academy of breastfeeding medicine annotated bibliography ... · annotated bibliography: #19...

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Academy of Breastfeeding Medicine Annotated Bibliography:

#19 Breastfeeding promotion in the prenatal setting Reference Content Levelof

Evidence*

LCsupport

Martin,J.;MacDonald-Wicks,L.;Hure,A.;Smith,R.;Collins,C.E.Reducingpostpartumweightretentionandimprovingbreastfeedingoutcomesinoverweightwomen:apilotrandomisedcontrolledtrial.Nutrients,2015,7,1464-1479.

RCTofobesewomenwithintenttoBF,gavegroup1.antenatalinterventionwithdietarycounseling,2.antenatalinterventionwithdietarycounselingandlactationsupport(Two30minsantenataleducationsessionsandone2weekhomevisit,FUbyphoneasneeded),3.control(interventionat3mopostpartum).N=36.SecondaryoutcomefoundthatLCsupportimproveddurationofbreastfeeding.Notstatisticallysignificant.

HartmanS,BarnettJ,BonuckK.Implementinginternationalboard-certifiedlactationconsultantsinterventionintoroutinecare:Barriersandrecommendations.ClinicalLactation.2012;3-4:131.

QualitativeanalysisofinterventionthatintegratedIBCLCsintoroutinecare,prenatalandpostnatal.Theresultsindicatedthathealthcareprovider(HCP)supportforbreastfeedingwasunderminedbyinadequateeducationandexperience,oftenresultinginsupport“innameonly.” Inaddition,IBCLCsrapportandexpertise—withbothwomenandthehealthcareteam—helpedovercomeindividual-andsystem-levelbarrierstobreastfeeding.IBCLCs’ acceptanceandintegrationintotheprimary-careteamvalidatedtheirworkandincreasedtheireffectiveness.IBCLCscommentssuggestthatmotherscannotrelysolelyupontheirhealthcareprovidersforbreastfeedingeducationandsupport.IBCLCsintegratedintoroutineantenatalandpostpartumcarearepivotaltoencouragingandreinforcingawoman’schoicetobreastfeedthrougheducation,aswellasemotionalandskill-basedsupport.

Clifford,J.;McIntyre,E.Whosupportsbreastfeeding?Breastfeed.Rev.,2008,16,2,9-19,

Systematicreview(nometa-analysis)ofsocio-culturalsupportsforbreastfeedingwomenwithInternationalfocus.Includesbothquantitativeandqualitativestudies.

HumenickSS,HillPD,SpiegelbergPL.Breastfeedingandhealthprofessionalencouragement.JHumLact.1998Dec;14(4):305-10.

Longitudinal,cross-sectionalsurveyonnature,sourceandimpactofprofessionalbreastfeedingadvicefor340women.Lactationconsultantsgavesignificantlymorepositiveencouragement(98%,p=.01)thannurses(75%)orphysicians(65%).Primiparaewerelikelytodecreasetheirlevelofbreastfeedingifencouragedtosupplementorwean.Multiparaelevelofbreastfeeding,ingeneral,appearedindependentofhealthprovideradvice.

Prenatalcounseling/education

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Mekuria,G.;Edris,M.ExclusivebreastfeedingandassociatedfactorsamongmothersinDebreMarkos,NorthwestEthiopia:across-sectionalstudy.Int.BreastfeedJ.,2015,10,1,1-014-0027-0.eCollection2015,England

Community-basedcross-sectionalstudywithrandomsamplingtechniqueof423motherswithinfantslessthan6monthsoldinDebreMarkos,Ethiopia.FoundthatreceivingcounselingduringantenatalcarewasassociatedwithanAOF=2.44forexclusivebreastfeeding(crosssectionalsampleincludedbabies0-179days).

JHumLact.2015Apr23.pii:0890334415583294.GroupversusIndividualProfessionalAntenatalBreastfeedingEducationforExtendingBreastfeedingDurationandExclusivity:ASystematicReview.WongKL1,TarrantM2,LokKY2.

SystematicreviewofliteraturecomparinggroupandindividualantenatalBFeducation,found3935citationsleadingto19articlesreviewed.Foundthatbotheducationtypesshowedsomeeffectinextendingthedurationofexclusiveand/oranybreastfeedingwhentargetedatvulnerablepopulations,likeminority,low-incomeorlow-educationparticipants.Significanteffectsnotfoundwithlow-risk,educatedwomen.Also,“duetothelimitednumberofstudiesexaminingindividualantenataleducationandduetotheheterogeneityandlowerqualityofstudiesexamininggroupantenataleducation,noconclusionscouldbedrawnontheeffectivenessofeithermodeofeducation.”Maynothavelong-termeffectonbreastfeedingrates,suchasat3and6months.

Dean,S.V.;Lassi,Z.S.;Imam,A.M.;Bhutta,Z.A.Preconceptioncare:closingthegapinthecontinuumofcaretoaccelerateimprovementsinmaternal,newbornandchildhealth.Reprod.Health.,2014,11Suppl3,S1-4755-11-S3-S1.Epub2014Sep26,England

Systematicreviewofevidenceonpreconceptioncareanditsimpact.Thebreastfeedingdatawerecollectedfrom5studies,with17,690pooledpatients.Promotinghealthbeforeconceptioncanincreaseantenatalcareseekingby39%,reduceneonatalmortalityby17%(RR0.83;95%CI:0.72to0.95)(Figure2),increasetheuseofsafedeliverykitsathomebirthsindevelopingcountriesby1.82times(RR1.82;95%CI:1.10to3.02),andincreasethelikelihoodofbreastfeedingby71%(RR1.71;955CI:1.13to2.58)(figure3).

Gurka,K.K.;Hornsby,P.P.;Drake,E.;Mulvihill,E.M.;Kinsey,E.N.;Yitayew,M.S.;Lauer,C.;Corriveau,S.;Coleman,V.;Gulati,G.;Kellams,A.L.Exploringintendedinfantfeedingdecisionsamonglow-incomewomen.BreastfeedMed.,2014,9,8,377-384.

Datafrom520low-incomewomeninterviewedat24-41weeks’gestationduringenrollmentinanantenatalbreastfeedingeducationstudywereanalyzed.Most(95%)participantshadchosenaninfantfeedingmethodatthetimeoftheinterview.Womenintendingartificialfeedingwerelesslikelytoreportreceivinginformationregardingbenefitsofbreastfeedingorhowtobreastfeed.Theywerealsomorelikelytochooseartificialfeedingiftheyhadapreviouslivebirthorhadnotbreastfedachild,includingthemostrecent.

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Jahan,K.;Roy,S.K.;Mihrshahi,S.;Sultana,N.;Khatoon,S.;Roy,H.;Datta,L.R.;Roy,A.;Jahan,S.;Khatun,W.;Nahar,N.;Steele,J.Short-termnutritioneducationreduceslowbirthweightandimprovespregnancyoutcomesamongurbanpoorwomeninBangladesh.FoodNutr.Bull.,2014,35,4,414-421,Japan

RCTwith150womenininterventiongroup,150incontrolin2antenatalclinicsinurbanDhaka,Bangladesh.Interventionincludedthree1houreducationsessionsonpregnancyandinfantfeeding(importanceofexclusivebreastfeeding,awarenessoffoodtaboosrelatingtoinfantfeeding).Foundincreaseinbreastfeedingwithin1hourofbirthininterventiongroup(86.0%vs.56.7%,P=0.001),colostrumfeeding(86%vs.65.3%,p=0.001),andexclusivebreastfeedingat1month(83%vs.69.3%,p=0.003).

Wong,K.L.;Fong,D.Y.;Lee,I.L.;Chu,S.;Tarrant,M.Antenataleducationtoincreaseexclusivebreastfeeding:arandomizedcontrolledtrial.Obstet.Gynecol.,2014,124,5,961-968.

469primiparouspregnantwomenintendingtoBFwererandomizedtoreceivestandardcareora20to30minuteone-on-oneBFsupportandeducationsessionafter35weeksofgestation.Nosignificantdifferencesinexclusivitywereseenat6weeksor3and6months.

HowellEA,Bodnar-DerenS,BalbierzA,etal.AninterventiontoextendbreastfeedingamongblackandLatinamothersafterdelivery.AmJObstetGynecol.2014;210(3):239-248.

Controlledtrialinwhichself-identifiedblackandLatinamothersearlyafterdeliverywereassignedrandomlytoreceiveabehavioraleducationalinterventionorenhancedusualcare.The2-stepinterventionaimedtoprepareandeducatemothersaboutpostpartumsymptomsandexperiencesandtobolstersocialsupportandself-managementskills.Enhancedusualcareparticipantsreceivedalistofcommunityresourcesandreceiveda2-weekcontrolcall.Intention-to-treatanalysesexaminedbreastfeedingduration(measuredinweeks)forupto6monthsofobservation.Fivehundredfortymotherswereassignedrandomlytotheintervention(n=270)vscontrolsubjects(n=270).Meanagewas28years(range,18–46years);62%ofthewomenwereLatina,and38%wereblack.Baselinesociodemographic,clinical,psychosocial,andbreastfeedingcharacteristicsweresimilaramonginterventionvscontrolsubjects.Mothersintheinterventionarmbreastfedforalongerdurationthandidthecontrolsubjects(median,12.0vs6.5weeks,respectively;P=.02).Mothersintheinterventionarmwerelesslikelytoquitbreastfeedingoverthefirst6monthsafterdelivery(hazardratio,0.79;95%confidenceinterval,0.65–0.97).

MartinA,HorowitzC,BalbierzA,etal.Viewsofwomenandcliniciansonpostpartumpreparationandrecovery.MaternChildHealthJ.2014;18(3):707-13.

Qualitativeresearchstudywasconductedtoexplorewomen’sandclinicians’perceptionsofthepostpartumexperience.Fourfocusgroupsofpostpartumwomen(n=45)andtwofocusgroupsofobstetricclinicians(n=13)wereheldatalargeurbanteachinghospitalinNewYorkCity.Allfocusgroupswereaudiorecorded,transcribed,andanalyzedusinggroundedtheory.Fourmainthemeswereidentified:lackofwomen’sknowledgeabout

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postpartumhealthandlackofpreparationforthepostpartumexperience,lackofcontinuityofcareandabsenceofmaternalcareduringtheearlypostpartumperiod,disconnectbetweenprovidersandpostpartummothers,andsuggestionsforimprovement.Mothersdidnotexpectmanyofthesymptomstheyexperiencedafterchildbirthandweredisappointedwiththelackofsupportbyprovidersduringthiscriticaltimeintheirrecovery.Differencesexistedinthemajorpostpartumconcernsofmothersandclinicians.However,bothmothersandcliniciansagreedthatpreparationduringtheantepartumperiodcouldbebeneficialforpostpartumrecovery.Resultsfromthisstudyindicatethatmanymothersdonotfeelpreparedforthepostpartumexperience.

IslamKhan,A.Effectsofpre-andpostnatalnutritioninterventionsonchildgrowthandbodycomposition:theMINIMattrialinruralBangladesh.Glob.Health.Action,2013,6,22476.

IntheMINIMattrialinBangladesh,pregnantwomenwererandomizedtoearly(around9weeks)orusualinvitation(around20weeks)tofoodsupplementationandtooneofthethreedailymicronutrientsupplements.Subjectswerealsorandomizedtoexclusivebreastfeeding(EBF)counseling(by“trainedcounselors,” 2prenataland6postnatalsessions)ortousualhealthmessages.ViaCommunity-healthworkers/homevisits.Nodifferencesinbackgroundcharacteristicswereobservedamongtheinterventiongroups.Therewasalsonodifferentialeffectofprenatalinterventionsonbirthweightorbirthlength.Earlyfoodsupplementationreducedthelevelofstuntingfromearlyinfancyupto54monthsofageamongboys(averagedifference– 6.5%units,95%confidenceinterval[CI]1.7–11.3,p=0.01)butnotamonggirls(averagedifference– 2.4%units,95%CI−2.2–7.0,p=0.31).MMSresultedinmorestuntingcomparedtostandardFe60F(averagedifference– 4.8%units,95%CI0.8–8.9,p=0.02).BreastfeedingcounselingprolongedthedurationofEBF(difference– 35days,95%CI30.6–39.5,p<0.001).Neitherpregnancyinterventionsnorbreastfeedingcounselinginfluencedthebodycompositionofchildrenat54monthsofage.Theeffectsofprenatalinterventionsonpostnatalgrowthsuggestprogrammingeffectsinearlyfetallife.

Pitcock,N.EvaluationofanInitiativetoIncreaseRatesofExclusiveBreastfeedingAmongRuralHispanicImmigrantWomen.UniversityofVirginia,2013.

Retrospectiveevaluationofspanishlanguageculturally-competentexclusivity-focusedprenataleducationcomponentofastagedBFpromotionintervention.nourishtheirnewborns.Electedtoparticipateinprenatalclass.chartreview,N=39ininterventiongroup,hada53.8%BFintentvs.usualcare37.5%BFintent(n=32).EBFatdischargewas41%forgroupattendeesand3.1%fornon-attendees.77.1%ofallparticipantsdidnotreceiveaccesstoLactationConsultationservices.

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Lumbiganon,P.;Martis,R.;Laopaiboon,M.;Festin,M.R.;Ho,J.J.;Hakimi,M.AntenatalbreastfeedingeducationforincreasingbreastfeedingdurationCochraneDatabaseSyst.Rev.,2012,9,CD006425,England

CochranereviewofRCTsofformalantenatalBFeducation,excludingintrapartumorpostpartuminterventionpieces.19studieswith8506womenwereincludedinthereview,nometa-analysiswaspossible.Findings:1)PeercounsellingsignificantlyincreasedBFinitiation.2)NointerventionwassignificantlymoreeffectivethananotherinterventioninincreasinginitiationordurationofBF.3)CombinedBFeducationalinterventionswerenotsignificantlybetterthanasingleinterventionininitiatingorincreasingBFduration.However,inonetrialacombinedBFeducationsignificantlyreducednipplepainandtrauma.4)TherewasamarginallysignificantincreaseinexclusiveBFatsixmonthsinwomenreceivingabookletplusvideopluslactationconsultation(LC)comparedwiththebookletplusvideoonly.Inanothergroup,thecombinationofBFbookletplusvideoplusLCwassignificantlybetterthanroutinecareforexclusiveBFatthreemonths.5)Significantmethodologicallimitationsandobservedeffectsizesweresmall,itisnotappropriatetorecommendanyspecificantenatalBFeducation.ThereisanurgentneedtoconductRCTswithadequatepowertoevaluatetheeffectivenessofantenatalBFeducation.

Wambach,K.A.;Aaronson,L.;Breedlove,G.;Domian,E.W.;Rojjanasrirat,W.;Yeh,H.W.Arandomizedcontrolledtrialofbreastfeedingsupportandeducationforadolescentmothers.West.J.Nurs.Res.,2011,33,4,486-505,UnitedStates

RCTwith1interventiongroup,1controland1attentioncontrolgroupenrolling15-18yopregnantwomeninMidwesternUS,N=390,N=289forBFinitiation.Intervention'sprenatalcomponentincluded1-2RN/IBCLCandteenBFpeercounselorrunclass(es)and3phonecalls,educationinformedbydevelopmentally-appropriatebehaviorandcompetencetheory.Outcomemeasuresattributabletotheprenatalinterventionpieceincludetheprenatalsurveysofknowledgeandattitudesandbreastfeedinginitiation.Higherinitiationseeninexperimentalgroup,butnotafteraddingcovariates.waslikelyunderpowered."Statisticallysignificantfactorspredictingbreastfeedinginitiationincludedbreastfeedingknowledge,prenatalintentiontobreastfeed,thetimewhenthefeedingdecisionwasmade,andsocialandprofessionalsupport."Decisionin1sttrimesterwasmorepredictiveofBFinitiationthandecidinglater.Noneofthevariablesthatpredictedbreastfeedinginitiationweresignificantpredictorsofexclusivebreastfeeding.

