WIC-Based Interventions to Promote Breastfeeding Among African-American Women in Baltimore: Effects on Breastfeeding Initiation and Continuation A Clinic-Based Breastfeeding Peer Counselor Intervention in an Urban, Low-Income Population The application of autogenic training in counseling center for mother and child in order to promote breastfeeding. [Promotion of breastfeeding: the importance of pediatricians with specific training]. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial Breastfeeding preterm infants: an educational program to support mothers of preterm infants in Cairo, Egypt. The effect of peer counselors on breastfeeding rates in the neonatal intensive care unit: results of a randomized controlled trial. Effect of Prenatal Counseling on Breastfeeding Rates in Mothers of Twins The Effect of a Breastfeeding Motivation Program Maintained During Pregnancy on Supporting Breastfeeding: A Randomized Controlled Trial. Lactation counseling increases breast-feeding duration but not breast milk intake as measured by isotopic methods. Lactation counseling increases exclusive breast-feeding rates in Ghana. Telephone-based support prolongs breastfeeding duration in obese women: a randomized trial. Breastfeeding Education and Support Trial for Overweight and Obese Women: A Randomized Trial Home breastfeeding support by health professionals: findings of a randomized controlled trial in a population of Italian women Breastfeeding and Complementary Food: Randomized Trial of Community Doula Home Visiting Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs Breast-feeding promotion in a diarrhoea programme in rural communities. Does telephone lactation counselling improve breastfeeding practices? A randomised controlled trial. Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial Effect of a peer support service on breast-feeding continuation in the UK: a randomised controlled trial. Effectiveness of policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial Supporting breastfeeding In Local Communities (SILC) in Victoria, Australia: a cluster randomised controlled trial Does breastfeeding offer protection against maternal depressive symptomatology? Intervention based on BASNEF model increases exclusive breastfeeding in preterm infants in Iran: a randomized controlled trial Impact of counselling on exclusive breast-feeding practices in a poor urban setting in Kenya: a randomized controlled trial. Lactation Support and Breastfeeding Duration in Jaundiced Infants: A Randomized Controlled Trial The effect of postpartum lactation counseling on the duration of breast-feeding in low-income women. A Randomized Controlled Trial of Breastfeeding Support and Education for Adolescent Mothers A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community. The Effects of In-Hospital Lactation Education on Breastfeeding Practice Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial. Randomized trial of postpartum care after hospital discharge. Focused breastfeeding counselling improves short- and long-term success in an early-discharge setting: A cluster-randomized study. Effectiveness of home-based peer counselling to promote breastfeeding in the northeast of Brazil: a randomized clinical trial. A breast-feeding promotion and support program a randomized trial in The Netherlands. 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 A structured telephonic counselling to promote the exclusive breastfeeding of healthy babies aged zero to six months: a pilot study. Effect of nutrition education on exclusive breastfeeding for nutritional outcome of low birth weight babies Home versus hospital breastfeeding support for newborns: a randomized controlled trial. Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial Breastfeeding Attitudes, Intention, and Initiation in Low-Income Women: the Effect of the Best Start Program Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use. The effect of training administered to working mothers on maternal anxiety levels and breastfeeding habits. Postnatal peer counselling on exclusive breastfeeding of low-birthweight infants: a randomized, controlled trial. Effect of Intervention to Improve Breastfeeding Technique on the Frequency of Exclusive Breastfeeding and Lactation-Related Problems Effect of an extended midwifery postnatal support programme on the duration of breast feeding: a randomised controlled trial. Comparison of the effect of two systems for the promotion of exclusive breastfeeding The effect of a postnatal education and support program on breastfeeding among primiparous women: a randomized controlled trial. Does continuity of care by well-trained breastfeeding counselors improve a mother's perception of support? 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.
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 Background : Whereas breastfeeding initiation rates have risen in all groups throughout the country , rates of breastfeeding duration have changed more slowly . Peer counseling has had some success in sustaining breastfeeding , but with intensive programs and variable effects . Objectives : We aim ed to improve rates of any and exclusive breastfeeding at 1 and 6 months using a low-intensity peer counseling intervention beginning prenatally . We also planned to study the interaction of breastfeeding attitude and self-efficacy with the intervention . Methods : One hundred twenty prenatal women underwent stratified r and omization based on breastfeeding attitude , measured by the Iowa Infant Feeding Attitude Scale ( IIFAS ) . The peer counselor contacted the intervention group by telephone or in clinic up to 4 months postdelivery . Study groups were compared on breastfeeding outcomes , adjusting for IIFAS strata , and on interactions with self-efficacy . Results : One hundred three women were followed to at least 1 month . Women with positive attitudes had significantly higher rates of initiation ( 93 % vs 61 % ) and breastfeeding at 1 and 6 months ( 79 % vs 25 % and 12 % vs 0 % , respectively ) than those with negative attitudes , regardless of intervention . After adjusting for self-efficacy , women who received peer counseling had significantly higher breastfeeding rates at 1 month ( odds ratio = 3.2 ; 95 % confidence interval , 1.02 - 9.8 ) . The intervention group was marginally more likely to achieve their breastfeeding goal ( 43 % vs 22 % , P = .073 ) . Conclusion : Breastfeeding rates in all women improved during the study period . Breastfeeding attitude was more strongly associated with breastfeeding behavior than peer support . Peer counseling supported women with low self-efficacy and helped women achieve their breastfeeding goals The aim of this study was to investigate whether mothers with newborn children , the usage of autogenic training with advice on breastfeeding effect on : the decision and the duration of breastfeeding , increase maternal confidence and support . It was assumed that the above result in a higher percentage of mothers who exclusively breastfed baby during the first six months of child 's life . The survey was conducted in the Association " For a healthy and happy childhood"-Counseling center for mother and child , in Bjelovar in 2010 . The Counseling center was attended by 100 nursing mothers with children aged up to two months . They r and omly went to the study or control group . Mothers of both groups were advised to successful breastfeeding . Study group has practice d autogenic training until the child 's age of six months . In parallel , by using psychotherapeutic interview and specific question naires we collected data on the somatic , psychological and social situation of the mother , discovered mother 's mental changes ( anxiety , depression ) that were treated . The results at the end of the study confirm the initial expected benefits from the application of autogenic training . Mothers of the study group were significantly more emotionally balanced with a higher self-esteem .  Autogenous training with the advices for successful breastfeeding conducted in this counseling center contributed in significantly higher rate of breastfeeding children up to six months of life , improved mental and physical health of mother and child and their peculiar relationship OBJECTIVE To study the factors involved in the maintenance of exclusive breastfeeding  in healthy infants during the first 4 months of life , with emphasis on the role of pediatricians . MATERIAL AND METHODS A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba , state of Minas Gerais , Brazil . The babies were divided at r and om into three groups : G1 , receiving advice from a multiprofessional breastfeeding team ; G2 , receiving advice from a pediatrician trained in breastfeeding ; and G3 , receiving advice from a pediatrician with no breastfeeding training . Group r and omization was confirmed by analysis of variance . The factors involved in the type of feeding at 4 months were analyzed by the chi-square test , by analysis of variance and by multiple variable analysis . RESULTS At the end of follow-up , Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding . In addition , the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 ( p = 0.002 ) . The use of a pacifier was negatively correlated with exclusive breastfeeding ( p = 0.003 ) . More maternal schooling increased the chance of exclusive breastfeeding at 4 months ( p = 0.041 ) . CONCLUSIONS In this study , a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months 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 PURPOSE To develop , implement , and examine the effect of a breastfeeding educational program on breastfeeding