1

Running head: LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

Comparing the Effects of Lactation Consultants Versus Information Materials on Breastfeeding

Outcomes

Caroline Baehr, Bailey Dickerson, Anna Hall, Emily C. Herring, Katie Hydrick, Meghan Reed

Auburn University School of Nursing

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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

Abstract

Various educational interventions may affect the duration and exclusivity of breastfeeding in

mothers during the postpartum period. The data from six scholarly articles were analyzed to

determine the difference in effectiveness between education from lactation consultants versus

information materials on the duration and exclusivity of postpartum breastfeeding. The authors

included systematic reviews, primary research articles, and meta-analyses. Information materials

are defined in this review as specifically pamphlets and videos. The articles favor education and

support provided by lactation consultants and counselors. The effectiveness of group education

and prenatal consults were reviewed in relation to breastfeeding duration and exclusivity. Two

articles concluded insufficient evidence to support information materials over lactation

consultations. The sample sizes were too small and family involvement needed to be measured in

the studies as well. Education of mothers both before and after birth increased duration and

exclusivity of breastfeeding during the postpartum period. The authors offered evidence-based

practice recommendations to support breastfeeding mothers. Ultimately, more evidence is

needed to have a definitive answer on the superior method of breastfeeding education.

Breastfeeding education and strong support systems improve breastfeeding rates in the

postpartum period. 

Keywords: breastfeeding education, postpartum, exclusivity

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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

Comparing the Effects of Lactation Consultants Versus Information Materials on Breastfeeding

Outcomes

Breastfeeding is often misunderstood by mothers and requires education to allow for the

understanding of the benefits associated. Nurses and healthcare professionals are tasked with the

duty of supplying the education and making it clear why breastfeeding is superior. According to

Dr. Ruth Petersen of the Center for Disease Control (CDC):

Breastfeeding provides unmatched health benefits for babies and mothers. It is the

clinical gold standard for infant feeding and nutrition, with breast milk uniquely tailored

to meet the health needs of a growing baby. We must do more to create supportive and

safe environments for mothers who choose to breastfeed” (2021). 

The benefits of breastfeeding for the infant include reduced occurrences of obesity, asthma, type

1 diabetes, SIDS, and more. For the mother, breastfeeding can assist in lowering the risk of

ovarian/breast cancer, type 2 diabetes, and high blood pressure. Furthermore, the lack of

education on the importance of breastfeeding has a correlation to the decline in breastfeeding

exclusivity and duration. According to the CDC, only 25% of infants are exclusively breastfed at

six months old (2021). The recommendation is six months of exclusive breastfeeding and then

another six months of complementary breastfeeding (CDC, 2021). The lack of breastfeeding is

putting infants and mothers at risk. Education is imperative!

            The statistics were too low to go unnoticed. Auburn University’s School of Nursing

Evidence Based Practice class formulated a PICO question to address the issue of the lack of

exclusivity and duration relating to education: In breastfeeding women, how does the use of

information materials (videos and pamphlets) compared to the use of lactation consultants impact

the duration/exclusivity of breastfeeding? Breastfeeding women is the population to then focus

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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

on the duration and exclusivity after initiation of breastfeeding. The intervention is the use of

informational materials (videos and pamphlets specifically) which then is being compared to the

use of lactation consultants. Both the intervention and comparison focus on education. Finally,

the outcome is in regard to the duration and exclusivity of breastfeeding. 

            The chosen PICO question can be seen as a challenge for nurses. The question is being

researched due to the fact hospitals, doctors, and nurses have not found a fail-proof way to

educate and persuade mothers to breastfeed/breastfeed for the recommended amount of time.

Nurses come in contact with patients more than any other position in the hospital. Therefore,

nurses play a big part in breastfeeding education to further the practice of breastfeeding. In

regard to the comparison of the PICO question, nurses can complete additional certification to

become lactation consultants. Lactation consultants counsel and educate breastfeeding mothers.

Nurses, themselves, can educate mothers as well. Moms often feel more comfortable talking with

nurses, so nurses have a special influence regarding breastfeeding. 

Search for Evidence

 The databases utilized include the Cumulative Index to Nursing and Allied Health

Literature (CINHAL) and PubMed. Three out of six sources are from CINHAL and three out of

six are from PubMed. After defining a PICO question involving breastfeeding women, the group

identified terms and subject headings related to specific key components of the question to

search. In order to maximize search results, the group identified synonyms of key terms in the

PICO question and other related terms. The key terms included breastfeeding education,

postpartum, and exclusivity. The search was limited to systematic reviews, primary research

articles, and meta-analysis. Limits also utilized in the search included English, peer reviewed,

and publish date within the last five years. Four out of six articles came from the Journal of
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

Human Lactation. The article by Wood, Woods, Blackburn, & Sanders (2016) came from The

American Journal of Maternal/Child Nursing. The final article by Huang et al. (2019) appeared

in Medicine. The review of the six articles included allowed for exploration of breastfeeding

interventions and subsequent outcomes.

