Operation Initiation: A look through the window of opportunity that facilitates successful breastfeeding initiation

Background: Evaluation was conducted on the integration of a peer-based community intervention model within an existing home-visitation program (HVP) that served Medicaid-eligible women at risk for child maltreatment. The intervention was designed to improve prenatal and childbirth outcomes, although the impact on breastfeeding warranted a closer look at the program components that contributed to impressive initiation rates.

Methods: A non-profit organization received philanthropic funding to partner with the HVP and conduct a two-year pilot of the integrated intervention. A total of 102 women under age 24 were enrolled; 73% were African-American. Four community workers were employed and specially trained as doulas to provide support during the critical months of pregnancy, birth and early parenting.

Results: Pregnancy outcomes among the 78 active participants who had given birth were equal to or better than a non-equivalent comparison group of mothers similar in ethnicity, age, and residency. Breastfeeding initiation was most promising: 92% initiated breastfeeding, compared to 55% in the comparison group. The lessons learned could enhance efforts to increase breastfeeding. Namely, train trusted community members to: 1) provide breastfeeding education as part of prenatal and childbirth support; 2) facilitate successful initiation by offering encouragement and breastfeeding support at the time of birth, through the critical hours that follow; 3) continue home-based support during the critical weeks that breastfeeding is established.

Conclusion: Community-based programs are ideally positioned to train community members who are willing to provide breastfeeding support during critical periods. Their ability to effectively support breastfeeding contributes to developing healthier communities.