knowledge and practice s of Egyptian mothers of preterm infants . METHODS An experimental design was used with a convenience sample of 60 mothers and their preterm infants who were born before 37 weeks of gestation . They were r and omly assigned to intervention and control groups . Data collection instruments included breastfeeding knowledge question naire , observational checklist of mother 's breastfeeding practice s , breastfeeding diary , infant 's and mother 's profile form , and demographic information . A five-session breastfeeding educational program based on B and ura 's Social Cognitive Theory was implemented with the intervention group during the infant 's hospitalization and after discharge . Both groups were followed up to 3 months after discharge . Descriptive statistics , ANOVA , Chi-square , and regression were used to analyze the data . FINDINGS Mother 's knowledge significantly increased for the intervention group but not the control group ( p = 0.041 ) . The intervention group showed gradual improvement in breastfeeding practice s , i.e. , started breast milk expression earlier and had more breast milk expression frequency than the control group . Of the intervention group , 80 % were discharged on exclusive breastfeeding compared to 40 % among the control group , and breastfeeding problems were less among the intervention group . CONCLUSIONS The breastfeeding educational program was effective in improving breastfeeding knowledge and practice s among mothers of preterm infants OBJECTIVE To determine whether peer counselors impacted breastfeeding duration among premature infants in an urban population . DESIGN This was a r and omized controlled clinical trial . SETTING The trial was conducted in the Newborn Intensive Care Unit at Boston Medical Center , an inner-city teaching hospital with approximately 2000 births per year . PARTICIPANTS One hundred eight mother-infant pairs were enrolled between 2001 and 2004 . Pairs were eligible if the mother intended and was eligible to breastfeed per the 1997 guidelines from the American Academy of Pediatrics and if the infant was 26 to 37 weeks ' gestational age and otherwise healthy . INTERVENTION Subjects were r and omized to either a peer counselor who saw the mother weekly for 6 weeks or to st and ard of care . MAIN OUTCOME MEASURE The main outcome measure was any breast-milk feeding at 12 weeks postpartum . RESULTS Intervention and control groups were similar on all measured sociodemographic factors . The average  gestational age of infants was 32 weeks ( range , 26.3 - 37 weeks ) with a mean birth weight of 1875 g ( range , 682 - 3005 g ) . At 12 weeks postpartum , women with a peer counselor had odds of providing any amount of breast milk 181 % greater than women without a peer counselor ( odds ratio , 2.81 [ 95 % confidence interval , 1.11 - 7.14 ] ; P = .01 ) . CONCLUSIONS Peer counselors increased breastfeeding duration  among premature infants born in an inner-city hospital and admitted to the neonatal intensive care unit .  Peer counseling programs can help to increase breastfeeding in this vulnerable population Objective : To investigate the effect of antenatal breastfeeding counseling on the breastfeeding rates for women who give birth to twins . Design : Prospect i ve r and omized trial . Setting : Multiple Pregnancy Unit , Obstetrics Department , University of São Paulo , Brazil . Participants : A total of 171 mothers of twins and their 342 infants . Methods : The participants were r and omized into the prenatal counseling group ( PCG ) or control group ( CG ) . Breastfeeding data were collected through personal interviews at three times after birth : 30 to 40 days ( Time 1 ) , 90 days ( Time 2 ) , and 180 days ( Time 3 ) . The primary endpoint was a comparison of the mothers ' breastfeeding rates between PCG and CG in each analyzed period . The secondary endpoint was the comparison of the overall rates of twin infant breastfeeding between PCG and CG until 180 days after birth . Results : The final analysis included 68 women pregnant with twins in the PCG and 60 in the CG . There was no significant difference in the breastfeeding rates between PCG and CG in the analyzed periods : Time 1 ( odds ratio [ OR ] = 1.87 , 95 % confidence interval [ CI ] [ 0.71 , 4.95 ] ) , Time 2 ( OR = 1.50 , 95 % CI [ 0.72 , 3.10 ] ) , and Time 3 ( OR = 1.06 , 95 % CI [ 0.51 , 2.19 ] ) . Also , no difference existed in the overall rates of breastfeeding between PCG and CG at 180 days . Conclusion : In women pregnant with twins , antenatal breastfeeding counseling did not significantly affect the breastfeeding rates . Further research about the best moment to counsel mothers of twins is needed to improve breastfeeding rates BACKGROUND Exclusive breastfeeding is the recommended breastfeeding method for infants during the first 6 postnatal months . OBJECTIVE This study aim ed to increase breastfeeding duration and frequency using a breastfeeding motivation program ( BMP ) , which was structurally based on Pender 's Health Promotion Model ( HPM ) and administered during pregnancy and the postnatal period . The study was also design ed to determine the BMP effectiveness in supporting exclusive breastfeeding . MATERIAL S AND METHODS The sample of this r and omized controlled trial included 100 pregnant women ( 50 in the BMP , 50 in the control group ) who applied to the pregnancy preparation course in a state hospital located in Usak , western Turkey . Participants in the study were allocated into either the BMP group or control group through systematic sampling and r and omization . The BMP was structured based on the HPM and was carried out with the BMP study group four times : during the antenatal period , on the first postnatal day , between the fourth and sixth postnatal weeks , and during the fourth postnatal month . Data were analyzed using the descriptive statistical test , Pearson 's chi-square test , independent sample s t test , and ANOVA . RESULTS The mothers in the BMP group started breastfeeding earlier than the mothers in the control group ( 97.1 % ) and had fewer problems with their first breastfeeding experience . The average score of perceived self-efficacy in breastfeeding and the rate of first breastfeeding experience ( 70.6 % ) were higher in the BMP group by a statistically significant amount . CONCLUSION BMP for breastfeeding , structurally based on Pender 's HPM , can help in supporting and maintaining exclusive breastfeeding 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 Exclusive breast-feeding ( EBF ) rates remain low despite numerous health benefits associated with this behavior . We conducted a r and omized trial on the effect of lactation counseling on EBF , which controlled for the Hawthorne effect while also varying the timing of the intervention . Pregnant women attending prenatal clinics in Tema were r and omly assigned to 1 of 2 intervention groups ( IG ) or to a control group ( C ) , as follows : 1 ) EBF support given pre- , peri- , and postnatally ( IG1 ; n = 43 ) ; 2 ) EBF support given only peri- and postnatally ( IG2 ; n = 44 ) ; or 3 ) nonbreast-feeding health educational support ( C ; n = 49 ) that had an equal amount of contact with lactation counselors . Two educational sessions were provided prenatally , and 9 home follow-up visits were provided in the 6-mo postpartum period . Infant feeding data were collected monthly at the participant 's home . The 3 groups did not differ in sociodemographic characteristics . At 6 mo postpartum , 90.0 % in IG1 and 74.4 % in IG2 had exclusively breast-fed during the previous month . By contrast , only 47.7 % in C were doing so ( P = 0.008 ) . Similarly , the percentage of EBF during the 6 mo was significantly higher ( P = 0.02 ) among IG1 and IG2 ( 39.5 % ) than among C ( 19.6 % ) . The 100 % increase in EBF rates can be attributed to the lactation counseling provided . Additional prenatal EBF support may not be needed within a context of strong routine prenatal EBF education BACKGROUND Obese women often have difficulties breastfeeding . OBJECTIVE We evaluated whether telephone-based support could increase the duration of breastfeeding in obese women and , thereby , reduce offspring growth . DESIGN We recruited 226 dyads of obese mothers and their singleton , healthy , term infants . The women were r and omly assigned to 6 mo of breastfeeding support or st and ard care controls . At 6 mo , there were 207 dyads in the study ; 105 dyads received support , and 102 dyads were control subjects . One International Board Certified Lactation Consultant carried out the intervention , which was based on structured interviews and consisted of encouraging telephone calls . RESULTS The support group breastfed exclusively for a median of 120 d ( 25th-75th percentiles : 14 - 142 d ) compared with 41 d ( 3 - 133 d ) for control subjects ( P = 0.003 ) . Any breastfeeding was maintained for a median of 184 d ( 92 - 185 d ) for the support group compared with 108 d ( 16 - 185 d ) for control subjects ( P = 0.002 ) . Support increased the adjusted ORs for exclusive breastfeeding at 3 mo and the ratios for partial breastfeeding at 6 mo to 2.45 ( 95 % CI : 1.36 , 4.41 ; P = 0.003 ) and 2.25 ( 95 % CI : 1.24 , 4.08 ; P = 0.008 , respectively ) . Although the duration of exclusive breastfeeding was inversely associated with infant weight ( β = -4.39 g/d ; 95 % CI : -0.66 , -8.11 g/d ; P = 0.021 ) and infant length at 6 mo ( β = -0 . 