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Caes L, Abbott K, Currie S. Exploring women's perceptions of pain when breastfeeding using online forums. Int Breastfeed J 2021; 16:84. [PMID: 34663383 PMCID: PMC8524842 DOI: 10.1186/s13006-021-00426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite numerous benefits, many mothers stop breastfeeding soon after birth. A common reason for this is the experience of pain or discomfort. One resource which women use to share their breastfeeding challenges and seek support are online forums. This study aimed to collect data from online forums to explore 1) usage of forums as social support for breastfeeding-related pain; 2) experiences of breastfeeding-related pain; 3) perceptions and strategies to deal with breastfeeding-related pain; and 4) the impact of pain on breastfeeding duration. METHODS Data was gathered through searches of online forums based in the UK and USA: Netmums, What to Expect and Mumsnet using key terms: 'painful breastfeeding' and 'sore breastfeeding'. Data extraction took place in July 2018 and included posts made between 2012 and 2018. Data included 123 posts and 193 replies, analysed using thematic analysis. RESULTS The first theme identified was 'variation in types of pain', highlighting the variety of painful experiences and their descriptions. In particular, this theme reveals the large variety of different types of pain women experience at different stages throughout their breastfeeding journey, as well as the different pain characteristic they focus on in the description of their experience (i.e., location, sensory or physical aspects). Secondly, the theme 'perceived causes and explanations for pain' revealed how women interpret pain experiences either due to a recognised condition or behavioural cause. The third theme 'cessation of breastfeeding related to pain' identified. How women experience both physical and psychological struggles (e.g., guilt) related to breastfeeding cessation, with pain being a main factor in considering cessation of breastfeeding. Finally, the theme 'shared experiences and support' identified women's strong need for both practical and emotional support to deal with pain. Many women look for this support through the knowledge exchange offered on the online forums. CONCLUSIONS Pain was a key reason for breastfeeding cessation, commonly associated with strong feelings of guilt. The online forums provide a unique form of social support for breastfeeding women to find ways to cope with the pain, while highlighting the urgent need for more appropriate antenatal education on realistic expectation surrounding breastfeeding.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland
| | - Katie Abbott
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland
| | - Sinéad Currie
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland.
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Rodríguez-Gallego I, Leon-Larios F, Ruiz-Ferrón C, Lomas-Campos MDLM. Evaluation of the impact of breastfeeding support groups in primary health CENTRES in Andalusia, Spain: a study protocol for a cluster randomized controlled trial (GALMA project). BMC Public Health 2020; 20:1129. [PMID: 32682408 PMCID: PMC7368689 DOI: 10.1186/s12889-020-09244-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2003, the World Health Organization recommended exclusive breastfeeding (EB) during the newborn's first 6 months of life and, if possible, during the first 2 years. However, EB rates resist these recommendations. In developed countries, only 1 out of 3 babies is breastfed during its first 6 months of life, and great differences between areas and countries can be observed. Only 35% of the newborns receive breastfeeding at 3-4 months of age. There are diverse strategies described in the literature that have proven their efficiency in improving breastfeeding rates. It has also been proven that professional support is an effective tool to extend any kind of breastfeeding; besides, it has been observed that mother-to-mother support also increases breastfeeding initiation, sustainment, and exclusive duration. The overall aim of the study is to assess the impact of the support groups on the sustainment of exclusive breastfeeding until 6 months after birth. METHODS/DESIGN This study is a cluster-random multicentric clinical trial with a control group and an intervention group, without blinding because it is impossible to mask the intervention. A randomization by centres of primary health (clusters) will be carried out. The women allocated to the intervention or control group will be randomized with a simple randomization sampling. The participants' breastfeeding rate will be followed up at the first 10 days, and at 2, 4, and 6 months of their newborn's life. DISCUSSION There is a need to assess the impact of mother support groups on exclusive breastfeeding. This study aims to analyse the outcomes related to the support received and to identify what should the structure of these groups be; in other words, to describe factors related to a better breastfeeding experience in order to help women increase breastfeeding rates. TRIAL REGISTRATION The trial is prospectively recorded at the ISRCTN registry (Trial ID: ISRCTN17263529 ). Date recorded: 17/06/2020.
