Running head: PROMOTION OF BREASTFEEDING

Promotion of Breastfeeding
Amanda Poplin
University of South Florida

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Abstract
Clinical Problem: Pregnant women and new mothers are not provided appropriate education,
counseling and postpartum support informing them of the benefits of exclusive breastfeeding.
Objective: To determine if one-to-one education sessions and postpartum follow-ups supporting
breastfeeding compared to the standard maternal nursing care influence the rates of breastfeeding
and the duration that mothers choose to breastfeed over a six month period.
Research Sources: CIHNAL, PubMed, and National Guideline Clearinghouse search engines
were used to access randomized controlled trials and clinical guidelines concerning breastfeeding
education and promotion, using the key words benefits of breastfeeding, randomized controlled
trials breastfeeding, breastfeeding education, and breastfeeding interventions.
Results: The Academy of Breastfeeding Medicine (AMB, 2010) guidelines recommend that each
expecting mother should be provided education and counseling from a multidisciplinary team,
including a lactation specialist, in order for mothers to fully understand the positive effect
breastfeeding holds for the baby as well as the mother herself. The research demonstrated that
education sessions and supportive follow-ups increased the rates and duration of exclusive
breastfeeding.
Conclusion: Pregnant women and women who have just given birth that receive one-to-one
education sessions and counseling along with postpartum follow-ups have an increased rate oand
duration of breastfeeding.

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Promotion of Breastfeeding
Breastfeeding has been proven to harvest multiple health benefits, both short term and
long term, for the mother as well as for the baby. The World Health Organization (WHO)
recommends that infants be exclusively breastfed for the first six months of life, and to continue
breastfeeding after the introduction of complementary foods as well (WHO, 2015). An infant
who is breastfed exclusively for at least six months of life receives the protective immunologic
factors that breast milk contains such as protection against gastrointestinal infections, as well as a
lower rate of obesity and the provision of all of the infants energy and nutritional needs for the
first six months of life (WHO, 2015). The implementation of one-to-one education and support
group follow-ups for new mothers subsequent to discharge could significantly increase the
number of mothers who choose to breastfeed, whether it be exclusively or at all, and for a longer
duration post-partum. In pregnant women and women who have just given birth, how do one-toone education sessions and postpartum follow-ups supporting breastfeeding compared to the
standard maternal nursing care influence the rates of breastfeeding and the duration that mothers
choose to breastfeed over a six month period? The expected outcome of this study would be to
increase the rates and duration of breastfeeding as well as decrease the percentage of infants who
are admitted to hospitals due to gastrointestinal illnesses.
Literature Search
The search engines used to acquire randomized controlled trials concerning the
promotion of breastfeeding and effectiveness of interventions used in the promotion included
CINAHL and PubMed. The key terms used to search for the trials were benefits of breastfeeding,
randomized controlled trials breastfeeding, breastfeeding education, and breastfeeding
interventions.
Literature Review

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To assess the effectiveness of prenatal one-to-one education and postnatal support group
follow-ups on breastfeeding duration, three randomized controlled trials and one clinical
guideline were utilized. Fu, Fong & Heys (2014) used a randomized controlled trial to determine
whether the provision of two postnatal professional support interventions influenced the
proportion of first time mothers who chose to engage in any or full breastfeeding. The population
for this study was 722 first-time mothers with full-term pregnancies. The study compared the
effect of standard postnatal care and education (n = 263), an in-hospital support group comprised
of three professional breastfeeding support sessions during the first two days postpartum (n =
191), and standard care combined with weekly postpartum telephone support for one month after
discharge (n = 268). The results found that the rate of mothers who engaged in any or full
breastfeeding at one month (76.2 versus 67.3%; 95% confidence interval 1.10-2.41) and two
months (58.6 versus 48.9%, 95% CI 1.04-2.10) was considerably higher in the intervention group,
as well as the rate of exclusive breastfeeding at one month postpartum (28.4 versus 16.9%; 95%
CI 1.24-2.90). Therefore, education and support provided to additionally to standard post-partum
care significantly increased the proportion and duration of first time mothers who chose to
breastfeed, any or fully. The primary strength of this trial was that the study included home-based
interventions for a thorough amount of time to evaluate the efficacy of the interventions: from
the antenatal period all the way until 12 months postpartum; other strengths include subjects that
were similar demographically and clinically (all first-time mothers) and randomization of subject
allocation into each group. The primary weakness of this study was that the randomization of
subjects led to disproportionate group sizes, with an especially low number of participants in the
in-hospital group.
Kronborg, Maimburg & Vaeth (2012) explored the effects of educating pregnant women

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halfway through pregnancy with an antenatal educating program concerning breastfeeding and
the importance of breastfeeding duration, compared to the effect of using usual practice methods
to educate the mothers mid-pregnancy. The design of this study was a randomized controlled
trial, in which 1193 first-time mothers were gathered at 21 weeks of pregnancy; 603 women
were allocated to the intervention group and 590 to the control group. The data was measured by
self-evaluations sent out to the participants 6 weeks postpartum and 12 months postpartum,
inquiring how the education affected the participants choice to breastfeed or not as well as if
they chose to exclusively breastfeed or to combine it with other methods of feeding. The results
found that the intervention group reported having a higher level of confidence (p=0.05) with
breastfeeding due to the education providing them with sufficient knowledge (p=0.02), and this
confidence led to a longer duration of breastfeeding correlation not found in the control group
(CI = 0.58-0.97). The strengths of this trial are a large population of participants, randomization
of participants, and data collection up until one month postpartum, allowing for thorough
observation of the efficacy of the interventions. The weakness of this trial was that there was an
uneven number of subjects allocated to the control group and the intervention group.
Wen, Baur, Simpson, Rissel, & Flood (2011) created a randomized controlled trial to
evaluate how effective antenatal home-based education on breastfeeding practices is for new
mothers during the first year of infancy. The study included five to six antenatal home visits, and
home visits at 1, 3, 5, 9 and 12 months postnatal. The control (n = 337) and intervention groups
(n = 330) consisted of 667 first-time mothers in Sydney, Australia. The results of this study
showed that the intervention group breastfed for a significantly longer time period at 12 months
(17 weeks [95% confidence interval, 13.9 20.4 weeks]) than the control group did (13 weeks
[95% confidence interval, 10.1 15.0 weeks; P = 0.3]). This study also showed that the

