Breastfeeding Task Force Summary

Wednesday, March 9, 2022 10:38:31 AM

Breastfeeding Task Force Summary



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The USPSTF found insufficient evidence to determine the direct effects of interventions to support breastfeeding on child and maternal health outcomes. Six trials reported inconsistent effects of counseling interventions on a range of infant health outcomes, including gastrointestinal illness, otitis media, respiratory tract illness, and health care use. None of the studies reported maternal health outcomes. However, the USPSTF found evidence that interventions to support breastfeeding can increase the rate and duration of breastfeeding.

An analysis of 43 trials found that breastfeeding support and education interventions targeting women were associated with a higher likelihood of any and exclusive breastfeeding at less than 3 months and at 3 to 6 months compared with usual care. Pooled estimates indicate a beneficial association for any breastfeeding at less than 3 months risk ratio [RR], 1. The association between individual-level interventions and breastfeeding initiation was not significant, based on the pooled point estimate RR, 1. Despite great variation in interventions and study design, there was little evidence that the effects of individual-level interventions vary across different populations or intervention characteristics, although the variability may have masked such relationships.

There was some suggestion that interventions taking place during a combination of prenatal, peripartum, or postpartum time periods were more effective than those taking place only during 1 time period. Some data also suggested that interventions are effective in both adolescents and adults. All 4 trials of individual-level interventions among adolescents or young adults reported higher rates of breastfeeding among intervention versus control group participants. There are very few data on the potential harms of interventions to support breastfeeding, which in theory could include guilt related to not breastfeeding, increased anxiety about breastfeeding, and increased postpartum depression.

Only 2 trials among adults reported on adverse events related to a breastfeeding support intervention. One trial found no significant differences in maternal anxiety between groups at 2 weeks. The other trial reported that a few mothers expressed feelings of anxiety and decreased confidence in their breastfeeding ability despite breastfeeding going well and discontinued their participation in the peer counseling intervention. There is adequate evidence that interventions to support breastfeeding change behavior and that the harms of these interventions are no greater than small. Therefore, the USPSTF concludes with moderate certainty that interventions to support breastfeeding have a moderate net benefit.

Many comments expressed concern that the recommendation did not explicitly include the term "promotion" of breastfeeding. The USPSTF revised the recommendation statement to clarify that it has not changed its confidence in the benefits of breastfeeding and that it continues to recommend interventions to encourage breastfeeding. The USPSTF also clarified that there has been no change from the previous recommendation in the type of interventions being recommended. Other comments expressed concern that the recommendation would lead to undue pressure on women who decide not to breastfeed. This recommendation updates the USPSTF recommendation on primary care interventions to promote and support breastfeeding. The scope of the review and type of interventions recommended did not change.

The grade of the recommendation remains a B. To encourage widespread discussion, consideration, adoption, and implementation of USPSTF recommendations, AHRQ permits members of the public to reproduce, redistribute, publicly display, and incorporate USPSTF work into other materials provided that it is reproduced without any changes to the work of portions thereof, except as permitted as fair use under the U. Copyright Act. AHRQ and the U. Department of Health and Human Services cannot endorse, or appear to endorse, derivative or excerpted materials, and they cannot be held liable for the content or use of adapted products that are incorporated on other Web sites.

Any adaptations of these electronic documents and resources must include a disclaimer to this effect. Advertising or implied endorsement for any commercial products or services is strictly prohibited. This work may not be reproduced, reprinted, or redistributed for a fee, nor may the work be sold for profit or incorporated into a profit-making venture without the express written permission of AHRQ. Clinician Summary Expand All. Population Pregnant women, new mothers, and their children Recommendation Provide interventions during pregnancy and after birth to support breastfeeding. Grade: B Interventions Primary care clinicians can support women before and after childbirth by providing interventions directly or by referral to help them make an informed choice about how to feed their infants and to be successful in their choice.

Implementation Not all women choose to or are able to breastfeed. October July Importance There is convincing evidence that breastfeeding provides substantial health benefits for children and adequate evidence that breastfeeding provides moderate health benefits for women. Harms of Interventions to Change Behavior There is adequate evidence to bound the potential harms of interventions to support breastfeeding as no greater than small, based on the nature of the intervention, the low likelihood of serious harms, and the available information from studies reporting few harms. Clinical Considerations. Patient Population Under Consideration This recommendation applies to pregnant women, new mothers, and their infants and children. Interventions Breastfeeding support can begin during pregnancy and continue through the early life of the child.

Professional Support Professional support is 1-on-1 counseling about breastfeeding provided by a health professional medical, nursing, or allied professionals, including those providing lactation care. Peer Support Similar to professional support, peer support provides women with 1-on-1 counseling about breastfeeding but is delivered by a layperson generally a mother with successful breastfeeding experience and a background similar to that of the patient who has received training in how to provide support.