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Affiliation(s)
- Isabel Rodríguez-Gallego
- Virgen del Rocío University Hospital (Seville), Centro Universitario de Enfermería Cruz Roja, University of Seville, Sevilla, Spain
| | - Fatima Leon-Larios
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Sevilla, Spain.
| | - Cecilia Ruiz-Ferrón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Sevilla, Spain
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McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017; 2:CD001141. [PMID: 28244064 PMCID: PMC6464485 DOI: 10.1002/14651858.cd001141.pub5] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. 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). 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). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
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Affiliation(s)
- Alison McFadden
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Anna Gavine
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Angela Wade
- Institute of Child HealthCentre for Paediatric Epidemiology and Biostatistics30 Guilford StLondonUKWC1N 1 EH
| | | | | | - Emma Veitch
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Anne Marie Rennie
- NHS Grampian, Aberdeen Maternity HospitalCornhill RoadAberdeenUKAB25 2ZL
| | - Susan A Crowther
- Robert Gordon UniversityFaculty of Health and Social Care, School of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7AQ
| | - Sara Neiman
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Stephen MacGillivray
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
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Artieta-Pinedo I, Paz-Pascual C, Grandes G, Espinosa M. Framework for the establishment of a feasible, tailored and effective perinatal education programme. BMC Pregnancy Childbirth 2017; 17:58. [PMID: 28178926 PMCID: PMC5299744 DOI: 10.1186/s12884-017-1234-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/21/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Antenatal education needs to be renewed and adapted to the needs of women. OBJECTIVES to assess women needs, identify factors that influence the desired outcomes, and propose a framework for developing new perinatal education based on the guidance published by the UK Medical Research Council for the development and evaluation of complex interventions in primary care. METHODS For this study: (a) four focus group sessions were held from October to November 2010 in Bizkaia (Spain) with 30 women exploring their needs during pregnancy and postpartum; (b) two literature reviews were conducted on women's needs at these times and theoretical models of healthcare education; and (c) seven discussion and consensus sessions were run with a group of experts composed of midwifes, gynaecologists, paediatricians, and paediatric and postpartum nurses. RESULTS Various areas for improvement were identified: needs assessment of each woman/family, consideration of pregnancy and childbirth as normal physiological processes, participation of fathers, establishment of social networks, continuity of postpartum care, better access to and training for midwives, and more flexible format and contents for the programme. We propose a woman-focused framework that includes three exploratory interviews during pregnancy, personalized interventions coordinated between professionals, empowerment to choose the type of birth, and postpartum activities. CONCLUSION New perinatal education should be on-going and focused on each woman. It is necessary to assess the feasibility of implementing this type of programme, depending on the context, professionals' readiness for change and characteristics of the proposed interventions. Then, its effectiveness and sustainability must be assessed.
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Affiliation(s)
- Isabel Artieta-Pinedo
- Primary Care Midwife Zuazo Health Centre, Barakaldo, (Bizkaia); and Associate Professor of the School of Nursing, University of the Basque Country, Leioa, Bizkaia, Spain.
- Primary Care Research Unit of Bizkaia, Centro de Salud de Deusto, 4ª planta, 48014, Bilbao, Bizkaia, Spain.
