Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding

Abstract

Objective To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding. Design Randomised controlled trial. Setting 32 general practices in London and south Essex. Participants 720 women considering breast feeding. Main outcome measures Primary outcome was prevalence of any breast feeding at six weeks. Secondary outcomes were the proportion of women giving any breast feeds, or bottle feeds at four months, duration of any breast feeding, time to introduction of bottle feeds, and satisfaction with breast feeding. Results Offering support in breast feeding did not significantly increase the prevalence of any breast feeding to six weeks (65% (218/336) in the intervention group and 63% (213/336) in the control group; relative risk 1.02, 95% confidence interval 0.84 to 1.24). Survival analysis up to four months confirmed that neither duration of breast feeding nor time to introduction of formula feeds differed significantly between control and intervention groups. Not all women in the intervention group contacted counsellors postnatally, but 73% (123/179) of those who did rated them as very helpful. More women in the intervention group than in the control group said that their most helpful advice came from counsellors rather than from other sources. Conclusions Women valued the support of a counsellor in breast feeding, but the intervention did not significantly increase breastfeeding rates, perhaps because some women did not ask for help.

A Controlled Trial of the Father's Role in Breastfeeding Promotion

“…Moreover, teaching the fathers seems to represent a valid and cost-effective intervention 21,23,24 when we consider that other educational interventions led by volunteer counselors and health professionals have shown a not yet well-established influence on breastfeeding rates. [6][7][8][9] The advantages of intervention based on the fathers rather than on volunteers and health professionals can be represented by the emotional support and the continuity of care that the father can provide and by the fact that some women can be reluctant to ask for help from people who are not part of the family. 6 The weaknesses of this study are represented by the limited numbers of participants enrolled, by the single-hospital setting, and by sequential rather than random allocation of the participants.…”

“…[6][7][8][9] The advantages of intervention based on the fathers rather than on volunteers and health professionals can be represented by the emotional support and the continuity of care that the father can provide and by the fact that some women can be reluctant to ask for help from people who are not part of the family. 6 The weaknesses of this study are represented by the limited numbers of participants enrolled, by the single-hospital setting, and by sequential rather than random allocation of the participants. However, we think that because the participants and the interviewers were genuinely blind to the study design, the method that we chose provided valid data.…”

“…2 Several strategies have been used to promote breastfeeding, such as setting standards for maternity services 3,4 (eg, the joint World Health Organization-United Nations Children's Fund [WHO-UNICEF] Baby Friendly Initiative), public education through media campaigns, and health professionals and peer-led initiatives to support individual mothers. [5][6][7][8][9] Support from the infant's father through active participation in the breastfeeding decision, together with a positive attitude and knowledge about the benefits of breastfeeding, has been shown to have a strong influence on the initiation and duration of breastfeeding in observational studies, 2,10 but scientific evidence is not available as to whether training fathers to manage the most common lactation difficulties can enhance breastfeeding rates. We conducted a controlled trial to test the hypothesis that teaching the fathers how to prevent and manage breastfeeding problems is associated with an increased duration of breastfeeding.…”

An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health.

“…However, in the studies of lay support that reported exclusive breastfeeding, there was a marked reduction in the cessation of exclusive breastfeeding before the last study assessment (RR 0.72, 95% CI 0.57 to 0.90). 114,355,356,[358][359][360] There was heterogeneity among these studies (I 2 = 96.3%). Further subgroup analysis indicated that this effect was significant within the first 3 months (RR before 4-6 six weeks 0.66, 95% 0.46 to 0.96; RR before 2 months 0.44, 95% CI 0.26 to 0.73; RR before 3 months 0.42, 95% CI 0.31 to 0.57)…”

“…Trials that used laypeople to deliver the intervention demonstrated a significant reduction in breastfeeding cessation at the time of the last study assessment (RR 0.86, 95% CI 0.76 to 0.98). 88,114,[354][355][356][357][358][359][360] Significant heterogeneity was present among these studies (I 2 = 75.6%). Further subgroup analysis did not reveal a statistically significant effect at any time point up to 4 months.…”