Testing the effectiveness of a motivational program to sustain breastfeeding behaviour

Abstract: Background: Babies, women and society benefit nutritionally, psychologically and economically by breastfeeding. As a result the WHO challenges health professionals to achieve higher rates of breastfeeding. Initiation rates are increasing, but motivating women to sustain breastfeeding remains equivocal (Infant Feeding Survey 2005, European Commission 2004). Aims: To examine the effect of a new motivation programme on women’s breastfeeding behaviour, a randomised control trial was completed, comparing motivationally-enhanced breastfeeding instruction by midwives with current best practice (BFI, 1998). Methods: Following a literature review, an experiment was designed and subject to Research Governance and Ethics approval. Primigravida women were recruited at their 20 week antenatal appointment and written consent obtained. Women were randomised to receive the motivationally enhanced instruction or current best practice. Midwives supporting the experimental group attended a one-day training course. Women’s motivation to breastfeed was measured prior to discharge from hospital by structured interview. Follow-up telephone calls determined duration of breastfeeding. Results: 181 women were recruited. With attrition, analysis was performed on an intention to treat basis using Chi Squares. No significant difference in the initiation rates was noted. On discharge from hospital more intervention cases (44) were breastfeeding than controls (33), p<0.01. Persistence at 3-4 weeks was noted in 36 intervention cases (15 controls), p<0.001. Independent t-tests verified the differences in duration of the 69 intervention cases that commenced breastfeeding (75 controls). The differences in motivation to breastfeed were explained in part by the uptake of relevant breastfeeding instruction (p<0.001) and increased maternal confidence (p<0.01). Discussion and Conclusions: Breastfeeding is a complex activity with many benefits and influences. As motivational enhancement of routine instruction has a positive effect on breastfeeding duration, further research is required to establish effectiveness in different cultural settings. Funded by Research & Development Office for Northern Ireland Trial Registration: ISRCTN 47056748 Recommended reading: Baby Friendly Initiative (1998) Implementing the Ten Steps to Successful Breastfeeding – A Guide for UK Maternity Service Providers Working Towards Baby Friendly Accreditation U.K. Committee for UNICEF London http: //www.babyfriendly.org.uk/ guid-ant.htm European Commission (2004) Protection, Promotion and Support of Breastfeeding in Europe: A Blueprint for Action: www.epha.org/a/1301 Infant Feeding Survey (2005) Office of National Statistics http: //www.ic.nhs.uk/pubs/breastfeed