012 cm/d ; 95 % CI : -0.004 , -0.02 cm/d ; P = 0.004 ) , the breastfeeding support did not achieve a significant effect on infant growth at 6 mo ( n = 192 ) . CONCLUSIONS Telephone-based advisory support was very effective in prolonging breastfeeding  in obese mothers who often terminate the breastfeeding of their infants prematurely . A longer duration of breastfeeding may decrease risk of noncommunicable diseases in these infants . This trial was registered at clinical trials.gov as NCT01235663 OBJECTIVE : To evaluate a specialized breastfeeding peer counseling ( SBFPC ) intervention promoting exclusive breastfeeding ( EBF ) among overweight/obese , low-income women . METHODS : We recruited 206 pregnant , overweight/obese , low-income women and r and omly assigned them to receive SBFPC or st and ard care ( controls )  at a Baby-Friendly hospital . SBFPC included 3 prenatal visits , daily in-hospital support , and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers . St and ard care involved routine access to breastfeeding support from hospital personnel , including staff peer counselors . Data collection included an in-hospital interview , medical record review , and monthly telephone calls through 6 months postpartum to assess infant feeding practice s , demographics , and health outcomes . Bivariate and logistic regression analyses were conducted . RESULTS : The intervention had no impact on EBF or breastfeeding continuation at 1 , 3 , or 6 months postpartum . In adjusted posthoc analyses , at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding ( adjusted odds ratio [ aOR ] : 3.76 [ 95 % confidence interval ( CI ) : 1.07–13.22 ] ) , and giving at least 50 % of feedings as breast milk ( aOR : 4.47 [ 95 % CI : 1.38–14.5 ] ) , compared with controls . Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth ( aOR : 0.24 [ 95 % CI : 0.07–0.86 ] ) . CONCLUSIONS : In a Baby-Friendly hospital setting , SBFPC targeting overweight/obese women did not impact EBF practice s but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth Aim : We conducted a r and omized controlled trial to assess the effectiveness of a support intervention delivered by health professionals to increase the rate and duration of breastfeeding . Methods : A r and omized controlled intervention study was conducted in the period 2000–2001 among 605 mothers who had given birth in a public maternity ward located in the city of Rome , Italy . The intervention consisted of a home visit by a midwife from the maternity ward of the hospital . The outcome of the study was the infant 's feeding habits , assessed by a 24‐h recall . The effect of the intervention on the duration of breastfeeding was estimated by the Kaplan‐Meier method and by the Cox multivariate regression model . Results : According to intention‐to‐treat analysis , there was no significant difference between the intervention and the control group , after controlling for confounding factors ( hazard ratio ( HR ) 1.04 ; 95 % confidence interval ( 95 % CI ) : 0.85–1.26 ) . The duration of breastfeeding was shorter ( HR 1.61 ; 95 % CI : 1.13–2.31 ) for women in the intervention group who refused the obstetric visit OBJECTIVES : Despite recent efforts to increase breastfeeding , young African American mothers continue to breastfeed at low rates , and commonly introduce complementary foods earlier than recommended . This study examines the effects of a community doula home visiting intervention on infant feeding practice s among young mothers . METHODS : Low-income , African American mothers ( n = 248 ) under age 22 years participated in a r and omized trial of a community doula intervention . Intervention-group mothers received services from paraprofessional doulas : specialized home visitors trained as childbirth educators and lactation counselors . Doulas provided home visits from pregnancy through 3 months postpartum , and support during childbirth . Control-group mothers received usual prenatal care . Data were obtained from medical records and maternal interviews at birth and 4 months postpartum . RESULTS : Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers ( 64 % vs 50 % ; P = .02 ) and were more likely to breastfeed longer than 6 weeks ( 29 % vs 17 % ; P = .04 ) , although few mothers still breastfed at 4 months . The intervention also impacted mothers ’ cereal/solid food introduction ( P = .008 ) : fewer doula-group mothers introduced complementary foods before 6 weeks of age ( 6 % vs 18 % ) , while more waited until at least 4 months ( 21 % vs 13 % ) compared with control-group mothers . CONCLUSIONS : Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines . The intervention ’s success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting , and the doula ’s presence at the birth , where she supports early breastfeeding experiences Background . Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health , the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal . The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks . Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed , problems with the infant latching or suckling , and lack of individualized encouragement from their clinicians in the early postdischarge period . Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practice s during routine preventive visits . However , robust scientific evidence based on r and omized , controlled trials is currently lacking . Objective . The purpose of this study was to determine whether attending an early , routine , preventive , outpatient visit delivered in a primary care physician ’s office would improve breastfeeding outcomes . Design . The study was a prospect i ve , r and omized , parallel-group , open trial . Setting . Participants were recruited at a level 3 maternity facility , with an average of 2000 births per year , in France . Participants . A total of 231 mothers who had delivered a healthy singleton infant ( gestational age : ≥37 completed weeks ) and were breastfeeding on the day of discharge were recruited and r and omized ( 116 were assigned to the intervention group and 115 to the  control group ) between October 1 , 2001 , and May 31 , 2002 ; 226 mother-infant pairs ( 112 in the intervention group and 114 in the control group ) contributed data on outcomes . Intervention . Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members , a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge , provision of the telephone number of a peer support group , m and atory routine , preventive , outpatient visits at 1 , 2 , 3 , 4 , 5 , and 6 months of infant age , and 10 weeks of paid maternity leave ( extended to 18 weeks after the birth of the third child ) . In addition to the usual predischarge and postdischarge support , the mothers in the intervention group were invited to attend an individual , routine , preventive , outpatient visit in the office of 1 of the 17 participating primary care physicians ( pediatricians or family physicians ) within 2 weeks after the birth . The participating physicians received a 5-hour training program on breastfeeding , delivered in 2 parts in 1 month , before the beginning of the study . Outcome Measures . The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks ( defined as giving maternal milk as the only food source , with no other foods or liquids , other than vitamins or medications , being given ) . The secondary outcomes included any breastfeeding reported at 4 weeks , breastfeeding duration , breastfeeding difficulties , and satisfaction with breastfeeding experiences . Classification into breastfeeding categories reported at 4 weeks was based on 24-hour dietary recall . Results . Ninety-two mothers ( 79.3 % ) assigned to the intervention group and 8 mothers ( 7.0 % ) assigned to the control group reported that they had attended the routine , preventive , outpatient visit in the office of 1 of the 17 primary care physicians participating in the study . Mothers in the intervention group were more likely to report exclusive breastfeeding at 4 weeks ( 83.9 % vs 71.9 % ; hazard ratio : 1.17 ; 95 % confidence interval [ CI ] : 1.01–1.34 ) and longer breastfeeding duration ( median : 18 weeks vs 13 weeks ; hazard ratio : 1.40 ; 95 % CI : 1.03–1.92 ) . They were less likely to report any breastfeeding difficulties ( 55.3 % vs 72.8 % ; hazard ratio : 0.76 ; 95 % CI : 0.62–0.93 ) . There was no significant difference between the 2 groups with respect to the rate of any breastfeeding at 4 weeks ( 89.3 % vs 81.6 % ; hazard ratio : 1.09 ; 95 % CI : 0.98–1.22 ) and the rate of mothers fairly or very satisfied with their breastfeeding experiences ( 91.1 % vs 87.7 % ; hazard ratio : 1.04 ; 95 % CI : 0.95–1.14 ) . Conclusions . Although we can not exclude the possibility that findings might differ in other health care systems , this study provides preliminary evidence of the efficacy of breastfeeding support through an early , routine , preventive visit in the offices of trained primary care physicians . Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes . Multifaceted interventions aim ing to support breastfeeding should involve primary care physicians 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 BACKGROUND Exclusive breastfeeding rates in Malaysia remains low despite the implementation of the Baby Friendly Hospital Initiative ( BFHI ) policy in government hospitals . It has been suggested that any form of postnatal lactation support will lead to an increase in exclusive breastfeeding rates . OBJECTIVE To study the effectiveness of telephone lactation counselling on breastfeeding practice s. DESIGN Single blinded , r and omised controlled trial ( RCT ) . SETTING Maternity wards in a public hospital in Kuala Lumpur , Malaysia . PARTICIPANTS 357 mothers , each of whom had delivered a full term , healthy infant via spontaneous vaginal delivery . METHODS Mothers were followed up for 6 months . The intervention group ( n=179 ) received lactation counselling via telephone twice monthly by certified lactation counsellors in addition to receiving the current conventional care of postnatal breastfeeding support . The control group ( n=178 ) received the current conventional care of postnatal breastfeeding support . Definitions of breastfeeding practice s were according to World Health Organization ( WHO ) definitions . Participants answered a self-administered question naire during recruitment and were later followed up at one , four and 6-month intervals during the postpartum period via a telephone-based question naire . RESULTS At 1 month , a higher percentage of mothers in the intervention group practice d exclusive breastfeeding , compared to the control group ( 84.3 % vs. 74.7 % , OR 1.825 95 % , p=0.042 , CI=1.054 , 3.157 ) . At 4 and 6 months postpartum , similar percentages of mothers from the two groups practice d exclusive breastfeeding ( 41.98 % vs. 38.99 % ; 12.50 % vs. 12.02 % , no significant differences , both p>0.05 ) . Slightly higher numbers of mothers in the control group had completely stopped breastfeeding at the 1 , 4 and 6 month marks , compared to the intervention group ( 7.4 % vs. 5.4 % ; 12.6 % vs. 9.9 % ; 13.9 % vs. 9.4 % ; all p>0.05 ) . The reason cited by most mothers who had completely stopped breastfeeding during the early postpartum period was a low breast milk supply , while returning to work was the main reason for stopping breastfeeding later in the postpartum period . CONCLUSIONS Telephone lactation counselling provided by certified lactation counsellors from the nursing profession was effective in increasing the rate of exclusive breastfeeding for the first postpartum month but not during the 4 and 6month postpartum intervals OBJECTIVE : The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) . As of 2008 , 50 % of WIC clients received services from local WIC agencies that offered peer counseling . Little is known about the effectiveness of these peer counseling programs . R and omized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration , but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally . We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation , duration , and exclusivity . METHODS : We r and omly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms : no peer counseling , 4 telephone contacts , or 8 telephone contacts . RESULTS : We combined 2 treatment arms because there was no difference in the distribution of peer contacts . Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group ( adjusted relative risk : 1.22 ; 95 % confidence interval [ CI ] : 1.10–1.34 ) but greater at 6 months for Spanish-speaking clients only ( adjusted relative risk : 1.29 ; 95 % CI : 1.10–1.51 ) . The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients ( adjusted odds ratio : 0.78 ; 95 % CI : 0.68–0.89 ) . CONCLUSIONS : A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women OBJECTIVE to assess the effectiveness of a peer support worker ( PSW ) service on breast-feeding continuation . DESIGN cluster r and omised controlled trial ( IS RCT N16126175 ) . SETTING Primary Care Trust , UK serving a multi-ethnic , socio-economically disadvantaged population . PARTICIPANTS 2,724 women giving birth following antenatal care from 66 clinics : 33 clinics ( 1,267 women ) r and omised to the PSW service and 33 clinics ( 1,457 women ) to usual care . 848 women consented to additional follow-up by question naire at 6 months . INTERVENTION PSW service provided in the antenatal and postnatal period . MEASUREMENTS any and exclusive breast feeding at 10 - 14 days obtained from routine computerised records and at 6 weeks and 6 months from a question naire . FINDINGS follow-up : 94 % at 10 - 14 days , 67.5 % at 6 months . There was no difference in any breast feeding at 10 - 14 days between intervention and usual care , odds ratio ( OR ) 1.07 ( 95 % CI 0.87 - 1.31 , p=0.54 ) . Proportion of women reporting any breast feeding in the intervention group at 6 weeks was 62.7 % and 64.5 % in the usual care group OR 0.93 ( 95 % CI 0.64 - 1.35 ) ; and at 6 months was 34.3 % and 38.9 % , respectively , OR 1.06 ( 95 % CI 0.71 - 1.58 ) . KEY CONCLUSIONS universal antenatal peer support and postnatal peer support for women who initiated breast feeding did not improve breast-feeding rates up to 6 months in this UK population . IMPLICATION S FOR PRACTICE with high levels of professional support part of usual maternity care it may not be possible for low intensity peer support to produce additional benefit . More intensive or targeted programmes might be effective , but should have concurrent high quality evaluation Objective To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women . Design Cluster r and omised controlled trial with prospect i ve mixed method embedded case studies to evaluate implementation processes . Setting Primary care in Scotl and . Participants Pregnant women , breastfeeding mothers , and babies registered with 14 of 66 eligible clusters of general practice s ( localities ) in Scotl and that routinely collect breastfeeding outcome data . Intervention Localities set up new breastfeeding groups to provide population coverage ; control localities did not change group activity . Main outcome measures Primary outcome : any breast feeding at 6 - 8 weeks from routinely collected data for two pre-trial years and two trial years . Secondary outcomes : any breast feeding at birth , 5 - 7 days , and 8 - 9 months ; maternal satisfaction . Results Between 1 February 2005 and 31 January 2007 , 9747 birth records existed for intervention localities and 9111 for control localities . The number of breastfeeding groups increased from 10 to 27 in intervention localities , where 1310 women attended , and remained at 10 groups in control localities . No significant differences in breastfeeding outcomes were found . Any breast feeding at 6 - 8 weeks declined from 27 % to 26 % in intervention localities and increased from 29 % to 30 % in control localities ( P=0.08 , adjusted for pre-trial rate ) . Any breast feeding at 6 - 8 weeks increased from 38 % to 39 % in localities not participating in the trial . Women who attended breastfeeding groups were older ( P<0.001 ) than women initiating breast feeding who did not attend and had higher income ( P=0.02 ) than women in the control localities who attended postnatal groups . The locality cost was £ 13 400 ( € 14 410 ; $ 20 144 ) a year . Conclusion A policy for providing breastfeeding groups in relatively deprived areas of Scotl and did not improve breastfeeding rates at 6 - 8 weeks . The costs of running groups would be similar to the costs of visiting women at home . Trial registration Current Controlled Trials IS RCT N44857041 Objectives Breastfeeding has significant health benefits for mothers and infants . Despite recommendations from the WHO , by 6 months of age 40 % of Australian infants are receiving no breast milk . Increased early postpartum breastfeeding support may improve breastfeeding maintenance . 2 community-based interventions to increase breastfeeding duration in local government areas ( LGAs ) in Victoria , Australia , were implemented and evaluated . Design 3-arm cluster r and omised trial . Setting LGAs in Victoria , Australia . Participants LGAs across Victoria with breastfeeding initiation rates below the state average and > 450 births/year were eligible for inclusion . The LGA was the unit of r and omisation , and maternal and child health centres in the LGAs comprised the clusters . Interventions Early home-based breastfeeding support by a maternal and child health nurse ( home visit , HV ) with or without access to a community-based breastfeeding drop-in centre ( HV+drop-in ) . Main outcome measures The proportion of infants receiving ‘ any ’ breast milk at 3 , 4 and 6 months ( women 's self-report ) . Findings 4 LGAs were r and omised to the comparison arm and provided usual care ( n=41 clusters ; n=2414 women ) ; 3 to HV ( n=32 clusters ; n=2281 women ) ; and 3 to HV+drop-in ( n=26 clusters ; 2344 women ) . There was no difference in breastfeeding at 4 months in either HV ( adjusted OR 1.04 ; 95 % CI 0.84 to 1.29 ) or HV+drop-in ( adjusted OR 0.92 ; 95 % CI 0.78 to 1.08 ) compared with the comparison arm , no difference at 3 or 6 months , nor in any LGA in breastfeeding before and after the intervention . Some issues were experienced with intervention protocol fidelity . Conclusions Early home-based and community-based support proved difficult to implement . Interventions to increase breastfeeding in complex community setting s require sufficient time and partnership building for successful implementation . We can not conclude that additional community-based support is ineffective in improving breastfeeding maintenance given the level of adherence to the planned protocol . Trial registration number ACTRN12611000898954 ; Results Mothers who breastfeed typically exhibit lower levels of depressive symptomatology than mothers who do not . However , very few studies have investigated the directionality of this relationship . Of the prospect i ve studies published , all but one focus exclusively on whether maternal depression reduces rates of subsequent breastfeeding . This study again examines this relationship , but also the reverse — that breastfeeding might predict lower levels of later depression . Using multilevel modeling , we investigated the relationship between breastfeeding and self-reported depressive symptomatology in 205 women followed prenatally and at 3 , 6 , 12 , and 24 months after birth . Consistent with previous research , women with prenatal depressive symptomatology weaned their infants 2.3 months earlier , on average , than women without such symptomatology . We also found , however , that women who breastfed more frequently at 3 months postpartum showed greater subsequent declines in depressive symptomatology over time compared to women who breastfed less frequently , result ing in lower absolute levels of depressive symptoms by 24 months postpartum , controlling for important confounds . In sum , these findings are consistent with a bidirectional association between breastfeeding and depression , with prenatal depression predicting less breastfeeding soon after birth and breastfeeding predicting declines in maternal depression up to 2 years after birth . We discuss mechanisms that could potentially explain these associations and avenues for future research Background The objective of this study is to determine the effect of a consultation model , Beliefs , Attitudes , Subjective Norms and Enabling Factors ( BASNEF ) , and the counselling steps using GATHER-Greet clients , Ask clients about themselves , Tell clients about their choices , Help clients choose , Explain what to do , and Return for follow-up-on the continuation rates of exclusive breastfeeding in mothers of premature infants . Methods This is a r and omized controlled clinical trial carried out on 124 mothers with premature infants hospitalized in Fatemieh Hospital , city of Hamadan , in 2014 . Participants were r and omly assigned to either the intervention or control groups . The initial demographic question naire carried out in both groups included three questions about the continuation of exclusive breastfeeding , BASNEF , a checklist related to the lactation performance documented by mothers and the weight gain of their infants . Five breastfeeding consultation sessions based on the BASNEF model and counselling steps using GATHER , were held for the mothers in the intervention group for five consecutive days . Then follow-up weight gain and the question naire completion were performed in both groups at 1 , 2 , 3 and 4 months after the intervention . Results Baseline characteristics were similar in the two groups . There were no significant differences between both groups in the rate of exclusive breastfeeding , lactation performance and infant weight at baseline . The intervention group had significantly higher rates of exclusive breastfeeding , 72.6 % versus the control group of 16.1 % , at the end of the 4 month follow-up . Also the intervention group had significantly higher mean scores of lactation performance ( 8.62 ± 2.08 vs 6.40 ± 1.84 in the control group ) and infant weight ( 5694.80 ± 779.43 vs 4760.17 ± 859.12 in the control group ) at the end of the 4 month follow-up . Conclusion Breastfeeding consultation of mothers based on the BASNEF model and using GATHER counselling steps increased the rate of exclusive breastfeeding , lactation performance and weight gain of premature infants . Therefore , breastfeeding counselling sessions are recommended for all mothers of premature infants . Trial registration Iranian Registry of Clinical Trials number I RCT 2014111013405N6 and date registered , January 5 , 2015 OBJECTIVE To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding ( EBF )  in a low-re source urban setting in Kenya . DESIGN A cluster r and omized controlled trial in which nine villages were assigned on a 1:1:1 ratio , by computer , to two intervention groups and a control group . The home-based intensive counselling group ( HBICG ) received seven counselling sessions at home by trained peers , one prenatally and six postnatally . The facility-based semi-intensive counselling group ( FBSICG ) received only one counselling session prenatally . The control group ( CG ) received no counselling from the research team . Information on infant feeding practice s was collected monthly for 6 months after delivery . The data -gathering team was blinded to the intervention allocation . The outcome was EBF prevalence at 6 months . SETTING Kibera slum , Nairobi . SUBJECTS A total of 360 HIV-negative women , 34 - 36 weeks pregnant , were selected from an antenatal clinic in Kibera ; 120 per study group . RESULTS Of the 360 women enrolled , 265 completed the study and were included in the analysis ( CG n 89 ; FBSICG n 87 ; HBICG n 89 ) . Analysis was by intention to treat . The prevalence of EBF at 6 months was 23.6 % in HBICG , 9.2 % in FBSICG and 5.6 % in CG . HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG ( adjusted relative risk = 4.01 ; 95 % CI 2.30 , 7.01 ; P=0.001 ) . There was no significant difference between EBF rates in FBSICG and CG . CONCLUSIONS EBF can be promoted in low socio-economic conditions using home-based intensive counselling . One session of facility-based counselling is not sufficient to sustain EBF Objectives Neonatal jaundice is the most common problem in full-term infants during the immediate post-natal period . We examined the effect of a lactation support intervention on breastfeeding duration in hospitalized jaundiced infants . Study Design We conducted a r and omized controlled trial with a qualitative component involving mothers of hospitalized jaundiced breastfed infants < 4 weeks of age . Mothers receiving the intervention met with an International Board-Certified Lactation Consultant in hospital and 1–3 times post discharge . Both groups received the st and ard care for jaundice . The primary outcome was exclusive breastfeeding at 3 months . To the exception of research assistants enrolling participants and completing qualitative interviews , all research staff , investigators and statisticians were blinded to group assignment . Qualitative interviews elicited feedback on breastfeeding experiences for both groups . Results 99 participants were recruited , and 86 analyzed for primary outcome . There was no difference in exclusive breastfeeding at 3 months between groups ( RR 0.84 , 95 % CI 0.56–1.24 , p = 0.40 ) or in the secondary outcomes . 31 participants were included in the qualitative analysis . Participants in the intervention group described an increase in comfort and confidence levels with breastfeeding . Participants in the control group reported limited lactation support . Conclusions Our hospital-based lactation support program did not result in a higher proportion of mothers exclusively breastfeeding at 3 months compared to current hospital st and ard care . Qualitative feedback from the intervention group suggests that mothers ’ confidence was increased , which is linked to breastfeeding duration . The decision to breastfeed is multifactorial and hospital-based lactation support may be only a small piece of the puzzle in hospitalized jaundiced infants . Further studies may be needed to fully eluci date the impact of an in-hospital lactation support program on successful breastfeeding for these infants . Trial Registration Clinical Trials.gov NCT00966719 https://www . clinical trials.gov/ct2/show/NCT00966719?term=Lactation+Support+ and + Breastfeeding+ Duration + in+Jaundiced+Infants%3A+a+R and 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 Despite substantial evidence of maternal and infant benefits of breastfeeding , adolescent mothers initiate breastfeeding less often and maintain breastfeeding for shorter duration s when compared to their adult counterparts . A r and omized controlled trial drawing on the theory of planned behavior and developmental theory was conducted to determine if an education and counseling intervention provided by a lactation consultant — peer counselor team increased breastfeeding initiation and duration up to 6 months postpartum among adolescent mothers . Study participants ( N = 289 ) enrolled from multiple prenatal clinic and school setting s , were 15 to 18 years old , and predominately African American , single , and primiparous . The intervention , which started in the second trimester of pregnancy and extended through 4 weeks postpartum , positively influenced breastfeeding duration ( p < .001 ) within the experimental group , but not breastfeeding initiation or exclusive breastfeeding rates . This education/support intervention was partially effective in enhancing breastfeeding outcomes . Implication s for research and practice are described OBJECTIVE To assess the efficacy of peer counseling to promote exclusive breastfeeding ( EBF ) among low-income inner-city women in Hartford , Conn. DESIGN Participants recruited prenatally were r and omly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support ( peer counseling group [ PC ] ) or only conventional breastfeeding support ( control group [ CG ] ) and followed through 3 months post partum . SETTING Low-income predominantly Latina community . PARTICIPANTS Expectant mothers , less than 32 weeks gestation and considering breastfeeding ( N = 162 ) . Intervention Exclusive breastfeeding peer counseling support offering 3 prenatal home visits , daily perinatal visits , 9 postpartum home visits , and telephone counseling as needed . MAIN OUTCOME MEASURES Exclusive breastfeeding rates at hospital discharge , 1 , 2 , and 3 months post partum ( n = 135 ) . RESULTS At hospital discharge , 24 % in the CG compared with 9 % in the PC had not initiated breastfeeding , with 56 % and 41 % , respectively , nonexclusively breastfeeding . At 3 months , 97 % in the CG and 73 % in the PC had not exclusively breastfed ( relative risk [ RR ] = 1.33 ; 95 % CI , 1.14 - 1.56 ) during the previous 24 hours . The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC ( 99 % vs 79 % ; RR = 1.24 ; 95 % CI , 1.09 - 1.41 ) . Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months ( 33 % vs 52 % ; RR = 0.64 ; 95 % CI , 0.43 - 0.95 ) . The likelihood of having 1 or more diarrheal episode in infants was cut in half in the PC ( 18 % vs 38 % ; RR = 2.15 ; 95 % CI , 1.16 - 3.97 ) . CONCLUSION Well-structured , intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income , inner-city women in the United States The effectiveness of an in-hospital lactation education session on breastfeeding duration and satisfaction among postpartum women was investigated . In equal number , a total of 150 women were r and omly assigned to a st and ardized curriculum ( experimental group ) or a routine-care control group . No differences were found between the groups regarding breastfeeding duration , mother 's satisfaction level , or her perceived support . Item-scale analyses , however , were promising ( a=0 . 77 ) and a preliminary factor analysis suggested three underlying subscales : professional encouragement , satisfaction , and familial relationships . Based on a stepwise , multiple regression analysis three variables were related to length of breastfeeding experience , that is , level of satisfaction , educational level of the mother , and expected length of breastfeeding . Implication s of these results toward lactation education programs and further scale development are discussed BACKGROUND Breastfeeding peer counseling has improved breastfeeding rates in developing countries ; however , its impact in this country has not been adequately evaluated . OBJECTIVE To evaluate the effectiveness of an existing , breastfeeding peer counseling program within the United States . DESIGN R and omized , prospect i ve , controlled trial in which participants were recruited prenatally and r and omly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling . SETTING An urban hospital serving a large population of low-income Latinas . PARTICIPANTS Pregnant women ( < or = 26 weeks ' gestation ) were recruited from the hospital 's prenatal clinic . Inclusion criteria specified that participants be low income , be considering breastfeeding , have delivered a healthy , full-term singleton , and have access to a telephone . Intervention Breastfeeding peer counseling services included 1 prenatal home visit , daily perinatal visits , 3 postpartum home visits , and telephone contact as needed . MAIN OUTCOME MEASURES Breastfeeding rates at birth and 1 , 3 , and 6 months postpartum . RESULTS The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls ( 8/90 [ 9 % ] vs 17/75 [ 23 % ] ; relative risk , 0.39 ; 95 % confidence interval , 0.18 - 0.86 ) . The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month ( 36 % vs 49 % ; relative risk , 0.72 ; 95 % confidence interval , 0.50 - 1.05 ) and 3 months ( 56 % vs 71 % ; relative risk , 0.78 ; 95 % confidence interval , 0.61 - 1.00 ) . CONCLUSION These findings demonstrate that , in the United States , peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum 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 Length of postnatal hospitalization has decreased and has been shown to be associated with infant nutritional problems and increase in readmissions . We aim ed to evaluate if guidelines for breastfeeding counselling in an early discharge hospital setting had an effect on  maternal breastfeeding self-efficacy , infant readmission and breastfeeding duration . A cluster r and omized trial was conducted and assigned nine maternity setting s in Denmark to intervention or usual care .  Women were eligible if they expected a single infant , intended to breastfeed , were able to read Danish , and expected to be discharged within 50 hr postnatally . Between April 2013 and August 2014 , 2,065 mothers were recruited at intervention and 1,476 at reference setting s. Results show that the intervention did not affect maternal breastfeeding self-efficacy ( primary outcome ) . However , less infants were readmitted 1 week postnatally in the intervention compared to the reference group ( adjusted OR 0.55 , 95 % CI 0.37 , -0.81 ) , and 6 months following birth , more infants were exclusively breastfed in the intervention group ( adjusted OR 1.36 , 95 % CI 1.02 , -1.81 ) . Moreover , mothers in the intervention compared to the reference group were breastfeeding more frequently ( p < .001 ) , and spend more hours skin to skin with their infants ( p < .001 ) . The infants were less often treated for jaundice ( p = 0.003 ) and there was more paternal involvement ( p = .037 ) . In an early discharge hospital setting , a focused breastfeeding programme concentrating on increased skin to skin contact , frequent breastfeeding , good positioning of the mother infant dyad , and enhanced involvement of the father improved short-term and long-term breastfeeding success AIMS To evaluate the effectiveness of home-based peer counselling to increase breastfeeding rates for unfavourably low birthweight babies . METHODS R and omized clinical trial carried out in maternity hospitals and households in Fortaleza , one of the regions in Brazil with very low income ; 1003 mothers and their newborns were selected in eight maternity hospitals . Newborns needed were healthy and weighed less than 3000 g. INTERVENTION Breastfeeding counselling , conducted by lay counsellors from the community , during home visits carried out on days 5 , 15 , 30 , 60 , 90 and 120 after birth . MAIN OUTCOME MEASURE Feeding methods in the fourth month of life . RESULTS The intervention increased exclusive breastfeeding ( 24.7 % vs 19.4 % ; p=0.044 ) , delayed the introduction of formula and increased the time infants substituted breastfeeding to bottle milk ( bottle milk 33.4 % in the control group and 20.1 % in the intervention group ; p=0.00002 ) . When comparing the frequency of artificial breastfeeding  versus all other forms of breastfeeding ( exclusive+predominant+partial ) , the intervention increased breastfeeding rates in 39 % ( RR=0.61 ; CI 95 % : 0.50 - 0.75 ) ; 15 % of children were free from artificial feeding ( absolute risk reduction ) . The number of families to be visited to avoid one child receiving artificial feeding ( NNT ) was 7 ( CI 95 % : 5 - 13 ) . CONCLUSIONS Breastfeeding counselling , promoted by lay counsellors , can impact favourably on exclusive breastfeeding rates and contribute to delaying the utilization of milk formula and weaning . The intervention has great application potential because most cities in the northeast of Brazil count on community health workers that could do the counselling BACKGROUND In the Netherl and s , the initiation rate of breast-feeding ( BF ) was 80 % in 2002 , but only 35 % of the mothers continued to breast-feed for 3 months . This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding . METHODS A cluster-r and omized intervention trial was used . Ten child health care centers in three regions of the home health care were r and omly allocated to the program or usual care . Elements in the program were health counseling , measures to enhance cooperation , early signaling of breast-feeding problems and continuity of care , and lactation consultancy .  Pregnant mothers who applied for home health care in the intervention or usual care regions were enrolled and were followed up from pregnancy until 6 months postpartum ( n = 683 ) . The primary outcome measure was the continuation of breast-feeding until at least 3 months . RESULTS The 3-month breast-feeding rate was 32 % in the intervention and 38 % in the control groups ( OR = 0.79 , 95 % CI = 0.58 - 1.08 ) . CONCLUSION The program was not effective . We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program , such as the categories of caregivers involved and the number and duration of contacts after parturition 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 This pilot study aim ed to test the effectiveness of a structured telephonic counselling ( STC ) on  exclusive breastfeeding ( EB ) on healthy babies .  The study was carried out on 114 primiparous women from February to March 2009 . After r and omization , women were divided into two groups : 55 receiving STC and 59 receiving conventional counselling . At 1 , 3 and 5 months after delivery , a nurse specialist evaluated the EB rates , the influence of mother 's educational level and employment status on EB . Breastfeeding rates in STC were higher compared to conventional counselling ( P < 0.01 ) ; resuming work was not an EB discouraging variable as 74.5 % women in the STC resumed work vs. 54.2 % of the conventional counselling . Breastfeeding promotion should start during pregnancy , advising women about benefits for the child in receiving human milk . STC should be used to improve EB in primiparous women Background / Objectives : Low birth weight ( LBW ) , defined as the body weight at birth of less than 2500 g , is a major public health problem in Bangladesh , where 37 % of the babies are born with LBW . The objective of this study is to see the impact of nutrition education on growth of LBW babies with early initiation and exclusive breastfeeding compared to control group . Subjects/ Methods : A total of 184 LBW babies and their mothers who attended the Maternal Care and Health Training Institute and Dhaka Medical College Hospital were r and omly allocated to either intervention or control group .  Enrollment of the study population started in May 2008 and was completed in October 2008 .  