Research

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

BMJ 2009; 338 doi: 10.1136/bmj.b131 (Published 30 January 2009)
Cite this as: BMJ 2009;338:b131
  1. Christine MacArthur, professor1,
  2. Kate Jolly, senior lecturer1,
  3. Lucy Ingram, research midwife1,
  4. Nick Freemantle, professor1,
  5. Cindy-Lee Dennis, associate professor2,
  6. Ros Hamburger, consultant in dental public health3,
  7. Julia Brown, breastfeeding coordinator3,
  8. Jackie Chambers, director of public health3,
  9. Khalid Khan, professor4
  1. 1School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT
  2. 2University of Toronto, Canada
  3. 3Heart of Birmingham Teaching Primary Care Trust, Birmingham
  4. 4School of Clinical and Experimental Medicine, University of Birmingham, and Birmingham Women’s Hospital
  1. Correspondence to: K Jolly c.b.jolly{at}bham.ac.uk
  • Accepted 1 November 2008

Abstract

Objective To assess the effectiveness of an antenatal service using community based breastfeeding peer support workers on initiation of breast feeding.

Design Cluster randomised controlled trial.

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

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

Intervention An antenatal peer support worker service planned to comprise a minimum of two contacts with women to provide advice, information, and support from approximately 24 weeks’ gestation within the antenatal clinic or at home. The trained peer support workers were of similar ethnic and sociodemographic backgrounds to their clinic population.

Main outcome measure Initiation of breast feeding obtained from computerised maternity records of the hospitals where women from the primary care trust delivered.

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

Conclusion A universal service for initiation of breast feeding using peer support workers provided within antenatal clinics serving a multiethnic, deprived population was ineffective in increasing initiation rates.

Trial registration Current Controlled Trials ISRCTN16126175.

Footnotes

  • Contributors: CMacA, KJ, NF, C-LD, JC, and KK designed the study. CMacA, KJ, and LI coordinated the day to day management of the trial. NF was the trial statistician. CMacA, KJ, LI, RH, JB, and KK sat on a trial management committee. CMacA, KJ, LI, NF, C-LD, JB, and KK formed the trial steering committee. CMacA drafted the manuscript and all authors commented on the manuscript and approved the final draft. CMacA is the guarantor. The funding body was not involved in the study design, collection, analysis, or interpretation of the data. RH, JB, and JC contributed to the writing of the paper.

  • Funding: Heart of Birmingham Teaching Primary Care Trust.

  • Competing interests: RH, JB, JC are from the Heart of Birmingham Primary Care Trust and were involved in the employment and management of the peer support workers.

  • Ethical approval: Not required.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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