ORIGINAL ARTICLE Types and timing of breastfeeding support and its impact on mothers’ behaviours Beth E Kervin, 1 Lynn Kemp 1 and Lisa Jackson Pulver 2 1 Centre for Health Equity Training Research and Evaluation (CHETRE), part of the Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of NSW, Liverpool Hospital, Liverpool BC, New South Wales, Australia and 2 Muru Marri Indigenous Health Unit, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia Aim: To determine the types and timing of breastfeeding support for mothers of newborn babies and the extent to which this affects breastfeeding intentions and behaviours in a region with low rates of breastfeeding initiation and duration. Methods: A cross-sectional study by interviewer-administrated questionnaire was undertaken of women birthing at a large teaching hospital in South Western Sydney, between August and October 2006 (n = 164), with a 2-week follow-up of breastfeeding or breastfeeding-intending women (n = 107). Types, timing and satisfaction with personal and professional sources of support (e.g. antenatal classes, help at birth, practical lessons on how to breastfeed, providing information, and attitude towards breastfeeding) and the impact of these on breastfeeding intention and behaviours were assessed. Results: Most women had intended to breastfeed (76.2%), and, within the first 24 hours, 77.4% of babies were breastfed to some extent (45.1% exclusively), and at 2 weeks 65.9% were breastfed (9.7% exclusively). Women felt most supported by their partners and least supported by their health-care team. Antenatal classes, breastfeeding help within half an hour of birth and positive health-care team attitudes were related to improved breastfeeding intentions and behaviours. However, these supports were infrequently reported. Personal support was commonly reported although support delivered by professionals was related to better breastfeeding behaviours. Conclusion: Despite the effectiveness of professional support interventions, particularly those delivered in the antenatal and immediate post-natal period, access to these sources of support was very low. For breastfeeding outcomes to be improved, effective professional support strategies need to be much more widely available. Key words: breastfeeding; patient education; social support. Breastfeeding is well known as the best nutrition for infants whose mothers are not taking contraindicated drugs. The ben- efits of breastfeeding are both psychological, as it facilitates bonding between mother and child, and physical, as it reduces rates of otitis media, gastrointestinal disease, respiratory disease, asthma and some maternal cancers. 1–3 The Australian guidelines for breastfeeding reflect the inter- national recommendation of exclusive breastfeeding for 6 months. 4,5 Despite the evidence, many mothers in Australia do not breastfeed, and few follow current guidelines to breast- feed for extended periods. 6 The proportion of infants fully breastfed to 6 months in south-western Sydney was 24.0% in 2003–2004. 7 Support, both actual and perceived, has been identified as a significant contributor to breastfeeding outcomes. 2,4,8 Trials of interventions to promote and support breastfeeding have shown that support is effective in increasing intention, initiation, dura- tion and exclusivity of breastfeeding, and improves maternal confidence. 8–10 Support is most effective when delivered in both the pre- and post-natal periods and can take many formats. 8,9,11,12 Professional support, particularly in the prenatal period, has the potential to influence both the initiation and duration Key Points 1 Support, both actual and perceived, has been identified as a significant contributor to breastfeeding outcomes, but little is known about the significance of the timing of breastfeeding support or women’s levels of satisfaction with the provided support. 2 Professional support needs to be more accessible to all women and at all times throughout the antenatal and post- natal periods to have a wider influence on breastfeeding outcomes. 3 To influence breastfeeding initiation, women should receive professional help with breastfeeding within half an hour of birth, practical lessons during their hospital stay and be spoken to about breastfeeding. Correspondence: Dr Lynn Kemp, Centre for Health Equity Training Research and Evaluation (CHETRE), part of the Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, Univer- sity of NSW, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871 Australia. Fax: +61 2 9612 0762; email: l.kemp@unsw.edu.au Accepted for publication 1 July 2009. doi:10.1111/j.1440-1754.2009.01643.x Journal of Paediatrics and Child Health 46 (2010) 85–91 © 2010 The Authors Journal compilation © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 85