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Sandy,J.M.;Anisfeld,E.;Ramirez,E.EffectsofaprenatalinterventiononbreastfeedinginitiationratesinaLatinaimmigrantsampleJ.Hum.Lact.,2009,25,4,404-11;quiz458-9,UnitedStates

RCTofmostlyDominicanmothersinNYC,BestBeginningsprogram(developedbyHealthyFamilies)enrolledinpregnancyorinfant<3mo+psychosocialriskfactorsforcaregivingdifficulties.Familysupportworkersdeliveredhome-basedprogram,breastfeedingsupportwasmostlyprenatal.Controlgroupreceived2homevisitsbutnoFUorBFsupport/education.ExposuretotheprenatalinterventionwasnotsignificantlyassociatedwithABF.EBFwassignificantlypositivelyassociatedwithexposuretotheprenatalintervention,with32%(44/137)ofexposedmothersreportingEBFcomparedto20%(20/101)ofnonexposedmothers(OR1.92;95%CI1.05-3.52).BFsignificantlypositivelyassociatedwithameasureofhouseholdincome(ABFandEBF)andsignificantlynegativelyassociatedwithmaternalacculturationlevel(ABF).Thefindingthatmoreacculturatedmothers(ie,English-speaking,firstgenerationUS-born)werelesslikelytoreportABFsuggeststhatnotonlyrecentimmigrants,butalsomoreacculturatedLatinasshouldbetargetsoffutureinterventionsaimedatincreasingbreastfeedinginitiationratesintheUnitedStates.

WongCheung,Ka-lun;Arandomizedcontrolledtrialofanantenatalinterventiontoincreaseexclusivebreastfeeding;HongKongUniversity,2014.http://hdl.handle.net/10722/208010

RCTofantenatalBFeducationandsupportsessionN=469primiparouswomenatantenatalclinicsofpublichospitalsinHongKong.NodifferenceinBFexclusivityordurationwereseen.

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SchlickauJMPrenatalbreastfeedingeducation:aninterventionforpregnantimmigrantHispanicwomenUniversityofNebraskaMedicalCenter,2005

one-to-onePrenatalBreastfeedingEducation(PBE)interventionforprimigravidimmigrantHispanicwomenwhoreceivedprenatalcareatapublichealthclinic.ThestudyframeworkwasderivedfromtheHealthPromotionModel.RCTonbreastfeedinginitiationanddurationParticipants(n=86)wererandomlyassignedtoreceiveeitherthePBEteachingsessioninadditionto"standardofcare"attheprenatalclinic(interventiongroup)ortoreceive"standardofcare"only(controlgroup).Breastfeedinginitiationrateswerenotsignificantlydifferentbetweeninterventionandcontrolgroups.Estimatedmeanbreastfeedingduration,assessedat42days,wassignificantlyhigherby20days(t[78]=5.63,p=.00)forthoseintheinterventiongroup.Meanbreastfeedingself-efficacyscoreswere6pointshigherintheinterventiongroupthaninthecontrol(X2[26]=38.77,p=.05).By42days,anestimated67%ofthoseintheinterventiongroupcontinuedtobreastfeed,whileanestimated13%ofthoseinthecontrolgroupcontinuedtobreastfeed.ResultsoftheKaplan-MeierLogRankTestshowedthedifferencebetweentheestimatedbreastfeedingsurvivaltime(20days)wassignificant(LR[1,N=80]=27.19,p=.00)Hispanicwomenareatriskforchoosingtobottle-feedratherthanbreastfeedandhavenotpreviouslybeenassessedforbreastfeedingself-efficacychange.Theinterventionwasqualitativelyderivedandprovidesculturallyappropriatecontent.Self-efficacyandcommitmenttoaplanofactionwerekeyaspectsoftheintervention

GuiseJ,PaldaV,WesthoffC,ChanB,HelfandM,LieuT.TheEffectivenessofPrimaryCare-BasedInterventionstoPromoteBreastfeeding:SystematicEvidenceReviewandMeta-AnalysisfortheUSPreventiveServicesTaskForce.AnnFamMed2003;1(2):70-78.

Meta-analysisofthirtyrandomizedandnonrandomizedcontrolledtrialsand5systematicreviewofbreastfeedingcounseling.Educationalprogramshadthegreatesteffectonbothinitiationandshort-termduration.Supportprogramsincreasedbothshort-termandlong-termduration.Writtenmaterialsdidnotsignificantlyincreasebreastfeeding.

DuffyEP,PercivalP,KershawE.Positiveeffectsofanantenatalgroupteachingsessiononpostnatalnipplepain,nippletraumaandbreastfeedingrates.Midwifery.1997Dec;13(4):189-96.

RCTof70primaparasintendingtobreastfeedtoassesswhetheranantenatalteachingsessiononpositionandattachmenthadaneffectonpostnatalnipplepain,traumaandbreastfeedingduration.Interventiongrouphadbetterpositionandattachment,lessnipplepain,traumaandhigherBFdurationat6weeks(92%vs.29%,p<0.001).

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HartleyBM,O’ConnorME.Evaluationofthe‘BestStart’ breast-feedingeducationprogram.ArchPediatrAdolescMed.1996Aug;150(8):868-71.

Preandpostinterventiontrialwithhistoricalcontrolsexaminingtheeffectofthe“BestStart” breastfeedingeducationalprogram.Breastfeedingincreasedfrom15to31%aftertheprogramwasimplementedandbreastfeedingat2weeksincreasedfrom13to21%.

BestStartSocialMarketing.Usinglovingsupport© toimplementbestpracticesinpeercounseling.http://www.nal.usda.gov/wicworks/Learning_Center/research_brief.pdf.Updated2004.AccessedJuly3,2015.

BestStartbreastfeedingeducationalprogramwebsite. n/a

ReifsniderE,EckhartD.Prenatalbreastfeedingeducation:itseffectonbreastfeedingamongWICparticipants.JHumLact.1997Jun;13(2):121-5.

Theeffectofprenatalbreastfeedingeducationonbreastfeedingincidenceanddurationwasdeterminedamong31prenatalWICparticipantsinanon-randomized,controlledtrial.Theinterventiongroupshowedanincreaseindurationofbreastfeeding.

DeOliveiraMI,CamachoLA,TedstoneAE.Extendingbreastfeedingdurationthroughprimarycare:asystematicreviewofprenatalandpostnatalinterventions.JHumLact.2001Nov;17(4):326-43.

Literaturereviewofstrategiesandproceduresusedtoextendbreastfeedingduration.Duringprenatalcare,groupeducationwaseffectiveinincreasingbreastfeedingrates.

IsslerH,deSaMB,SennaDM.Knowledgeofnewbornhealthcareamongpregnantwomen:basisforpromotionalandeducationalprogramsonbreastfeeding.SaoPauloMedJ.2001Jan4;119(1):7-9.

Cross-sectionalstudyofpregnantwomen’sknowledgeofnewbornhealthcareandbreastfeedingpracticeswhichwasfoundtobelow.

LohNR,KelleherCC,LongS,LoftusBG.Canweincreasebreastfeedingrates?IrMedJr.1997Apr-May;90(3):100-1.

RCTofbreastfeedingeducationinitiatedat36weeksgestation.Thetestgroupshowedincreasedratesofbreastfeeding(43.9%vs.31.5%,p=0.07).Whilenotstatisticallysignificant,thestudyonlyincluded190mothers.

Community-basedinterventions

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Memon,Z.A.;Khan,G.N.;Soofi,S.B.;Baig,I.Y.;Bhutta,Z.A.TitleImpactofacommunity-basedperinatalandnewbornpreventivecarepackageonperinatalandneonatalmortalityinaremotemountainousdistrictinNorthernPakistanBMCPregnancyChildbirth,2015,15,1,106-015-0538-8,England

Non-randomizedcontrolledtrialincluding3,200pregnantwomenreceivingintervention,andapopulationof283,324,whichconsistedofacommunity-basedinterventionpackageincludingawarenesscreation,communitymobilizationandeducation,enhancedtrainingsforcommunityhealthworkers,homevisits,counselingsessionswithpregnantwomen,videoandeducationsessionsforpregnantwomenaswellascommunitymembers.Foundincreasedcolostrumadministration(83%vs71%,p<0.001)andinitiationofbreastfeedingwithin1hourofbirth(55%vs.40%,p<0.001)ininterventionvs.controlgroup,inadditiontodecreasedoverallneonatalmortality.

Brunton,G.;O'Mara-Eves,A.;Thomas,J.The'activeingredients'forsuccessfulcommunityengagementwithdisadvantagedexpectantandnewmothers:aqualitativecomparativeanalysisJ.Adv.Nurs.,2014,70,12,2847-2860,JohnWiley&SonsLtd,England

Qualitativecomparativeanalysisofstudiesinasystematicreviewlookingatantenatal,immunization,breastfeedingandearlyprofessionalinterventionoutcomes.Peerdelivery(consistency083;uniquecoverage063);andmother-professionalcollaboration(consistency0833;uniquecoverage021)weremoderatelyalignedwitheffectiveinterventions.Community-identifiedhealthneedplusconsultation/collaborationininterventiondesignandleadingondeliverywereweaklyalignedwith‘noteffective’interventions(consistency078;uniquecoverage029).Conclusions.Fordisadvantagednewandexpectantmothers,peerorcollaborativedeliverymodelscouldbeusedininterventions.

II-2orII-3??

Lassi,Z.S.;Das,J.K.;Salam,R.A.;Bhutta,Z.A.Evidencefromcommunitylevelinputstoimprovequalityofcareformaternalandnewbornhealth:interventionsandfindingsReprod.Health.,2014,11Suppl2,S2-4755-11-S2-S2.Epub2014Sep4,England

POSTNATALHomevisitsbyCHWtoimproveneonatalhealthwasassociatedwithimprovedbreastfeedinginitiationwithin1hour(RR:3.35,95%CI:1.31-8.59).PRENATALCochrane:CommunitybasedpackageswithanemphasisonprovisionofcarethroughtrainedCHWviahomevisitationsignificantlyimprovedearlybreastfeedinginitiation(RR:1.94,95%CI:1.56-2.42).PRENATALCochrane:Careprovidedbymidwiveswasfoundtobeassociatedwithsignificantimprovementsininitiationofbreastfeeding(RR:1.35,95%CI:1.03-1.76).Cochrane,mixedPREANDPOSTNATAL:AnotherreviewevaluatingtheeffectsofCHWinterventionsreportedsignificantimpactsonbreastfeedinginitiation(RR:1.36,95%CI:1.14-1.61).

Muhajarine,N.;Ng,J.;Bowen,A.;Cushon,J.;Johnson,S.UnderstandingtheimpactoftheCanadaPrenatalNutritionProgram:aquantitativeevaluationCan.J.PublicHealth,2012,103,7Suppl1,eS26-31,Canada

ReviewoftheCPNP,agroupofinterventionsofferedinCanadatohigh-riskpregnantwomenandnewborns.Thelevelsofinterventionandinterventiontypeswerevaried(330projectsin2000communities,potentiallyincluding28,415womenforBFinitiationand20,642forduration).FoundimprovedBFinitiationanddurationingroupswithhighexposuretotheprograms,especiallyinsingle/divorcedwomen(22%morelikelytoinitiateBFinhighexposuregroups).

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Hoddinott,P.;Britten,J.;Prescott,G.J.;Tappin,D.;Ludbrook,A.;Godden,D.J.Effectivenessofpolicytoprovidebreastfeedinggroups(BIG)forpregnantandbreastfeedingmothersinprimarycare:clusterrandomisedcontrolledtrialBMJ,2009,338,a3026,England

ClusterRCTofprimarycarepopulationsinScotlandreceivingapolicyinterventiontoincreasebreastfeedinggroups,prenatalandpostnatal.QualandQuantmethods.Theproportionsofwomenattendingonlyinpregnancy,onlyafterbirth,andbothbeforeandafterbirthwere0.21,0.69,and0.10.Thenumberofbreastfeedinggroupsincreasedfrom10to27ininterventionlocalities.Nosignificantdifferencesinbreastfeedingatbirth.Only229/799(28.7%)womenwhoinitiatedbreastfeedingreportedattendingantenatalbreastfeedinggroupsininterventionlocalitiescomparedwith99/416(23.8%)respondentsincontrollocalities(P=0.093).Thecostsofrunninggroupswouldbesimilartothecostsofvisitingwomenathome.(postnataloutcomessimilarlynon-significantornegative).Limitations:groupsinvolvedwomenonly,fewattended,mostlyhigherincomeolderwomenattended,fewproviders/midwivesledthegroups,significantorganizationalproblems.

IandIII

Self-efficacybackground

OtsukaK,DennisCL,TatsuokaH,JimbaM.Therelationshipbetweenbreastfeedingself-efficacyandperceivedinsufficientmilkamongjapanesemothers.JObstetGynecolNeonatalNurs.2008;37(5):546-555.

Twohundredandsixty-twoin-hospitalbreastfeedingmothersinJapan.MAINOUTCOMEMEASURE:Breastfeedingself-efficacywasmeasuredin-hospitalandperceptionofinsufficientmilkwasmeasuredat4weekspostpartum.RESULTS:Althoughmostmothersintendedtoexclusivelybreastfeed,lessthan40%weredoingsoat4weekspostpartum.Amongthemothersusingformula,73%citedperceivedinsufficientmilkastheprimaryreasonforsupplementationorcompletelydiscontinuingbreastfeeding.Mothers'perceptionofinsufficientmilkat4weekspostpartumweresignificantlyrelatedtobreastfeedingself-efficacyinhospitalintheimmediatepostpartumperiod(r=.45,p<.001).Hierarchicalmultipleregressionrevealedthatbreastfeedingself-efficacyexplained21%ofthevarianceinmaternalperceptionsofinsufficientmilk,andthecontributionwasindependentofsociodemographicvariables

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BlythR,CreedyDK,DennisCL,MoyleW,PrattJ,DeVriesSM.Effectofmaternalconfidenceonbreastfeedingduration:Anapplicationofbreastfeedingself-efficacytheory.Birth.2002;29(4):278-284.

Aprospectivesurveywasconductedwith300womeninthelasttrimesterofpregnancyrecruitedfromtheantenatalclinicofalargemetropolitanhospitalinBrisbane,Australia.Telephoneinterviewswereconductedat1weekand4monthspostpartumtoassessinfantfeedingmethodsandbreastfeedingconfidenceusingtheBreastfeedingSelf-EfficacyScale.RESULTS:Although92percentofparticipantsinitiatedbreastfeeding,by4monthspostpartumalmost40percentdiscontinuedandonly28.6percentwerebreastfeedingexclusively;themostcommonreasonfordiscontinuationwasinsufficientmilksupply.Antenataland1-weekBreastfeedingSelf-EfficacyScalescoresweresignificantlyrelatedtobreastfeedingoutcomesat1weekand4months.Motherswithhighbreastfeedingself-efficacyweresignificantlymorelikelytobebreastfeeding,anddoingsoexclusively,at1weekand4monthspostpartumthanmotherswithlowbreastfeedingself-efficacy.

