Breastfeeding and Complementary Food: Randomized Trial of Community Doula Home Visiting

Abstract

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 practices among young mothers.METHODS: Low-income, African American mothers (n = 248) under age 22 years participated in a randomized 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. Pediatrics 2013;132: S160-S166

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0–5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

“…(2013), low income young black mothers [36]√Delay solidsRCT248AntenatallyDoulasBirth, 6 weeks, 4 mLow+BF, +solids 1° Aim: Increase BF and delay early introduction of solids Black et al . (2001), USA, low income black adoescents [46]Delay solids√RCT181BirthTrained mentors3 &12 mModerate+solids 1° Aim: Delay early introduction of solids Wen et al .…”

“…With two exceptions [35, 36], all of these studies were assessed as moderate to high quality. The majority of these studies (n = 7) were intensive home visiting interventions delivered antenatally [36, 37] from birth [38, 39] or early infancy [35, 40, 41] with 8–12 home visits in the first 12 to 24 months of the child’s life. Most of these studies (n = 5) used trained field workers and volunteers to deliver the intervention and only two studies used health professionals, with outcomes similar between delivery agents.…”

Breastfeeding among Adolescent Mothers

“…[23][24][25][26][27][28] A summary of the selected intervention studies and their characteristics are found in Table 1. [23][24][25][26][27][28] A summary of the selected intervention studies and their characteristics are found in Table 1.…”

“…As shown in Table 1, sample sizes ranged from 41 26 to 460 25 women, with a median sample size of 169 participants. 24,28 The sixth study was conducted in the Netherlands. 28 Three studies were conducted on the East Coast of the United States, with 1 conducted in Florida, 27 1 in New York, 23 and 1 in the mid-Atlantic region 26 ; 2 other studies were conducted in the Midwest.…”

Racial and Ethnic Disparities in Breastfeeding

“…[52][53][54][55] These studies included prenatal, perinatal, and postpartum behavioral education interventions delivered in hospitals or homes or via telephone by social workers, family support workers, and doulas. The intervention programs aimed to prepare and educate mothers about the benefits and challenges of breastfeeding.…”