Interventions for promoting the initiation of breastfeeding

Abstract

BACKGROUND: Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups. OBJECTIVE: To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed. METHODS: Data collection and analysis:One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information. MAIN RESULTS: Main results: Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needsbased, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding in the USA (RR 4.02, 95% CI 2.63 to 6.14, P < 0.00001). AUTHORS' CONCLUSIONS:This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Findings from these studies suggest that larger increases are likely to result from needs-based, informal repeat education sessions than more generic, formal antenatal sessions. These findings are based only on studies conducted in the USA, among women on low incomes with varied ethnicity and feeding intention, and this raises some questions regarding generalisability to other settings.This is the abstract of a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2005, issue 2,

Early lactation failure and formula adoption after elective caesarean delivery: cohort study

“…As stated in the Cochrane Database of Systematic Reviews 2005 concerning interventions to promote breastfeeding: ‘initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups’ 23. Additional studies in high-income and low-income populations are of course warranted.…”

Being baby friendly: evidence-based breastfeeding support

“…A Cochrane review and meta-analysis of randomised controlled trials of breastfeeding education for low-income women showed a significantly higher rate of breastfeeding initiation compared with standard care (risk ratio 1.57, 95% CI 1.15 to 2.15). For every 100 women receiving education, 20 more women initiated breast feeding 13. Subgroup analyses suggested that one-to-one, needs-based, informal repeat education sessions were more effective than generic, formal antenatal education sessions.…”

Prenatal care

“…Prenatal education directed at specific objectives (e.g., promoting breastfeeding and avoiding planned induction of labor) has been demonstrated to be effective (77,78). Individualized prenatal education directed toward avoidance of a cesarean delivery does not increase the rate of vaginal birth after cesarean section (79).…”

“…27). Counseling and education during pregnancy have been shown to facilitate breastfeeding success (77). Attitudes of the health care provider are highly associated with breastfeeding success.…”