The Effectiveness of Midwife-Led and Nurse-Led Interventions on Breastfeeding Self-Efficacy and Exclusive Breastfeeding Rates: A Systematic Review and Meta-Analysis

Abstract

Introduction:

Several factors influence breastfeeding, including breastfeeding self-efficacy, which can be enhanced through midwives’ or nurses’ interventions. While previous reviews have evaluated the effectiveness of programs targeting breastfeeding self-efficacy, none have specifically assessed the impact of nurse- or midwife-led interventions.

Research Aim:

To systematically review the literature and evaluate studies assessing the efficacy of nurse-led and midwife-led interventions on BSE and exclusive breastfeeding rates.

Methods:

This systematic review and meta-analysis, conducted per PRISMA guidelines, searched databases such as MEDLINE, Scopus, Web of Science, CINAHL, the Cochrane Database, and PsycINFO. We included randomized controlled trials enrolling healthy pregnant or postpartum women (P), comparing nurse‑ or midwife‑led interventions (I) with usual care (C). The primary outcome was breastfeeding self-efficacy; secondary outcomes were exclusive breastfeeding rates and exclusive breastfeeding duration (O). The Cochrane Risk of Bias Tool assessed study quality, and a random-effects meta-analysis calculated standardized mean differences for breastfeeding self-efficacy and risk ratio for exclusive breastfeeding.

Results:

A total of 21 randomized controlled trials encompassing 2,415 participants were identified, primarily conducted in Asia and the Middle East. The interventions significantly increased breastfeeding self-efficacy from 15 days (N = 1343; SMD = 1.75; 95% CI [0.94; 2.56], I² = 97%, p < 0.01) up to 6 months (N = 246; SMD: 0.56; 95% CI [0.31; 0.82]; I² = 0%, p = 0.48) postpartum and improved exclusive breastfeeding rates at 4 (N = 650; RR = 1.22; 95% CI [1.04; 1.41], I² = 0%, p = 0.48), 12 (N = 718; RR = 1.61; 95% CI [1.25; 2.08], I² = 52%, p = 0.05), and 20 weeks (N = 487; RR = 2.35; 95% CI [1.47; 3.76], I² = 52%, p = 0.06) postpartum. Subgroup analyses highlighted that interventions were particularly effective in the Middle East, during the immediate postpartum, with durations exceeding 1 day, and through mono-component strategies. However, substantial heterogeneity was observed across studies, driven by different geographical location, timing, duration, and intervention type.

Conclusion:

Postpartum support from nurses and midwives is vital for promoting breastfeeding. Results emphasize the importance of tailored, long-term interventions to improve maternal and infant health outcomes, with further research needed to align strategies with World Health Organization recommendations. However, the high heterogeneity observed for breastfeeding self-efficacy limits the certainty of the pooled estimate, and should be carefully considered when interpreting the results.