Effect of a peer support service on breast-feeding continuation in the UK: A randomised controlled trial

Objective

to assess the effectiveness of a peer support worker (PSW) service on breast-feeding continuation.

Design

cluster randomised controlled trial (ISRCTN16126175).

Setting

Primary Care Trust, UK serving a multi-ethnic, socio-economically disadvantaged population.

Participants

2,724 women giving birth following antenatal care from 66 clinics: 33 clinics (1,267 women) randomised to the PSW service and 33 clinics (1,457 women) to usual care. 848 women consented to additional follow-up by questionnaire at 6 months.

Intervention

PSW service provided in the antenatal and postnatal period.

Measurements

any and exclusive breast feeding at 10–14 days obtained from routine computerised records and at 6 weeks and 6 months from a questionnaire.

Findings

follow-up: 94% at 10–14 days, 67.5% at 6 months. There was no difference in any breast feeding at 10–14 days between intervention and usual care, odds ratio (OR) 1.07 (95% CI 0.87–1.31, p=0.54). Proportion of women reporting any breast feeding in the intervention group at 6 weeks was 62.7% and 64.5% in the usual care group OR 0.93 (95% CI 0.64–1.35); and at 6 months was 34.3% and 38.9%, respectively, OR 1.06 (95% CI 0.71–1.58).

Key conclusions

universal antenatal peer support and postnatal peer support for women who initiated breast feeding did not improve breast-feeding rates up to 6 months in this UK population.

Implications for practice

with high levels of professional support part of usual maternity care it may not be possible for low intensity peer support to produce additional benefit. More intensive or targeted programmes might be effective, but should have concurrent high quality evaluation.     

Notes from a support group for women over 40 trying to have their first child

This paper is about a support group in the USA for women over 40 years of age with fertility problems who were attempting to have their first child, which was run by a therapist with fertility problems herself. Some of us had had abortions in the past, with varying levels of regret about them; others of us had never had evidence of our fertility. Some had tried assisted conception techniques; all of us had experienced medical or financial obstacles. Given our ages, use of donor eggs was the only way most of us could have achieved our own pregnancies. This paper is about how we confronted infertility individually and as a group and came to terms with the fact that although technology gives hope, hope is not always realistic.     

An evaluation of economics and acceptability of screening for Chlamydia trachomatis infection, in women attending antenatal, abortion, colposcopy and family planning clinics in Scotland, UK

OBJECTIVE: The aims of this study were to determine cost effectiveness of screening for Chlamydia trachomatis in hospital-based antenatal and gynaecology clinics, and community-based family planning clinics. Additionally, women's views of screening were determined in the hospital-based clinics. DESIGN: Cost effectiveness based on decision model. Model probabilities were generated for a hypothetical sample of 250 women in each age group in each setting, based on prevalence studies, published data and expert opinion. A prospective observational study was used to generate data on prevalence and acceptability. SETTING: Antenatal, gynaecology and family planning clinics in Aberdeen, Edinburgh and Glasgow. SAMPLE: Prevalence was estimated in 2817 women. Acceptability was determined in 484 women. METHODS: An economic evaluation was performed using prevalence data from this and a previous study, and using outcome data from the literature and observational work. Incremental cost effectiveness ratios were estimated for each age group and clinical setting. Sensitivity analyses were performed to determine the robustness of incremental cost effectiveness ratios to changes in the incidence of long term sequelae and costs. The prevalence of infection was determined by nucleic acid amplification of urine samples or endocervical swabs. Knowledge of C. trachomatis and women's views of screening were determined using structured questionnaires. MAIN OUTCOME MEASURES: Direct health service costs of screening, incidence and costs associated with adverse sequelae, women's views of screening and prevalence of infection. RESULTS: The estimated cost of screening 250 women in each age group in each the four sample populations (total population of 3750) is 49,367 UK pounds, while preventing 64 major sequelae. This represents a net cost of 771.36 UK pounds in preventing one major sequela. Selective screening of all women under 20 years and all patients attending abortion clinics were shown to be the most cost effective strategies. These results were relatively insensitive to changes in estimated parameters, such as uptake rate, probabilities and unit costs of all major sequelae averted. Prevalence (95% CI) of infection in the highest risk groups (those aged under 20 in both antenatal and abortion clinics) was 12.1% (8.6-16.7) and 12.7% (7.3-21.2), respectively. The majority (>95%) of women agreed with a policy of regular screening for C. trachomatis, and screening in the settings employed in this study was largely acceptable. CONCLUSIONS: A single episode of screening for C. trachomatis does not result in net cost savings. Currently recommended strategies of screening for C. trachomatis in women under 25 years of age in abortion clinics are supported by our data on prevalence and acceptability. These data also suggest that hospital-based screening strategies should be further extended to include younger women attending antenatal clinics and all women of reproductive age attending colposcopy clinics.     

