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Review
. 2016 Sep 28;9(9):CD009067.
doi: 10.1002/14651858.CD009067.pub3.

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

Anne Fallon  1 , Deirdre Van der Putten, Cindy Dring, Edina H Moylett, Gerard Fealy, Declan Devane
Affiliations
Review

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

Anne Fallon et al. Cochrane Database Syst Rev. .

Abstract

Background: Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that women are provided with high-quality evidence to inform their feeding decisions.

Objectives: To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 February 2016), CINAHL (1981 to 23 February 2016), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (10 May 2016).

Selection criteria: We planned to include randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form would have been eligible for inclusion if sufficient data were available. Studies using a cross-over design would not have been eligible for inclusion.

Data collection and analysis: Two review authors independently assessed for inclusion all potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary.

Main results: No studies were identified that were eligible for inclusion in this review.

Authors' conclusions: This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns. It is recommended that no changes are made to current practice guidelines without undertaking robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Future exploratory research is needed on baby-led breastfeeding that takes the mother's perspective into consideration.

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Conflict of interest statement

Anne Fallon is an International Board Certified Lactation Consultant (IBCLC) and Health Research Board (Ireland) Cochrane Research Fellow.

Deirdre Van der Putten: none known.

Cindy Dring is a Leader with La Leche League International.

Edina H Moylett: none known.

Gerard Fealy: none known.

Declan Devane: none known.

Figures

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Study flow diagram.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009067.pub2

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References

References to studies excluded from this review

Carlsson 1978 {published data only}
    1. Carlsson SG, Fagerberg H, Horneman G, Hwang CP, Larsson K, Rodholm M, et al. Effects of amount of contact between mother and child on the mother's nursing behavior. Developmental Psychobiology 1978;11:143‐50. - PubMed
    1. Carlsson SG, Fagerberg H, Horneman G, Hwang CP, Larsson K, Rodholm M, et al. Effects of various amounts of contact between mother and child on the mother's nursing behavior: a follow‐up study. Infant Behaviour and Development 1979;2:209‐14. - PubMed
    1. Carlsson SG, Larsson K, Schaller J. Early mother‐child contact and nursing. Reproduction, Nutrition, Development 1980;20:881‐9. - PubMed
De Carvalho 1983 {published data only}
    1. Carvalho M, Robertson S, Friedman A, Klaus M. Effect of frequent breast‐feeding on early milk production and infant weight gain. Pediatrics 1983;72(3):307‐11. - PubMed
    1. Carvalho M, Robertson S, Klaus M. Does the duration and frequency of early breastfeeding affect nipple pain?. Birth 1984;11(2):81‐4. - PubMed
Gale 1989 {published data only}
    1. Gale R, Dollberg S, Branski D, Stevenson DK, Seidman DS. Breast‐feeding of term infants. Three‐hour vs four‐hour non‐demand. A randomized controlled reappraisal of hospital‐based feeding schedules. Clinical Pediatrics 1989;28(10):458‐60. - PubMed
Illingworth 1952 {published data only}
    1. Illingworth RS, Stone DGH, Jowett GH, Scott JF. Self‐demand feeding in a maternity unit. Lancet 1952;1:683‐7. - PubMed
Johnson 1976 {published data only}
    1. Johnson NW. Breast‐feeding at one hour of age. American Journal of Maternal Child Nursing 1976;1:12‐6. - PubMed
Maisels 1994 {published data only}
    1. Acquavita A, Vain N, Maisles MJ, Cohen A, Blanco N, Digregorio J. Effect of breast feeding frequency on serum bilirubin (SB) levels [abstract]. Pediatric Reserach 1991;30:390.
    1. Maisels J, Vain N, Acquavita AM, Blanco NV, Cohen A, DiGregorio J. The effect of breast‐feeding frequency on serum bilirubin levels. American Journal of Obstetrics and Gynecology 1994;170(3):880‐3. - PubMed
    1. Vain N, Acquavita AM, Maisels MJ, Blanco NV, Cohen A, Gregorio J. Effect of breast feeding frequency on serum bilirubin (SB) levels. Pediatric Research 1990;27(4):259A.
Ojofeitimi 1982 {published data only}
    1. Ojofeitimi EO, Elegbe IA. The effect of early initiation of colostrum feeding on proliferation of intestinal bacteria in neonates. Clinical Pediatrics 1982;21:39‐42. - PubMed
Pinilla 1993 {published data only}
    1. Pinilla T, Birch LL. Help me make it through the night: behavioral entrainment of breast‐fed infants' sleep patterns. Pediatrics 1993;91(2):436‐44. - PubMed
Salariya 1978 {published data only}
    1. Salariya EM, Easton PM, Cater JI. Duration of breast‐feeding after early initiation and frequent feeding. Lancet 1978;2(8100):1141‐3. - PubMed
    1. Salariya EM, Easton PM, Cater JI. Early and often for best results. RCT on breast feeding. Nursing Mirror 1979;148:15‐7. - PubMed
Slaven 1981 {published data only}
    1. Slaven S, Harvey D. Unlimited sucking time improves breast feeding. Lancet 1981;317(8216):392‐3. - PubMed

