Effect of early postnatal breastfeeding support: a cluster-randomized community based trial
H. Kronborg
Department of Nursing Science, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark
School of Nursing, cvu vita, 7500 Holstebro, Denmark
Search for more papers by this authorM. Væth
Department of Biostatistics, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark
Search for more papers by this authorJ. Olsen
Department of Epidemiology, School of Public Health, UCLA, Los Angeles, CA 90095-1772, USA
Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark
Search for more papers by this authorL. Iversen
Muusmann Research & Consulting, 1210 Copenhagen, Denmark
Search for more papers by this authorI. Harder
Department of Nursing Science, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark
Search for more papers by this authorH. Kronborg
Department of Nursing Science, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark
School of Nursing, cvu vita, 7500 Holstebro, Denmark
Search for more papers by this authorM. Væth
Department of Biostatistics, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark
Search for more papers by this authorJ. Olsen
Department of Epidemiology, School of Public Health, UCLA, Los Angeles, CA 90095-1772, USA
Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark
Search for more papers by this authorL. Iversen
Muusmann Research & Consulting, 1210 Copenhagen, Denmark
Search for more papers by this authorI. Harder
Department of Nursing Science, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark
Search for more papers by this authorAbstract
Aim: To assess the impact of a supportive intervention on the duration of breastfeeding.
Design and setting: A community based cluster-randomized trial in Western Denmark.
Subjects: Fifty-two health visitors and 781 mothers in the intervention group, and 57 health visitors and 816 mothers in the comparison group.
Intervention: Health visitors in the intervention group received an 18-h course. The intervention addressed maternal psychosocial factors and consisted of 1–3 home visits during the first 5 weeks post-partum. Health visitors in the comparison group offered their usual practice.
Main outcome measure: Duration of exclusive breastfeeding during 6 months of follow-up.
Results: Mothers in the intervention group had a 14% lower cessation rate (HR = 0.86 CI: 0.75–0.99). Similar results were seen for primipara, and multipara with previously short breastfeeding experience. Mothers in the intervention group received their first home visit earlier, had more visits and practical breastfeeding training within the first 5 weeks. Babies in the intervention group were breastfed more frequently, fewer used pacifiers, and their mothers reported more confidence in not knowing the exact amount of milk their babies had received when being breastfed.
Conclusion: Home visits in the first 5 weeks following birth may prolong the duration of exclusive breastfeeding. Postnatal support should focus on both psychosocial and practical aspects of breastfeeding. Mothers with no or little previous breastfeeding experience require special attention.
References
- 1 Gartner LM , Morton J , Lawrence RA , Naylor AJ , O'Hare D , Schanler RJ , et al . Breastfeeding and the use of human milk . Pediatrics 2005 ; 115 : 496 – 506 .
- 2 Scott JA , Binns CW . Factors associated with the initiation and duration of breastfeeding: a review of the literature . Breastfeed Rev 1999 ; 7 : 5 – 16 .
- 3 Ertem IO , Votto N , Leventhal JM . The timing and predictors of the early termination of breastfeeding . Pediatrics 2001 ; 107 : 543 – 8 .
- 4 Kronborg H , Vaeth M . The influence of psychosocial factors on the duration of breastfeeding . Scand J Public Health 2004 ; 32 : 210 – 16 .
- 5 Taveras EM , Capra AM , Braveman PA , Jensvold NG , Escobar GJ , Lieu TA . Clinician support and psychosocial risk factors associated with breastfeeding discontinuation . Pediatrics 2003 ; 112 : 108 – 15 .
- 6 Anderson GC , Moore E , Hepworth J , Bergman N . Early skin-to-skin contact for mothers and their healthy newborn infants . Cochrane Database Syst Rev 2003 ; CD003519 .
- 7 Renfrew MJ , Lang S , Martin L , Woolridge MW . Feeding schedules in hospitals for newborn infants . Cochrane Database Syst Rev 2000 ; CD000090 .
- 8 Righard L , Alade MO . Sucking technique and its effect on success of breastfeeding . Birth 1992 ; 19 : 185 – 9 .
- 9 Howard CR , Howard FM , Lanphear B , Eberly S , deBlieck EA , Oakes D , et al . Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding . Pediatrics 2003 ; 111 : 511 – 18 .
- 10 Hellings P , Howe C . Breastfeeding knowledge and practice of pediatric nurse practitioners . J Pediatr Health Care 2004 ; 18 : 8 – 14 .
