Open Access Study protocol

The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial

Jenny Ericson123*, Mats Eriksson45, Lena Hellström-Westas1, Lars Hagberg45, Pat Hoddinott6 and Renée Flacking178

Author Affiliations

1 Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

2 Centre for Clinical Research Dalarna, Nissersväg 3, Falun, S-79182, Sweden

3 Department of Pediatrics, Falu Hospital, Falun, Sweden

4 School of Health and Medical Sciences, Örebro University, Örebro, Sweden

5 Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden

6 Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, Scotland

7 School of Health and Social Studies, Dalarna University, Falun, Sweden

8 Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, UK

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BMC Pediatrics 2013, 13:73  doi:10.1186/1471-2431-13-73

Published: 10 May 2013



Although breast milk has numerous benefits for infants’ development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers’ sense of trust in their own capacity and thereby facilitate breastfeeding.


A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff.


This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed.

Trial registration


Breastfeeding; Mothers; Neonatal care; Preterm infant; Support; Telephone