Antenatal Breastfeeding Education for Increasing Breastfeeding Duration

Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M. Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD006425. doi: 10.1002/14651858.CD006425.pub2. Review. Update in: Cochrane Database Syst Rev. 2012;9:CD006425. PubMed PMID: 22071830; PubMed Central PMCID: PMC4164447.

Background
Breastfeeding (BF) is well recognised as the best food for infants. The impact of antenatal BF education on the duration of BF has not been evaluated.

Objectives
To evaluate the effectiveness of antenatal BF education for increasing BF initiation and duration.

Search methods
We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (21 April 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE (1966 to April 2010) and SCOPUS (January 1985 to April 2010). We contacted experts and searched reference lists of retrieved articles. We updated the search of the Pregnancy and Childbirth Group’s Trials Register on 28 September 2011 and added the results to the awaiting classification section of the review.

Selection criteria
All identified published, unpublished and ongoing randomised controlled trials (RCTs) assessing the effect of formal antenatal BF education or comparing two different methods of formal antenatal BF education, on duration of BF. We excluded RCTs that also included intrapartum or postpartum BF education.

Data collection and analysis
We assessed all potential studies identified as a result of the search strategy. Two review authors extracted data from each included study using the agreed form and assessed risk of bias. We resolved discrepancies through discussion.

Main results
We included 17 studies with 7131 women in the review and 14 studies involving 6932 women contributed data to the analyses. We did not do any meta-analysis because there was only one study for each comparison.

Five studies compared a single method of BF education with routine care. Peer counselling significantly increased BF initiation.

Three studies compared one form of BF education versus another. No intervention was significantly more effective than another intervention in increasing initiation or duration of BF.

Seven studies compared multiple methods versus a single method of BF education. Combined BF educational interventions were not significantly better than a single intervention in initiating or increasing BF duration. However, in one trial a combined BF education significantly reduced nipple pain and trauma.

One study compared different combinations of interventions. There was a marginally significant increase in exclusive BF at six months in women receiving a booklet plus video plus lactation consultation (LC) compared with the booklet plus video only.

Two studies compared multiple methods of BF education versus routine care. The combination of BF booklet plus video plus LC was significantly better than routine care for exclusive BF at three months.

Authors’ conclusions
Because there were significant methodological limitations and the observed effect sizes were small, it is not appropriate to recommend any antenatal BF education. There is an urgent need to conduct RCTs study with adequate power to evaluate the effectiveness of antenatal BF education.

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