Support for breastfeeding mothers

Britton C, McCormick FM, Renfrew MJ, Wade A, King SE

Published Online:

October 7, 2009

There is extensive evidence on the short-term and long-term health benefits of breastfeeding for infants and mothers. In 2003, the World Health Organization recommended that, wherever possible, infants should be fed exclusively on breast milk until six months of age. However, in some high-income countries, many mothers stop breastfeeding before they want to and this causes disappointment for the mothers and more health problems for the infants. This review looked at whether providing support for breastfeeding mothers, either from professionals, or from trained lay people, or both, would help mothers to continue to breastfeed. The review found 34 studies, from 14 countries, including almost 30,000 women. Both professional and lay support were effective, and together they were also effective, in areas where initiation and continuation of breastfeeding was not high. Further research is needed to identify the aspects of support that are the most effective.

Abstract (click to read)

Background:

There is extensive evidence of the benefits of breastfeeding for infants and mothers. In 2003, the World Health Organization (WHO) recommended infants be fed exclusively on breast milk until six months of age. However, breastfeeding rates in many developed countries continue to be resistant to change.

Objectives:

To assess the effectiveness of support for breastfeeding mothers.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2006), MEDLINE (1966 to November 2005), EMBASE (1974 to November 2005) and MIDIRS (1991 to September 2005).

We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 27 July 2009 and added the results to the awaiting classification section.

Selection criteria:

Randomised or quasi-randomised controlled trials comparing extra support for breastfeeding mothers with usual maternity care.

Data collection and analysis:

Two authors independently assessed trial quality and extracted data.

Main results:

We have included 34 trials (29,385 mother-infant pairs) from 14 countries. All forms of extra support analysed together showed an increase in duration of 'any breastfeeding' (includes partial and exclusive breastfeeding) (relative risk (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.86 to 0.96). All forms of extra support together had a larger effect on duration of exclusive breastfeeding than on any breastfeeding (RR 0.81, 95% CI 0.74 to 0.89). Lay and professional support together extended duration of any breastfeeding significantly (RR before 4-6 weeks 0.65, 95% 0.51 to 0.82; RR before 2 months 0.74, 95% CI 0.66 to 0.83). Exclusive breastfeeding was significantly prolonged with use of WHO/UNICEF training (RR 0.69, 95% CI 0.52 to 0.91). Maternal satisfaction was poorly reported.

Authors' conclusions:

Additional professional support was effective in prolonging any breastfeeding, but its effects on exclusive breastfeeding were less clear. WHO/UNICEF training courses appeared to be effective for professional training. Additional lay support was effective in prolonging exclusive breastfeeding, while its effects on duration of any breastfeeding were uncertain. Effective support offered by professionals and lay people together was specific to breastfeeding and was offered to women who had decided to breastfeed.

Further trials are required to assess the effectiveness (including cost-effectiveness) of both lay and professional support in different settings, particularly those with low rates of breastfeeding initiation, and for women who wish to breastfeed for longer than three months. Trials should consider timing and delivery of support interventions and relative effectiveness of intervention components, and should report women's views. Research into appropriate training for supporters (whether lay or professional) of breastfeeding mothers is also needed.

[Note: The 79 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

This record should be cited as:

Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001141. DOI: 10.1002/14651858.CD001141.pub3

Assessed as up to date:

November 9, 2006

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Lactation > Supporting breastfeeding mothers

Demographic:

Children

Women

Cochrane group topics: