Effectiveness of Nurse- and Midwife-Led Lactation Counseling on Exclusive Breastfeeding Rates: A Systematic Review and Evidence Synthesis

Effectiveness of Nurse- and Midwife-Led Lactation Counseling on Exclusive Breastfeeding Rates: A Systematic Review and Evidence Synthesis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Effectiveness of Nurse- and Midwife-Led Lactation Counseling on Exclusive Breastfeeding Rates: A Systematic Review and Evidence Synthesis Mekala Moorthy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9398160/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Exclusive breastfeeding (EBF) for the first six months of life provides optimal nutrition and immune protection for infants; however, global adherence remains suboptimal. Nurses and midwives play a pivotal role in promoting breastfeeding through structured counseling and continuous support. Aim To systematically evaluate the effectiveness of nurse- and midwife-led lactation counseling on exclusive breastfeeding rates and to identify intervention components associated with improved maternal and infant outcomes. Methods A systematic search of PubMed (MEDLINE), Scopus, and Google Scholar was conducted for studies published between January 2020 and December 2025. Eligible studies included nurse- or midwife-led structured counseling, peer support, or digital/telehealth interventions reporting measurable exclusive breastfeeding outcomes. Study selection followed PRISMA 2020 guidelines. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Due to heterogeneity in study designs, intervention modalities, and outcome assessment time points, findings were narratively synthesized. Results Thirteen studies conducted across Asia, Europe, Africa, and North America met the inclusion criteria. Study designs included randomized controlled trials, quasi-experimental studies, cross-sectional studies, and cluster randomized trials. Structured nurse- and midwife-led counseling was associated with a 10–30% increase in exclusive breastfeeding rates at follow-up periods ranging from six weeks to six months postpartum. Interventions combining antenatal and postnatal counseling demonstrated greater effectiveness than isolated postnatal interventions. Peer-supported and group-based counseling enhanced maternal breastfeeding self-efficacy and confidence, while digital and telehealth interventions improved accessibility and continuity of lactation support. Conclusions Nurse- and midwife-led lactation counseling is an effective strategy for improving exclusive breastfeeding rates and maternal psychosocial outcomes. Multimodal interventions integrating structured counseling with peer and digital support appear most beneficial. Strengthening nurse- and midwife-led breastfeeding support within routine maternal care may contribute to improved maternal and child health outcomes. These findings support integration of structured nurse- and midwife-led lactation interventions into routine maternal care systems. Obstetrics & Gynecology Exclusive breastfeeding nurse-led counseling midwife-led interventions lactation support maternal self-efficacy digital health Figures Figure 1 Contribution of the Paper What is already known Nurse- and midwife-led lactation counseling improves breastfeeding confidence and maternal self-efficacy. Structured counseling and peer support positively influence exclusive breastfeeding rates. Digital breastfeeding interventions enhance accessibility and continuity of lactation support. What this paper adds Synthesizes recent international evidence (2020–2025) demonstrating that nurse- and midwife-led counseling increases exclusive breastfeeding rates by 10–30%. Highlights that interventions combining structured counseling with peer and digital support yield the most consistent improvements in breastfeeding outcomes. Identifies workload, limited formal training, and cultural misconceptions as key barriers affecting the effectiveness of nurse- and midwife-led breastfeeding support. Introduction Exclusive breastfeeding (EBF) for the first six months of life is universally recognized as the optimal infant feeding practice, providing complete nutrition and protection against infectious diseases. Despite strong global recommendations, exclusive breastfeeding rates remain suboptimal in many regions. In India, fewer than two-thirds of infants are exclusively breastfed for the recommended duration, indicating persistent gaps in breastfeeding support and maternal education. Nurses and midwives occupy a central position in maternal and newborn care and are uniquely placed to influence breastfeeding practices through education, counseling, and sustained follow-up. Evidence suggests that mothers receiving professional breastfeeding counseling from nurses or midwives are significantly more likely to initiate and maintain exclusive breastfeeding. In recent years, peer support models and digital health technologies have expanded the scope of lactation counseling beyond traditional face-to-face