Studies examining the role of antenatal education in improving breastfeeding rates have produced modest results. We designed a low-cost intervention that could be widely implemented to improve breastfeeding self-efficacy and behavior.METHODS:
This is a randomized trial using activity sheets to prepare pregnant women for breastfeeding. Subjects completed assessments of their breastfeeding intent and self-efficacy prior to and after an intervention of three activity sheets. Postpartum surveillance assessed breastfeeding 6 weeks postpartum.RESULTS:
One hundred seventy-six subjects were randomized to the intervention group and 159 to the control group, with follow up to 6 weeks postpartum in 151 and 137 subjects respectively. Initial feeding plans were similar between groups. There was no difference at six weeks postpartum in breastfeeding rates between intervention and control groups (n=60, 39.7% versus n=57, 41.6%, p=0.747). Baseline self-efficacy scores were similar between the intervention group and control group (median 85.0 [IQR 68.0,94.5] versus 84.0 [IQR 188.8.131.52]) and there was no difference in the change in scores between groups. Median self-efficacy scores were higher among breastfeeding subjects at baseline (92.0 [IQR 77.0,98.0]) and prior to delivery (94.0 [IQR 80.0,99.0]) than among subjects not breastfeeding (80.0 [IQR 66.0,81.5] and 82.0 [IQR 74.5,91.5]), p<0.01).CONCLUSION:
Our intervention did not impact prenatal breastfeeding self-efficacy, feeding plans or duration of breastfeeding. In spite of sub-optimal breastfeeding, self-efficacy scores were high relative to the study in which the scale was validated. However, self-efficacy predicted success in breastfeeding. Improvement of self-efficacy may be a fruitful focus of breastfeeding promotion.