Additional references

Ahluwalia 2012
    1. Ahluwalia IB, Morrow B, D’Angelo D, Li R. Maternity care practices and breastfeeding experiences of women in different racial and ethnic groups: pregnancy risk assessment and monitoring system (PRAMS). Maternal and Child Health Journal 2012;16:1672–8. - PubMed
Brown 2016
    1. Brown A, Rance J, Bennett P. Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing 2016;72(2):273‐82. - PMC - PubMed
Callen 2004
    1. Callen J, Pinelli J. Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review. Birth 2004;31(4):285‐92. - PubMed
Carletti 2011
    1. Carletti C, Pani P, Knowles A, Monasta L, Montico M, Cattaneo A. Breastfeeding to 24 months of age in the northeast of Italy: a cohort study. Breastfeeding Medicine 2011;6(4):177‐82. - PubMed
Casiday 2004
    1. Casiday RE, Wright CM, Panter‐Brick C, Parkinson KN. Do early infant feeding patterns relate to breast‐feeding continuation and weight gain?. European Journal of Clinical Nutrition 2004;58:1290‐6. - PubMed
CDC 2013
    1. Centre for Disease Control and Prevention. Progress in increasing breastfeeding and reducing racial/ethnic dfferences‐United States, 2000‐2008 births. Morbidity and Mortality Weekly Report 2013;62(5):77‐90. - PMC - PubMed
CDC 2016
    1. Centre for Disease Control and Prevention. Breastfeeding among U.S. Children Born 2002‐2012, CDC National Immunization Surveys. www.cdc.gov/breastfeeding/data/nis_data/index.htm (accessed May 2016).
Crenshaw 2007
    1. Crenshaw J. Care practice #6: No separation of mother and baby, wIth unlimited opportunities for breastfeeding. Journal of Perinatal Education 2007;16(3):39‐43. - PMC - PubMed
Crowther 2009
    1. Crowther SM, Reynolds LA, Tansey EM (eds). The Resurgence of Breastfeeding, 1975‐2000. Wellcome Witnesses to Twentieth Century Medicine. Vol. 35, London: Wellcome Trust Centre for the History of Medicine at UCL, 2009.
Dykes 2005
    1. Dykes F. 'Supply' and 'demand': breastfeeding as labour. Social Science and Medicine 2005;60:2283‐93. - PubMed
Entwistle 2013
    1. Entwistle FM. The Evidence and Rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK, 2013.
Fildes 1986
    1. Fildes V. Breasts, Bottles and Babies a History of Infant Feeding. Edinburgh: Edinburgh University Press, 1986.
Ghosh 2006
    1. Ghosh R, Mascie‐Taylor N, Rosetta L. Longitudinal study of the frequency and duration of breastfeeding in rural Bangladeshi women. American Journal of Human Biology 2006;18:630‐8. - PubMed
Gionet 2013
    1. Gionet L. Statistics Canada, Heath at a Glance. Breastfeeding Trends in Canada. www.statcan.gc.ca/pub/82‐624‐x/2013001/article/11879‐eng.htm (accessed July 2016) 2013.
Graffy 2005
    1. Graffy J, Taylor J. What information, advice, and support do women want with breastfeeding?. Birth 2005;32(3):179‐86. - PubMed
Guo 2013
    1. Guo S, Fu X, Scherpbier RW, Wang Y, Zhou H, Wang X, et al. Breastfeeding rates in central and western China in 2010: implications for child and population health. Bulletin of the World Health Organization 2013;91:322‐31. - PMC - PubMed
Hawkins 2014
    1. Hawkins SS, Stern AD, Baum CF, Gillman MW. Compliance with the baby‐friendly hospital initiative and impact on breastfeeding rates. Archives of Disease in Childhood. Fetal and Neonatal Edition 2014;99:F138‐F145. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hinsliff‐Smith 2014
