Forster Della A, McLardie-Hore Fiona E, McLachlan Helen L, Davey Mary-Ann, Grimes Heather A, Dennis Cindy-Lee, Mortensen Kate, Moorhead Anita M, Tawia Susan, Gold Lisa, Shafiei Touran, Small Rhonda, East Christine E, Amir Lisa H
Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia.
Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia.
EClinicalMedicine. 2019 Mar 6;8:20-28. doi: 10.1016/j.eclinm.2019.02.003. eCollection 2019 Feb.
Breastfeeding rates are suboptimal internationally, and many infants are not receiving any breast milk at all by six months of age. Few interventions increase breastfeeding duration, particularly where there is relatively high initiation. The effect of proactive peer (mother-to-mother) support has been found to increase breastfeeding in some contexts but not others, but if it is shown to be effective would be a potentially sustainable model in many settings. We aimed to determine whether proactive telephone-based peer support during the postnatal period increases the proportion of infants being breastfed at six months of age.
RUBY (Ringing Up about Breastfeeding earlY) was a multicentre, two-arm un-blinded randomised controlled trial conducted in three hospitals in Victoria, Australia. First-time mothers intending to breastfeed were recruited after birth and prior to hospital discharge, and randomly assigned (1:1) to usual care or usual care plus proactive telephone-based breastfeeding support from a trained peer volunteer for up to six months postpartum. A computerised random number program generated block sizes of four or six distributed randomly, with stratification by site. Research midwives were masked to block size, but masking of allocation was not possible. The primary outcome was the proportion of infants receiving any breast milk at six months of age. Analyses were by intention to treat; data were collected and analysed masked to group. The trial is registered with ACTRN, number 12612001024831.
Women were recruited between Feb 14, 2013 and Dec 15, 2015 and randomly assigned to peer support ( = 574) or usual care ( = 578). Five were not in the primary analysis [5 post-randomisation exclusions]. Infants of women allocated to telephone-based peer support were more likely than those allocated to usual care to be receiving breast milk at six months of age (intervention 75%, usual care 69%; Adj. RR 1·10; 95% CI 1·02, 1·18). There were no adverse events.
Providing first time mothers with telephone-based support from a peer with at least six months personal breastfeeding experience is an effective intervention for increasing breastfeeding maintenance in settings with high breastfeeding initiation.
The Felton Bequest, Australia, philanthropic donation and La Trobe University grant.
国际上母乳喂养率未达理想水平，许多婴儿在6个月大时根本没有接受任何母乳。很少有干预措施能延长母乳喂养时间，尤其是在母乳喂养起始率相对较高的情况下。已发现积极的同伴（母亲对母亲）支持在某些情况下能增加母乳喂养率，但在其他情况下则不然，但如果证明其有效，在许多环境中都将是一种潜在的可持续模式。我们旨在确定产后基于电话的积极同伴支持是否会增加6个月大时进行母乳喂养的婴儿比例。
RUBY（早期致电母乳喂养）是一项在澳大利亚维多利亚州的三家医院进行的多中心、双臂非盲随机对照试验。打算进行母乳喂养的初产妇在产后且出院前被招募，并随机分配（1:1）接受常规护理或常规护理加由经过培训的同伴志愿者提供的长达产后6个月的基于电话的积极母乳喂养支持。一个计算机随机数程序生成大小为4或6的随机分组块，并按地点分层。研究助产士对分组块大小不知情，但不可能对分配情况进行设盲。主要结局是6个月大时接受任何母乳的婴儿比例。分析采用意向性分析；数据收集和分析时对分组情况设盲。该试验已在澳大利亚新西兰临床试验注册中心注册，注册号为12612001024831。
在2013年2月14日至2015年12月15日期间招募了女性，并随机分配至同伴支持组（n = 574）或常规护理组（n = 578）。5名女性未纳入主要分析[随机分组后排除5名]。分配至基于电话的同伴支持组的女性的婴儿在6个月大时比分配至常规护理组的婴儿更有可能接受母乳喂养（干预组75%，常规护理组69%；调整后风险比1.10；95%置信区间1.02，1.18）。没有不良事件。
为初产妇提供来自有至少6个月个人母乳喂养经验的同伴的电话支持，是在母乳喂养起始率较高的环境中提高母乳喂养维持率的有效干预措施。
澳大利亚费尔顿遗产、慈善捐赠和拉筹伯大学资助。
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