During the four years that I coordinated a hospital-based peer 
counseling program, I collated data on approx 1000 women. When we began 
the program, the avg age of weaning in the clinic was 2 weeks. By one 
year, the avg age of weaning was 4 months. This was among the most 
vulnerable population in one of the poorest cities in the US.

During the program, we looked closely at the components that had the 
most positive impact. We were very fortunate to have about 70% of our 
clients use the ped clinic, which was very supportive of our program. 
The head of the newborn nursery loved the peer counselors and so did 
the clinic peds.The OB staff was very unsupportive as a rule, but we 
had some fabulous nurses who made a lot of referrals.

The greatest improvements came from all of the things the recent study 
did not do--very early referrals and extensive prenatal contact and 
education, ongoing support (alll including home visits) for as long as 
the women breastfed, 24-hour a day phone support (with me available to 
my staff 24/7), teen groups for our teen moms (25% of the population), 
spanish-speaking PC's for the moms who requetsed one, subsidized 
nursing bras and slings and free rental pumps. Most importantly--we 
were embedded into the hospital. This meant that we had peer counselors 
do rounds every single day (except Christmas) and we saw every mother 
every day that she was in the hospital. Many of the nurses came to rely 
on the PC.s, but the PP floor was a love/hate relationship, to say the 
least. Our babies in NICU had the same support (ezxcept that the NICU 
staff was less supportive of the program, but as in all areas, we did 
have a few key very supportive nurses and docs).

I also trained the peer counselors as if they were going to be 
LCs--they had 20 hours of training, including counseling skills, then 3 
months supervised by a more experienced PC.  There was a similar 
program running at the same time that had a lot more support than ours, 
except that it was not hospital-based and the training was poor and the 
screening for staff was not stringent (all of my staff had to be 
currently breastfeeding or have bf a baby for at least one year)---the 
success rates were comparatively very low.

In my opinion, all of the above elements contributed greatly to our 
success, but the most important is that the women all came from the 
community in which they worked--had the same socio-economic status, 
lived in the same neighborhoods, etc. The PCs also brought their babies 
to the clinic and home visits. They only could not bring babies on 
rounds.

I have never seen a bridge that worked better than our model. Sadly, it 
was funded very much as a PR effort and it was the OB dept, not the Ped 
dept that had all the power. Empowered women tend to be much less 
threatening to peds than to OBs, in my observation and the Peer 
Counselors became VERY empowered, and in turn became catalysts to 
empower their clients. But, that's another story.

So, my own experience and data are convincing enough for me.
Jennifer Tow, IBCLC, CT, USA

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