MeedyaS,FahyK,KableA.Factorsthatpositivelyinfluencebreastfeedingdurationto6months:Aliteraturereview.WomenBirth.2010;23(4):135-145.

AnonlineliteraturesearchwasconductedinMedline,CINAHL,MaternityandInfantCare,andCochraneDatabaseofsystematicreviews.Thesearchstrategyincludedthefollowingkeywords:breastfeeding,duration,initiation,cessation,factors,intervention,education,partner,intention,confidence,self-efficacyandsupport.AdditionalstudieswerelocatedandextractedfromonlinepublicationsofNewSouthWalesDepartmentofHealth,Australia.Bio-psycho-socialfactorsthatarepositivelyassociatedwithbreastfeedingdurationwereidentified.ResultsModifiablefactorsthatinfluencewomen'sbreastfeedingdecisionsare:breastfeedingintention,breastfeedingself-efficacyandsocialsupport.Existingmidwiferybreastfeedingpromotionstrategiesoftenincludesocialsupportbutdonotadequatelyaddressattemptstomodifybreastfeedingintentionandself-efficacy.

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InoueM,BinnsCW,OtsukaK,JimbaM,MatsubaraM.Infantfeedingpracticesandbreastfeedingdurationinjapan:Areview.IntBreastfeedJ.2012;7(1):15-4358-7-15.

searchofelectronicdatabasesinJapaneseandEnglishwasundertakenupto2011.TheinclusioncriteriaforthisreviewwerestudiesthatfocusedoninfantfeedingpracticesandtargetedJapanesemothers,fathers,orhealthprofessionals,butexcludedmothers'friendsandpeergroups.Intotal,12articleswereselectedforthefinalanalysis.Smokingstatus,lowbirthweightofinfantsandmaternalperceptionsofinsufficientbreastmilksupplywerenegativeinfluencesonbreastfeedingduration,whilesupportfromhusbands/partnersisassociatedwithcontinuedbreastfeeding.Somefactorsthathavebeenfoundtobeassociatedwithbreastfeedinginothercountries,includingmaternalage,familyincome,maternaleducationallevels,andlivingwithgrandparentsofinfantshavenotbeenconfirmedinJapan.Whilethenationalbreastfeedingrateswerehigherthanothercountriesofsimilarhealthstatus,inconsistentknowledgeofbreastfeedingbenefitsandinappropriatehospitalpracticesremaininJapanmaybeassociatedwithincreasedtheuseofinfantformulaandreducedbreastfeedingduration.Mostofthestudiesreviewedwerecross-sectionalindesign,withonlyalimitednumberofcohortstudies.Alsomanypublishedstudiesusedsmallsamplesizes.

HundalaniSG,IrigoyenM,BraitmanLE,MatamR,Mandakovic-FalconiS.Breastfeedingamonginner-citywomen:Fromintentionbeforedeliverytobreastfeedingathospitaldischarge.BreastfeedMed.2013;8(1):68-72.

Inmultivariableanalysis,oldermothersandthosewithlowerparityweremorelikelytobreastfeedatdischargeandalsotobreastfeedexclusively,controllingforethnicity,parity,insurance,pregravidabodymassindex,scoreontheEdinburghPostpartumDepressionScale,typeofdelivery,infantbirthweightandgestationalage.Conclusions:Inaminorityinner-citypopulation,onlythreeinfourwomenwhointendedtobreastfeedpriortodeliverywerebreastfeedingathospitaldischarge.However,onein10womenpreviouslynotintendingtobreastfeeddidso.Strategiesareneededtopromoteandstrengthenwomen'sintentiontobreastfeedandtohelpwomen'sbreastfeedingoutcomesmeettheirintentions.

Psychoeducational/behavioralapproaches

Sikander,S.;Maselko,J.;Zafar,S.;Haq,Z.;Ahmad,I.;Ahmad,M.;Hafeez,A.;Rahman,A.Cognitive-behavioralcounselingforexclusivebreastfeedinginruralpediatrics:aclusterRCT.Pediatrics,2015,135,2,e424-31

RCTinNorthwestPakistanincluding224interventiongroupwomenwhoreceived7psychoeducationalsessions(1beforebirth,secondafterbirth,remiaining5sessionsgivenmonthly),whilecontrolgroupwomenreceived7"routine"sessions.Thoughthestudyfocusedmostlyonthepostnatalperiod,prelactealfeedingwasshowntobereduced(ARR=0.51,95%CI0.34-0.78),whichisanoutcomemeasurethatmaybepredominantlyinfluencedbyprenataleducation.

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Hildebrand,D.A.;McCarthy,P.;Tipton,D.;Merriman,C.;Schrank,M.;Newport,M.InnovativeuseofinfluentialprenatalcounselingmayimprovebreastfeedinginitiationratesamongWICparticipants.J.Nutr.Educ.Behav.,2014,46,6,458-466.

Demonstrationprojectwith456parents/caregivers,withabehaviorchangeinterventionbasedonSocialCognitiveTheoryusingCaildini'sPrinciplesofInfluence.Traditional-modelgroups(control)receivedservicespriortotheintervention;influence-modelgroups(experimental)receivedservicesafterinitiationoftheintervention.Thedemonstrationprojectresultedin5improvedinfluencemeasures(P<.02),aligningwiththeinfluenceprincipleof“feelingliked.”Themodelhadasmalleffect(φ=0.10)indistinguishingbreastfeedinginitiation;womenintheinfluencemodelwere1.5timesmorelikely(95%CI,1.19–1.86;P<.05)toinitiatebreastfeedingcomparedwithwomeninthetraditionalmodel,controllingforparity,mother'sage,andrace.ConsistentwithSocialCognitiveTheory,changingtheWICenvironmentbyintegratinginfluenceprinciplesmaypositivelyaffectwomen'sinfantfeedingdecisionsandbehaviors,specificallybreastfeedinginitiationrates.

Otsuka,K.;Taguri,M.;Dennis,C.L.;Wakutani,K.;Awano,M.;Yamaguchi,T.;Jimba,M.Effectivenessofabreastfeedingself-efficacyintervention:dohospitalpracticesmakeadifference?Matern.ChildHealthJ.,2014,18,1,296-306.

Interventionstudywithacontrolgroup.781pregnantwomenwererecruitedfrom2“Baby-Friendly”-certifiedhospitals(BFH)and2non-Baby-FriendlyHospitals(nBFH)inJapan,andwereallocatedtoaninterventionorcontrolgroup.Participantsintheinterventiongroupwereprovidedwithabreastfeedingself-efficacyworkbookintheirthirdtrimester.InBFHs,theinterventionimprovedbothbreastfeedingself-efficacythrough4weekspostpartum(p=0.037)andtheexclusivebreastfeedingrateat4weekspostpartum(AOR2.32,95%CI1.01–5.33).InnBFHs,however,nopositiveeffectwasobservedonbreastfeedingself-efficacyorontheexclusivebreastfeedingrateat4weekspostpartum.

Kronborg,H.;Maimburg,R.D.;Vaeth,M.Antenataltrainingtoimprovebreastfeeding:arandomisedtrialMidwifery,2012,28,6,784-790,ElsevierLtd,Scotland

RCTevaluatinganantenataleducationprogramon603interventionwomen(590controls),providing3x3hmidwife-deliveredgroupsessions“readyforchild” programinDenmark.“Theinterventiondidnotleadtoastatisticallysignificantimprovementofthedurationofbreastfeedingandnodifferencewasseenbetweengroupsinrelationtoself-efficacyorbreast-feedingproblems.However,wefoundthattheantenataltrainingcourseincreasedthenumberofwomenwhoexperiencedhavingsufficientknowledgeaboutbreastfeeding6weeksafterbirth,andthiswasreflectedinaprolongedself-reporteddurationofanybreastfeedingintheinterventiongroup.Theantenatalcoursecontributedtomaintainconfidenceinbreastfeedingduringpregnancybutwasunabletoincreasethelevelofself-efficacyordecreasebreast-feedingproblemsasthereasonforhavingdifficultyafterbirth.”

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Nichols,J.;Schutte,N.S.;Brown,R.F.;Dennis,C.L.;Price,I.Theimpactofaself-efficacyinterventiononshort-termbreast-feedingoutcomesHealthEduc.Behav.,2009,36,2,250-258,UnitedStates

ConveniencesampleRCTofN=90in3Australianhospital-basedprenatalclinics.self-efficacyinterventionat36weeksincludeda9pginteractiveworkbook,controlhad5pagenon-BFrelatedworkbook.Interventiongphadsignificantlygreaterincreasesinbreast-feedingself-efficacythandidthewomeninthecontrolgroup."trendtowardincreaseddurationandexclusivity."(measurementscaleforexclusivityand"daysBF"forduration,insteadofmonths).Increasedself-efficacycorrelatedwithhigherlevelofBF.

Hannula,L.;Kaunonen,M.;Tarkka,M.T.AsystematicreviewofprofessionalsupportinterventionsforbreastfeedingJ.Clin.Nurs.,2008,17,9,1132-1143,England

SearchofCINAHL,MedlineandCochraneCentralRegisterdatabaseswereconductedfordatacollection.ThesearchwaslimitedtoarticlespublishedinFinnish,SwedishandEnglishbetweentheyear2000andMarch2006,focusingonbreastfeedingandbreastfeedingsupportinterventions.Tworeviewersindependentlyanalysed36articlesinthefinalanalysis.Interventionsexpandingfrompregnancytotheintrapartumperiodandthroughoutthepostnatalperiodweremoreeffectivethaninterventionsconcentratingonashorterperiod.Inaddition,interventionpackagesusingvariousmethodsofeducationandsupportfromwell-trainedprofessionalsaremoreeffectivethaninterventionsconcentratingonasinglemethod.Duringpregnancy,theeffectiveinterventionswereinteractive,involvingmothersinconversation.TheBabyFriendlyHospitalInitiative(BFHI)aswellaspracticalhandsoff-teaching,whencombinedwithsupportandencouragement,wereeffectiveapproaches.Postnatallyeffectivewerehomevisits,telephonesupportandbreastfeedingcentrescombinedwithpeersupport.

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Olenick,PLTheeffectofstructuredgroupprenataleducationonbreastfeedingconfidence,durationandexclusivitytotwelveweekspostpartumTorontoUniversityInternational,2006

RCTN=168with2-hourbreast-feedingself-efficacytheorybasedclass.Mainoutcomemeasureswerebreastfeedingduration,exclusivityandconfidencethroughtwelveweeks.Breastfeedingconfidencewasassociatedwithhigherfullratesbreastfeedingatweeksone,sixandtwelvewithmeandifferencesof14.73,15.70,and14.14ontheBSES-SF70pointscale..Higherbreastfeedingconfidencewasassociatedwithlongermeanduration(10weeks)versuslowerscores(5weeks)(KaplanMeierL.R.61.57,p<.0001).Theinterventionwasnotassociatedwithsignificantdifferencesinthefullsampleusing“intenttotreat” analysis.Cross-overanalysisbyclassattendancefoundconsistentdifferencesinat-risksubgroups.Classattendancebyinexperiencedmotherswasassociatedwithhigherfullbreastfeedingratesthanthosewithoutclassatone(39%verses12%)(X2[82]=6.94,p=.01),six(42%versus9%)(X2[85]=11.35,p<.001),andtwelve(35%versus11%)(X2[83]=6.16,p=.02)weeks.Cesareandeliveredmotherswithoutclassattendancehadafullbreastfeedingrateof8%versusthosewithclasshavingratesof39%(X2[49]=7.99,p<.01),42%(X2[50]=11.08,p=.001),and35%,atone,sixandtwelveweeks(X2[51]=7.39,p<.01).Confidenceconsistentlypredictedbreastfeedingexclusivityanddurationinmultivariateanalysis.

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SchlickauJMPrenatalbreastfeedingeducation:aninterventionforpregnantimmigrantHispanicwomenUniversityofNebraskaMedicalCenter,2005

one-to-onePrenatalBreastfeedingEducation(PBE)interventionforprimigravidimmigrantHispanicwomenwhoreceivedprenatalcareatapublichealthclinic.ThestudyframeworkwasderivedfromtheHealthPromotionModel.RCTonbreastfeedinginitiationanddurationParticipants(n=86)wererandomlyassignedtoreceiveeitherthePBEteachingsessioninadditionto"standardofcare"attheprenatalclinic(interventiongroup)ortoreceive"standardofcare"only(controlgroup).Breastfeedinginitiationrateswerenotsignificantlydifferentbetweeninterventionandcontrolgroups.Estimatedmeanbreastfeedingduration,assessedat42days,wassignificantlyhigherby20days(t[78]=5.63,p=.00)forthoseintheinterventiongroup.Meanbreastfeedingself-efficacyscoreswere6pointshigherintheinterventiongroupthaninthecontrol(X2[26]=38.77,p=.05).By42days,anestimated67%ofthoseintheinterventiongroupcontinuedtobreastfeed,whileanestimated13%ofthoseinthecontrolgroupcontinuedtobreastfeed.ResultsoftheKaplan-MeierLogRankTestshowedthedifferencebetweentheestimatedbreastfeedingsurvivaltime(20days)wassignificant(LR[1,N=80]=27.19,p=.00)Hispanicwomenareatriskforchoosingtobottle-feedratherthanbreastfeedandhavenotpreviouslybeenassessedforbreastfeedingself-efficacychange.Theinterventionwasqualitativelyderivedandprovidesculturallyappropriatecontent.Self-efficacyandcommitmenttoaplanofactionwerekeyaspectsoftheintervention

GroupPrenatalSupport/Education

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Tanner-SmithE,Steinka-FryK,LipseyM.(2013)EffectsofCenteringPregnancyGroupPrenatalCareonBreastfeedingOutcomes.JournalofMidwifery&Women’sHealth1526-9523/09.

Aquasi-experimentalresearchdesignwasconductedwith794womenreceivingprenatalcaredeliveredinagrouporindividualformatat4sitesinTennessee.Propensityscoreswereusedtocreategroupsofwomenstatisticallymatchedonbackgrounddemographicsandmedicalhistory.Outcomesincludedbreastfeedingatdischargeandbreastfeedingatpostpartumfollow-up.Comparedwiththematchedcomparisongroupofwomenreceivingprenatalcareinanindividualformat,womeninCenteringPregnancygroupprenatalcarehadsignificantlyhigheroddsofanybreastfeedingatdischarge(oddsratio[OR],2.08;95%confidenceinterval[CI],1.32-3.26;P<.001).Acrossthe4sites,therewerenoconsistentdifferencesintheoddsofanybreastfeedingatfollow-uporexclusivebreastfeedingatdischargeorpostpartumfollow-up.AuthorsconcludedthereisnotsufficientevidencetoconcludethatCenteringPregnancygroupprenatalcarehasrobusteffectsonexclusivebreastfeedingatdischargeorpostpartumfollow-up.

IckovicksJR,KershawTS,WestdahlC.Groupprenatalcareandperinataloutcomes:Arandomized,controlledtrial.ObstetricsandGynecology.2007;110(2pt1):330-339.

