Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Partner-Level Intervention, Technology-Based Support,

Intervention Description: One modifiable risk factor amenable to intervention is partner support. Having women work as a team with their co-parents to meet their breastfeeding goals have been found to improve breastfeeding outcomes. eHealth resources have been found to be accessible and feasible ways to provide breastfeeding education yet, the best way to design breastfeeding interventions for mothers and their co-parents is not known. Couples allocated to the eHealth study condition (SC1) were provided with access to a previously created, publicly available eHealth breastfeeding co-parenting website, which they could access independently throughout the perinatal period. Couples allocated to the Available Resources Only condition were informed that they could assess breastfeeding resources generally available in the community. Among couples randomized to the SC1, information was collected regarding participation in the virtual meeting and use of the eHealth resource which was assessed at all follow-up time points.

Intervention Results: Breastfeeding rates were high in both groups (SC1 63% and SC2 57% ‘exclusive’ 6 months) and (SC1 71% and SC2 78% ‘any’ 12 months) and not statistically significantly different. High scores were found in both groups in secondary outcome measures. Generally available breastfeeding resources were used in both groups with websites being used often and rated as most helpful. SC1 rated the eHealth resource provided to them highly.

Conclusion: The findings suggest both mothers and their co-parents should be targeted in breastfeeding education and web-based resources designed to meet their needs.

Study Design: RCT

Setting: Online

Population of Focus: Expectant women planning to breastfeed for the first time and their co-parents

Sample Size: 113 expectant women and 104 of their co-parents

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Partner-Level Intervention, Technology-Based Support, COMMUNITY, Social Supports, Individual Supports,

Intervention Description: Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. Mobile health (mHealth) interventions employing digital technologies provide a rapidly evolving means of engaging fathers and providing them with information and support to address their needs related to both breastfeeding and transitioning to fatherhood. The Parent Infant Feeding Initiative (PIFI) was a 4-arm, randomized controlled trial conducted in Perth, Australia. The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. The primary outcomes were duration of exclusive and any breastfeeding. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions.

Intervention Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers.

Conclusion: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports.

Study Design: RCT

Setting: Antenatal breastfeeding class/Online

Population of Focus: Couples from public and private hospitals in Perth, Australia

Sample Size: 1426 couples

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Telephone Support, Partner-Level Intervention, Professional Support,

Intervention Description: The study examines the effectiveness of a comprehensive, evidence-based, professional support intervention for breastfeeding that was implemented in the Netherlands: the Breastfeeding Support Program (BSP). The BSP tries to increase the proportion of mothers who breastfeed exclusively for six months or longer by positively influencing 1) the mother's attitude towards breastfeeding (by focusing on the positive effects of exclusive breastfeeding for 6 months or longer for mother and child), 2) the subjective norm (by explicitly involving the father and by forming a reliable source of support and positive messages about breastfeeding throughout the program), and 3) the mother's perceived behavioral control (by providing information, encouragement, and practical support to improve breastfeeding skills). The BSP combines both education and support, extends from pregnancy to the postnatal period, and uses a protocolled series of six individual consults delivered by an IBCLC. The sixth and final consult is held 10 weeks after delivery by telpehone and focuses on further support for returning to work.

Intervention Results: The effect of the BSP on survival rates for any and exclusive breastfeeding were significant while controlling for differences between the two groups at baseline (respectively HR = 0.34, p < .001 [95% CI = 0.18–0.61] and HR = 0.46, p < .001 [95% CI = 0.29–0.72]). Among mothers in the BSP group there was on average 66% less risk of cessation of any breastfeeding and on average 54% less risk of cessation of exclusive breastfeeding at any point in time compared to those in the control group.

Conclusion: The BSP appears to be an effective means to delay cessation of any and exclusive breastfeeding cessation and therefore to increase breastfeeding duration and exclusivity. This is an important finding, because earlier cessation of breastfeeding than desired is a common problem in many countries. Future research into the effectiveness of the BSP could consider random assignment to conditions and test the effectiveness of the intervention in other populations to investigate further whether wide-scale implementation of this intervention could be useful to promote breastfeeding.

Study Design: Quasi-experimental study

Setting: Breastfeeding Support Program in the Netherlands

Population of Focus: Pregnant women who were planning to breastfeed and who made a personal decision to enroll in the BSP

Sample Size: 138 women (66 mothers in the intervention group and 72 mothers in the control group)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Partner-Level Intervention

Intervention Description: A randomized controlled trial in which expectant fathers (n = 59) were assigned randomly to attend either a 2-hour intervention class on infant care and breastfeeding promotion (intervention) or a class on infant care only (control group). Couples were recruited during the second trimester from a university obstetrics practice.

Intervention Results: Overall, breastfeeding was initiated by 74% of women whose partners attended the intervention class, as compared with 41% of women whose partners attended the control class (P = .02).

Conclusion: Expectant fathers can be influential advocates for breastfeeding, playing a critical role in encouraging a woman to breastfeed her newborn infant.

Study Design: RCT

Setting: Johns Hopkins Hospital in Baltimore, MD

Population of Focus: Women who sought prenatal care at the resident and faculty practices

Data Source: Mother self-report

Sample Size: Intervention (n=27) Control (n=32)

Age Range: Not specified