Are 2 weeks of daily breastfeeding support insufficient to overcome the influences of formula?
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 < or =2 supplemental formula feedings on day 4 were more likely than mothers reporting > or =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.
Departments of Pediatrics, University of Colorado Denver, Aurora, USA. Bunik.maya@tchden.org
Maya
M
Bunik
Patricia
P
Shobe
Mary E
ME
O'Connor
Brenda
B
Beaty
Sharon
S
Langendoerfer
Lori
L
Crane
Allison
A
Kempe
D000328:Adult; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data*; D003120:Colorado; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007231:Infant, Newborn; D007407:Interviews as Topic; D016015:Logistic Models; D009035:Mothers / Q000523:psychology; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data; D012944:Social Support; D013689:Telephone; D013997:Time Factors; D055815:Young Adult