Amultisiterandomizedcontrolledtrialwasconductedattwoprenatalclinics.Pregnantwomenaged14-25years(n=1,047)wererandomlyassignedtoeitherstandardorgroupcare.Groupparticipantsreceivedcareinagroupsettingwithwomenhavingthesameexpecteddeliverymonth.Timingandcontentofvisitsfollowedobstetricguidelinesfromweek18throughdelivery.Each2-hourprenatalcaresessionincludedphysicalassessment,educationandskillsbuilding,andsupportthroughfacilitatedgroupdiscussion.Structuredinterviewswereconductedatstudyentry,duringthethirdtrimester,andpostpartum.Meanageofparticipantswas20.4years;80%wereAfricanAmerican.Usingintent-to-treatanalyses,womenassignedtogroupcareweresignificantlylesslikelytohavepretermbirthscomparedwiththoseinstandardcare:9.8%comparedwith13.8%,withnodifferencesinage,parity,education,orincomebetweenstudyconditions,equivalenttoariskreductionof33%.Womeningroupsessionswerelesslikelytohavesuboptimalprenatalcare(P<.01),hadsignificantlybetterprenatalknowledge(P<.001),feltmorereadyforlaboranddelivery(P<.001),andhadgreatersatisfactionwithcare(P<.001).Breastfeedinginitiationwashigheringroupcare:66.5%comparedwith54.6%,P<.001.Therewerenodifferencesinbirthweightnorincostsassociatedwithprenatalcareordelivery.

DeOliveiraMI,CamachoLA,TedstoneAE.Extendingbreastfeedingdurationthroughprimarycare:asystematicreviewofprenatalandpostnatalinterventions.JHumLact.2001Nov;17(4):326-43.

Literaturereviewofstrategiesandproceduresusedtoextendbreastfeedingduration.Duringprenatalcare,groupeducationwaseffectiveinincreasingbreastfeedingrates.

BreastCrawl

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HendersonA.Understandingthebreastcrawl:implicationsfornursingpractice.NursWomensHealth.2001;15(4):296-307.

Reviewarticlesummarizingthephysiologyofnewbornbehaviorintheimmediatepostpartumperiodthatcontributestothe“breastcrawl,”welldescribedinothernursingarticlesandtextbooks.Summarizeskeyrecommendationsfornursesintermsofsupportingnormalphysiologicbondingandearlybreastfeedingbehavior,withanemphasisoninitiationandmaintenanceearlyskin-to-skincontactandlatchwithinthefirsthouroflife.

KlausM.Motherandinfant:earlyemotionalties.Pediatrics.1998;Nov:102(5SuppE):1244-6.

Reviewarticlesummarizingrecentbehavioralandphysiologicobservationsofinfantsandmotherswhichhaveshownthemreadytobegininteractinginthefirstminutesoflife.Includedamongthesefindingsarethenewborninfant'sabilitytocrawltowardthebreasttoinitiatesucklingandmother-infantthermoregulation.Theattachmentfeltbetweenmotherandinfantmaybebiochemicallymodulatedthroughoxytocin;encouragingattachmentthroughearlycontact,suckling,androoming-inhasbeenshowntoreduceabandonment.

Positionpapers

PositionPaper:Breastfeeding,FamilyPhysiciansSupporting.AmericanAcademyofFamilyPhysicians(AAFP),2014,May29,2015,http://www.aafp.org/about/policies/all/breastfeeding-support.html

AAFP’sofficialpositionpaperontheimportanceofbreastfeeding,impactonpublichealthandrecommendationsforwaysinwhichfamilyphysicianscanpromoteandsupportbreastfeeding.SupportsrecommendationsoftheBaby-FriendlyHospitalInitiativeandBaby-FriendlyOfficewithmultipleprimaryreferences.

TheAmericanCollegeofObstetriciansandGynecologists.CommitteeOpinion:BreastfeedinginUnderservedWomen:IncreasingInitiationandContinuationofBreastfeeding.Obstet.Gynecol.,2013,122,423-8.

ReviewstheimportanceofbreastfeedingandsummarizesguidelinessimilartothoseoftheSurgeonGeneralandtheAAP.TheCollegesupportseffortstoeducatepatientsonthebenefitsandmechanicsofbreastfeeding,andencourageshealthcareproviders,nursingstaff,andgovernmentassistanceagenciestoremainstrongadvocatesforbreastfeeding,includinglactationprogramswithinhospitals.Amultidisciplinaryapproachthatinvolvescommunity,family,patients,andallinvolvedcliniciansisadvisedinordertoachieveHealthyPeople2020breastfeedinggoals.The10StepsoftheBabyFriendlyHospitalInitiativearereviewedandendorsed.

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TheAmericanCollegeofObstetriciansandGynecologists.CommitteeOpinion:Breastfeeding:MaternalandInfantAspects.Obstet.Gynecol.,2013,361,479-80.

ACOGstronglysupportsbreastfeeding(includingexclusivebreastfeeding6monthsormore)andcallsuponitsFellows,otherhealthcareprofessionalscaringforwomenandtheirinfants,hospitals,andemployerstosupportwomeninchoosingtobreastfeedtheirinfants.Inadditiontoprovidingsupportiveclinicalcarefortheirownpatients,obstetrician–gynecologistsshouldbeintheforefrontoffosteringchangesinthepublicenvironmentthatwillsupportbreastfeeding,whetherthroughchangeinhospitalpractices,throughcommunityefforts,orthroughsupportivelegislation.Thisguidelinedetailsevidence-basedpracticesforobstetrician–gynecologiststosupportbreastfeedingduringpreconception,prenatal,postpartum,andinterconceptioncare.(adviceandencouragement,hospitalpractices,giftpacks,breastexams,contraception,maintainingmilksupply/lifeissues,officepractices,24hpostpartumresource)

Eidelman,AandSchanler,RAAPExecutiveSummary:BreastfeedingandtheUseofHumanMilkPediatrics,2012,129,3,600-603

ExecutivereportonBFepidemiology,infantoutcomes,BFandtheprematurebaby,maternaloutcomes,economicbenefits,duration,contraindications,maternaldiet,maternalmedicaitons,hospitalroutines/10steps,pacifieruse,vitaminDuse,managementofBF,roleofthepediatricianinBFsupportandmanagement,businesscaseforBF.Partoftheroleofthepediatricianisto“Collaboratewiththeobstetriccommunitytodevelopoptimalbreastfeedingsupportprograms.”

AcademyofBreastfeedingMedicine.ClinicalProtocol#14:Breastfeeding-FriendlyPhysiciansOfficePart1:OptimizingCareforInfantsandChildren.BreastfeedingMedicine2006;1(2):115-119.www.bfmed.org(LastaccessedJune9,2008)

Clinicalprotocolforcreatingabreastfeedingfriendlyoffice.Basedonmultipleprimaryresources.

AAP,ACOG.BreastfeedingHandbookforPhysicians.Breastfeeding:ManagementBeforeandAfterConception.55-65

Reviewoftechniquesforhistory,examandeducationregardingbreastfeedingduringofficevisitswithmultipleprimaryreferences.

SectiononBreastfeeding.TenStepstoSupportParents’ ChoicetoBreastfeedTheirBaby.ElkGroveVillage,IL:AmericanAcademyofPediatrics;2003.

AAP’s10Stepstosupportbreastfeeding,basedonBFHI. III

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WorldHealthOrganization.InternationalCodeofMarketingofBreast-milkSubstitutes,1981,ResolutionWHA34.22.http://www.who.int/nutrition/publications/code_english.pdf.Accessed:Sept10,2015.

WorldHealthOrganizationsetofrecommendationsfortheregulationofmarketingofbreast-milksubstitutes.

Supportofproviders/offices

HartmanS,BarnettJ,BonuckK.Implementinginternationalboard-certifiedlactationconsultantsinterventionintoroutinecare:Barriersandrecommendations.ClinicalLactation.2012;3-4:131.

QualitativeanalysisofinterventionthatintegratedIBCLCsintoroutinecare,prenatalandpostnatal.Theresultsindicatedthathealthcareprovider(HCP)supportforbreastfeedingwasunderminedbyinadequateeducationandexperience,oftenresultinginsupport“innameonly.”Inaddition,IBCLCsrapportandexpertise—withbothwomenandthehealthcareteam—helpedovercomeindividual-andsystem-levelbarrierstobreastfeeding.IBCLCs’acceptanceandintegrationintotheprimary-careteamvalidatedtheirworkandincreasedtheireffectiveness.IBCLCscommentssuggestthatmotherscannotrelysolelyupontheirhealthcareprovidersforbreastfeedingeducationandsupport.IBCLCsintegratedintoroutineantenatalandpostpartumcarearepivotaltoencouragingandreinforcingawoman’schoicetobreastfeedthrougheducation,aswellasemotionalandskill-basedsupport.

BonuckK,StuebeA,BarnettJ,LabbokM,FletcherJ,BernsteinP.Effectofprimarycareinterventiononbreastfeedingdurationandintensity.AmJPublicHealth,2014,104,S1,S119-127.Andaya,E.;Bonuck,K.;Barnett,J.;Lischewski-Goel,J.Perceptionsofprimarycare-basedbreastfeedingpromotioninterventions:qualitativeanalysisofrandomizedcontrolledtrialparticipantinterviewsBreastfeedMed.,2012,7,6,417-422,UnitedStates

Resultsof2RCTs(275womenand666women)arepresentedcomparingusualcarevs.prenatalLCeducationorelectronically-prompted(EP)educationfromprenatalproviders.At3monthspostpartum,high-intensityorexclusivebreastfeedingwasgreaterfortheLC+EPgroupsvs.usualcare,butnotfortheEPgroupalone.AuthorsconcludedthatLCintegrationintoroutineprenatalcare,withorwithoutEPs,increasedbreastfeedingintensityat3months.#2:Qualitativeanalysisof6monthexitinterviewsofasubsample(67)ofparticipants(nearly1000)inanRCTcomparingroutinepre/postnatalLCsupport(LC),electronicprompts(EP)toproviderstodiscussBFinprenatalcarevisits,acombinedinterventionofboth(LC+EP),andcontrols.Qualitativeanalysisfoundthat1)exitinterviewsfocusedattentiononfeedingpracticesandpromotedBFwhencoupledw/theintervention,2)theEPandLCinterventionswerecomplementary,EPinfluencedinitiationwhileLCshelpedovercomebarriersandsustainBF,3)prenatalintenttofeedbothformulaandBFwasassociatedwithgreatedreceptivitytostudymessages.

TechnologyandInternet

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Giglia,R.;Binns,C.Theeffectivenessoftheinternetinimprovingbreastfeedingoutcomes:asystematicreviewJ.Hum.Lact.,2014,30,2,156-160,UnitedStates

Poorstudydesign,numerousstudylimitations,andalackofscientificrigormakeitdifficulttodeterminewhatroletheInternetcanplayinbreastfeedingsupport.AtthispointintimeitwouldbeunethicaltorecommendtheInternetasthesolesourceofbreastfeedingsupportandeducationintheantenatalorpostnatalperiod.

IorII-2

BonuckK,StuebeA,BarnettJ,LabbokM,FletcherJ,BernsteinP.Effectofprimarycareinterventiononbreastfeedingdurationandintensity.AmJPublicHealth,2014,104,S1,S119-127.Andaya,E.;Bonuck,K.;Barnett,J.;Lischewski-Goel,J.Perceptionsofprimarycare-basedbreastfeedingpromotioninterventions:qualitativeanalysisofrandomizedcontrolledtrialparticipantinterviewsBreastfeedMed.,2012,7,6,417-422,UnitedStates

Resultsof2RCTs(275womenand666women)arepresentedcomparingusualcarevs.prenatalLCeducationorelectronically-prompted(EP)educationfromprenatalproviders.At3monthspostpartum,high-intensityorexclusivebreastfeedingwasgreaterfortheLC+EPgroupsvs.usualcare,butnotfortheEPgroupalone.AuthorsconcludedthatLCintegrationintoroutineprenatalcare,withorwithoutEPs,increasedbreastfeedingintensityat3months.#2:Qualitativeanalysisof6monthexitinterviewsofasubsample(67)ofparticipants(nearly1000)inanRCTcomparingroutinepre/postnatalLCsupport(LC),electronicprompts(EP)toproviderstodiscussBFinprenatalcarevisits,acombinedinterventionofboth(LC+EP),andcontrols.Qualitativeanalysisfoundthat1)exitinterviewsfocusedattentiononfeedingpracticesandpromotedBFwhencoupledw/theintervention,2)theEPandLCinterventionswerecomplementary,EPinfluencedinitiationwhileLCshelpedovercomebarriersandsustainBF,3)prenatalintenttofeedbothformulaandBFwasassociatedwithgreatedreceptivitytostudymessages.

GallegosD,Russell-BennettR,PreviteJ,etal.Canatextmessageaweekimprovebreastfeeding?BMCPregnancyChildbirth.2014;14(374):1-11.

Randomizedcontrolledtrialofasimpleintervention:womenintheinterventiongroupreceivedMumBubConnect,atextmessagingservicewithautomatedresponsesdeliveredonceaweekfor8weeks.Womeninthecomparisongroupreceivedtheirusualcareandweresampledtwoyearsaftertheinterventiongroup.Datacollectionincludedonlinesurveysattwotimepoints,weekzeroandweeknine,tomeasurebreastfeedingexclusivityandduration,coping,emotions,accountabilityandself-efficacy.Arangeofstatisticalanalyseswereusedtotestfordifferencesbetweengroups.Hierarchicalregressionwasusedtoinvestigatechangeinbreastfeedingoutcome,betweengroups,adjustingforco-variates.Theinterventiongrouphad120participantsatcommencementand114atcompletion,thecomparisongrouphad114participantsatcommencementand86atcompletion.MumBubConnecthadapositiveimpactontheprimaryoutcomeofbreastfeedingbehaviorswithwomenreceivingtheinterventionmorelikelytocontinueexclusivebreastfeeding;witha6%decreaseinexclusivebreastfeedingintheinterventiongroup,comparedtoa14%

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decreaseinthecomparisongroup(p < 0.001).Thisremainedsignificantaftercontrollingforinfantage,mother’sincome,educationanddeliverytype(p = 0.04).Womenintheinterventiongroupdemonstratedactivecopingandwerelesslikelytodisplayemotions-focussedcoping(p < .001).Therewasnodiscerniblestatisticaleffectonself-efficacyoraccountability.

FlaxVL,NegerieM,IbrahimAU,etal.Integratinggroupcounseling,cellphonemessaging,andparticipant-generatedsongsanddramasintoamicrocreditprogramincreasesNigerianwomen'sadherencetointernationalbreastfeedingrecommendations.JNutr.2014;144(7):1120-4.

Cluster-randomizedcontrolledtrialinBauchiState,Nigeria,withtheaimofincreasingearlybreastfeedinginitiationandexclusivebreastfeedingamongfemalemicrocreditclients.Theinterventionhad3components.Trainedcreditofficersledmonthlybreastfeedinglearningsessionsduringregularlyscheduledmicrocreditmeetingsfor10months.Textandvoicemessagesweresentoutweeklytoacellphoneprovidedtosmallgroupsofmicrocreditclients(5-7women).Thesmallgroupspreparedsongsordramasaboutthemessagesandpresentedthematthemonthlymicrocreditmeetings.Thecontrolarmcontinuedwiththeregularmicrocreditprogram.Randomizationoccurredatthelevelofthemonthlymeetinggroups.Pregnantclientswererecruitedatbaselineandinterviewedagainwhentheirinfantswereaged$6mo.Logisticregressionmodelsaccountingforclusteringwereusedtoestimatetheoddsofperformingrecommendedbehaviors.Amongtheclientswhocompletedthefinalsurvey(n=390),theoddsofexclusivebreastfeedingto6mo(OR:2.4;95%CI:1.4,4.0)andtimelybreastfeedinginitiation(OR:2.6;95%CI:1.6,4.1)wereincreasedintheinterventionvs.controlarm.Delayedintroductionofwaterexplainedmostoftheincreaseinexclusivebreastfeedingamongclientsreceivingtheintervention.

