Support for healthy breastfeeding mothers with healthy term babies

Mother and Infant Research Unit, Department of Health Sciences, University of York, York, UK.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 05/2012; 5(5):CD001141. DOI: 10.1002/14651858.CD001141.pub4
Source: PubMed


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.
To assess the effectiveness of support for breastfeeding mothers.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (3 October 2011).
Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care.
Two review authors independently assessed trial quality and extracted data.
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.
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.

    • "foods are introduced to alleviate sole responsibility of feeding , to modify behaviour or to attempt to counteract frequent demands for feeding e . g . for non - nutritious reasons . Introduction is often at an earlier stage than the current DoH guid - ance even though typically knowledge of guidelines is high among mothers ( Moore et al . 2012b ; Renfrew et al . 2012 ) . Although much debate surrounds whether ' around twenty - six weeks ' is the most appro - priate time to introduce solid foods , most agree than introducing solid foods before 4 months is detrimen - tal to infant health ( Agostoni et al . 2008 ; Schwartz et al . 2011 ) . Moving away from age , introduction of solid foods should be re"
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    ABSTRACT: The current UK Department of Health advice is to introduce solid foods to infants at around 6 months of age, when the infant is showing signs of developmental readiness for solid foods. However, many mothers introduce solid foods before this time, and for a wide variety of reasons, some of which may not promote healthy outcomes. The aim of the current study was to examine infant and maternal characteristics associated with different reasons for introducing solid foods. Seven hundred fifty-six mothers with an infant aged 6-12 months old completed a questionnaire describing their main reason for introducing solid foods alongside demographic questions, infant weight, gender, breast/formula feeding and timing of introduction to solid foods. The majority of mothers introduced solid foods for reasons explicitly stated in the Department of Health advice as not signs of readiness for solid foods. These reasons centred on perceived infant lack of sleep, hunger or unsettled behaviour. Maternal age, education and parity, infant weight and gender and breast/formula feeding choices were all associated with reasons for introduction. A particular association was found between breastfeeding and perceiving the infant to be hungrier or needing more than milk could offer. Male infants were perceived as hungry and needing more energy than female infants. Notably, signs of readiness may be misinterpreted with some stating this reason for infants weaned prior to 16 weeks. The findings are important for those working to support and educate new parents with the introduction of solid foods in understanding the factors that might influence them. © 2015 John Wiley & Sons Ltd.
    No preview · Article · Feb 2015 · Maternal and Child Nutrition
    • "Another randomised study of Sydney disadvantaged mothers found positive benefits of a home visit programme included higher median breast-feeding rates (Wen et al., 2011). Perhaps the systematic review of 51 international studies performed by Renfrew et al. (2012) demonstrates the strongest evidence of the importance of support in the early postnatal period finding the assistance given by both professionals and lay champions had a positive impact on breast feeding outcomes thus increasing the duration of both exclusive and non-exclusive breast feeding. This report forms part of a mixed methods multi-phase study that explored resources and services available to women regarding the establishment and continuation of breast feeding who reside in an outer metropolitan region south east of Melbourne. "
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    ABSTRACT: Objective to explore the views of midwives and maternal–child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration. Design a focus group study. Setting hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia. Methods twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified. Findings four key themes were: ‘Guiding women over breast-feeding hurdles’, ‘Timing, and time to care’; ‘Continuity of women’s care’ and ‘Imparting professional knowledge’. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to enable women to initiate and continue breast feeding. Community-based MCH nurses reported time gaps in uptake of new mother referrals and time-pressured face-to-face consultations. Both groups perceived barriers to continuity of women’s care. Conclusions health services subscribe to the Baby Friendly Health Initiative and government policies which support breast feeding, however providers described time pressures and a lack of continuity of women’s care, including during transition from hospital to community services. Implications for practice there is a need to examine administration of service delivery and how domiciliary and community nurses can collaborate to establish and maintain supportive relationships with breast feeding women.
    No preview · Article · Oct 2014 · Midwifery
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    • "In their Cochrane review, Renfrew et al. highlighted the importance of context on treatment effects and that non-proactive support was unlikely to be effective [20]. The systematic review also shows that all forms of extra breastfeeding support influence the duration of breastfeeding positively up to six months after birth [20]. Wambach et al. indicated in their summary of 20 years of evidence, that more research is needed to prevent and treat the most common breastfeeding problem reported by women: insufficient breast milk [11]. "
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    ABSTRACT: Background: The World Health Organization recommends promoting exclusive breastfeeding for six months. Women often end breastfeeding earlier than planned, however women who continue to breastfeed despite problems often experience good support and counselling from health professionals. The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, on women's satisfaction with breastfeeding counselling, problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months. Methods: An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. This study was conducted in Sweden, in 2000 - 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n = 540) were invited to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n = 162) started before the intervention was initiated. Data for control group B (n = 172) were collected simultaneously with the intervention group (IG) (n = 206). Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months. Results: Women in IG were more satisfied with the breastfeeding counselling (p = 0.008) and felt the breastfeeding counselling was more coherent (p = 0.002) compared to control groups, when exclusive breastfeeding was < 3 months.
    Full-text · Article · Sep 2014 · International Breastfeeding Journal
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