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Context: Breastfeeding in the United States remains below target goals.  Premature weaning may be preventable with adequate knowledge, skills and confidence.

Objective: To determine whether group prenatal education can improve breastfeeding outcomes in a private practice population.

Design, Setting, and Participants: A randomized, controlled prospective trial. Of the 182 enrolled, 168 completed data collection. The majority were Hispanic, married, and below the U.S. median income level.

Intervention: One two-hour class based on breast-feeding self-efficacy theory. Main Outcome Measures: Breastfeeding duration and exclusivity up to twelve weeks, and breastfeeding confidence measured with the Breastfeeding Self-Efficacy Scale- Short Form.
Results: Breastfeeding confidence was associated with higher rates of full breastfeeding at weeks one, six and twelve with mean differences of 14.73, 15.70, and 14.14 on the BSES-SF 70 point scale (week one: t (158), = -7.09, p < .001, week 6: t (160), = -8.06, p <.001, week 12: t (150), = -7.97, p < .001). High breastfeeding confidence was associated with longer mean duration of breastfeeding (10 weeks) versus lower scores (5 weeks) (Kaplan Meier L.R. 61.57, p <.0001).The intervention was not associated with significant differences in breastfeeding confidence, duration, or exclusivity in the full sample when analyzed as “intent to treat”.            However, in cross-over analysis by actual attendance to any breastfeeding class, there were consistent differences in subgroups at-risk for breastfeeding problems. For mothers without breastfeeding experience that had taken any breastfeeding class, full breastfeeding rates were higher (39%), than those with no class (12%) (X² [82] = 6.94, p = .01) at one week, at six weeks- 42% versus 9% (X² [85] = 11.35, p < .001), and at twelve weeks (35% versus 11% (X² [83] = 6.16, p = .02). For mothers delivered by cesarean, those who had no class consistently had an 8% rate of full breastfeeding versus those with any class with rates of 39% at one week (X² [49] = 7.99, p < .01), 42% at six weeks (X² [50] = 11.08, p = .001), and 35%, at twelve weeks (X² [51] = 7.39, p < .01).            Those without prior experience also had longer mean duration of breastfeeding with any class (9 weeks) versus no class (5 weeks) for (Kaplan Meier LR [80], = 9.27, p  <.01), and cesarean deliveries (LR [50], = 7.78, p  <.01).            In multivariate analysis, the effects of actual attendance to any breastfeeding class on rates of full breastfeeding were confirmed at one week postpartum (OR 4.36, 95% C.I. 1.46 – 13.03, p < .01). Breastfeeding confidence was consistently a strong predictor of breastfeeding exclusivity and duration in multivariate analysis.

Conclusions: Breastfeeding education shows potential for improving breastfeeding outcomes, especially in subgroups at risk for poor outcomes.