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Biomedical subjects

Ulla Waldenström

Publications and source records attributed to Ulla Waldenström.

At least 19 recordsLinked to original sources
PubMed2006

Intrapartum and postpartum care in Sweden: women's opinions and risk factors for not being satisfied.

BACKGROUND: The aim of this study was to investigate satisfaction with intrapartum and postpartum care, and the risk of not being satisfied in relation to 1) a woman's sociodemographic background, 2) physical and emotional well-being in early pregnancy, 3) labor outcomes, 4) care organization, and 5) a woman's subjective assessment of aspects of care. METHODS: All Swedish-speaking women booked for antenatal care during 3 weeks spread over 1 year (1999-2000) were invited to participate in the study, and 2,686 (82% of those who consented to participate and 58% of those who were eligible) completed questionnaires in early pregnancy and 2 months postpartum. Women who were satisfied with overall intrapartum and postpartum care respectively were compared with those who were not regarding possible risk factors, and associations were tested by logistic regression analysis. RESULTS: Ten percent of women were not satisfied with intrapartum care (ip) and 26% with postpartum care (pp). The following risk factors for not being satisfied were found: 1) age <25 years (ip), only elementary school (ip + pp), single status (pp), inconvenient timing of pregnancy (ip), lack of support from partner (ip); 2) suffering from many physical symptoms (ip + pp); 3) newborn transfer to neonatal clinic (ip + pp); 4) length of stay <1 day and > or =5 days (ip + pp), no "debriefing" after birth (ip), large hospital (pp); 5) lack of support by midwife (ip), little involvement in decision making (ip), dissatisfaction with birth environment (ip), insufficient time for breastfeeding support, encouragement and personal questions (pp).

Adult↗
PubMed2006

Obstetric pain relief and its association with remembrance of labor pain at two months and one year after birth.

The association between obstetric pain relief and long-term memory of pain is poorly researched in spite of the fact that a woman's memory of childbirth may affect her emotional wellbeing and future reproduction. The aim of this study was to investigate the association between epidural analgesia and other forms of pain relief, and memory of pain at two months and one year after birth. A national sample of 2482 Swedish speaking women with vaginal delivery or emergency cesarean section preceded by labor were followed from early pregnancy to one year after birth. Data were collected by three postal questionnaires: in early pregnancy, and two months and one year after the birth. Recollection of intense pain at two months and one year was associated with high rates of pain relief, and this was most obvious regarding epidural analgesia in first-time mothers. When comparing women with the same pain score at two months postpartum who had and who did not have an epidural, the first group seemed to have greater difficulty forgetting pain 10 months later. Possible explanations of these findings are discussed.

Adult↗
PubMed2006

Characteristics of primiparous women who are not reached by parental education classes after childbirth in Sweden.

BACKGROUND: Parental education classes are part of the national child health promotion programme of the Swedish Child Health Clinics (CHC). AIM: To investigate attendance at parental education classes during the infant's first year, and to identify factors associated with non-attendance in primiparous women. METHODS: Swedish-speaking women were recruited from 97% of all antenatal clinics in Sweden during 3 wk, evenly spread over 1 y from 1999 to 2000. Questionnaires were mailed in early pregnancy, and at 2 mo and 1 y after the birth. Two thousand, four hundred and forty women answered the main outcome question about class attendance asked in the third questionnaire, and 1076 of these were first-time mothers. RESULTS: Seventy-eight per cent of the primiparas attended classes and 31% of the multiparas. Factors associated with non-attendance in primiparas were: native language other than Swedish, a low level of education, smoking during pregnancy, inconvenient timing of pregnancy, feelings of loneliness and isolation, maternal hospital admission, and infant health problems. Three per cent of the primiparas did not attend classes either during pregnancy or after the birth, and this group seemed to constitute an even less privileged group. CONCLUSION: Parental education classes organized by the CHCs did not reach women who were more disadvantaged in terms of socio-demographic background, and maternal and infant health.

Adult↗
PubMed2005

Number of antenatal visits and women's opinion.

