The FEeding Support Team (FEST) randomised, controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas

OBJECTIVE To assess the feasibility of implementing a dedicated feeding support team on a postnatal ward and pilot the potential effectiveness and cost-effectiveness of team (proactive) and woman-initiated (reactive) telephone support after discharge. DESIGN Randomised controlled trial embedded within a before-and-after study. Participatory approach and mixed-method process evaluation. SETTING A postnatal ward in Scotland. SAMPLE Women living in disadvantaged areas initiating breast feeding. METHODS Eligible women were recruited to a before-and-after intervention study, a proportion of whom were independently randomised after hospital discharge to intervention: daily proactive and reactive telephone calls for ≤14 days or control: reactive telephone calls ≤ day 14. Intention-to-treat analysis compared the randomised groups on cases with complete outcomes at follow-up. MAIN OUTCOME MEASURES PRIMARY OUTCOME any breast feeding at 6-8 weeks assessed by a telephone call from a researcher blind to group allocation. SECONDARY OUTCOMES exclusive breast feeding, satisfaction with care, NHS costs and cost per additional woman breast feeding. RESULTS There was no difference in feeding outcomes for women initiating breast feeding before the intervention (n=413) and after (n=388). 69 women were randomised to telephone support: 35 intervention (32 complete cases) and 34 control (26 complete cases). 22 intervention women compared with 12 control women were giving their baby some breast milk (RR 1.49, 95% CI 0.92 to 2.40) and 17 intervention women compared with eight control women were exclusively breast feeding (RR 1.73, 95% CI 0.88 to 3.37) at 6-8 weeks after birth. The incremental cost of providing proactive calls was £87 per additional woman breast feeding and £91 per additional woman exclusively breast feeding at 6-8 weeks; costs were sensitive to service organisation. CONCLUSIONS Proactive telephone care delivered by a dedicated feeding team shows promise as a cost-effective intervention for improving breastfeeding outcomes. Integrating the FEeding Support Team (FEST) intervention into routine postnatal care was feasible. TRIAL REGISTRATION NUMBER ISRCTN27207603. The study protocol and final report are available on request.