Incidence and duration of breast-feeding in a group of primiparae after physiological delivery

A study has been performed on the incidence and duration of breast feeding in a group of 103 primiparous women who delivered in the Obstetrics Department of Sassari in 1980. The most important maternal variables that could be related with breast feeding were maternal age, level of school education, maternal feelings concerning the present pregnancy and maternal information concerning the advantages of breast feeding.     

A survey on difficulties and desires of breast-feeding women in Wuhan,China

Objectivesexclusive breast feeding in China is relatively low and no research has been conducted to explore the difficulties and desires of Chinese lactating mothers. Currently, Chinese women turn to massage therapists to increase breastmilk volume, implying that many breast-feeding women faced problems but had few support mechanisms.This study aimed to explore the difficulties and desires of Chinese breast-feeding women and to propose strategies for increasing the rate of exclusive breast feeding.Methodsthree hundred and seventy-five primiparous women were recruited from two randomized cluster communities in Wuhan following ethical approval. Face-to-face semistructured interviews were conducted with 76 of the participants to collect data on their infants' feeding status, duration of exclusive breast feeding, reasons for stopping, difficulties encountered, and sources of support for lactation.Resultsthe breast feeding initiation rate was 93.6%, but exclusive breast feeding was only 6.2% at six months. The most frequently cited reason for giving up exclusive breast feeding was perceived breastmilk insufficiency. Women cited a desire for professional and individualised instruction from following resources: (1) lactation consultants in hospital and communities; (2) Qualified cuirushi; (3) breast feeding website;(4) Relatives, friends and peers;(5) Telephone hotline.Conclusionsto improve the rate and duration of exclusive breast feeding in China, effective and available resources must be available. Timely,professional and face-to-face lactation counselling such as lactation consultant, qualified cuirushin is needed.     

Oxytocin and prolactin levels in breast-feeding women. Correlation with milk yield and duration of breast-feeding

The aim of the present study was to examine suckling-related plasma levels of oxytocin and prolactin in early and established lactation and to correlate hormone profiles to success of lactation performance. Fifty-five primiparous women participated in the study. From each, 18 blood samples were drawn in connection with breast-feeding on day 4 post partum and after 3-4 months. Oxytocin and prolactin levels were determined with radio-immunoassay. Basal levels of both hormones were significantly higher 4 days post partum than 3-4 months later and after weaning. Basal prolactin levels fell significantly within 24 h of weaning. Oxytocin and prolactin levels rose in response to breast-feeding--an effect which persisted during the lactation period. The suckling-induced release of prolactin--but not that of oxytocin--was related to basal hormone levels. Basal as well as stimulated oxytocin levels obtained 4 days and 3-4 months post partum correlated significantly, indicating that each woman has an individual, characteristic level of this hormone. Milk yield did not correlate with oxytocin or prolactin levels, but prolactin levels recorded 3-4 months post partum did correlate with the remaining period of breast-feeding. In addition, mothers who breast-fed exclusively 3-4 months post partum had significantly higher oxytocin and prolactin levels than those who gave supplementary feed. There was a significant correlation between oxytocin levels at 4 days and birth weight of the infant.     

A systematic review of the nature of support for breast-feeding adolescent mothers

OBJECTIVE: to review the evidence on the nature of support for breast-feeding adolescent mothers. METHODS: a systematic review of relevant English-language papers was conducted using an a-priori search strategy. Agreement on final inclusion was reached by consensus across the team. The findings were tabulated and described narratively and thematically. FINDINGS: of 209 studies identified, seven fitted the inclusion criteria. The papers included in this review varied in design, quality and focus. Five types of support were identified: emotional, esteem, instrumental, informational and network. The participants in the included studies seemed to find the emotional, esteem and network components of support most helpful. Support from the participants' mothers seemed to be particularly powerful. The provision of continuity of support from an expert individual who is skilled in both lactation support and working with adolescents was also highly valued by breast-feeding adolescents. There was also evidence to suggest that targeted breast-feeding educational programmes, specifically designed for the adolescent learner, may be successful in improving breast-feeding initiation and continuation rates in this population. However, a question still arises about which elements of the complex package on offer were most effective. CONCLUSION: the studies included in the review are diverse. Although the support provided by known and trusted individuals emerges as important to the adolescents, further research is required on the specific nature of that support and the person best placed to provide it. The acceptability and feasibility of other aspects of support and modes of provision also requires additional exploration. Further qualitative and feasibility studies are therefore warranted in order to inform future randomised-controlled interventions trials.     

