Abstract
Background
The rationale for antenatal breast examination has included the need to determine whether any problems with breastfeeding could be anticipated, using the time during examination as an opportunity for the healthcare provider to introduce and discuss the importance of breastfeeding, and for the detection of breast cancer during pregnancy. Despite these purported benefits of antenatal breast examination, whether there is evidence that it should be recommended for all pregnant women remains unclear.
Objectives
To determine the effect of antenatal breast examination(s) on the initiation of breastfeeding.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008).
Selection criteria
All randomised controlled trials of the effects of antenatal breast examination, with a concurrent comparison group.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data.
Main results
We identified no randomised controlled trials.
Authors' conclusions
Ideally, policies that govern the care of pregnant women should be evidence based. There is no doubt that breastfeeding is beneficial for both mother and infant. However, there is no evidence to support the notion that antenatal breast examinations are effective in promoting breastfeeding, nor any evidence on other potential effects of antenatal breast examination, such as the detection of breast anomalies or satisfaction with care.
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Plain language summary
Breast examination during pregnancy for promoting breastfeeding
The rationale for breast examination during pregnancy is to determine whether any problems with breastfeeding can be anticipated and to use the opportunity for the healthcare provider and pregnant woman to discuss breastfeeding. Examination by a healthcare provider is recommended in some countries. Breast examination can also be performed by the pregnant woman herself. Furthermore, breast examination during pregnancy has been recommended as a screening method for breast cancer, although no evidence has been found to support breast examination by a doctor, nurse or the woman as a primary screening technique for breast cancer. A woman’s breasts are often tender and swollen during pregnancy. This makes examination difficult and potentially compounds a woman's feelings of discomfort or vulnerability. Some women may find a clinical breast examination during pregnancy intrusive, and identification of flat or inverted nipples may actually act as a deterrent to breastfeeding. No randomised controlled trials were identified to guide a decision on whether antenatal breast examination promotes breastfeeding. Ideally, policies that govern the care of pregnant women should be evidence based and impact on any disease outcomes.
Background
Breast examination during pregnancy may be performed by a healthcare provider or by the pregnant woman herself. The rationale for antenatal breast examination has included the need to determine whether any problems with breastfeeding could be anticipated, using the time during examination as an opportunity for the healthcare provider to introduce and discuss the importance of breastfeeding, and for the detection of breast cancer during pregnancy. Despite these purported benefits of antenatal breast examination, whether there is evidence that it should be recommended for all pregnant women remains unclear.
Antenatal breast examination to determine whether any problems with breastfeeding could be anticipated typically included identification of the presence of flat or inverted nipples so that breast shells or nipple exercises (for example, Hoffman's exercises) could be prescribed to remedy the situation. Randomised controlled trials, however, have found that these interventions did not affect whether or not a woman was able to breastfeed successfully (Alexander 1992; MAIN 1994). Moreover, it was reported that 13% of the women approached during one of the trials who were intending to breastfeed decided not to breastfeed after being told that they had a potential problem (Alexander 1992). Therefore, antenatal breast examination for the purpose of treating flat or inverted nipples to prepare women for breastfeeding was not only found to be ineffective, but it may also act as a deterrent to breastfeeding. A Cochrane protocol assessing the effectiveness of nipple care on the duration of breastfeeding has been published (Blyth 2004).
More recently, in developed countries in particular, it has been hypothesised that as more women postpone childbirth until later in life, breast cancer in pregnancy will become an increasing concern ( Woo 2003). Thus, antenatal breast examination has been recommended as a screening method for breast cancer during pregnancy. In countries where national breast screening programmes are in place, however, it is only routinely offered to women aged 50