title: A Randomized Controlled Trial of Innovative Postpartum Care Model for Mother-Baby Dyads.
abstract: OBJECTIVE
  To evaluate the efficacy, safety, and maternal satisfaction of a newly established integrative postpartum community-based clinic providing comprehensive support for mothers during the first month after discharge from the hospital. Our primary interests were breastfeeding rates, readmission and patient satisfaction.
  
  
  METHODS
  A randomized controlled trial was conducted in Ottawa, Canada, where 472 mothers were randomized via a 1:2 ratio to either receive standard of care (n = 157) or to attend the postpartum breastfeeding clinic (n = 315). Outcome data were captured through questionnaires completed by the participants at 2, 4, 12 and 24 weeks postpartum. Unadjusted and adjusted logistic regression models were conducted to determine the effect of the intervention on exclusive breastfeeding at 12 weeks (primary outcome). Secondary outcomes included breastfeeding rate at 2, 4 and 24 weeks, breastfeeding self-efficacy scale, readmission rate, and satisfaction score.
  
  
  RESULTS
  More mothers in the intervention group (n = 195, 66.1%) were exclusively breastfeeding at 12 weeks compared to mothers in the control group (n = 81, 60.5%), however no statistically significant difference was observed (OR = 1.28; 95% CI:0.84-1.95)). The rate of emergency room visits at 2 weeks for the intervention group was 11.4% compared to the standard of care group (15.2%) (OR = 0.69; 95% CI: 0.39-1.23). The intervention group was significantly more satisfied with the overall care they received for breastfeeding compared to the control group (OR = 1.96; 95% CI: 3.50-6.88)).
  
  
  CONCLUSIONS
  This new model of care did not significantly increase exclusive breastfeeding at 12 weeks. However, there were clinically meaningful improvements in the rate of postnatal problems and satisfaction that support this new service delivery model for postpartum care. A community-based multidisciplinary postpartum clinic is feasible to implement and can provide appropriate and highly satisfactory care to mother-baby dyads. This model of care may be more beneficial in a population that is not already predisposed to breastfeed.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02043119.
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Corinne
authors.initials: C
authors.lastname: Laliberté
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.|Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Dunn
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.|Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pound
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Sourial
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.|Better Outcomes Registry & Network Ontario, Ottawa, Ontario, Canada.
authors.forename: Abdool S
authors.initials: AS
authors.lastname: Yasseen
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Millar
authors.affiliation: Obstetrics and Maternal Newborn Investigations, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Rennicks White
authors.affiliation: Obstetrics and Maternal Newborn Investigations, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Walker
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.|Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lacaze-Masmonteil
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology; D002170:Canada; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009035:Mothers / Q000523:psychology*; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000458:organization & administration / Q000523:psychology*; D049590:Postpartum Period; D011795:Surveys and Questionnaires