Primary Care Interventions to Promote Breastfeeding: Article

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Table 3. Characteristics of Randomized, Controlled Trials

Study, Year (Reference)	Design	Country	Patients, n	Population Characteristics	Intervention Components	Timing	Control	Outcomes	Quality^a
Developed countries
Anderson et al., 2005⁹³	Parallel	United States	182	Predominantly Latina and low-income, WIC	LS	Prenatal, peripartum, postnatal	BFHI^b	Breastfeeding rates, maternal and child health	Fair
Bonuck et al., 2005⁹⁴ and 2006⁹⁵	Parallel	United States;	382	56% Medicaid, 39% foreign-born	Ed, PS-IL, provided nursing bras and pump	Prenatal, peripartum, postnatal	Usual prenatal care	Breastfeeding rates, maternal and child health	Fair
Carfoot et al., 2004^96,c	Parallel	United Kingdom	28	General(sparse demographic data)	Skin-to-skin contact	Postnatal	Routine care	Breastfeeding rates	Poor
Carfoot et al., 2005⁹⁷	Parallel	United Kingdom	201	General (sparse demographic data)	Skin-to-skin contact	Postnatal	Routine care	Breastfeeding rates	Fair
Chapman et al., 2004¹¹⁷	Parallel	United States	219	Latino community from Puerto Rico, low-income, BFHI-accredited hospital	LS, provided electric breast pumps	Prenatal, peripartum, postnatal	Routine Ed	Breastfeeding rates	Fair
Dennis et al., 2002¹¹⁸	Parallel	Canada	256	General, well-educated (>60% college education)	LS, telephonebased support	Postnatal	Conventional in-hospital and community postpartum support	Breastfeeding rates	Fair
Di Napoli et al., 2004¹²⁴	Parallel	Italy	605	General, well-educated	PS-IL, telephonebased support	Postnatal	No intervention	Breastfeeding rates	Fair
Ekström and Nissen, 2006¹³⁰; Ekström et al., 2006¹³¹	Quasi	Sweden	378	Large municipalities, well-educated	PS-SL^d	Prenatal, peripartum	Usual care	Breastfeeding rates, absolute breastfeeding durations	Poor
Finch and Daniel, 2002⁹⁹	Parallel	United States	60	Low-income (urban WIC program), African- American and Hispanic, 25% ≥18 years old	Ed, incentives	Prenatal, peripartum	Usual prenatal care	Breastfeeding rates	Poor
Forster et al., 2004¹⁰⁰	Parallel	Australia	981	Low-income, culturally diverse, BFHI-accredited hospital	Ed ^e	Prenatal, peripartum	BFHI^f	Breastfeeding rates, absolute breastfeeding durations	Fair
Gagnon et al., 2002¹¹⁹	Parallel	Canada	586	General (living near the urban hospital)	S-IL^g, telephonebased support	Postnatal	Usual care in hospital and clinical follow-up	Breastfeeding rates, absolute breastfeeding durations	Fair
Graffy et al., 2004¹²³	Parallel	United Kingdom	720	General (urban areas)	PS-IL^h	Prenatal, peripartum, postnatal	Usual care with no counselor contact	Breastfeeding rates	Good
Henderson et al., 2001¹⁰¹	Parallel	Australia	160	2–3-d postpartum stay, well-educated	Ed	Postnatal	Usual postpartum care	Breastfeeding rates	Fair
Howard et al., 2003¹⁰²	Parallel	United States	700	Primarily white, well-educated, married, 77% employed	Delayed pacifier use (>4 wk)	Postnatal	Early pacifier use (2–5 d)	Absolute breastfeeding durations	Good
Kools et al., 2005¹²⁹	Cluster ;	Netherlands	781	General, well-educated	PS-ILⁱ	Prenatal, peripartum, postnatal	PS plus written material	Breastfeeding rates	Fair
Kramer et al., 2001¹⁰³	Parallel	Canada	281	Multicultural (67% Englishspeaking), well-educated, 76% employed	PS-IL, discouraged pacifier use	Postnatal	Pacifier use and PS	Breastfeeding rates	Good
Kronborg et al., 2007¹²⁸	Cluster	Denmark	1597	General, BFHI-accredited hospitals	PS-IL	Postnatal	Home visits by health visitors who did not have the training course	Breastfeeding rates	Fair
Labarere et al., 2003¹⁰⁴	Parallel	France	212	Employed, well-educated, prolonged maternity leave	Ed	Postnatal	Usual care in hospital	Breastfeeding rates	Good
