Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding.(Primary care)

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.

Introduction

Breast feeding makes an important contribution to the health of mothers and babies, but in the United Kingdom only 69% of infants born in 2000 were initially breast fed. (1 2) By four months, only 28% were still given any breast milk, even though most of the mothers would have preferred to continue. (2)

Several strategies have been used to promote breast feeding, such as setting standards for maternity services (for example, the joint World Health Organization and Unicef baby friendly hospital initiative), public education through media campaigns, and peer led initiatives to support individual mothers. (3-5) Voluntary organisations such as the National Childbirth Trust, Breastfeeding Network, and La Leche League have long played a part in supporting women. In 2000 they helped 8% of mothers in the United Kingdom. (2) We investigated whether offering voluntary support to all women considering breast feeding would increase the duration of any breast feeding, and their satisfaction with doing so.

Methods

Women were recruited during antenatal care at one of 32 general practices in London and south Essex. Recruitment was between April 1995 and August 1998. Inclusion criteria were considering breast feeding, and not having breast fed a previous child for six weeks (women who do are likely to breast feed again). We excluded those who had planned to contact a counsellor anyway, on ethical grounds; when it was potentially unsafe for home visits; and when women delivered before 36 weeks' gestation.

Women were randomised to counselling or to usual care. Overall, 28 accredited …