LMIC, low middle income country; LIC, low income country; IG, intervention group; CG, control group; RCTs, randomized controlled trials; ANC, antenatal care; PNC, postnatal care; LC, lactation consultation; SC, standard care; BF, breastfeeding; EIBF, early initiation of breastfeeding; EBF, exclusive breastfeeding; CHEI, community health educational intervention; HCP, health care professionals; CHW, community health workers; VHW, village health workers; KMC, kangaroo mother care; HCW, health care workers; TCC, targeted client communication; HBC, health behavior change; CBIP, community based intervention packages; ANM, ancillary nurse-midwives; LHW, lady health workers; TBA, traditional birth attendants; NR, not reported.
Six of the included SRs contributed data for analysis and reported interventions to promote breastfeeding practices. Lumbiganon et al. ( 43 ), conducted an SR on women attending monthly microcredit meetings. Pregnant women, mothers of neonates, women in their reproductive age, mothers in their postpartum period, partners/spouses, or family members exclusively or mostly from LMICs or LICs were all the recipients of the BF interventions in four included SRs ( 42 , 50 , 54 , 55 ). In addition, Abdulwadud et al. ( 49 ) performed an SR that targeted women in their full-time or part-time employment in both the commercial and public sectors who were returning to paid work following maternity break. Two of the six SRs ( 50 , 54 ) included participants mainly from LMIC or LIC, the other three SRs ( 42 , 43 , 55 ) included participants from a range of low to high-income countries although we retrieved the data solely from LIC/LMIC. Whereas, one of the SR ( 49 ) did not include any study. The number of participants included in the SRs ranged from 390 to 1,26,375. In the included SRs, participants were recruited from antenatal and/or postnatal phases. Four of the included SRs acknowledged the duration of the intervention ( 42 , 50 , 54 , 55 ). The other two SRs, on the other hand, did not specify the duration ( 49 , 51 ).
All SRs included in this overview had interventions aimed at optimizing and promoting BF practices, five SRs ( 42 , 43 , 50 , 54 , 55 ) evaluated the effect of educational interventions, and one SR ( 49 ) addressed support interventions for BF practices (including physical facilities, lactation breaks, creches, and nurseries). BF Interventions in the included SRs were delivered by personnel from government, non-governmental, and private organizations ( 54 ), health system or health workers ( 55 ), non-healthcare professionals (women's group peer counselors) ( 42 ), and female ancillary nurse midwives (ANMs) ( 50 ). Two of the included SRs ( 43 , 49 ) did not provide any information regarding the personnel who delivered the BF interventions.
Lumbiganon et al. ( 43 ) conducted a review on BF interventions which included weekly cell phone BF text and voice messages to cell phone and monthly face-to-face BF information delivered to women attending monthly microcredit meetings ( 43 ). Another review conducted by Lassi et al. ( 54 ), focussed on Community Health Education Interventions (CHEI) based on maternal and child health such as group counseling, one-to-one counseling, mass media (television, radio, cellular messages, brochures, newspaper, banners, etc.) or any combination of the above methods delivered to mothers or family members by the government, non-governmental organizations, and private providers. Palmer et al. ( 55 ) conducted an SR in both HICs and LICs settings and addressed Targeted Client Communication (TCC) via mobile devices delivered to pregnant women and parents of young children by the health system or health workers. An SR conducted by Balogun et al. ( 42 ) addressed any intervention such as BF education and support that promotes BF practices such as EIBF and EBF, delivered to pregnant women and reproductive age group women by women's group peer counselors. Lassi and Bhutta ( 50 ) promoted additional training (including lectures supervised hands-on training) of community midwives, lady health workers or visitors, community or village health workers, traditional birth attendants (TBAs), or facilitators in maternal care during pregnancy, delivery, and the postpartum period offered to pregnant and women of reproductive age by Auxillary nurse midwives (ANMs) from local government and non-government organizations. According to Abdulwadud and Snow ( 49 ), any form of workplace approach to promote, support, and assist BF practices for women returning to work after maternity leave is considered as workplace intervention. This SR, on the other hand, found no studies on workplace interventions to support BF.
Four of the six included SRs ( 42 , 43 , 50 , 54 ) included comparison groups that were either standard or routine care whereas one SR ( 55 ) had comparison groups both as standard care and another type of intervention which includes TCC with non-digital communication (face-to-face communication, pamphlets, letters). And one SR ( 49 ) had two or more workplace interventions compared against each other or no intervention.
All six included SRs evaluated the impact of BF interventions on BF practices such as EIBF, EBF, and continued BF up to 2 years of age. Included SRs reported only two of the primary outcomes, EIBF and/or EBF in this overview. The third primary outcome i.e., continued BF up to 2 years of age as well as secondary outcomes such as acceptability and satisfaction were not assessed in any of the included SRs. The results were evaluated using two major comparisons groups: BF intervention against routine care and one type of BF intervention vs. other types of BF intervention. Four SRs ( 42 , 43 , 50 , 54 ) assessed the effect of interventions on EIBF whereas two SRs ( 43 , 55 ) evaluated the effect of interventions on EBF in BF intervention vs. routine care comparison group. Only one SR ( 55 ) reported EBF in another group i.e., one BF intervention vs. another form of BF intervention comparison group.
We retrieved relevant outcomes (reported as events and population size as well as RR) and categorized them for analysis based on the results mentioned below in Tables 2 , ,3 3 .
Findings of included studies.
EIBF (early Initiation of breastfeeding) | ( ) | : 1 cluster-randomized trial (LMIC) : 390 | RR = 1.44 (95% CI = 1.06, 1.97) = 23.3% | High | NR | Insufficient evidence to suggest that any antenatal BF education was found to be more effective than standard care for improving EIBF |
( ) | : 11 RCTs : 72,464 | RR = 1.93 (95% CI = 1.55–2.39) = 98% | NR | NR | CBIP were found to be significantly effective in improving maternal and neonatal health | |
( ) | : 19 RCTs : 1,26,375 | : 100%RR = 1.56, (95% CI =1.37–1.77) = 99% | NR | NR | CHEI was found to be significantly effective for improving BF practices when given to mothers and other family members | |
( ) | : 3 RCTs : Total: 2,066 IG: 1,064 CG: 1,002 | RR = 1.7 (95% CI = 0.98–2.95) = 78% | Low | NR | BF interventions provided by non-healthcare professionals reported improvements in EIBF rates but the result was not statistically significant | |
EBF (exclusive breast feeding) | ( ) | : 1 cluster-randomized trial (LMIC) : 390 | RR = 1.21 (95% CI = 0.91–1.61) RR = 1.47 (95% CI = 1.06, 2.05) | Moderate | NR | Insufficient evidence to suggest that any antenatal BF education was found to be more effective than standard care for improving EBF at 3 or 6 months |
( ) | : 1 RCT : 40 | RR = 0.92 (95% CI = 0.79–1.08) | Low | All women in the control group exclusively breastfed their babies | The intervention provided no significant improvement in BF practices as 100% of women reported EBF to their babies. | |
Continue BF for 2 years | None of the SRs reported this outcome. | NR | NR | NR | NR | None of the SRs had assessed these parameters. Therefore, SR needs to be conducted considering these parameters. |
Acceptability | None of the SRs reported this outcome. | NR | NR | NR | None of the SRs had assessed these parameters. Therefore, SR needs to be conducted considering these parameters. | |
Satisfaction | None of the SRs reported this outcome. | NR | NR | NR | None of the SRs had assessed these parameters. Therefore, SR needs to be conducted considering these parameters. |
Comparison 1: BF intervention vs. routine care. NR, not reported.
