Running Head: THE EFFECTS OF BREASTFEEDING EDUCATION

The Effects of Breastfeeding Education

David Lepin
University of South Florida

THE EFFECTS OF BREASTFEEDING EDUCATION

ABSTRACT
Clinical Problem: The World Health Organization(WHO) recommends that mothers breast feed
for at least six months after delivery; however, many new mothers fall short of this
recommendation.
Objective: The objective of this paper is to determine the effects that a comprehensive approach
of professional healthcare intervention has on the duration of breastfeeding. The Wiley Online
Library, the University of South Florida Library, and Sage Journals were all used as search
engines to collect information from randomized controlled trials in regards to this topic. Standard
breastfeeding education protocols and interventions are specific to each article. Key words used
in these search engines were breastfeeding, education, duration, randomized, trials, and support.
Results: The subjects in the experimental groups of each trial breastfed for longer durations as
opposed to their counter parts. Results were significant (p<0.05) in the first article. The results in
the second article showed one intervention group was less likely to discontinue breastfeeding at
six months (hazard ratio, HR 0.79, 95% CI 0.64-0.98). The third articles results also supported
the implementation of thorough breastfeeding education (p<0.01).
Conclusion: These studies reveal that a comprehensive breastfeeding education positively
influenced breastfeeding duration at any and all follow-up interviews when compared to standard
breastfeeding education.

THE EFFECTS OF BREASTFEEDING EDUCATION

The Effect of Breastfeeding Education

The World Health Organization(WHO) (2013) and recommends at least six months of
exclusive breastfeeding after delivery. Research shows a positive correlation between
breastfeeding and overall well-being in infants (Wambach et al., 2010). Despite these
recommendations, many mothers do not breastfeed and others do not breastfeed for the
recommended amount of time. In many developed countries breastfeeding initiation is above
eighty percent, but only twenty percent of mothers continue to exclusively breastfeeding after
three months (Fu et al., 2014). Many hospitals and healthcare providers provide minimal
breastfeeding education and support. The purpose of this paper is to analyze the effects of a
comprehensive approach of healthcare intervention in support of breastfeeding compared to
standard breastfeeding education. Comprehensive healthcare intervention in these articles
includes, but is not limited to: lactation consultation, peer counseling, postnatal support via
telephone communication, etc. Standard breastfeeding education protocols and interventions are
specific to each article. For new mothers, does a comprehensive approach of professional
healthcare intervention on breastfeeding compared to standard healthcare intervention, have an
affect on the duration of breastfeeding for the recommended first six months of the infants life?
Literature Search
The Wiley Online Library, the University of South Florida Library, and Sage Journals
were all used as search engines to collect information from randomized controlled trials in
regards to this topic. Standard breastfeeding education protocols and interventions are specific to

THE EFFECTS OF BREASTFEEDING EDUCATION

each article. Key words used in these search engines were breastfeeding, education, duration,
randomized, trials, and support.
Literature Review
Three randomized controlled trials were used to evaluate the effect that a comprehensive
approach of professional healthcare intervention has on the duration of breastfeeding. Aksu,
Kucuk, and Duzgun (2011) used a randomized controlled trial in their study. This study was
conducted in the state hospital of Aydin, Turkey on sixty different women who were randomly
allocated to two groups. Random assignment was concealed from the participating women to
avoid compromising any personal information or results. There were thirty women in each
group. The purpose of the study was to compare breastfeeding duration between women who
received standard breastfeeding education and women who received postpartum breastfeeding
education three days after delivery, in addition to the standard breastfeeding education. In this
article standard breastfeeding education is described as breastfeeding counseling on the benefits
of breastfeeding for the mother and child, techniques, and lactation management courses in the
first few hours after delivery. The three day postpartum education addressed these same topics,
but more in depth over the course of three days. To meet the eligibility criteria for this study the
mothers had to have a vaginal delivery, speak Turkish, and have an intent to breastfeed. Initial
interviews were conducted at least twenty-four hours after delivery. The mothers were then
contacted via phone at two weeks, six weeks, and finally six months postpartum to check the
status of breastfeeding participation. Mothers from the experimental group breastfed for a longer
duration as opposed to mothers from the control group (p<0.05). The main weakness of this
article is that lactation consultants, nurse midwifes, and other healthcare providers were not blind

THE EFFECTS OF BREASTFEEDING EDUCATION

to this study. The strengths of this study are random assignment of participants, length of follow
up assessments, validity of follow up assessments, and the fact that the mothers in each group
were of the same demographic.
Fu et al. (2014) constructed a three-arm randomized controlled trial was conducted on
seven hundred twenty-four women in China to evaluate the effects of postpartum support
interventions. The purpose of this trial was to see what effects these interventions had on the
duration of breastfeeding. Two mothers were excluded because they did not meet the criteria to
participate. The remaining mothers in this study were divided into three groups by an online
program by a person not involved in the recruitment process, or data collection. The first group
of two hundred sixty-four mothers that were given usual postnatal care. This was made up of
postnatal lactation education, personal assistance to overcome breastfeeding issues, and an
outpatient follow up appointment. The other two groups of mothers also received this postnatal
care. Along with this usual care one group received three thirty minute professional breastfeeding
support sessions 48 hours after delivery. This group was made up of one hundred ninety-one
mothers. The last group involved two hundred sixty-nine mothers who received weekly
telephone support for up to four weeks after delivery. Both groups receiving additional postnatal
care breastfed for longer durations. Specifically, mothers in the group receiving weekly
telephone calls were less likely to stop breastfeeding in the first six months, as opposed to the
mothers receiving standard postnatal support (hazard ratio, HR 0.79, 95% CI 0.64-0.98). The
main weakness of this study is that healthcare providers were not blind to the two groups that
received the interventional education. The strengths of this study include the random allocation

