study did not demonstrate a significant difference in duration of breastfeeding . These results may be explained by the high motivation to breastfeed in both groups , a relatively advantaged population , and the availability of community breastfeeding re sources , which may have diminished any significant differences that could have result ed from a breastfeeding intervention . The results of this study , compared with previous studies of very low-birth-weight infants , indicate a new trend to longer duration of breastfeeding in preterm infants Since very few tools used in health education are carefully evaluated , the aim of this study was to examine the effect that a breastfeeding information booklet had on breastfeeding behaviour . Feedback about breastfeeding information needs from a preliminary study of 58 Perth mothers at 3 months postpartum provided the basis for the development of an information booklet . The sample consisted of 150 mothers of full-term infants who were breastfeeding for the first time . Upon discharge from hospital , a r and om sample of 75 mothers were sent the booklet . These mothers and a control group ( n = 75 ) were surveyed for 52 weeks to compare breastfeeding duration . Although the breastfeeding information booklet was found to be useful by 97 % of the experimental group , there was no significant difference noted for breastfeeding duration between groups . Study findings have implication s for clinical practice in highlighting the importance of breastfeeding information in increasing mothers ' confidence , providing suggestions for breastfeeding practice , and helping mothers not to feel alone in their concerns . Further research should include investigations into the association between mothers reaching their intended goal for breastfeeding duration and being satisfied with the breastfeeding experience . Success with breastfeeding tends to be measured by duration alone , but no research to date has specifically examined the criteria mothers use to determine if their breastfeeding experience was successful BACKGROUND Children of adolescent mothers may suffer because of parenting inadequacies . The use of volunteer home visitors to enhance parenting skills has not been well studied . OBJECTIVE To evaluate the effect of a volunteer model home visitation program on  adolescent parenting outcomes . DESIGN R and omized trial with assignment to home visitation or control group . SETTING Urban , African American community . PARTICIPANTS Adolescents aged 12 to 18 years at 28 or more weeks ' gestation or who had delivered a baby in the past 6 months were recruited between February 1996 and August 1999 . INTERVENTION Volunteers were recruited from the community and trained to implement a parenting curriculum during weekly home visits . Each volunteer was paired with one teenager . MAIN OUTCOME MEASURE Vali date d instruments measuring parenting stress , parenting behaviors , and mental health . RESULTS A total of 232 teenagers were successfully r and omized to home visitation and control groups . At baseline , the groups were comparable on demographic , social support , and mental health measures . Almost half the teenagers had poor mental health at baseline , and high rates persisted at follow-up in both groups . In multivariate models , the home visitation group demonstrated significantly better parenting behavior scores at follow-up than did the control group ( P = .01 ) but showed no differences in parenting stress or mental health . CONCLUSIONS The volunteer home visitation program significantly improved some parenting outcomes but not parental distress or poor mental health . Volunteers may be an effective means of providing parenting education , but interventions that include specific means of addressing poor mental health are likely to have greater effects BACKGROUND The American Academy of Pediatrics , the Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) , and the World Health Organization recommend that infants receive only breast milk or formula for the first 4 to 6 months of life , followed by the introduction of complementary foods . Despite these recommendations , many infants , particularly those with adolescent mothers , receive solid foods ( often cereal mixed with formula in a bottle ) and liquids other than formula or breast milk in the first few weeks of life . Decisions on early feeding are often guided by gr and mothers and influenced by beliefs that infants need complementary food to counteract signals of hunger , reduce crying , and sleep through the night . OBJECTIVE This investigation evaluated the efficacy of an intervention to delay the early introduction of complementary feeding among first-time , black , adolescent mothers living in multigenerational households . The intervention focused on reducing the cultural barriers to the acceptance of the recommendations of the American Academy of Pediatrics , WIC , and World Health Organization on complementary feeding by highlighting 3 topics : 1 ) recognition of infants ' cues ; 2 ) nonfood strategies for managing infant behavior ; and 3 ) mother-gr and mother negotiation strategies . The intervention was delivered through a mentorship model in which a videotape made by an advisory group of black adolescent mothers was incorporated into a home-visiting program and evaluated through a r and omized , controlled trial . METHODS One hundred eighty-one first-time , low-income , black mothers < 18 years old , living in multigenerational households were recruited from 3 urban hospitals . Infants were born at term , with birth weight appropriate for gestational age and no congenital problems . Shortly after delivery , mothers and gr and mothers completed a baseline assessment and mothers were r and omized into an intervention or control group . Intervention group mothers received home visitation every other week for 1 year . At 3 months , a subset of 121 adolescent mothers reported on their infant 's intake through a food frequency question naire . Mothers who fed their infant only breast milk , formula , or water were classified as optimal feeders . Mothers who provided complementary foods other than breast milk , formula , or water were classified as less optimal feeders . RESULTS Sixty-one percent of the infants received complementary foods before 3 months old . Multivariate hierarchical logistic regression was used to evaluate the determinants of being in the optimal versus less optimal feeders group . After controlling for infant age and family income , mothers of infants in the optimal feeders group were more likely to report accurate messages from WIC regarding the timing of complementary food and nearly 4 times more likely to be in the intervention group . The most common complementary food was cereal mixed with formula in the bottle . CONCLUSIONS The success of this relatively brief intervention demonstrates the importance of using ecological theory and ethnographic research to design interventions that enable participants to alter their behavior in the face of contradictory cultural norms . The intervention focused on interpreting infants ' cues , nonfood methods of managing infant behavior , and mother-gr and mother negotiations . It was delivered through methods that were familiar and acceptable to adolescent mothers-a mentorship model incorporating home visits and videotape . The skill-oriented aspects of the intervention delivered in a culturally sensitive context may have enabled the young mothers to follow the guidelines that they received from WIC and from their pediatricians . Strategies , such as those used in this intervention , may be effective in promoting other caregiving recommendations , thereby enabling providers to meet the increasing dem and s from parents for advice regarding children 's early growth and development Breast-feeding promotion is an important intervention for the control of infant diarrhoea .  