Simple Antenatal Preparation to Improve Breastfeeding Practice

Department of Obstetrics and Gynaecology, National University of Singapore, Tumasik, 00, Singapore
Obstetrics and Gynecology (Impact Factor: 5.18). 02/2007; 109(1):73-80. DOI: 10.1097/01.AOG.0000249613.15466.26
Source: PubMed


To address the impact of simple antenatal educational interventions on breastfeeding practice.
A randomized controlled trial was carried out in a tertiary referral center from May 2002 to December 2004. A random sample of eligible low-risk antenatal patients was recruited from clinics in the National University Hospital, Singapore. Group A received breastfeeding educational material and individual coaching from a lactation counselor. Group B received breastfeeding educational material with no counseling. Group C received routine antenatal care only.
A total of 401 women were recruited. Mothers receiving individual counseling and educational material practiced exclusive and predominant breastfeeding more often than mothers receiving routine care alone at 3 months (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.2-5.4) and 6 months (OR 2.4, 95% CI 1.0-5.7) postpartum. More mothers practiced exclusive and predominant breastfeeding at 6 months among women receiving individual counseling compared with women exposed to educational material alone (OR 2.5, 95% CI 1.0-6.3).
Where breastfeeding practices are suboptimal, simple one-encounter antenatal education and counseling significantly improve breastfeeding practice up to 3 months after delivery. Provision of printed or audiovisual educational material is not enough. Health care workers should make every effort to have one face-to-face encounter to discuss breastfeeding with expectant mothers before they deliver.
(, NCT002770192