Factors influencing initiation of breast-feeding among urban women

The objective of our study was to identify factors associated with the initiation of breast-feeding in a poor urban area. One hundred postpartum, nonadolescent, non-drug using mothers, 50 breast-feeding and 50 formula feeding, were consecutively interviewed. Breast-feeding women were more likely to be born outside of the United States (42 versus 14%, p = 0.002), have more years of education (12.1 +/- 1.9 versus 10.9 +/- 1.7, p = 0.002), be employed either prior to or during pregnancy (38 versus 16%, p = 0.000), be married (46 versus 26%, p = 0.037), be a nonsmoker (86 versus 64%, p = 0.011), have more prenatal visits (8.4 +/- 7.3 versus 5.0 +/- 5.9, p = 0.010), or have a breast-feeding mother (48 versus 26%, p = 0.023). There were no differences in age or ethnicity. The father of the breast-feeding baby was more likely to be better educated (12.0 +/- 2.8 versus 10.5 +/- 3.6 years, p = 0.022) and to work full-time (68 versus 40%, p = 0.005). Eighty-four percent of formula feeders knew that breast milk was better for their babies but decided not to breast-feed due to concerns of pain, smoking, and work. Sixty-three percent of women made the choice to breast-feed prior to the pregnancy, 26% during the pregnancy, and 11% after delivery. Significantly more multiparas decided prior to the pregnancy compared with primaparas. We recommend that breast-feeding education should be started prior to the first pregnancy and tailored to the concerns of the women.     

乙型肝炎病毒携带者母乳喂养的研究

目的探讨乙型肝炎(乙肝)病毒(hepatitis B virus，HBV)携带者在其新生儿、婴儿接受被动及主动全程联合免疫的条件下，是否可以母乳喂养。方法对2001年9月至2003年10月间妊娠期无症状HBV携带者所娩婴儿进行前瞻性随访研究，新生儿出生时留取脐血检测HBV脱氧核糖核酸(HBV DNA)，出生后12h内及第14天注射乙肝免疫球蛋白，并按0、1、6的程序全程接种乙肝疫苗，由产妇自愿选择母乳喂养或人工喂养，55例母乳喂养，36例人工喂养。分别于婴儿7个月和12个月时随访检测HBV DNA及乙肝血清标志物，婴儿7个月时未感染乙肝但抗-HBs阴性者给予乙肝疫苗5μg加强注射。结果婴儿7个月和12月时，母乳喂养组HBV DNA阳性率分别为9．09％(5／55)及9．09％(5／55)，抗HBs阳性率分别为85．45％(47／55)及90．90％(50／55)；人工喂养组HBVDNA阳性率分别为8．33％(3／36)及8．33％(3／36)，抗HBs阳性率分别为86．11％(31／36)及91．67％(33／36)。母乳喂养与人工喂养相比，差异均无统计学意义。结论在新生儿、婴儿接受被动及主动全程联合免疫的条件下，无症状HBV携带者可以母乳喂养。     

Morphine suppresses the oxytocin response in breast-feeding women.

The activity of opiate-mediated regulatory mechanisms of oxytocin secretion during breast-feeding was studied by the administration of either morphine, naloxone or placebo to women prior to the commencement of breast-feeding. Seventeen healthy women in the first week after delivery who had established lactation were randomized to receive either intravenous morphine 5 mg (n = 6), naloxone 2.4 mg (n = 6) or a placebo, sterile water (n = 5), which was given prior to commencement of breast-feeding. Oxytocin levels were measured by radioimmunoassay prior to initiation of breast-feeding and then at 2-min intervals until the feed was complete. Breast-feeding produced a significant rise in oxytocin levels in the control and naloxone groups but no significant rise in the patients given morphine. There was a significant reduction in oxytocin response following morphine administration when compared to placebo but not between naloxone and placebo. In conclusion, oxytocin secretion to breast-feeding is inhibited by exogenous morphine when compared to a control group but the administration of naloxone did not produce a significant difference from control.     

