A Self-Guided Breastfeeding Program
Condition: Breastfeeding
Study type: Interventional

Summary: 
      This intervention would be a series of self-help-style educational and motivational activity
      sheets for patients to complete independently. This will be a randomized clinical control
      trial.

      Subjects will complete a pre delivery questionnaire and a postpartum questionnaire. Subjects
      in the intervention arm will complete 3 activity sheets prenatally during their wait time at
      the clinic. The first worksheet can be completed the day of recruitment after consent is
      signed.

      Subjects will be contacted by phone at 3 and 6 months postpartum to assess long term duration
      of breast feeding.
    

Detailed description: 
      As the benefits of human milk become evident, the investigators are striving to improve the
      breastfeeding (BF) rate among new mothers. In April and May of 2014, 73 (71%) of well babies
      received human milk at discharge from our postpartum unit, with 40 (35%) and receiving human
      milk exclusively. In the neonatal intensive care unit, 83 (89%) received human milk during
      those months.

      Many of the patients at the teaching institution share risk factors for failure to BF,
      including poverty, obesity, unplanned pregnancy and being African American. Efforts have had
      limited effect in improving initiation and duration among these patients.

      Studies examining the efficacy of various modalities of antenatal education produced modest
      results in improving initiation and duration of BF. Several studies examined group BF
      education versus routine prenatal care without significant differences in initiation,
      exclusivity (the practice of using human milk exclusively and not supplementing with formula)
      or duration. Conversely, other study showed a difference in initiation with group education
      and showed a difference in exclusivity. Formalized education compared to routine clinical
      practice education did not result in a difference in exclusivity in several studies and
      neither did a program that included a video showed a difference in initiation with formal
      education.

      A few studies compared peer counseling to routine prenatal care. One small study of 59 women
      found an increase in initiation rate, while a larger study of 2511 women did not find a
      difference in initiation or duration.

      Other studies found no significant difference in initiation, duration or exclusivity with an
      educational program on practical BF skills nor a program on BF attitudes. A small study that
      paired BF education with material incentives increased exclusivity. Three studies comparing
      interventions by lactation consultants found no difference in initiation or duration,
      although one study showed improvement in exclusivity. Postpartum BF self-efficacy correlates
      with BF duration and two studies showed improvement in exclusivity with a BF class based on
      principles of self-efficacy. These studies based their intervention on Bandura's theory of
      self-efficacy, which proposes that an individual's expectation of personal efficacy will
      determine her initiation of coping behavior, effort expenditure and duration of persistence.
      This theory recognizes four components that contribute to an individual's sense of self-
      efficacy, and these include performance accomplishment, vicarious, or social, experience,
      verbal persuasion and psychological state. developed a validated scale at measuring prenatal
      maternal self-efficacy in breastfeeding.

      These two studies used a teaching approach that assumes that pregnant women are adults who
      are self-motivated and have past experience that shapes their learning and are a component to
      their perception of self-efficacy.

      Printed self-help materials are appealing as a low cost intervention that could be widely
      implemented. Furthermore, a large study among pregnant women showed that a self-help guide
      that is particularly tailored towards pregnant women could be effective in promoting another
      healthy behavior modification: smoking cessation. Potentially this method could be effective
      when used to prepare mothers for breastfeeding.
    

Intervention name(s): Education on Breast Feeding
Intervention type(s): Behavioral
Intervention description(s): Subjects in the intervention arm will complete 3 activity sheets prenatally-study related.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care