79What information and support do women want/value to help them successfully breastfeed?

Grading:1++High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
RID: 1510Reference number 2873
Fairbank L;O’Meara S;Renfrew MJ;Woolridge M;Sowden AJ;
A systematic review to evaluate the effectiveness of interventions to promote the initation of breastfeeding
20004 25Health Technology Assessmentpgs
Study Type:Systematic Review
PatientBreastfeeding women
Characteristics
InterventionInitiation and duration of breastfeeding
ComparisonsNA
Study LengthNA
OutcomesNo summary statistics. Outcomes for individual studies presented by topic area
EffectSee previous comments
FundingNHS
Conclusions
Quality
RID: 1512Reference number 4211
Renfrew MJ;Wallace L;D’Souza L;Spiby H;Dyson L;
Effectiveness of public health interventions to promote the duration of breastfeeding: systematic reviews of the evidence: report to the Health Development Agency
2004Health Development Agencypgs
Study Type:Systematic Review
PatientBreastfeeding women
Characteristics
InterventionDuration of breastfeeding
ComparisonsNA
Study LengthNA
OutcomesNo summary statistics. Outcomes for individual studies presented by topic area
EffectSee previous comments
FundingHDA
ConclusionsAs yet unpublished report to HDA
Quality
RID: 1370Reference number 2951
Sikorski J;Renfrew MJ;Pindoria S;Wade A;
Support for breastfeeding mothers
2004Issue 2The Cochrane Librarypgs
Study Type:Systematic Review
PatientMother-infant pairs
Characteristics
InterventionBreastfeeding promotiion
ComparisonsNA
Study LengthNA
OutcomesDuration of breastfeeding for 6 months; Meta-analysis
EffectThere was a beneficial effect on the duration of any breastfeeding in the meta-analysis of all forms of extra support (RR for stopping any breastfeeding before six months 0.88, CI 0.81–0.95).
Extra professional support appeared beneficial for any breastfeeding (RR0.89, CI 0.81–0.97) but did not reach statistical significance for exclusive breastfeeding (RR 0.90, CI 0.81–0=1.01).
The effect of lay support was the opposite. Peer support was effective in reducing the cessation of exclusive breastfeeding (RR 0.66, CI 0.49–0.89) but its effect on any breastfeeding did not reach statistical significance (RR 0.69–1.02).
FundingCochrane
ConclusionsSee effect size.
Quality
Grading:1+Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
RID: 1467Reference number 4149
Pittard WB;Geddes KM;Brown S;Mintz S;Hulsey TC;
Bacterial contamination of human milk: container type and method of expression
19918 1American Journal of Perinatologypgs 25 27
Study Type:Randomised Controlled Trial
PatientPostpartum, breastfeeding women
Characteristics
InterventionMeasurement of bacterial contamination of expressed breastmilk
ComparisonsMethod of expression of breastmilk and clean versus sterile containters
Study LengthBacterial growth in lab
OutcomesCFU
EffectNo significant difference in CFUs/ml between clean versus sterile containers and between manual versus pump collection methods
FundingUnknown
ConclusionsThis is a small study and power calculations are not provided. However it is based on laboratory collection and analysis techniques which give strength to the findings.
Quality
Grading:2Case–control or cohort studies with a high risk of confounding bias, or chance and a significant
RID: 1468Reference number 4150
Pugh LC;
The breastfeeding support team for low-income, predominantly-minority women: a pilot intervention study
200122 5Health Care Women Intpgs 501 515
Study Type:Case-Control
PatientBreastfeeding women matched on type of delivery, previous breastfeeding experience and race.
Characteristics
InterventionIntensive intervention of 3 nurse visit and peer counsellor phone calls and visits twice a week
ComparisonsIntensive intervention compared to routine care
Study Length5 months
OutcomesFrequency percents
EffectNo statistical calculations done
FundingUnknown
ConclusionsThe study raises the issue of intensive followup for minority and low income women.
Quality
Grading:3Non-analytic studies (for example, case reports, case series)
RID: 1209Reference number 521
England R;Doughty K;Genc S;
Working with refugees: health education and communication issues in a child health clinic.
200362 4Health Education Journalpgs 359 368
Study Type:Qualitative
PatientTurkish and Kurdish mothers
Characteristics
InterventionFocus groups
ComparisonsNA
Study LengthNA
OutcomesNA
EffectNA
FundingCity and East London Education Consortium
ConclusionsAims were to identify the mother’s concerns about their children’s health in relation to infant feeding and basic nutrition and to obtain information About mothers’ attitudes towards health. All Turkish and Kurdish women attending the surgery during a two week period were approached. 24 women attended the groups. Women in the groups had generally breastfed successfully but still often felt worried, particularly about insufficient milk. This study showed that even where health advocates are used, access is good and there is a wide range of health education materials in appropriate language available, misunderstandings and preconceptions still exist. Communication in this context is more than translation.
Quality
RID: 1137Reference number 238
Morse JM;Jehle C;Gamble D;
Initiating breastfeeding: a world survey of the timing of postpartum breastfeeding
199027 3International Journal of Nursing Studiespgs 303 313
Study Type:Qualitative
Patient120 countries
Characteristics
InterventionTiming of pp breastfeeding
ComparisonsInternational comparison of feeding of colostrum
Study LengthNA
OutcomesFrequency percents
Effect50 of 120 cultures delay implementation of breastfeeding for more than two days
FundingUnknown
ConclusionsThis is not a systematic review but searches the “Human Relations Area Files” which are a compendium of cross cultural data. Women who do not wish to feed colostrums should not be presumed to be refusing to breastfeed. Acceptable prelactal feeds should be given to the baby.
Quality
Grading:4Expert opinion, formal consensus
RID: 1508Reference number
Singapore Ministry of Health;
Management of breastfeeding for healthy full-term infants.
2002Singapore Ministry of Healthpgs
Study Type:Guideline
Patient
Characteristics
Intervention
Comparisons
Study Length
Outcomes
Effect
Funding
Conclusions
Quality

From: Appendix C, Clinical Evidence Extractions

Cover of Postnatal Care
Postnatal Care: Routine Postnatal Care of Women and Their Babies [Internet].
NICE Clinical Guidelines, No. 37.
National Collaborating Centre for Primary Care (UK).
Copyright © 2006, National Collaborating Centre for Primary Care.

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