Interventions to promote breastfeeding: Updated recommendations

Prepared  by V.A. Palda, MD, MSc, FRCPC, J-M. Guise, MD, MPH, and C.N. Wathen, MA, with the Canadian Task Force on Preventive Health Care

These recommendations were finalized by the Task Force in February 2003.

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION
Education programs and postpartum support to promote breastfeeding* Structured antepartum breastfeeding education improves both initiation and continuation of short term breastfeeding rates post-partum, compared to usual care.*

In-person or telephone support strengthens the effect of education by an additional 5-10% increase in breastfeeding initiation and short-term duration.

In-person or telephone support by itself may increase both short- and long-term breastfeeding rates.

 Education:

Level I - Fair <Duffy, Percival & Kershaw, 1997; Pugh & Milligan, 1998; Hill, 1987; Kistin, Benton & Rao, 1990; Brent et al., 1995; Redman et al., 1995>

Level I - Poor <Sciacca et al., 1995; McEnery & Rao, 1986; Rossiter, 1994; Wiles, 1984; Reifsnider & Eckhart, 1997>

Education & Support:

Level I - Fair <Pugh & Milligan, 1998; Brent et al., 1995; Redman et al., 1995; Oakley & Rajan, 1990; Frank et al., 1987; Serafino-Cross & Donovan, 1992>

Level I - Poor <Sciacca et al., 1995; Jones & West, 1985>

 There is good evidence to recommend providing structured antepartum educational programs and postpartum support1 to promote breastfeeding initiation and duration (A recommendation).
Peer counselling to promote breastfeeding. Significant effect from peer counsellors on breastfeeding rates and duration. Level I - Fair <Dennis et al., 2002>

Level I - Poor <Sciacca et al., 1995>

Level II-1 - Poor <Caulfield et al., 1998; Schafer et al., 1998; Kistin, Abramson & Dublin, 1994; McInnes, Love & Stone, 2000>

 

 There is fair evidence to recommend peer counselling to promote initiation and maintenance of breastfeeding (B recommendation).
Provision of written materials to new mothers to promote breastfeeding. There is not benefit when written materials are used alone. Level I - Good <Curro et al., 1997>

Level I - Fair <Hill, 1987; Redman et al., 1995; Frank et al., 1987>

Level I - Poor <Rossiter, 1994; Kaplowitz & Olson, 1983; Loh et al., 1997; Grossman et al., 1990>

 There is good evidence to recommend against providing written materials alone to promote breastfeeding (D recommendation).
Primary caregiver advice to expectant or new mothers to promote breastfeeding. Unknown. No studies found. There is insufficient evidence to make a recommendation regarding advice by primary caregivers to promote breastfeeding (I recommendation).
Provision of commercial discharge packages to new mothers. Women receiving commercial discharge packages had decreased breastfeeding rates compared to patients not receiving packages. Level I (Systematic Review) - Good <Donnelly et al., 2001> There is good evidence to recommend against providing commercial discharge packages to new mothers (E recommendation).
Rooming-in and early maternal contact to promote breastfeeding. The sole new study of rooming-in included multiple interventions and does not allow drawing conclusions.

Insufficient new data regarding early maternal contact.

 Level I - Fair/Poor <Winikoff et al., 1987>

Level I (individual studies and meta-analysis) - Fair/Poor  <deChateau & Winberg, 1977; Salariya, Easton & Cater, 1978; Thomson, Hartsock & Larson, 1979; Taylor, Maloni & Taylor, 1985>

 There is no new evidence of compelling quality to overturn the earlier published A recommendations <Wang, 1994>  regarding rooming-in or maternal contact to promote breastfeeding.

*In the studies reviewed, these interventions were usually provided in the clinical setting by lactation specialists or nurses, and consisted of individual or group instruction about breastfeeding knowledge, practical skills and problem-solving techniques.