interactions. This systematic review evaluates the effectiveness of nurse- and midwife-led lactation counseling in improving exclusive breastfeeding rates and identifies intervention characteristics that enhance maternal and infant outcomes. Methods Search Strategy A comprehensive systematic search was conducted in PubMed (MEDLINE), Scopus, and Google Scholar to identify relevant studies published between January 2020 and December 2025. These databases were selected to ensure broad coverage of biomedical, nursing, and public health literature. The review adhered to PRISMA 2020 reporting guidelines. The search strategy combined Medical Subject Headings (MeSH) and free-text terms. The PubMed search strategy was: (“exclusive breastfeeding” OR “breastfeeding” OR “infant feeding”) AND (“nurse-led” OR “midwife-led” OR “nursing intervention” OR “lactation counseling”) AND (“counseling” OR “education” OR “support”). The strategy was adapted for Scopus and Google Scholar. Reference lists of included studies were manually screened to identify additional eligible articles. Inclusion Criteria Nurse- or midwife-led breastfeeding interventions Structured counseling, peer support, or digital/telehealth interventions Quantitative, qualitative, or mixed-methods studies reporting exclusive breastfeeding outcomes English-language publications Exclusion Criteria Studies without nursing or midwifery involvement Studies not reporting exclusive breastfeeding outcomes Editorials, commentaries, or opinion pieces without primary data Non-English publications Screening and Selection Screening and selection were conducted independently by the author. Thirty-three records were identified through database searching. No additional records were identified through other sources. After removal of duplicates and title/abstract screening, 17 full-text articles were assessed for eligibility. Four studies were excluded due to lack of nursing involvement (n = 2), absence of exclusive breastfeeding outcomes (n = 1), or editorial format (n = 1). Thirteen studies were included in the final review. The study selection process is presented in Fig. 1 in accordance with PRISMA 2020 guidelines. Data Extraction Data extracted included author, year, country, study design, sample size, intervention description, outcome measures, timing of outcome assessment, and key findings. Quality Assessment Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools appropriate to each study design. All included studies met minimum quality criteria. Data Synthesis Due to heterogeneity in study designs, intervention components, outcome measures, and timing of assessment, meta-analysis was not feasible. A narrative synthesis was therefore undertaken. Protocol Registration Protocol Registration This review was not prospectively registered; however, PRISMA 2020 guidelines were followed. Results Characteristics of Included Studies The 13 included studies were conducted in Asia, Europe, Africa, and North America. Study designs included randomized controlled trials (n = 6), quasi-experimental studies (n = 3), cross-sectional studies (n = 2), and cluster randomized controlled trials (n = 2). Sample sizes ranged from 120 to 382 participants. The characteristics of the included studies are summarized in Table 1 . Table 1 Characteristics of Included Studies Author (Year) Country Study design Sample size Intervention description Outcome measures Timing of outcome assessment Karimi & Maleki (2024) Iran RCT 180 Structured nurse-led antenatal and postnatal breastfeeding counseling EBF rate, maternal confidence 1, 3, 6 months Şimşek-Çetinkaya et al. ( 2024 ) Turkey RCT 152 Midwife-led individualized counseling EBF, breastfeeding self-efficacy 6 weeks, 3 months Fallah Karimi et al. ( 2025 ) Iran Quasi-experimental 200 Nurse-led group education with follow-up EBF rate 3, 6 months Rodríguez-Gallego et al. ( 2024 a) Spain Cluster RCT 240 Midwife-led structured antenatal counseling EBF, maternal satisfaction 1, 6 months Rodríguez-Gallego et al. ( 2024 b) Spain RCT 198 Postnatal counseling + peer groups EBF, self-efficacy 3 months Yang et al. ( 2024 ) China RCT 300 Nurse-led mobile app counseling EBF rate 1, 3, 6 months Deybasso et al. ( 2024 ) Ethiopia Cross-sectional 382 Facility-based nurse counseling EBF prevalence 6 months Bengough et al. ( 2022 ) USA Quasi-experimental 145 Nurse-coordinated peer support EBF continuation 3 months Keenan-Devlin et al. ( 2024 ) USA Cluster RCT 210 Multicomponent nurse-led support EBF rate Discharge, 6 weeks McGovern et al. ( 2024 ) Ireland RCT 168 Midwife-led behavioral intervention EBF, maternal behavior 3, 6 months Ramadan et al. ( 2025 ) Egypt RCT 190 Nurse-led structured counseling EBF rate 6 weeks, 3 months Acheampong & Abukari ( 2021 ) Ghana Cross-sectional 120 Community nurse education EBF prevalence 6 months He et al. ( 2025 ) China RCT 260 Nurse-led telehealth follow-up EBF rate 1, 3, 6 months Effectiveness of Nurse- and Midwife-Led Counseling Structured counseling delivered by nurses or midwives