Effect of breastfeeding counseling in rooming-in to prevent the use of artificial nipples among primiparous women: a secondary outcome of multicenter, randomized, parallel, and open-label clinical trial

Breastfeeding counseling is an effective public health intervention, and Rooming-in is considered a strategic location and time for this assistance. Breastfeeding process involves important factors that can negatively affect its continuation. The literature indicates that the use of artificial nipples is one of the factors associated with early interruption of breastfeeding. Thus, this study aims to analyze the effect of breastfeeding counseling among primiparous women, applied during the dyad’s hospitalization in Rooming-In, in preventing the use of artificial nipples, compared to standard care. This is a non-prespecified (post-hoc) secondary analysis of a randomized, multicenter, parallel, open-label clinical trial involving two Brazilian university hospitals. Between December 2023 and April 2024, 102 primiparous women with conditions and intentions favorable to breastfeeding were enrolled. After hospital discharge, telephone follow-up continued until the child was 6 months old, with the protocol ending in October 2024. Participants were randomized into two groups. In the intervention group, breastfeeding mothers received two to four sessions of breastfeeding counseling during their hospital stay. The control group received standard institutional care. Both groups received educational materials about the advantages of breastfeeding and where to seek help in case of complications. Outcomes were measured during telephone contacts, and no interventions were performed. Chi-square and Fisher’s exact tests were applied, considering a significance level of 5%. Prevalence ratios and their respective 95% confidence intervals were calculated. To assess the effect of breastfeeding counseling on preventing the use of artificial nipples, the Generalized Estimating Equations model was adopted. Most primiparous women were exclusively breastfeeding at discharge; however, less than half maintained this until six months of age, as recommended. The use of artificial nipples was frequent and significant from the first week of life, influencing the indicators of exclusive breastfeeding ( p < 0.001). Pacifiers were the most used nipple in the first weeks. However, a higher frequency of bottle feeding was observed from the first month of the child’s life. The results suggest a possible reduction in the use of artificial nipples with breastfeeding counseling (β = 1.13, 95% CI − 0.01 to 2.26, p = 0.05), with no evidence that this borderline effect varied over the follow-up period. Breastfeeding counseling was associated with a possible reduction in the use of artificial nipples with no evidence of variation across follow-up. This study was registered prospectively in The Brazilian Registry of Clinical Trials (ReBEC) “The Effect of Individualized Counseling on the duration of Exclusive Breastfeeding” RBR-4W9V5RQ on 3.20.2023.