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Interventions for promoting the initiation of breastfeeding

  1. Lisa Dyson*,
  2. Felicia M McCormick,
  3. Mary J Renfrew

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 20 APR 2005

Assessed as up-to-date: 30 JUL 2007

DOI: 10.1002/14651858.CD001688.pub2


How to Cite

Dyson L, McCormick FM, Renfrew MJ. Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001688. DOI: 10.1002/14651858.CD001688.pub2.

Author Information

  1. University of York, Mother and Infant Research Unit, Department of Health Sciences, York, UK

*Lisa Dyson, Mother and Infant Research Unit, Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. ld518@york.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 APR 2005

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Characteristics of included studies [ordered by study ID]
Brent 1995

MethodsRandomisation by permuted block.

Analysis was by intention to treat.


Participants108 English speaking, nulliparous, pregnant women attending a prenatal clinic, regardless of infant feeding preference were recruited into study. Participants stratified by age into 3 groups (less than 20, 20-29, or at least 30 years).


InterventionsExperimental group: (N = 51).
Bf education and support provided throughout the prenatal and postpartum periods and into the first year of the child's life. Education consisted of 2-4 individual 10-15 minute sessions with a lactation consultant discussing the benefits and practice of bf. Content of sessions was based on the women's needs and interests. After delivery, mothers were followed up with daily inpatient rounds by the lactation consultant. Further follow up consisted of a telephone call 48 hours after discharge, a visit to the lactation clinic at 1 week and lactation consultation present at each health supervision visit until weaning or when the infant was 1 year of age, whichever came first.
Professional education was directed at nursing and medical staff who interacted with the bf dyad.

Control group: (N = 57).
Routine care, consisting of optional prenatal bf classes; postpartum bf instruction by nurses and doctors; outpatient follow up in the paediatric ambulatory department.


OutcomesIncidence of breastfeeding in hospital.
Incidence of breastfeeding at 2 weeks.
Incidence of breastfeeding at 2 months.
Incidence of breastfeeding at 6 months.
Median duration of breastfeeding.
Subgroup analysis for women who indicated at the first prenatal visit that they planned to formula feed or were undecided.


NotesTo determine if a comprehensive breastfeeding promotion programme increased the incidence and duration of breastfeeding in a low-income population.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear whether allocation concealment was adequate.

Blinding?
Women and staff
NoInadequate due to non-blinded study.

Blinding?
Outcome assessors
NoOutcome assessors were not blinded to group allocations.

Incomplete outcome data addressed?
All outcomes
YesAdequate, breastfeeding initiation reported for all 108 women in the study.

Caulfield 1998

MethodsMethod of allocation of the four clinics: 4 slips of paper labelled with 1 of 4 clinics randomly selected from pot for centralised allocation to a pre-ordered list of comparison groups.

Analysis was not by intention to treat.


Participants4 clinics administered through the Johns Hopkins University WIC program, that had similar rates for ethnicity (90.4-96.1% African-American) and breastfeeding rates at 1 month (2.0-5.9% in 1991).
Women were recruited between April 1992 and January 1994 as they registered for prenatal care at the 4 clinics. 674 women were eligible. 242 had complete data (36%) and only these were included in the results. Differences were noted by clinic in parity, education and employment status before and during pregnancy of the included women.


Interventions2 x 2 factorial design.
Control (N = 57). Routine WIC services and nutrition education.
Video intervention (N = 64). Breastfeeding motivational video, based on Best Start video, consisted of 8 trigger vignettes 2-5 mins in length, about benefits of and major benefits to breastfeeding, played continuously in the waiting area without staff supervision. Discussion with service provider following video was encouraged. Posters displayed in clinic areas and relevant sites.

Peer counselling intervention (N = 55). Women interested in breastfeeding received personalised information and support on breastfeeding issues of concern specific to each participant. Women received counselling 3 times during pregnancy. WIC counsellors were former WIC clients, had successfully breastfed and completed 5-week training program.

Video and peer counsellor (N = 66). All the components described above.


