Results

Response rate

A total of 22 classes held between May 2005 and May 2006 were included in this evaluation. Of the 162 original mothers, 40 were not called because of errors in record keeping. One hundred and twenty six were called two weeks after their expected dates of delivery of whom 103 were reached and 91 agreed to continue participating in the evaluation. Seventy completed the telephone interview at six weeks postpartum, for crude response rate of 43.2% (70/162).  Excluding from the denominator the 40 mothers who were not called yields a response rate of 55.5% (70/126) that more accurately reflects the level of participation. Figure 1 illustrates the follow-up of participants.

The average class had seven mothers, with a range from 2 to 14. There were five coaches/partners in the average class, with a range from 1 to 9. The majority of mothers had a coach/partner accompany her.

The mean gestational age of mothers who participated in the class was 30.5 weeks. As the mean gestational age of the 70 mothers who completed the entire evaluation (to six weeks postpartum) was 31.1 weeks, the final sample is deemed representative of all the original participants with respect to gestational age at the time of the class.

Impact of the breastfeeding class

Mothers' knowledge, importance and confidence

A total of 162 mothers completed both the pre- and post-class knowledge questionnaires. The mean post-class knowledge score (7.7) was significantly higher than the pre-class score (mean = 6.2; z = -8.126, p. <.0001).  A total of 153 mothers provided ratings on the importance of breastfeeding pre-and post-class. The mean post-class rating of breastfeeding importance (6.6) was significantly higher than the mean pre-class rating (6.4; z = -4.86, p<.0001). Similarly, ratings of ability to breastfeed increased after the class, with a significantly higher mean post-class rating of confidence (5.9) was than the mean pre-class rating (5.4; z = 5.748, p<.0001).

Partners' knowledge, importance and confidence

A total of 89 partners completed both the pre- and post-class knowledge questionnaires. As with mothers, the mean post-class knowledge score (7.6) was higher than the mean pre-class knowledge score (5.3; z = -7.316, p<.0001). A total of 90 partners provided ratings on the importance of breastfeeding pre and post-class. The mean post-class rating (6.7) was higher than the mean pre-class rating (6.3) of breastfeeding importance (z = - 3.157, p<.002). Similarly, the class increased partners' ratings of confidence in their ability to provide breastfeeding support, such that the mean post-class rating of confidence (6.4) was higher than the mean pre-class rating (4.6; z = -6.565, p<0001).

The breastfeeding class achieved its intended immediate objectives. Both mothers and their partners increased their knowledge of breastfeeding as a result of taking the class. Furthermore, mothers' perceptions of the importance of breastfeeding increased, as did confidence in their ability to breastfeed. Their partners' perceptions of the importance of breastfeeding increased, as did their confidence in providing support.

Participant satisfaction with the breastfeeding class

Both mothers and their partners were asked to rate their satisfaction with the class on a six-point rating scale, ranging from 'very dissatisfied' to 'highly satisfied'. Most mothers and partners were either 'fairly" or 'highly' satisfied with the class (90.1% and 89.8%, respectively). Only one mother and one partner reported being 'very dissatisfied'.

Breastfeeding status and mothers' confidence at six-weeks post partum

Of the 70 mothers interviewed at 6 weeks postpartum, 67 reported how they were feeding their infants. Among these, 91% (n=61) indicated that they were breastfeeding, while

8.9% (n=6) were not. Among the 61 mothers who were breastfeeding, 59% (n=36) were doing so exclusively, while 39.3% (n=24) indicated that they were both breast and bottle feeding.

Mothers were asked whether the class affected their level of confidence in breastfeeding. The majority (77.1%) reported that taking the class increased their confidence, while 17.1% said their confidence was unchanged, and 4.3% said their confidence was decreased. Reported confidence level was not related to breastfeeding status (Chi Square = 43.25, df = 4, p = 0.36).

Mothers were asked which community resources they had used to obtain information about breastfeeding. Table 1 displays the reported frequency of accessing breastfeeding support resources available in the community. Home visits were by far the most frequently used resource.

Table 1: Breastfeeding resources accessed by study participants