PC increases the incidence and duration of BF. We hypothesized that the incidence of BF and the cost-effectiveness of a lactation program (LP) might be related to the model used for PC. We conducted a retrospective analysis of BF at 6 weeks postpartum among all mothers whose neonates were admitted to JMC from 1/1/194 until 10/31/97 and did not need intensive care. Mothers were classified by choice of prenatal care (PNC) & BF education: group I, PNC at JMC with BF education sessions (BFES); group II, PNC at JMC without BFES; and group III, PNC elsewhere or no PNC. We compared three successive models of PC: model 1, PC provided by a full-time lactation coordinator (LC); model 2, PC provided by the LC and by obstetric personnel (ObP) trained by the LC; and model 3, PC provided by ObP and by the LC who then worked half-time at the LP, thereby halving its cost. The adjusted odds ratio (OR) of BF in group I vs group II was 5.4 (95% confidence interval 4.3-6.8) and that in group II vs group III was 2.0 (1.4-2.9). The incidence of BF increased from 19% in model 1 to 27% in model 2 (OR vs model 1, 1.7 [1.3-2.2]) and 23% in model 3 (OR vs model 1, 1.9 [1.4-2.5]; OR vs model 2, NS). In group I the incidence of BF was highest in model 2 (OR vs other models 1.2 [1.1-1.3]). In group II the incidence of BF was higher in models 2 and 3 than in model 1 (OR, 1.5[1.3-1.7] and 1.7 [1.4-2.0], respectively). In group III the incidence of BF remained low throughout the study (6-8%). Thus, BF was associated with PNC at JMC and with BFES. The LP appeared to be most cost-efficient when PC was given by trained ObP and by a half-time LC.
