An Integrated Model of Breastfeeding Peer Counseling Support is Feasible and Associated with Improved Exclusive Breastfeeding.

Background Though in-person contacts in the home have demonstrated efficacy in improving breastfeeding outcomes in peer counseling programs, home contacts are resource-intensive. Objective To compare the feasibility and effectiveness of an Integrated Model of peer counseling breastfeeding support characterized by select home visits augmented with individual WIC clinic visits and group education, in contrast to the Standard Model which includes a standard number of in-person home contacts. Methods Six counties (n = 226 participants) and nine counties (n = 472 participants) were assigned to the Standard Model and the Integrated Model, respectively. Differences in demographic characteristics and breastfeeding outcomes were tested using Chi square tests and Cox proportional hazards regression models. Results Participants in counties where the Integrated Model was implemented had fewer home contacts (p = 0.03) and were more likely to have a hospital (p = 0.03) or group education (p < 0.001) contact, whereas Standard Model participants were more likely to receive an individual WIC clinic contact (p < 0.001). While there was no difference in the hazard of discontinuing any breastfeeding between groups, participants in the Integrated Model group had a lower hazard of discontinuing exclusive breastfeeding by 3 months postpartum (p = 0.02). Among participants within the Integrated Model, group education classes were associated with higher hazard of discontinuation (p = 0.04 and p = 0.003 for any and exclusive breastfeeding, respectively). Conclusions It was feasible for peer counselors to implement changes in program delivery to achieve fewer home visits without a detrimental impact on breastfeeding outcomes. However, group education classes did not appear to be beneficial for improving breastfeeding outcomes in this population.

Characteristics associated with longer breastfeeding duration: an analysis of a peer counseling support program.

Breastfeeding peer counseling support programs for low-income women have been implemented across the United States. Data from one such program were used to examine participant and program characteristics, of those enrolled prenatally (n = 2168) or postnatally (n = 2899), and to determine how these characteristics affected breastfeeding outcomes. Shorter breastfeeding duration was significantly predicted by introduction of formula on day 1 postpartum in participants enrolled prenatally (-37.9 days [95% CI: -57.9 to -17.9]) as well as postnatally (-49.1 days [95% CI: -63.4 to -34.8]). In both groups, increasing maternal age and previous breastfeeding experience were associated with significantly longer breastfeeding duration. Breastfeeding duration may be improved in programs by targeting younger mothers, those without breastfeeding experience, and focusing on delaying the introduction of formula.