    1. Hinsliff‐Smith K, Spencer R, Wash D. Realities, difficulties and outcomes for mothers choosing to breastfeed: Primigravid mothers experiences in the early postpartum period (6‐8 weeks). Midwifery 2014;30:e14‐e19. - PubMed
Hoddinott 2012
    1. Hoddinott P, Craig, LCA, Britten J, McInnes RJ. A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2012;2:1‐14. - PMC - PubMed
Howe‐Hayman 2016
    1. Howe‐Hayman A, Lutenbacher M. The Baby‐Friendly Hospital Initiative as an Intervention to Improve breastfeeding rates: a review of the literature. Journal of Midwifery & Women's Health 2016;61(1):77‐102. - PubMed
Howel 2013
    1. Howel D, Ball H. Association between length of exclusive breastfeeding and subsequent breastfeeding continuation. Journal of Human Lactation 2013;29:579‐85. - PubMed
Häggkvist 2010
    1. Häggkvist AP, Brantsaester AL, Grjibovski AM, Helsing E, Meltzer HM, Haugen M. Prevalence of breastfeeding in Norwegian Mother and Child Cohort Study and health‐service correlates of cessation of full breastfeeding. Public Health Nutrition 2010;13(12):2076‐86. - PubMed
Jonas 2016
    1. Jonas W, Woodside B. Physiological mechanisms, behavioural and psychological factors influencing the transfer of milk from mothers to their young. Hormones and Behaviour 2016;77:167‐81. - PubMed
Kent 2006
    1. Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and frequency of breastfeeding and fat content of breast milk throughout the day. Pediatrics 2006;117(3):e387‐e395. - PubMed
Kent 2012
    1. Kent JC, Prime DK, Garbin CP. Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN 2012;41(1):114‐21. - PubMed
Kent 2015
    1. Kent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, et al. Nipple pain in breastfeeding mothers: incidence, causes and treatments. International Journal of Environmental Research and Public Health 2015;12:12247‐63. [DOI: 10.3390/ijerph121012247] - DOI - PMC - PubMed
Klaus 1987
    1. Klaus MH. The frequency of suckling. A neglected but essential ingredient of breast‐feeding. Obstetrics and Gynecology Clinics of North America 1987;14(3):623‐33. - PubMed
Kramer 2012
    1. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews 2012, Issue 8. [DOI: 10.1002/14651858.CD003517.pub2] - DOI - PMC - PubMed
Leonard 2000
    1. Leonard L. Breastfeeding triplets. The at‐home experience. Public Health Nursing 2000;17(3):211‐21. - PubMed
Leurer 2015
    1. Leurer MD, Misskey E. "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal 2015;10(10):2‐11. - PMC - PubMed
Mangesi 2016
    1. Mangesi L, Zakarija‐Grkovic I. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2016, Issue 6. [DOI: 10.1002/14651858.CD006946.pub3] - DOI - PMC - PubMed
Manz 1999
    1. Manz F, Van't Hof MA, Haschke F. The mother‐infant relationship: who controls breastfeeding frequency? Euro Growth Study Group. Lancet 1999;353:1152. - PubMed
Marshall 2007
    1. Marshall JL, Godfrey M, Renfrew MJ. Being a ‘good mother’: managing breastfeeding and merging identities. Social Science & Medicine 2007;65(10):2147‐59. - PubMed
McAndrew 2012
    1. McAndrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ. Infant Feeding Survey 2010. Health and Social Care Information Centre.