BACKGROUND: The national recommendation in Sweden regarding number of antenatal care visits was reduced in 1996. The aim of this study was to explore the factors associated with number of visits made and with women's own opinions about these visits. Another aim was to study associations between the number of visits and satisfaction with antenatal care overall. METHODS: All Swedish-speaking women who came for their first visit to the midwife in 593 participating clinics during 3 weeks evenly spread over 1 year in 1999-2000 were invited to participate in the study. Information was collected by postal questionnaires after the booking visit and 2 months after childbirth. Cases of preterm delivery and intrauterine death were excluded. RESULTS: After excluding miscarriages, non-Swedish-speaking women, and women booked at non-participating clinics, about 69% of all women booked in antenatal care were recruited. Of these, 2421 (83%) completed the two questionnaires. About 25% followed the standard visiting schedule for a normal pregnancy, 57% made more visits, and 17% fewer visits. The number of visits made was associated with parity, medical diagnosis, depressive symptoms, level of education, and women's preferences in early pregnancy. Women's own opinion that they made too few visits was associated with a preference for more visits in early pregnancy and actually receiving fewer visits than the standard schedule. The view that they made too many visits was associated with a previous negative birth experience, a wish for fewer visits, having a medical diagnosis, many children, and major worries. The vast majority of women (87.6%) were satisfied with antenatal care overall but less with emotional (76.9%) than with medical (82.3%) aspects. No association was found between number of visits made and satisfaction, but women's own opinion that they had too few visits was associated with dissatisfaction with medical as well as emotional aspects of care and the opinion that they made too many visits with the emotional aspects of care. CONCLUSION: Two-thirds of the women did not follow the standard visiting schedule, the majority of women made more visits. The number of antenatal visits seemed to be fairly well adapted to women's individual needs and, to some extent, to their own wishes. Very few women were dissatisfied with the number of visits made as well as the antenatal care overall.

Adolescent↗
PubMed2005

Childbirth and parenthood education classes in Sweden. Women's opinion and possible outcomes.

OBJECTIVE: To investigate first-time mothers' views about antenatal childbirth and parenthood education and their contact with other class participants after birth, and to compare participants and non-participants with respect to the use of pain relief, experience of pain, mode of delivery, childbirth overall, duration of breastfeeding, and assessment of parental skills. METHODS: A national cohort of 1197 Swedish-speaking women completed three questionnaires: during early pregnancy, 2 months, and 1 year after giving birth. RESULTS: Seventy-four percent of first-time mothers stated that antenatal education helped prepare them for childbirth, and 40% for early parenthood. One year after giving birth, 58% of the mothers had met with other class participants. These outcomes were associated with the number of class sessions. When controlling for the selection of women into participants and non-participants, no statistical differences were found concerning memory of labor pain, mode of delivery, overall birth experience, duration of breastfeeding, and assessment of parental skills. However, participants had a higher rate of epidural analgesia. Mothers who were young, single, with low level of education, living in a small city, and smokers were less likely to find the classes helpful. CONCLUSION: Participation in childbirth and parenthood education classes did not seem to affect first-time mothers' experience of childbirth and assessment of parental skills, but expanded their social network of new parents. The higher epidural rate suggests that participation in classes made women more aware of pain relief techniques available, rather than improving their own coping with pain. More research should focus on current forms of antenatal education, with special focus on women of low socioeconomic status.

Adult↗
PubMed2005

Patient choice cesarean--the Maine experience.

BACKGROUND: Patient choice cesarean refers to elective primary cesarean in the absence of a medical or obstetrical indication. The purpose of this study was to determine obstetricians' attitudes and practices with respect to patient choice cesarean in Maine, United States. METHODS: A questionnaire was sent to all Maine Fellows of the American College of Obstetricians and Gynecologists actively practicing obstetrics, after receiving institutional review exemption. Data were analyzed using descriptive statistics, Fisher exact, or chi-square tests. RESULTS: Seventy-eight of 110 (70.9%) obstetricians responded. Of these, 60 of 71 (84.5%) respondents performed or were willing to perform patient choice cesarean. However, 15 of 71 (21.1%) preferred a cesarean delivery for themselves (women) or partners (men). Indications included urinary continence (53.3%), adverse previous birth experience (41.7%), anal continence (35.0%), concern for fetal death or injury (33.3%), and fear of childbirth, preservation of sexual function, or pelvic organ prolapse (26.7% each). Less frequent were pain (11.7%), convenience (8.3%), and provider availability (10.0%). In addition, 82.1 percent believed medical evidence and 85.9 percent believed ethical issues sometimes or always supported patient choice cesarean. Responses were similar by gender, age, and time interval from training completion with two exceptions. Women under age 35 years were more likely to opt for a cesarean delivery themselves (p = 0.04), and 42.9 percent of respondents under age 35 years interpreted the medical literature as supporting cesarean in all cases versus 4.2 percent of older colleagues (p = 0.008). Sixty-four of 78 (82.1%) respondents would find a randomized trial of planned vaginal versus planned cesarean delivery helpful in addressing the issue of patient choice cesarean. CONCLUSIONS: Although Maine obstetricians were willing to perform patient choice cesarean, few preferred this delivery mode for themselves or their partners. A randomized trial of planned vaginal versus planned cesarean delivery is highly desired.