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Available from: Yap-Seng Chong, Aug 31, 2014
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    • "In Table 3, we report the quality assessment of breastfeeding promotion intervention on ‘no breast feeding’. Of the 97 papers [10-14,17-20,33,35-38,40-42,44,45,47,49,51-55,57-74,76-84,86,88-130] reporting this particular outcome, 23 were from developing countries. Overall, educational interventions significantly decreased rates of no breastfeeding by 32% at day 1 (RR: 0.68, 95% CI: 0.54-0.87), "
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    ABSTRACT: Exclusive Breastfeeding (EBF) rates remain low in both low-income and high-income countries despite World Health Organization recommendations for EBF till 6 months. Breastfeeding has been shown to have a protective effect against gastrointestinal infections, among other benefits. Large-scale interventions focusing on educating mothers about breastfeeding have the potential to increase breastfeeding prevalence, especially EBF, up to recommended standards and also to decrease infant morbidity. A systematic literature search was conducted for RCTs and quasi-experimental studies comparing breastfeeding education or support to routine care. The effect of interventions was observed for exclusive, predominant, partial and no breastfeeding rates. The time intervals of interest were day 1, <1 month, and 1 to 5 months. Outcome-specific evidence was graded according to the Child Health Epidemiology Reference Group (CHERG) rules using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria and recommendations were made from studies in developing countries for inclusion into the Lives Saved Tool (LiST) model. After reviewing 4600 abstracts, 372 studies were selected for full text screening and 110 of these studies were finally included. Statistically significant increases in EBF rates as a result of breastfeeding promotion interventions were observed: 43% at day 1, 30% at <1 month, and 90% at 1-5 months. Rates of 'no breastfeeding' reduced by 32% at 1 day, 30% at <1 month, and 18% at 1-5 months. The effect of interventions on the rates of predominant and partial breastfeeding were non-significant. Breastfeeding education and/or support increased EBF rates and decreased no breastfeeding rates at birth, <1 month and 1-5 months. Combined individual and group counseling appeared to be superior to individual or group counseling alone. Interventions in developing countries had a greater impact than those in developed countries.
    Full-text · Article · Sep 2013 · BMC Public Health
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    • "A number of experimental studies have addressed this issue (Pugin et al., 1996; Duffy et al., 1997; Forster et al., 2004; Bonuck et al., 2005; Noel-Weiss et al., 2006b; Mattar et al., 2007; Su et al., 2007). The intervention (health education) strategies have mainly focused on practical aspects of coping with breast feeding (Pugin et al., 1996; Duffy et al., 1997; Forster et al., 2004; Noel-Weiss et al., 2006b; Mattar et al., 2007; Su et al., 2007) and some on psychosocial aspects such as intention, attitude, and confidence in breast feeding (Forster et al., 2004; Bonuck et al., 2005; Noel- Weiss et al., 2006b; Mattar et al., 2007). Two of the trials were followed by postnatal procedures (Bonuck et al., 2005; Su et al., 2007). "
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    ABSTRACT: OBJECTIVE: to assess the effect of an antenatal training programme on knowledge, self-efficacy and problems related to breast feeding and on breast-feeding duration. DESIGN: a randomised controlled trial. SETTING: the Aarhus Midwifery Clinic, a large clinic connected to a Danish university hospital in an urban area of Denmark. PARTICIPANTS: a total of 1193 nulliparous women were recruited before week 21+6 days of gestation, 603 were randomised to the intervention group, and 590 to the reference group. INTERVENTION: we compared a structured antenatal training programme attended in mid-pregnancy with usual practice. MEASUREMENTS: data were collected through self-reported questionnaires sent to the women's e-mail addresses and analysed according to the intention to treat principle. The primary outcomes were duration of full and any breast feeding collected 6 weeks post partum (any) and 1 year post partum (full and any). FINDINGS: no differences were found between groups according to duration of breast feeding, self-efficacy score, or breast-feeding problems, but after participation in the course in week 36 of gestation women in the intervention group reported a higher level of confidence (p=0.05), and 6 weeks after birth they reported to have obtained sufficient knowledge about breast feeding (p=0.02). Supplemental analysis in the intervention group revealed that women with sufficient knowledge breast fed significantly longer than women without sufficient knowledge (HR=0.74 CI: 0.58-0.97). This association was not found in the reference group (HR=1.12 CI: 0.89-1.41). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: antenatal training can increase confidence of breast feeding in pregnancy and provide women with sufficient knowledge about breast feeding after birth. Antenatal training may therefore be an important low-technology health promotion tool that can be provided at low costs in most settings. The antenatal training programme needs to be followed by postnatal breast-feeding support as it is not sufficient in itself to increase the duration of breast feeding or reduce breast-feeding problems.
    Full-text · Article · Oct 2011 · Midwifery
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    • "Where breastfeeding practices are suboptimal, simple one-encounter antenatal education and counseling may improve breastfeeding practice up to 3 months after delivery [9]. Provision of printed or audiovisual educational material is not enough. "
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    ABSTRACT: Antenatal counseling on breastfeeding and postnatal lactation support are likely to improve rates of exclusive breastfeeding. This descriptive study was undertaken to assess whether antenatal visits were utilized for promotion of exclusive breastfeeding in addition to the routine obstetric services. This descriptive study was conducted at a tertiary hospital in Pondicherry, India. Every third primigravida mother admitted in the maternity ward from June to December 2005 was recruited. Among these 144 primigravida mothers, 108 who had a minimum of three antenatal visits ("booked") were included in the study. These 108 mothers were administered a pre-tested semi-structured questionnaire on breastfeeding in the local language, Tamil, within 24 hours of giving birth. Appropriate flash cards with pictures were also used while administering the questionnaire. The awareness among mothers (both "counseled" and "not counseled") regarding health information pertaining to breastfeeding was assessed. Of the booked mothers, 21% (n = 23) had received some antenatal counseling about breastfeeding while 79% (n = 85) had not received any such counseling. Four percent had undergone breast examination during antenatal visits. Awareness related to breastfeeding among mothers in the "counseled" group was better than those in the "not counseled" group. Even in the "counseled" group, awareness among mothers with regard to correct breastfeeding technique and concept of continuing breastfeeding during illness in the baby was no different from those in the "not counseled" group. Existing antenatal counseling on breastfeeding is inadequate in the population studied and needs to be strengthened. Informing all pregnant women about the benefits and management of breastfeeding should be a priority during antenatal visits.
    Full-text · Article · Feb 2008 · International Breastfeeding Journal
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