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Meta-Analysis
. 2012 May 16;5(5):CD001141.
doi: 10.1002/14651858.CD001141.pub4.

Support for healthy breastfeeding mothers with healthy term babies

Mary J Renfrew  1 , Felicia M McCormick, Angela Wade, Beverley Quinn, Therese Dowswell
Affiliations
Meta-Analysis

Support for healthy breastfeeding mothers with healthy term babies

Mary J Renfrew et al. Cochrane Database Syst Rev. .

Update in

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.

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Figures

Figure 1
Figure 1
Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
Figure 2
Figure 2
Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Funnel plot of comparison: 1 All forms of support versus usual care, outcome: 1.1 Stopping breastfeeding (any) before last study assessment up to 6 months.
Figure 4
Figure 4
Funnel plot of comparison: 1 All forms of support versus usual care, outcome: 1.2 Stopping exclusive breastfeeding before last study assessment.
Figure 5
Figure 5
Funnel plot of comparison: 1 All forms of support versus usual care, outcome: 1.3 Stopping breastfeeding (any) at up to 4-6 weeks.
Figure 6
Figure 6
Funnel plot of comparison: 1 All forms of support versus usual care, outcome: 1.4 Stopping exclusive breastfeeding at up to 4-6 weeks.
See this image and copyright information in PMC

Update of

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