Labarere et al., 2005¹⁰⁵	Parallel	France	231	Well-educated, employed, prolonged hospital stay	PS-SL^j	Postnatal	Usual care, including LS	Breastfeeding rates, absolute breastfeeding durations	Good
Lavender et al., 2005¹²⁷	Cluster	United Kingdom	742	Low-income, lack of social support	PS-SL^k	Prenatal, peripartum	Usual prenatal breastfeeding advice	Breastfeeding rates	Poor
Mattar et al., 2007¹¹⁴	Parallel	Singapore	401	Low-income, less-educated	PS-IL^l, Ed materials(book and video)	Prenatal, peripartum	Routine prenatal care	Breastfeeding rates	Good
McKeever et al., 2002¹⁰⁶	Parallel	Canada	101	Metropolitan area, well-educated, about a 48-h postpartum stay	PS-IL	Postnatal	No home visits from lactation nurses	Breastfeeding rates	Poor
McLeod et al., 2004¹³²	Quasi	New Zealand	228	Maori, smokers	Ed^m, PS-IL	Prenatal, peripartum, postnatal	Usual care for women who smoked	Breastfeeding rates	Poor
Mizuno et al., 2004¹⁰⁷	Parallel	Japan	60	Postpartum stay ≥4 d, infants not with mothers for 24 h and were fed formula	Skin-to-skin contact	Postnatal	Routine care	Breastfeeding rates, absolute breastfeeding durations	Fair
Moore and Anderson, 2007¹¹⁵	Parallel	United States	21	General, well-educated	Skin-to-skin contact	Postnatal	Routine care	Breastfeeding rates	Poor
Muirhead et al., 2006¹⁰⁸	Parallel	Scotland	225	Some premature babies (5.3%) and babies in special care, few demographic data on the mothers	LS	Prenatal, peripartum, postnatal	Usual careⁿ	Breastfeeding rates	Fair
Noel-Weiss et al., 2006¹²⁵	Parallel	Canada	101	High family income, well-educated, 36% cesarean section, 68% received free formula	Ed	Prenatal,peripartum	Not described (no education)	Breastfeeding rates, absolute breastfeeding durations	Good
Pugh et al., 2002¹²⁰	Parallel	United States	41	Low-income, receiving financial medical assistance	PS-IL, LS	Postnatal	Usual care	Breastfeeding rates	Poor
Quinlivan et al., 2003¹²¹	Parallel	Australia	136	Age <18 y	PS-IL	Postnatal	Routine postnatal support	Breastfeeding rates, absolute breastfeeding durations	Good
Ryser, 2004¹⁰⁹	Parallel	United States	54	Low-income (90% eligible for Medicaid)	Ed	Prenatal, peripartum	No intervention	Breastfeeding rates	Poor
Schlickau and Wilson, 2005¹¹⁰	Parallel	United States	30	Hispanic women, emigrated from Mexico	Ed, commitment to breastfeed^o	Prenatal, peripartum	Usual care	Breastfeeding rates, absolute breastfeeding durations	Poor
Su et al., 2007¹¹⁶	Parallel	Singapore	450	Low-income, less-educated	PS-IL^p, printed materials	Prenatal, peripartum, postnatal	Usual care	Breastfeeding rates	Fair
Wallace et al., 2006¹¹¹	Parallel	United Kingdom	270	General (not BFHI-accredited hospital)	PS-SL^q	Postnatal	Usual postpartum care	Breastfeeding rates	Good
Wilhelm et al., 2006¹¹²	Parallel	United States	73	Rural community	Motivational interview	Postnatal	Usual care^r	Breastfeeding rates, absolute breastfeeding durations	Poor
Winterburn et al., 2003¹²²	Parallel	United Kingdom	72	No data (women in a university hospital)	PS-IL, LS^s	Prenatal, peripartum	Routine prenatal care	Breastfeeding rates	Poor
Wolfberg et al., 2004¹¹³	Parallel	United States	59	Low-income, minority	Ed^t	Prenatal, peripartum	Control education (baby care and safety)	Breastfeeding rates	Poor
Developing countries (for BFHI only)
Coutinho et al., 2005⁹⁸	Parallel	Brazil	350	Low-income, 24-h hospital stay	PS-IL^u	Prenatal, peripartum, postnatal	BFHI (steps 4–9)^v	Breastfeeding rates	Good
Kramer et al., 2001¹²⁶	Cluster	Belarus	17 046	Prolonged postpartum stay; maternity leave	PS-SL^w	Prenatal, peripartum, postnatal	Usual care	Breastfeeding rates, maternal and child health	Good