OutcomesBreastfeeding initiation.
Breastfeeding initiation by infant feeding intention at enrolment.
Breastfeeding at 7-10 days for those who initiated.


NotesNot included in the meta-analysis on statistician's advice, because with only 1 clinic in each group, it is not possible to calculate the standard error of difference.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate.

Blinding?
Women and staff
UnclearPartially adequate. Randomisation at clinic level minimised crossover and contamination between groups compared to randomisation at level of individual. Unlikely that providers of intervention were blind.

Incomplete outcome data addressed?
All outcomes
UnclearPartially adequate.

Chapman 2004

MethodsRecruiter not the same as peer counsellors. Computerised random allocation of weekly cases: appears to be on-site but not stated. Data entry of cases likely to be Research Assistant who recruited but not likely to know how case would be allocated as SPSS random selection.

Analysis was by intention to treat.


ParticipantsPregnant women attending Hartford Hospital, Connecticut, USA, on 1 of 3 days a week when recruitment conducted between July 2000 and August 2002.
Inclusion (prenatal) over 18 years old, considering breastfeeding, low income.
Inclusion (postpartum) healthy full-term singleton infant, no maternal history of HIV.
Exclusion: infants admitted to Special Care.


InterventionsControl group (N = 75).
Routine prenatal breastfeeding education consisted of individualised breastfeeding information offered in response to women's questions, and written breastfeeding materials from the prenatal clinic. Routine perinatal breastfeeding education included hands-on assistance and education from maternity ward nurses, written breastfeeding materials and access to an IBCLC for breastfeeding problems.

Intervention group (N = 90).
In addition to routine care as for control group, prenatal, perinatal (and postnatal) peer support services, consisting of at least 1 prenatal home visit to review benefits of breastfeeding, screen for inverted nipples, discuss breastfeeding myths, positioning and anticipatory guidance. Breastfeeding video viewed if possible. Additional prenatal visits if necessary.


OutcomesBreastfeeding initiation.
Breastfeeding at 1 month and 3 months.


Notes


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate.

Blinding?
Women and staff
NoNot possible to sustain blinding for either party.

Blinding?
Outcome assessors
UnclearPartially adequate. Data on peer counsellor contact collected at end of each interview.

Incomplete outcome data addressed?
All outcomes
UnclearNot applicable for initiation data as no withdrawals reported.

Partially adequate for duration data as reasons for withdrawal not reported.

Coombs 1998

MethodsAllocation method was an opaque container filled with 100 tags (50 - experimental group; 50 - control group). Following greater selection of women to the control group, a statistician calculated the number of C tags to be removed to bias further selection in favour of I tag until groups were balanced.

Analysis was not by intention to treat.


Participants200 pregnant women, age 18 years or more, literate, no medical conditions likely to make bf difficult, willing to consider using the manual and to undertake interview about bf.

Those who agreed to participate after the interview differed significantly from those who declined in terms of parity, bf knowledge, attitudes, confidence and intention to bf.


InterventionsExperimental group (N = 104).
Received the self-help manual 7 weeks before delivery during standard prenatal breastfeeding counselling from nutritionist. The manual was modelled on successful self-help smoking cessation interventions to reduce cigarette smoking among low-income pregnant women using cognitive behavioural theory. Received a total of 2 prenatal interviews and 2 postnatal interviews.

Control group (N = 96).
Standard prenatal breastfeeding counselling from nutritionist. No manual. Received a total of 2 prenatal interviews and 2 postnatal interviews.


OutcomesExclusive bf at hospital discharge or if bf initiated later, exclusive bf within 1 week.


NotesTo determine if a self-help manual assisted low-income pregnant women to prepare for, initiate and maintain breastfeeding.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate.

Blinding?
Women and staff
NoInadequate due to non-blinding.

Blinding?
Outcome assessors
UnclearNot clear if those assessing outcomes were blind to group allocation.

Incomplete outcome data addressed?
All outcomes
NoInadequate, 23/104 lost from the intervention group and 26/96 from the control group (24.5% overall).

