Results

A total of 130 primipara mothers were randomized to the study. After attrition during follow-up, 105 mothers completed the study and were included in the final analysis, comprising 56 mothers in the intervention group and 49 mothers in the control group. The baseline demographic and clinical characteristics of the participants are presented in Table 1. The majority of mothers in both groups were aged 24-29 years (55.4% vs. 53.1%). None of the participants lacked formal education, and most had completed a diploma or higher qualification (60.7% vs. 69.4%). Homemakers constituted the majority of participants in both groups (87.5% vs. 91.8%). Approximately half of the participants had been married for one to three years, belonged to joint families, and reported a monthly family income below ₹10,000. Around three-quarters had not previously received breastfeeding information. Among those who had, healthcare professionals were the most common source. Overall, the two groups were comparable at baseline (Table 1).

Sl. No | Demographic and clinical variables | Intervention (n = 56), n (%) | Control (n = 49), n (%)
1 | Age group, years
18-23 | 18 (32.1) | 13 (26.5)
24-29 | 31 (55.4) | 26 (53.1)
30-35 | 7 (12.5) | 10 (20.4)
2 | Education
No formal education | 0 (0.0) | 0 (0.0)
Up to higher secondary | 22 (39.3) | 15 (30.6)
Diploma and above | 34 (60.7) | 34 (69.4)
3 | Occupation
Homemakers | 49 (87.5) | 45 (91.8)
Employed | 7 (12.5) | 4 (8.2)
4 | Duration of marriage, years
< 1 | 13 (23.2) | 9 (18.4)
1-3 | 28 (50.0) | 28 (57.1)
3-5 | 10 (17.9) | 7 (14.3)
> 5 | 5 (8.9) | 5 (10.2)
5 | Type of family
Joint | 37 (66.1) | 36 (73.5)
Nuclear | 19 (33.9) | 13 (26.5)
6 | Family monthly income, INR
< 10,000 | 32 (57.1) | 34 (69.4)
10,000-20,000 | 16 (28.6) | 9 (18.4)
> 20,000 | 8 (14.3) | 6 (12.2)
7 | Information obtained regarding breastfeeding practices previously
Yes | 14 (25.0) | 11 (22.4)
No | 42 (75.0) | 38 (77.6)
8 | Source of information
Family members | 4 (7.8) | 3 (6.1)
Healthcare professionals | 10 (19.6) | 8 (16.3)
Mass media | 0 (0.0) | 0 (0.0)

The breastfeeding practices of the mothers are presented in Table 2. Most primipara mothers, 78.6% in the intervention group and 73.5% in the control group, initiated breastfeeding within one hour. No participants discarded colostrum or gave prelacteal feeds in either group. In the intervention group, all the primipara mothers remained calm and relaxed while breastfeeding, took adequate water and food before breastfeeding, and fed their babies every two hours, whereas in the control group, almost all the primipara mothers (48, 98.0%) remained calm while breastfeeding, the majority of them (44, 89.8%) took adequate water and food before breastfeeding, and 46 (93.9%) fed their babies every two hours (Table 2).

Sl. No. | Items | Intervention (n = 56), no, n (%) | Intervention (n = 56), yes, n (%) | Control (n = 49), no, n (%) | Control (n = 49), yes, n (%)
1 | Did you initiate breastfeeding within one hour? | 12 (21.4) | 44 (78.6) | 13 (26.5) | 36 (73.5)
2 | Did you give the colostrum to your baby? | 0 (0) | 56 (100.0) | 0 (0) | 49 (100.0)
3 | Did you give your baby honey, plain water, sugar water, or other milk? | 56 (100.0) | 0 (0) | 49 (100.0) | 0 (0)
4 | Do you remain calm and relaxed while breastfeeding your baby? | 0 (0) | 56 (100.0) | 1 (2.0) | 48 (98.0)
5 | Did you take adequate water and food before breastfeeding? | 0 (0) | 56 (100.0) | 5 (10.2) | 44 (89.8)
6 | Did you sit comfortably with your back straight while breastfeeding? | 3 (5.4) | 53 (94.6) | 7 (14.3) | 42 (85.7)
7 | Do you keep the baby's head, neck, and body in the same plane? | 3 (5.4) | 53 (94.6) | 6 (12.2) | 43 (87.8)
8 | Do you ensure the baby's mouth widens, and the majority of the areola is inside the baby's mouth while breastfeeding? | 1 (1.8) | 55 (98.2) | 6 (12.2) | 43 (87.8)
9 | Do you allow the baby to feed on one breast till the baby stops sucking and releases the breast? | 5 (8.9) | 51 (91.1) | 9 (18.4) | 40 (81.6)
10 | Do you burp the baby immediately after breastfeeding? | 3 (5.4) | 53 (94.6) | 7 (14.3) | 42 (85.7)
11 | Do you offer the other breast for the next feed? | 6 (10.7) | 50 (89.3) | 8 (16.3) | 41 (83.7)
12 | Do you clean your breasts each time before and after feeding the baby? | 1 (1.8) | 55 (98.2) | 2 (4.1) | 47 (95.9)
13 | Do you breastfeed your baby every 2 hours? | 0 (0) | 56 (100.0) | 3 (6.1) | 46 (93.9)
14 | Do you breastfeed your baby on demand during the day and night? | 2 (3.6) | 54 (96.4) | 2 (4.1) | 47 (95.9)
15 | Is the baby able to establish an effective sucking pattern on both breasts (initial rapid sucks, then slower sucks with pauses)? | 4 (7.1) | 52 (92.9) | 4 (8.2) | 45 (91.8)
16 | Do you use artificial pacifiers or teats for your baby? | 56 (100.0) | 0 (0) | 49 (100.0) | 0 (0)
17 | Do you monitor the urine frequency and pattern of sleep after each feed to assess the adequacy of milk intake? | 4 (7.1) | 52 (92.9) | 8 (16.3) | 41 (83.7)