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education intervention resulted in mothers waiting a significantly longer time to introduce solid
foods to the infant (P<0.001 for trend), decreasing the amount of mothers who introduced solid
foods before six months from 74% to 62% (95% confidence interval, 4% to 20%). In conclusion,
home-based breastfeeding education intervention significantly improved infant feeding
practices. The strengths of this study were that there were two different intervention groups to
measure the efficacy of different measures of intervention promoting breastfeeding,
randomization of subjects, and subjects that were similar clinically (first time mothers). The
weakness of this study was that data was not collected long enough during the postnatal period to
evaluate the percentage of participants who engaged in exclusive breastfeeding for the entire six
month period.
The Academy of Breastfeeding Medicine Protocol Committee (ABM) created a clinical
guideline, retrieved from the National Guidelines Clearinghouse (ABM, 2010) that defines the
model breastfeeding policy which recommends a multidisciplinary team to identify and
eliminate barriers to breastfeeding, and to educate and advise pregnant women with information
such as latch and suckling, milk production, frequency of feeding, assessment of infant
nourishment, and when to contact a provider.
Synthesis
The study done by Fu et al. (2014) indicated that prenatal education along with multiple
postnatal support sessions significantly increased the proportion and duration of first time
mothers who chose to breastfeed, any or fully. The intervention group had a higher rate of full
breastfeeding up to 12 months than the control group (p = 0.03). Kronborg et al. (2012) also
showed that an antenatal breastfeeding education program proved successful; the intervention
group reported having a higher level of confidence (p=0.05) with breastfeeding due to the

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education providing them with sufficient knowledge (p=0.02), and this confidence led to a longer
duration of breastfeeding correlation not found in the control group (CI = 0.58-0.97).
Additionally, the study completed by Wen et al. (2011) indicates that antenatal education and
postnatal follow-ups led to results that showed the intervention group breastfed for a
significantly longer time period at 12 months (17 weeks [95% confidence interval, 13.9 20.4
weeks]) than the control group did (13 weeks [95% confidence interval, 10.1 15.0 weeks; P =
0.3]). Lastly, the ABMs (2010) clinical guideline recommended that a model breastfeeding
policy included education and counseling by a multidisciplinary team in order to inform pregnant
women, before and after birth, of the benefits of breastfeeding so that mothers will choose to
breastfeed exclusively for the first six months of infancy.
The evidence from these research studies demonstrates the significant efficacy of
antenatal one-to-one education and postpartum follow ups on the rates and duration of
breastfeeding. Providing these interventions combined with standard post-partum care allows
mothers to understand and engage in the health benefits received from exclusive breastfeeding
for both the infant and the mother. Although this is a priority health policy, many hospitals do not
implement such practices so the rates of success are confined to the few hospitals that provide
these services and to research studies such as the ones previously referenced.
Clinical Recommendation
The AMB (2010) guidelines recommend that each expecting mother should be provided
education and counseling from a multidisciplinary team, including a lactation specialist, in order
for mothers to fully understand the positive effect breastfeeding holds for the baby as well as the
mother herself, along with eighteen concurrent interventions to achieve model breastfeeding
policy. Research shows that one-to-one education and counseling along with postpartum support

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sessions and follow-ups for up to one year significantly improve breastfeeding rates and the
duration that mothers choose to engage in breastfeeding which is recommended by the WHO
(2015) to be exclusive for the first six months of infancy. As more hospitals implement this
policy and provide these resources for mothers, the rate of success will be more accurate.
Implementing this policy will improve patient outcomes and reduce hospital costs by decreasing
the amount of admissions due to infants with numerous illnesses, primarily gastrointestinal
illness, credited to the nutrition and health benefits of exclusive breastfeeding.

References

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Fu, I., Fong, D., & Heys, M. (2014). Professional breastfeeding support for first-time mothers: A
multicentre cluster randomised controlled trial. BJOG: An International Journal of
Obstetrics and Gynaecology, 121(13), 1673-1683. doi: 10.1111/1471-0528.12884.
Kronborg, H., Maimburg, M., & Vaeth, M. (2012). Antenatal training to improve breast feeding:
A randomised trial. Midwifery, 28(6), 784-790. doi: 10.1016/j.midw.2011.08.016
The Academy of Breastfeeding Medicine Protocol Committee (2010). ABM clinical protocol
#7: Model breastfeeding policy. Breastfeeding Medicine, 5(4): 173-177.
doi:10.1089/bfm.2010.9986.
Wen, L.M., Baur, L.A., Simpson, J.M., Rissel, C., & Flood, V.M. (2011). Effectiveness of an
early intervention on infant feeding practices and tummy time: a randomized controlled
trial. JAMA Pediatrics: Archives of Pediatrics and Adolescent Medicine, 165(8), 701707. doi: 10.1001/archpediatrics.2011.115.
World Health Organization (2015). Infant and young child feeding. Retrieved from
http://www.who.int/mediacentre/factsheets/fs342/en/.