This study assesses the impact of a breast-feeding counselling programme on the prevalence of exclusive breast feeding in rural communities in Nigeria . Mothers attending primary care facilities because their infants had acute diarrhoea were r and omised into two groups . The study group ( n = 82 ) received individual , focused breast-feeding counselling , while the controls ( n = 79 ) had routine advice for diarrhoea . Both groups were monitored and followed with home visits to determine infant-feeding practice s. The results showed marked increases in exclusive breast-feeding prevalence for the intervention group at day 7 ( 49 % vs. 6 % control ; p < 0.0001 ) and day 21 ( 46 % vs. 8 % ; p < 0.0001 ) . Moreover , diarrhoea re-occurrence at day 21 was less in the intervention group ( 12 % ) than controls ( 18 % ) . It is concluded that focused breast-feeding counselling can increase exclusive breast feeding and reduce the prevalence of diarrhoea in rural communities Abstract Objective : To investigate the relation of infant feeding practice to childhood respiratory illness , growth , body composition , and blood pressure . Design : Follow up study of a cohort of children ( mean age 7.3 years ) who had detailed infant feeding and demographic data collected prospect ively during the first two years of life . Setting : Dundee . Subjects : 674 infants , of whom 545 ( 81 % ) were available for study . Data on respiratory illness were available for 545 children ( mean age 7.3 ( range 6.1- 9.9 ) years ) ; height for 410 children ; weight and body mass index for 412 children ; body composition for 405 children ; blood pressure for 301 children ( mean age 7.2 ( range 6.9 - 10.0 ) years ) . Main outcome measures : Respiratory illness , weight , height , body mass index , percentage body fat , and blood pressure in relation to duration of breast feeding and timing of introduction of solids . Results : After adjustment for the significant confounding variables the estimated probability of ever having respiratory illness in children who received breast milk exclusively for at least 15 weeks was consistently lower ( 17.0 % ( 95 % confidence interval 15.9 % to 18.1 % ) for exclusive breast feeding , 31.0 % ( 26.8 % to 35.2 % ) for partial breast feeding , and 32.2 % ( 30.7 % to 33.7 % ) for bottle feeding . Solid feeding before 15 weeks was associated with an increased probability of wheeze during childhood ( 21.0 % ( 19.9 % to 22.1 % ) v 9.7 % ( 8.6 % to 10.8 % ) ) . It was also associated with increased percentage body fat and weight in childhood ( mean body fat 18.5 % ( 18.2 % to 18.8 % ) v 16.5 % ( 16.0 % to 17.0 % ) ; weight st and ard deviation score 0.02 ( −0.02 to 0.06 ) v −0.09 ( −0.16 to 0.02 ) . Systolic blood pressure was raised significantly in children who were exclusively bottle fed compared with children who received breast milk ( mean 94.2 ( 93.5 to 94.9 ) mm Hg v 90.7 ( 89.9 to 91.7 ) mm Hg ) . Conclusions : The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time . Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease . Key messages Current guidelines in the United Kingdom recommend that babies are exclusively breast fed for the first 4 months of life , with solids being introduced thereafter This study found that exclusive breast feeding is associated with a significant reduction in childhood respiratory illness The early introduction of solids is associated with increased body fat and weight in childhood Exclusive bottle feeding is associated with higher systolic blood pressure in childhood Breast feeding and delaying the introduction of solids until after 15 weeks may have a beneficial effect on childhood health and subsequent adult An attempted controlled trial of exclusively breast fed neonates with atopic parents , to assess the effectiveness of breast feeding in preventing atopic allergy , was not successfully achieved . Analysis of the data as an observational study , however , provided evidence that breast feeding offers some protection against eczema in genetically vulnerable infants .  Feeds of soya preparations were associated with eczema as often as cows ' milk based feeds Abstract Objectives : To evaluate impact of postnatal health education for mothers  on infant care and postnatal family planning practice s in Nepal . Design : R and omised controlled trial with community follow up at 3 and 6 months post partum by interview . Initial household survey of study areas to identify all pregnant women to facilitate follow up . Setting : Main maternity hospital in Kathm and u , Nepal . Follow up in urban Kathm and u and a periurban area southwest of the city . Subjects : 540 mothers r and omly allocated to one of four groups : health education immediately after birth and three months later ( group A ) , at birth only ( group B ) , at three months only ( group C ) , or none ( group D ) . Interventions : Structured baseline household question naire ; 20 minute , one to one health education at birth and three months later . Main outcome measures : Duration of exclusive breast feeding , appropriate immunisation of infant , knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea , knowledge of infant signs suggesting pneumonia , uptake of postnatal family planning . Results : Mothers in groups A and B ( received health education at birth ) were slightly more likely to use contraception at six months after birth compared with mothers in groups C and D ( no health education at birth ) ( odds ratio 1.62 , 95 % confidence interval 1.06 to 2.5 ) . There were no other significant differences between groups with regards to infant feeding , infant care , or immunisation . Conclusions : Our findings suggest that the recommended practice of individual health education for postnatal mothers in poor communities has no impact on infant feeding , care , or immunisation , although uptake of family planning may be slightly enhanced . Key messages Health education is widely promoted in primary care , but there have been few rigorous evaluations of its impact , especially in developing countries A r and omised controlled trial of postnatal individual health education for mothers given by trained female health workers showed no significant impact on maternal knowledge and practice s of child care or on infant health outcomes , but there was a small improvement in uptake of family planning at six months after birth The efficacy of health education interventions that rely solely on giving people information to bring about a change in health behaviour is unproved ; interventions should be evaluated before being implemented on a large scale Alternative strategies for health promotion in developing countries such as interactions within families , peer groups , or communities may be more effective but are costly and difficult to implement on a large This study was undertaken to determine the effects of a partner-support , incentive-baed educational program on breast feeding knowledge , attitudes and support and to examine the relationship between feeding intentions and feeding behavior among low-income women . Women who expressed a willingness to participate in the intervention were r and omly assigned to “ intervention ” and “ usual breast feeding ” ( control ) groups . Sixty-eight primipara women , with expected due date s between May and December , 1992 , volunteered to participate in the study . Of these , 34 were r and omly assigned to each of the two groups . Approximately 81 percent of the women completed the study , leaving n=29 in the control group and n-26 in the intervention group . The intervention consisted of special incentives ( prizes ) for women and their partners to participate in several breast feeding education and promotion activities . Intervention group women and their partners experienced positive changes in breast feeding knowledge and attitudes . Furthermore , the intervention seemed to have influenced more women in the treatment group to breast feed despite their prenatal feeding intentions . In addition , the partners of intervention group women were perceived to be more supportive of , breast feeding than control group partners . These findings suggest that incentives , such as donated prizes , can be used to attract lower socioeconomic group women and their partners to breast feeding promotion interventions . Participation in such interventions can produce positive changes in breast feeding knowledge , attitudes , and support , and can have a dramatic effect in promoting breast feeding BACKGROUND 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 r and omized 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 . METHODS Forty-one women were recruited after delivery of a full-term singleton infant and r and omly assigned to intervention or usual care groups . RESULTS 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 . CONCLUSIONS 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 BACKGROUND The aim of the study was to determine whether peer counselling in the antenatal and post-natal period would increase the prevalence and duration of breastfeeding among low-income women in Glasgow . METHODS The study was design ed as a quasi-experimental evaluation of a community-based breastfeeding promotion programme . The intervention comprised peer counselling of pregnant women , support of breastfeeding mothers and local awareness-raising activities .  The study subjects were all women attending the antenatal booking clinic resident in either the intervention or control area . Data were collected by means of four self-completion question naires , two administered antenatally and two post-natally . The proportions intending to breastfeed or breastfeeding in the intervention and control groups were compared at each assessment and over time . RESULTS Of the 995 women enrolled in the study , data were available for analysis on 919 ( 92 per cent ) to 6 weeks postnatally . At booking , 18 per cent of the intervention group and 21 per cent of the control group stated an intention to breastfeed . At delivery , the proportions initiating breastfeeding were 23 per cent of the intervention subjects and 20 per cent of the controls , and by 6 weeks post-natally , the proportion providing any breast milk had declined to 10 per cent of the intervention group and 8 per cent of the control group . Using multivariate analysis to adjust for factors ( such as socio-economic status ) known to influence breastfeeding , the breastfeeding prevalence was significantly higher in the intervention group relative to the controls at delivery [ odds ratio ( OR ) 2.0 ; 95 per cent confidence interval ( CI ) 1.2 - 3.1 , p = 0.006 ] . By 6 weeks post-natally the difference between the two groups was not statistically significant ( OR 1.8 ; 95 per cent CI 1.0 - 3.4 , p=0.07 ) . CONCLUSIONS As the impact of the intervention was not sustained even for the modest duration of 6 weeks postnatally , it would be premature to justify widespread use of peer support programmes to increase the prevalence of breastfeeding in socially disadvantaged communities Abstract Objective To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding .  Design R and omised controlled trial . Setting 32 general practice s in London and south Essex . Participants 720 women considering breast feeding . Main outcome measures 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 . Results 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 . Conclusions 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 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 OBJECTIVES To determine whether the outcomes of routine home visiting by public health nurses ( PHN ) after early obstetrical discharge differ from those of a screening telephone call design ed to identify mothers who need further intervention . METHODS Primiparas delivering a singleton infant and eligible for postpartum follow-up were r and omized to a  home visit or screening telephone call . Data were collected by telephone from 733 participants located at two tertiary care centres in Ontario . Outcomes included maternal confidence at two weeks , health problems of the infants between discharge and four weeks postpartum , breastfeeding rates at six months and costs of the two models . RESULTS Differences between the sample s at the two sites necessitated stratified analyses . No differences were detected between the groups in maternal confidence ( p = 0.96 ) , health problems of infants ( p = 0.87 ) , or rates of breastfeeding at six months ( p = 0.22 ) . However , at both sites the cost of routine home visits was found to be higher than that of screening by telephone . CONCLUSION Although universal access to postpartum support is important , the results suggest that a routine home visit is not always necessary to identify the women who need it . These results can be generalized only to low-risk women and infants 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 