The overall breastfeeding practice scores are presented in Table 3. None of the mothers in either group demonstrated poor breastfeeding practices. Good breastfeeding practices were observed in 96.4% of the intervention group compared to 71.4% of the control group. The mean breastfeeding practice score was significantly higher in the intervention group than in the control group (16.17 ± 1.40 vs. 14.51 ± 1.76; t = 5.384, df = 103, p < 0.001), indicating that antenatal lactation counseling significantly improved breastfeeding practices among primipara mothers (Table 3).

Level of breastfeeding practice (score) | Intervention (n = 56), n (%) | Intervention (n = 56), mean ± SD | Control (n = 49), n (%) | Control (n = 49), mean ± SD | df | t-value | P-value
Poor practice (0-7) | 0 (0) | 16.17 ± 1.40 | 0 (0) | 14.51 ± 1.76 | 103 | 5.384 | 0.000*
Fair practice (8-12) | 2 (3.6) | 9 (16.1)
Good practice (13-17) | 54 (96.4) | 40 (71.4)

The newborn feeding behavior scores are presented in Table 4. Vigorous and effective feeding was observed in 91.1% of newborns in the intervention group compared to 62.5% in the control group. Moderately effective feeding was observed in 8.9% and 25.0% of newborns, respectively, while no newborn demonstrated poor feeding behavior. The mean feeding behavior score was significantly higher in the intervention group (11.55 ± 1.67) than in the control group (11.44 ± 1.15) (t = 3.221, df = 103, p = 0.002), demonstrating the effectiveness of antenatal lactation counseling (Table 4).

Level of newborn feeding behavior (score) | Intervention (n = 56), n (%) | Intervention (n = 56), mean ± SD | Control (n = 49), n (%) | Control (n = 49), mean ± SD | df | t-value | P-value
Poor feeding (0-6) | 0 (0) | 11.55 ± 1.67 | 0 (0) | 11.44 ± 1.15 | 103 | 3.221 | 0.002*
Moderately effective feeding (7-9) | 5 (8.9) | 14 (25)
Vigorous effective feeding (10-12) | 51 (91.1) | 35 (62.5)

The incidence of breast engorgement is presented in Table 5. In the intervention group, the majority of the primipara mothers (53, 94.6%) had no breast engorgement. Very few of them (3, 5.4%) had breast engorgement, whereas in the control group, 42 (75%) had no breast engorgement, and seven (12.5%) had breast engorgement; breast engorgement was less prevalent in the intervention group. However, the difference was not statistically significant (Table 5). The intervention group showed significant improvement in breastfeeding practices (t = 5.384, p = 0.00) and newborn feeding behavior (t = 3.22, p = 0.02), proving that antenatal lactation counseling effectively improves breastfeeding practices and newborn feeding behavior (Tables 3-4).

Presence of breast engorgement (score) | Intervention (n = 56), n (%) | Intervention (n = 56), mean ± SD | Control (n = 49), n (%) | Control (n = 49), mean ± SD | df | t-value | P-value
No | 53 (94.6) | 0.05 ± 0.22 | 42 (75) | 0.14 ± 0.35 | 103 | 1.550 | 0.122*
Yes | 3 (5.4) | 7 (12.5)