Adult↗
PubMed2005

Physical symptoms after childbirth: prevalence and associations with self-rated health.

OBJECTIVE: The aims of the present study were to describe the prevalence of a number of physical symptoms, as described by women themselves, two months and one year after childbirth in a national Swedish sample and to investigate the association between specific symptoms and women's self-rated health. DESIGN: Cohort study. SETTING: Swedish antenatal clinics. POPULATION: A total of 2413 women recruited from 593 antenatal clinics in Sweden during three one-week periods evenly spread over one year (1999-2000), representing 54% of women eligible for the study and 76% of those who consented to participate. The representativity of the sample was assessed by comparison with the total Swedish birth cohort of 1999. METHODS: Data were collected by means of questionnaires in early pregnancy, two months and one year after the birth and from the Swedish Medical Birth Register. MAIN OUTCOME MEASURES: Self-reported symptoms and self-rated health. RESULTS: Tiredness, headache, neck, shoulder and low back pain were common problems at two months as well as one year after childbirth. At two months, pain from caesarean section, dyspareunia and haemorrhoids were frequent problems, whereas stress incontinence was often reported at one year. Ninety-one percent of the women said self-rated health was 'very good' or 'good' at two months after birth, and 86% at one year. Low self-rated health was associated with symptoms that affected general physical functioning and wellbeing, such as tiredness, headache, musculoskeletal problems, mastitis, perineal pain, dysuria, stomachache and nausea. Complaints related to more specific situations, such as dyspareunia, constipation and stress incontinence were not associated with self-rated health. CONCLUSION: Despite the fact that physical symptoms were common two months and one year after the birth, the vast majority of women rated their health as 'very good' or 'good'.

Cohort Studies↗
PubMed2005

Birth centre care over a 10-year period: infant morbidity during the first month after birth.

AIM: To study morbidity during the first month of life affecting infants of mothers booked for birth centre care during pregnancy. METHODS: 3238 live single-born infants whose mothers were admitted to an in-hospital birth centre, located at South Hospital in Stockholm, between 1989 and 2000 were compared with 179,502 infants whose mothers received standard maternity care in the Stockholm region during the same period, and who fulfilled the same medical inclusion criteria as those of the birth centre group. Information on other exposures and outcomes was collected from the Swedish Medical Birth and Hospital Discharge Registers. Logistic regression analyses were performed to calculate the odds ratio (OR), using 95% confidence intervals (95% CI). RESULTS: Compared with infants born in standard care, infants in the birth centre group had a higher risk of respiratory problems (OR 1.39; 95% CI 1.14-1.69), a difference correlated to less serious respiratory diagnoses. However, the difference was not statistically significant if the birth centre group was compared only with infants born in standard care at South Hospital (OR 1.18; 95% CI 0.94-1.47). Birth centre care was associated with a lower risk of fractures (OR 0.40; 95% CI 0.25-0.63). CONCLUSION: Birth centre care was not associated with severe infant morbidity and even appeared to reduce the risk of birth trauma, such as clavicle and other fractures.

Birthing Centers↗
PubMed2005

Mothers' experiences of child health clinic services in Sweden.