Assessed is a breast-feeding training course that was attended by health professionals at the Santos Lactation Center ( SLC ) , Santos , São Paulo , Brazil , as well as its impact on the implementation of breast-feeding programmes in maternity hospitals . Eight maternity hospitals were studied -- four were r and omly allocated to the experimental group and sent three health professionals to attend an 18-day course at SLC ; the remaining four institutions constituted the  control group . The compliance of all eight hospitals with WHO/UNICEF 's " Ten steps for successful breast-feeding " was determined using scores obtained before and 6 months after the training course . Institutions in the experimental group had an improved score , but those in the control group did not . The SLC training course was efficient since it enabled the participants to promote breast-feeding practice s. However , in order to succeed in implementing breast-feeding programmes , health professionals require also to develop skills to apply the knowledge they acquire in the course , as well as to involve the whole maternity unit team in the activities 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 This is a report of results from a case-control study of the relationship of the long-acting progestational contraceptive , depot-medroxyprogesterone acetate ( DMPA ) to risk of endometrial carcinoma . Prior use of DMPA and information on known and suspected risk factors for endometrial cancer were ascertained in personal interviews with 122 women with histologically confirmed disease and 939 controls selected from 2 hospitals in Bangkok and 1 in Chiang Mai , Thail and . Based on 3 exposed cases and 84 exposed controls , the relative risk of endometrial cancer was estimated to be 0.21 ( 95 % confidence interval = 0.06 , 0.79 ) in women who had ever used  DMPA ( but who had not first used DMPA in the year prior to diagnosis ) . All 3 exposed cases had also received estrogens pre-menopausally . Exposure to such estrogens enhanced risk of endometrial cancer and reduced the apparent protective effect of DMPA .  Although based on small numbers of exposed women , the protective effect of DMPA appeared to last for at least 8 years after cessation of use . The reduction in risk of endometrial cancer is at least as great for DMPA as for combined oral contraceptives OBJECTIVE 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 ? " METHODS A r and omized , 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 . RESULTS No clinical ly 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 . CONCLUSIONS 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 BACKGROUND Recently enacted federal legislation m and ates insurance coverage of at least 48 hours of postpartum hospitalization , but most mothers and newborns in the United States will continue to go home before the third postpartum day . National guidelines recommend a follow-up visit on the third or fourth postpartum day , but scant evidence exists about whether home or clinic visits are more effective . METHODS We enrolled 1163 medically and socially low-risk mother-newborn pairs with uncomplicated delivery and r and omly assigned them to receive home visits by nurses or pediatric clinic visits by nurse practitioners or physicians on the third or fourth postpartum day . In contrast with the 20-minute pediatric clinic visits , the home visits were longer ( median : 70 minutes ) , included preventive counseling about the home environment , and included a physical examination of the mother . Clinical utilization and costs were studied using computerized data bases . Breastfeeding continuation , maternal depressive symptoms , and maternal satisfaction were assessed by means of telephone interviews at 2 weeks ' postpartum . RESULTS Comparing the 580 pairs in the home visit group and the 583 pairs in the pediatric clinic visit group , no significant differences occurred in clinical outcomes as measured by maternal or newborn rehospitalization within 10 days postpartum , maternal or newborn urgent clinic visits within 10 days postpartum , or breastfeeding discontinuation or maternal depressive symptoms at the 2-week interview . The same was true for a combined clinical outcome measure indicating whether a mother-newborn pair had any of the above outcomes . In contrast , higher proportions of mothers in the home visit group rated as excellent or very good the preventive advice delivered ( 80 % vs 44 % ) , the provider 's skills and abilities ( 87 % vs 63 % ) , the newborn 's posthospital care ( 87 % vs 59 % ) , and their own posthospital care ( 75 % vs 47 % ) . On average , a home visit cost $ 255 and a pediatric clinic visit cost $ 120 . CONCLUSIONS For low-risk mothers and newborns in this integrated health maintenance organization , home visits compared with pediatric clinic visits on the third or fourth postpartum hospital day were more costly , but were associated with equivalent clinical outcomes and markedly higher maternal satisfaction . This study had limited power to identify group differences in rehospitalization , and may not be generalizable to higher-risk population s without comparable access to integrated hospital and outpatient care Abstract . A prospect i ve study of the course of breast feeding was carried out in 75 r and omly 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 r and omly 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 OBJECTIVE Our purpose was to compare an early postpartum discharge program versus st and ard postpartum care . STUDY DESIGN A r and omized controlled trial in a 637-bed university hospital included 175 healthy women recruited at 32 to 38 weeks gestation from physicians ' offices and sonograms . Experimental intervention consisted of discharge 6 to 36 hours post partum with nursing care available by telephone or at home at 34 to 38 weeks ' gestation and at < or = 48 hours and at 3 , 5 , and 10 days post partum . The control included a postpartum stay of 48 to 72 hours and st and ard follow-up . RESULTS At 1 month no significant differences were seen in perceived maternal competence ( Experimental-Control = 4.3 points [ 95 % confidence interval-7.7 to 16.3 ] ) , infant weight gain ( 1.2 gm/ day [ -2.8 to 5.2 ] ) ; identification of significant neonatal hyperbilirubinemia ( rate ratio 0.50 [ 0.10 to 2.51 ] ) , infant utilization of health services ( rate ratio 0.88 [ 0.45 to 1.73 ] ) , or predominant breast-feeding ( adjusted odds ratio 1.25 [ 0.88 to 1.75 ] ) . Program participants did have significantly less frequent infant bilirubin testing ( rate ratio 0.39 [ 0.17 to 0.94 ] ) . The program also enhanced perceived maternal competence in recent immigrants ( 26.9 points [ 2.7 to 51.5 ] ) . CONCLUSIONS Early postpartum discharge coupled with prenatal , postnatal , and home contacts leads to no apparent disadvantage and may yield benefits for some mothers and infants Exclusive