title: Process-oriented training in breastfeeding for health professionals decreases women's experiences of breastfeeding challenges.
abstract: BACKGROUND
  The World Health Organization recommends promoting exclusive breastfeeding for six months. Women often end breastfeeding earlier than planned, however women who continue to breastfeed despite problems often experience good support and counselling from health professionals. The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, on women's satisfaction with breastfeeding counselling, problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months.
  
  
  METHODS
  An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. This study was conducted in Sweden, in 2000 - 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n = 540) were invited to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n = 162) started before the intervention was initiated. Data for control group B (n = 172) were collected simultaneously with the intervention group (IG) (n = 206). Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months.
  
  
  RESULTS
  Women in IG were more satisfied with the breastfeeding counselling (p = 0.008) and felt the breastfeeding counselling was more coherent (p = 0.002) compared to control groups, when exclusive breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p = 0.01).
  
  
  CONCLUSIONS
  A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in line with their planned breastfeeding duration, compared to women who had breastfeeding duration < 3 months.
  
  
  BACKGROUND
  ACTRN12611000354987.
authors.affiliation: Department of Obstetrics and Gynaecology, Eskilstuna, Mälarhospital, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Blixt
authors.affiliation: School of Health and Education, University of Skövde, Skövde, Sweden.
authors.forename: Lena B
authors.initials: LB
authors.lastname: Mårtensson
authors.affiliation: School of Health and Education, University of Skövde, Skövde, Sweden.
authors.forename: Anette C
authors.initials: AC
authors.lastname: Ekström
keywords: Breastfeeding-problems; Counselling; Health professionals; Intervention study; Process-oriented training; Support