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Are 2 Weeks of Daily Breastfeeding Support Insufficient to Overcome the Influences of Formula?

  • Maya Bunik
    Correspondence
    Address correspondence to Maya Bunik, MD, MSPH, Department of Pediatrics, The Children's Hospital, 13123 E 16th Ave, B032, Aurora, Colorado 80045.
    Affiliations
    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
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  • Patricia Shobe
    Affiliations
    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
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  • Mary E. O'Connor
    Affiliations
    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
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  • Brenda Beaty
    Affiliations
    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
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  • Sharon Langendoerfer
    Affiliations
    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
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  • Lori Crane
    Affiliations
    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
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  • Allison Kempe
    Affiliations
    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
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      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.

      Key Words

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      References

        • US Department of Health and Human Services
        Healthy People 2010.
        US Department of Health and Human Services, Washington, DC2000
        • Zimmerman D.R.
        • Guttman N.
        “Breast is best”: knowledge among low-income mothers is not enough.
        J Hum Lact. 2001; 17: 14-19
      1. Centers for Disease Control and Prevention. Breastfeeding practices—results from the National Immunization Survey. 2008. Available at: http://www.cdc.gov/breastfeeding/data/NIS_data/. Accessed May 20, 2008.

        • Lu M.C.
        • Lange L.
        • Slusser W.
        • et al.
        Provider encouragement of breast-feeding: evidence from a national survey.
        Obstet Gynecol. 2001; 97: 290-295
        • Feinberg A.N.
        • Hicks W.B.
        Patient compliance with the first newborn visit appointment.
        J Perinatol. 2003; 23: 37-40
        • Li R.
        • Rock V.J.
        • Grummer-Strawn L.
        Changes in public attitudes toward breastfeeding in the United States, 1999–2003.
        J Am Diet Assoc. 2007; 107: 122-127
        • Pisacane A.
        • Continisio G.I.
        • Aldinucci M.
        • et al.
        A controlled trial of the father's role in breastfeeding promotion.
        Pediatrics. 2005; 116: e494-e498
        • Pugh L.C.
        • Milligan R.A.
        • Frick K.D.
        • et al.
        Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women.
        Birth. 2002; 29: 95-100
        • Dennis C.L.
        Breastfeeding peer support: maternal and volunteer perceptions from a randomized controlled trial.
        Birth. 2002; 29: 169-176
        • Chapman D.J.
        • Damio G.
        • Young S.
        • et al.
        Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial.
        Arch Pediatr Adolesc Med. 2004; 158: 897-902
        • Anderson A.K.
        • Damio G.
        • Young S.
        • et al.
        A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community.
        Arch Pediatr Adolesc Med. 2005; 159: 836-841
        • Macleod Z.R.
        • Charles M.A.
        • Arnaldi V.C.
        • et al.
        Telephone counseling as an adjunct to nicotine patches in smoking cessation: a randomized controlled trial.
        Med J Aust. 2003; 179: 349-352
        • Simon G.E.
        • VonKorff M.
        • Rutter C.
        • et al.
        Randomized trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care.
        BMJ. 2000; 320: 550-554
        • Dennis C.L.
        • Kingston D.
        A systematic review of telephone support for women during pregnancy and the early postpartum period.
        J Obstet Gynecol Neonatal Nurs. 2008; 37: 310-314
        • SAS for Windows
        Version 9.1 [computer program].
        SAS Institute Inc, Cary, NC2003
        • Bunik M.
        • Clark L.
        • Zimmer L.M.
        • et al.
        Early infant feeding decisions in low-income Latinas.
        Breastfeed Med. 2006; 1: 225-235
        • Seacat J.
        • Neifert M.
        • DeMarzo S.
        Findings from a self-administered screening form to assess the onset of breast-feeding.
        Am J Dis Child. 1989; 143: 428
        • World Health Organization
        Indications for Assessing Breastfeeding Practices.
        World Health Organization, Geneva, Switzerland1991 (Document WHO/CDD/SER/91.14)
        • Dennis C.L.
        The breastfeeding self-efficacy scale: psychometric assessment of the short form.
        J Obstet Gynecol Neonatal Nurs. 2003; 32: 734-744
        • Thorne S.
        Interpretive Description.
        Left Coast Press, Walnut Creek, Calif2008
        • Gray-Donald K.
        • Kramer M.S.
        • Munday S.
        • et al.
        Effect of formula supplementation in the hospital on the duration of breast-feeding: a controlled clinical trial.
        Pediatrics. 1985; 75: 514-518
        • Kurinij N.
        • Shiono P.H.
        Early formula supplementation of breast-feeding.
        Pediatrics. 1991; 88: 745-750
        • Philipp B.L.
        Every call is an opportunity. Supporting breastfeeding mothers over the telephone.
        Pediatr Clin North Am. 2001; 48: 525-532
        • Parrilla-Rodriguez A.M.
        • Davila T.R.
        • Gorrin-Peralta J.J.
        Profile of calls to a breastfeeding clinic information and help telephone line.
        P R Health Sci J. 2001; 20: 377-381
        • Steel O'Connor K.O.
        • Mowat D.L.
        • Scott H.M.
        • et al.
        A randomized trial of two public health nurse follow-up programs after early obstetrical discharge: an examination of breastfeeding rates, maternal confidence and utilization and costs of health services.
        Can J Public Health. 2003; 94: 98-103
        • Frank D.A.
        • Wirtz S.J.
        • Sorenson J.R.
        • et al.
        Duration of breastfeeding among low-income women: A randomized trial of effects of hospital discharge packs and hospital based telephone counseling.
        Am J Dis Child. 1986; 140: 311
        • Zimmerman D.R.
        You can make a difference: increasing breastfeeding rates in an inner-city clinic.
        J Hum Lact. 1999; 15: 217-220
        • Petrova A.
        • Hegyi T.
        • Mehta R.
        Maternal race/ethnicity and one-month exclusive breastfeeding in association with the in-hospital feeding modality.
        Breastfeed Med. 2007; 2: 92-98
        • Rassin D.K.
        • Markides K.S.
        • Baranowski T.
        • et al.
        Acculturation and the initiation of breastfeeding.
        J Clin Epidemiol. 1994; 47: 739-746
        • Denman-Vitale S.
        • Murillo E.K.
        Effective promotion of breastfeeding among Latin American women newly immigrated to the United States.
        Holist Nurs Pract. 1999; 13: 51-60
        • Ahluwalia I.B.
        • Morrow B.
        • Hsia J.
        Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System.
        Pediatrics. 2005; 116: 1408-1412
        • Donnelly A.
        • Snowden H.M.
        • Renfrew M.J.
        • Woolridge M.W.
        Commercial hospital discharge packs for breastfeeding women.
        Cochrane Database Syst Rev. 2007; (CD002075)
        • Loughlin H.H.
        • Clapp-Channing N.E.
        • Gehlbach S.H.
        • et al.
        Early termination of breast-feeding: identifying those at risk.
        Pediatrics. 1985; 75: 508-513
        • Sievers E.
        • Clausen U.
        • Oldigs H.D.
        • et al.
        Supplemental feeding in the first days of life—effects on the recipient infant.
        Ann Nutr Metab. 2002; 46: 62-67