Background
Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups.

Objectives
To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed.

Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to 15 August 2007, and scanned reference lists of all articles obtained.

Selection criteria
Randomised controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem.

Data collection and analysis
One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information.

Main results
Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needs-based, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding in the USA (RR 4.02, 95% CI 2.63 to 6.14, P < 0.00001).

Authors' conclusions
This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Findings from these studies suggest that larger increases are likely to result from needs-based, informal repeat education sessions than more generic, formal antenatal sessions. These findings are based only on studies conducted in the USA, among women on low incomes with varied ethnicity and feeding intention, and this raises some questions regarding generalisability to other settings.

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Interventions for promoting the initiation of breastfeeding

Studies in human lactation: milk volume and nutrient composition during weaning and lactogenesis.

Lactogenesis. The transition from pregnancy to lactation.

The ‘anatomy’ of infant sucking

OBJECTIVES. The purpose of this review is to examine the plausibility of a causal relationship between maternity ward practices and lactation success. METHODS. Studies were located with MEDLINE, from our personal files, and by contacting researchers working in this field. Of the 65 studies originally reviewed, 18 met our inclusion criteria (i.e., hospital-based intervention, experimental design with randomization procedures, or quasi-experimental design with adequate documentation). RESULTS. Meta-analysis indicated that commercial discharge packs had an adverse effect on lactation performance. The impact of early mother-infant contact on lactation success was unclear. Rooming-in and breast-feeding guidance in a rooming-in context had a beneficial impact on breast-feeding among primiparae. Breast-feeding on demand was positively associated with lactation success. In-hospital formula supplementation of 48 mL per day was not associated with poor breast-feeding performance. CONCLUSIONS. Hospital-based breast-...

Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview.

Sucking patterns of human babies on the breast

The initiation of lactation: the effect of early versus delayed contact for suckling on milk intake in the first week post-partum. A study in Chiang Mai, Northern Thailand

The term "human milk banking" refers to the collection storage and processing of human milk donated by lactating mothers for infants other than their own. Much emphasis has been placed on attainment of intrauterine growth rates for infants of low birthweight somewhat at the expense of the therapeutic effects of human milk and the biological importance of human milk for the intrauterine to extrauterine transition. Antibody effects of human milk and apparently also of banked human milk are proven and would be especially indicated in the case of premature infants deprived of transplacentally acquired antibodies. The validity of the intrauterine growth model to estimate nutritional requirements may be diminished by the possibility that tissue accretion by low birthweight babies is different. Nutrient quality of human milk is less questionable than quantity. Human milk was banked at Oxford by some use of pumps and hand expression but with principal emphasis on drip breast milk (DBM secreted by the contralateral breast during feeding and usually wasted) as being a source least likely to deprive the donors infant a consideration that also precluded paying of donors. Milk is frozen and pooled diluting environmental contaminants but increasing risks of infection not existent in the case of a mothers breastfeeding her own infant. Pasteurizing processes which destroy microorganisms without reducing nutritive/antibody benefits are elusive: the Oxford project now uses a 30 minute 56 degree Centigrade cycle which eliminates the need for constant bacteriologic screening. Centrifugation ultrafiltration and freeze-drying have enabled Oxford scientists to manipulate protein us. Energy content of human milk to adapt it to varied nutrient needs at different infant growth stages.

M.W. Woolridge

Papers

Sucking patterns of human babies on the breast

The initiation of lactation: the effect of early versus delayed contact for suckling on milk intake in the first week post-partum. A study in Chiang Mai, Northern Thailand

Human milk banking.

Evaluating breast-milk intake by test weighing: a portable electronic balance suitable for community and field studies