AIM: To investigate women's experiences of child health clinic (CHC) care and risk factors for being dissatisfied. Experiences of specific aspects of care were further explored in subgroups of women who were not generally satisfied. METHODS: All Swedish-speaking women admitted to any of the approximately 600 antenatal clinics in Sweden during 3 wk evenly spread over 1 y in 1999 and 2000 were invited to participate in the study. Altogether, 3113 women agreed to participate. Data were collected by questionnaires: in early pregnancy, 2 mo and 1 y postpartum, and from the Swedish Medical Birth Register. For the purpose of this study, data from the 2415 women who answered the question used as the principal outcome in this study, i.e. overall satisfaction with CHC care, were analysed. RESULTS: Psychological factors, such as maternal depressive symptoms and worry about caring for the newborn, and serious infant feeding problems were predictors of less satisfied or mixed feelings about CHC care. About one in three women were dissatisfied with the attention paid to their own needs, and a similar proportion said information about vaccinations was insufficient. Of the four subgroups-mothers whose babies had feeding problems and mothers with depressive symptoms at 2 mo, 1 y, and on both occasions-the latter group was the least satisfied with the nurse and the time allocated to various issues. CONCLUSIONS: Swedish mothers appear to be satisfied with the attention given to their infants at CHCs, but many feel that their own needs as new mothers are neglected. This study supports current development towards screening for maternal depression at CHCs.

Adult↗
PubMed2004

Characteristics of Swedish women who do not attend childbirth and parenthood education classes during pregnancy.

OBJECTIVE: to investigate the attendance rate at childbirth and parenthood education classes during pregnancy in a national Swedish sample and describe the characteristics of women who did not attend. DESIGN: a cohort study utilising a postal questionnaire in early pregnancy and at 2 months after birth. SETTING: women were recruited from 97% of all antenatal clinics in Sweden at their first 'booking' visit during three different weeks spread over 1 year in 1999-2000. PARTICIPANTS: 2546 women, who were 77% of those who consented to participate in the study and 55% of all women eligible for the study. MEASUREMENT AND FINDINGS: most primiparous women (93%) attended classes and the majority of the multiparae (81%) did not. Having a native language other than Swedish was associated with non-attendance in both primiparae and multiparae (OR 2.7, 95% CI 1.3-5.4; OR 2.1, 95% CI 1.4-3.1). In addition, the following factors were associated with non-attendance in the primiparae: unemployment (OR 2.0, 95% CI 1.1-3.8), smoking during pregnancy (OR 2.7, 95% CI 1.2-5.8), having considered abortion (OR 4.3, 95% CI 1.2-16.1), and having had few antenatal check-ups (OR 2.0, 95% CI 1.1-3.7). The following factors were associated with non-attendance in the multiparae: age older than 35 years (OR 1.6, 95% CI 1.1-2.3), low level of education (OR 3.6, 95% CI 2.3-5.7), and pregnancy unplanned but welcome (OR 1.5, 95% CI 1.1-2.0), having had counselling because of fear of childbirth (OR 1.6, 95% CI 1.1-2.4), and expressing a need of such counselling (OR 1.9, 95% CI 1.1-3.1). KEY CONCLUSIONS: the childbirth and parenthood education programme reached the majority of pregnant women, and that non-attendees were more disadvantaged in terms of socio-demographic background and feelings about the approaching birth. These women should be given special attention during the antenatal check-ups so that childbirth and parenthood education could be adapted to their specific needs.

Adult↗
PubMed2004

Safety of birth centre care: perinatal mortality over a 10-year period.

OBJECTIVE: To study perinatal mortality in women booked for birth centre care during pregnancy. DESIGN: Retrospective cohort study. SETTING: In-hospital birth centre and standard maternity care in Stockholm. POPULATION: Two thousand and five hundred and thirty-four women (3256 pregnancies) admitted to an in-hospital birth centre over 10 years (1989-2000) and 126818 women (180380 pregnancies) who gave birth in standard care during the same period and who met the same medical inclusion criteria as in the birth centre. Multiple pregnancies were excluded. METHODS: Data were collected from the Swedish Medical Birth Register. Information on all cases of perinatal death in the birth centre group was retrieved from the medical records. MAIN OUTCOME MEASURE: Perinatal mortality. RESULTS: No statistically significant difference in the overall perinatal mortality rate was observed between the birth centre group and the standard care group (odds ratio [OR] 1.5, 95% CI 0.9-2.4), but infants of primiparas were at greater risk (OR 2.2, 95% CI 1.3-3.9). Infants of multiparas tended to be at lower risk, but this difference was not statistically significant (OR 0.7, 95% CI 0.3-1.9). These figures were adjusted for maternal age and gestation in multiple regression analyses. CONCLUSION: Birth centre care may be less safe for infants of first-time mothers.

Adult↗
PubMed2004

Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample.

