The Impact of Antenatal Lactation Counseling on Breastfeeding Practices and Newborn Feeding Behavior Among Primipara Mothers Attending a Tertiary Care Hospital in Puducherry, India: A Randomized Controlled Trial

Introduction Although human milk provides unparalleled immunobiological and nutritional advantages essential for optimal neonatal development, the establishment of successful lactogenesis and sustained breastfeeding remains a complex psychophysiological challenge, particularly for primiparous mothers. First-time parturients frequently encounter biomechanical difficulties, such as suboptimal infant positioning and latch, which are compounded by postnatal anxiety. These factors can disrupt oxytocin-mediated milk let-down and precipitate disorganized neurobehavioral feeding reflexes in the newborn. Traditional postnatal lactation support is often reactive, administered during a period of high maternal fatigue and physiological stress. Therefore, structured antenatal lactation counseling emerges as a critical, proactive intervention designed to enhance maternal self-efficacy, provide anticipatory guidance, and mitigate the early introduction of prelacteal feeds. This randomized controlled trial (RCT) aimed to empirically validate this paradigm shift within a localized, high-volume clinical setting. It sought to investigate the effectiveness of targeted antenatal lactation counseling on both maternal breastfeeding practices and newborn feeding behaviors among primiparous mothers attending a tertiary care hospital in Puducherry, ultimately seeking to optimize perinatal care protocols through rigorous, evidence-based intervention. Methods An RCT was conducted with 130 primiparous women aged 18 to 35 years who had completed 32 weeks of gestation and delivered at term. A group counseling technique was used for the intervention group, wherein groups of five mothers received 30-minute antenatal lactation counseling sessions during antenatal visits. The lactation counseling on breastfeeding was repeated three times at 32, 34, and 36 weeks of gestation, while the control group received only routine care. Breastfeeding practices and newborn feeding behavior were assessed using a structured breastfeeding practices checklist and the Infant Breastfeeding Assessment Tool (IBFAT) on the second postnatal day. Results Baseline variables did not differ significantly between the groups. The intervention group showed significantly better breastfeeding practices (t = 5.384, p = 0.000) and newborn feeding behavior (t = 3.22, p = 0.02). Breast engorgement was lower in the intervention group, though the difference was not statistically significant. Conclusions Based on our findings, proper lactation counseling provided to primiparous mothers at each contact point during antenatal visits improves breastfeeding practices and promotes optimal newborn feeding behavior.