EIBF | None of the SRs reported this outcome. | NR | NR | NR | None of the SRs had assessed these parameters. Therefore, SR needs to be conducted considering these parameters. |
EBF | ( ) | 1 RCT 42 participants | RR = 0.92 (95% CI = 0.79–1.07) | Low | Insignificant improvements were reported in BF practices in the TCC mobile devices group compared to non-digital TCC as 100% of women exclusively breastfed their babies. |
Continue BF for 2 years | None of the SRs reported this outcome. | NR | NR | NR | None of the SRs had assessed these parameters. Therefore, SR needs to be conducted considering these parameters. |
Accepatability | None of the SRs reported this outcome. | NR | NR | NR | None of the SRs had assessed these parameters. Therefore, SR needs to be conducted considering these parameters. |
Satisfaction | None of the SRs reported this outcome. | NR | NR | NR | None of the SRs had assessed these parameters. Therefore, SR needs to be conducted considering these parameters. |
Comparison 2: One BF intervention vs. other intervention. NR, not reported.
We excluded 16 SRs ( 56 – 71 ) from this overview following the screening of full texts articles. The most common reasons for exclusion were unrelated interventions and population. Of the 16 excluded SRs, seven SRs ( 56 – 62 ) did not focus on the interventions intended to promote BF practices, six SRs ( 63 – 68 ) did not target the population of interest, two SRs ( 69 , 70 ) did not specify the population and one SR had no subgroup analysis for LMICs/LICs population ( 71 ). We presented the list of excluded studies in Table 4 .
List of excluded studies with reasons.
Kramer and Kakuma ( ) | Optimal duration of exclusive breastfeeding | Low birth weight babies Interventions not related to BF |
Ndikom et al. ( ) | Extra fluids for breastfeeding mothers for increasing milk production | Interventions not related to BF |
Bryanton et al. ( ) | Postnatal parental education for optimizing infant general health and parental infant relationships | Population from HIC |
Fair et al. ( ) | Interventions for supporting the initiation and continuation of breastfeeding among women who are overweight or obese | Population from HIC |
McFadden et al. ( ) | Support for healthy breastfeeding mothers with healthy term babies | No segregated data from HIC and LIC |
Lewin et al. ( ) | Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases | Interventions not related to BF |
Gagnon and Sandall ( ) | Individual or group antenatal education for childbirth or parenthood, or both | Population from HIC |
Sandall et al. ( ) | Midwife-led continuity models vs. other models of care for childbearing women | Population from HIC |
Barlow et al. ( ) | Individual and group based parenting programmes for improving psychosocial outcomes for teenage parents and their children | Population from HIC |
Becker et al. ( ) | Methods of milk expression for lactating women | Interventions not related to BF |
Opiyo and English ( ) | In-service training for health professionals to improve care of seriously ill newborns and children in low-income countries | Interventions not related to BF |
Pantoja et al. ( ) | Implementation strategies for health systems in low-income countries: an overview of systematic reviews | Intervention not related to BF |
Ciapponi et al. ( ) | Delivery arrangements for health systems in low-income countries: an overview of systematic reviews | Intervention not related to BF |
Jaafar et al. ( ) | Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding | Population from HIC |
Jaafar et al. ( ) | Rooming-in for new mother and infant vs. separate care for increasing the duration of breastfeeding | Population not specified |
Lee and Thomas ( ) | Antenatal breast examination for promoting breastfeeding | Population not specified |
The R-AMSTAR grading system was developed to evaluate the procedures employed in Cochrane reviews. All Cochrane reviews followed a general protocol outlining procedures, five of the six included reviews had a high score, while one included SR ( 49 ) had a low score. R-AMSTAR ratings for each Cochrane systematic review—Breastfeeding (BF) interventions—( Table 5 ).
Methodological quality of included studies.
) | ) | ) | ) | ) | ) | ||
---|---|---|---|---|---|---|---|
1. | Was an “a priori” design provided? | 4 | 4 | 4 | 4 | 4 | 4 |
2. | Was there duplicate study selection and data extraction? | 4 | 4 | 4 (one author extract and other cross-checked) | 4 | 4 | 4 |
3. | Was a comprehensive literature search performed? | 4 | 4 | 4 | 4 | 4 | 4 |
4. | Was the status of publication (i.e., gray literature) used as an inclusion criterion? | 4 | 4 | 4 | 4 | 4 | 4 |
5. | Was a list of studies (included and excluded) provided? | 4 | 4 | 4 | 4 | 4 | 1 (no included studies) |
6. | Were the characteristics of the included studies provided? | 3 | 4 | 4 | 3 (data is not complete and accurate) | 4 | 1 (no included studies) |
7. | Was the scientific quality of the included studies assessed and documented? | 4 | 4 | 4 | 4 | 3 | 1 (no included studies) |
8. | Was the scientific quality of the included studies used appropriately in formulating conclusions? | 2 | 2 | 4 | 3 | 4 | 1 (no included studies) |
9. | Were the methods used to combine the findings of studies appropriate? | 4 | 4 | 4 | 3 | 4 | 1 (no included studies) |
10. | Was the likelihood of publication bias assessed? | 3 | 3 | 3 | 3 | 3 | 1 (no included studies) |
11. | Was the conflict of interest included? | 3 | 4 | 3 | 3 | 3 | 3 |
39 | 41 | 42 | 39 | 41 | 25 |
All six SRs ( 42 , 43 , 49 , 50 , 54 , 55 ) had provided a “a priori” design, and data was retrieved by two authors who independently searched and selected studies. All SRs had mentioned the type of publication (published, unpublished, gray literature). Only one SR ( 49 ) did not meet the criteria since there were no included studies. Five of the six included SRs provided the list of included and excluded studies. In presenting characteristics of included studies, three SRs ( 50 , 54 , 55 ) scored four ratings, two SRs ( 42 , 43 ) scored three ratings and one ( 49 ) scored one rating (since this SR did not include any study). Five of the included SRs also evaluated the scientific quality of included studies and described statistical methods used to combine findings of included studies. There were no publication biases and conflicts of interest reported in any of the six SRs. All included SRs scored high ratings except for one ( 49 ) as this SR did not include any study. All included five SRs ( 42 , 43 , 50 , 54 , 55 ) were of high quality.
We summarized the key findings of all six included SRs in Tables 2 , ,3 3 .
These findings provided a summary of the reported effects as well as the degree of certainty of the evidence for each intervention. We have presented the outcomes for all interventions for which independent data were available in two primary comparison groups
None of the included SRs reported the results for both types of comparisons. Included SRs compared the intervention with standard/routine care or with other interventions.
We organized the overall number of studies and a total number of participants randomized for each included SR. We also presented the number of studies and numbers of women randomized to each comparison group.
Comparison 1: bf intervention vs. routine care, primary outcome.
Four included SRs ( 42 , 43 , 50 , 54 ) reported findings on EIBF ( Figure 2 ; Table 2 ). All the included SRs in this overview agreed that the BF interventions improved EIBF as compared to routine care. The overall improvement in EIBF reported in included SRs varied from 44% (RR = 1.44, 95% CI = 1.06–1.97; one study; 390 participants) ( 43 ) to 93% (RR = 1.93, 95% CI = 1.55–2.39; 11 studies; 72,464 participants) ( 50 ). Community-Based Intervention Packages delivered to pregnant and reproductive-age women during their ANC and/or PNC period by Ancillary Nurse-Midwives reported the highest improvement in EIBF by 93% (RR = 1.93, 95% CI = 1.55–2.39; 11 studies; 72,464 participants ; QoE = NR ) ( 50 ), followed by BF education and support and early mother-infant contact administered to pregnant and reproductive age group women during the antenatal period by women's group peer counselor by 70% (RR = 1.7, 95% CI = 0.98–2.95; three studies; 2,066 participants; QoE = low ) ( 42 ). Community Health Educational Intervention (CHEI) delivered to pregnant women and mothers throughout both the antenatal and postnatal period by health care workers improved EIBF by 56% (RR = 1.56, 95% CI = 1.37–1.77; 19 studies; 1,26,375 participants; QoE = NR ) ( 54 ). Another included SR addressed BF intervention which includes monthly BF education sessions and weekly cell phone messages delivered to women attending monthly microcredit meetings and reported an improvement in EIBF by 44% (RR = 1.44, 95% CI = 1.06–1.97; one study; 390 participants; QoE = high ) ( 43 ). However, three SRs ( 42 , 50 , 54 ) had reported significant heterogeneity ( I 2 between 78 and 98%).