Forster 2004

MethodsA computerised system of biased urn randomisation was accessed by telephone by the research midwife after written consent was obtained.

Analysis undertaken by authors for this review was by intention to treat based on data reported by study authors.


ParticipantsWomen booking for antenatal care at the Royal Women's Hosptial in Melbourne, Australia, between May 1999 and August 2001. The hospital had been an accredited Baby Friendly hospital since 1995.
Inclusion: booking as public patients, having a first child, 16-24 weeks' pregnant at recruitment, able to speak and write in English
Exclusion: physical problems that prevented breastfeeding, chose birth centre or private obstetric care.


InterventionsControl group (N = 327).
Received BFHI accredited standard care.
Practical skills intervention (N = 327).
In addition to BFHI accredited standard care, received the offer of a single session of 1.5 hours focusing on practical breastfeeding skills. 'Latching on' was explained and demonstrated using dolls and knitted 'breasts'. Breastfeeding complications and management were discussed. Partners were not present.

Attitudes intervention (N = 327).
In addition to BFHI accredited standard care, received the offer of 2 1-hour sessions focusing on changing attitudes to breastfeeding. Partners/significant others were encouraged to attend. The first class included information about the advantages of breastfeeding and explored participants' views of breastfeeding and their perceptions of the attitudes of others. Between classes participants were encouraged to interview their own and their partner's mother. The second class included a group discussion based on these interviews, and discussion of resources for breastfeeding women. Women were encouraged to write a breastfeeding plan.


OutcomesBreastfeeding initiation.
Breastfeeding and exclusive breastfeeding at 6 months.


NotesAuthors concluded that in settings where breastfeeding initiation is high, neither of the interventions could be recommended as effective.
Results not included in the meta-analysis because we considered the control group, BFHI standard care, had received an intervention that meant we could not compare this control group with the control groups of other studies in the review.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate.

Blinding?
Women and staff
NoNeither participants nor providers could be blinded because of the nature of the intervention.

Blinding?
Outcome assessors
UnclearUnclear whether outcome assessors were blinded to group allocation.

Incomplete outcome data addressed?
All outcomes
YesAdequate.

Hill 1987

MethodsTable of random numbers was used to allocate women of different parity to intervention or control groups.

Analysis was by intention to treat.


Participants64 women intending to give birth at the study hospital and keep their infant, and who gave birth to a healthy infant, and had a telephone or agreed to return the Telephone Interview Survey by post.

95% of the total sample were white women.


InterventionsExperimental group (N = 31).
Attended a 40 minute lecture including 5-10 minutes for questions and answers; received a pamphlet with information that reinforced lecture content.

Control group (N = 33).
Routine breastfeeding classes to all women attending antenatal clinic with no lecture, discussion, pamphlet or post-test.


OutcomesBf knowledge scores.
Bf outcomes: no bf, any bf, bf less than 6 weeks, bf more than 6 weeks.


NotesTo determine the effects of a breastfeeding education programme among low-income pregnant women in Chicago.


Risk of bias

ItemAuthors' judgementDescription

Blinding?
Women and staff
NoInadequate. Participants were not excluded from any breastfeeding classes offered by the staff at the antepartum unit regardless of group allocation.

Blinding?
Outcome assessors
UnclearUnclear if outcome assessors were blind to group allocations.

Incomplete outcome data addressed?
All outcomes
YesAdequate. Breastfeeding initiation reported for all 64 participants.

Howard 2000

MethodsRandomisation using computer-generated random number lists. Potential participants were identified by regularly reviewing first prenatal appointments scheduled at each of the 6 clinical sites. Randomly sized blocks of pregnant women were stratified further by obstetric practice before assigning to study group.
56% of the intervention (research pack) group reported prenatal receipt of formula company promotion items from sources other than their obstetric provider.

Authors stated that attrition from the study did not vary significantly by study group. Of the 547 women randomised, breastfeeding initiation data were not reported for 103 (18.9%).