Initiation, Duration, and Exclusivity of Breastfeeding 

Wong, Tarrant, and Lok (2015) and Wouk, Tully, and Labbok (2017) focused on the

duration and exclusivity of breastfeeding in prenatal women. Wong et al. (2015) additionally

reviewed articles about breastfeeding initiation in prenatal, intrapartum, and postpartum women.

Breastfeeding initiation, duration, and exclusivity was increased through interventions such as

group education and prenatal consultants. The studies used in reviews by Wong et al. (2015) and

Wouk et al. (2017) suggest the need for higher quality trials and larger sample sizes.

Furthermore, research could have been improved if the role of family members was measured

more directly as an indicator of breastfeeding outcomes (Wong et al., 2015). In future studies,

time and cost associated with different breastfeeding interventions should be analyzed to

determine the most accessible and cost-effective intervention. The result of data collected by

Wong et al. (2015) and Wouk et al. (2017) found interventions which focused on breastfeeding

education and psychosocial support promoted breastfeeding initiation, duration, and exclusivity. 

Researchers commonly utilize lactation consultants and educational videos as tools to assess

breastfeeding outcomes.

Comparison: Educational Video

Research articles by Kellams et al. (2016) and Huang, Yao, Liu, and Luo (2019) were

randomized controlled trials involving educational videos on breastfeeding in order to discover

breastfeeding initiation rates and exclusivity during the women’s stay in the hospital. The
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

research article by Kellams et al. (2016) found when an intervention including an educational

video was implemented, only fifty percent of the women demonstrated breastfeeding exclusivity.

The educational videos were found to offer less support to mothers in breastfeeding initiation,

but when paired with prenatal education and postpartum lactation support, breastfeeding

exclusivity rates increase (Huang, Yao, Liu, & Luo, 2019). 

Comparison: Lactation Consultant 

A key factor when assessing the efficacy of an intervention in a systematic review is

consistency in results. The crucial element of consistency is present in a review by Patel and

Patel (2016) which explores the effects of lactation counselors on breastfeeding initiation and

exclusivity in 14 studies. A similar review by Wood, Woods, Blackburn, and Sanders (2016)

explores the effects of breastfeeding interventions implemented by lactation consultants,

midwives, RNs, and physicians in six studies. Successful interventions included structured

counseling, education, and support programs. Any contact between lactation counselors and

study participants impacted breastfeeding rates, whether face-to-face, by telephone or video

(Patel & Patel, 2016). The studies utilize video education report much more inconsistency in

results, and the success of the interventions, measured by exclusivity and duration, do not

replicate the level of effectiveness seen with lactation counselors (Patel & Patel, 2016; Wood,

Woods, Blackburn, & Sanders, 2016). 

While the review by Patel and Patel (2016) provided clear positive results on

breastfeeding initiation and exclusivity, the overall evidence for the effects on breastfeeding

duration and infant and maternal outcomes was too limited to make any conclusions, partially

because the studies included in the systematic review varied in the degree to which the

researchers followed up with participants. Wood et al. (2016) include two studies with
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

participant follow-up as late as six months and one study with the last follow-up date at one year

postpartum. In the systematic review, studies assessed participants over a longer period of time,

breastfeeding exclusivity and duration decreased less over time when the interventions were

ongoing throughout observation (Wood et al., 2016). Breastfeeding support interventions used

professionals such as lactation consultants and lactation counselors increased the number of

women who initiated breastfeeding, improved any breastfeeding rates, and improved exclusive

breastfeeding rates consistently (Patel & Patel, 2016). Wood et al. (2016) found education about

milk sufficiency alone did not increase breastfeeding duration. Mother’s rely on cues from the

infant, primarily crying, to signal need, and the most effective interventions explored involved

education about infant cues (Wood et al, 2016). The success of breastfeeding intervention also

depends on timing. Wood et. al. (2016) found education is more effective when done before birth

and immediately following birth in the home setting. 

Recommendations for Evidence-Based Practice 

One recommendation found to help improve rates of initiation and duration of

breastfeeding was the use of lactation consultants or counselors in the hospital setting. In order

for nurses to take on the role of a lactation counselor, there is specific training registered nurses

can undergo. Nurses who are not specifically trained to be lactation counselors can still provide

adequate education to breastfeeding mothers. In labor and delivery and postpartum units,

lactation counselors can educate the registered nurses on breastfeeding education to be passed on

to the breastfeeding mothers. The use of lactation counselors enables breastfeeding mothers to

receive structured counseling, education, and support programs to enhance knowledge of

breastfeeding and to improve breastfeeding rates (Patel & Patel, 2016). The use of lactation

consultants and counselors to improve rates of initiation and duration of breastfeeding has been
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

supported by sufficient evidence and has been proven through level I evidence of the evidence

hierarchy. Within one supporting article, the search for literature included 16 separate studies

consisting of randomized control trials supporting the benefits of lactation consultants and

counselors (Patel & Patel, 2016). The other supporting article included six separate studies also

consisting of randomized controlled trials (Wood et al., 2016). With the use of lactation

counselors, education and encouragement is implemented in order to help women and families

meet breastfeeding goals. Educational sessions can occur within a formally structured setting

such as a prenatal breastfeeding workshop in the hospital or at an individual level given at the

hospital or via communication through technology (Patel & Patel, 2016). Lactation problems,

such as latch and positioning, can be managed to allow for the continuation of breastfeeding