Comparison 1: BF intervention vs. routine care. EIBF, early initiation of breastfeeding.
Two included SRs ( 43 , 55 ) reported EBF findings and concluded that monthly BF education sessions and weekly cell phone messages ( 43 ) reported the highest improvements in EBF at 6 months compared to TCC via mobile devices ( 55 ) ( Figure 3 ; Table 2 ). An SR conducted by Lumbiganon et al. ( 43 ) assessed EBF at 3 and 6 months. Palmer et al. ( 55 ) evaluated EBF for up to 3 months in a low-risk setting (Kenya) where all women in the control group exclusively breastfeed. Therefore, the intervention did not have any impact on improving EBF as 100% of the women reported EBF.
Comparison 1: BF intervention vs. routine care. EBF, exclusive breastfeeding.
Monthly BF education sessions and weekly cell phone messages delivered to women attending monthly microcredit meetings reported an improvement in EBF at 3 months by 21% (RR = 1.21, 95% CI = 0.91–1.61; one study; 390 participants; QoE = moderate) and at 6 months by 47% (RR = 1.47, 95% CI = 1.06–2.05; one study; 390 participants ; QoE = moderate) ( 43 ). In another included SR, Targeted Client Communication via mobile devices delivered to pregnant and postpartum women and caregivers during the antenatal and postnatal period by health care workers reported a little improvement in EBF up to 3 months by only 8% (RR = 0.92, 95% CI = 0.79–1.08; one study; 40 participants; QoE = low) in low-risk setting ( 55 ). Significant heterogeneity, on the other hand, was not applicable.
No secondary outcomes such as Acceptability and Satisfaction were reported in this comparison group by any of the included SR.
Only one included SR ( 55 ) reported EBF findings (9 months postpartum) in this comparison group ( Figure 4 ; Table 3 ). Palmer et al. ( 55 ) assessed that Targeted client communication (TCC) via mobile devices compared to non-digital TCC (pamphlets) had less or no effect on the improvement of EBF. TCC via mobile devices delivered to pregnant and postpartum women and caregivers during both antenatal and postnatal periods by health care workers showed an improvement of only 8% (RR = 0.92, 95% CI = 0.79–1.07; one study; 42 participants; QoE = low) ( 55 ).
Comparison 2: One BF intervention vs. other intervention. EBF, exclusive breastfeeding.
We aimed to identify specific interventions with the potential to promote and optimize breastfeeding practices. Our discussion had focussed on where we have found high-quality evidence of important effects. We listed key Cochrane reviews in need of an update. Finally, we had made recommendations for future systematic reviews and clinical research.
We had foreseen that there can be variations in the population, interventions, and outcomes of interest that can lead to heterogeneity. We also anticipated that there would be different approaches across SRs, across different author teams.
To reduce bias in the overview process, we followed standard review methods such as methods regarding duplication of effort, discussion-based resolution, and exclusion of overview authors from assessing their systematic reviews or trials. The inclusion of subject experts, public health experts, methodological experts, and information specialists strengthens the overview.
We intended to look into the evidence generated in LICs and LMICs and hence generalizability of the findings was restricted to LICs and LMICs. We evaluated six SRs that assessed the effects of different BF interventions to promote and optimize BF practices such as EIBF, EBF, and continued BF up to 2 years. The highest number of SRs addressed only two categories of primary outcome: EIBF and EBF. None of the SRs reported other outcomes of this overview such as continued BF up to 2 years, acceptability, and satisfaction.
In this overview, we used the R-AMSTAR tool for assessing methodological quality. Overall, the methodological quality of all the included SRs was high except for one ( 49 ) as it did not meet the R-AMSTAR tool criteria. The quality of evidence (QoE) reported in the included SRs varied from high to low.
The overview identified extensive evidence based on the type of interventions: educational intervention or support intervention, who delivered the interventions: digital or non-digital devices, personals from government, non-governmental, and private organizations, health system or health workers, non-healthcare professionals (women's group, peer counselors), and female ancillary nurse midwives (ANMs), recipients of the intervention: pregnant women, mothers of neonates, women in their reproductive age, mothers in their postpartum period, partners/spouses, or family members and the duration of the intervention: antenatal or postnatal phase.
Only two studies from LMICs (Nigeria and Iran) were included by Lumbiganon et al. ( 43 ). However, since there was no subgroup analysis for any of the listed outcomes, we did not extract the data from Iran and only retrieved the data from Nigeria. In another included SR, conducted by Palmer et al. ( 55 ), BF intervention did not show any significant improvements in BF practices since 100% of women in the control group reported EBF, and also the reported evidence was of very low certainty. Balogun et al. ( 42 ) included three studies from LMICs (Ghana, Nicaragua, and Nigeria) and one from LIC (Malawi). The study from Malawi, Nigeria, and Ghana addressed the impact of non-healthcare professional-led BF education on EIBF. However, a study from Nicaragua evaluated the impact of early mother-infant contact. In addition, the number of participants from Ghana was not available. Therefore, only two studies (Malawi and Nigeria) reported the data on EIBF.
In summary, all forms of included BF interventions were found to be effective in improving BF practices in many low-middle-income countries except for TCC via mobile devices which favors standard care and non-digital TCC since all of the women in the comparison group were exclusively breastfed their babies ( 55 ). The results were evaluated using two major comparisons groups: BF intervention against routine care and one BF intervention vs. other intervention comparison groups. Four SRs ( 42 , 43 , 50 , 54 ) assessed the effect of interventions on EIBF whereas two SRs ( 43 , 55 ) evaluated the effect of interventions on EBF in BF intervention vs. routine care comparison group. Only one included SR ( 55 ) reported EBF in another group i.e., one BF intervention vs. other intervention comparison group. However, no significant improvement was reported since the evidence was of very low certainty.
In the BF intervention vs. routine care comparison group, Community Based Intervention Packages (CBIP) delivered to pregnant and reproductive-age women during their ANC and/or PNC periods by Ancillary Nurse-Midwives reported the highest improvement in EIBF. However, insufficient evidence was reported to suggest that BF intervention showed improvements in EBF in both the comparison groups.
Limitations of the review.
This overview examined the available evidence concerning the interventions addressed to improve BF practices with no restrictions on the type of interventions. We did, however, limit our search to Cochrane reviews alone. We found limited reviews on the proposed topic. We acknowledge that not all SRs included in this overview came from LMICs or LICs only. We discovered that some of the SRs included participants ranging from low to high-income countries. We excluded some of the SRs that lacked participant subgroup analysis, even though they were designed to promote BF practices.
The possible bias in the overview is estimated to be low. We followed the methods described in the Cochrane handbook ( 72 ). The search was as comprehensive as possible. Two authors independently screened studies, extracted data, and evaluated the methodological quality of reviews. We intended to investigate the evidence generated in LICs and LMICs and hence generalizability of the findings was limited to LICs and LMICs.
After an extensive literature search, we did not come across any overview of SRs that has addressed this area. Although, we found few SRs on interventions to promote BF practices while searching in Pubmed ( 32 , 36 , 73 – 77 ).
Implications for practice.
