Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial

doi:10.1136/bmj.b131

Published 30 January 2009, doi:10.1136/bmj.b131
Cite this as: BMJ 2009;338:b131

Research

Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial

Christine MacArthur, professor¹, Kate Jolly, senior lecturer¹, Lucy Ingram, research midwife¹, Nick Freemantle, professor¹, Cindy-Lee Dennis, associate professor², Ros Hamburger, consultant in dental public health³, Julia Brown, breastfeeding coordinator³, Jackie Chambers, director of public health³, Khalid Khan, professor⁴

¹ School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, ² University of Toronto, Canada, ³ Heart of Birmingham Teaching Primary Care Trust, Birmingham, ⁴ School of Clinical and Experimental Medicine, University of Birmingham, and Birmingham Women’s Hospital

Correspondence to: K Jolly c.b.jolly{at}bham.ac.uk

Objective To assess the effectiveness of an antenatal serviceusing community based breastfeeding peer support workers oninitiation of breast feeding.

Design Cluster randomised controlled trial.

Setting Community antenatal clinics in one primary care trustin a multiethnic, deprived population.

Participants 66 antenatal clinics with 2511 pregnant women:33 clinics including 1140 women were randomised to receive thepeer support worker service and 33 clinics including 1371 womenwere randomised to receive standard care.

Intervention An antenatal peer support worker service plannedto comprise a minimum of two contacts with women to provideadvice, information, and support from approximately 24 weeks’gestation within the antenatal clinic or at home. The trainedpeer support workers were of similar ethnic and sociodemographicbackgrounds to their clinic population.

Main outcome measure Initiation of breast feeding obtained fromcomputerised maternity records of the hospitals where womenfrom the primary care trust delivered.

Results The sample was multiethnic, with only 9.4% of womenbeing white British, and 70% were in the lowest 10th for deprivation.Most of the contacts with peer support workers took place inthe antenatal clinics. Data on initiation of breast feedingwere obtained for 2398 of 2511 (95.5%) women (1083/1140 interventionand 1315/1371 controls). The groups did not differ for initiationof breast feeding: 69.0% (747/1083) in the intervention groupand 68.1% (896/1315) in the control groups; cluster adjustedodds ratio 1.11 (95% confidence interval 0.87 to 1.43). Ethnicity,parity, and mode of delivery independently predicted initiationof breast feeding, but randomisation to the peer support workerservice did not.

Conclusion A universal service for initiation of breast feedingusing peer support workers provided within antenatal clinicsserving a multiethnic, deprived population was ineffective inincreasing initiation rates.

Trial registration Current Controlled Trials ISRCTN16126175 [controlled-trials.com] .

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to StumbleUpon StumbleUpon Add to Technorati Technorati What's this?

Relevant Articles

What factors predict differences in infant and perinatal mortality in primary care trusts in England? A prognostic model: Nick Freemantle, J Wood, C Griffin, P Gill, M J Calvert, A Shankar, J Chambers, and C MacArthur
BMJ 2009 339: b2892. [Abstract] [Full Text] [PDF]

Experience of a new mum: Eleanor J Midgley
BMJ 2009 338: b857. [Extract] [Full Text]

What do people think about breasts and breast feeding?: Edward Lavender
BMJ 2009 338: b858. [Extract] [Full Text]

Promoting breast feeding in the community: Adriano Cattaneo
BMJ 2009 338: a2657. [Extract] [Full Text]

This article has been cited by other articles:

Freemantle, N., Wood, J, Griffin, C, Gill, P, Calvert, M J, Shankar, A, Chambers, J, MacArthur, C (2009). What factors predict differences in infant and perinatal mortality in primary care trusts in England? A prognostic model. BMJ 339: b2892-b2892 [Abstract] [Full text]
Midgley, E. J (2009). Experience of a new mum. BMJ 338: b857-b857 [Full text]
Lavender, E. (2009). What do people think about breasts and breast feeding?. BMJ 338: b858-b858 [Full text]
Cattaneo, A. (2009). Promoting breast feeding in the community. BMJ 338: a2657-a2657 [Full text]

Rapid Responses:

Read all Rapid Responses

Experience of a New Mum: Eleanor J Midgley
bmj.com, 14 Feb 2009 [Full text]
Effect of peer support service on the fall in intended method of feeding: S A Deshpande
bmj.com, 14 Feb 2009 [Full text]