PeerSupport

Brunton,G.;O'Mara-Eves,A.;Thomas,J.The'activeingredients'forsuccessfulcommunityengagementwithdisadvantagedexpectantandnewmothers:aqualitativecomparativeanalysisJ.Adv.Nurs.,2014,70,12,2847-2860,JohnWiley&SonsLtd,England

Qualitativecomparativeanalysisofstudiesinasystematicreviewlookingatantenatal,immunization,breastfeedingandearlyprofessionalinterventionoutcomes.Peerdelivery(consistency083;uniquecoverage063);andmother-professionalcollaboration(consistency0833;uniquecoverage021)weremoderatelyalignedwitheffectiveinterventions.Community-identifiedhealthneedplusconsultation/collaborationininterventiondesignandleadingondeliverywereweaklyalignedwith‘noteffective’interventions(consistency078;uniquecoverage029).Conclusions.Fordisadvantagednewandexpectantmothers,peerorcollaborativedeliverymodelscouldbeusedininterventions.

Bevan,G.;Brown,M.Interventionsinexclusivebreastfeeding:asystematicreview.Br.J.Nurs.,2014,23,2,86-89,England

Reviewoftheevidenceforinterventionsinexclusivebreastfeeding.Supportmechanisms,peersupportandculturalfactorsarediscussed.

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Chapman,D.J.;Morel,K.;Bermudez-Millan,A.;Young,S.;Damio,G.;Perez-Escamilla,R.Breastfeedingeducationandsupporttrialforoverweightandobesewomen:arandomizedtrial.Pediatrics,2013,131,1,e162-70.

Recruited206pregnant,overweight/obese,low-incomewomenandrandomlyassignedthemtoreceivespecializedbreastfeedingpeercounseling(SBFPC)orstandardcare(controls)ataBaby-Friendlyhospital.SBFPCincluded3prenatalvisits,dailyin-hospitalsupport,andupto11postpartumhomevisitspromotingEBFandaddressingpotentialobesity-relatedbreastfeedingbarriers.TheinterventionhadnoimpactonEBForbreastfeedingcontinuationat1,3,or6monthspostpartum.Inadjustedposthocanalyses,at2weekspostpartumtheinterventiongrouphadsignificantlygreateroddsofcontinuinganybreastfeeding(adjustedoddsratio[aOR]:3.76[95%confidenceinterval(CI):1.07–13.22]),andgivingatleast50%offeedingsasbreastmilk(aOR:4.47[95%CI:1.38–14.5]),comparedwithcontrols.Infantsintheinterventiongrouphadsignificantlyloweroddsofhospitalizationduringthefirst6monthsafterbirth(aOR:0.24[95%CI:0.07–0.86]).

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Chung,M.;Ip,S.;Yu,W.;Raman,G.;Trikalinos,T.;DeVine,D.;Lau,J.InterventionsinPrimaryCaretoPromoteBreastfeeding,AHRQ,2008,Rockville(MD)

Systematicreviewofevidencefortheeffectivenessofprimarycare–initiatedinterventionstopromotebreastfeeding-includedrandomized,controlledtrialsofprimarycare–initiatedinterventions,mainlyindevelopedcountries.Thirty-eightrandomized,controlledtrialsmeteligibilitycriteria.Breastfeedingpromotioninterventionsindevelopedcountriesresultedinsignificantlyincreasedratesofshort-(1to3months)andlong-term(6to8months)exclusivebreastfeeding(rateratios,1.28[95%CI,1.11to1.48]and1.44[CI,1.13to1.84],respectively).Insubgroupanalyses,combiningpre-andpostnatalbreastfeedinginterventionshadalargereffectonincreasingbreastfeedingdurationsthaneitherpre-orpostnatalinterventionsalone.Interventionswithacomponentoflaysupport(suchaspeersupportorpeercounseling)weremoreeffectivethanusualcareinincreasingtheshort-termbreastfeedingrate.

ChapmanDJ,DamioG,Perez-EscamillaR.Differentialresponsetobreastfeedingpeercounselingwithinalow-income,predominantlyLatinapopulation.JHumLact2004Nov;20(4):389-96.

Logisticregressionmodelsbaseduponarandomizedcontroltrialtoidentifythosemostresponsivetopeercounseling.Multiparae(OR=6.4)andwomenwithuncertainbreastfeedingintentions(OR=7.4)werefoundtobenefitthemostfromaprenatalvisit.

ChapmanDJ,DamioG,YoungS,Perez-EscamillaR.Effectivenessofbreastfeedingpeercounselinginalow-income,predominantlyLatinapopulation:arandomizedcontrolledtrial.ArchPediatrAdolescMed.2004Sep;158(9):897-902

RCTofabreastfeedingpeer-counselingprogramforlow-incomepopulation.Theinterventiongroupshowedincreasedinitiationratesandduration(91%vs.77%).

In-homeinterventions

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Memon,Z.A.;Khan,G.N.;Soofi,S.B.;Baig,I.Y.;Bhutta,Z.A.TitleImpactofacommunity-basedperinatalandnewbornpreventivecarepackageonperinatalandneonatalmortalityinaremotemountainousdistrictinNorthernPakistanBMCPregnancyChildbirth,2015,15,1,106-015-0538-8,England

Non-randomizedcontrolledtrialincluding3,200pregnantwomenreceivingintervention,andapopulationof283,324,whichconsistedofacommunity-basedinterventionpackageincludingawarenesscreation,communitymobilizationandeducation,enhancedtrainingsforcommunityhealthworkers,homevisits,counselingsessionswithpregnantwomen,videoandeducationsessionsforpregnantwomenaswellascommunitymembers.Foundincreasedcolostrumadministration(83%vs71%,p<0.001)andinitiationofbreastfeedingwithin1hourofbirth(55%vs.40%,p<0.001)ininterventionvs.controlgroup,inadditiontodecreasedoverallneonatalmortality.

Martin,J.;MacDonald-Wicks,L.;Hure,A.;Smith,R.;Collins,C.E.Title:Reducingpostpartumweightretentionandimprovingbreastfeedingoutcomesinoverweightwomen:apilotrandomisedcontrolledtrial.Nutrients,2015,7,1464-1479.

Lassi,Z.S.;Das,J.K.;Salam,R.A.;Bhutta,Z.A.Evidencefromcommunitylevelinputstoimprovequalityofcareformaternalandnewbornhealth:interventionsandfindingsReprod.Health.,2014,11Suppl2,S2-4755-11-S2-S2.Epub2014Sep4,England

POSTNATALHomevisitsbyCHWtoimproveneonatalhealthwasassociatedwithimprovedbreastfeedinginitiationwithin1hour(RR:3.35,95%CI:1.31-8.59).PRENATALCochrane:CommunitybasedpackageswithanemphasisonprovisionofcarethroughtrainedCHWviahomevisitationsignificantlyimprovedearlybreastfeedinginitiation(RR:1.94,95%CI:1.56-2.42).PRENATALCochrane:Careprovidedbymidwiveswasfoundtobeassociatedwithsignificantimprovementsininitiationofbreastfeeding(RR:1.35,95%CI:1.03-1.76).Cochrane,mixedPREANDPOSTNATAL:AnotherreviewevaluatingtheeffectsofCHWinterventionsreportedsignificantimpactsonbreastfeedinginitiation(RR:1.36,95%CI:1.14-1.61).

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Edwards,R.C.;Thullen,M.J.;Korfmacher,J.;Lantos,J.D.;Henson,L.G.;Hans,S.L.Breastfeedingandcomplementaryfood:randomizedtrialofcommunitydoulahomevisiting.Pediatrics,2013,132Suppl2,S160-6.

Low-income,AfricanAmericanmothers(n=248)underage22yearsparticipatedinarandomizedtrialofacommunitydoulaintervention.Doulasprovidedhomevisitsfrompregnancythrough3monthspostpartum,andsupportduringchildbirth.Control-groupmothersreceivedusualprenatalcare.Intent-to-treatanalysesshowedthatdoula-groupmothersattemptedbreastfeedingatahigherratethancontrol-groupmothers(64%vs50%;P=.02)andweremorelikelytobreastfeedlongerthan6weeks(29%vs17%;P=.04),althoughfewmothersstillbreastfedat4months.Theinterventionalsoimpactedmothers’ cereal/solidfoodintroduction(P=.008):fewerdoula-groupmothersintroducedcomplementaryfoodsbefore6weeksofage(6%vs18%),whilemorewaiteduntilatleast4months(21%vs13%)comparedwithcontrol-groupmothers.

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IslamKhan,A.Effectsofpre-andpostnatalnutritioninterventionsonchildgrowthandbodycomposition:theMINIMattrialinruralBangladesh.Glob.Health.Action,2013,6,22476.Khan,A.I.;Hawkesworth,S.;Ekstrom,E.C.;Arifeen,S.;Moore,S.E.;Frongillo,E.A.;Yunus,M.;Persson,L.A.;Kabir,I.Effectsofexclusivebreastfeedinginterventiononchildgrowthandbodycomposition:theMINIMattrial,Bangladesh.ActaPaediatr.,2013,102,8,815-823.

IntheMINIMattrialinBangladesh,pregnantwomenwererandomizedtoearly(around9weeks)orusualinvitation(around20weeks)tofoodsupplementationandtooneofthethreedailymicronutrientsupplements.Subjectswerealsorandomizedtoexclusivebreastfeeding(EBF)counseling(by“trainedcounselors,” 2prenataland6postnatalsessions)ortousualhealthmessages.ViaCommunity-healthworkers/homevisits.Nodifferencesinbackgroundcharacteristicswereobservedamongtheinterventiongroups.Therewasalsonodifferentialeffectofprenatalinterventionsonbirthweightorbirthlength.Earlyfoodsupplementationreducedthelevelofstuntingfromearlyinfancyupto54monthsofageamongboys(averagedifference– 6.5%units,95%confidenceinterval[CI]1.7–11.3,p=0.01)butnotamonggirls(averagedifference– 2.4%units,95%CI−2.2–7.0,p=0.31).MMSresultedinmorestuntingcomparedtostandardFe60F(averagedifference– 4.8%units,95%CI0.8–8.9,p=0.02).BreastfeedingcounselingprolongedthedurationofEBF(difference– 35days,95%CI30.6–39.5,p<0.001).Neitherpregnancyinterventionsnorbreastfeedingcounselinginfluencedthebodycompositionofchildrenat54monthsofage.Theeffectsofprenatalinterventionsonpostnatalgrowthsuggestprogrammingeffectsinearlyfetallife.Sametrialasabove,withjustthebreastfeedinginterventiondiscussed.Subjectswerealsorandomizedtoexclusivebreastfeeding(EBF)counseling(by“trainedcounselors,” 2prenataland6postnatalsessions)ortousualhealthmessages.BreastfeedingcounselingprolongedthedurationofEBF(difference– 35days,95%CI30.6–39.5,p<0.001).

Karp,S.M.;Howe-Heyman,A.;Dietrich,M.S.;Lutenbacher,M.Breastfeedinginitiationinthecontextofahomeinterventiontopromotebetterbirthoutcomes.BreastfeedMed.,2013,8,4,381-387.

Dataforasubsampleofwomen(n=130)werederivedfromarandomizedclinicaltrialtestingahomevisitinterventiontoimprovebirthoutcomes.Thesubsampleincludedwomenwhogavebirthtoaninfantgreaterthan35weeksofgestation.Interventionparticipants(n=73)alsoreceivedaseriesof4homevisitsbynurse-midwives.Descriptiveandlogisticregressionanalyseswereused,controllingforfactorspreviouslyassociatedwithbreastfeeding.Although85%ofwomenreportedanintentiontobreastfeed,only65%reportedinitiatingbreastfeedingat48hourspostpartum.Aftercontrollingforrace,income,maritalstatus,smoking,andage,highermaternaleducationandlowerpregravidbodymassindexwereassociatedwithhigherratesofinitiation(oddsratio[OR]=1.30,p=0.010andOR=0.94,p=0.007,respectively).Lowerlevelsofdepressivesymptoms(OR=0.95,p=0.039)andhigherlevelsofprenatalstress(OR=1.11,p=0.042)increasedthelikelihoodofinitiatingbreastfeeding.Womenintheinterventiongroupweremorelikelytoreportbreastfeeding(p=0.007).

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Kirkwood,B.R.;Manu,A.;tenAsbroek,A.H.;Soremekun,S.;Weobong,B.;Gyan,T.;Danso,S.;Amenga-Etego,S.;Tawiah-Agyemang,C.;Owusu-Agyei,S.;Hill,Z. EffectoftheNewhintshome-visitsinterventiononneonatalmortalityrateandcarepracticesinGhana:aclusterrandomisedcontrolledtrial.Lancet,2013,381,9884,2184-2192.

Clusterrandomisedtrialwasundertakenin98zonesinsevendistrictsinGhana.Community-basedsurveillancevolunteers(CBSVs)inNewhintszonesweretrainedtoidentifypregnantwomenintheircommunityandtomaketwohomevisitsduringpregnancyandthreeinthefirstweekoflifetopromoteessentialnewborn-carepractices,weighandassessbabiesfordangersigns,andreferasnecessary.Initiationofbreastfeedinginlessthan1hofbirthwasimprovedforinterventionvs.control(3743[49%]of7673vs3280[41%]of7921,respectively;1·22,1·07–1·40;p=0·004).Skintoskincontactpostdeliveryalsoimproved(3355[44%]vs1931[24%],respectively;2·30,1·85–2·87;p=0·0002),aswellasexclusivebreastfeedingfor26–32days(1217[86%]of1414vs1091[80%]of1371;1·10,1·04–1·16;p=0·001).

AuthorsOchola,S.A.;Labadarios,D.;Nduati,R.W.Impactofcounsellingonexclusivebreast-feedingpracticesinapoorurbansettinginKenya:arandomizedcontrolledtrial.publichealthnutrition

RandomizedControlledtrialinwhich9villageswereassignedto1of3groups:controlgroup,ahome-basedinterventiongroup,andafacility-basedinterventiongroup.Thehome-basedgroupreceived1prenataland6postnataleducationsessions,thefacility-basedgroupreceivedonly1prenatalone-on-oneBFeducationsession.SignificantimprovementswereseeninBFratesforbothinterventiongroupsat1month(84.3%forfacility-basedand87%forhome-basedvs.72%fortheControlgroup),butonlyforthehome-basedgroupbeyond1month.

Gogia,S.;Sachdev,H.S.Homevisitsbycommunityhealthworkerstopreventneonataldeathsindevelopingcountries:asystematicreview.Bull.WorldHealthOrgan.,2010,88,9,658-666B,Switzerland

Systematicreviewandmeta-analysisof5programs(13articles)ofhome-basedinterventionsdeliveredbycommunityhealthworkersinperinatalperiod.TrialswereinIndia,PakistanorBangladesh..Alltrialsincludedantenatalcomponents.Dataon17675and14251livebirths(I+C),andon746and779neonataldeaths.SawimprovedBFby1hofbirthinalltrialsandpooledanalysis(pooledRR=3.35,CI1.31-8.59)

Ingram,J.;Johnson,D.Usingcommunitymaternitycareassistantstofacilitatefamily-focusedbreastfeedingsupportMatern.Child.Nutr.,2009,5,3,276-281,England

11womenreceived1homevisitwith40minsbreastfeedingcounselingforfathers/partnersandpregnantwomenfrom"MaternityCareAssistants"intheUK.Qualitativemethodsfoundthatmothersandotherfamilymembersvaluedthesessions,theMCAsfoundgivingsuchbreastfeedingsupportbothenjoyableandfulfilling,whileinvolvingfathersandfamilymembersprovedapracticalwayofencouragingthemtobemoresupportive.MidwivesandmidwiferymanagerswerepositiveaboutinvolvingMCAsingivingtheantenatalintervention,butdidnotseetheroutineintroductionofthistypeofsessionforcouplesbeingpossibleatpresentduetocurrentstaffingproblems.