BF interventions mentioned in this overview such as BF education sessions and support interventions, Community Based Intervention Packages, Community Health Educational Intervention delivered by health and non-healthcare professionals reported some improvements in the initiation of breastfeeding whereas insufficient evidence was reported for the improvement of EBF in LICs and LMICs. Among the different types of BF interventions, Community Based Intervention Packages (CBIP) was found to be most effective in improving BF initiation rates whereas BF intervention using multimedia such as TCC via mobile devices was found to be the least effective in promoting BF practices particularly in low and low-middle income countries.
This overview can assist personnel from government, non-governmental, and private organizations as well as a health system or health workers in raising awareness and encouraging pregnant women, mothers of neonates, women in their reproductive age, mothers in their postpartum period, partners/ spouses, or family members to improve BF practices.
Based on the data extracted from included SRs, this overview highlights the gaps in primary research regarding the uncertainty about the settings such as LICs or LMICs, lack of evidence from LMICs, and also identified gaps in the availability of reliable up-to-date SRs on the effects of several BF interventions to promote and optimize BF practices. None of the included SR reported one of the primary outcomes i.e., continued BF up to 2 years of age and the duration of BF practices ( Tables 2 , ,3). 3 ). In addition, the included SRs did not evaluate any of the secondary outcomes such as acceptability and satisfaction ( Tables 2 , ,3 3 ).
These identified gaps open up a new area of research and can be done on a priority basis. With an improved understanding of the significance of BF and the escalating risk of neonatal mortality and malnutrition due to inappropriate BF practices, there is an urgent need to perform good quality primary research on the mentioned interventions, especially in low-income (LIC) and low-middle-income countries (LMICs).
Author contributions.
AG proposed the concept of the review. MK developed and implemented the search strategies. AG and MK developed the protocol. SU and SQ screened the title and abstract. SS and PS screened full texts articles. Through conversation, AG resolved discrepancies for screening among primary reviewers. SU extracted data. AG and DS evaluated the methodological quality of included SRs. MK and SU drafted the manuscript with inputs from ST, AG, and SQ. All authors made significant contributions to this overview in reading, writing, and revision of the manuscript. All authors contributed to the article and approved the submitted version.
We gratefully acknowledge the work of ST, Datta Meghe Institute of Medical Sciences for her administrative support.
This overview was funded by the Indian Council of Medical Research (ICMR), New Delhi, India.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Problem: Early discharge following birth has become an emerging phenomenon in many countries. It is likely early discharge has an impact on the establishment of breastfeeding.
Objective: To critically appraise the evidence on what women value in relation to breastfeeding initiation and support, and investigate the impact early discharge can have on these values.
Method: A literature search was conducted for publications since 2005 using the following databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Scopus and PsycINFO; 21 primary articles were selected and included in the review.
Findings: There is no standard definition for 'early discharge' worldwide. Due to inconsistent definitions worldwide and minimal literature using a 24h definition, research defining early discharge as up to 72h postpartum is included. Seven key factors in relation to breastfeeding initiation and support following early discharge were identified, namely trust and security, consistent advice, practical breastfeeding support, breastfeeding education, comfortable environment, positive attitudes and emotional support, and individualised care.
Conclusion: The findings suggest individualised postnatal lengths of stay may be beneficial for the initiation of breastfeeding. Five values were not impacted by early discharge, but rather individual midwives' practice. There is consensus in the literature that early discharge promoted a comfortable environment to support breastfeeding initiation. Wide variations in the definition of early postnatal discharge made it difficult to draw influential conclusions. Therefore, further research is required.
Keywords: Breastfeeding; Early discharge; Initiation or establish; Length of stay; Postnatal care.
Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
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The COVID-19 pandemic is disrupting normal life globally, every area of life is touched. The pandemic demands quick action and as new information emerges, reliable synthesises and guidelines for care are urgently needed. Breastfeeding protects mother and child; its health benefits are undisputed and based on evidence. To plan and support breastfeeding within the current pandemic, two areas need to be understood: 1) the clinical characteristics of COVID-19 as it applies to breastfeeding and 2) the protective properties of breastfeeding, including the practice of skin-to-skin care. This review aims to summarise how to manage breastfeeding during COVID-19. The summary was used to create guidelines for healthcare professionals and mothers.
Current publications on breastfeeding during the COVID-19 pandemic were reviewed to inform guidelines for clinical practice.
Current evidence states that the Coronavirus is not transmitted via breastmilk. Breastfeeding benefits outweigh possible risks during the COVID-19 pandemic and may even protect the infant and mother. General infection control measures should be in place and adhered to very strictly.
Breastfeeding should be encouraged, mothers and infant dyads should be cared for together, and skin-to-skin contact ensured throughout the COVID-19 pandemic. If mothers are too ill to breastfeed, they should still be supported to express their milk, and the infant should be fed by a healthy individual. Guidelines, based on this current evidence, were produced and can be distributed to health care facilities where accessible information is needed.
The COVID-19 pandemic is creating global disruption, causing markets to plummet and generating many questions in every area of life. Since it affects health in multiple ways, including sexual and reproductive health, publishing in all these areas has increased lately. Not all knowledge is based on scientific evidence, resulting in consequences which could be detrimental rather than providing the needed protection. One area, that needs to be based on scientific evidence, is breastfeeding. Although limited clinical research is available, we can build on what we know about breastfeeding and previous similar infection outbreaks to plan and manage the crisis. This review is intended for healthcare professionals involved with breastfeeding populations, both in an acute care and community health setting. It should not replace clinical judgement or specialist consultation, but rather strengthen clinical management, provide up-to-date evidence and optimize health in infants who may or may not have been exposed to COVID-19. This review has been compiled from information that is currently known about COVID-19 and since new information about the disease is becoming rapidly available, suggestions may be subject to change as additional information is shared.
The novel corona virus (SARS-CoV-2) originated in Wuhan, in Central China in December of 2019 and spread rapidly across China [ 1 , 2 , 3 ]. Forty-nine percent of patients who presented with pneumonia were exposed to the Huanan Seafood Wholesale Market [ 2 , 3 ]. On 5 February 2020, the virus also spread to other countries including Japan, Thailand, Singapore, Republic of Korea, the United States of America and Australia [ 1 ]. Currently, every continent across the globe has been affected [ 3 ] and the World Health Organization (WHO) declared the outbreak of the disease as an international public health emergency [ 4 ].
Although most of the infections occur in adults older than 60 years [ 3 ], some pregnant women have also been infected, causing concerns for the management of the perinatal period. A few studies have explored the infection of neonates with SARS-CoV-2 and none showed breastfeeding as method of the transmission of the virus [ 1 , 5 , 6 , 7 ]. Various research studies reporting primary data have been published on SARS-CoV-2 transmission in the perinatal period. Chen et al. published a retrospective review of medical records of nine infected pregnant woman [ 5 ], while Rasmussen et al. published their article on COVID-19 and Pregnancy: What obstetricians need to know [ 8 ]. Zhu and colleagues published a clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia [ 1 ], while Zeng et al. performed a retrospective analysis of 33 neonates born from COVID-19 positive mothers [ 6 ]. Schwartz published an analysis of 38 pregnant women with COVID-19 and found no evidence supporting intrauterine or transplacental transmission from infected pregnant women to their foetuses [ 9 ]. Aligned with these publications, authoritative bodies released statements regarding COVID-19: the incidence, mortality, prevention and treatment thereof.
Within this valuable, but limited scientific information, in addition to an overload of public information, the question remained: How do we manage breastfeeding in the wake of COVID-19? The authors aim to provide a synthesis on what is currently known about COVID-19, with specific reference to breastfeeding in infants born to healthy, exposed or infected mothers. In addition, the authors aim to provide guidelines for the management of breastfeeding at home and within health facilities, including in the high risk and neonatal intensive care units. To plan and support breastfeeding within the current pandemic, two areas need to be understood: 1) the clinical characteristics of COVID-19 as it applies to breastfeeding and 2) the protective properties of breastfeeding, including the practice of skin-to-skin care. Taking these aspects into account it was possible to compile a clinical guide for both healthcare professionals and breastfeeding mothers.
