Report: classes best way to promote breast-feeding: start in prenatal period.(Obstetrics)

Breast-feeding education classes with a nurse or a midwife are the most effective way to increase the number of women who initiate breast-feeding and sustain it for up to 3 months, according to an evidence review by the US Preventive Services Task Force.

Based on published evidence, other interventions to encourage new mothers to breast-feed for longer than 3 months appear to have no influence, the task force said (Ann. Fam. Med 1[2]:70-80, 2003).

An extensive analysis of data from studies on how to increase and support breastfeeding found that education and behavioral counseling programs improve the rate to the degree that for every 3-5 women enrolled in such a program, 1 woman would breast-feed for up to 3 months, the task force said.

The programs evaluated in the different studies varied, particularly in terms of whether the educational sessions were done in groups or individually But their pertinent characteristics were that the classes started in the prenatal period and were conducted by either a nurse with expertise or a midwife. The number of sessions that participants attended ranged from one to eight, and most programs included additional interventions, such as continued support or home visits after the birth. The studies did not show that the programs significantly increased the number of women who breast-fed after 3 months (from 4 to 6 months), the task force concluded.

Eight randomized studies have looked at the impact of breast-feeding support, which was defined as appointments, problem-oriented visits, or advice from lactation consultants, nurses, or peers. The data from those studies suggest that support alone has a modest, perhaps insignificant, effect on the initiation of breast-feeding (an increase of 6%), the continuation of breast-feeding for 3 months (11%), and the continuation of breast-feeding for 6 months (8%).

When support was combined with an educational program, the combination increased breast-feeding, but not to a degree that was greater than the educational program alone.