Are 2 Weeks of Daily Breastfeeding Support Insufficient to Overcome the Influences of Formula?
Received 2 April 2009; accepted 14 September 2009.
Objective
To evaluate the effectiveness of proactive telephone breastfeeding support in low-income, primiparous, primarily Latina women on 1) duration and exclusivity of breastfeeding, 2) satisfaction with feeding, 3) rationale for discontinuing breastfeeding and 4) health care utilization.
Methods
Randomized controlled trial comparing usual care to 2 weeks of daily telephone calls by nurses by using culturally informed scripted protocols; and qualitative study of focused interviews on a sample of women in the intervention group (n = 40).
Results
Breastfeeding duration and exclusivity rates, feeding method satisfaction, and reasons for stopping breastfeeding did not differ significantly between intervention (n = 161) and control (n = 180) groups, with 74% of both breastfeeding at 1 month and 28% and 37%, respectively, at 6 months. Insufficient milk supply was the main reason for stopping in both groups. Intervention infants were less likely to have a sick visit by 1 month (25%) than controls (35%, P = .05). Qualitative interviews revealed that the intervention was informative and helpful, with breastfeeding reported as healthier but harder; formula was a good alternative. Intervention mothers reporting ≤2 supplemental formula feedings on day 4 were more likely than mothers reporting ≥3 supplemental feedings to breastfeed at 1 month (odds ratio 7.7; 95% confidence interval 2.4–24.3).
Conclusions
Two weeks of daily telephone support did not increase breastfeeding duration but was associated with a decrease in sick visits in the first month. Early supplementation and the perception of formula as a good alternative to dealing with the breastfeeding difficulties appeared to be factors in failure of the intervention.
Departments of Pediatrics (Drs Bunik, O'Connor, and Kempe), Preventive Medicine and Biometrics (Dr Crane), and the Colorado Health Outcomes Program (Ms Shobe and Ms Beaty), University of Colorado Denver, Aurora, Colo; the Children's Outcomes Research Program (Drs Bunik, Crane, and Kempe, and Ms Shobe), The Children's Hospital, Aurora, Colo; and Department of Pediatrics (Dr O'Connor and Dr Langendoerfer), Denver Health Medical Center, Denver, Colo
Address correspondence to Maya Bunik, MD, MSPH, Department of Pediatrics, The Children's Hospital, 13123 E 16th Ave, B032, Aurora, Colorado 80045.
ABSTRACT