The current (15 June 2020) publications on COVID-19 with specific reference to breastfeeding were reviewed to provide evidence-based information for healthcare professionals as well as mothers. Official documents available in English were included due to language abilities of the authors. These included published and in-press clinical research articles, as well as interim guides, expert reviews or guidelines/official statement documents from international associations, including the clinical management interim guides released by the World Health Organization in 2020 and the International Confederation of Midwives’ (ICM) Official Statements of Novel Coronavirus (SARS-CoV-2) and Pregnancy, as well as the Academy of Breastfeeding Medicine (ABM). In addition, articles discussing the characteristics of COVID-19 were included with specific interest in vertical transmission potential in the perinatal period. Articles explaining how breastfeeding could protect against the virus were also included.
The following exclusion criteria were used: Webpages which provide the public with questions and answers, media releases and practice advisories were excluded, since it was based on, and mostly included a repetition of official statements and documents and articles. Country-based webpages were read to compare available data, but not included in the review summary, since it was mostly based on the global recommendations of the WHO and if any discrepancies in management were found, the WHO recommendations were regarded as superior to country recommendations.
The publications have been reviewed for the characteristics of COVID-19 in the perinatal period, the potential of transmission from infected mother to her breastfeeding infant and proposed management of healthy, exposed and infected mother-infant dyads. The findings were synthesised and a clinical guide with rationale for each suggestion provided (see Table 1 ) and algorithms for both healthcare providers (Additional file 1 ) and mothers (Additional file 2 ) were designed.
Since the Coronavirus is a novel virus, we have little research to work with and must explore the data that is available, as well as build on knowledge and experience of similar past viral outbreaks, including SARS-CoV-1 and Middle Eastern Respiratory Syndrome (MERS). Furthermore, there is considerable knowledge on the properties of breastmilk which can inform researchers and clinicians of the most suitable route of action, within the limited knowledge on the COVID-19 disease. We will first discuss what is known about COVID-19 specifically within the context of breastfeeding [ 10 ] and then look at how breastmilk can be utilized as an intervention to protect infants. Laboratory research on breastfeeding and COVID-19 seems to have been initiated, as evident from social media, however no research on this topic is currently available.
SARS-CoV-2 is a beta coronavirus, which cause the COVID-19 disease [ 11 ]. Currently the mode of transport of SARS-CoV-2 suggests person-to-person transmission which occurs when in close contact with an infected person. The virus is transferred via respiratory droplets produced when coughing and sneezing. Droplets can either land on a healthy individual close to a cavity in the facial area or be inhaled into the lungs of persons in close proximity. It is important to note that the airborne transmission over long distances is unlikely.
In a recent study published in The Lancet, it was stated that all the information available on pneumonia caused by the 2019 novel coronavirus disease was based on information from the general population [ 2 ]. The conclusion drawn by Qiao was that the SARS-CoV-2 may have similar pathogenesis to the SARS-CoV1 and therefore we can draw on the management of these previous epidemics to inform current practice guidelines [ 12 ].
Vertical transmission refers to the passage of a pathogen from mother to infant during the period before and after birth, including via placental blood during pregnancy, via the birth canal during labour, delivery and during postpartum feeding [ 1 ]. In their study Zhu et al. found no evidence of such vertical transmission [ 1 ]. In addition, in a retrospective review of clinical records of nine pregnant women by Chen, Guo et al., the authors found limited data available to support the transmission potential of SARS-CoV-2 from mother to child via breastmilk. They assessed the evidence of intrauterine vertical transmission by testing for the presence of the virus in amniotic fluid, cord blood, neonatal throat swab samples and breastmilk samples collected and tested from patients after the first lactation [ 5 ]. Although some case studies of infants infected with COVID-19 have been reported, it can be noted that these studies did not test for the presence of the virus in amniotic fluid, cord blood, neonatal throat swabs or breastmilk [ 7 , 13 , 14 , 15 ] and included only three infants in total, indicating further investigation is needed. A few case studies were published from Spain [ 16 ], Vietnam [ 13 ], China [ 15 ] and USA [ 17 ], and none of these reported transmissions of the SARS-CoV-2 via breastmilk. A systematic review by Duran et al. and a study by Lu and Shi also reported that breastmilk does not appear to be a method of transmission of the virus [ 18 , 19 ]. Samples of breastmilk from 18 women infected with SARS-CoV-2 were evaluated and although SARS-CoV-2 RNA was detected in one sample of milk, the follow-up culture of the same sample was negative. It is likely that the SARS-CoV-2 RNA that was found does not contain replication-competent virus and so is unlikely to infect an infant [ 20 ]. Findings from this group of cases suggest that there is currently no evidence to show that respiratory viruses can be transmitted through breast milk.
Breastfeeding protects neonates, infants and children against morbidity and death [ 21 , 22 ]. The protective effect is particularly strong against infectious diseases, due to the direct transfer of antibodies as well as anti-infective factors and long-lasting transfer of immunological competence and memory [ 23 ].
Breastfeeding has both short and long-term benefits for the mother and her infant. To benefit from the protective factors in breast milk, every effort should be made to support and enable early and immediate initiation of breastfeeding. Not only does the early initiation decrease neonatal deaths, but together with frequent breastfeeding, ensures that the breastfeeding dyad are not separated. Early initiation of breastfeeding significantly increases the breastfeeding rates in healthy term infants at one to 4 month’s age by stimulating hormones and facilitating bonding [ 24 , 25 , 26 ]. The Lancet Breastfeeding Series (2016) reported that scaling up breastfeeding could prevent around 823,000 child deaths annually [ 21 ]. Breastfeeding reduces 64% of morbidity and mortality in diarrhoea, 74% in the severity of RSV and its hospitalization with 72% [ 22 ]. This demonstrates the protective benefits of breastfeeding, which pertain to COVID-19 pandemic.
The neonate has an immature immune system and colostrum, a powerful immune booster, protects infants from infections by means of bioactive factors and secretory IgA antibodies. Breast milk with its abundant source of immunoglobulins, lactoferrin, lysozyme and cytokines play an important role in absorbing and engulfing harmful micro-organisms and targeting specific bacteria and providing protection by regulating the immune response [ 27 ]. Human milk oligosaccharides, abundant in human milk, shape the microbiome, provide probiotics and modulate the developing immune system also displaying anti-adhesive effects for bacterial antigens [ 28 , 29 , 30 ]. All the above are compelling reasons for every infant to receive only breast milk and preferably their own mothers’ milk.
The best way to promote successful breastfeeding, is to ensure that the mother-infant dyad is kept together, and skin-to-skin contact is supported and encouraged [ 31 ]. Skin-to-skin is the safest and best transition for mothers and their infants to a new life together. Ensuring it happens immediately after birth, the infant’s microbiome can develop from the mother’s flora, so beneficial during a pandemic [ 32 ]. Skin-to-skin also increases blood glucose levels 75–90 min after birth, improves cardiorespiratory stability [ 26 ] and significantly reduces stress levels in the infant and mother [ 33 ]. Keeping mother and infant together can reduce birth stress and even prevent neurodevelopmental disorders in the infant. The smell, touch and voice of the mother naturally calms the infant [ 34 ].