(Patel & Patel, 2016).  Lactation counselors can also help new mothers understand infant

behavior. According to Wood et al. (2016), the cessation of breastfeeding is often due to the lack

of knowledge in the perception of infant behavior. Many women believe an infants’ cries relating

to hunger are due to a lack of milk supply when in reality the infant is upset because of unrelated

factors (Wood et al., 2016). Lactation consultants can educate mothers on normal infant behavior

and how to recognize common hunger cues. Lactation counselors can also provide support for

breastfeeding mothers throughout the role of motherhood. Support provided can be

psychological, physical, financial, or informational and can be given prenatally or after the baby

is born. Another recommendation suggested involving the use of lactation counselors is

providing follow-up appointments with postpartum mothers after leaving the hospital. Lactation

counselors could provide appointments within the hospital or via telephone to check in on

the mothers and answer any questions or concerns. Overall, the use of lactation counselors and

consultants has been proven beneficial by increasing the initiation and duration of breastfeeding
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

rates. The benefits of increased breastfeeding rates on the patient population consist of health

benefits and protective effects for both mothers and infants (Wood et al., 2016).

Another recommendation is the breastfeeding attrition prediction scale and the

breastfeeding knowledge scale/questionnaire given upon admission to improve the rates of

exclusivity in breastfeeding mothers (Huang et. al, 2019). The breastfeeding attrition prediction

scale, or BAPT, helps health care providers and nurses assess women’s knowledge on

breastfeeding, support, and confidence to predict if the mother will prematurely wean from

exclusively breastfeeding. The reliability of the results presented by Huang et. Al (2019) is

evidenced by the level II article; the quality of the evidence is shown through the research

methods. Identified benefits to the patient using the BAPT include increased maternal

knowledge, maternal satisfaction, and infant satisfaction. No risks have been identified with the

use of the BAPT. Multiple studies included health care provider’s and lactation nurse’s

recommendations to use BAPT as an efficient source to improve breastfeeding exclusivity. 

 The scale is split into three sections. The first section is a series of statements on

breastfeeding in which the mother has the option to agree, disagree, or neither agree nor disagree.

The mother’s answers are then tallied to see if the mother has positive breastfeeding knowledge

or negative breastfeeding knowledge. For example, one statement is, “breast milk is more

nutritious than infant formula,” and the mother will then choose to agree, neither agree nor

disagree, or disagree. 

The second section is based on what individuals in the mother’s life support

breastfeeding. Evidence shows a mother will be more likely to exclusively breastfeed if she is

supported by those around her, which includes socially (family/friends) and professionally

(doctors, nurses, etc.). The mother will fill in an answer with how a certain individual thinks she
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

should feed the infant. An example statement is, “the baby’s father thinks I should...,” and the

answer choices include feed formula, no opinion, feed breastmilk, and not applicable. 

The third and final section of the BAPT is focused on the perceived confidence the

mother either has or does not have in her breastfeeding capability. For the example, “I am

confident I can breastfeed,” the answer choices include, agree, neither agree nor disagree, or

disagree. Once the researcher has the results, individualized interventions are provided to the

breastfeeding mother. If the participant scores high on one section and low on another, the

researchers focus individualized education on the low scoring section. The women assessed with

the BAPT have shown evidence of a higher success rate in breastfeeding knowledge and

performance compared to those not assessed with the BAPT. 

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References

The Centers for Disease Control. (2021, February 22). Why it matters. Retrieved from

https://www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html

Huang, P., Yao, J., Liu, X., & Luo, B. (2019). Individualized intervention to improve rates of

exclusive breastfeeding: A randomized controlled trial. Medicine, 98(47), 1–7.

doi:10.1097/MD.0000000000017822

Kellams, A. L., Gurka, K. K., Hornsby, P. P., Drake, E., Riffon, M., Gellerson, D., Gulati, G., &

Coleman, V. (2016). The impact of a prenatal education video on rates of

breastfeeding initiation and exclusivity during the newborn hospital stay in a

low-income population. Journal of Human Lactation, 32(1), 152–159.

doi:10.1177/0890334415599402

Patel, S., & Patel, S. (2016). The effectiveness of lactation consultants and lactation

counselors on breastfeeding outcomes. Journal of Human Lactation: official journal of

International Lactation Consultant Association, 32(3), 530–541.

doi:10.1177/0890334415618668

Wong, K.L., Tarrant, M., Lok, K.Y.W. (2015). Group versus individual professional antenatal

breastfeeding education for extending breastfeeding duration and exclusivity: A

systematic review. Journal of Human Lactation, 31(3), 354-366.

doi:10.1177/0890334415583294

Wood, N.K., Woods, N. F., Blackburn, S. T., & Sanders, E. A. (2016). Interventions that

enhance breastfeeding initiation, duration, and exclusivity: A systematic review. MCN:

