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Support for healthy breastfeeding mothers with healthy term babies

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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.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Support for breastfeeding mothers

The World Health Organization recommends that infants should 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. This is because there is extensive evidence on the short‐term and long‐term health risks of not breastfeeding for both infants and their mothers. Many mothers stop breastfeeding before they want to as a result of problems, many of which are preventable with good care and support. This premature discontinuation may cause disappointment and distress for the mothers and health problems for both themselves and their infants. Support for breastfeeding can include giving reassurance, praise, information, and the opportunity to discuss and to respond to a mother’s questions. This review looked at whether providing extra support for breastfeeding mothers, from professionals or from trained lay people or both, would help mothers to continue to breastfeed when compared with providing standard maternity care. The review found 52 randomised controlled studies from 21 countries that included more than 56,000 women. All forms of extra support, analysed together, showed an increase in the length of time women continued to breastfeed and the length of time women breastfed without introducing any other types of liquids or foods. Support by both lay supporters and professionals had a positive impact on breastfeeding outcomes. Face‐to‐face support was associated with a larger treatment effect than telephone support. Support that is only offered if women seek help is unlikely to be effective. This indicates that women should be offered predictable, scheduled, ongoing visits. Interventions providing extra support had a more pronounced effect when background rates of breastfeeding initiation were high. Women's views about support interventions were not well reported in these studies. Support should be tailored to the setting and the needs of the population group. Further research is needed to identify the aspects of support that are the most effective.