BHFI = Baby-Friendly Hospital Initiative; Ed = formal/structured breastfeeding education; LS = lay support; PS = professional support; PS-IL = professional support—individual level; PS-SL = professional support—system level; WIC = Women, Infants, and Children program.
a See Appendix Table for the detailed quality assessment.
b BFHI: breastfeeding warm line (telephone support), conventional breastfeeding education before birth, hands-on breastfeeding assistance, and education from the maternity ward nursing staff.
c Pilot study for reference 97.
d Health professionals received a process-oriented program on breastfeeding counseling, including lectures on breastfeeding management and promotion, counseling skills, and personal breastfeeding experiences.
e Two intervention groups: practical skills or attitudes.
f Standard care included formal breastfeeding education, peer support, and postnatal home visits by midwives (BFHI-accredited hospital); the same control group was used to compare both intervention groups (practical skills or attitudes).
g Community follow-up (intervention group): telephone contact 48 hours after delivery and nurse contact in the home on day 3.
h Trained, accredited counselors who visited once before birth, followed by telephone support or home visits if requested.
i Enhanced access to lactation consultants.
j Pediatricians or family physicians who had attended a 5-hour training program (breastfeeding-related knowledge and counseling skills) delivered in 2 parts in 1 month before the beginning of the study.
k Education session (1 day, 9 a.m.–4 p.m.) to help midwives revise their knowledge of lactation management and educate women on basic lactation physiology and effective breastfeeding techniques.
l Two intervention groups: education materials (book and video) and individual counseling (1 session) or education materials (book and video) alone.
m Two intervention groups: breastfeeding support only or breastfeeding support and smoking cessation.
n Usual care included a community midwife for the first 10 days, health visitor after 10 days, breastfeeding support groups, and breastfeeding workshops.
o Two intervention groups: breastfeeding education or breastfeeding education plus commitment to breastfeed.
p Two intervention groups: 1) 1-session video before birth, printed materials, or 15-minute counseling with lactation consultant or 2) counseling sessions after delivery (30 minutes each with lactation consultant) and printed materials.
q Midwives received a 4-hour workshop ("hands-off" approach to breastfeeding: advice about baby initiation of feeding, positioning, and attachment).
r Usual care included a lactation consultant troubleshooting problems during the hospital stay and at each visit by using the American Academy of Pediatrics’ 2002 guide to breastfeeding.
s Members of the intervention group were invited to choose a female confidante who could offer support with infant feeding, and the community midwife visited both mother and confidante together at home.
t Breastfeeding classes for expectant fathers taught by peer who was a father.
u BFHI step 10, postnatal home visits by professionals.
v BFHI step 4, skin-to-skin contact in delivery room and helped to breastfeed in delivery room; BFHI step 5, shown how to breastfeed (positioning and attachment); BFHI step 6, infant given only breast milk, given no water/tea, and given no other milk; BFHI step 7, roomed-in; BFHI step 8, advised to breastfeed on demand; BFHI step 9, advised not to give pacifiers and bottles; and BFHI step 10, postnatal home visits by professionals.
w Modeled BFHI.

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