A randomized controlled trial of a professional breastfeeding support intervention to increase the exclusivity and duration of breastfeeding

Breastmilk is the most natural and complete nutrition for infants, and breastfeeding incurs numerous benefits for both infants and mothers. The World Health Organization recommends that mothers exclusively breastfeed their infants for six months and continue breastfeeding for up to two years of age and beyond. More than 80% of Hong Kong mothers now initiate breastfeeding. However, overall breastfeeding duration remains short and rates of exclusive breastfeeding are low. Premature weaning is influenced by multiple factors, and mothers require additional support from healthcare professionals to overcome various lactation difficulties in the early postpartum period. This study aimed to evaluate the effect of two postnatal professional support interventions on the duration of any and exclusive breastfeeding. We conducted a cluster randomized controlled trial to evaluate the efficacy of in-hospital support and post-discharge telephone support on breastfeeding outcomes among first-time mothers in Hong Kong. Seven hundred and twenty two mother-infant pairs with uncomplicated, full-term pregnancies were recruited from the postnatal units of three large public hospitals. With the hospital as the unit of randomization, participants were allocated to standard care (n=263), in-hospital support (n=191), or post-discharge telephone support (n=268). Mothers in the in-hospital group were given three individualized breastfeeding support sessions during the postnatal hospitalization, with two sessions given in first 24 hours after birth and one the following day, providing lactation knowledge and instructions on breastfeeding techniques. Participants in the telephone group were provided with weekly 30-minute breastfeeding counseling and support sessions for the first four weeks after delivery, with first contact initiated within 72 hours after discharge. The primary study outcomes were the prevalence of any and exclusive breastfeeding at one, two and three months postpartum. Seven hundred (97%) participants completed the six-month follow-up, while eleven had partial follow-up and eleven could not be contacted. The rates of any and exclusive breastfeeding were higher among participants in the two intervention groups at all follow-up points when compared with those who received standard care. Participants receiving the telephone support were significantly more likely to continue any breastfeeding at one month (76.2% vs. 67.3%; OR=1.63, 95% CI 1.10-2.41) and two months (58.6% vs. 48.9%; OR=1.48, 95% CI 1.04-2.10), and to be exclusively breastfeeding at one month (28.4% vs. 16.9%; OR=1.90, 95% CI 1.24-2.91). Participants in the in-hospital support group were also more likely to be breastfeeding at all time points in the first six months but the effect was not statistically significant. Early professional breastfeeding support, especially weekly telephone counseling, significantly increased the rates of any and exclusive breastfeeding in the early postpartum period and significantly increased overall breastfeeding duration in the first six months among first-time mothers. Additional postnatal professional support when given to breastfeeding mothers on a one-to-one basis can improve breastfeeding outcomes. While hospital practices need to be strengthened to further promote and support breastfeeding, more well-designed trials are required to determine the most effective mode and intensity of intervention that improves the longer-term breastfeeding rates.published_or_final_versionNursing StudiesDoctoralDoctor of Nursin