| Context. Breastfeeding rates remain below target goals. Adequate knowledge and confidence may prevent premature weaning.;Objective. To determine whether group prenatal education improves breastfeeding outcomes.;Design, setting, and participants. A randomized, controlled prospective trial in a private practice setting with 168 completing data collection.;Intervention. Two-hour breast-feeding self-efficacy theory based class.;Main outcome measures. Breastfeeding duration, exclusivity and confidence through twelve weeks.;Results. Breastfeeding confidence was associated with higher full rates breastfeeding at weeks one, six and twelve with mean differences of 14.73, 15.70, and 14.14 on the BSES-SF 70 point scale (one: t (158), = -7.09, p < .001, 6: t (160), = -8.06, p <.001, 12: t (150), = -7.97, p < .001). Higher breastfeeding confidence was associated with longer mean duration (10 weeks) versus lower scores (5 weeks) (Kaplan Meier L.R. 61.57, p <.0001).The intervention was not associated with significant differences in the full sample using "intent to treat" analysis.;Cross-over analysis by class attendance found consistent differences in at-risk subgroups. Class attendance by inexperienced mothers was associated with higher full breastfeeding rates than those without class at one (39% verses 12%) (X2 [82] = 6.94, p = .01), six (42% versus 9%) (X2 [85] = 11.35, p < .001), and twelve (35% versus 11%) (X 2 [83] = 6.16, p = .02) weeks. Cesarean delivered mothers without class attendance had a full breastfeeding rate of 8% versus those with class having rates of 39% (X2 [49] = 7.99, p < .01), 42% (X2 [50] = 11.08, p = .001), and 35%, at one, six and twelve weeks (X2 [51] = 7.39, p < .01). Inexperienced mothers also had longer mean duration with class (9 weeks) versus no class attendance (5 weeks) (Kaplan Meier LR [80], = 9.27, p <.01), and cesarean deliveries (LR [50], = 7.78, p <.01).;Multivariate analysis confirmed the effects of actual class attendance on full breastfeeding rates at one week postpartum (OR 4.36, 95% C.I. 1.46-13.03, p < .01). Confidence consistently predicted breastfeeding exclusivity and duration in multivariate analysis.;Conclusions. Education shows potential for improving breastfeeding outcomes in at risk subgroups. |
