Antenatal education and postnatal support
improving rates of exclusive breast feeding: randomised
Lin-Lin Su, associate consultant,
Yap-Seng Chong, senior consultant, Yiong-Huak Chan, head, biostatistics
unit, Yah-Shih Chan, assistant director of nursing, Doris Fok, research
coordinator and lactation
consultant, Kay-Thwe Tun, clinical project coordinator, Faith S P Ng,
biostatistician, Mary Rauff, senior
Objective : To investigate whether antenatal breast feeding education alone
or postnatal lactation support alone improves rates of exclusive breast
feeding compared with routine hospital care.
Design : Randomised controlled trial.
Setting : A tertiary hospital in Singapore.
Participants : 450 women with uncomplicated pregnancies.
Main outcome measures :Primary outcomes were rates of exclusive breast
feeding at discharge from hospital and two weeks, six weeks, three months,
and six months after delivery. Secondary outcomes were rates of any breast
Results : Compared with women who received routine care, women in the
postnatal support group were more likely to breastfeed exclusively at two
weeks (relative risk 1.82, 95% confidence interval 1.14 to 2.90), six weeks
(1.85, 1.11 to 3.09), three months (1.87, 1.03 to 3.41), and six months
(2.12, 1.03 to 4.37) postnatally. Women receiving antenatal education were
more likely to breast feed exclusively at six weeks (1.73, 1.04 to 2.90),
three months (1.92, 1.07 to 3.48), and six months (2.16, 1.05 to 4.43)
postnatally. The numbers needed to treat to achieve one woman exclusively
breast feeding at six months were 11 (6 to 80) for postnatal support and 10
(6 to 60) for antenatal education. Women who received postnatal support were
more likely to exclusively or
predominantly breast feed two weeks after delivery compared with women who
received antenatal education (1.53, 1.01 to 2.31). The rate of any
breastfeeding six weeks after delivery was also higher in the postnatal
support group compared with women who received routine care (1.16, 1.02 to
Conclusions : Antenatal breast feeding education and postnatal lactation
support, as single interventions based in hospital both significantly
improve rates of exclusive breast feeding up to six months after delivery.
Postnatal support was marginally more effective than antenatal education.
Trial registration : Clinical Trials NCT00270920.
Access the full study on BMJ.com.