Nutrition education was given to mothers twice weekly for 2 months , on initiation of breastfeeding within 1 h , exclusive breastfeeding and increasing their dietary intake . Nutritional status of LBW babies was assessed for length and weight every 2 weeks . Data were analyzed using SPSS/Window 's version 12 . Comparison of mean of data was done using st and ard Student 's t-test . Results : Mean initial body weight and length of LBW babies were similar in both groups ( 2261±198 g vs 2241±244 g , P=0.535 and 43.0±1.3 cm vs 43.0±1.7 cm , P=0.77 ) . Body weight and length of the LBW babies after 2 months increased significantly ( 3620±229 g vs 3315±301 g , P<0.001 and 50.2±1.3 cm vs 48.7±1.6 cm , P<0.001 ) . It was found that the intervention group suffered less from respiratory illness compared with the control group ( 39 % vs 66 % , P<0.001 ) . The rate of early initiation of breastfeeding was also significantly higher with nutrition intervention ( 59.8 % vs 37.2 % , P<0.001 ) . Exclusive breastfeeding rate was significantly higher in intervention group ( 59.8 % vs 37 % , P=0.003 ) . Conclusions : The present study showed that weight and length gain of  LBW  babies significantly increased by breastfeeding and nutrition education . Therefore , nutrition education on breastfeeding proves to be a strong tool to reduce the high risk of malnutrition and mortality of the LBW babies 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 BACKGROUND Exclusive breastfeeding ( EBF ) is reported to be a life-saving intervention in low-income setting s. The effect of breastfeeding counselling by peer counsellors was assessed in Africa . METHODS 24 communities in Burkina Faso , 24 in Ug and a , and 34 in South Africa were assigned in a 1:1 ratio , by use of a computer-generated r and omisation sequence , to the control or intervention clusters . In the intervention group , we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers . The data gathering team were masked to the intervention allocation . The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks .  Country-specific prevalence ratios were adjusted for cluster effects and sites . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , number NCT00397150 . FINDINGS 2579 mother-infant pairs were assigned to the intervention or control clusters in Burkina Faso ( n=392 and n=402 , respectively ) , Ug and a ( n=396 and n=369 , respectively ) , and South Africa ( n=535 and 485 , respectively ) .  The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 ( 79 % ) of 392 and 139 ( 35 % ) of 402 , respectively , in Burkina Faso ( prevalence ratio 2·29 , 95 % CI 1·33 - 3·92 ) ; 323 ( 82 % ) of 396 and 161 ( 44 % ) of 369 , respectively , in Ug and a ( 1·89 , 1·70 - 2·11 ) ; and 56 ( 10 % ) of 535 and 30 ( 6 % ) of 485 , respectively , in South Africa ( 1·72 , 1·12 - 2·63 ) . The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 ( 77 % ) and 94 ( 23 % ) , respectively , in Burkina Faso ( 3·27 , 2·13 - 5·03 ) ; 305 ( 77 % ) and 125 ( 34 % ) , respectively , in Ug and a ( 2·30 , 2·00 - 2·65 ) ; and 41 ( 8 % ) and 19 ( 4 % ) , respectively , in South Africa ( 1·98 , 1·30 - 3·02 ) . At 24 weeks , the prevalences based on 24-h recall were 286 ( 73 % ) in the intervention cluster and 88 ( 22 % ) in the control cluster in Burkina Faso ( 3·33 , 1·74 - 6·38 ) ; 232 ( 59 % ) and 57 ( 15 % ) , respectively , in Ug and a ( 3·83 , 2·97 - 4·95 ) ; and 12 ( 2 % ) and two ( < 1 % ) , respectively , in South Africa ( 5·70 , 1·33 - 24·26 ) . The prevalences based on 7-day recall were 279 ( 71 % ) in the intervention cluster and 38 ( 9 % ) in the control cluster in Burkina Faso ( 7·53 , 4·42 - 12·82 ) ; 203 ( 51 % ) and 41 ( 11 % ) , respectively , in Ug and a ( 4·66 , 3·35 - 6·49 ) ; and ten ( 2 % ) and one ( < 1 % ) , respectively , in South Africa ( 9·83 , 1·40 - 69·14 ) . Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 ( 5 % ) and 36 ( 9 % ) , respectively , in Burkina Faso ( 0·57 , 0·27 - 1·22 ) ; 39 ( 10 % ) and 32 ( 9 % ) , respectively , in Ug and a ( 1·13 , 0·81 - 1·59 ) ; and 45 ( 8 % ) and 33 ( 7 % ) , respectively , in South Africa ( 1·16 , 0·78 - 1·75 ) . The prevalence at age 24 weeks in the intervention and control clusters was 26 ( 7 % ) and 32 ( 8 % ) , respectively , in Burkina Faso ( 0·83 , 0·45 - 1·54 ) ; 52 ( 13 % ) and 59 ( 16 % ) , respectively , in Ug and a ( 0·82 , 0·58 - 1·15 ) ; and 54 ( 10 % ) and 33 ( 7 % ) , respectively , in South Africa ( 1·31 , 0·89 - 1·93 ) . INTERPRETATION Low-intensity individual breastfeeding peer counselling is achievable and , although it does not affect the diarrhoea prevalence , can be used to effectively increase EBF prevalence in many sub-Saharan African setting s. FUNDING European Union Sixth Framework International Cooperation-Developing Countries , Research Council of Norway , Swedish International Development Cooperation Agency , Norwegian Programme for Development , Research and Education , South African National Research Foundation , and Rockefeller Brothers Foundation This study compared breastfeeding attitudes , intention , and initiation among low-income women exposed or not exposed to the Best Start program .  A between- ( experimental vs control group ) and within-factor ( pretest vs posttest ) repeated measures design was employed . A nonprobability sample of 54 subjects was r and omly assigned to a control group ( n = 28 ) or an experimental group ( n = 26 ) . Using the Breastfeeding Attrition Prediction Tool , statistically significant group by time interaction effects were found for negative breastfeeding sentiment , positive breastfeeding sentiment , and breastfeeding control scales . Compared to the control group , the experimental group had significantly increased positive breastfeeding sentiment ( P < .01 ) , decreased negative breastfeeding sentiment ( P < .01 ) , and increased breastfeeding control ( P < .01 ) from pretest to posttest . Following exposure to the Best Start program , subjects in the experimental group showed statistically significantly higher breastfeeding intention and initiation than did those in the control group . Practical implication s are discussed . J Hum Lact . 20(3):300 - 305 OBJECTIVE To determine whether infants of women r and omized to a prenatal and postpartum lactation support intervention  incur fewer otitis media- , respiratory tract- , or gastrointestinal-related visits than controls . DESIGN R and omized , unmasked controlled trial recruiting women from prenatal care setting s. Breastfeeding sensitive ( BFS ) illness visits for otitis media or respiratory tract or gastrointestinal complaints were obtained up to 12 months . SETTING Two urban community health centers . PARTICIPANTS Analytic sample of 338 low-income , primarily Hispanic and /or black mother-infant dyads ( n = 163 for the intervention group and n = 175 for the control group ) . INTERVENTION Study lactation consultants attempted 2 prenatal meetings , 1 postpartum hospital and /or home visit , and telephone calls as needed . Controls received the st and ard of care . MAIN OUTCOME MEASURES Combined outpatient and emergency department visits with illness and BFS illness diagnoses . RESULTS There was a significant interaction between treatment and Medicaid ; among those not receiving Medicaid , the number of otitis media visits was higher among controls ( P</=.03 ) . Visits for any illness and BFS , gastrointestinal , or respiratory tract illnesses did not differ by treatment group . Intervention group infants received more breast milk than controls , but exclusive breastfeeding rates remained low and did not differ between groups at any point . CONCLUSIONS Only the number of otitis media visits was reduced , in a subset of the intervention group . The intervention did not reduce visits for respiratory tract or gastrointestinal illness . Limited intervention contact and low exclusive breastfeeding rates may have attenuated intervention effects . Future interventions design ed to yield markedly increased breastfeeding rates may show greater effects in low-income multiethnic sample s. Health coverage for visits may moderate intervention effects AIM AND OBJECTIVE This study was conducted to determine the effect of training administered to working mothers and its duration on  maternal anxiety levels and breastfeeding habits . BACKGROUND Within the scope of Health for All in the 21st Century project , a goal was set to increase the rate of infants fed exclusively by breastfeeding during the first six months of life to 80 % by the year 2015 . DESIGN A r and omised design with repeated measures . METHODS During collection of pretest data , a Personal Information Form , a Question naire Form and a  State Trait Anxiety Inventory  were administered to the mothers in the experimental and control groups . Five home visits were conducted starting two weeks before the date when mothers returned to work and ending when the infants became six months old . Breastfeeding techniques were taught to these mothers . Data were subjected to Proc MEAN , FREQ , anova and GENMOD procedures . RESULTS The rate of natural feeding ( breastfeeding exclusively ) among trained mothers was greater than untrained mothers . The frequency of breastfeeding affects maternal anxiety levels ; the anxiety level of mothers decreased with increasing frequency of breastfeeding . CONCLUSION Educating working mothers about breastfeeding reduces their anxiety levels and influences positively their breastfeeding habits . RELEVANCE TO CLINICAL PRACTICE With the support of health-care staff to increase awareness and knowledge on the value and sufficiency of breast milk , the rate and period of natural feeding increased significantly among working mothers AIM Exclusive breastfeeding increases survival and optimizes growth of low-birthweight ( LBW ) infants . If supported , mothers can overcome the unique difficulties associated with breastfeeding from birth to 6 mo . We tested the efficacy of postnatal peer counselling among first-time mothers that aim ed to increase exclusive breastfeeding of term LBW infants . METHODS In a Manila hospital , 204 mothers were r and omized into three groups .  