How to promote exclusive breastfeeding with antenatal milk expression and implementation science: A mixed methods systematic review

Abstract

Background

Only 48 % of infants worldwide achieve the World Health Organization's recommendation of exclusive breastfeeding for the first six months of life. The leading cause of early breastfeeding cessation is self-reported milk insufficiency. Research into breastfeeding interventions that focus on promoting a person's confidence in their milk supply is therefore recommended.

Purpose

This systematic review aimed to explore whether antenatal milk expression could be optimized as a breastfeeding promotion intervention, using implementation science.

Methods

The Joanna Briggs Institute convergent segregated approach to mixed methods systematic reviews was used. A meta-aggregation and CERQual assessment of qualitative data was undertaken. Effect estimates of relevant quantitative data were summarized in forest plots. Results were organized into the following five implementation outcomes from an evidence-based framework: acceptability, appropriateness, adoption, feasibility, and fidelity.

Results

Of the 207 studies identified, 22 were included. A significant proportion of people will find the intervention acceptable, but those who do not will require additional ongoing support. Among people with diabetes, antenatal milk expression is associated with greater exclusive breastfeeding rates up to three months postpartum. Qualitative data described how antenatal milk expression may physically and psychologically prepare people for breastfeeding, encourage resilience, reassure individuals of their ability to produce milk and lead to a volume of stored colostrum.

Conclusions

There is evidence that antenatal milk expression may prevent early breastfeeding cessation among people with diabetes. Further quantitative research is needed to confirm the efficacy of antenatal milk expression for other groups. Optimal implementation requires training for relevant healthcare professionals, alongside education and ongoing support for the pregnant population.