It should be noted that the WHO interim guidance documents on the management of COVID-19 has been informed by evidence-based guidelines also published by the WHO, such as the Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care [ 35 ], as well as current information on COVID-19. General infection prevention measures should therefore always be taken, in all circumstances, with special attention to droplet protection. Guidance about the need for exposed and infected breastfeeding mothers to practice hand and respiratory hygiene has been given by many organisations internationally and experts in the field [ 36 , 37 , 38 , 39 ]. Additional suggestions are provided based on the current knowledge of COVID-19. Based on this information, and her right to choose, the mother can make an informed choice regarding breastfeeding during the pandemic [ 40 ]. Measures for expressing breastmilk should also be applied as in normal situations, however, no equipment should be shared between mothers. All equipment used to express milk, should be rinsed with cold water and secondly washed with warm water and soap and thirdly, sterilized. In case of an epidemic it may be advisable to sterilise equipment after each use, instead of once in 24 h [ 27 ]. Another additional measure is that if a mother is potentially exposed or tested positive for COVID-19, she should use a dedicated breast pump and not share one with other mothers. She should also express in the area in which she has been isolated. A practical suggestion may be that the mother express in her container in isolation and then decant the expressed milk into a clean container held by a healthy person with appropriate protective clothing, including masks and gloves, to prevent the virus from spreading via the surface of the container. In this manner a clean container can then also be stored/milk frozen for later use without the risk of contaminating other containers with milk [ 41 ]. There has been much debate on ways to reduce the risk of the external contamination of expressed human milk containers. Marinelli and Lawrence, advise bottles to be wiped down with a viricidal agent or a dilution of 1:10 diluted bleach (sodium hypochlorite [NaOCl]) and bottles stored in separate bins for each infant in refrigerators [ 37 ]. However, concerns were expressed about the necessity to do this as no proof of contamination of bottle surfaces exists [ 42 ].
Table 1 provide a synthesis of the evidence supported recommendations for breastfeeding amidst COVID-19, based on the latest evidence as available on 15 June 2020. Information about SARS-CoV-2 transmission is emerging daily, and the latest information should always be considered in clinical decision making.
Based on the evidence presented in Table 1 , a visual presentation for quick clinical reference is presented as an algorithm for healthcare professionals (Additional file 1 ) and mothers (Additional file 2 ) to support in decision-making regarding breastfeeding practices in the wake of COVID-19.
Global measures to control the spread of the coronavirus should be applied in everyday situations to prevent and stop the spread of pathogens. These measures include personal hygiene and social distancing, which should be applied to all infants, to prevent them from contracting the illness (refer to Table 1 ). This review aimed to map the current evidence-based literature about breastfeeding and COVID-19.
Continued breastfeeding and zero-separation of the mother-infant dyad appears to be the best practice in this situation. Considering the current evidence, it is not common for respiratory viruses to be transmitted via breast milk and transmission such as this has not been demonstrated in infants who contracted COVID-19 or were born to mothers who tested positive for the virus [ 16 , 53 ]. In addition, the properties in breast milk can protect the infant [ 10 , 43 ].
In their Practice Advisory on the Novel Coronavirus 2019 (SARS-CoV-2), the American College of Obstetricians and Gynecologists (ACOG), state that infants born to mothers with confirmed COVID-19, should be considered persons under investigation (PUI), and as such should be isolated according to the Infection Prevention and Control Guidance for PUIs [ 54 , 55 ]. They further state that confirmed or PUI mothers should be separated from their infants, in separate rooms until the maternal transmission-based precautions are discontinued. The National Health Commission of China in their notice: strengthening maternal disease treatment and safe midwifery during the prevention and control of new coronavirus pneumonia, in February 2020 [ 56 ], also followed this recommendation of separation for at least 14 days and not breastfeeding. However, in the next section of the ACOG advisory on breastfeeding it is stated that breastfeeding should be initiated and continued, since currently it seems that this respiratory virus cannot be transmitted through breastmilk [ 54 ]. American Academy of Pediatrics (AAP), 2020 and the Centers for Disease Control and Prevention (CDC), also suggest that infected mothers and their infants be temporarily separated and once home should maintain a distance of at least 6 feet (2 m) between them, with mothers expressing to provide breastmilk for their infants [ 57 , 58 ].
The ICM [ 4 ] concur with UNICEF, the ABM and RCOG in that currently there is no evidence that respiratory viruses can be transmitted via breast milk. Therefore, breastfeeding should be continued while general infection control measures are applied in symptomatic mothers and when mothers are too ill to breastfeed. Mothers who are too ill to breastfeed could express milk, and a healthy individual could then cup, or spoon feed the infant.
The authors agree that breastfeeding should be continued, since the protective benefits of breastmilk far outweigh the risk of potential pathogen transmission. In addition, we want to highlight that mother and infant separation has negative effects on the mental and physical health of both mothers and infants [ 34 , 59 ] and should therefore be limited to extreme situations and supported by good evidence or clinical reasoning (see Table 1 ).
Breastfeeding is the best protective measure available for healthy and at-risk infants and their mothers during the COVID-19 pandemic. Therefore, breastfeeding should not be interrupted, mothers and infants should not be separated, and skin-to-skin contact should not be discontinued. While ensuring normality as far as possible, general infection control measures should be in place and adhered to very strictly. In exposed or infected mother’s additional droplet protection should be taken by mother by wearing a (see-through), surgical face mask when handling and feeding her infant. When mothers are too ill to breastfeed, they should still be supported to express their milk, and the infant should be fed by a healthy individual. Breastfed infants have an advantage receiving additional protection against SARS-CoV-2. Based on the current evidence, it seems that the virus is not transmitted via breastmilk. For this reason, the benefits of breastmilk outweigh the risk of breastfeeding cessation and of a potential transmission of the coronavirus [ 38 ].
Not applicable
Severe acute respiratory syndrome coronavirus 2
Middle Eastern Respiratory Syndrome
Coronavirus disease 2019
2019 Novel Coronavirus
Respiratory Syncytial Virus
World Health Organization
Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51–60.
Article PubMed PubMed Central Google Scholar
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507.
Article CAS PubMed PubMed Central Google Scholar
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199–207.
CAS PubMed PubMed Central Google Scholar
International Confederation of Midwives, (ICM). Official statements on novel coronavirus (COVID-19) and pregnancy. Available at: https://www.internationalmidwives.org/icm-news/unfpa-statement-on-novel-coronavirus-(covid-19)-and-pregnancy.html . Issued 7 Mar 2020. Accessed 20 Mar 2020.
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809.
Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr. 2020;174(7):722–5.
Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020;323(18):1846–8.
Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020;222(5):415–26.
Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med. 2020;144(7):799–805.
Article PubMed Google Scholar
Centers for Disease Control and Prevention, (CDC). Interim infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in healthcare settings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html . Updated 18 May 2020. Accessed 15 June 2020.
Hong H, Wang Y, Chung HT, Chen CJ. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr Neonatol. 2020;61(2):131–2.
Qiao J. What are the risks of COVID-19 infection in pregnant women? Lancet. 2020;395(10226):760–2.
Le TH, Nguyen VL, Tran MD, Do TH, Tran TH, Le TY, et al. The first infant case of COVID-19 acquired from a secondary transmission in Vietnam. Lancet Child Adolesc Health. 2020;4(5):405–6.
Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020;323(18):1848–9.
Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis. 2020. https://doi.org/10.1093/cid/ciaa226 .
Díaz AC, Maestro LM, Pumarega MT, Antón FB, Alonso PCR. First case of neonatal infection due to SARS-CoV-2 in Spain. An Pediatr. 2020;92(4):237–8.
Article Google Scholar
Dumpa V, Kamity R, Vinci AN, Noyola E, Noor A. Neonatal coronavirus 2019 (COVID-19) infection: a case report and review of literature. Cureus. 2020;12(5):e8165.
PubMed PubMed Central Google Scholar
Duran P, Berman S, Niermeyer S, Jaenisch T, Forster T, Gomez Ponce de Leon R, et al. COVID-19 and newborn health: systematic review. Rev Panam Salud Publica. 2020;44:e54.
Lu Q, Shi Y. Coronavirus disease (COVID-19) and neonate: what neonatologist need to know. J Med Virol. 2020;92(6):564–7.