BACKGROUND: The aims of the present study were to describe the prevalence of stress incontinence, as described by women themselves, 1 year after childbirth in a national sample of Swedish-speaking women, and to identify possible predictors. METHODS: A cohort study, including 2390 women recruited from 593 antenatal clinics in Sweden during three 1-week periods evenly spread over 1 year (1999-2000), representing 53% of women eligible for the study and 75% of those who consented to participate. Data were collected by means of questionnaires in early pregnancy, 2 months and 1 year after the birth, and from the Swedish Medical Birth Register. RESULTS: One year after the birth, 22% of the women had symptoms of stress incontinence but only 2% said it caused them major problems. The strongest predictor was urinary incontinence (overall leakage) 4-8 weeks after a vaginal delivery (OR 5.5, CI 95% 4.1-7.4) as well as after a cesarean section (OR 11.9, CI 95% 2.9-48.1). Other predictors in women with a vaginal delivery were: multiparity (OR 1.4; CI 95% 1.1-1.8), obesity (OR 1.6; CI 95% 1.1-2.4) and constipation 4-8 weeks postpartum (OR 1.4; CI 95% 1.1-1.9). CONCLUSION: Stress incontinence 1 year after childbirth is a common symptom, which could possibly be reduced by identifying women with urinary leakage at the postnatal check-up.

Adult↗
PubMed2004

Does fetal screening affect women's worries about the health of their baby? A randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening.

BACKGROUND: Screening for fetal abnormality may increase women's anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Down's syndrome on women's anxiety in mid-pregnancy and 2 months after delivery. METHOD: Two thousand and twenty-six women were randomly allocated to an ultrasound examination at 12-14 gestational weeks (gws) including risk assessment for Down's syndrome or to a routine scan at 15-20 gws. Questionnaires including the State-Trait Anxiety Inventory (STAI), the Cambridge Worry Scale (CWS), and the Edinburgh Postnatal Depression Scale (EPDS) were filled in at baseline in early pregnancy, at 24 gws and 2 months after delivery. RESULTS: No statistically significant differences were found between the trial groups regarding women's worries about the health of the baby, general anxiety and depressive symptoms during pregnancy or 2 months after delivery. Women's worries about something being wrong with the baby in the early ultrasound group and routine group, respectively, decreased from baseline (39.1% versus 36.0%) to mid-pregnancy (29.2% versus 27.8%), and finally to 2 months after delivery (5.2% versus 6.6%). CONCLUSION: Fetal screening for Down's syndrome by an early ultrasound scan did not cause more anxiety or concerns about the health of the baby in mid-pregnancy or 2 months after birth than in women who had a routine scan.

Adolescent↗
PubMed2004

Why do some women change their opinion about childbirth over time?

BACKGROUND: The current investigation is a follow-up of a study on women's memory of childbirth, which showed that 60 percent made the same assessment of their overall birth experience at 1 year after delivery as they did at 2 months postpartum, and 24 percent had became more negative and 16 percent more positive. The study purpose was to gain some understanding of what factors make some women change their assessment over time. METHODS: Data from a longitudinal cohort study of 2,428 women who completed questionnaires in early pregnancy, at 2 months, and at 1 year after birth were analyzed. Two subsamples were studied: 1,451 women who said childbirth was a positive experience at 2 months and 151 who said it was a negative experience. Comparisons were made, within each sample, between those who made the same assessment at 1 year and those who had changed their view, with respect to psychosocial background, labor outcomes, infant health outcomes during first year, and experiences of intrapartum care. RESULTS: Changing the assessment from positive to less positive, mostly to "mixed feelings," was associated with difficult childbirth, such as painful labor and cesarean section; dissatisfaction with intrapartum care; and psychosocial problems, such as single status, depressive symptoms, and worry about the birth in early pregnancy. Changing the assessment from negative to less negative was associated with less worry about the birth in early pregnancy and a more positive experience of support by the birth-attending midwife. CONCLUSIONS: This study supported the view that measures of satisfaction with childbirth soon after delivery may be colored by relief that labor is over and the happy birth of a baby. More negative aspects may take longer to integrate. Supportive care may have long-term effects and may protect some women from a long-lasting negative experience.

Adult↗
PubMed2004

Two mid-pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial.