Analysis undertaken by authors for this review was by intention to treat based on data reported by study authors.


Participants547 pregnant women attending prenatal visits at any one of 6 obstetric outpatient settings in Rochester, New York.

Participants were largely white (94.4%) and privately insured (96.8%) and most had plans to return to work within 6 months (60%).


InterventionsExperimental group (N = 270).
At the first prenatal visit, participants received a research pack containing a generic diaper bag, non-commercial educational materials on pregnancy, infant feeding and infant growth and development, a coupon redeemable for $5 worth of infant items at a local store, and a package of electrical socket outlet covers.

Control group (N = 277).
At the first prenatal visit, participants received a commercial pack containing a formula company diaper bag, formula company produced educational materials on pregnancy, infant feeding and infant growth and development, a can of powdered formula, a business reply card to join a 'baby club' redeemable for a case of infant formula, and several infant formula discount coupons.


OutcomesAny bf at delivery.
Mean duration (days) of any bf.
Cessation of breastfeeding during hospital stay.
Cessation of breastfeeding in relation to breastfeeding goals.
Risks for cessation of breastfeeding at 2 weeks.


NotesTo compare the effect of formula company-produced materials about infant feeding, to bf promotion materials without formula advertising, on breastfeeding initiation and duration.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear if allocation concealment was adequate.

Blinding?
Women and staff
YesAdequate due to blinding of both participants and providers.

Blinding?
Outcome assessors
YesAdequate. Outcome assessors were blind to group allocations

Incomplete outcome data addressed?
All outcomes
UnclearPartially adequate. Reasons for withdrawals in the prenatal (intervention) phase of the study were not reported by group.

Lindenberg 1990

MethodsRandomisation using a table of random numbers for the first 3 months. In the fourth month, a third group were assigned consecutively (due to ethical and organisational limitations) to a second intervention group. Results from this group have been excluded from this study due to the lack of randomisation for allocation.

Analysis was not by intention to treat.


Participants259 women experiencing a normal, vaginal delivery with no complications and living in poor urban areas of Managua, Nicaragua.


InterventionsExperimental group (N = 136).
First 3 months of study: 45 minutes of mother-infant contact immediately after birth with standardised (uniform) breastfeeding promotion followed by complete separation until discharge. Standardised breastfeeding promotion consisted of a series of specific breastfeeding promotional messages.

Control group (N = 123).
First 3 months of study: complete separation throughout hospitalisation with usual (ad hoc) breastfeeding promotion. Ad hoc breastfeeding promotion consisted of the routine infant feeding information a mother might receive which, given the large volume of deliveries and short hospital stay, was usually very scant to non-existent.


OutcomesAny bf at 1 week.
Exclusive bf at 1 week.
Any bf at 4 months.
Exclusive bf at 4 months.


NotesTo examine the effects of early postpartum mother-infant contact, followed by separation until discharge, on the incidence and continuation of breastfeeding.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear whether allocation concealment was adequate.

Blinding?
Women and staff
UnclearUnclear whether blinding of participants and providers for delivery of intervention and standardised care was adequate.

Blinding?
Outcome assessors
YesOutcome assessors were blinded to hypothesis regarding breastfeeding and early mother-infant contact.

Incomplete outcome data addressed?
All outcomes
YesAdequate. Breastfeeding initiation reported for all participants.

Ryser 2004

MethodsRandom assignment by participants selecting a sealed envelope (not sequentially numbered, opacity not specified) to determine assignment to intervention or control group.

Analysis was by intention to treat.


Participants54 English speaking pregnant women of 18 years or more, literate, eligible for Medicaid, access to telephone and stated feeding intention of 'bottle (formula) feed' or 'undecided'.

Marital status and intention to formula feed differed significantly between comparison groups.


InterventionsExperimental group (N = 26).
Received the Best Start Program (Bryant 1990), presented as a breastfeeding promotion campaign that aims to allow health professionals to examine women's misconceptions and educate them about their specific concerns. It has been marketed since 1992 and its materials have been used by various programs, including the SNPWIC Program. In this study, the researcher used the 'Best Start' videotapes, training manuals and handouts to implement the educational program during 4 prenatal visits (2 more than control group as visits also included data collection phase).

