Breastfeeding skills training for health care professionals: A systematic review.

Background: Breastfeeding is a public health issue and the response to the low rates in the Global North needs to be multi-faceted. Within this context healthcare professionals have an important role to play in the overall multi-dimensional promotion and support of breastfeeding. As a learned skill, there is a fundamental need to improve breastfeeding skills amongst healthcare professionals. Aim: To identify, analyse and evaluate studies on breastfeeding skills education for health care professionals. Methods: The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies from June 2006 to July 2021 that examined the provision of breastfeeding skills-based education for qualified or student healthcare professionals were included. A narrative synthesis was conducted, and risk of bias independently assessed by two reviewers. Findings: Of 5,497 papers originally identified, 11 were included in the review. Nine studies were interventional, whilst two were observational. Participants included paediatric residents, midwives, nurses, care co-ordinators and other health care staff. Training took place in classrooms, practical workshops, or clinical settings. Observational or experiential teaching components in combination with theoretical knowledge were found to produce better outcomes than classroom-based interventions. However, the findings need to be interpreted with caution due to the risk of bias regarding study design-specific criteria. Discussion: There is both a paucity of studies, and from those available, a lack of quality in terms of educational interventions specifically offering skills-based training to healthcare professionals. Breastfeeding education needs to incorporate practical breastfeeding skills not just theoretical training. Lack of standardisation currently exists across guiding frameworks, course content, educator qualification and assessment strategies which impedes the optimisation of breastfeeding education and subsequent support for mothers. Serious or high risk of bias was identified in all but one of the studies included in the review. Conclusion: There is a need for high quality research evidence to optimise the design and delivery of skills-based breastfeeding education for healthcare professionals. This would have the potential to contribute to the broad suite of interventions necessary to improve support for breastfeeding.