Feasibility study to test designer breastfeeding™: A randomised controlled trial

Background. The World Health Organization challenges health professionals to increase breastfeeding rates, which means increasing initiation and duration rates. Initiation rates in the UK are improving, but evidence on duration is equivocal. Research shows increased maternal confidence and professional and peer support as key determinants in increasing breastfeeding duration rates. Aim. To compare current breastfeeding instruction with a motivationally-enhanced version. It was hypothesised that increased motivation to breastfeed would lead to increased persistence to breastfeed. Design and setting. Single, blind, randomised controlled trial with participants blinded to group membership. The setting was a single suburban hospital and community health and social care Trust serving an urban and rural population. Participants. Primigravid women (n=182) recruited at the 20-week antenatal appointment gave written informed consent to participate. Intervention. Application of a model of motivational instructional design to routine breastfeeding instruction led to the creation of an intervention package intended to increase maternal confidence through routine antenatal and postnatal instruction. Outcome measures. Women's motivation to sustain breastfeeding, as measured by three components of the breastfeeding motivational instructional measurement scale: total value placed on breastfeeding, total perceived midwife support and total expectancy for success. Results. The motivationally-enhanced instruction significantly increased maternal confidence (t=4.81; df=89.22; p<0.001) and perceived midwife support (t=7.21; df=80.39; p<0.001). Secondary outcomes included increased persistence to breastfeed on discharge ( ² =5.64; df=l; p<0.02) and at three weeks postnatal ( ² =16.26; df=l; p<0.001). Conclusions. Breastfeeding is a complex behaviour with known benefits and influences. The findings present breastfeeding educators and researchers with two challenges: to explore the role of expectancy for success further in relation to women's perceived experience of breastfeeding and to re-direct the development and testing of interventions based on the trial findings.