Abstract
BackgroundInternational studies suggest that breastfeeding interventions in primary care are more effective than usual care in increasing short and long term breastfeeding rates. Interventions that combine pre- and postnatal components have larger effects than either alone, and those that including lay support in a multicomponent intervention may be more beneficial. Despite the mixed reports of the effectiveness of breastfeeding peer support in the UK, targeted peer support services are being established in many areas of the UK. In 2010, NHS Bristol Primary Care Trust commissioned a targeted breastfeeding peer support service for mothers in 12 lower socio-economic areas of the city, with one antenatal visit and postnatal contact for up to 2 weeks.MethodsMothers receiving the peer support service were invited to complete an on-line survey covering infant feeding; breastfeeding support; and confidence in breastfeeding (using the Breastfeeding Self-Efficacy Scale). Semi-structured interviews and a focus group explored perceptions of mothers, midwives and peer supporters. The effects of the service on breastfeeding rates were documented and compared.Results163 mothers completed the on-line survey; 25 participants were interviewed (14 mothers, 7 peer supporters and 4 maternity health professionals); exclusive and total breastfeeding rates for initiation and at 8 weeks were compared for 12 months before and after the service started.The targeted peer support service was associated with small non-significant increases in breastfeeding rates, (particularly exclusive breastfeeding), compared to the rest of the city. The service was very positively evaluated by mothers, health professionals and peer supporters. Mothers felt that peer support increased their confidence to breastfeed; peer supporters found the contacts rewarding, enjoyable and important for mothers; midwives and maternity support workers were positive about the continuity of an antenatal visit and postnatal support from the same local supporter.ConclusionsThe introduction of a targeted peer support service was associated with psycho-social benefits for mothers, health professionals and peer supporters. Continuity of peer support with an antenatal visit and postnatal support from the same local supporter was also thought to be beneficial.
Highlights
International studies suggest that breastfeeding interventions in primary care are more effective than usual care in increasing short and long term breastfeeding rates
Most of the mothers (93%) lived with a partner and 11 were single parents; for 66% of the mothers this was their first baby and 53% of the babies were boys. All those completing the survey started breastfeeding; 62% (101) were still exclusively breastfeeding when they completed the survey and a further 21% (35) were mixed feeding. 42% of mothers reported that their partners had been most helpful in supporting breastfeeding, 29% felt that the peer supporter had helped them most, 15% mentioned their midwife and some said that it was a combination of all three with the local breastfeeding counsellors involved
This study has shown that the introduction of a targeted peer support service was associated with psycho-social benefits as outlined in the positive evaluation of the service by mothers, health professionals and peer supporters
Summary
International studies suggest that breastfeeding interventions in primary care are more effective than usual care in increasing short and long term breastfeeding rates. A systematic review of international studies of breastfeeding interventions in primary care reported that they are more effective than usual care (without such interventions) in increasing short and long term breastfeeding rates [1]. Interventions that combined pre- and postnatal components had a larger effect than either alone, and those that included lay support (such as peer support) in a multicomponent intervention may be more beneficial. Hoddinott [7] in an evidence synthesis of nine UK randomised trials of breastfeeding interventions explored these issues and has highlighted the complex nature of the interventions, the importance of the context in which an intervention is delivered, the choice of intervention, and the nature of the behaviour change involved All these factors can contribute to an apparent absence of the effect of an intervention
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