Effectiveness of breast pumps in early postpartum breastfeeding for women after cesarean section: A systematic review.

Aim: We sought to assess the effectiveness of using a breast pump for nipple stimulation to promote breastfeeding in the early postpartum period after c-section in women with full-term infants.

Methods: Selection criteria were individual and cluster randomized control trials and quasi-randomized control trials that compared using a breast pump combined with standard care to promote breastfeeding in the early postpartum period after c-section with standard care. In this systematic review, guided by the Cochrane Handbook, we conducted comprehensive searches across databases such as Medline, Embase, CINAHL, Cochrane Library, and PsycINFO (Search: April 22, 2024). We used the PRISMA flowchart for data extraction. Three review authors independently assessed trials for inclusion and risk of bias, outcome synthesis for Review Manager, and evidence quality evaluation for GRADE.

Results: We included four trials with 318 women and their infants. The trials took place in four countries. Women using a breast pump for nipple stimulation from the early postpartum period had an earlier onset of lactation of 19.57 h than women in standard care (mean difference [MD] -19.57 h, 95% confidential interval [CI] -26.18 to -12.96; participants = 143; studies = two; I = 20%; GRADE: moderate certainty of evidence).

Conclusion: Evidence supports the use of a breast pump to promote breastfeeding in the early postpartum period after c-section because it is effective in accelerating the timing of onset of lactation. Studies with large sample sizes focusing on feasibility and implementation in clinical practice are necessary to determine the ways of promoting breastfeeding after c-section.