Evidence-based interventions to support breastfeeding

Journal club

• Author: Lori Feldman-Winter,MD,MPH

• Journal:Pediatric clinics of North America:

Breast feeding Updates for the

Pediatrician.

Morrow and Chantry

February 2013,Volume 60,Number 1

Introduction

• Decision to breast feed is one of the most important decision a mother can make.

• 75% of US mothers started breastfeeding in early postpartum period according to CDC and NIS.

• Merely 14.8% women exclusively breast fed upto6 months(NIS) in 2008.

• Therefore along with focusing on the decision to breastfeed there should be focus on protection and support of breastfeeding

• Describes evidence based practices that have been established to support breastfeeding.

• Discusses barriers and challenges to breastfeeding support .

Support for pregnant women:

Ample time with prenatal healthcare practioner providing ampleopputunity for brestfeedingsupport.

Peer counselling , formal lactational consultation and breast feeding education.

Mothers who are at more risk of not breast feeding are more to gain from prenatal support.

Content of effective sessions-benefits,priciplesof lactation,myths,commonproblems,solutions and skill training.

Prenatal classes in workshop format increases self efficacy.

Weight control strategies should be offered.

More effective when combined with elimination of infant formula marketing

Step 3 of BFHI

Support in preipartum setting:

• Importance of skin to skin conatct : improves physiologic transition,increases success of first breast feed and more effective breast feeding.

• The first breast feed: early first breastfeed leads to increased milk supply in first days, early passage of meconium and continuing of breast feeding.

• Newborn procedures:weighing,injectons,blood sampling.

BFHI:

• Has been shown to increase initiation, continuation and exclusivity.

• 10 steps have dose dependent effect.

Support for postpartum women in community

• Support by physician and advanced practice nurses.

Professional support by other health care professional:

Peer(lay) Support

Employment

• Schools and preconception education:

• Government and legistation:

Conclusion

• Considerable progress has been made in past decade in developing support systems to enable more women to reach breastfeeding goals.

• Each of this system is to rigorously tested and replicated if effective.

• Additional research is needed to determine best support during preconception period

• Along with outcome ,cost benefit analysis of breast feeding support program.

• evaluation of government activities and program.