BACKGROUND: Despite high levels of breastfeeding initiation in Australia, only 46 percent of women are still breastfeeding (exclusively or partially) 6 months later, with marked differences between social groups. This study aimed to determine the influence of mid-pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge, and on the duration of breastfeeding. METHODS: A randomized controlled trial to compare two strategies for increasing the initiation and duration of breastfeeding was conducted, in which 981 primiparas who attended a public, tertiary women's hospital in Melbourne, Australia, were randomized to one of two interventions or to standard care (327 in each group). The interventions were a 1.5-hour class on practical aspects of breastfeeding using a previously tested tool (Practical Skills), and two 1-hour classes exploring family and community attitudes toward, and experiences of, breastfeeding (Attitudes). Both interventions took place in interactive small groups when women were in mid-pregnancy. Breastfeeding initiation was ascertained by interview 2 to 4 days after birth, and breastfeeding duration was assessed by telephone interview 6 months after birth. RESULTS: Neither intervention increased breastfeeding initiation or duration compared with standard care. Rates at initiation were 97 percent (296/306) for the Practical Skills intervention, 95 percent (291/308) for the Attitudes intervention, and 96 percent (297/310) for standard care. Rates at 6 months were, respectively, 55 percent (162/297), 50 percent (146/293), and 54 percent (162/299). CONCLUSIONS: In settings where breastfeeding initiation is already high, neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration.

Adult↗
PubMed2004

A negative birth experience: prevalence and risk factors in a national sample.

BACKGROUND: A woman's dissatisfaction with the experience of labor and birth may affect her emotional well-being and willingness to have another baby. The aim of this study was to investigate the prevalence and risk factors of a negative birth experience in a national sample. METHODS: A longitudinal cohort study of 2541 women recruited from all antenatal clinics in Sweden during 3 weeks spread over 1 year was conducted. Data were collected by three questionnaires, which measured women's global experience of labor and birth 1 year after the birth, and obtained information on possible risk factors during pregnancy and 2 months after the birth. RESULTS: Seven percent of the women had a negative birth experience. The following risk factors were found: (1) factors related to unexpected medical problems, such as emergency operative delivery, induction, augmentation of labor, and infant transfer to neonatal care; (2) factors related to the woman's social life, such as unwanted pregnancy and lack of support from partner; (3) factors related to the woman's feelings during labor, such as pain and lack of control; and (4) factors that may be easier to influence by the caregivers, such as insufficient time allocated to the woman's own questions at antenatal checkups, lack of support during labor, and administration of obstetric analgesia. CONCLUSIONS: Many risk factors were related to unexpected medical problems and participants' social background. Of the established methods to improve women's birth experience, childbirth education and obstetric analgesia seemed to be less effective, whereas support in labor and listening to the woman's own issues may be underestimated.

Adult↗
PubMed2003

ABFAB. Attachment to the breast and family attitudes to breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the initiation and duration of breastfeeding: a randomised controlled trial [ISRCTN21556494].

BACKGROUND: It has proven difficult to reach World Health Organization (WHO) recommendations that infants be exclusively breastfed from birth to six months of age 12, yet there is limited knowledge about interventions that are effective in increasing breastfeeding initiation and duration. Particularly lacking is evidence about how to maintain breastfeeding rates in countries which already have a high initiation of breastfeeding. This study aims to determine whether mid-pregnancy breastfeeding education, with a focus on either attitudes to breastfeeding or on technical aspects of breastfeeding, has an effect on rates of breastfeeding initiation and duration. Secondary aims of the study are to: explore what factors might affect the duration of breastfeeding and evaluate the interventions from the participant and childbirth facilitator perspectives. METHODS/DESIGN: A randomised controlled trial (RCT) design will be used. Women having their first baby, and planning to give birth as public patients at the Royal Women's Hospital (RWH), Melbourne, will be approached at 18-20 weeks of pregnancy and invited to participate in the study. Participants will be randomly allocated to a control group or one of two group interventions: a previously designed and trialled tool to teach practical aspects of breastfeeding or an exploration of family attitudes to breastfeeding. The latter was developed and piloted by the investigators in conjunction with the group facilitators, prior to trial commencement. The interventions are planned to take place at 20-25 weeks. Data will be collected by questionnaire at recruitment, at interview in hospital after the birth and by telephone interview six months later. Medical/obstetric outcomes will be obtained from the medical record. The sample size (972) was calculated to identify an increase in breastfeeding initiation from 75 to 85% and an increase from 40 to 50% in breastfeeding at six months.

Journal Article↗