breastfeeding has generally been considered incompatible with working separated from the infant . This prospect i ve , controlled intervention trial shows that breastfeeding support , including anticipatory counseling and monthly clinical follow-up of the mother and infant , can significantly increase the percentage of infants exclusively fed with breastmilk at the end of 6 months of life . Over 80 per cent of women from control and intervention groups expressed a desire to breastfeed for more than 6 months and more than 50 per cent thought it was best for the infant to be exclusively breastfed for 6 months . Only 6 per cent of women in the control group were able to complete 6 months of exclusive breastmilk feeding compared to 53 per cent of those in the intervention group . The most important difference between the strategies used by both groups of mothers for maintaining exclusive breastmilk feeding after returning to work was that only 23 per cent of the control group practice d milk expression compared to 66 per cent in the intervention group . All women from the supported group stated that they would advise a friend to combine exclusive breastfeeding and work and that they would like to do so again with another child BACKGROUND Several studies have demonstrated the positive effects of peer support on various breastfeeding outcomes , but no study has assessed women 's and peer volunteers ' views on , or the nature and intensity of , the supportive intervention . The objective of this study was to describe maternal and peer volunteer perceptions of their experience while participating in a breastfeeding peer support trial . METHODS A r and omized controlled trial was conducted to evaluate the effect of telephone-based peer ( mother-to-mother ) support on breastfeeding duration .  Two hundred and fifty-six primiparous breastfeeding women were r and omly allocated to receive either conventional care or conventional care plus peer support . Three primary outcome measures were peer volunteer activity logs , maternal perceptions of peer support , and evaluations of the peer volunteer experience . RESULTS Question naires were completed by 98.5 percent ( n=130 ) of the mothers in the peer support group . Mothers reported their peer volunteers were available when difficulties were experienced , increased their confidence , decreased their concerns , and assisted them in reaching their breastfeeding goals . These supportive interactions result ed in 81.5 percent of mothers ( n=106 ) being satisfied with their peer support experience and suggesting that every new mother should be offered this intervention . Similarly , all the peer volunteers interviewed ( n=30 ) viewed their experience positively . They suggested some intervention modifications as follows : ensure that mothers enrolled in the program want peer support ; provide peer volunteers with ongoing educational sessions and opportunities to " socialize " with other volunteers ; and disseminate the results of peer support efforts . CONCLUSIONS Both mothers and peer volunteers perceived their intervention experiences positively . Whereas maternal satisfaction was related to the number and duration of peer volunteer contacts , peer volunteers enjoyed their training session and the opportunity to assist mothers for a variety of reasons . Specific intervention modifications should be implemented to enhance peer volunteer satisfaction and retention In a prospect i ve multicentre study on 926 preterm infants formally assigned to their early diet , necrotising enterocolitis developed in 51 ( 5.5 % ) .  Mortality was 26 % in stringently confirmed cases . In exclusively  formula-fed  babies confirmed disease was 6 - 10 times more common than in those fed breast milk alone and 3 times more common than in those who received formula plus breast milk . Pasteurised donor milk seemed to be as protective as raw maternal milk . Among babies born at more than 30 weeks ' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk ; it was 20 times more common in those fed formula only . Other risk factors included very low  gestational age , respiratory disease , umbilical artery catheterisation , and polycythaemia . In formula-fed but not breast-milk-fed infants , delayed enteral feeding was associated with a lower frequency of necrotising enterocolitis . With the fall in the use of breast milk in British neonatal units , exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year . About 100 of these infants would die This study examined the effect of support from trained peer counselors on breastfeeding initiation , duration , and exclusivity among low-income urban women .  Training of counselors , under the supervision of a registered nurse certified in lactation , adapted education techniques from Paulo Freire to provide information about lactation management and other health care issues . The study compared infant feeding practice s of women who planned to breastfeed and received support from counselors ( counselor group , N=59 ) to women who requested counselors but , owing to inadequate numbers of trained counselors , did not have a counselor ( No-counselor group , N=43 ) . Women in the counselor group had significantly greater ( p<.05 ) breastfeeding initiation ( 93 percent vs. 70 percent ) , exclusivity ( 77 percent vs. 40 percent ) , and duration ( mean of 15 weeks vs. mean of 8 weeks ) than women in the no-counselor group . The findings suggest that peer counselors , well-trained , and with on-going supervision , can have a positive effect on breastfeeding practice s among low-income urban women who intend to breastfeed OBJECTIVE To determine the effects of a partner-supported , incentive-based educational program on rates and duration of breast-feeding among low-income women . DESIGN Women who expressed a willingness to participate in the breast-feeding educational program  were r and omly assigned to one of two groups : an intervention group and a control group who received usual breast-feeding education . SETTING Clinics of the Special Supplemental Food Program for Women , Infants , and Children in Flagstaff , Ariz. SUBJECTS Sixty-eight primiparous pregnant women with expected due date s between May 1992 and December 1992 were willing to participate in the study . Of these , 34 were r and omly assigned to the intervention group and 34 to the control group . Approximately 81 % of the women completed the study : 29 in the control group and 26 in the intervention group . INTERVENTION The intervention consisted of special incentives ( prizes ) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth . Women were also encouraged to use a breast-feeding support program in which peers serve as role models . MAIN OUTCOME MEASURES The primary outcome measure was infant feeding method . Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks , 6 weeks , and 3 months postpartum . STATISTICAL ANALYSES PERFORMED Binomial proportional analyses of the feeding data were performed . RESULTS Women in the intervention group reported a higher percentage of breast-feeding at all measurement times . APPLICATIONS These findings suggest that incentives , such as donated prizes , can be used to attract primiparous women from lower socioeconomic groups , along with their partners , to participate in educational interventions design ed to promote breast-feeding . Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding BACKGROUND 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 . METHODS We developed the intervention through formative research , pair-matched eight communities on their baseline characteristics , and r and omised 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 . FINDINGS 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 . INTERPRETATION 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 Objective To determine whether a single one‐to‐one in‐hospital education session could increase the rate of breastfeeding at 17 weeks 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 Exclusive breastfeeding is recommended worldwide but not commonly practised . We undertook a r and omised 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 . METHODS 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 . FINDINGS 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 ) . INTERPRETATION This is the first reported community-based r and omised 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 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 BACKGROUND 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 setting s on breastfeeding outcomes and maternal satisfaction for mothers of term and near-term newborns who experienced st and ard or early discharge . METHODS In a r and omized controlled trial with prognostic stratification for gestational age , 101 term and 37 near-term ( 35 - 37 weeks ' gestational age ) mother-newborn pairs were r and omized to either a st and ard care group ( st and ard care and st and ard length of hospitalization ) or an experimental group ( st and ard hospital care with early discharge and home support from nurses who were certified lactation consultants ) . Data collection occurred before r and omization , at discharge from hospital , and from 5 to 12 days postpartum . Primary outcomes included breastfeeding rates and maternal satisfaction . RESULTS 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 st and ard care groups . CONCLUSIONS 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 implication s for health caregivers and policy makers with respect to postpartum lactation and health care services Abstract Problem : Breastfeeding rates and related hospital practice s need improvement in Italy and elsewhere . Training of staff is necessary , but its effectiveness needs assessment . Context : Eight hospitals in different regions of Italy . Design : Controlled , non-r and omised study . Data collected in three phases . Training after the first phase in group 1 hospitals and after the second phase in group 2 . Strategies for change : Training of trainers and subsequent training of health workers with a slightly adapted version of the 18 hour Unicef course on breastfeeding management and promotion . Key measures for improvement : Hospital practice s , knowledge of 571 health workers  , and  breastfeeding rates at discharge , three , and six months in 2669 mother and baby pairs . Effects of change : After training hospitals improved their compliance with the “ ten steps to successful breast feeding , ” from an average of 2.4 steps at phase one to 7.7 at phase three . Knowledge scores of health professionals increased from 0.41 to 0.72 in group 1 ( training after phase one ) and from 0.53 to 0.75 in group 2 ( after phase two ) . The rate of exclusive breast feeding at discharge increased significantly after training : 41 % to 77 % in group 1 and 23 % to 73 % in group 2 , as did the rates of full ( exclusive plus predominant ) breast feeding at three months ( 37 % to 50 % in group 1 v 40 % to 59 % in group 2 ) and any breast feeding at six months ( 43 % to 62 % in group 1 v 41 % to 64 % in group 2 ) . Lessons learnt : Training for at least three days with a course including practical sessions and counselling skills is effective in changing hospital practice s , knowledge of health workers , and breastfeeding rates BACKGROUND Despite data relating body size in early life to later cardiovascular outcomes , the hypothesis that nutrition affects such outcomes has not been established . Breastfeeding has been associated with lower blood pressure in later life , but previous studies have not controlled for possible confounding factors by using a r and omised design with prospect i ve follow-up . We undertook such a study to test the hypothesis that early diet programmes blood pressure in later life in children r and omly assigned different diets at birth . METHODS Blood pressure was measured at age 13 - 16 years in 216 ( 23 % ) of a cohort of 926 children who were born prematurely and had participated at birth in two parallel r and omised trials in five neonatal units in the UK . Dietary interventions were : donated banked breastmilk versus preterm formula and st and ard term formula versus preterm formula . FINDINGS Children followed up at age 13 - 16 years were similar to those not followed up in terms of social class and anthropometry at birth . Mean arterial blood pressure at age 13 - 16 years was lower in the 66 children assigned banked breastmilk ( alone or in addition to mother 's milk ) than in the 64 assigned preterm formula ( mean 81.9 [ SD 7.8 ] vs 86.1 [ 6.5 ] mm Hg ; 95 % CI for difference -6.6 to -1.6 ; p=0.001 ) . In non-r and omised analyses , the proportion of enteral intake as human milk in the neonatal period was inversely related to later mean arterial pressure ( beta=-0.3 mm Hg per 10 % increase [ 95 % CI -0.5 to -0.1 ] ; p=0.006 ) . No differences were found in the term formula ( n=44 ) versus preterm formula ( n=42 ) comparison . INTERPRETATION Breastmilk consumption was associated with lower later blood pressure in children born prematurely . Our data provide experimental evidence of programming of a cardiovascular risk factor by early diet and further support the long-term beneficial effects of breastmilk 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 In a r and omised 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 New parents have fewer supports today than in previous decades due to factors such as short postpartum hospital stay , fragmentation of services , and long-distance families . This controlled trial evaluated the frequency of use of a 24-hour , in-hospital telephone line  by 130 parents r and omly invited to use the service and 130 who were not aware of this service . A special line with a separate extension was installed on the postpartum unit . R and omly arranged , sealed envelopes were given to 260 women at the time of discharge , containing a congratulations message or description of a new 24-hour telephone line for advice given by postpartum nurses . Of 53 calls requesting help , 36 were received on the special line and 17 on regular ward telephones ; 28 percent of those invited to call back did so , and 13 percent of those without an invitation called on the regular extension , ( P = 0.015 ) . Recommendations for future program planning are based on the results of this study BACKGROUND Much postpartum physical and psychological morbidity is not addressed by present care , which tends to focus on routine examinations . We undertook a cluster r and omised controlled trial to assess community postnatal care that has been re design ed to identify and manage individual needs . METHODS We r and omly allocated 36 general practice clusters from the West Midl and s health region of the UK to intervention ( n=17 ) or control ( 19 ) care . Midwives from the practice s recruited women and provided care . 