Effect of a peer support service on breast-feeding continuation in the UK: a randomised controlled trial.

OBJECTIVE: to assess the effectiveness of a peer support worker (PSW) service on breast-feeding continuation. DESIGN: cluster randomised controlled trial (ISRCTN16126175). SETTING: Primary Care Trust, UK serving a multi-ethnic, socio-economically disadvantaged population. PARTICIPANTS: 2,724 women giving birth following antenatal care from 66 clinics: 33 clinics (1,267 women) randomised to the PSW service and 33 clinics (1,457 women) to usual care. 848 women consented to additional follow-up by questionnaire at 6 months. INTERVENTION: PSW service provided in the antenatal and postnatal period. MEASUREMENTS: any and exclusive breast feeding at 10-14 days obtained from routine computerised records and at 6 weeks and 6 months from a questionnaire. FINDINGS: follow-up: 94% at 10-14 days, 67.5% at 6 months. There was no difference in any breast feeding at 10-14 days between intervention and usual care, odds ratio (OR) 1.07 (95% CI 0.87-1.31, p=0.54). Proportion of women reporting any breast feeding in the intervention group at 6 weeks was 62.7% and 64.5% in the usual care group OR 0.93 (95% CI 0.64-1.35); and at 6 months was 34.3% and 38.9%, respectively, OR 1.06 (95% CI 0.71-1.58). KEY CONCLUSIONS: universal antenatal peer support and postnatal peer support for women who initiated breast feeding did not improve breast-feeding rates up to 6 months in this UK population. IMPLICATIONS FOR PRACTICE: with high levels of professional support part of usual maternity care it may not be possible for low intensity peer support to produce additional benefit. More intensive or targeted programmes might be effective, but should have concurrent high quality evaluation.

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

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.