For
cessation of exclusive breastfeeding at up to six months the treatment effect appears to be greater when the intervention was delivered by non-professionals (lay support) compared with professionals or mixed support (test for subgroup differences: Chi ² = 7.74, df = 2 (P = 0.02), I ² = 73.1 %; Analysis 2.2).
There was a reduction in
the cessation of exclusive breastfeeding within the first six months and at up to four to six weeks when lay support was used, although in view of considerable within - subgroup heterogeneity, these findings should be interpreted with caution.
For
cessation of exclusive breastfeeding at up to six months face - to - face interventions may be associated with greater effects than other types of support; however, very high within - group heterogeneity remains in the analysis, and we advise caution when interpreting this result (test for subgroup differences: Chi ² = 37.55, df = 2 (P <.00001, I ² = 94.7 %; Analysis 3.2).
For
cessation of exclusive breastfeeding at up to six months, there appears to be a differential effect of the number of postnatal contacts, with four to eight contacts performing best.
For
cessation of exclusive breastfeeding by four to six weeks the test for subgroup differences indicates a possible differential treatment effect (test for subgroup differences: Chi ² = 7.12, df = 2 (P = 0.03), I ² = 71.9 %).
In this review, the greatest effect of breastfeeding support interventions on reducing
cessation of exclusive breastfeeding before six months occurred in communities with high (over 80 %) levels of breastfeeding initiation.
For
cessation of exclusive breastfeeding at up to four to six weeks there appears to be differential treatment effect according to the number of support contacts, with four to eight contacts the most effective schedule.
All forms of extra support together also showed a decrease in
cessation of exclusive breastfeeding at six months (average RR 0.88, 95 % CI 0.85 to 0.92; moderate - quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95 % CI 0.71 to 0.89; moderate quality, 32 studies).
Not exact matches
Results
of the analyses continue to confirm that all forms
of extra support analyzed together showed a decrease in
cessation of «any
breastfeeding», which includes partial and
exclusive breastfeeding (average risk ratio (RR) for stopping any
breastfeeding before six months 0.91, 95 % confidence interval (CI) 0.88 to 0.95; moderate - quality evidence, 51 studies) and for stopping
breastfeeding before four to six weeks (average RR 0.87, 95 % CI 0.80 to 0.95; moderate - quality evidence, 33 studies).
Supplementation with formula or donor EBM may be considered by staff if it is thought that there is insufficient supply
of mother's own EBM, however inadequate pumping can lead to reduced stimulation
of the breast, a reduced maternal milk supply and earlier
cessation or less likelihood
of exclusive breastfeeding (Gromada 1998).
While the effect size
of support interventions on reducing the
cessation of any
breastfeeding is modest, there is evidence
of a greater effect on the prolongation
of exclusive breastfeeding.
The overall findings
of this review, that
breastfeeding support interventions have been shown to be effective in reducing the risk
of cessation of any
breastfeeding and
of exclusive breastfeeding, are similar to the findings
of other reviews (Rollins 2016; Sinha 2015).