Control group (N = 28).
No exposure to Best Start Program. No details of routine breastfeeding promotion activities at the physician's office were provided.


OutcomesAny bf at 1 week postpartum.
Attitudes to breastfeeding.
Social and professional support.


NotesTo evaluate the effect of the 'Best Start' program on breastfeeding attitudes, intention and initiation in low-income women.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear whether allocation concealment was adequate.

Blinding?
Women and staff
NoInadequte due to lack of blinding of researcher and of participants.

Blinding?
Outcome assessors
NoInadequate. Outcome assessors were not blinded to group allocations or study hypotheses.

Incomplete outcome data addressed?
All outcomes
UnclearPartially adequate. Withdrawals reported by group (I: 1/27; C: 3/26, 7.4% overall) but reasons not reported.

Serwint 1996

MethodsRandom number table with blocks of 10 to assign participants. Allocation of women to a paediatrician was not completely random as based on paediatrician availability according to mother's due date.

Analysis undertaken by authors for this review was by intention to treat based on data reported by study authors.


Participants156 nulliparous women, > 18 years, between 8 and 28 weeks' gestation, who had not yet selected a paediatrician or wanted their infant to receive paediatric care at the hospital-based paediatric clinic.

Both experimental and control groups comprised 91% of African- American women.


InterventionsExperimental group (N = 81).
In addition to routine care, received a scheduled prenatal visit between 32 and 36 weeks' gestation at a hospital-based clinic with the infant's future paediatrician. The clinic was in an urban academic medical centre where mothers received their obstetric care. Prior to visits, paediatricians received training in counselling parents of newborn infants and bf techniques/promotion. During visits, paediatricians recorded data on timing of pregnancy, preparation for the infant, involvement of father, social support and maternal medical history. Parents-to-be were counselled on feeding options, advantages of bf, infant car safety, circumcision and access to paediatric healthcare.

Control group (N = 75).
Similar management except no prenatal paediatric visits.


OutcomesBf intent before prenatal visit.
Bf initiation at birth.
Bf at 30 days postpartum.
Bf at 60 days postpartum.
Mothers who changed their mind in favour of bf after enrolment.
Parent-physician relationship.


NotesTo assess the impact of prenatal paediatrician visits on breastfeeding decisions of low-income mothers.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate concealment of allocation.

Blinding?
Women and staff
UnclearUnclear whether participants were blinded to their assigned intervention although providers do not appear to have been blinded to assigned intervention.

Blinding?
Outcome assessors
UnclearUnclear if outcome assessors were blind to group allocations.

Incomplete outcome data addressed?
All outcomes
YesAdequate. Comparable withdrawals reported by group (I:7/84; C:5/75, 8% overall) with reasons for losses.

Wolfberg 2004

MethodsMethod of randomisation not stated.

Analysis was not by intention to treat.


ParticipantsPregnant women attending for prenatal care at Johns Hopkins Hospital for an unknown period between March 2001 and August 2002.

Inclusion: consent of woman and partner.
All but 1 of the women who completed the study was receiving public assistance or WIC. Most women and partners were black and had more than high school education.


InterventionsIntervention (27 couples completed and contributed data)
One 2-hour class for dads on breastfeeding promotion led by a black father. Nondidactic informal teaching method using discussion, role play, videos and slides to dispel myths about breastfeeding and provide information on benefits and technical aspects of breastfeeding.

Control (30 couples completed and contributed data).
One 2-hour class for dads on infant care including car seat use, sleeping positions, fire safety, bath safety. Taught by same facilitator using same informal methods.


OutcomesBreastfeeding initiation.
Breastfeeding at 4, 6 and 8 weeks.


NotesData not included in meta-analyses because number randomised to each group not reported.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearMethod of allocation not stated.

Blinding?
Women and staff
NoInadequate.