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The American Journal of Maternal/Child Nursing, 41(5), 299-307.

doi:10.1097/nmc.0000000000000264

Wouk, K., Tully, K. P., & Labbok, M. H. (2017). Systematic review of evidence for baby-

friendly hospital initiative step 3. Journal of Human Lactation, 33(1), 50-82.

doi:10.1177/0890334416679618
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Appendix A

• Article title & year Purpose of Description of the Major findings

published study or study or the review and findings
• Article authors with titles review relevant to your
(i.e., PhD, RN, MD) project.
• Name of journal Include statistics.
• Level of Evidence (I – VI) (May use bullet
points)
 Caroline Baehr  The aim of  This article is a  The primary
 Individualized this study is randomized outcome
intervention to improve to controlled trial showed the
rates of exclusive investigate that divides 352 rates of
breastfeeding, 2019 the women into two exclusive
 Pan Huang, MD, effectivenes groups. A breast
Jianrong Yao, MD, s of lactation feeding from
Xinghui Liu, PhD, Biru individualiz consultant discharge to
Luo, PhD ed recruited women 4 months
 Medicine intervention from the was higher in
 Level II compared obstetric group 2
with routine admission office, (intervention
care in these women group).
improving were over 18  At discharge,
rates of years old with a 43.2% of
exclusive gestation of women that
breast greater than 34 received
feeding. weeks. High risk individual
women, women breastfeeding
with multiple education
pregnancies, and and postnatal
women with lactation
contraindications support were
for breastfeeding exclusively
were excluded. breastfeeding
The first group , whereas
received routine 30% of
care, the second women who
group is received
provided routine care
individual group were
antenatal exclusively
breastfeeding breastfeeding
education and .
postnatal  At 4 months,
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

lactation 70.9% of
support. This women in
study compares group 2 were
the rate of exclusively
breastfeeding breastfeeding
exclusivity compared
between the with 46.2%
groups at in group 1.
discharge and 4  The
months secondary
postpartum. outcomes
Group 1 was the measured
control group that at
given routine discharge,
care in 95.1% of
accordance with women in
the requirements group 2 were
of Baby-Friendly breastfeeding
Hospital. This on demand
included, a 30- compared
minute antenatal with 68.1%
breastfeeding in group 2.
educational  At 4 months,
video and after 94.6% of
delivery they women in
received group 2 were
postnatal visits breastfeeding
by a lactation on demand
consultant and compared to
printed guides 75%.9 in
on breastfeeding group 2.
at discharge.  Women in
Group 2 was the the
intervention intervention
group given group
individual care reported
by a researcher lower
who used the incidence of
breastfeeding cracked
attrition nipples,
prediction scale higher
and maternal
breastfeeding satisfaction
knowledge scale of
to provide breastfeeding
individualized , and a
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

intervention. The higher

researchers gave understandin
monthly follow g of
ups up to 4 breastfeeding
months via knowledge.
telephone. They
also received
routine care. The
primary outcome
measured is
breastfeeding
exclusivity
which is defined
as an infant only
given breast
milk, no water or
formula.
Secondary
outcomes
included
breastfeeding
behavior (on-
demand
lactation,
maternal cracked
nipple, maternal
and baby
satisfaction, and
breastfeeding
knowledge).Wo
men provided
with antenatal
education and
postnatal
lactation support
have higher rates
of exclusively
breastfeeding
from discharge
to 4 months
postpartum.

Meghan Reed  “To A) Study design  This article

 Article Title: The determine This study was is relevant to
Impact of a Prenatal whether a designed as a my project
Education Video on low-cost randomized, because the
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

Rates of Breastfeeding prenatal control trial with intervention

Initiation and education intervention. of our PICO
Exclusivity during the video There was a question is
Newborn Hospital Stay improves control group informationa
in a Low-income hospital (video on l materials
Population rates of nutrition) and an (videos,
 Year Published: 2016 breastfeedin intervention pamphlets,
 Article Authors: Ann g initiation group (video on etc.). This
L. Kellams, MD, Kelly and breastfeeding). article
K. Gurka, MPH, PhD, exclusivity B) Target addresses the
Paige P. Hornsby, PhD, in a low- population video aspect.
Emily Drake, RN, income • The target The overall
PhD, Mark Riffon, population. population conclusion of
MPH, Daphne ” was low- this RCT is
Gellerson, Gauri income, that a video,
Gulati, MD, and English alone, is not
Valerie Coleman, RN, speaking effective in
MSN women. The improving
women had rates of
 Name of Journal: to have breastfeeding
Journal of Human qualified for initiation and
Lactation WIC to be exclusivity in
eligible. the hospital.
 Level of Evidence: Qualifying The study
Level 2- Randomized, for WIC says that
controlled trial means that approx. 70%
the woman of women in
needed to both groups
have an started
income of breastfeeding
185% or less while in the
of the federal hospital. 174
poverty women in
income the
guidelines. intervention
Also, the group began
women breastfeeding
needed to be and 172
between 24- women in
41 weeks’ the control
gestation. group began
• Exclusions: breastfeeding
multiple . This
gestation, statistic
contraindicati means that
ons to the video on
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