1087 ( 53 % ) of 2064 women were in practice s r and omly assigned to the  intervention  group , with 977 ( 47 % ) women in practice s assigned to the  control group . Care was led by midwives , with no routine contact with general practitioners , and was extended to 3 months . Midwives used symptom checklists and the Edinburgh postnatal depression scale ( EPDS ) to identify health needs and guidelines for the management of these needs . Primary outcomes at 4 months were obtained by postal question naire and included the women 's short form 36 physical ( PCS ) and mental ( MCS ) component summary scores and the EPDS . Secondary outcomes were women 's views about care . Multilevel analysis accounted for possible cluster effects . FINDINGS 801 ( 77 % ) of 1087 women in the intervention group and 702 ( 76 % ) of 977 controls responded at 4 months . Women 's mental health measures were significantly better in the intervention group ( MCS , 3.03 [ 95 % CI 1.53 - 4.52 ] ; EPDS -1.92 [ -2.55 to -1.29 ] ; EPDS 13 + odds ratio 0.57 [ 0.43 - 0.76 ] ) than in controls , but the physical health score did not differ . INTERPRETATION Re design of care so that it is midwife-led , flexible , and tailored to needs , could help to improve women 's mental health and reduce probable depression at 4 months ' postpartum CONTEXT 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 . OBJECTIVE To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants . DESIGN The Promotion of Breastfeeding Intervention Trial ( PROBIT ) , a cluster-r and omized trial conducted June 1996-December 1997 with a 1-year follow-up . SETTING Thirty-one maternity hospitals and polyclinics in the Republic of Belarus . PARTICIPANTS 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 . INTERVENTIONS Sites were r and omly 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 practice s and policies . MAIN OUTCOME MEASURES 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 . RESULTS 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 ) . CONCLUSIONS 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 OBJECTIVE To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income , inner-city population . DESIGN A r and omized , nonblinded clinical control trial . Patients were followed up through pregnancy , delivery , and the first year of the infant 's life or until the time of weaning from the breast , whichever came first . SETTING The ambulatory care center for prenatal and pediatric care and the inpatient maternity unit of a primary care center that serves a low-income , inner-city population . PATIENTS There were a total of 108 patients : 51 were r and omized to the intervention group that received prenatal and postnatal lactation instruction from a lactation consultant , and 57 were r and omized to the control group that  received the st and ard of care at the institution . Patients in the control group were not seen by the lactation consultant . The two groups were similar demographically . INTERVENTION This program consisted of individual prenatal lactation consultation , daily rounds by the lactation consultant on the postpartum unit , and outpatient follow-up at 48 hours after discharge , at the time that the infant was 1 week of age , and at all future health supervision visits for infants up to 1 year of age . MAIN OUTCOME MEASURES The incidence and duration of breast-feeding . RESULTS There was a markedly higher incidence of breast-feeding in the intervention group , as compared with that of the control group ( 61 % vs 32 % , respectively ; P = .002 ) . The duration of breast-feeding was also significantly longer in the intervention group ( P = .005 ) . CONCLUSIONS This lactation program increased the incidence and duration of breast-feeding in our low-income cohort . We suggest that similar efforts that are applied to analogous population s may increase the incidence and duration of breast-feeding in low-income population s in the United States BACKGROUND Smoking in the postpartum period may contribute to early weaning , although the nature and temporal aspect of the relationship are poorly understood . The objective of this study was to examine the association between early weaning and smoking relapse among women who stopped smoking during pregnancy . METHODS A secondary analysis of data from a r and omized controlled trial was conducted . The participants were 228 women who had stopped smoking for pregnancy , who participated in a smoking relapse prevention trial , and who breastfed .  Women who relapsed to daily smoking postpartum were compared with those who remained abstinent or smoked occasionally . The dependent variable was  breastfeeding for less than 26 weeks ( early weaning ) . Potential covariates included intended duration of breastfeeding , parity , partner 's smoking , nicotine dependence , emotional health , return to paid employment , and various sociodemographic variables . RESULTS Approximately two-thirds ( 65.1 % ) of the women who relapsed to daily smoking weaned before 26 weeks compared with 33.8 percent of the women who remained abstinent or smoked occasionally . Controlling for intended duration of breastfeeding , education , and return to paid employment , women who resumed daily smoking were almost four times more likely to wean early than those who abstained or smoked occasionally . CONCLUSIONS Early weaning may result from psychological or physiological changes associated with tobacco use . Smoking relapse prevention in the postpartum period may be one of the most effective interventions in ensuring that women who stop smoking for pregnancy remain stopped and breastfeed their babies for the recommended duration 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 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 T HE U.S. DEPARTMENT OF HEALTH and Human Services ( 1994 ) published the Healthy People 2000 guidelines as a statement of national concerns regarding health in the U.S. One