McClellan 2012
    1. McClellan HL, Hepworth AR, Kent JC, Garbin CP, Williams TM, Hartmann PE, et al. Breastfeeding frequency, milk volume, and duration in mother–infant dyads with persistent nipple pain. Breastfeeding Medicine 2012;7(4):275‐81. - PubMed
Motee 2013
    1. Motee A, Ramasawmy D, Pugo‐Gunsam P, Jeewon R. An assessment of the breastfeeding practices and infant feeding pattern among mothers in Mauritius. Journal of Nutrition and Metabolism, Article ID 243852, doi.org/10.1155/2013/243852 2013; Vol. 2013. - PMC - PubMed
Neovita Study Group 2016
    1. Neovita Study Group. Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials. Lancet 2016;4:e266‐e275. - PubMed
NICE 2010
    1. National Institute for Clinical Evidence. Jaundice in newborn babies under 28 days. National Institute for Clinical Evidence London 2010 (Updated 2016).
Nickel 2013
    1. Nickel NC, Labbok MH, Hudgens MG, Daniels JL. The extent that noncompliance with the ten steps of successful breastfeeding influences breastfeeding. Journal of Human Lactation 2013;29(1):59‐70. - PubMed
Oddie 2013
    1. Oddie SJ, Craven V, Deakin K, Westman J, Scally A. Severe neonatal hypernatraemia: a population based study. Archives of Disease in Childhood. Fetal and Neonatal Edition 2013;98:F384‐F387. - PubMed
OECD/WHO 2014
    1. OECD/WHO. Infant and Young Child Feeding. www.oecd‐ilibrary.org/social‐issues‐migration‐health/health‐at‐a‐glance‐asia‐paci... (accessed July 2016) 2014.
Ogburn 2011
    1. Ogburn T, Philipp BL, Epsey E, Merewood A, Espindola D. Assessment of breastfeeding information in general obstetrics and gynaecology textbooks. Journal of Human Lactation 2011;27(1):58‐62. - PubMed
Parry 2013
    1. Parry JE, Ip DKM, Chau PYK, Wu KM, Tarrant M. Predictors and consequences of in‐hospital formula supplementation for healthy breastfeeding newborns. Journal of Human Lactation 2013;29(4):527–36. - PubMed
Perrine 2012
    1. Perrine CG, Scanlon KS, Li R, Odom E, Grummer‐Strawn LM. Baby‐Friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics 2012;130(1):54‐60. - PMC - PubMed
Pierro 2016
    1. Pierro J, Abulaimoun B, Roth P, Blau J. Factors associated with supplemental formula feeding of breastfeeding infants during postpartum hospital stay. Breastfeeding Medicine 2016;11:196‐202. - PubMed
Prusova 2014
    1. Prusova K, Tyler A, Churcher L, Lokugamage U. Royal College of Obstetricians and Gynaecologists guidelines: How evidenced‐based are they?. Journal of Obstetrics and Gynaecology 2014;34(8):705‐11. [DOI: 10.3109/01443615.2014.920794] - DOI - PMC - PubMed
Putthakeo 2009
    1. Putthakeo P, Ali M, Ito C, Vilayhong P, Kuroiwa C. Factors influencing breastfeeding in children less than 2 years of age in Lao PDR. Journal of Paediatrics and Child Health 2009;45:487‐92. - PubMed
Renfrew 2005
    1. Renfrew M, Dyson L, Wallace L, D'Sousa L, McCormack F, Spiby H. The Effectiveness of Public Health Interventions to Promote the Duration of Breastfeeding: Systematic Review. 1st Edition. London: NICE, 2005.
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Schafer 2015
    1. Schafer R, Genna CW. Physiologic breastfeeding: a contemporary approach to breastfeeding initiation. Journal of Midwifery & Women's Health 2015;60(5):546‐53. - PubMed
