Fathers, Coparenting, and Breastfeeding

Source: Abbass-Dick J, Stern SB, Nelson LE, et al. Coparenting breastfeeding support and exclusive breastfeeding: a randomized controlled trial. Pediatrics. 2015; 135(1): 102– 110; doi: 10.1542/peds.2014-1416Investigators from Toronto studied the effect of a coparenting breastfeeding support intervention on breastfeeding rates. Mothers were recruited from a teaching hospital within their first 2 days postpartum and were eligible if they were primiparous, ≥18 years old, English-speaking, planning to breastfeed for >12 weeks, living with a male partner who could participate in the study, and had delivered a healthy singleton infant at ≥37 weeks’ gestation. Couples were randomized to receive either usual care or a coparenting breastfeeding support intervention. Usual care consisted of standard in-hospital breastfeeding support and any breastfeeding assistance that was proactively sought in the community. The coparenting intervention included both parents and involved a 15-minute in-hospital discussion, a video, a workbook, a breastfeeding booklet, access to a secure study website, 2 follow-up emails, and 1 telephone call.The primary study outcomes were exclusive breastfeeding and continuation of breastfeeding assessed at 6 and 12 weeks postpartum. Secondary outcomes included maternal satisfaction with their partner’s involvement with breastfeeding, maternal perception of the coparenting relationship as measured by the Coparenting Relationship Scale at 12 weeks, and maternal perception of breastfeeding support from their partner as measured by the Postpartum Partner Support Scale at 6 and 12 weeks. Also, paternal breastfeeding confidence was measured by the Breastfeeding Self-Efficacy Scale at birth and 6 weeks and paternal attitude towards breastfeeding was measured by the Iowa Infant Attitude Scale at birth and 6 weeks.There were 107 couples in the control group and 107 in the intervention group. Significantly more mothers in the intervention group than the control group continued to breastfeed at 12 weeks postpartum (96% vs 88%, P = .02). There were no significant differences in breastfeeding rates at 6 weeks nor in exclusive breastfeeding rates at 6 and 12 weeks. There were no significant differences between groups with regard to maternal perception of the coparenting relationship, maternal perception of support, or paternal infant feeding attitude. Fathers in the intervention group had a significantly greater increase in breastfeeding self-efficacy scores from baseline to 6 weeks postpartum compared with fathers in the control group (P = .03). In addition, significantly more mothers in the intervention group than in the control group reported that their partners provided them with breastfeeding help in the first 6 weeks (71% vs 52%, P = .02) and that they were satisfied with their partners’ involvement with breastfeeding (89% vs 78%, P = .04).The authors conclude that including fathers in a coparenting breastfeeding support intervention may have a beneficial effect for first-time parents.Dr Noble has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.This study confirms the importance of coparenting interventions for new parents. Coparenting aims for more cooperative and supportive teamwork between parents by teaching effective communication, problem solving, and conflict resolution. For instance, in a recently published study, a brief coparenting intervention was shown to positively affect family relationships and decrease maternal stress.1 The present study shows that a coparenting intervention may increase breastfeeding.This study also adds to the growing literature demonstrating that including fathers in breastfeeding interventions increases breastfeeding rates.2 In reality, most breastfeeding interventions are designed exclusively for mothers. Most new fathers report being ignored by or having a negative experience with postpartum nurses.3 A recent study revealed that fathers often felt helpless to support their partner, as they were excluded from antenatal breastfeeding education and postnatal support.4 Fathers wanted more information about breastfeeding to be directed towards them as well as ideas about how they could practically support their partner. Without paternal breastfeeding interventions, fathers may feel that breastfeeding excludes them and continues the exclusive relationship that the mother and infant experienced during pregnancy.A limitation of this current study is that it measured a multifaceted intervention. Therefore, it is not possible to ascertain which specific components of the intervention (ie, the discussion, video, workbook, booklet, website, emails, or telephone call) were responsible for the increased breastfeeding duration. We also cannot measure whether the improvement was related to coparenting education, breastfeeding education, or paternal involvement in breastfeeding. Nevertheless, the results of this study suggest that a relatively simple intervention combining support of coparenting and breastfeeding could be effective. If further studies confirm these results, this could be a simple but effective method to improve parenting and breastfeeding.

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