THE EFFECTS OF BREASTFEEDING EDUCATION

of participants into one of the three groups, the concealment from the participants, similar
demographics among the subjects, and the length of follow up assessments.
The third study from Wambach et al. (2010) evaluated the effect lactation consultation
had on breastfeeding duration up to six months after delivery. This trial was conducted on three
hundred ninety adolescent females between the ages of fifteen and eighteen years old. Of the
three hundred ninety, only two hundred eighty-nine provided complete and adequate data. The
participants were predominantly African American, single, and of low socioeconomic status.
These females had to be first-time mothers in their second trimester who were able to read and
speak english, in order to meet the criteria for the study. There were two hundred fifty-six
participants in the experimental groups which were followed by a team of certified lactation
consultants and trained peer counselors. Peer counselors in this study were previous teenage
breastfeeding mothers. This team of counselors provided prenatal and postnatal education and
support up to four weeks after delivery. Educational measures consisted of two classes on the
benefits of breastfeeding. Counselors also provided support via telephone and a one-time face-toface visit for encouragement of breastfeeding. Members of the control group consisted of one
hundred thirty-four mothers. They were also provided prenatal and postnatal education, but theirs
did not involve education on breastfeeding. Each participant was contacted at three weeks, six
weeks, three months, and finally six months postpartum to follow-up and collect data. This study
shows that the experimental group benefited from the interventions. Breastfeeding duration was
positively influenced up to six months (p<0.001) when breastfeeding education and support
surpassed the minimal standard. The fact that lactation consultants and the peer counselors were
not blind to this study highlights one weakness of this study. The strengths are random

THE EFFECTS OF BREASTFEEDING EDUCATION

assignments of participants, the length of the study, the similar demographics, and the follow up
consults were reliable and valid.
The guidelines for breastfeeding are recommended by the WHO and retrieved from the
Agency for Healthcare Research and Quality(AHRQ). The WHO (2013) recommends six
months of exclusive breastfeeding after delivery. In order to do so healthcare providers should
provide the necessary education and support. The AHRQ determined that this was a strong
recommendation.
Synthesis
Aksu, Kucuk, and Duzgun (2011) indicated that mothers who received postpartum
breastfeeding education three days after delivery in addition to the standard breastfeeding
education breastfed for a longer duration as opposed to mothers from the control group (p<0.05).
Fu et al. (2014) demonstrated a longer duration of breastfeeding for at least six months (p<0.05)
with additional postnatal support. Furthermore, Wambach et al. (2010) shows that a
comprehensive approach of professional postnatal healthcare intervention has a positive effect
(p<0.001) on breastfeeding duration. From these articles one can see how standard breastfeeding
education does not help mothers achieve the recommendations from the WHO. The data suggests
that a comprehensive approach of professional healthcare intervention on breastfeeding increases
breastfeeding duration when compared to standard healthcare intervention. Additionally, these
studies generate new knowledge on the impact of breastfeeding education, and provide research
to support changes in healthcare intervention.
Clinical Recommendations

THE EFFECTS OF BREASTFEEDING EDUCATION

The WHO (2013) recommends that new mothers breastfeed for at least six months after
delivery. Research shows a positive correlation between comprehensive breastfeeding education
and breastfeeding duration, which promotes adherence to the recommendations from the WHO.
The supporting articles identify a comprehensive breastfeeding education as additional education
on overall health benefits of breastfeeding, technique, lactation consultation, and peer counseling
and support. Healthcare providers should implement changes to standard breastfeeding education
so that they include these similar elements.

THE EFFECTS OF BREASTFEEDING EDUCATION

References
Aksu, H., Kk, M., & Dzgn, G. (2011). The effect of postnatal breastfeeding education/
support offered at home 3 days after delivery on breastfeeding duration and knowledge: A
randomized trial. Journal of Maternal-Fetal and Neonatal Medicine, 24(2), 354-361 doi:
10.3109/14767058.2010.497569
Fu, I., Fong, D., Heys, M., Lee, I., Sham, A., & Tarrant, M. (2014). Professional breastfeeding
support for first-time mothers: A multicentre cluster randomised controlled trial. BJOG:
An International Journal of Obstetrics & Gynaecology, 121(13), 1673-1683. doi:
10.1111/1471-0528.12884
Wambach, K. A., Aaronson, L., Breedlove, G., Domian, E. W., Rojjanasrirat, W., & Yeh, H
(2010). A randomized controlled trial of breastfeeding support and education for
adolescent mothers. Western Journal of Nursing Research, 33(4), 486-505. doi:
10.1177/0193945910380408
World Health Organization (WHO). (2013). WHO recommendations on postnatal care of the
mother and newborn. Geneva (Switzerland): World Health Organization (WHO).