Introduction
The World Health Organization (WHO)1, UNICEF2, Health Canada3, and the Canadian Paediatric Society (CPS)4 recommend exclusive breastfeeding for the first six months for health, term infants, as breast milk is the best food for optimal growth. At six months, babies are ready for other foods, but breastfeeding may continue for up to two years and beyond. Canadian women are initiating breastfeeding in larger numbers than in the past three generations, but breastfeeding rates still drop precipitously in the early weeks postpartum. Approximately 85% of Canadian women initiate breastfeeding, of whom about one third stop by the eighth week postpartum. The most common reason given for weaning is lack of milk6. In the KFL&A area, the 2008 Infant Feeding Survey found that 90.1% of women initiated breastfeeding, but that at the end of one week only 73% were still breastfeeding. The survey also indicated that only 35% of women were still breastfeeding at six months.7
Antenatal breastfeeding education
A review of the literature on antenatal breastfeeding education by the WHO shows some evidence that it is beneficial, with the greatest benefit for primigravid women. Some of the most effective antenatal breastfeeding interventions covered breastfeeding technique and aimed to build mothers' confidence levels. Increasing social support by including the woman's partner, mother, close friends or peers in the program is often more effective in facilitating initiation.8 Methods that seem to be effective include practical demonstrations and group discussions about myths and inhibitions. However, the most useful topics of discussion often depend upon the mothers' pregnancy stage.8
A large tertiary hospital in Ontario conducted a successful randomized controlled trial in antenatal breastfeeding education. The study was conducted with 110 primiparous women, aged 17-42, who planned to breastfeed. It found that a two and a half-hour prenatal breastfeeding workshop (based on adult learning principles and self-efficacy theory) increased maternal breastfeeding self-efficacy and exclusive breastfeeding.6
Description of class
At KFL&A Public Health, a two-hour breastfeeding class is conducted by public health nurses who are also certified lactation consultants. The class is offered to the general public for pregnant women and their partners or coaches, who are encouraged to take the course during the prenatal period. The objectives of the class are to provide new mothers with the knowledge, skills and confidence to successfully initiate and maintain breastfeeding for at least six months. The class also aims to prepare partners and coaches to support the breastfeeding mother. Topics included the anatomy and physiology of the breast, positioning and latch, breastfeeding management, family support, common breastfeeding challenges and troubleshooting, and community breastfeeding supports and services.