Formal Education Formal education interventions typically include a formalized program to convey general breastfeeding knowledge, most often in the prenatal period, although some may span time periods. Useful Resources The Centers for Disease Control and Prevention provides information on different breastfeeding intervention strategies, including program examples and resources. Other Considerations. The categories as defined in the statute are as follows: Ambulatory patient services outpatient care you get without being admitted to a hospital Emergency services Hospitalization like surgery and overnight stays Maternity and newborn care both before and after birth Mental health and substance use disorder services, including behavioral health treatment this includes counseling and psychotherapy Prescription drugs Rehabilitative and habilitative services and devices services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care Note: The EHB requirements apply to small group and individual plans, but not to large group plans.

Where do breastfeeding supports fit into these provisions? Interventions to support breastfeeding may also involve a woman's partner, other family members, and friends. This recommendation does not apply in circumstances where there are contraindications to breastfeeding e. Interventions: Breastfeeding support can begin during pregnancy and continue through the early life of the child. Primary care clinicians can support women before and after childbirth by providing interventions directly or through referral to help them make an informed choice about how to feed their infants and to be successful in their choice.

Interventions include promoting the benefits of breastfeeding, providing practical advice and direct support on how to breastfeed, and providing psychological support. Interventions can be categorized as professional support, peer support, and formal education, although none of these categories are mutually exclusive, and interventions may be combined within and between categories. Implementation Considerations: Lactation support services include counseling, education, and breastfeeding equipment and supplies. A lactation care provider should deliver lactation support and provide services across the antenatal, perinatal, and postpartum periods to ensure successful preparation, initiation, and continuation of breastfeeding.

Lactation care providers include, but are not limited to, lactation consultants, breastfeeding counselors, certified midwives, certified nurse-midwives, certified professional midwives, nurses, advanced practice providers eg, physician assistants and nurse practitioners , and physicians. Breastfeeding equipment and supplies, as agreed upon by the woman and her lactation care provider, include, but are not limited to, double electric breast pumps including pump parts and maintenance and breast milk storage supplies. Access to double electric pumps should be based on optimization of breastfeeding, and not predicated on prior failure of a manual pump. Note: While not included as part of the HRSA-supported guidelines, the Implementation Considerations provide additional clarity on implementation of the guidelines into clinical practice.

They are separate from the clinical recommendations, are informational, and are not part of the formal action by the Administrator under Section What does this mean: what are insurers specifically required to cover? Are breastfeeding equipment and supplies unlimited? From FAQs Set 29 Q1: Are plans and issuers required to provide a list of the lactation counseling providers within the network? Q2: My group health plan has a network of providers and covers recommended preventive services without cost sharing when such services are obtained in-network.

However, the network does not include lactation counseling providers. Is it permissible for the plan to impose cost sharing with respect to lactation counseling services obtained outside the network? Cultural competence training has shown great promise at improving the knowledge, attitudes, and skills of health professionals when it comes to working with diverse populations Mareno, I find that it would be good for every organization to establish a generalized diversity training for all staff to take.

This training could discuss that its okay to ask a patient about their cultural and how we as a care provider could better meet their needs. This training could also discuss the topic of being self-aware. Their mission is to eliminate racism, empower women and promote peace, justice, freedom and dignity for all. The YWCA accomplish their mission by empowering generations of women addressing their changing personal needs. They hope to equip many diverse individuals to achieve and maintain social, physical, financial, intellectual and spiritual well-being.

Healthy People aims to educate and support the nation in wellness and prevention just as well as nurses do. This initiative is a community-based public health effort, which relies on schools, churches, local organizations, and businesses of it to be successful in improving birth outcomes. MOMS This includes methods for better community services, social services, addressing race related issues, and improving the available medical services. CCBOH currently has awareness programs, training and education programs, community outreach strategies, and other system of support for the citizens of Clayton.

Healthy People are objectives established nationally to improve the health of all Americans Office of Disease Prevention and Health Promotion, The improvement on Adolescent health is a topic addressed by healthy people that is supported by the work of school nurses. Specific objectives apart of Healthy People that school nurse can address include increasing the number of adults in the children lives with who they can discuss serious issues, increasing the number of adolescents that consider school work to be important, and lastly decreasing absenteeism from school due to illness or injury Office of Disease Prevention and Health Promotion, She spread the word about infant massage and helped new mothers learn the importance of using these new techniques in caring for their children McClure.

Infant massage provides many proven benefits through touch and the use of oils not only for the infants themselves but the parents as well. The objective is to offer an environment of calm, tranquillity and peace, maintaining the mother as relaxed as possible. NICE guidelines on intrapartum care should lead the continuous care.

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