breastfeeding breastfeeding
did not have
a significant
effect over
C) Sampling the control
method and size video. Of
• 2 study sites those women
were used. who started
• The sampling breastfeeding
method was , 84 women
that women in each
were group
approached demonstrated
in the exclusivity in
prenatal regard to
clinic waiting breastfeeding
area. Once . This is
the study was approx. 50%
explained and of each
consent was group of
received, data women who
was collected began
from the breastfeeding
women. demonstrated
Women were exclusivity.
randomly put
into either the
intervention
or the control
group.
• 2875 charts
were
reviewed,
1580 women
were eligible
based on the
criteria, 522
women
enrolled.
• The
intervention
group
contained
249 women,
and the
control group
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

contained
248 women.
D) Description of
methods/interven
tions (if any)
• The
intervention
used was a
25-minute
video that
focused on
breast
feeding. “The
intervention
video
provided
general
information
about
breastfeeding
, including
importance,
latch, hunger
cues,
positioning,
sore nipples,
engorgement,
how breast
milk is made,
and lifestyle
issues.”
E) Instruments used
• Intervention=
breastfeeding
video
• Control
group=
prenatal
nutrition and
exercise
video
F) Outcomes
measured
• Multivariable
analyses were
used to
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

compare
breastfeeding
initiation
rates and
exclusivity
during the
women’s stay
in the
hospital
 Katie Hydrick  The objective A. Type of Review:  Breastfeedin
 The Effectiveness of of this review Systematic Review g support
Lactation Consultants and was to assess if of Randomized interventions
Lactation Counselors on lactation Control Trials that used
Breastfeeding Outcomes, education or B. Target Population: professionals
2015 support Pregnant Women such as
 Sanjay Patel, MD’ and programs using and New Mothers lactation
Shveta Patel, RN, BSN, lactation C. Describe the consultants
IBCLC consultants or process of how the and lactation
 Journal of Human lactation authors identified counselors
Lactation counselors articles to be increased the
 Level 1 on the Evidence would increase included in the number of
Hierarchy rates of review and how women who
initiation and many articles were initiated
duration of any included breastfeeding
breastfeeding  English , improved
and exclusive language any
breastfeeding studies breastfeeding
compared with conducted in rates, and
usual practice. developed improved
countries were exclusive
included. breastfeeding
 Included studies rates.
that looked at Interventions
the use of that were
IBCLCs, CLCs, used for this
lactation success
consultants, or included
lactation structured
counselors to counseling,
affect education,
breastfeeding and support
outcomes. programs.
 The search for Support for
literature to be these
included mothers was
resulted in 44 psychologica
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

full text reports l, physical,

being assessed. financial,
The net search and
corresponded informationa
with 16 separate l. Studies
studies. also looked
D. Describe the study at the
designs for the different
articles included in kinds of
the review presentation
 They for the
considered all support
randomized groups.
controlled trials Many
that were focused on
completed face-to-face
between methods that
January 1985 were
and January delivered in
2014. a hospital or
E. Instruments used to clinic setting,
conduct the review while some
 Joanna Biggs focused on
Institute Data telephone or
Extraction video contact
Form for that could be
Experimental initiated at
and home. All of
Observational these
Studies. components
F. Outcomes together
Measured helped to
 The primary keep the
outcomes that mothers
were measured involved in
in the review breastfeeding
included: and
breastfeeding contributed
initiation rates, to the
breastfeeding increase in
duration, any rates of
breastfeeding breastfeeding
rates, and women.
exclusive  The odds
breastfeeding ratio for any
rates. initiation
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

 The secondary versus not

outcomes that initiating
were measured breast
in the review feeding was
included: infant 1.35 with a
health outcomes 95% CI of
and maternal 1.10 to 1.67.
health outcomes  Any
breastfeedin
g and
exclusive
breastfeedin
g duration
have a
beneficial
effect with
increased
median and
mean
duration.
 The odds
ratio for any
breastfeedin
g versus not
breastfeedin
g was 1.76
with a 95%
CI of 1.20
to 2.57.
 For
exclusive
breastfeedin
g up to 1
month, the
odds ratio
of exclusive
breastfeedin
g versus not
breastfeedin
g was 1.71
with a 95%
CI of 1.20
to 2.44.
 For
exclusive
breastfeedin
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

g between 1
month and
up to 3
months, the
odds ratio
of exclusive
breastfeedin
g versus not
exclusive
breastfeedin
g was 1.80
with a 95%
CI of 1.14
to 2.83.
 Overall, the
results of
the study
were
consistent
and showed
that the use
of lactation
counselors
and
consultants
increased
the number
of women
initiating
breastfeedin
g as well as
increased
the number
of overall
breastfeedin
g rates and
improved
exclusive
breastfeedin
g rates. The
overall
evidence for
the effects
on
breastfeedin
g duration
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LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

