Abstract
BackgroundWhile Australia has high breastfeeding initiation, there is a sharp decline in the first weeks postpartum and this continues throughout the first year. Supporting breastfeeding In Local Communities (SILC) was a three-arm cluster randomised controlled trial to determine whether early home-based breastfeeding support by a maternal and child health nurse (SILC-MCHN), with or without access to a community-based breastfeeding drop-in centre, increased the proportion of infants receiving any breast milk at three, four and six months. The trial was conducted in ten Local Government Areas (LGAs) in Victoria, Australia.The primary aim of this paper is to describe the three drop-in centres established during the trial; and the profile of women who accessed them. The secondary aim is to explore the views and experiences of the drop-in centre staff, and the challenges faced in establishing and maintaining a breastfeeding drop-in centre in the community.MethodsEvaluation of the three LGAs with drop-in centres was multifaceted and included observational visits and field notes; data collected from attendance log books from each drop-in centre; a written survey and focus groups with maternal and child health (MCH) nurses who ran the drop-in centres; and semi-structured interviews with MCH coordinators of the participating LGAs.ResultsThe three LGAs developed and ran different models of breastfeeding drop-in centres. They reported challenges in finding convenient, accessible locations. Overall, attendance was lower than expected, with an average of only one attendee per session. Two global themes were identified regarding staff views: implementation challenges, encompassing finding accessible, available space, recruiting volunteers to provide peer support, and frustration when women did not attend; and the work of SILC-MCHNs, including themes of satisfying and rewarding work, juggling roles, and benefits to women, babies and the community.ConclusionProviding community-based breastfeeding support was satisfying for the drop-in centre staff but proved difficult to implement, reflected by the lower than anticipated attendances at all of the drop-in centres. Interventions to increase breastfeeding in complex community settings require sufficient time to build partnerships with the existing services and the target population; to understand when and how to offer interventions for optimum benefit.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611000898954.
Highlights
While Australia has high breastfeeding initiation, there is a sharp decline in the first weeks postpartum and this continues throughout the first year
Description of drop-in centres Local Government Areas (LGAs) A is located in regional Victoria, with 1300 births registered in the LGA per year [44]
At the time the Supporting breastfeeding In Local Communities (SILC) study commenced, the LGA had been awarded government funding to establish a service aimed at parenting support more broadly, not solely focussed on breastfeeding, and a local decision was made to combine this funding with the allocated SILC trial funds and establish a parenting drop-in centre (Fig. 1)
Summary
While Australia has high breastfeeding initiation, there is a sharp decline in the first weeks postpartum and this continues throughout the first year. Supporting breastfeeding In Local Communities (SILC) was a three-arm cluster randomised controlled trial to determine whether early home-based breastfeeding support by a maternal and child health nurse (SILC-MCHN), with or without access to a community-based breastfeeding drop-in centre, increased the proportion of infants receiving any breast milk at three, four and six months. LGAs that had a lower than average rate of women providing any breast milk to their infants at discharge from hospital, with greater than 450 births per year, and that agreed to participate, were randomly allocated to one of three trial arms: 1) standard care (comparison arm); 2) home-based breastfeeding support (home visits, HV); or 3) homebased breastfeeding support plus access to a communitybased breastfeeding drop-in centre (HV plus drop-in centre). Further details of the recruitment and randomisation process can be found in the SILC trial protocol [5]
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