Doctors and hospitals should continue encouraging new mothers to breastfeed their children, an independent panel of experts has concluded, but some common strategies might need to be abandoned.

On Wednesday, the US Preventive Services Task Force (USPSTF) issued their final recommendations on how to promote breastfeeding within hospitals following a delivery. They reviewed the available evidence, and found support that interventions to promote breastfeeding work, however, only individual-level support, such as peer counseling, seemed to encourage women to breastfeed. Other hospital-wide interventions, such as recommending every mother avoid using formula and pacifiers, had no significant effect on breastfeeding rates.

“There is adequate evidence that interventions to support breastfeeding change behavior...,” the USPSTF’s recommendation statement, published in JAMA, read. The task force concluded that interventions have a moderate net benefit. 

While the overall news is good, the task force noted that no single intervention proved to be especially effective at encouraging breastfeeding, and women still don't breastfeed long enough. Eighty percent of new mothers breastfed their children soon after delivery in 2012, but only about half continued doing so at six months, and less than a third after a year.

Outdated Advice?

Bringing these rates up will require improving strategies that work and discarding those that don’t, noted an accompanying JAMA editorial authored by Dr. Valerie Flaherman and Dr. Isabelle Von Kohorn.

For instance, telling women to avoid pacifiers is bad advice because pacifiers can reduce the risk of sudden infant death syndrome, the most common cause of death among newborns. “Thus, routine counseling to avoid pacifiers may very well be ethically problematic,” they wrote.

And telling women to exclusively breastfeed for six months may lead to dehydrated babies because mothers can have trouble providing milk in the first days following delivery, or even later. Other research has shown that exposing children to common allergenic foods like peanut by the time they’re 4 to 6 months old can prevent later allergies, further evidence against exclusive breastfeeding. Forty-three percent of women reported only breastfeeding for the first six months, the USPSTF said.

Both recommendations are promoted by the World Health Organization (WHO), as part of their Baby-Friendly Hospital Initiative (BFHI). The initiative features 10 policy steps to improve breastfeeding rates, and hospitals can receive a BFHI certification by adhering to them. Other organizations such as the American College of Obstetricians and Gynecologists have similarly endorsed the WHO’s recommendations.

While there’s some research showing that BFHI recommendations can improve breastfeeding rates in specific groups of women, the USPSTF declined to include these studies in their review, since they didn’t meet their criteria.

“To improve breastfeeding rates in the United States, further implementation of system-level interventions such as the BFHI for the general population should be reconsidered until good-quality evidence emerges that these interventions are safe and effective,” concluded Flaherman and Von Kohorn.

Rather than rely on universal guidelines, they added, doctors should tailor their breastfeeding pitch to patients individually, based on their needs, concerns, and even work environment. Making sure women get access to counseling or breastfeeding education before and after their pregnancy may also help women feel more comfortable with it, both they and the USPSTF said.

Children regularly breastfed are known to be at lower risk of many health problems, such as childhood infections and asthma. There's also evidence that it may steer them away from later chronic conditions like obesity and diabetes.    

Sources:

US Preventive Services Task Force. Primary Care Interventions to Support Breastfeeding: US Preventive Services Task Force Recommendation Statement. JAMA. 2016.

Flaherman V, Von Kohorn I. Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms. JAMA. 2016.