Portland, Ore.
OHSU physician who led the team found that breastfeeding classes work but just giving out pamphlets doesn't
The U.S. Preventive Services Task Force today recommended structured education and counseling programs to promote breastfeeding because such programs increase the proportion of women who begin and continue to breastfeed their babies. Simply telling mothers they should breastfeed or giving them pamphlets is not enough, the task force concluded.
The task force based its conclusions on a report prepared by a team led by Jeanne-Marie Guise, M.D., M.P.H., from the Evidence-Based Practice Center at Oregon Health & Science University under contract to the Agency for Healthcare Research and Quality. The report was published in the July/August issue of Annals of Family Medicine. The task force conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services.
"I am encouraged to find that educational classes work," said Guise, an assistant professor of obstetrics and gynecology in OHSU School of Medicine and a member of the OHSU Center for Women's Health. "Hospitals and clinics can do this, and in fact many already do. The challenge will be to find ways to make education sessions available for everyone, including women who may not have the means to pay fees for additional education or who may not have received prenatal care."
In general, the task force found that classes do the best job of encouraging women to breastfeed and continue breastfeeding. Just handing out pamphlets is not effective. Also not effective are the gift packs containing infant formula or coupons for formula, which are given to many women as they leave the hospital after giving birth. They are actually counterproductive for promoting breastfeeding. "The packs, which often contain samples or coupons for formula, appear to be discouraging breastfeeding," Guise said.
The report found that educational programs share some elements: They include from one to eight individual or group sessions that follow specific formats and last 30 to 90 minutes; they are led by specially trained nurses, midwives, lactation specialists and peer counselors; and they include lectures along with practical skills that help women master breastfeeding techniques and deal with problems that may arise from breastfeeding.
In addition, structured programs include information about the benefits of breastfeeding for mother and child, how the body produces breast milk, training in positioning the baby and latch-on techniques, and the use of mechanical breast pumps.
They also found that supplementing successful programs by providing ongoing support to new mothers through in-person visits or telephone contacts by providers or counselors may help women continue breastfeeding for more than three months. It was clear that providing ongoing support is not effective as a stand-alone strategy for increasing rates of breastfeeding. More research is needed in this area, however, Guise said.
Meanwhile, the task force found insufficient evidence to recommend less-intensive intervention, such as having primary care providers advise mothers to breastfeed.
National data from 1998 showed that 64 percent of all mothers breastfed immediately after giving birth, but only 29 percent of all mothers and 19 percent of black mothers were breastfeeding by six months. The goal for Healthy People 2010 is 75 percent of mothers to be breastfeeding right after having a baby, 50 percent at six months and 25 percent at one year.
While the programs reviewed by the task force did not all take place in primary care clinics, the task force highlighted the important role of primary care clinicians such as family physicians, pediatricians, obstetricians and nurses in referring women to breastfeeding programs to ensure they begin and continue to breastfeed.
Evidence shows that breastfeeding reduces the incidence of childhood obesity and diabetes, bolsters the immune system, and reduces ear infections and infant diarrhea, Guise said.
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