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Adolescentmothers

Apostolakis-Kyrus,K.;Valentine,C.;DeFranco,E.FactorsassociatedwithbreastfeedinginitiationinadolescentmothersJ.Pediatr.,2013,163,5,1489-1494.

Retrospectivepopulation-basedcohortstudyofallnon-anomalouslivebirthsinOhio(2006-2007).Breastfeedinginitiationrateswerecomparedbetweenadolescentmothersage≤19yearsandareferencegroupage>19years.Amultivariatelogisticregressionmodelassessedtheassociationbetweenbreastfeedinginitiationinadolescentmotherswhileadjustingforimportantconcomitantriskfactorsincludingrace,socioeconomic,demographic,prenatal,anddeliveryfactors.Ofadolescentmothers,44%initiatedbreastfeedingcomparedwith65%ofoldermothers,P<.001.Adolescentswere33%lesslikelytobreastfeedafteradjustingforimportantcoexistingfactors,adjustedrelativerisk0.77(95%CI0.75-0.80).Socioeconomicfactorsandlackofsocialsupporthadthemostsignificantinfluenceonbreastfeedinginitiationinadolescentmothers.

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Obesemothers

Martin,J.;MacDonald-Wicks,L.;Hure,A.;Smith,R.;Collins,C.E.Title:Reducingpostpartumweightretentionandimprovingbreastfeedingoutcomesinoverweightwomen:apilotrandomisedcontrolledtrial.Nutrients,2015,7,1464-1479.

MinoritywomeninUS,UK

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Edwards,R.C.;Thullen,M.J.;Korfmacher,J.;Lantos,J.D.;Henson,L.G.;Hans,S.L.Breastfeedingandcomplementaryfood:randomizedtrialofcommunitydoulahomevisiting.Pediatrics,2013,132Suppl2,S160-6.LEVEL:I.

Low-income,AfricanAmericanmothers(n=248)underage22yearsparticipatedinarandomizedtrialofacommunitydoulaintervention.Doulasprovidedhomevisitsfrompregnancythrough3monthspostpartum,andsupportduringchildbirth.Control-groupmothersreceivedusualprenatalcare.Intent-to-treatanalysesshowedthatdoula-groupmothersattemptedbreastfeedingatahigherratethancontrol-groupmothers(64%vs50%;P=.02)andweremorelikelytobreastfeedlongerthan6weeks(29%vs17%;P=.04),althoughfewmothersstillbreastfedat4months.Theinterventionalsoimpactedmothers’ cereal/solidfoodintroduction(P=.008):fewerdoula-groupmothersintroducedcomplementaryfoodsbefore6weeksofage(6%vs18%),whilemorewaiteduntilatleast4months(21%vs13%)comparedwithcontrol-groupmothers.

Pitcock,N.EvaluationofanInitiativetoIncreaseRatesofExclusiveBreastfeedingAmongRuralHispanicImmigrantWomen.UniversityofVirginia,2013.

Retrospectiveevaluationofspanishlanguageculturally-competentexclusivity-focusedprenataleducationcomponentofastagedBFpromotionintervention.nourishtheirnewborns.Electedtoparticipateinprenatalclass.chartreview,N=39ininterventiongroup,hada53.8%BFintentvs.usualcare37.5%BFintent(n=32).EBFatdischargewas41%forgroupattendeesand3.1%fornon-attendees.77.1%ofallparticipantsdidnotreceiveaccesstoLactationConsultationservices.

Chapman,D.J.;Perez-Escamilla,R.Breastfeedingamongminoritywomen:movingfromriskfactorstointerventionsAdv.Nutr.,2012,3,1,95-104,UnitedStates

ReviewoftheevidenceforBFinterventionsinminoritywomen.Oftheprenatalinterventions,groupprenatalcareandgroupprenatalBFclassesimprovedbreastfeedinginitiation.Durationwasimprovedby1study(groupBFclassvs.individualclass).1group“targetedmalepartnersofpregnant,predominantlyblackwomen”andwas“taughtbyablackfather.”PrenatalPeerCounselingalsoimprovedBFinitiationandduration,thoughsomestudieshadapostpartumcomponent,soimpactofprenatalcomponentondurationishardtoevaluate.

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Otherreportsofinterest

IsslerH,deSaMB,SennaDM.Knowledgeofnewbornhealthcareamongpregnantwomen:basisforpromotionalandeducationalprogramsonbreastfeeding.SaoPauloMedJ.2001Jan4;119(1):7-9.

Cross-sectionalstudyofpregnantwomen’sknowledgeofnewbornhealthcareandbreastfeedingpracticeswhichwasfoundtobelow.

Fathers/Partners

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Kraft,J.M.;Wilkins,K.G.;Morales,G.J.;Widyono,M.;Middlestadt,S.E.Anevidencereviewofgender-integratedinterventionsinreproductiveandmaternal-childhealthJ.HealthCommun.,2014,19Suppl1,122-141,UnitedStates

Reviewofgender-integratedinterventionsinmaternal-childhealthoutcomes.Onestudyexclusivelyonbreastfeeding,providededucationandcounseling(in-personandvideo),andencouragedmentohelptheirwiveswithchoresduringthebreastfeedingperiod.Althoughinterveningwithcoupleswasassociatedwithmoreexclusivebreastfeedingforupto6months(relativetostandardofcare),theprotectiveeffectofthefather’sinvolvementwasstrongeramongfatherswithhigherlevelsofeducationwhomayhavebeenmoreopentomessagesconcerningshareddomesticresponsibilities(Susinetal.,2008).3of5antenatalcareinterventionstargetedmultiplebehaviors(e.g.,makingbirthplans,usingrecommendedsupplementsandservices,breastfeedingand/orimmunizingchildren).OneinterventioninbothIndiaandSouthAfricaincludededucationalmaterialsandindividual,coupleandgroupcounselingonpregnancycare,breastfeedingandpostpartumfamilyplanning,noeffectonbreastfeeding.Evidencepointstotheindirect,butimportant,roleofaddressinggenderdynamicsonselectchildhealthrelated-behaviors.Thelackofclearpatterns,whichcouldbeduetodifferencesincommunitycontext,howgenderdynamicsinfluencetheparticularbehavioraloutcomeoraspectsoftheintervention,makeitdifficulttomakerecommendationsaboutimplementingthesetypesofinterventions.

Bevan,G.;Brown,M.Interventionsinexclusivebreastfeeding:asystematicreview.Br.J.Nurs.,2014,23,2,86-89,England

Reviewoftheevidenceforinterventionsinexclusivebreastfeeding.Supportmechanisms,peersupportandculturalfactorsarediscussed.

Chapman,D.J.;Perez-Escamilla,R.Breastfeedingamongminoritywomen:movingfromriskfactorstointerventionsAdv.Nutr.,2012,3,1,95-104,UnitedStates

ReviewoftheevidenceforBFinterventionsinminoritywomen.Oftheprenatalinterventions,groupprenatalcareandgroupprenatalBFclassesimprovedbreastfeedinginitiation.Durationwasimprovedby1study(groupBFclassvs.individualclass).1group“targetedmalepartnersofpregnant,predominantlyblackwomen”andwas“taughtbyablackfather.”PrenatalPeerCounselingalsoimprovedBFinitiationandduration,thoughsomestudieshadapostpartumcomponent,soimpactofprenatalcomponentondurationishardtoevaluate.

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Ingram,J.;Johnson,D.Usingcommunitymaternitycareassistantstofacilitatefamily-focusedbreastfeedingsupportMatern.Child.Nutr.,2009,5,3,276-281,England

11womenreceived1homevisitwith40minsbreastfeedingcounselingforfathers/partnersandpregnantwomenfrom"MaternityCareAssistants"intheUK.Qualitativemethodsfoundthatmothersandotherfamilymembersvaluedthesessions,theMCAsfoundgivingsuchbreastfeedingsupportbothenjoyableandfulfilling,whileinvolvingfathersandfamilymembersprovedapracticalwayofencouragingthemtobemoresupportive.MidwivesandmidwiferymanagerswerepositiveaboutinvolvingMCAsingivingtheantenatalintervention,butdidnotseetheroutineintroductionofthistypeofsessionforcouplesbeingpossibleatpresentduetocurrentstaffingproblems.

IngramJ,JohnsonD.AfeasibilitystudyofaninterventiontoenhancefamilysupportforbreastfeedinginadeprivedareainBristol,UK.Midwifery.2004Dec;20(4):367-79

Qualitativefocusgroupsandinterviewstoevaluateanantenatalinterventionforfathersandgrandmotherstosupportbreastfeedingmothers.Breastfeedingrateswereincreasedat8weeksininterventiongroup(38%vs.14%).

ProviderRecommendation

Cross-Barnet,C.;Augustyn,M.;Gross,S.;Resnik,A.;Paige,D.Long-termbreastfeedingsupport:failingmothersinneedMatern.ChildHealthJ.,2012,16,9,1926-1932,UnitedStates

Qualitativeanalysisofconveniencesampleof75blackandwhiteWICparticipantsat3MarylandWICagenciescoveringBFeducationandsupportfrompregnancythroughtointerviewdate.Mostmothersreportedreceivingnoeducationorsupportat1ormorestage(prenatal,hospitalorinfancy).Mothersoftenfelteducation/supportwascursoryandinadequateandsomereceivedmisinformation,hadproviderswhowerehostileorindifferenttoBF,notreferredtoavailableresources,gotinconsistentmessages.

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Lu,M.C.;Lange,L.;Slusser,W.;Hamilton,J.;Halfon,N.Providerencouragementofbreast-feeding:evidencefromanationalsurvey.Obstet.Gynecol.,2001,97,2,290-295,UnitedStates

Telsurveyof1229womenwithchildren<3y.Respondentswereaskedtorecallwhethertheirphysiciansornurseshadencouragedordiscouragedthemfrombreast-feeding.

(Thesurveyquestiondidnotspecifythetimingorthecontentofproviderencouragement.Becausethequestionfollowedseveralquestionsonnewborncareinthehospitalorbirthingcenter,itwasprobablyinterpretedbymostrespondentstomeanin-hospital,peripartumencouragement.)Three-fourths(73.2%)ofwomenreportedhavingbeenencouragedbytheirphysiciansornursestobreast-feed;74.6%ofwomenwhowereencouragedinitiatedbreast-feeding,comparedwithonly43.2%ofthosewhowerenotencouraged(P<0.001).Womenwhowereencouragedtobreast-feedweremorethanfourtimes(relativerisk4.39;95%confidenceinterval2.96,6.49)aslikelytoinitiatebreast-feedingaswomenwhodidnotreceiveencouragement.Theinfluenceofproviderencouragementwassignificantacrossallstrataofthesample.Inpopulationstraditionallylesslikelytobreast-feed,providerencouragementsignificantlyincreasedbreast-feedinginitiation,bymorethanthreefoldamonglow-income,young,andless-educatedwomen;bynearlyfivefoldamongblackwomen;andbynearly11-foldamongsinglewomen.

HumenickSS,HillPD,SpiegelbergPL.Breastfeedingandhealthprofessionalencouragement.JHumLact.1998Dec;14(4):305-10.

Longitudinal,cross-sectionalsurveyonnature,sourceandimpactofprofessionalbreastfeedingadvicefor340women.Lactationconsultantsgavesignificantlymorepositiveencouragement(98%,p=.01)thannurses(75%)orphysicians(65%).Primiparaewerelikelytodecreasetheirlevelofbreastfeedingifencouragedtosupplementorwean.Multiparaelevelofbreastfeeding,ingeneral,appearedindependentofhealthprovideradvice.

MansbachIK,PaltiH,PevsnerB,PridanH,PaltiZ.Advicefromtheobstetricianandothersources:dotheyaffectwomen’sbreast-feedingpractices?AstudyamongdifferentJewishgroupsinJerusalem.SocSciMed.1984;19(2):157-62.

Breastfeedingpracticesandthesourcesofadvicethatinfluencedthemwerestudiedinasampleof276womenfromNorthEastJerusalem.Obstetrician’sadvicegivenatthe6weekspostpartumexaminationwassignificantlyassociatedwithdurationofbreastfeeding(p=0.001).Countryoforiginandsocialclassaffectedpatternsaswell.

BFoutcomes

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IpS,ChungM,RamanG,etal.Breastfeedingandmaternalandinfanthealthoutcomesindevelopedcountries.EvidRepTechnolAssess(FullRep).2007;(153)(153):1-186.

SystematicReviewofhealthoutcomesforbreastfeedingmothersandbreastfedbabies.

Horta,B.andVictoraC.Long-termeffectsofbreastfeeding:Asystematicreview..2013;ISBN9789241505307.

SystematicReviewofhealthoutcomesforbreastfeedingmothersandbreastfedbabies.

Bagdistribution

HurwitzAG,FarrowPR,PreerG,PhilippBL.Bagfreeinthebaystate.BreastfeedMed.2014;9(5):257-260.

Massachussetsas2nd“bag-free” stateintheUnitedStates.MaternityfacilitiesinMassachusettsweresurveyedregardingdischargegiftpractices.

Results:Theresponseratewas100%.Fifty-ninepercentofthefacilitiesreplacedtheformulacompany–sponsoredbagwiththeirowngiftbagcarryingthehospital'slogo.Bagswereeithergivenemptyorcontainededucationalmaterialsand/oragiftsuchasaT-shirt,hat,orbabybook.Fourteenpercentofthefacilitiesgaveagiftthatdidnotincludeabag.Twenty-sevenpercentoffacilitiesgavenogift.Costofthegiftsrangedfrom$1to$35,withameancostof$10.67.Thehospitalbudgetwasusedtopartiallyorfullyfund58%ofgifts;22%werecoveredinpartbydonations.

Conclusions:Althoughmostmaternityfacilitiessurveyedreplacedtheformulacompany–sponsoreddischargebagwithadifferentgift,one-quartergavenoreplacement.Thesedataindicatethatdiscontinuingdischargegiftscanbeareadilyaccepted,cost-neutralsteptowardevidence-basedbreastfeedingbestpractice.

Formulaadvertising

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Feldman-WinterL,GrossmanX,PalaniappanA,etal.Removalofindustry-sponsoredformulasamplepacksfromthehospital:Doesitmakeadifference?JHumLact.2012;28(3):380-388.

Methods:WeenrolledmotherspostpartumatCooperUniversityHospital,anurbanNewJerseyhospital,in2009-2010.Forthefirst6months,allwomenreceivedindustry-sponsoredformulasamplespacks(controlgroup);forthenext6months,allpostpartumwomenreceivedhospital-sponsoredbagswithnoformulaatsource(interventiongroup).Researchassistantsblindedtothedesigncalledsubjectsweeklyfor10weekstodeterminefeedingpractices.