Article CAS PubMed Google Scholar
Chambers CD, Krogstad P, Bertrand K, Contreras D, Bode L, Tobin N, et al. Evaluation of SARS-CoV-2 in breastmilk from 18 infected women. medRxiv. 2020. https://doi.org/10.1101/2020.06.12.20127944 .
Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.
American Academy of Pediatrics, (AAP). Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827.
Hanson LA. Breastfeeding provides passive and likely long-lasting active immunity [published correction appears in Annals of Allergy, Asthma & Immunology. 1999 May;82(5):478]. Ann Allergy Asthma Immunol. 1998;81(6):523–37.
Khan J, Vesel L, Bahl R, Martines J. Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity—a systematic review and meta-analysis. Matern Child Health J. 2015;19(3):468–79.
Jaafar SH, Ho JJ, Lee KS. Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding. Cochrane Database Syst Rev. 2016;8:CD006641.
Google Scholar
Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11:CD003519.
PubMed Google Scholar
Hamosh M. Bioactive factors in human milk. Pediatr Clin N Am. 2001;48(1):69–86.
Article CAS Google Scholar
Coppa VG, Gabrielli VO, Zampini VL, Galeazzi VT, Ficcadenti VA, Padella VL, et al. Oligosaccharides in 4 different milk groups, Bifidobacteria, and Ruminococcus Obeum. J Pediatr Gastroenterol Nutr. 2011;53(1):80–7.
Morrow AL, Ruiz-Palacios G, Altaye M, Jiang X, Lourdes Guerrero M, Meinzen-Derr J, et al. Human milk oligosaccharides are associated with protection against diarrhea in breast-fed infants. J Pediatr. 2004;145(3):297–303.
Williams JE, Price WJ, Shafii B, Yahvah KM, Bode L, McGuire MA, et al. Relationships among microbial communities, maternal cells, oligosaccharides, and macronutrients in human Milk. J Hum Lact. 2017;33(3):540–51.
Karimi FZ, Sadeghi R, Maleki-Saghooni N, Khadivzadeh T. The effect of mother-infant skin to skin contact on success and duration of first breastfeeding: a systematic review and meta-analysis. Taiwan J Obstet Gynecol. 2019;58(1):1–9.
Dumas L. Safe skin-to-skin contact between mother and baby. Procedure and important notes. 2015. Available at: https://www.saskatoonhealthregion.ca/locations_services/Services/Maternal-Newborn-Care/Documents/Procedure%20for%20Safe%20Skin%20to%20Skin%20%28Louise%20Dumas%29.pdf . Accessed 26 Mar 2020.
Mörelius E, Theodorsson E, Nelson N. Salivary cortisol and mood and pain profiles during skin-to-skin care for an unselected group of mothers and infants in neonatal intensive care. Pediatrics. 2005;116(5):1105–13.
Császár-Nagy N, Bókkon I. Mother-newborn separation at birth in hospitals: a possible risk for neurodevelopmental disorders? Neurosci Biobehav Rev. 2018;84:337–51.
World Health Organization, (WHO). Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Available at: https://apps.who.int/iris/handle/10665/112656 . Accessed 20 Mar 2020.
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID 19). Pregnancy & Breastfeeding. Information about coronavirus disease 2019. Available at: https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html . Updated June 2020. Accessed 17 Jun 2020.
Marinelli KA, Lawrence RW. Safe handling of containers of expressed human milk in all settings during the SARS-CoV-2 (COVID-19) pandemic. J Hum Lact. 2020. https://doi.org/10.1177/0890334420919083 .
Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, Royal College of Paediatrics and Child Health, Public Health England and Health Protection Scotland. Coronavirus (COVID-19) infection in pregnancy. Information for healthcare professionals Version 10.1. 2020. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-06-18-coronavirus-covid-19-infection-in-pregnancy.pdf . Updated 19 June 2020. Accessed 17 July 2020.
World Health Organization, (WHO). Breastfeeding and COVID-19 for health care workers. Available at: https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_5 . Issued 12 May 2020. Accessed June 2020.
Academy of Breastfeeding Medicine, (ABM). ABM Statement on coronavirus 2019 (COVID-19). Available at: https://www.bfmed.org/abm-statement-coronavirus . Issued 10 Mar 2020. Accessed 15 Mar 2020.
Moro GE, Bertino E. Breastfeeding, human milk collection and containers, and human milk banking: hot topics during the COVID-19 pandemic. J Hum Lact. 2020. https://doi.org/10.1177/0890334420934391 .
Mitchell KB, Weinstein SR. Concerns regarding the article entitled safe handling of containers of expressed human milk in all settings during the SARS-CoV-2. J Hum Lact. 2020. https://doi.org/10.1177/0890334420922580 .
World Health Organization (WHO). Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. 2020. Available at: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected . Issued Mar 2020. Accessed 13 Mar 2020.
UNICEF. Coronavirus disease (COVID-19): What parents should know how to protect yourself and your children. Available at: https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know . Issued 29 Mar 2020. Accessed 20 June 2020.
Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection and pregnancy. Information for pregnant women and their families. 2020. Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/ . Updated 10 July 2020. Accessed 17 July 2020.
World Health Organization, (WHO). Infant and young child feeding. Available at: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding . Updated 1 Apr 2020. Accessed 17 July 2020.
Carvalho WB, Gibelli MABC, Krebs VLJ, Calil VMLT, Johnston C. Expert recommendations for the care of newborns of mothers with COVID-19. Clinics. 2020;75:e1932.
Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang Z. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA. 2020;323(13):1313–4.
Kampf G. Potential role of inanimate surfaces for the spread of coronaviruses and their inactivation with disinfectant agents. Infect Prev Pract. 2020;2(2):100044.
Siddharta A, Pfaender S, Vielle NJ, Dijkman R, Friesland M, Becker B, et al. Virucidal activity of World Health Organization–recommended formulations against enveloped viruses, including Zika, Ebola, and emerging coronaviruses. J Infect Dis. 2017;215(6):902–6.
Widstrom A-M, Brimdyr K, Svensson K, Cadwell K, Nissen E. Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr. 2019;108(7):1192–204.
Kelvin AA, Halperin S. COVID-19 in children: the link in the transmission chain. Lancet Infect Dis. 2020;20(6):633–4.
Aghdam K, Jafari N, Eftekhari K. Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect Dis. 2020;52(6):427–9.
The American College of Obstetricians and Gynecologists, (ACOG). Novel coronavirus 2019 (COVID-19). Available at: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019 . Updated 1 July 2020. Accessed 18 July 2020.
Centers for Disease Control and Prevention, (CDC). CDC infection prevention and control guidance for PUIs. Available at: https://www.cdc.gov/coronavirus/2019-ncov/php/guidance-evaluating-pui.html . Issued 10 Apr 2020. Accessed 18 July 2020.
National Health Commission of the People’s Republic of China. National Health Commission (NHC) of the People’s Republic of China. Notice on strengthening maternal disease treatment and safe midwifery during the prevention and control of new coronavirus pneumonia. Available at: http://www.nhc.gov.cn/xcs/zhengcwj/202002/4f80657b346e4d6ba76e2cfc3888c630.shtml . Accessed 8 Feb 2020.
American Academy of Pediatrics, (AAP). Guidance on breastfeeding during the COVID-19 pandemic. Available at: https://www.aappublications.org/news/2020/04/23/covid19breastfeeding042320 . Issued 23 Apr 2020. Accessed 19 June 2020.
Centers for Disease Control and Prevention, (CDC). Evaluation and management considerations for neonates at risk for COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-newborns.html . Updated 20 May 2020. Accessed 19 June 2020.
Bystrova K, Ivanova V, Edhborg M, Matthiesen AS, Ransjö-Arvidson AB, Mukhamedrakhimov R, et al. Early contact versus separation: effects on mother-infant interaction one year later. Birth. 2009;36(2):97–109.
