How can we best support mothers to reach their breastfeeding goals?

Written by Jennie Bever Babendure, PhD, IBCLC

Photo via laurabl @ Flickr

Despite the recent media attention on toddler breastfeeding, a majority of women in the US and many other countries struggle to reach even 6 months of breastfeeding. To help mothers reach their breastfeeding goals, researchers have long created and studied support interventions. On May 16th, a review and meta-analysis was released by the Cochrane Collaboration looking at breastfeeding support interventions at the highest tier of evidence, randomized and quasi-randomized controlled trials. The study, “Support for healthy breastfeeding mothers with healthy term babies” focused on the effectiveness of 52 postnatal support interventions from 21 countries between 1979 and 2011 looking at primary outcomes of breastfeeding duration and exclusivity in healthy full term babies born to healthy mothers. 1

While some of their findings came as no surprise, others are very telling for the future of our efforts to increase breastfeeding duration and exclusivity all over the world.

What we might have expected:

1. Taken as a whole, support interventions reduced the number of women who stopped breastfeeding before 6 months and reduced the number of women who were no longer breastfeeding exclusively at 4-6 weeks and at 6 months.

2. Face to face support was more effective than telephone support

What we might not expect:

3. Support interventions were more effective in populations in which breastfeeding initiation was high.

Support is more effective when women are already motivated to breastfeed.

4. Lay support was more or as effective as professional support in reducing breastfeeding

As the most common reason mothers cite for stopping breastfeeding is the perception of not enough milk, encouragement and education from a peer counselor, community health worker, or other lay supporter can be exactly what a mother needs to reach her goals.

Most significantly, the study found that:

5. Interventions in which mothers had to ask for support, travel a distance to access
support, and in which only one interaction was provided were NOT effective at increasing
breastfeeding duration and exclusivity.

The review goes on to conclude that “Support that is only offered if women seek help is unlikely to be effective. This indicates that women should be offered predictable, scheduled, ongoing visits.” For most countries, providing this type of proactive support to all mothers would require systematic change. Most of the reviewed studies provided support by home visits or telephone calls to mothers soon after birth and continuing for many weeks postpartum. Home visits by lactation consultants, nurses, midwives, and peer counselors have demonstrated positive results, as has an intervention to incorporate lactation consultations into the regular pediatric office visits. For a more in-depth discussion of the need for proactive support, see my most recent post at

Based on the above findings it is clear that if we are to create systematic, sustainable impacts on how mothers feed their children, we need to think about how ongoing proactive support for breastfeeding mothers can best tie into our existing culture. Given the recent movement towards sustainability and health, our community has an opportunity to put forth a unified front and effect change to ensure that routine lactation support is as normal as a pediatric check-up.

The 203 page study is freely accessible in its entirety here.

1. Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews 2012; 5.

Editor’s Note:  Please take the opportunity to read Jennie’s companion post to this one on her blog. In it, she highlights how formula companies have figured out how to make their product available to mothers in the ways mentioned above and makes suggestions for ways that lactation professionals could change their thinking on such matters.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.

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7 Responses to How can we best support mothers to reach their breastfeeding goals?

  1. Shayne 9 June 2012 at 17:35 #

    I had one nurse come in after my son was born to check his sugars every hour (he was induced for being overdue and was 9 pounds 14 ounces) and when they got around fifty indicated they were getting low” so I suggested I give him an eyedropper of formula while nursing; the other nurse promptly came in and said he was not “low” and that fifty was not a huge deal, she said just to nurse him more. When the previous nurse came in she said the other nurse was a NICU nurse and knew more than she did. So, I think having the right qualified people around you after the baby is born is important.

    • Nikolas 26 June 2012 at 21:29 #

      =( $45 is too much =( $45 is too much to be flopping my twins ..have you tried gourlammom? I like them but they shrink after few washes.Do you use any nursing pads? I always gets a early let-down even if I feed my baby on time and it leak like crazy! any suggestion to avoid it? Thank you luvs!

    • breastfeedingscience 3 July 2012 at 04:55 #

      I agree–having the right people around is SO important. I’m glad to hear the right person was around in your case. Thanks for sharing!

  2. Helen 10 June 2012 at 09:16 #

    Good work, Jennie. Home visits would be ideal or at the Pediatricians offices. Our hospital offers outpatient visits for a fee and we do offer support over the phone. With the Affordable Health Care Act, hopefully insurance will cover the visits as this is to their benefit. Extended maternity leave would also help breastfeeding duration.
    Keep up the good work, as it is important to support breastfeeding Mothers.

    • breastfeedingscience 3 July 2012 at 04:57 #

      Thanks Helen. I think we all have high hopes that the Affordable Care Act will make a difference for breastfeeding!

  3. mary kay smith 11 July 2012 at 01:17 #

    The trouble is finding money to pay the people who could provide this support. We’ve got to convince doctor’s offices to staff with IBCLCs who KNOW how to help mothers.


  1. Is it time breastfeeding supporters began to think like formula companies? | breastfeeding science - 5 June 2012

    […] My comments on the rest of the excellent review and meta-analysis described above (including all the major findings), are available at ILCA’s Lactation Matters blog.… […]

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