Nine studies were included in the review. All studies used before-and-after designs that included education of health care professional. All studies had problems with various aspects of study quality. No studies were identified that assessed breast feeding counsellors.
Educational interventions for healthcare professionals that aimed to increase knowledge and support breast feeding (six studies). These studies showed a statistically significant increase in the proportion of women who reported exclusive breast feeding at discharge, full breast feeding at three months and any breast feeding at six months (actual values not provided , p<0.05) after the introduction in eight hospitals of the 18 hour United Nations Childrens' Fund (UNICEF) training to prepare for the Baby Friendly Hospital Initiative (BFI) (one study, 571 health workers, 2,669 mother-baby pairs). Another study (73 midwives and paediatricians; 50 mother-baby pairs before and 50 after) of a similar intervention performed in a teaching hospital was of higher methodological quality and showed no effect on breast feeding duration, although there was a reduction in babies separated from their mothers overnight and use of formula feed in hospital. Four other studies showed mixed results.
Teaching of "hands-off" technique to hospital midwives and healthcare assistants (one study, 1,400 mothers). At two weeks after discharge there was a statistically significant increase in any breast feeding and in exclusive breast feeding (p=0.005, actual values not reported). However, at six weeks there was no significant difference.
Changing maternity unit philosophy (one study; 325 mother-baby pairs before and 325 after). At six days after discharge there was an increased in exclusive breast feeding (48% before, 90% after) and a decrease in mixed feeding (37% before, 7% after) and bottle feeding (15% before, 3% after) (statistical significance not reported).
Introduction of evidence-based guidelines supported by other strategies (one study; 702 mother before and 866 after). There was no significant difference in breast feeding initiation or duration or the number of babies readmitted to hospital, but there was an increase in readmission due to jaundice (statistical significance not reported).