Dennis Cindy-Lee, Hodnett Ellen, Gallop Ruth, Chalmers Beverley
Faculty of Nursing, University of Toronto, Ont.
CMAJ. 2002 Jan 8;166(1):21-8.
Most mothers stop breast-feeding before the recommended 6 months post partum. A systematic review showed that breast-feeding support programs by health care professionals did not substantially improve breast-feeding outcomes beyond 2 months post partum. We conducted a randomized controlled trial to evaluate the effect of peer (mother-to-mother) support on breast-feeding duration among first-time breast-feeding mothers.
We recruited 256 breast-feeding mothers from 2 semi-urban community hospitals near Toronto and randomly assigned them to a control group (conventional care) or a peer support group (conventional care plus telephone-based support, initiated within 48 hours after hospital discharge, from a woman experienced with breast-feeding who attended a 2.5-hour orientation session). Follow-up of breast-feeding duration, maternal satisfaction with infant feeding method and perceptions of peer support received was conducted at 4, 8 and 12 weeks post partum.
Significantly more mothers in the peer support group than in the control group continued to breast-feed at 3 months post partum (81.1% v. 66.9%, p = 0.01) and did so exclusively (56.8% v. 40.3%, p = 0.01). Breast-feeding rates at 4, 8 and 12 weeks post partum were 92.4%, 84.8% and 81.1% respectively among the mothers in the peer support group, as compared with 83.9%, 75.0% and 66.9% among those in the control group (p < or = 0.05 for all time periods). The corresponding relative risks were 1.10 (95% confidence interval [CI] 1.01-2.72) at 4 weeks, 1.13 (95% CI 1.00-1.28) at 8 weeks and 1.21 (95% CI 1.04-1.41) at 12 weeks post partum. In addition, when asked for an overall rating of their feeding experience, significantly fewer mothers in the peer support group than in the control group were dissatisfied (1.5% v. 10.5%) (p = 0.02). Of the 130 mothers who evaluated the peer support intervention, 81.6% were satisfied with their peer volunteer experience and 100% felt that all new breast-feeding mothers should be offered this peer support intervention.
The telephone-based peer support intervention was effective in maintaining breast-feeding to 3 months post partum and improving satisfaction with the infant feeding experience. The high satisfaction with and acceptance of the intervention indicates that breast-feeding peer support programs, in conjunction with professional health services, are effective.
大多数母亲在产后6个月这一推荐时长之前就停止了母乳喂养。一项系统评价显示，医疗保健专业人员开展的母乳喂养支持项目在产后2个月之后并未显著改善母乳喂养结局。我们进行了一项随机对照试验，以评估同伴（母亲对母亲）支持对首次进行母乳喂养的母亲的母乳喂养时长的影响。
我们从多伦多附近的2家半城市社区医院招募了256名母乳喂养的母亲，并将她们随机分配至对照组（常规护理）或同伴支持组（常规护理加出院后48小时内开始的电话支持，提供支持的是一位有母乳喂养经验且参加过2.5小时培训课程的女性）。在产后4周、8周和12周对母乳喂养时长、母亲对婴儿喂养方式的满意度以及对所获得的同伴支持的看法进行随访。
同伴支持组中在产后3个月仍继续母乳喂养的母亲显著多于对照组（81.1%对66.9%，p = 0.01），且纯母乳喂养的母亲也显著更多（56.8%对40.3%，p = 0.01）。同伴支持组母亲在产后4周、8周和12周的母乳喂养率分别为92.4%、84.8%和81.1%，而对照组母亲相应的母乳喂养率分别为83.9%、75.0%和66.9%（所有时间段p≤0.05）。相应的相对风险在产后4周为1.10（95%置信区间[CI] 1.01 - 2.72），8周时为1.13（95% CI 1.00 - 1.28），12周时为1.21（95% CI 1.04 - 1.41）。此外，当被要求对她们的喂养经历进行总体评分时，同伴支持组中表示不满的母亲显著少于对照组（1.5%对10.5%）（p = 0.02）。在评估同伴支持干预的130名母亲中，81.6%对她们的同伴志愿者经历感到满意，100%认为所有新的母乳喂养母亲都应接受这种同伴支持干预。
基于电话的同伴支持干预在维持母乳喂养至产后3个月以及提高对婴儿喂养经历的满意度方面是有效的。对该干预的高度满意度和接受度表明，母乳喂养同伴支持项目与专业医疗服务相结合是有效的。
