Antenatal training to improve breast feeding: a randomised trial

Objective: to assess the effect of an antenatal training programme on knowledge, self-efficacy and problems related to breast feeding and on breast-feeding duration. Design: a randomised controlled trial. Setting: the Aarhus Midwifery Clinic, a large clinic connected to a Danish university hospital in an urban area of Denmark. Participants: a total of 1193 nulliparous women were recruited before week 21 + 6 days of gestation, 603 were randomised to the intervention group, and 590 to the reference group. Intervention: we compared a structured antenatal training programme attended in mid-pregnancy with usual practice. Measurements: data were collected through self-reported questionnaires sent to the women's e-mail addresses and analysed according to the intention to treat principle. The primary outcomes were duration of full and any breast feeding collected 6 weeks post partum (any) and 1 year post partum (full and any). Findings: no differences were found between groups according to duration of breast feeding, selfefficacy score, or breast-feeding problems, but after participation in the course in week 36 of gestation women in the intervention group reported a higher level of confidence (p = 0.05), and 6 weeks after birth they reported to have obtained sufficient knowledge about breast feeding (p = 0.02). Supplemental analysis in the intervention group revealed that women with sufficient knowledge breast fed significantly longer than women without sufficient knowledge (HR = 0.74 CI: 0.58-0.97). This association was not found in the reference group (HR = 1.12 CI: 0.89-1.41). Key conclusions and implications for practice: antenatal training can increase confidence of breast feeding in pregnancy and provide women with sufficient knowledge about breast feeding after birth. Antenatal training may therefore be an important low-technology health promotion tool that can be provided at low costs in most settings. The antenatal training programme needs to be followed by postnatal breast-feeding support as it is not sufficient in itself to increase the duration of breast feeding or reduce breast-feeding problems. (C) 2011 Elsevier Ltd. All rights reserved.