Breastfeeding expectations versus reality: a clusterrandomised controlled trial


Professor T. Lavender, Department Midwifery Studies, University of Central Lancashire, Preston, PR1 2HE, UK.


Objective  To evaluate the affect of an antenatal educational breastfeeding intervention on women's breastfeeding duration.

Design  Cluster randomised controlled trial. Unit of randomisation: electoral ward. The primary outcome was the proportion that fulfilled their antenatal breastfeeding expectation. Secondary outcomes were the number of women breastfeeding on discharge and at four months. Data were collected using a series of questionnaires and diaries.

Setting  Teaching hospital in North West of England.

Participants  Women who expressed a desire to breastfeed at the start of their pregnancy.

Methods  Women were allocated to either routine antenatal education or an additional single educational group session supervised by a lactation specialist and attended by midwives from their locality.

Main outcome measure  The proportion of women who fulfilled their expectation of breastfeeding.

Result  One thousand three hundred and twelve women were randomised, with 1249 (95%) women available for analysis. There was no difference between the groups in the proportion of women who attained their expected duration of breastfeeding (OR 1.2; 95% CI 0.89–1.6; χ2= 1.4, df= 1, P= 0.2; mean cluster size 156, design effect 1.6). There were no differences between the groups in the uptake of breastfeeding on discharge (OR = 1.2; 95% CI 0.8–1.7; χ2= 1.1, df= 1, P= 0.3; mean cluster size 163, design effect = 2.0) or exclusively at four months (OR = 1.1; 95% CI 0.6–1.8; χ2= 0.07, df= 1, P= 0.8; mean cluster size 156, design effect 1.6).

Conclusion  The provision of a single educational group session supervised by a lactation specialist, and attended by midwives and women, failed to promote the uptake of breastfeeding. Public health interventions, which encourage positive attitudes to breastfeeding within the family and wider community, should be developed and evaluated.