Results:Weenrolled527breastfeedingwomen(284control;243intervention).At10weekspostpartum,82%ofcontroland36%ofinterventionwomen(P<.001)reportedreceivingformulainthe“diaperdischargebag.” Kaplan-Meyercurvesforanybreastfeedingshowedtheinterventionwasassociatedwithincreasedbreastfeeding(P=.03);however,exclusivebreastfeedingwasnotsignificantlydifferentbetweeninterventionandcontrols(P=.46).Inposthocanalysis,receivingnotake-homeformulainbottlesfromthehospitalwasassociatedwithincreasedexclusivebreastfeedingincontrol(P=.02)andintervention(P=.03)groupsat10weeks.

Conclusion:Althoughthehospital-brandedreplacementcontainednoformulaatsource,manywomenreportedreceivingbottlesofformulafromthehospital.Changeinpracticetoremoveindustry-sponsoredformulasamplepackswasassociatedwithincreasedbreastfeedingover10weeks,buttheinterventionmayhavehadagreaterimpacthaditnotbeencontaminated.

RosenbergKD,EasthamCA,KasehagenLJ,SandovalAP.Marketinginfantformulathroughhospitals:Theimpactofcommercialhospitaldischargepacksonbreastfeeding.AmJPublicHealth.2008;98(2):290-295.

Weanalyzeddatafromthe2000and2001OregonPregnancyRiskAssessmentMonitoringSystem(PRAMS),apopulation-basedsurveyofpostpartumwomen(n=3895;unweightedresponserate=71.6%).

Results.Amongwomenwhohadinitiatedbreastfeeding,66.8%reportedhavingreceivedcommercialhospitaldischargepacks.Wefoundthatwomenwhoreceivedthesepacksweremorelikelytoexclusivelybreastfeedforfewerthan10weeksthanwerewomenwhohadnotreceivedthepacks(multivariateadjustedoddsratio=1.39;95%confidenceinterval=1.05,1.84).

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DonnellyA,SnowdenHM,RenfrewMJ,WoolridgeMW.Commercialhospitaldischargepacksforbreastfeedingwomen.CochraneDatabaseSystRev.2000;(2)(2):CD002075.

Ninerandomisedcontrolledtrialsinvolvingatotalof3730womenwereanalysed.ThestudiesonlyincludedwomenfromNorthAmerica.Themeta-analysisshowedthatwhencomparingcommercialdischargepackswithanyofthecontrols(nointervention,non-commercialpackandcombinationsofthese),exclusivebreastfeedingwasreducedatalltimepointsinthepresenceofcommercialhospitaldischargepacks.Therewasnoevidencetosupporttheconjecturethatuseofhospitaldischargepackscausestheearlyterminationofnon-exclusivebreastfeeding.Wheretheintroductionofsolidfoodwasmeasured,givingacommercialpack(withorwithoutformula)reducedthetimebeforesolidfoodwasintroduced.

HowardCR,HowardFM,LawrenceRA,AndresenE,deBliekEA,WeitzmanM.Theeffectonbreastfeedingofphysicians’ office-basedprenatalformulaadvertising.ObstetGynecol95(2):296-303,2000.

RCTtocomparetheeffectofformulacompany-producedmaterialsaboutinfantfeedingtobreastfeedingpromotionmaterialswithoutformulaadvertisingonbreastfeedinginitiationandduration.Shorttermoutcomeswerenotaffectedhoweverwomeninthecommercialgroupweremorelikelytoceasebreastfeedingbeforehospitaldischarge.Inaddition,womenwhowereuncertainofbreastfeedinggoalsweremorelikelytoshortendurationwhenexposedtocommercialintervention.

Providerpracticesandeducation

Pound,C.M.;Williams,K.;Grenon,R.;Aglipay,M.;Plint,A.C.BreastfeedingKnowledge,Confidence,Beliefs,andAttitudesofCanadianPhysiciansJ.Hum.Lact.,2014,30,3,298-309

Methods:Abreastfeedingquestionnairewasdevelopedandpilotedpriortostudyenrollment.Thesequestionnairesweresentto1429pediatricians(PED),1329familyphysicians(FP),andfinal-yearpediatricandfinal-yearfamilymedicineresidents(PRandFMR).Results:Theanalysisincluded397PED,322FP,17PR,and44FMRwhocompletedthequestionnaire.Meanoverallcorrectknowledgescorewas67.8%forPED,64.3%forFP,72.7%forPR,and66.8%forFMR.Twohundredeighty-fivePED(74.2%),228FP(73.1%),7PR(41.2%),and21FMR(53.8%)feltconfidentwiththeirbreastfeedingcounselingskills.Lessthanhalf(49.6%ofPEDand45.4%ofFP)believedthatevaluatingbreastfeedingwasaprimarycarephysician’sresponsibility,andfewPEDorFP(5.1%and11.3%)routinelyobservedbreastfeedinginmother-infantpairs.Conclusion:SeveralareasofpotentialdeficitswereidentifiedinCanadianphysicians’ breastfeedingknowledge.Physicianswouldbenefitfromgreatereducationandsupport,tooptimizecareofinfantsandtheirmothers.

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Demirci,J.R.;Bogen,D.L.;Holland,C.;Tarr,J.A.;Rubio,D.;Li,J.;Nemecek,M.;Chang,J.C.CharacteristicsofbreastfeedingdiscussionsattheinitialprenatalvisitObstet.Gynecol.,2013,122,6,1263-1270,UnitedStates

METHODS:Thisanalysiswaspartofalargerstudyinvolving69healthcareprovidersand377patientsattendingtheirinitialprenatalvisitsatasingleclinic.Audiorecordingsandtranscriptsfromthefirst172visits(including36obstetric–gynecologyresidents,sixnursemidwives,andfivenursepractitioners)werereviewedforbreastfeedingdiscussionoccurrence,timingandinitiatorofdiscussions,andadherencetoAmericanCollegeofObstetriciansandGynecologists(College)prenatalbreastfeedingguidelines.Descriptivestatisticswereusedtocharacterizethesampleandfrequencyofbreastfeedingdiscussions.Logisticregressionand[chi]2testswereusedtoexaminepatternsinwomen'sbreastfeedingdiscussionpreferencesanddiscussionoccurrence.Conversationswerequalitativelyanalyzedforbreastfeedingcontent.RESULTS:Breastfeedingdiscussionswereinfrequent(29%ofvisits),brief(mean39seconds),andmostofteninitiatedbycliniciansinanambivalentmanner.Sixty-ninepercentofbreastfeedingdiscussionsincorporatedanyCollegebreastfeedingrecommendations.Breastfeedingwassignificantlymorelikelytobediscussedbycertifiednursemidwivesthanresidents(oddsratio24.54,95%confidenceinterval3.78–159.06;P<.01),andcertifiednursemidwivestendedtoengagepatientsinmoreopendiscussions.Womenindicatingapreferenceforbreastfeedingdiscussionsatthefirstvisit(n=19)weremorelikelytoactuallyhavethediscussion(P<.001).

Cross-Barnet,C.;Augustyn,M.;Gross,S.;Resnik,A.;Paige,D.Long-termbreastfeedingsupport:failingmothersinneedMatern.ChildHealthJ.,2012,16,9,1926-1932,UnitedStates

Qualitativeanalysisofconveniencesampleof75blackandwhiteWICparticipantsat3MarylandWICagenciescoveringBFeducationandsupportfrompregnancythroughtointerviewdate.Mostmothersreportedreceivingnoeducationorsupportat1ormorestage(prenatal,hospitalorinfancy).Mothersoftenfelteducation/supportwascursoryandinadequateandsomereceivedmisinformation,hadproviderswhowerehostileorindifferenttoBF,notreferredtoavailableresources,gotinconsistentmessages.

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Archabald,K.;Lundsberg,L.;Triche,E.;Norwitz,E.;Illuzzi,J.Women'sprenatalconcernsregardingbreastfeeding:aretheybeingaddressed?J.MidwiferyWomensHealth,2011,56,1,2-7,bytheAmericanCollegeofNurse-Midwives,UnitedStates

Qualandquantanalysisofinterviewof130EnglishandSpanishspeakingwomenatYaleNewHavenHospitalRESULTS:

Whenaskedanopen-endedquestionregardingwhethertheyhadconcernsaboutbreastfeedingwhilemakingtheirdecisionsaboutfeedingtheirinfants,81.5%ofwomenidentifiedatleast1concern.Ofthesewomen,only25.4%reportedthatthisconcernwasaddressedbytheproviderduringprenatalcare.Whenpromptedwith8commonconcernsregardingbreastfeedingduringtheprenatalperiod,95.4%ofwomenidentifiedatleast1ofthesepreidentifiedconcerns.Only17.4%ofwomenwhoidentifiedanyofthese8concernsreportedthattheconcernshadbeendiscussedwithaprovider.

Szucs,K.A.;Miracle,D.J.;Rosenman,M.B.Breastfeedingknowledge,attitudes,andpracticesamongprovidersinamedicalhomeBreastfeedMed.,2009,4,1,31-42,UnitedStates

Weconductedeightfocusgroupsusingsemistructuredinterviews:(1)pediatricians;(2)obstetricians;(3)pediatricnursesandalliedhealthprofessionals;(4)obstetricnursesandalliedhealthprofessionals;(5)24-hourtelephonetriageansweringservicenurses;(6)publichealthnurses;(7)SpecialSupplementalNutritionProgramforWomen,Infants,andChildren(WIC)personnel;and(8)lactationconsultantsandpeercounselors.

Results:Weidentifiedgapsinproviders'breastfeedingknowledge,counselingskills,andprofessionaleducationandtraining.Providers'culturesandattitudesaffectbreastfeedingpromotionandsupport.Providersusedtheirownbreastfeedingexperiencestoreplaceevidence-basedknowledgeandAAPpolicystatementrecommendationsforbreastfeedingdyads.Therewerecommunicationdisconnectsbetweenprovidergroups.Providersunderestimatedtheirown,andoverestimatedothers',influenceonbreastfeeding.Thesystemlackedacoordinatedbreastfeedingmission.

Conclusions:Thisstudyilluminatedkeydisconnectednesschallenges(and,hence,opportunities)foramodelmedicalhomeinfosteringcontinuous,comprehensive,coordinated,culturallyeffective,andevidence-basedbreastfeedingpromotionandsupport.

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Miracle,D.J.;Fredland,V.Providerencouragementofbreastfeeding:efficacyandethicsJ.MidwiferyWomensHealth,2007,52,6,545-548,UnitedStates

Giventhisevidence,healthcareprovidersshouldtakeanassertivestanceinpromoting,protecting,andrecommendingbreastfeedingtoexpectantandnewmothers.Thisisconsistentwithcurrentprofessionalpolicystatements1,2,3and4onbreastfeedingandtheuseofhumanmilk.Thiscommentarydiscussestheethicalobligationforproviderencouragementofbreastfeeding,giventhestateofthescienceregardingthehealthbenefitsofbreastfeeding.

Dusdieker,L.B.;Dungy,C.I.;Losch,M.E.PrenatalofficepracticesregardinginfantfeedingchoicesClin.Pediatr.(Phila),2006,45,9,841-845,UnitedStates

Aquestionnaireaddressingbreast-feedingissueswassenttofamilypractitioners(FP),obstetric-gynecologists(OB/GYN),andnursemidwives(NM)inIowa,USA.AllNM,97%ofFP,and85%ofOB/GYNreportedaskinginfantfeedingpreference—usuallyonlyatthefirstprenatalvisit.NM(73%)weremostlikelytoprovideextensivebreast-feedingcounseling.OB/GYN(68%)andFPphysicians(90%)reporteddoingtheirownbreast-feedingcounseling.Breastexaminationstargetingfuturebreast-feedingproblemsweredonein82%to84%ofpatients.NMpracticessharedmoreinformationsupportiveofbreast-feeding.Nearlyallprovidersofferedprenatalclasses,butonly41%ofFPofferedbreast-feedingclasses.Freeformulasampleswereavailablein73%ofFP,54%ofOB/GYN,and36%NMoffices.Pamphletsonformulafeedingandalsobreast-feedingwerereadilyavailable.OverallNM(64%)reportedbeingstrongbreast-feedingadvocatescomparedtoonly13%ofFPand7%ofOB/GYN.Inconclusion,littlepromotionofbreast-feedingoccursinmostprenatalpracticesettings.

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Taveras,E.M.;Li,R.;Grummer-Strawn,L.;Richardson,M.;Marshall,R.;Rego,V.H.;Miroshnik,I.;Lieu,T.A.

Mothers'andclinicians'perspectivesonbreastfeedingcounselingduringroutinepreventivevisitsPediatrics,2004,113,5,e405-11,UnitedStates

prospectivecohortstudyoflow-riskmother-newbornpairsandtheircliniciansinalargemultispecialtygrouppractice.Theparticipatingmotherscompletedtelephoneinterviewsat4and12weekspostpartum,andtheirdatawerelinkedwiththeirobstetricandpediatricclinicians'responsestoacross-sectionalmailedsurveyconductedduringthesametimeperiod.Overall,responserateswere63%formothers(n=429)and82%forclinicians(obstetricclinicians:n=54;pediatricclinicians:n=67).Results.Ofthe429low-riskmother-newbornpairsinthestudy,61%werewhite,16%wereblack,10%wereHispanic,and8%wereAsian,withamean(SD)ageof32.7(5.1)years.At4weekspostpartum,319mothers(74%)wereeitherexclusivelyormixedbreastfeeding.Accordingtotheinterviews,fewmothersdiscussedbreastfeedingdurationwiththeirobstetriccliniciansduringtheirprenatalvisits(15%)orwiththeirpediatriccliniciansduringtheirinfants'2-weekpreventivevisit(24%).Among164motherswhoseobstetricproviderssaidtheyusuallyoralwaysdiscussbreastfeedingdurationduringprenatalvisits,only26(16%)ofthemothersreportedthatthetopicwasdiscussedwiththem(22%agreement;κ =−.004).Amongthosemotherswhosepediatricclinicianssaidtheyusuallyoralwaysdiscussbreastfeedingdurationduringthe2-weekpreventivevisit,only25%ofthemothersreportedthatthetopicwasdiscussed(32%agreement;κ =.05).Manyofthemothershadeitherreturnedtoworkby12weeks(29%)orplannedtoreturntoworkwithinthenextfewmonths(43%).Althoughnearlyalltheobstetric(91%)andpediatric(97%)cliniciansreportedthattheyusuallyoralwaysdiscusswhetheramotherplanstocontinuebreastfeedingafterreturningtowork,onlyapproximatelyhalf(55%)ofthemothersseenbythecliniciansreportedthatthetopicwasdiscussed.Overall,fewmothersreporteddiscussingwiththeircliniciansspecificwaystocontinuebreastfeedingafterreturningtowork.

Conclusion.Mothers'reportsofbreastfeedingadvicegivenduringroutinepreventivevisitsidentifiedseveralareasinwhichunintentionalcommunicationgapsmayoccur,includingspecificsaboutbreastfeedingdurationandmethodsofbreastfeedingafterreturningtowork.Developingapproachestoenhancecommunicationwithmothersduringroutinepreventivevisitscouldimprovethesupportofbreastfeeding.