An evaluation by focus group and survey of a course for Midwifery Ventouse Practitioners

OBJECTIVE: to evaluate the Midwifery Ventouse Practitioners' (MVPs) Course and the MVPs' perception of its effect on their practice. DESIGN: qualitative and quantitative. PARTICIPANTS: 18 midwives who had completed the MVP course at Bournemouth University 1998-2000. DATA COLLECTION: focus group (n=8) and postal questionnaire (n=18). FINDINGS: important issues were identified by the focus group and informed the development of the questionnaire which achieved a 100% response rate. The mean length of full-time experience as a midwife was 18.6 years (SD 6.8; range 9-33); 11 midwives were based in community maternity units and seven in consultant units. Seventeen of the MVPs had been called to assist 505 women in this capacity; 366 (72%) had an MVP ventouse-assisted birth, 129 (26%) a normal birth and 10 women (2%) needed obstetric assistance. In this regard, there were considerable differences between individual MVPs. The midwives gave high priority to woman-centred values and to the very judicious use of intervention. They felt that the course had increased their confidence in relation to their midwifery practice, in general, and their ability to define fetal position and station, in particular. They reported a high level of confidence when undertaking their first ventouse birth after completing the course. KEY CONCLUSIONS AND IMPLICATIONS: midwives who have undertaken this course do not appear to expand their role to the detriment of normal midwifery, as had been feared. Even highly experienced midwives value increasing their confidence in relation to vaginal and abdominal examination. Ambulance transfer in the second stage of labour was prevented for at least 109 women. A long-term clinical evaluation of the births to which an MVP has been called is needed.     

The process of implementing a community-based peer breast-feeding support programme: the Glasgow experience

AIM: to document the process of implementing and maintaining a community-based peer-support programme. DESIGN AND SETTING: a community-based study located in a socio-economically disadvantaged housing estate on the outskirts of Glasgow. PARTICIPANTS: pregnant women residing in a target postcode area. INTERVENTION: a programme of peer counselling and support for breast feeding, comprising antenatal and postnatal home visits over a period of three years. IMPLICATIONS FOR PRACTICE: peer support may provide an acceptable and appropriate role model for breast-feeding mothers. However, further research is required on other influential factors such as the social network and the impact of this programme on the peer supporter. CONCLUSIONS: despite a low prevalence of breast feeding, initiating and maintaining peer breast-feeding support was possible. Peer support appeared to be acceptable to mothers and health professionals. Study mothers spoke enthusiastically of the intervention and mentioned increased confidence and self-esteem.     

Release of vasoactive intestinal polypeptide (VIP) in breast-feeding women

Blood samples were collected in peripheral venous blood of ten postpartum women before, during and after breast-feeding. Vasoactive intestinal polypeptide (VIP) and prolactin (PRL) were measured radioimmunochemically. A parallel significant increase in the VIP and PRL concentrations was observed following breast-feeding. VIP increased from a median control value of 4.5 pmol . 1(-1) to 18 pmol . 1(-1), and PRL increased from 2.8 U . 1(-1) to 5.2 U . 1(-1). A positive but insignificant correlation between corresponding PRL and VIP values was found.     

An Australian study of midwives' breast-feeding knowledge

OBJECTIVE: To investigate midwives' breast-feeding knowledge, assess associations between knowledge and role, and report on the validity and reliability of the Breast-feeding Knowledge Questionnaire for the Australian context. DESIGN: Postal questionnaire. SETTING: National Australia. PARTICIPANTS: Midwives (n=3500) who are members of the Australian College of Midwives Inc (ACMI). FINDINGS: A response rate of 31% (n=1105) was obtained. Respondents were knowledgeable of the benefits of breast feeding and common management issues. Key areas requiring attention included management of low milk supply, immunological value of human milk, and management of a breast abscess during breast feeding. Participants over the age of 30, possessing IBCLC qualifications; having personal breast-feeding experience of more than three months; and more clinical experience achieved higher knowledge scores. Role perceptions were positive with 90% of midwives reporting being confident and effective in meeting the needs of breast-feeding women in the early postnatal period. Midwives' role perception contributed 39% of the variance in general breast-feeding knowledge scores and was a significant predictor of participants' breast-feeding knowledge. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The level of basic breast-feeding knowledge of Australian midwives was adequate but there are deficits in key areas. Knowledge variations by midwives may contribute to conflicting advice experienced by breast-feeding women. Further research is needed to investigate in-depth breast-feeding knowledge, breast-feeding promotion practices, and associations between knowledge and practice.