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NECOT: North East Cot Trial
A research project of the Department of Anthropology.
The project is funded by the following grants.
- New Data Collection Methodology (£5825.62 from Foundation for Study of Infant Deaths)
- RF170028: NIHR Research for the Patient Benefit Programme: NECOT Trial, £263,104, 2007-11-01 - 2011-09-30
NECOT final results
What we already knew
It is well known that close contact between mums and babies at night makes it easier to establish breastfeeding, and to continue breastfeeding for longer. Previous research done by the Parent-Infant Sleep Lab found that mums and babies using stand-alone cots during their postnatal stay in hospital breastfed much less frequently than those who used a side-car crib or had the baby in the mother's bed. It also suggested that mums who had their babies in a side car crib, during their postnatal stay in hospital, breastfed for longer than mums who had a standalone cot. Close contact allows the baby to suckle more frequently, which helps with initiation of breastfeeding, and also with establishing a good long-term milk supply.
What we aimed to find out
While we know that close contact is good for breastfeeding, some people have concerns about mums and babies sharing a bed, especially in the immediate postnatal period when mums may have had pain relief potentially affecting their awareness of the baby.
Our previous research had demonstrated with a sample of x that using a side-car crib instead of a stand-alone bassinette resulted in mums and babies interacting in the same way as if they were sharing the same bed. They also breastfed for significantly longer - more than twice as many 'side-car' mums than 'standalone crib' mums were still breastfeeding at 16 weeks. We wanted to find out if we would still obtain this result when the side-car cribs were used on a much larger scale.
The NECOT trial involved 1232 participants, all of whom thought they might breastfeed, and all recruited at the RVI, Newcastle. Participants were randomly assigned to receive either the side-car or standalone crib, and were then asked to report their infant feeding and sleeping data until their baby was 6 months old. Following dropouts from the trial we obtained data from 870 participants.
What we found
94% of mums started out breastfeeding their babies. By 7 weeks 75% were still breastfeeding and at 26 weeks 50% were still doing so. Despite finding a small increase in breastfeeding duration in the side-car crib group (both any and exclusive breastfeeding), this was not statistically significant. There were also no statistically significant differences between the two groups in terms of bed-sharing at home, and no differences emerged when length of hospital stay was taken into account. Some mums were not given the correct cot - to check whether or not this influenced the results, we re-ran the analyses using only participants who had received the right cot, and still there was no difference between the groups.
Given the results of our previous study, it was disappointing to find that in the NECOT trial there was no difference between the side-car and standalone groups in terms of how long they breastfed for after leaving hospital.
There are a number of reasons why we might have obtained this result.
Firstly, in our previous study participants were videoed through two nights stay on the postnatal ward. For this reason we knew exactly where the baby was during the night. During the NECOT trial, however, mums and babies were not filmed. It is possible that mums in the standalone cot group spent more time with their babies in bed with them (feeding, cuddling or sleeping), therefore masking any differences between the two conditions.
Secondly - because we saw increased breastfeeding rates in BOTH groups, compared to that reported in other studies - it is possible that the very act of asking mums to report their breastfeeding behaviour for 6 months resulted in them breastfeeding for longer in both groups than they would otherwise have done. The intervention - what had most effect - in this case may have actually been reporting of data, rather than type of crib.
Some of the NECOT participants, and hospital staff took part in interviews after the main trial to find out how mothers and staff felt about the use of side-car cribs. Mums were overwhelmingly in favour, but staff found them awkward to work around. The results of the interview study will be available later this year.
In order to tease apart some of the factors that may have influenced the NECOT results we are hoping to conduct another trial in Midwifery-led Units and to assess shorter breastfeeding outcomes using routinely collected data.