Shloim 2015
    1. Shloim N, Hugh‐Jones S, Rudolf MCJ, Feltbower RG, Lans O, Hetherington MM. "It's like giving him a piece of me.": Exploring UK and Israeli women's accounts of motherhood and feeding. Appetite 2015;95:58‐66. - PubMed
Skafida 2012
    1. Skafida V. Juggling work and motherhood: the impact of employment and maternity leave on breastfeeding duration: a survival analysis on Growing Up in Scotland data. Maternal and Child Health Journal 2012;16(2):519‐27. - PubMed
Teich 2014
    1. Teich AS, Barnett J, Bonuck K. Women’s perceptions of breastfeeding barriers in early postpartum period: a qualitative analysis nested in two randomized controlled trials. Breastfeeding Medicine 2014;9(1):9‐14. - PMC - PubMed
Tierney 2005
    1. Tierney JF, Stewart LA. Investigating patient exclusion bias in meta‐analysis. International Journal of Epidemiology 2005;34:79‐87. - PubMed
Tin 2014
    1. Tin W. Defining neonatal hypoglycaemia: a continuing debate. Seminars in Fetal & Neonatal Medicine 2014;19:27‐32. - PubMed
Victoria 2016
    1. Victoria CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms and lifelong effect. Lancet 2016;387:475‐90. - PubMed
Watt 2013
    1. Watt J, Mead J. What paediatricians need to know about breastfeeding. Paediatrics and Child Health 2013;23(8):362‐6.
WHO 1998
    1. World Health Organization. Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization, 1998.
WHO 2001
    1. WHO. The Optimal Duration of Exclusive Breastfeeding. Report of an Expert Consultation. World Health Organization 2001.
WHO 2002
    1. WHO. Global Strategy on Infant and Young Child Feeding. WHO 2002. - PubMed
WHO 2008
    1. World Health Organization. Indicators for Assessing Infant and Young Child Feeding Practices. Part 1, Definitions. Geneva: World Health Organization, 2008.
WHO 2009
    1. World Health Organization and United Nations Children’s Fund. Baby Friendly Hospital Initiative Revised, Updated and Expanded for Integrated Care. Geneva: World Health Organization, 2009. - PubMed
WHO 2014
    1. WHO UNICEF. Global Nutrition Targets 2025. Breastfeeding Policy Brief. www.who.int/nutrition/publications/globaltargets2025_policybrief_breastf... (accessed July 2016) 2014.
Woolridge 2008
    1. Woolridge MW, Ingram JC. ‘‘Rigid’’ versus ‘‘baby‐led’’—no contest. Archives of Disease in Childhood 2008;93(4):353. - PubMed
Wright 2011
    1. Wright JD, Pawar N, Gonzalez JSR, Lewin SN, Burke WM, Simpson LL, et al. Scientific evidence underlying the American College of Obstetricians and Gynecologists’ Practice Bulletins. Obstetrics & Gynecology 2011;118(3):505‐12. - PubMed
Yotebieng 2015
    1. Yotebieng M, Labbok M, Soeters HM, Chalachala JL, Lapika B, Vitta BS, et al. Ten Steps to Successful Breastfeeding programme to promote early initiation and exclusive breastfeeding in DR Congo: a cluster‐randomised controlled trial. Lancet 2015;3(9):e546‐e555. - PubMed

References to other published versions of this review

Fallon 2014
    1. Fallon A, Putten D, Dring C, Moylett EH, Fealy G, Devane D. Baby‐led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews 2014, Issue 7. [DOI: 10.1002/14651858.CD009067.pub2] - DOI - PubMed

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