| | - Carmen Paz-Pascual
- Primary Care Midwife in Sestao Health Centre, Bizkaia; and Lecturer in the Midwifery Training Unit of the Basque Country, Bilbao, Bizkaia, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Centro de Salud de Deusto, 4ª planta, 48014, Bilbao, Bizkaia, Spain
| | - Maite Espinosa
- Primary Care Research Unit of Bizkaia, Centro de Salud de Deusto, 4ª planta, 48014, Bilbao, Bizkaia, Spain
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Martínez-Galán P, Martín-Gallardo E, Macarro-Ruiz D, Martínez-Martín E, Manrique-Tejedor J. Educación prenatal e inicio de la lactancia materna: Revisión de la literatura. ENFERMERÍA UNIVERSITARIA 2017. [DOI: 10.1016/j.reu.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Martin J, MacDonald-Wicks L, Hure A, Smith R, Collins CE. Reducing postpartum weight retention and improving breastfeeding outcomes in overweight women: a pilot randomised controlled trial. Nutrients 2015; 7:1464-79. [PMID: 25723973 PMCID: PMC4377862 DOI: 10.3390/nu7031464] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/01/2014] [Accepted: 02/15/2015] [Indexed: 01/11/2023] Open
Abstract
Overweight and obesity is prevalent among women of reproductive age (42% BMI > 25 kg/m2) and parity is associated with risk of weight gain. Weight gain greater than that recommended by the Institute of Medicine (IOM )is also associated with lower rates of breastfeeding initiation and duration in women. The aim of this pilot randomised controlled trial is to examine the feasibility of recruiting and maintaining a cohort of pregnant women with the view of reducing postpartum weight retention and improving breastfeeding outcomes. Women (BMI of 25-35 kg/m2 (n = 36)) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Participants were stratified by BMI and randomised to one of three groups with follow-up to six months postpartum. Women received a dietary intervention with or without breastfeeding support from a lactation consultant, or were assigned to a wait-list control group where the dietary intervention was issued at three months postpartum. Feasibility and acceptability was assessed by participation rates and questionnaire. Analysis of variance and covariance was conducted to determine any differences between groups. Sixty-nine per cent of the participants were still enrolled at six months postpartum. This pilot demonstrated some difficulties in recruiting women from antenatal clinics and retaining them in the trial. Although underpowered; the results on weight; biomarkers and breastfeeding outcomes indicated improved metabolic health.
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Affiliation(s)
- Julia Martin
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Newcastle 2308, New South Wales, Australia.
| | - Lesley MacDonald-Wicks
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Newcastle 2308, New South Wales, Australia.
| | - Alexis Hure
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Newcastle 2308, New South Wales, Australia.
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, Level 3, Endocrinology, Locked Bag 1, Hunter Region Mail Centre, Newcastle 2310, New South Wales, Australia.
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Newcastle 2308, New South Wales, Australia.
- Priority Research Centre in Physical Activity and Nutrition, Faculty of Health and Medicine, University of Newcastle, Callaghan, Newcastle 2308, New South Wales, Australia.
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Abstract
BACKGROUND Despite the health benefits of breastfeeding, initiation and duration rates continue to fall short of international guidelines. Many factors influence a woman's decision to wean; the main reason cited for weaning is associated with lactation complications, such as mastitis. OBJECTIVES To assess the effects of preventive strategies for mastitis and the subsequent effect on breastfeeding duration. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (8 August 2012). SELECTION CRITERIA We included randomised controlled trials of interventions for preventing mastitis in postpartum breastfeeding women. DATA COLLECTION AND ANALYSIS We independently identified relevant studies and assessed the trial quality. We contacted trial authors for missing data and information as appropriate. MAIN RESULTS We included five trials (involving 960 women). In three trials of 471 women, we found no significant differences in the incidence of mastitis between use of antibiotics and no antibiotics (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.11 to 1.61; or in one trial of 99 women comparing two doses (RR 0.38; 95% CI 0.02 to 9.18). We found no significant differences for mastitis in three trials of specialist breastfeeding education with usual care (one trial); anti-secretory factor cereal (one trial); and mupirocin, fusidic acid ointment or breastfeeding advice (one trial).Generally we found no differences in any of the trials for breastfeeding initiation or duration; or symptoms of mastitis. AUTHORS' CONCLUSIONS There was insufficient evidence to show effectiveness of any of the interventions, including breastfeeding education, pharmacological treatments and alternative therapies, regarding the occurrence of mastitis or breastfeeding exclusivity and duration. While studies reported the incidence of mastitis, they all used different interventions. Caution needs to be applied when considering the findings of this review as the conclusion is based on studies, often with small sample sizes. An urgent need for further adequately powered research is needed into this area to conclusively determine the effectiveness of these interventions.