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NuMIQ – Quality in Nursing and Midwifery, North-West University, 11 Hoffman St, Potchefstroom, South Africa
Welma Lubbe
School of Health, Midwifery, Tampere University of Applied Sciences, Tampere, Finland
Elina Botha
Department of Nursing Science, University of Turku, Turku, Finland
Hannakaisa Niela-Vilen
Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa
Penny Reimers
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WL conceptualised and drafted the article, designed table and critical review. EB were involved in data collection and analysis as well as design of supplements and critical review. HN were responsible for methodology section and critical review. PR were responsible breastfeeding characteristics section and critical review. All authors read and approved the final manuscript.
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Additional file 1..
Professional guide to breastfeeding and COVID-19.
Mothers guide to breastfeeding and COVID-19.
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Lubbe, W., Botha, E., Niela-Vilen, H. et al. Breastfeeding during the COVID-19 pandemic – a literature review for clinical practice. Int Breastfeed J 15 , 82 (2020). https://doi.org/10.1186/s13006-020-00319-3
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Received : 03 April 2020
Accepted : 10 August 2020
Published : 14 September 2020
DOI : https://doi.org/10.1186/s13006-020-00319-3
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A systematic review of the limitations and associated opportunities of chatgpt, deductive qualitative analysis: evaluating, expanding, and refining theory, conceptualising and measuring positive mental health literacy: a systematic literature review, mental health education integration into the school curriculum needs to be implemented, review: school-based mental health literacy interventions to promote help-seeking - a systematic review., public opinion towards mental health (the case of the vologda region), quantifying the global burden of mental disorders and their economic value, mental health literacy: it is now time to put knowledge into practice, clarifying the concept of mental health literacy: protocol for a scoping review, positive mental health literacy: a concept analysis, related papers.
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A Literature Review of the Factors That Influence Breastfeeding: An A pplicatio n of the Health Believe Model. International Journal of Nursing and Health Science. V ol. 2, No. 3, 2015, pp. 28-36.
included for review. Results: Shortterm and longterm benefits of exclusive breastfeeding for children were identified. such as he althier eating habits, reduced length of hospital stay, fa vorable ...
very low, because there are man y factors that in fluence exclusive breastfeeding such as, lack of knowledge, lactation problem s, poor family and. social support, social norms, embarrassment ...
Structural. Breastfeeding is much more than the transfer of breastmilk from mother to baby. Suckling from the mother's breast is a crucial part of the nurturing of infants. Direct breastfeeding versus feeding breastmilk with a bottle, cup, or spoon has important implications for infant health and development.
Review. Lactation and the stress response. There is a strong correlation between lactation and reduced stress responses, specifically that of cortisol [].A study conducted among 10 lactating and 10 non-lactating women discovered that plasma ACTH (p < 0.001), cortisol (p < 0.05), and glucose (p < 0.001) responses to exercise were significantly reduced in lactating women [].
Perceptions about breastfeeding. Women's perceptions about breastfeeding were covered in 83% (n = 49) of the papers.Most articles (n = 31) suggested that women perceived breastfeeding as a positive experience and believed that breastfeeding had many benefits [19, 20].The phrases "breast is best" and "breastmilk is best" were repeatedly used by the participants of studies included in ...
The vast majority ( n = 50) of the reviewed literature identified various barriers for successful breastfeeding. A sizeable proportion of literature (41%, n = 24) explored women's experiences with the physical aspects of breastfeeding [ 23, 33 ]. In particular, problems with latching and the pain associated with breastfeeding were commonly ...
Abstract. Objectives: Breastfeeding during pregnancy has unintended repercussions that have yet to be determined. Previous research employed various approaches and reached varied outcomes, with some emphasizing on advantages and others focusing on hazards. With this study we aim at shedding light on the effects of breastfeeding during pregnancy ...
effects of breastfeeding on mental health were screened and included in this review. Search terms related to breastfeeding, postpartum, and mental health were used. This review on breastfeeding and postpartum depression (PPD) begins by discussing the correlation between lactation and the maternal stress response.
This systematic literature review synthesises published evidence on the factors and barriers associated with the initiation of breastfeeding within 1 h of birth in South Asian countries to inform a future of relevant, context-specific actions. Methods Protocol of the systematic literature review was pro-
erm consequences of breastfeeding. The Department of Maternal, Newborn, Child and Adolescent Health of the World Health Organization has now com. issioned an update of this review. The following long-term out-comes were reviewed: blood pressure, type-2 diabetes, serum cholesterol, overweight and obe.
A review of the breastfeeding literature specific to this region had not yet been done prior to writing this report. In 2019, only one-third of infants were exclusively breastfed in West and Central Africa. 5 METHODS The literature review included quantitative, qualitative, and mixed-method studies on feeding practices of infants aged zero to six
Findings reveal that maternal sociodemograhpic characteristic like age, education, parity, economic status, and employment may influence breastfeeding. Breastfeeding is beneficial for both mother and child. Exclusive breastfeeding rate and early initiation of breastfeeding has not reached desirable level in many countries. Understanding the factors that influence infant feeding will help in ...
Aim: This is a systematic literature review that investigates the benefits of, risks of, and questions about breastfeeding. Methods: A literature search was performed in Pubmed for "breastfeeding ...
The US National breastfeeding recommendations are that infants need to be exclusively breastfed for at least the first 6 months of life [].However, the US national rates show that only 58% of the infants born in 2017 were breastfeeding until 6 months [].Furthermore, breastfeeding rates for Black infants are disproportionately lower with only 17% of Black infants exclusively breastfed until the ...
ur from birth) and exclusive breastfeeding for the first 6 months. The exclusive breastfeeding rate and early initiation to breastfeeding are still very low, because there are many factors that influence exclusive breastfeeding such as, lack of knowledge, lactation problems, poor family and social support, social n.
The review then shifts to focus more on the psychological aspects of breastfeeding, notably on changes to the sleep-wake cycle and mother-infant interactions. The final part of the review emphasizes the danger that early breastfeeding cessation imposes on a mother's mental health, portraying how prenatal and early-onset postpartum depression ...
A literature review THESIS CENTRIA UNIVERSITY OF APPLIED SCIENCES Degree Programme in Nursing March 2014. ABSTRACT Unit Unit of Kokkola-Pietarsaari Date March 2014 ... Breastfeeding is a natural process of infant feeding involving two main methods; exclusive and partial with the latter being trendiest. Nevertheless, exclusivity is the ...
Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC Public Health. (2013) 13 Suppl 3:S18. 10.1186/1471-2458-13-S3-S18 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Early or timely initiation of breastfeeding is crucial in preventing newborn deaths and influences childhood nutrition however remains low in South Asia and the factors and barriers warrant greater consideration for improved action. This review synthesises the evidence on factors and barriers to initiation of breastfeeding within 1 h of birth in South Asia encompassing Afghanistan, Bangladesh ...
Problem: Early discharge following birth has become an emerging phenomenon in many countries. It is likely early discharge has an impact on the establishment of breastfeeding. Objective: To critically appraise the evidence on what women value in relation to breastfeeding initiation and support, and investigate the impact early discharge can have on these values.
Background The COVID-19 pandemic is disrupting normal life globally, every area of life is touched. The pandemic demands quick action and as new information emerges, reliable synthesises and guidelines for care are urgently needed. Breastfeeding protects mother and child; its health benefits are undisputed and based on evidence. To plan and support breastfeeding within the current pandemic ...
Purpose This paper aims to explore how the term "mental health literacy" (MHL) is defined and understand the implications for public mental health and educational interventions. Design/methodology/approach An extensive search was conducted by searching PubMed, ERIC, PsycINFO, Scopus and Web of Science. Keywords such as "mental health literacy" and "definition" were used. The ...
babies against harm caused by pathogens (3, 4). Breast-. feeding is also an important source of antioxidants, such. as vitamin C and vitamin E, that prevent or reduce oxida-. tive damages to ...