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Taveras,E.M.;Li,R.;Grummer-Strawn,L.;Richardson,M.;Marshall,R.;Rego,V.H.;Miroshnik,I.;Lieu,T.A.OpinionsandpracticesofcliniciansassociatedwithcontinuationofexclusivebreastfeedingPediatrics,2004,113,4,e283-90,UnitedStates

Weconductedaprospectivecohortstudyoflow-riskmother-newbornpairsinalarge,multispecialtygrouppracticeinwhichthemotherwasbreastfeedingat4weeks.Motherscompletedtelephoneinterviewsat4and12weekspostpartum,andtheirdatawerelinkedwiththeirobstetricandpediatricclinicians’ responsestoacross-sectionalmailedsurveyconductedduringthesametimeperiod.Obstetricandpediatriccliniciansincludedmedicaldoctors,nursepractitioners,andnursemidwives.Overallresponserateswere63%formothersand82%forclinicians(54obstetricand67pediatricclinicians).Bivariateandmultivariateanalyseswereconductedtoidentifythecharacteristicsofcliniciansandmothersthatpredictedexclusivebreastfeedingat12weeks.

Results.Ofthe288motherswhowerebreastfeedingat4weeksandhadacomplete12-weekinterview,152(53%)wereexclusivelybreastfeedingtheirinfantsat12weeks.Motherswhodiscontinuedexclusivebreastfeedingweremorelikelytohaveexperiencedproblemswiththeirinfantlatchingonorsucking(oddsratio[OR]:3.8;95%confidenceinterval[CI]:1.5–9.7)orreportthatahealthcareproviderrecommendedformulasupplementation(OR:2.3;95%CI:1.1–5.0).

Cliniciansreportedlimitedtimeduringpreventivevisitstoaddressbreastfeedingproblemsasaveryimportantbarriertopromotingbreastfeeding.Obstetricproviderswereleastconfidentinresolvingproblemswithmothersnotproducingenoughbreastmilk.Pediatricproviderswereleastconfidentinresolvingproblemswithbreastpainortendernessorcrackedorpainfulnipples.

Inthefinalmultivariatemodel,motherswhosepediatricprovidersrecommendedformulasupplementationifaninfantwasnotgainingenoughweight(OR:3.2;95%CI:1.04,9.7)orwhoconsideredtheiradvicetomothersonbreastfeedingdurationtobenotveryimportant(OR:2.2;95%CI:1.2–3.9)weremorelikelytohavediscontinuedexclusivebreastfeedingby12weekspostpartum.Blackmothersweresignificantlymorelikelytodiscontinueexclusivebreastfeedingby12weeks.

Conclusions.Clinicians’ practicesregardingformulasupplementationofhealthyinfantsandtheiropinionsabouttheimportanceoftheirbreastfeedingadviceareassociatedwiththelikelihoodthatmotherswillcontinueexclusivebreastfeeding.Policiestoenhanceclinicians’ abilitiestoaddressbreastfeedingproblemswithintheconstraintsofbusypracticescouldimprovetheirabilitytosupportexclusivebreastfeeding

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Taveras,E.M.;Capra,A.M.;Braveman,P.A.;Jensvold,N.G.;Escobar,G.J.;Lieu,T.A.CliniciansupportandpsychosocialriskfactorsassociatedwithbreastfeedingdiscontinuationPediatrics,2003,112,1Pt1,108-115,UnitedStates

Methods.Aprospectivecohortstudywasconductedoflow-riskmothersandinfantswhowereinahealthmaintenanceorganizationandenrolledinarandomized,controlledtrialofhomevisits.Motherswereinterviewedinpersonat1to2dayspostpartumandbytelephoneat2and12weeks.Logisticregressionmodelingwasperformedtoassesstheindependenteffectsofthepredictorsofinterest,adjustingforsociodemographicandotherconfoundingvariables.

Results.Ofthe1163mother-newbornpairsinthecohort,1007(87%)initiatedbreastfeeding,872(75%)werebreastfeedingatthe2-weekinterview,and646(55%)werebreastfeedingatthe12-weekinterview.Inthefinalmultivariatemodels,breastfeedingdiscontinuationat2weekswasassociatedwithlackofconfidenceinabilitytobreastfeedatthe1-to2-dayinterview(oddsratio[OR]:2.8;95%confidenceinterval[CI]:1.02–7.6),earlybreastfeedingproblems(OR:1.5;95%CI:1.1–1.97),Asianrace/ethnicity(OR:2.6;95%CI:1.1–5.7),andlowermaternaleducation(OR:1.5;95%CI:1.2–1.9).Mothersweremuchlesslikelytodiscontinuebreastfeedingat12weekspostpartumiftheyreported(duringthe12-weekinterview)havingreceivedencouragementfromtheircliniciantobreastfeed(OR:0.6;95%CI:0.4–0.8).Breastfeedingdiscontinuationat12weekswasalsoassociatedwithdemographicfactorsandmaternaldepressivesymptoms(OR:1.18;95%CI:1.01–1.37)andreturningtoworkorschoolby12weekspostpartum(OR:2.4;95%CI:1.8–3.3).

Conclusions.Ourresultsindicatethatsupportfromcliniciansandmaternaldepressivesymptomsareassociatedwithbreastfeedingduration.Attentiontotheseissuesmayhelptopromotebreastfeedingcontinuationamongmotherswhoinitiate.Policiestoenhanceschedulingflexibilityandprivacyforbreastfeedingmothersatworkorschoolmayalsobeimportant,giventheelevatedriskofdiscontinuationassociatedwithreturntoworkorschool.

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Bentley,M.E.;Caulfield,L.E.;Gross,S.M.;Bronner,Y.;Jensen,J.;Kessler,L.A.;Paige,D.M.SourcesofinfluenceonintentiontobreastfeedamongAfrican-AmericanwomenatentrytoWICJ.Hum.Lact.,1999,15,1,27-34,UNITEDSTATES

Toexaminehowindividualswithinawoman'slifeinfluenceherinfantfeedingintention,weinterviewed441African-Americanwomenonthebreastfeedingattitudesandexperiencesoftheirfriends,relatives,mother,andthebaby'sfather.WomenwereinterviewedatentryintoprenatalcareatclinicsassociatedwithoneoffourBaltimoreWICclinicschosenforabreastfeedingpromotionproject.Qualitativedatawerealsocollectedamong80women.Friendsand"other"relativeswerenotinfluential.Grandmothers'opinionsandexperienceswereimportant,buttheirinfluencewasreducedafterconsideringtheopinionofthebaby'sfather.Theopinionofthewoman'sdoctorwasanindependentpredictorofinfantfeedingintention.Breastfeedingpromotionprogramsshouldrecognizetheseparateinfluenceoffathers,healthproviders,andgrandmothersinwomen'sinfantfeedingdecisions

IzattSD.Breastfeedingcounselingbyhealthcareproviders.JHumLact.1997Jun;13(2):109-13.

Cross-sectionalstudyofsourcesofbreastfeedinginformation.23%receivedcounselfromtheirobstetrician,47%frombooksand21%fromclasses.

Doulas

HodnettE,GatesS,HofmeyrG,etal.Continuoussupportforwomenduringchildbirth.CochraneDatabaseSystRev2013;7:CD003766.

Meta-analysisofRCTsrelatedtocontinuouslaborsupportinchildbirthandpostpartumcare.Inadditiontomultipleotherbenefitsrelatedtobirthoutcomes,continuouslaborsupportwithatraineddoulawasfoundtoincreasebreastfeedinginitiationandtoalesserextentexclusivity.

Labor&Delivery

HolmesA,McLeodA,BunikM;AcademyofBreastfeedingMedicine.ABMclinicalprotocol#5:Peripartumbreastfeedingmanagementforthehealthymotherandinfantatterm,revised2013.BreastfeedMed2013;8:469-473.

Evidencereviewofcurrentliteraturerelatedtointrapartumcareforwomenanditsimpactonbreastfeedingoutcomes.Discussespainmedicationsandcontinuouslaborsupportintermsoftheirimpactonbreastfeeding,prenatalpreparationforthebreastfeedingwomenandtheimportanceofearlyskin-to-skincontactinrelationtobreastfeeding.

MontgomeryA,HaleTW;AcademyofBreastfeedingMedicine.ABMclinicalprotocol#15:Analgesiaandanesthesiaforthebreastfeedingmother,revised2012.BreastfeedMed2012;7:547-553.

Evidencereviewofcurrentliteraturerelatedtointrapartumcareforwomenanditsimpactonbreastfeedingoutcomes.Discussespainmedicationsintermsoftheirimpactonbreastfeeding.

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ThukralA,SankarMJ,AgarwalR,etal.Earlyskin-to-skincontactandbreastfeedingbehaviorintermneonates:Arandomizedcontrolledtrial.Neonatology2012;102:114-119.

Terminfantsbornbynormaldeliverywererandomizedatbirthtoeitherearlyskin-to-skincontact(SSC)(n=20)orconventionalcare(controls;n=21).SSCwascontinuedforatleast2hafterbirth.Subsequently,oneBFsessionoftheinfantswasvideorecordedatabout48hoflife.Theprimaryoutcome,infants'BFbehaviorat48hoflife,wasassessedusingthemodifiedinfantBreast-FeedingAssessmentTool(BAT;ascoreconsistingofinfant'sreadinesstofeed,sucking,rootingandlatching,eachitemscoredfrom0to3)bythreeindependentmaskedobservers.ThesecondaryoutcomeswereEBFratesat48hand6weeksofageandsalivarycortisollevelofinfantsat6hofage.Baselinecharacteristicsincludingbirthweightandgestationwerecomparablebetweenthetwogroups.TherewasnosignificantdifferenceintheBATscoresbetweenthegroups[median:8,interquartilerange(IQR)5-10vs.median9,IQR5-10;p=0.6].EBFratesat48handat6weekswere,however,significantlyhigherintheearly-SSCgroupthaninthecontrolgroup[95.0vs.38.1%;relativerisk(RR):2.5,95%confidenceinterval(95%CI):1.4-4.3and90vs.28.6%;RR:3.2,95%CI:1.6-6.3].

HungKJ,BergO.Earlyskin-to-skinaftercesareantoimprovebreastfeeding.AmJMaternChildNurs2011;36:318-324.

Thisarticledescribesaqualityimprovementprojectinwhichearlyskin-to-skin(STS)contact,intheoperatingroom(OR)andduringrecovery,wasusedasaninterventiontoincreasethesuccessofbreastfeedinginitiationamonghealthyinfantsaftercesarean,atalarge,urban,acutecareteachinghospital.Thenursingroleiskeyfortheintervention,buttheprograminvolvestheentireperinatalteam,includingtheobstetricians,pediatricians,andanesthesiologists.Duringthefirst3monthsofourintervention,therateofearlySTSamonghealthybabiesbornbycesareanincreasedfrom20%to68%.TherateofinfantswhodidnotgetSTScontactwithin4hoursofbirthdecreasedfrom40%to9%.Ninemonthsaftertheinitiationoftheintervention,60%ofhealthycesareanbirthsutilizedSTSintheOR,and70%involvedSTSwithin90minutesofbirth.HealthyinfantsbornbycesareanwhoexperiencedSTSintheORhadlowerratesofformulasupplementationinthehospital(33%),comparedtoinfantswhoexperiencedSTSwithin90minutesbutnotintheOR(42%),andthosewhodidnotexperienceSTSinthefirst90minutesoflife(74%).

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MahmoodJ,JamalM,KhanJ.Effectofmother-infantearlyskin-to-skincontactonbreastfeedingstatus:Arandomizedcontrolledtrial.JCollPhysiciansSurgeonsPakistan2011;21:601-605.

EligiblemotherswereassessedforthesuccessfulbreastfeedingbyusingIBFATtool.Thetimetoinitiatethefirstfeed,timetoeffectivebreastfeeding,maternalsatisfactionwiththecareprovided,preferenceforthesamecareinfutureandlevelofexclusivebreastfeedingattheageofonemonthwerealsonoted.ThedatawascomparedbyusingX2andt-test.Significantp-valuewastakenas<0.05.Atotalof183mother-infantpairs(92inskin-to-skincare[SSC]groupand91inconventionalcare[CC]group)wereanalyzedforbreastfeedingbehavioroftheinfants.Thefirstbreastfeedwas26.25%moresuccessfulinSSCgroup(58.8%inSSCgroupascomparedto32.5%inCCgroupwithp-valueof0.001).InSSCgroup,themeantimetoinitiatefirstbreastfeedwas61.6minutesshorterthanCCgroup(40.62vs.101.88;p<0.001).Meantimetoachieveeffectivebreastfeedingwas207minutesearlierinSSCgroup(149.69vs.357.50;p<0.001).ThelevelofsatisfactioninthemothersofSSCgroupwassignificantlyhighascomparedtocontrols(56%vs.6.2%).Similarly,53.8%mothersofSSCgroupshowedpreferenceforsimilarcareinfutureascomparedto5%inCCgroup.InSSCgroup85.3%infantswereexclusivelybreastfedatonemonthascomparedto65.7%inCCgroup(p=0.025).Theauthorsconcludedthatmaternal-infantearlyskin-to-skincontactsignificantlyenhancedthesuccessoffirstbreastfeedandcontinuationofexclusivebreastfeedingtillonemonthofage.Italsoreducedthetimetoinitiatefirstfeedandtimetoeffectivebreastfeeding.

*USPreventiveServicesTaskForceRankingofEvidencefromScientificStudiesI EvidenceobtainedfromatleastoneproperlyrandomizedcontrolledtrialII-1 Evidenceobtainedfromwell-designedcontrolledtrialswithoutrandomization.II-2 Evidenceobtainedfromwell-designedcohortorcase-controlanalyticstudies,preferablefrommorethanonecenterorresearchgroupII-3 Evidenceobtainedfrommultipletimeserieswithorwithouttheintervention.Dramaticresultsinuncontrolledexperiments(suchastheresultsoftheintroductionofpenicillintreatmentinthe1940(s))couldberegardedasthistypeofevidence.III Opinionsofrespectedauthorities,basedonclinicalexperience,descriptivestudiesandcasereports;orreportsofexpertcommittees.

SEARCH METHODOLOGY: Searched PubMed, Cochrane, CINAHL, AAP, AAFP, ACOG, reference lists of identified articles from May 2015-Sept 2015.

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1.PubMedsearch terms: ("prenatal care"[MeSH Terms] OR ("prenatal"[All Fields] AND "care"[All Fields]) OR "prenatal care"[All Fields] OR "prenatal"[All Fields]) AND ("Intervention (Amstelveen)"[Journal] OR "intervention"[All Fields] OR "IntervSchClin"[Journal] OR "intervention"[All Fields]) AND ("breast feeding"[MeSH Terms] OR ("breast"[All Fields] AND "feeding"[All Fields]) OR "breast feeding"[All Fields] OR "breastfeeding"[All Fields]) From: Jan 2008-present Original results: 231 Identified relevant abstracts: 55 Articles reviewed: 55 2.pubmed search: antenatal [All Fields] AND ("Intervention (Amstelveen)"[Journal] OR "intervention"[All Fields] OR "IntervSchClin"[Journal] OR "intervention"[All Fields]) AND ("breast feeding"[MeSH Terms] OR ("breast"[All Fields] AND "feeding"[All Fields]) OR "breast feeding"[All Fields] OR "breastfeeding"[All Fields]) From: Jan 2008-present original results: 128 identified relevant abstracts that were additional to the ones above: 19 articles reviewed: 12 3. CINAHL Search terms: “prenatal care” OR “breastfeeding support” AND breastfeeding AND intervention: 3 4. Additional articles reviewed: 5(AAPx1, ACOG x2, AAFPx1, Cochrane x1) + 15 identified in reference lists, recommendations = 20 TOTAL Articles reviewed: 100 Excluded: 23 Exclusion criteria: not done yet, poor scholarship, postnatal only, combined intervention that had no measures related to prenatal intervention piece, not relevant.

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