Incomplete outcome data addressed?
All outcomes
NoApproached 567 women and completed with 59 couples: significant attrition during enrolment process.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Aidam 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Anderson 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Ball 2006Not concerned with activity intended to increase breastfeeding initiation rates.

Bishop 1978No concurrent controls (3 interventions groups, no routine care group).

Bonuck 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Byrne 2000Not concerned with activity intended to increase breastfeeding initiation rates.

Carfoot 2001Not concerned with activity intended to increase breastfeeding initiation rates.

Carfoot 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Cattaneo 2001Not concerned with activity intended to increase breastfeeding initiation rates.

Chapman 1986Lack of outcome data. We have written to the authors but have not yet received clarification.

Chong 2007Does not report breastfeeding initiation.

Coutinho 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Di Napoli 2004Not concerned with activity intended to increase breastfeeding initiation rates.

Feldman 1987Not concerned with activity intended to increase breastfeeding initiation rates.

Froozani 1999Not concerned with activity intended to increase breastfeeding initiation rates.

Garcia-Montrone 1996Not a RCT (non-randomised controlled trial).

Gordon 1999Not concerned with activity intended to increase breastfeeding initiation rates.

Graffy 2001Not concerned with activity intended to increase breastfeeding initiation rates.

Grossman 1988Contacted authors but unable to acquire sufficient information on method of allocation for this update.

Haider 2000Not concerned with activity intended to increase breastfeeding initiation rates.

Harvey 1996Not concerned with activity intended to increase breastfeeding initiation rates.

Hegedus 2000Not a RCT (before-after study).

Henderson 2001Not concerned with activity intended to increase breastfeeding initiation rates.

Kaplowitz 1983From information provided, we could not tell whether or not randomisation had taken place. We have written to the authors but have not yet received clarification.

Kistin 1990Quasi-RCT (women were allocated to the intervention group if they attended clinic on Monday, and to the control group if they attended on Friday).

Kools 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Kramer 2001This study (PROBIT) was primarily concerned with activity intended to increase the duration, but not the initiation, of breastfeeding.

Langer 1996Not concerned with activity intended to increase breastfeeding initiation rates.

Langer 1998Not concerned with activity intended to increase breastfeeding initiation rates.

Lavender 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Loh 1997Quasi-RCT (intervention was delivered in alternate weeks).

MacVicar 1993Not concerned with activity intended to increase breastfeeding initiation rates.

Martens 2000Not a RCT (not randomised).

Martens 2001From information provided, we could not tell whether or not randomisation had taken place. We have written to the authors but have not yet received clarification.

Matilla Mont 1999Not an RCT (before-after study).

Mattar 2007Contacted authors but unable to acquire sufficient information on method of allocation for this update.

McEnery 1986Not a RCT (no randomisation at the point of analysis).

McInnes 2000Not a RCT (not randomised).

Moran 2000Not concerned with activity intended to increase breastfeeding initiation rates.

Morrow 1999Not concerned with activity intended to increase breastfeeding initiation rates.

Muirhead 2006Not concerned with activity intended to increase breastfeeding initiation rates.

Nikodem 1998Not concerned with activity intended to increase breastfeeding initiation rates.

Noel-Weiss 2006Not concerned with activity intended to increase breastfeeding initiation rates.

Oakley 1990Not concerned with activity intended to increase breastfeeding initiation rates.

Page 1999Not a RCT (not randomised).

Philipp 2004Not concerned with activity intended to increase breastfeeding initiation rates (all the mothers intended to breastfeed).

Pisacane 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Pobocik 2000Quasi-RCT (some school principals would not allow recruitment of control subjects).

Prakhin 2001Not concerned with activity intended to increase breastfeeding initiation rates.

Rea 1999Not concerned with activity intended to increase breastfeeding initiation rates.

Redman 1995Not concerned with activity intended to increase breastfeeding initiation rates.

Reifsnider 1996Not a RCT (not randomised).

Ross 1983Not concerned with activity intended to increase breastfeeding initiation rates.