- 11 World Health Organisation . Evidence for the Ten Steps to Successful Breastfeeding . Geneva : Division of Child Health and Development , 1998 . Available from: URL : http://www.who.int/child-adolescent-health/publications/NUTRITION/WHO_CHD_98.9.htm
- 12 Cattaneo A , Buzzetti R . Effect on rates of breast feeding of training for the baby friendly hospital initiative . BMJ 2001 ; 323 : 1358 – 62 .
- 13 Coutinho SB , de Lira PI , de Carvalho LM , Ashworth A . Comparison of the effect of two systems for the promotion of exclusive breastfeeding . Lancet 2005 ; 366 : 1094 – 1100 .
- 14 Sikorski J , Renfrew MJ , Pindoria S , Wade A . Support for breastfeeding mothers . Cochrane Database Syst Rev 2002 ; CD001141 .
- 15 Bartholomew LK , Parcel GS , Kok G . Intervention mapping: a process for developing theory- and evidence-based health education programs . Health Educ Behav 1998 ; 25 : 545 – 63 .
- 16 Dennis CL . Theoretical underpinnings of breastfeeding confidence: a self-efficacy framework . J Hum Lact 1999 ; 15 : 195 – 201 .
- 17 Kronborg H , Væth M , Olsen J , Iversen L , Harder I . Early breastfeeding cessation: validation of a prognostic breastfeeding score . Acta Paediatr 2007; 96: 688692 .
- 18 World Health Organisation . Breastfeeding counselling: A Training Course . Geneva : Department of child and adolescent Health Development , 1994 . Available from: URL : http://www.who.int/child-adolescent-health/publications/NUTRITION/BFC.htm
- 19 World Health Organisation . Indicators for assessing breastfeeding practices . Geneva : Division of Child Health and Development , 1991 . Available from: URL : http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/WHO_CDD_SER_91.14.pdf
- 20 Grambsch PM , Therneau TM . Propotional hazards tests and diagnostics based on weighted residuals . Biometrika 1994 ; 81 : 515 – 26 .
- 21 Labarere J , Gelbert-Baudino N , Ayral AS , Duc C , Berchotteau M , Bouchon N , et al . Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs . Pediatrics 2005 ; 115 : e139–e46 .
- 22 Kramer MS , Chalmers B , Hodnett ED , Sevkovskaya Z , Dzikovich I , Shapiro S , et al . Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus . JAMA 2001 ; 285 : 413 – 20 .
- 23 Brent NB , Redd B , Dworetz A , D'Amico F , Greenberg JJ . Breast-feeding in a low-income population. Program to increase incidence and duration . Arch Pediatr Adolesc Med 1995 ; 149 : 798 – 803 .
- 24 Di Napoli A , Di Lallo D , Fortes C , Franceschelli C , Armeni E , Guasticchi G . Home breastfeeding support by health professionals: findings of a randomized controlled trial in a population of Italian women . Acta Paediatr 2004 ; 93 : 1108 – 14 .
- 25 Kools EJ , Thijs C , Kester AD , Van den Brandt PA , De Vries H . Breast-feeding promotion and support program a randomized trial in The Netherlands . Prev Med 2005 ; 40 : 60 – 70 .
- 26 Lynch SA , Koch AM , Hislop TG , Coldman AJ . Evaluating the effect of a breastfeeding consultant on the duration of breastfeeding . Can J Public Health 1986 ; 77 : 190 – 5 .
- 27 Bandura Albert . Self-efficacy. Cognitive regulators . In : Social foundation of thought and action. A social cognitive theory . New Jersey : Prentice Hall , 1986 : 390 – 482 .
- 28 Hillenbrand KM , Larsen PG . Effect of an educational intervention about breastfeeding on the knowledge, confidence, and behaviors of pediatric resident physicians . Pediatrics 2002 ; 110 : e59 . Available from: URL : http://pediatrics.aappublications.org/cgi/content/full/110/5/e59
- 29 Moran VH , Dinwoodie K , Bramwell R , Dykes F . A critical analysis of the content of the tools that measure breast-feeding interaction . Midwifery 2000 ; 16 : 260 – 8 .
- 30 Nagy E , Orvos H , Pal A , Kovacs L , Loveland K . Breastfeeding duration and previous breastfeeding experience . Acta Paediatr 2001 ; 90 : 51 – 6 .
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