and infant
and
maternal
outcomes
was too
limited to
make any
conclusions
although
their
intervention
s seemed to
have a
beneficial
effect.
 Bailey Dickerson  Compare the A.  Exclusive
effectiveness  Systematic breastfeeding
 Group versus of group and review is
Individual Professional individual B. recommende
prenatal  Target d until 6
Antenatal
education on
Breastfeeding population: months of
exclusivity
Education for and duration antenatal women age
Extending of C. according to
Breastfeeding Duration breastfeeding  The authors did WHO
and Exclusivity: A a systematic  Duration and
Systematic Review & search of exclusivity
2015 literature using rates are still
Medline, unsatisfactor
 Ka Lun Wong, RN, PubMed, the y compared
BNurs, Marie Tarrant, Cumulative to the
RN, MPH, PhD, and Index to Nursing increasing
Kris Yuet Wan Lok, and Allied breast-
PhD Health feeding rates
Literature,  In places
 Journal of Human EMBASE, with high
Lactation British Nursing rates of
Index, Google initiating
 Level I Scholar, and breast
Cochrane feeding,
Library. The education
search was interventions
limited to are shown to
education for be more
pregnant women effective in
given by increasing
healthcare duration and
24
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

professionals exclusivity.
only  Face-to-face
 Included studies education is
only on duration more
and exclusivity effective
of breastfeeding than over the
 The authors also phone.
looked at  In low to
reference lists of middle
each article that income
was reviewed counties and
 Group education minorities,
was included in peer support
the search as is more
well effective
 There were than
nineteen articles professional
included support for
 Thirteen articles breastfeeding
on antenatal rates.
group education  A better
 Five articles on outcome is
antenatal achieved if
individual the education
education begins earlier
 One article on or is of
both group and longer
individual duration.
D.  The
 The systematic assessment is
review included negatively
randomized affected by
control trials, the
cluster heterogeneou
randomized s
control trial, and interventions
quasi- .
experimental.  It is difficult
E. to determine
 Literature search the best time
used PRISMA to enact the
guidelines and interventions
comprehensive .
search strategies  Education in
 Inclusion a group and
individual
25
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

criteria: English, setting are

pregnant the occur
women, most often to
professional promote
antenatal breast
education feeding.
without  The majority
intrapartum, of the studies
postpartum, or came to the
peer components conclusion
F. that antenatal
 The outcomes education
measured were only effected
duration of outcomes of
breastfeeding or breastfeeding
duration of within the
exclusive first 3
breastfeeding months after
 Exclusive is birth.
when they only  Two studies
receive breast came to the
milk as conclusion
nourishment that there
was no
difference in
effectiveness
between
nurse-led or
peer-led
education
classes.
 Four out of
six studies
(67%) that
focused on
the
difference
between
standard care
and
individual
antenatal
education
had drastic
improvement
in exclusive
26
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

breast-
feeding rates
with
individual
education.
These four
studies used
individual
education
with
education
materials
compared to
standard care
or individual
without
materials.
There was an
increase at
six weeks,
three
months, and
six months.
 33% of
articles
studied
found that
group
education
increased
“full” or
regular
breast-
feeding rates.
These studies
compared
group
education
with or
without
materials to
standard
care.
The systematic
review concludes
that there needs to
 27
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

be further higher
quality trials with
larger sample sizes
to make a firm
conclusion on what
mode of education if
more effective on
exclusive
breastfeeding rates.
 Emily Claire Herring  “The purpose A) Type of review  The most
 Wood, N.K., Woods, N. F., of this review The systematic review common
Blackburn, S. T., & was to evaluate considered 6 cause of
Sanders, E. A. (2016). breastfeeding randomized control breastfeeding
Interventions that enhance interventions trials. Systematic [BF]
breastfeeding initiation, trialed to date reviews synthesize termination
duration, and exclusivity: and recommend relevant information is when
A systematic review. directions for from peer reviewed mother’s
MCN: The American future needs in studies within a specific think their
Journal of Maternal/Child breastfeeding topic. In this review, the milk
Nursing, 41(5), 299-307. research.” topic was breastfeeding production is
doi:10.1097/nmc.0000000 initiation, duration, and not enough
000000264 exclusivity. Three of the for the baby. 
included studies  Education
 Interventions that Enhance evaluated a prenatal about milk
Breastfeeding Initiation, population and the sufficiency
Duration, and Exclusivity: second group of three alone is not
A Systematic Review, studies evaluated helpful to
September/October 2016 postpartum women as increase BF
the population. duration.
 Natsuko K. Wood, PhD, B) Target population Mother’s
RN, Nancy F. Woods, The target population in rely on cues
PhD, RN, FAAN, Susan T. the review was from the
Blackburn, PhD, RN, breastfeeding women. infant,
FAAN, Elizabeth A. The first three studies primarily
Sanders, PhD considered used a crying, to
 MCN: The American longitudinal design with signal need.
Journal of Maternal/Child intervention occurring The most
Nursing during the prenatal effective
 Level I: Systematic review period and follow-up intervention
of all relevant RCTs. A data collection in the involves
total of 6 studies were first weeks to months education
included in this systematic postpartum. The second about infant
review. three studies considered cues.
were also longitudinal in  It is unclear
design but intervention how
and follow-up impactful
28
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