Two intervention groups receiving home-based counselling visits , one by counsellors trained in breastfeeding counselling ( n=68 ) , the other by counsellors trained in general childcare ( n=67 ) , were compared with a control group of mothers ( n=69 ) who did not receive counselling . RESULTS Eighty-eight per cent of the participating pairs completed the trial . At 6 mo , 44 % of the breastfeeding counselled mothers , 7 % childcare-counselled mothers and none of the mothers in the control group were exclusively breastfeeding . More mothers in the breastfeeding counselled group than in the other groups were still breastfeeding at 6 mo . Twenty-four infants who were exclusively breastfed for 6 mo did not have any diarrhoea . All groups had improved mean weight-for-age Z-scores at 6 mo . CONCLUSION This study has provided fundamental evidence of successful intervention to achieve 6 mo of exclusive breastfeeding among term LBW infants . By improving health outcomes , enhanced breastfeeding offers a distinct possibility of disrupting the intergenerational cycle of undernourished women giving birth to LBW infants This r and omized clinical trial compared frequencies of exclusive breastfeeding  and lactationrelated problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward , and 137 controls . The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days ( 79.7 % vs 82.5 % , respectively ) and 30 days ( 60.8 % vs 53.3 % ) . There was no difference between groups in the frequency of sore nipples at 7 and 30 days , in breast engorgement and mastitis , and in the quality of breastfeeding technique at 30 days . Therefore , a single intervention at maternity was not sufficient to improve breastfeeding technique , increase exclusive breastfeeding rates , and reduce the incidence of breastfeeding problems during the first month OBJECTIVE to evaluate the effects of an extended midwifery support ( EMS ) programme on the proportion of women who breast feed fully to six months . DESIGN r and omised controlled trial . SETTING large public teaching hospital in Australia . PARTICIPANTS 849 women who had given birth to a healthy , term , singleton baby and who wished to breast feed . INTERVENTION participants were allocated at r and om to EMS , in which they were offered a one-to-one postnatal educational session and weekly home visits with additional telephone contact by a midwife until their baby was six weeks old ; or st and ard postnatal midwifery support ( SMS ) . Participants were stratified for parity and tertiary education . MEASUREMENTS the main outcome measures were prevalence of full and any breast feeding at six months postpartum . FINDINGS there was no difference between the groups at six months postpartum for either full breast feeding [ EMS 43.3 % versus SMS 42.5 % , relative risk ( RR ) 1.02 , 95 % confidence interval ( CI ) 0.87 - 1.19 ] or any breast feeding ( EMS 63.9 % versus SMS 67.9 % , RR 0.94 , 95%CI 0.85 - 1.04 ) . CONCLUSIONS the EMS programme did not succeed in improving breast-feeding rates in a setting where there was high initiation of breast feeding . Breast-feeding rates were high but still fell short of national goals . IMPLICATION S FOR PRACTICE continuing research of programmes design ed to promote breast feeding is required in view of the advantages of breast feeding for all mothers and babies BACKGROUND Promotion of breastfeeding is an important child-survival intervention , yet little is known about which promotional strategies are the most effective . We aim ed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil -- a hospital-based system and the same system combined with a programme of home visits . METHODS In February , 2001 , maternity staff from two hospitals in Pernambuco , Brazil , were trained according to the Baby-Friendly Hospital Initiative ( BFHI ) . In a r and omised trial between March and August , 2001 , 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding ( n=175 ) or no home visits ( n=175 ) . Breastfeeding practice s were studied on days 1 , 10 , 30 , 60 , 90 , 120 , 150 , and 180 by research ers unaware of group allocation . The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months . Analyses were by intention to treat . FINDINGS The hospital-training intervention achieved a high rate ( 70 % ) of exclusive breastfeeding in the hospitals , but this rate was not sustained at home and at 10 days of age only 30 % of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10 - 180 differed significantly ( p<0.0001 ) , with a mean aggregated prevalence of 45 % among the group assigned home visits compared with 13 % for the group assigned none . INTERPRETATION The BFHI achieves high rates of exclusive breastfeeding in hospital ; however , in Brazil at least , the rates fall rapidly thereafter . Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed . A combination of promotional systems ( hospital-based and in the community ) is needed INTRODUCTION Women 's traditional way of breastfeeding has altered in Jordan with rates declining in recent years . OBJECTIVE The objectives of this study were to test whether the introduction of an educational program supporting breastfeeding would increase the proportion of women who breastfed fully to six months , improve the women 's level of breastfeeding knowledge , and decrease the proportion of infants admitted to hospitals due to gastrointestinal illnesses . METHODS A r and omized controlled trial was conducted in 90 primiparous women who had given birth to a healthy , full term , singleton baby at two hospitals in the southern region of Jordan . Women were r and omly allocated to either the intervention group  ( n=45 ) , in which they were offered a one-to-one postnatal educational session and follow-up phone calls at two months and four months postpartum , or the control group  ( n=45 )  , in which they received routine postnatal care . The primary outcomes were the proportion of women fully breastfeeding their babies at six months and the women 's level of breastfeeding knowledge at six months postpartum . RESULTS The postnatal education and support program significantly improved breastfeeding knowledge measured by differences between mean pre- and post-test scores . This was statistically significant for the intervention group ( p<0.001 ) but was not significant for the control ( p=0.23 ) . The proportion of women fully breastfeeding their babies at 6 months was not found to be statistically significantly different between the intervention group ( 39 % ) and the control group ( 27 % ) , percentage difference=12 % ( 95 % confidence interval [ -9 % to 30 % ] , Chi squared : χ(2)=3.54 , p>0.05 ) . CONCLUSIONS Although the postnatal education and support program improved breastfeeding knowledge among women in the study , this increase in knowledge did not translate to an increase in the duration of full breastfeeding to six months BACKGROUND Social support has been shown to be greatly important for breastfeeding success . The objective of this study was to investigate if  mothers who were attended by midwives and nurses specially trained in breastfeeding counseling  perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care . METHOD Ten municipalities , each with an antenatal center and child health center , in southwest Sweden were r and omized either to intervention or control municipalities . The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers . Primiparas were asked to evaluate the care given , and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups . The 540 mothers responded to 3 question naires at 3 days and at 3 and 9 months postpartum . The perception of support provided by the health professionals and from the family classes was rated on Likert scales . RESULTS Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups , and better than control group B mothers at 3 months postpartum ; compared with both control groups , intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby 's needs . At 9 months , intervention group mothers were more satisfied with knowledge about social rights , information about the baby 's needs , and their social network than control group B mothers . Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy . At 3 and 9 months , intervention group mothers perceived that postnatal nurses were more sensitive and underst and ing compared with both control groups . CONCLUSIONS After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care , the mothers were more satisfied with emotional and informative support during the first 9 months postpartum . The results lend support to family classes incorporating continuity of care 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
Background Many infants worldwide are not breastfeeding according to WHO recommendations and this impacts on the health of women and children .
Increasing breastfeeding is identified as a priority area supported by current policy targets .
However , interventions are complex and multi-component and it is unclear which elements of interventions are most effective to increase breastfeeding in which setting s. Breastfeeding counselling is often part of complex interventions but evidence is lacking on the specific effect of counselling interventions on breastfeeding practice s. The aim of this systematic review is to examine evidence on effectiveness of breastfeeding counselling to inform global guidelines .