Rossiter 1994From information provided, we could not tell whether or not randomisation had taken place. We have written to the authors but have not yet received clarification.

Schafer 1998Not a RCT (not randomised).

Schlickau 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Schy 1996Not concerned with activity intended to increase breastfeeding initiation rates.

Sciacca 1995Quasi-RCT (randomisation alternate and not concealed).

Shaw 1999Not a RCT (not randomised).

Sisk 2004Does not report breastfeeding initiation.

Toma 2001Not a RCT (not randomised).

Turan 2001Not concerned with activity intended to increase breastfeeding initiation rates.

Turnbull 1996Not concerned with activity intended to increase breastfeeding initiation rates.

Vaidya 2005Not concerned with activity intended to increase breastfeeding initiation rates.

Volpe 2000Quasi-RCT (randomisation not concealed, comparison groups not concurrent).

Waldenstrom 1994Not concerned with activity intended to increase breastfeeding initiation rates.

Westphal 1995Lack of outcome data. We have written to the authors but have not yet received clarification.

Wiles 1984Not concerned with activity intended to increase breastfeeding initiation rates.

Winterburn 2003Contacted authors but unable to acquire sufficient information on method of allocation for this update.

Zimmerman 1999Not a RCT (not randomised).

 
Characteristics of studies awaiting assessment [ordered by study ID]
Hoddinott 2007

Methods

Participants

Interventions

OutcomesPrimary outcome: breastfeeding rates at 6-8 weeks.

Secondary outcomes: breastfeeding rates at birth, 7 days and 8-9 months; maternal satisfaction with breastfeeding experience; social support; cost effectiveness; case study analysis of implementation processes.

NotesThe randomised controlled trial is not yet published, but is currently being considered for publication by the BMJ (email from Pat Hoddinott, 30 June 08).

Wambach 2006

Methods

ParticipantsPregnant adolescents

InterventionsTeens in the two intervention groups attend two prenatal classes specific to their focus between the fourth and ninth month of pregnancy and receive telephone calls from a peer counsellor. Teens in a usual care group receive no interventions beyond their standard prenatal care and education. After giving birth and still in the hospital, teens in the intervention groups receive a peer counsellor phone call and visit. Breastfeeding teens in the experimental group also receive a breastfeeding counsellor visit. After hospital discharge, breastfeeding teens from both intervention groups continue to receive peer counsellor telephone support and, in the experimental condition, breastfeeding counsellor phone calls for four weeks. Breastfeeding teens from all three groups complete short telephone interviews until six months after birth or until they stop breastfeeding.

OutcomesPrimary outcome is breastfeeding initiation at hospital discharge.

Notes30 June 08: Abstract has been updated on the website to indicate study is complete, and Karen Wambach's entry on her University web page states it was completed in late 2007. F McCormick emailed K Wambach to ask about publications.

 
Comparison 1. Any health education intervention for women of all feeding intentions vs standard care

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Initiation of breastfeeding5582Risk Ratio (M-H, Random, 95% CI)1.57 [1.15, 2.15]

    1.1 One-to-one client focused, informal repeat session
2162Risk Ratio (M-H, Random, 95% CI)2.40 [1.57, 3.67]

    1.2 Generic, formal antenatal session
3420Risk Ratio (M-H, Random, 95% CI)1.26 [1.00, 1.60]

 
Comparison 2. Peer support for women considering breastfeeding vs standard care

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Initiation of breastfeeding1165Risk Ratio (M-H, Fixed, 95% CI)4.02 [2.63, 6.14]

 
Comparison 3. Breastfeeding promotion packs for women of all feeding intentions vs standard care

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Initiation of breastfeeding1547Risk Ratio (M-H, Fixed, 95% CI)0.93 [0.80, 1.08]

 
Comparison 4. Early mother-infant contact followed by separation for women of all feeding intentions vs standard care

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Initiation of breastfeeding1259Risk Ratio (M-H, Fixed, 95% CI)1.05 [0.94, 1.17]