assessment occurred follow-up

during the postpartum sessions
period. during the
C) Describe postpartum
the process of period
how the impact BF
authors duration.
identified This is an
articles to be area for
included in future
the review exploration.  
(i.e., search  The
techniques) interventions
and how trialed for
many articles prenatal
were women
included included
The inclusion criteria educational
for the 6 studies workshops in
considered in the review both hospital
was based on primary or and
secondary outcomes that midwifery
evaluated breastfeeding clinic
exclusivity, duration, settings,
self-efficacy, and self- counseling,
reported difficulties. and usual
The research team care. The
conducted a search intervention
across three online in all of these
databases: PubMed, studies
CINAHL, and occurred
PsycINFO. A total of only once, in
261 studies were found the form of a
with the search criteria workshop led
(“breastfeeding, feeding by midwives,
behavior, nurses or
prenatal/patient lactation
education, health consultants. 
promotion, social  The first
support, prenatal
perinatal/prenatal/intrap study by
artum/postnatal care, Mattar et al.
and postpartum found that at
period”). Studies with 3 and 6
immunocompromised months
participants (HIV- postpartum,
29
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

positive status), exclusive BF

adolescent mothers, was more
mothers with a history common in
of drug abuse, studies the group
published in a language that received
other than English, and BF education
studies where the and
primary intervention counseling
took place immediately than in the
postpartum in the group that
hospital were excluded. received
The final review standard care
evaluated 6 studies only (2007).
D) Describe the study In the group
design(s) for the that received
articles included in the BF education
review and
The 6 studies included counseling,
in the review are the odds
randomized control ratio for BF
trials or clinical trials education
with a longitudinal and
method for data counseling/
collection. Data was BF
exclusivity
collected at several time
was 2.6 at 3
points in each of the 6
months
studies. One study postpartum
stopped evaluating and 2.4  at 6
participants at 4 weeks months
postpartum, while the postpartum.
longest follow-up In this study,
evaluated participants the 6 week
at 1 year postpartum. follow-up
E) Instruments used to was the most
conduct the review frequent time
The 6 studies used that mothers
guided response surveys reported BF
and structured cessation or
interviews to collect cessation of
baseline and follow-up BF
data. One study utilized exclusivity.
structured observation  The second
in the immediate prenatal
postpartum day and study
moved to structured explored the
30
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

interviews and surveys effects of a 2

for further follow up. hour
The review evaluated midwife
each study by number education
and type of participants, workshop
study objective, primary versus a
and secondary/tertiary control
outcome. Each study
group that
was also evaluated
received no
based upon the
providers of the workshop.
experimental The results
intervention (lactation for BF
counselor, midwife, RN, concerns
physician, etc.), factors and BF rate
included in the were not
intervention significantly
(knowledge, skills, different
emotional support, etc.), when the
number of experimental groups were
intervention sessions, evaluated at
timing of the 6 weeks
intervention, and timing postpartum
of follow-ups. Only 4 of (Kronborg et
the 6 studies reported
al., 2012).
fidelity.
 The final
study with a
prenatal
intervention
evaluated BF
confidence
or “self-
efficacy” and
BF duration
at 4 and 8
weeks. There
was no
difference
between the
control group
and the
experimental
group (BF
workshop) in
BF duration.
31
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

While the
experimental
group
reported
greater BF
self-efficacy
at 4 weeks,
there was no
significant
difference
between
experimental
and control
groups at 8
weeks (Noel-
Weiss et al.,
2006).
 The
interventions
trialed for
postpartum
women
included
comparison
of Baby-
Friendly
Hospital
initiatives
alone with
Baby-
Friendly
Hospital
initiatives
and
additional
education in
the home
setting. The
other two
studies
evaluate the
effects of RN
education in
the home
32
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

setting and
physician
education in
an
outpatient
setting
respectively.
 The first
study that
examined
postpartum
BF
interventions
compared BF
exclusivity in
one group
discharged
from a Baby-
Friendly
Hospital to
BF
exclusivity in
the
experimental
group to
whom 10
additional
one on one
BF support
sessions
were
provided in a
home setting
(Coutinho et
al., 2005). Of
the studies
included in
the review,
this
intervention
was the
longest and
most
33
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

personalized
to
participants,
however, in
the
experimental
group BF
exclusivity
dropped to
15% at the
one month
postpartum
follow-up
from 70% at
discharge
from the
hospital.
 The second
postpartum
study
evaluated
1,597
mothers in
two groups.
Both groups
received
home visits
from nurses
during the
initial
postpartum
period, and
the
experimental
group was
given an
additional
booklet as
well as
targeted BF
education
during the
home visits.
34
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

