Support for healthy breastfeeding mothers with healthy term babies

Abstract

Background There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended infants be exclusively breastfed until six months of age, with breastfeeding continuing as an important part of the infant’s diet till at least two years of age. However, breastfeeding rates in many countries currently do not reflect this recommendation. Objectives To assess the effectiveness of support for breastfeeding mothers. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (3 October 2011). Selection criteria Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Main results Of the 67 studies that we assessed as eligible for inclusion, 52 contributed outcome data to the review (56,451 mother-infant pairs) from 21 countries. All forms of extra support analysed together showed an increase in duration of ‘any breastfeeding’ (includes partial and exclusive breastfeeding) (risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.96). All forms of extra support together also had a positive effect on duration of exclusive breastfeeding (RR at six months 0.86, 95% CI 0.82 to 0.91; RR at four to six weeks 0.74, 95% CI 0.61 to 0.89). Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Maternal satisfaction was poorly reported. Authors’ conclusions All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. Support is likely to be more effective in settings with high initiation rates, so efforts to increase the uptake of breastfeeding should be in place. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed. Support that is only offered reactively, in which women are expected to initiate the contact, is unlikely to be effective; women should be offered ongoing visits on a scheduled basis so they can predict that support will be available. Support should be tailored to the needs of the setting and the population group.

Factors influencing the reasons why mothers stop breastfeeding

“…A recent Cochrane review of support for breastfeeding mothers with healthy term babies found that support from both professionals and lay supporters increased the duration; however, support offered reactively, which was initiated only after women sought out contact instead of on an ongoing, scheduled basis, was not effective. 24 They concluded that face-to-face support at scheduled visits was optimal.…”

Evaluating the impact of provider breastfeeding encouragement timing: Evidence from a large population-based study

“…[1] Mistrust of health care providers among Black women is well-documented and has been correlated with inadequate access to continuous care. [21] Renfrew MJ, et al [22] pointed out that when breastfeeding support is only offered reactively and women have to initiate the contact, it is unlikely to be effective. The reverse is also true.…”

“…A 2012 Cochrane Review of 52 randomized breastfeeding support trials (totaling 56,451 women) found that mothers who were encouraged by health care providers to breastfeed were less likely to stop breastfeeding at four months after birth. [7] "Encouragement" was defined broadly to include reassurance, praise, information, the opportunity to discuss and respond to mothers' questions, and staff training. Study neither identified nor addressed the optimal timing of provider encouragement.…”

ABM Clinical Protocol #5: Peripartum Breastfeeding Management for the Healthy Mother and Infant at Term, Revision 2013

“…At the same time, from a staffing standpoint, nursing personnel should arrange for time to be available to assess and document the status of the infant and infant feeding while the baby is in the family's room. 5,10,41,45,46 (I, II-3, III) 4. Women may need help from healthcare providers to ensure that they are able to position and attach their babies at the breast.…”

“…(I, III) Peer-to-peer support should also be offered and has been proven to be helpful in promoting breastfeeding success. 16,46 (I, I-2)…”