Interventions supporting medical practitioners in the provision of lactation care: A systematic review and narrative analysis

Abstract

Most children globally are not breastfed to recommendations. Medical practitioners are frequently visited in the first 6 months post-partum, and the interaction at such visits significantly influences subsequent infant feeding decisions. Medical practitioners report that clinical practice in lactation is often disproportionately reliant on personal experience. This systematic review synthesises the literature on lactation health interventions used to support clinical decision making by medical practitioners. MEDLINE, Embase, PsycINFO, Scopus and Cochrane Library databases were searched for peer-reviewed empirical studies published after 2000. Two reviewers independently screened and then assessed full-text articles against inclusion criteria. Quality of reporting and risk of bias were independently assessed using three validated tools. No conclusions can be made regarding the success or failure of implementation strategies used or the outcomes of putting them into effect due to problems with study methodology, intervention reporting and risk of bias.Good-quality research, which follows proven implementation frameworks, is needed to guide and sustain the incorporation of evidence-based decision support into medical practitioners' care of breastfeeding mothers and infants.

Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

“…However, most significantly, there is little evidence to support the therapeutic efficacy of the range of fit and hold, or latch and positioning, interventions commonly applied by International Board Lactation Consultants or other health professionals, and these approaches remain predominantly experience or opinion based. 8 – 11 …”

“…However, most significantly, there is little evidence to support the therapeutic efficacy of the range of fit and hold, or latch and positioning, interventions commonly applied by International Board Lactation Consultants or other health professionals, and these approaches remain predominantly experience or opinion based. [8][9][10][11] The physiologic approach to breastfeeding initiation, including skin-to-skin contact postpartum, has been a Box 1. The treatment of oral thrush in infants and painful breast and nipples in lactating mothers in an era of antifungal stewardship.…”

“…Much of what is offered women with breastfeeding difficulty, including interventions for fit and hold (also known as latch and positioning), is based on experience or opinion. 8 – 11 The popularly used cross-cradle hold with the other hand shaping the breast, for example, has been shown to increase the risk of nipple pain. 12 When women are taught baby-led or laid-back breastfeeding in hospital immediately after the birth (also known as skin-to-skin or the physiologic initiation of breastfeeding), the incidence of nipple pain and damage decreases.…”

Re-thinking lactation-related nipple pain and damage

“…107 Much of what is offered women with breastfeeding difficulty, including interventions for fit and hold, is based upon experience or opinion ( Box 8 ). 2 , 108 – 111 In 2016, Thompson et al demonstrated in a retrospective analysis of the medical records of 635 mother–baby pairs that symmetrical apposition of the infant’s chin, cheeks and nose against the breast decreased nipple pain fourfold, compared with cross-cradle hold in which the mother used one hand to shape her breast as she brought the baby on. Although this study elucidated one aspect of fit and hold required to optimize intra-oral breast tissue volume, it does not offer explanatory biomechanical models or develop an evidence-base for a fit and hold intervention.…”

Breastfeeding and Human Lactation Curriculum Survey of Midwifery Programs in the United States

“…Recent studies have indicated an increased focus on providing lactation education to health care providers 13,14 and have demonstrated that increased education can improve both the knowledge of breastfeeding management as well as impact attitudes toward breastfeeding support 15 . Many health care providers, however, continue to rely upon their own experiences rather than current evidence for clinical decision making when providing lactation support 16 …”