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Evidence-based interventions to support breastfeeding
Journal club
• Author: Lori Feldman-Winter,MD,MPH
• Journal:Pediatric clinics of North America:
Breast feeding Updates for the
Pediatrician.
Morrow and Chantry
February 2013,Volume 60,Number 1
Introduction
• Decision to breast feed is one of the most important decision a mother can make.
• 75% of US mothers started breastfeeding in early postpartum period according to CDC and NIS.
• Merely 14.8% women exclusively breast fed upto6 months(NIS) in 2008.
• Therefore along with focusing on the decision to breastfeed there should be focus on protection and support of breastfeeding
• Describes evidence based practices that have been established to support breastfeeding.
• Discusses barriers and challenges to breastfeeding support .
Support for pregnant women:
Ample time with prenatal healthcare practioner providing ampleopputunity for brestfeedingsupport.
Peer counselling , formal lactational consultation and breast feeding education.
Mothers who are at more risk of not breast feeding are more to gain from prenatal support.
Content of effective sessions-benefits,priciplesof lactation,myths,commonproblems,solutions and skill training.
Prenatal classes in workshop format increases self efficacy.
Weight control strategies should be offered.
More effective when combined with elimination of infant formula marketing
Step 3 of BFHI
Support in preipartum setting:
• Importance of skin to skin conatct : improves physiologic transition,increases success of first breast feed and more effective breast feeding.
• The first breast feed: early first breastfeed leads to increased milk supply in first days, early passage of meconium and continuing of breast feeding.
• Newborn procedures:weighing,injectons,blood sampling.
BFHI:
• Has been shown to increase initiation, continuation and exclusivity.
• 10 steps have dose dependent effect.
Support for postpartum women in community
• Support by physician and advanced practice nurses.
Professional support by other health care professional:
Peer(lay) Support
Employment
• Schools and preconception education:
• Government and legistation:
Conclusion
• Considerable progress has been made in past decade in developing support systems to enable more women to reach breastfeeding goals.
• Each of this system is to rigorously tested and replicated if effective.
• Additional research is needed to determine best support during preconception period
• Along with outcome ,cost benefit analysis of breast feeding support program.
• evaluation of government activities and program.