Timothy Mott, MD Mark Wirtz, MD Naval Hospital Pensacola, Fla
Joan Nashelsky, MLS University of Iowa, Iowa City
DEPUTY EDITOR E. Chris Vincent, MD Swedish Family Medicine Residency (First Hill), Seattle, Wash
The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Navy Medical Department, the US Navy at large, or the Department of Defense.
Breastfeeding support, beyond standard care, from lay people or professionals increases both short- and long-term breastfeeding duration (strength of recommendation: B, meta-analyses of randomized controlled trials [RCTs] with demonstrated heterogeneity).
A 2012 Cochrane review of 52 studies (44 RCTs and 8 cluster-randomized trials; N=56,451) assessed the overall effectiveness of multiple supportive measures on decreasing cessation of “any” (partial and exclusive) and “exclusive” breastfeeding compared with usual care.1 Participants were healthy breastfeeding mothers of healthy term babies. Support interventions were defined broadly but included individual and group interactions, as well as contact in person or over the phone by professionals or lay volunteers. Patients were approached proactively or reactively upon request, and the interventions occurred one or more times.
The interventions reduced discontinuation rates among both “exclusive” and “any” breastfeeding mothers (TABLE1). The review found lay and professional support to be equally effective at promoting continuation of breastfeeding. Limitations include a moderate to high amount of heterogeneity, as well as the inherent difficulty of blinding subjects in the studies.
Lay support can make a significant difference in the short term
A 2008 systematic review of 38 RCTs (N=29,020) compared any counseling or behavioral intervention initiated from a clinician’s practice (office or hospital) with usual care.2 The review excluded community and peer-initiated interventions. The reviewers defined breastfeeding duration as follows: initiation (up to 2 weeks), short-term (one to 3 months), intermediate-term (4 to 5 months), long-term (6 to 8 months), and prolonged (9 or more months). Investigators also analyzed breastfeeding rates by “exclusive” and “nonexclusive” (formula supplementation) regimens.