Healthy People 2000 objective is to increase the percentage of women who continue to breastfeed for the first 6 months of their infant 's life . The American Academy of Pediatrics recommends that women breastfeed their infant 's for the first year of life ( Gartner , 1997 ) . An intervention that increases the duration of breastfeeding in low-income women offers health benefits to mothers and babies ( Krebs & Murtaugh , 1997 ) . The benefits of breastfeeding are well established . Women who breastfeed are less likely to develop osteoporosis and some forms of cancer ( Cummings , Kelsey , & Nevitt , 1985 ; Michels et al. , 1996 ; Schneider , 1987 ) . Furthermore , breastfeeding is empowering for low-income minority women ( Locklin & Naber , 1993 ) . Infants who are breastfed for at least 4 months are less likely to die of UNLABELLED Despite known health benefits , exclusive breast-feeding for at least 4 months is uncommon in many countries . In Mexico , most mothers initiate breast-feeding but few breast-feed exclusively . OBJECTIVE The objective was to examine the effectiveness of home visits by lay peer counselors to increase exclusive breast-feeding among mothers in a periurban area of Mexico . METHODS An ethnographic assessment conducted in 1994 that identified key maternal beliefs , practice s , and needs was used to guide educational strategies . Lay counselors were recruited from the same community and trained by La Leche League . From March 1995 through September 1996 , pregnant women were identified by community census and invited to participate . Women were enrolled into a r and omized , controlled study of 3 groups : no intervention ( control ) , 3 visits , and 6 visits during pregnancy and early postpartum . Data collection was performed by a social worker apart from the counselors . Exclusive breast-feeding was defined by WHO criteria . RESULTS The study enrolled 130 women ; 52 were in the 3-visit group , 44 in the 6-visit group , and 34 in the control group . Study groups did not differ in the maternal characteristics or initiation of breast-feeding ( 96 % ) . At 3 months postpartum , exclusive breast-feeding was practice d by only 12 % of controls vs. 52 % in the 3-visit group and 67 % in the 6-visit group ( P < 0.001 , log rank test ) . In the first 3 months , significantly ( P = 0.037 ) fewer intervention than control infants had an episode of diarrhea ( 11 % vs. 26 % , respectively ) . Intervention effectiveness was independent of maternal factors or birth hospital . CONCLUSIONS This unique experimental study demonstrated a dramatic increase in exclusive breast-feeding and a significant reduction in infant illness in an urban community through well- design ed maternal support including early intervention and repeated contact OBJECTIVE 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 . DESIGN 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 . INTERVENTION Two-by-two factorial design , in which 4 clinics were r and omly assigned to receive either no intervention , a motivational video package intervention , a peer-counseling intervention , or both interventions . MAIN OUTCOME MEASURES Breast-feeding duration in weeks and relative risk ratios for breast-feeding cessation before 16 weeks postpartum . STATISTICAL ANALYSIS PERFORMED Contingency table analysis , including chi2 tests and log-rank tests ; multivariate analysis using Cox proportional hazards regression analysis . RESULTS 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 . APPLICATIONS/ CONCLUSIONS 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 exp and their efforts toward promoting increased duration of breast-feeding The rate of breastfeeding among immigrant Vietnamese women in Western countries is low compared to those in Vietnam . To counteract this trend , a language and culture specific education program was developed . An experimental design was used to test the effectiveness of this program . The sample consisted of 182 prenatal Vietnamese women . Data collection included question naires and interviews . Results suggested that the education program had significant effects on knowledge , attitudes , planned and actual behaviour towards breastfeeding . However , the effect did not sustain until 6 months postpartum . Implication s for nursing practice and further research are discussed We compared the lactation performance of 165 healthy mothers who planned to breastfeed and gave birth by vaginal delivery , without complications to a healthy infant in either a nursery ( NUR ) ( n = 58 ) or a rooming-in hospital where formula supplementation was not allowed . In the rooming-in hospital , women were r and omly assigned to a group that received breastfeeding guidance during the hospital stay ( RIBFG ) ( n = 53 ) or to a control group ( RI ) ( n = 54 ) . Women were interviewed in the hospital and at 8 , 70 and 135 days post-partum ( pp ) . The groups were similar in socio-economic , demographic , anthropometric , previous breastfeeding experience and prenatal care variables . Non-parametric survival analyses adjusting for potential confounding factors show that breastfeeding guidance had a positive impact ( P < or = 0.05 ) on breastfeeding duration  among primiparous women who delivered in the rooming-in hospital . Among primiparae , the RI and RIBFG groups had higher ( P < or = 0.05 ) full breastfeeding rates than the NUR group in the short term . In the longer term , only the difference between the RIBFG and the NUR group remained statistically significant . The maternity ward system did not have a statistically significant effect on the lactation performance of multiparae The purpose of this study was to discover factors related to  breastfeeding duration .  Of the 131 women who volunteered to complete question naires at one , three and six months postpartum , 46 provided baseline data , and 37 and 48 ( r and omly 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 BACKGROUND 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 . METHODS We enrolled 139 adolescents , attending a teenage pregnancy clinic , in a r and omised controlled trial . After completing an antenatal question naire design ed 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 . FINDINGS Three women withdrew before r and omisation because of late fetal loss , 11 mothers withdrew because of adverse neonatal outcomes  ( adverse neonatal outcome was a primary endpoint , but result ed 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 . INTERPRETATION 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
BACKGROUND There is extensive evidence of the benefits of  breastfeeding for infants and mothers .
In 2003 , the World Health Organization ( WHO ) recommended infants be fed exclusively on breast milk until six months of age .
However , breastfeeding rates in many developed countries continue to be resistant to change .
OBJECTIVES To assess the effectiveness of support for breastfeeding mothers .