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Artieta-Pinedo I, Paz-Pascual C, Grandes G, Bacigalupe A, Payo J, Montoya I. Antenatal education and breastfeeding in a cohort of primiparas. J Adv Nurs 2012; 69:1607-17. [PMID: 23013265 DOI: 10.1111/jan.12022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2012] [Indexed: 12/01/2022]
Abstract
AIMS To assess the association between attendance at antenatal education sessions and breastfeeding during the first year of life. BACKGROUND Although there is evidence that antenatal education encourages breastfeeding, the size and duration of its effect remain unclear. DESIGN A prospective cohort study. METHODS The study was conducted in Bizkaia (North of Spain) between May 2005-June 2007 with a consecutive sample of 614 primiparas. Women were classified into three groups according to whether they had received antenatal education and, if so, how many classes (0, 1-4, or 5 or more). Telephone interviews at 1·5, 3, 6 and 12 months were used to estimate the risk of cessation of any breastfeeding and to compare the groups with Cox proportional hazards regression models adjusted for potential confounders. FINDINGS Initially, 90% of women breastfed their infants, with no differences between the groups. During the first month, the risk of cessation of any breastfeeding was three times as high among non-attendees and twice as high among women who attended 1-4 classes compared with those who attended 5 or more classes. The risk was, however, similar in the three groups from the end of first month onwards. CONCLUSION The results suggest that though antenatal education may be associated with higher rates of breastfeeding in our setting this is only the case for the first month after the birth. Further research is necessary to optimize this beneficial effect to achieve long-term continuation of breastfeeding.
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Ward KN, Byrne JP. A critical review of the impact of continuing breastfeeding education provided to nurses and midwives. J Hum Lact 2011; 27:381-93. [PMID: 21757766 DOI: 10.1177/0890334411411052] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This review of 15 studies from nine different countries analyzes the practice of continuing education on breastfeeding for health professionals, with a specific focus on nurses and midwives. Continuing breastfeeding education improves the knowledge, clinical skills and practices, and counseling skills of nurses and midwives, and it improves the Baby-Friendly Hospital Initiative compliance of institutions. Education of any duration is beneficial; however, findings support the recommendation of the World Health Organization that at least 18 hours' education for all health professionals who advise pregnant women and mothers should be undertaken.
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Abstract
BACKGROUND Despite the health benefits of breastfeeding, initiation and duration rates continue to fall short of international guidelines. Many factors influence a woman's decision to wean; the main reason cited for weaning is associated with lactation complications, such as mastitis. OBJECTIVES To assess the effects of preventive strategies for mastitis and the subsequent effect on breastfeeding duration. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009), CENTRAL (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to November 2009), EMBASE (1974 to November 2009), CINAHL (1981 to November 2009), MIDIRS (1971 to November 2009), IPA (1970 to November 2009), AMED (1985 to November 2009) and LILACS (1982 to November 2009). SELECTION CRITERIA We included randomised controlled trials of interventions for preventing mastitis in postpartum breastfeeding women. DATA COLLECTION AND ANALYSIS We independently identified relevant studies and assessed the trial quality. We contacted trial authors for missing data and information as appropriate. MAIN RESULTS We included five trials (involving 960 women). In three trials of 471 women, we found no significant differences in the incidence of mastitis between use of antibiotics and no antibiotics (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.11 to 1.61; or in one trial of 99 women comparing two doses (RR 0.38; 95% CI 0.02 to 9.18). We found no significant differences for mastitis in three trials of specialist breastfeeding education with usual care (one trial); anti-secretory factor cereal (one trial); and mupirocin, fusidic acid ointment or breastfeeding advice (one trial).Generally we found no differences in any of the trials for breastfeeding initiation or duration; or symptoms of mastitis. AUTHORS' CONCLUSIONS There was insufficient evidence to show effectiveness of any of the interventions, including breastfeeding education, pharmacological treatments and alternative therapies, regarding the occurrence of mastitis or breastfeeding exclusivity and duration. While studies reported the incidence of mastitis, they all used different interventions. Caution needs to be applied when considering the findings of this review as the conclusion is based on studies, often with small sample sizes. An urgent need for further adequately powered research is needed into this area to conclusively determine the effectiveness of these interventions.
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Affiliation(s)
- Maree A Crepinsek
- Primary Healthcare Research, Evaluation and Development (PHCRED), Faculty of Health Sciences and Medicine, Bond University, University Drive, Robina, Gold Coast, Queensland, Australia, 4229
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