The
experimental
group had
higher BF
confidence
and
duration; the
control
group had a
hazard ratio
of 0.86 with
a confidence
interval of
95%
(Kronborg et
al., 2007).
 The final
postpartum
study
explored the
effect of
physician
counseling
on BF
exclusivity,
duration, and
difficulty
compared to
usual care in
postpartum
women. At 4
weeks
postpartum,
the hazard
ratio for the
experimental
group
(physician
counseling)
compared to
the control
group was
1.17 for BF
exclusivity,
1.40 for BF
 35
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

duration, and
0.76 for BF
difficulties
(Labarere et
al., 2005).
 The success
of BF
intervention
depends on
timing.
Education is
more
effective
when done
before birth
and
immediately
following
birth in the
home
setting. 
 Anna Hall  Informing  Type of Review:  Findings of
 Title: Systematic pregnant Systematic Prenatal
Review of Evidence for women Review of Interventions
Baby-Friendly Hospital about the Evidence Combined
Initiative Step 3: benefits and  Target with
Prenatal Breastfeeding managemen Population: Intrapartum
Education t of Pregnant women or
 Published: 2017 breastfeedin  Process of Postpartum
 Authors: Kathryn g. Also, to Identification: Support: Of
Wouk, MS, Kristin P. determine Records the 15
Tully, PhD, Miriam H. which identified studies that
Labbok, MD, MPH, increases through database focused on
FACPM, FABM, breastfeedin searching breastfeeding
IBCLC g initiation, (n=1369)Addi initiation, 8
 Journal: Journal of duration, tional records of them
Human Lactation and identified statistically
 Level of Evidence: I exclusivity; through other found a
prenatal sources (n=5) significant
clinic Records after effect on
education duplicates initiation
intervention removed  Of the 15
s or (n=1329) studies that
hospital- Abstracts focused on
based screened for breastfeeding
education duration, 7
36
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

intervention eligibility found a

s. (n=1329) Full intervention
text articles effective
assessed for  Of the 13
eligibility (n=73) studies that
Studies focused on
included in breastfeeding
systematic exclusivity, 9
review (n=38). found an
 Study Design: increase on
Bibliographies exclusivity
of relevant outcomes
systematic  Prenatal
reviews were Interventions
used to find : 5 out of the
potential studies. 10 studies
Randomized that focused
controlled trials on
and experimental breastfeeding
studies were initiation
included. interventions
 Instruments in the
Used: PRISMA prenatal
guidelines, period found
MEDLINE, significant
CINAHL, increase in
screened breastfeeding
bibliographies of initiation
relevant  2 out of the
systematic 10 studies
reviews that focused
 Background: on
The authors breastfeeding
engaged in The duration
Ten Steps to found an
Successful increase in
Breastfeeding, duration
which was  6 out of the
enacted by the 12 studies
World Health that focused
Organization on
(WHO) and the breastfeeding
United Nations exclusivity
International showed a
Children’s significant
Emergency Fund increase
37
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

(UNICEF). The
Ten Steps to
Successful
Breastfeeding
outlines the best
maternal
practices to
support
breastfeeding
and is the
backbone behind
the Baby-
Friendly
Hospital
Initiative. The
authors looked
into this outline
and focused on
Step 3 of the Ten
Steps, which is
about informing
pregnant women
about the
benefits of and
management of
breastfeeding.
The authors
wanted to find
out whether
prenatal clinic
breastfeeding
education or
hospital-based
education would
be better for
mothers’
initiation to
breastfeed, the
duration, or the
exclusivity. The
authors defined
breastfeeding
initiation to be
determined at
hospital
discharge or
38
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

within two
weeks of
delivery.
Breastfeeding
duration was
determined by
any
breastfeeding
continued after
at least two
weeks
postpartum.
Exclusivity to
breastfeeding
was determined
by study
definitions. To
determine which
intervention
would be best,
the authors
conducted a
systematic
review of
evidence by
finding peer-
reviewed
manuscripts
published in
English by
developed or
developing
countries
between January
1, 2000 and May
5, 2016 from the
electronic
databases
MEDLINE and
CINAHL. The
authors also
screened
bibliographies
for potential
studies. Thirty-
eight studies
39
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

were found, and

they were either
randomized
controlled trials
or quasi-
experimental
studies. Each
study focused on
either a prenatal
education
intervention or a
hospital-based
education
intervention to
find the results
on how it effects
the initiation,
duration,
exclusivity of
breastfeeding.
 Outcomes
Measured: The
authors found
that prenatal
education that
includes both
informational
material and
interpersonal
support
significantly
positivity
impacts the
initiation,
duration, and
exclusivity of
breastfeeding.
The best format
would be home
visits and
individual or
group sessions at
prenatal clinics.
The authors also
found that not
knowing the
40
LACTATION CONSULTANTS VERSUS INFORMATION MATERIALS

breastfeeding
intentions of the
participants’ in
the studies
limited the
comparability of
the inventions in
the review. The
authors also
noted how
research could
have been
improved if they
assessed the role
of family
members
compared to the
health providers,
and time and
cost associated
with different
interventions on
the effect of
breastfeeding
outcomes.