consistently improved exclusive breastfeeding rates, with reported increases ranging from 10% to 30%. Interventions initiated antenatally and continued postnatally were more effective than postnatal-only counseling. Peer and Digital Interventions Peer-supported and group-based counseling enhanced maternal confidence and self-efficacy and reduced postpartum anxiety. Digital and telehealth interventions improved access and continuity of lactation support, though challenges related to digital literacy were noted. Barriers and Facilitators Barriers included high workload, limited training, cultural misconceptions, and institutional constraints. Facilitators included ongoing education, supportive policies, peer mentorship, and digital tools. Discussion This review shows that nurse- and midwife-led lactation counseling is effective in improving exclusive breastfeeding rates and maternal confidence. Structured interventions consistently demonstrated positive outcomes across different settings. Interventions that began during the antenatal period and continued postnatally were more effective than those limited to the postnatal period, highlighting the importance of continuity of care. Peer support and digital interventions also contributed to improved breastfeeding practices by enhancing accessibility and ongoing support. However, challenges such as high workload, limited training, and cultural misconceptions may affect the implementation of these interventions. Addressing these barriers through better training, institutional support, and integration into routine maternal care is important. Overall, strengthening nurse- and midwife-led lactation counseling can help improve breastfeeding outcomes and support maternal and child health. Limitations Heterogeneity in study designs and outcome measures limited meta-analysis. Restriction to English-language publications may have excluded relevant studies. Although not registered in PROSPERO, methodological rigor was maintained through PRISMA-guided reporting and structured quality appraisal. Implications for Practice Integrate structured nurse- and midwife-led counseling into routine care Use peer and digital support to enhance continuity Invest in professional lactation training Implications for Research Standardize outcome measures Conduct long-term and implementation studies Conclusions Nurse- and midwife-led lactation counseling significantly improves exclusive breastfeeding rates and maternal self-efficacy. Multimodal, continuity-based approaches should be integrated into routine maternal healthcare to optimize breastfeeding outcomes globally. Abbreviations EBF Exclusive breastfeeding IBCLC International Board Certified Lactation Consultant JBI Joanna Briggs Institute PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses WHO World Health Organization Declarations Ethics approval and consent to participate Not applicable. Ethical approval was not required for this study as it is a systematic review based on previously published literature. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article and its supplementary information files. Competing interests The author declares that she has no competing interests. Funding No specific funding was received for this study. Authors’ contributions MM conceptualized the study, conducted the literature search, screening, data extraction, and quality appraisal, performed the data synthesis, and drafted the manuscript. The author read and approved the final manuscript. Acknowledgements The author acknowledges institutional access to electronic databases and thanks colleagues who provided methodological guidance during the review process. References Karimi M, Maleki A, Rastegari L (2024) Effect of structured breastfeeding counseling on exclusive breastfeeding. BMC Pregnancy Childbirth 24:376. 10.1186/s12884-024-06572-2 Şimşek-Çetinkaya Ş, Gümüş Çalış G, Kıbrıs Ş (2024) Effectiveness of midwife-led breastfeeding counseling. J Hum Lact 40(1):101–112. 10.1177/08903344231210813 Fallah Karimi S, Robabi H, Khalilzadeh Farsangi Z (2025) Nurse-led breastfeeding education and outcomes. BMC Pregnancy Childbirth 25:797. 10.1186/s12884-025-07955-9 Rodríguez-Gallego I, Vila-Candel R, Corrales-Gutiérrez I, Gómez-Baya D, León-Larios F (2024) Breastfeeding interventions in maternal care. Nutrients 16(2):227. 10.3390/nu16020227 Rodríguez-Gallego I, Corrales-Gutiérrez I, Gómez-Baya D, León-Larios F (2024) Peer-supported breastfeeding interventions. Nutrients 16(7):988. 10.3390/nu16070988 Yang Y, Liu H, Cui X, Meng J (2024) Digital breastfeeding counseling by nurses. Int Breastfeed J 19:7. 10.1186/s13006-024-00614-3 Deybasso HA, Begi SK, Lenjiso BD et al (2024) Facility-based breastfeeding counseling. SAGE Open Med 12:20503121241256810. 10.1177/20503121241256810 Bengough T, Dawson S, Cheng HL et al (2022) Peer-supported breastfeeding continuation. Matern Child Nutr 18(4):e13405. 10.1111/mcn.13405 Keenan-Devlin LS, Smart BP, Hirschhorn L et al (2024) Nurse-led perinatal breastfeeding support. Am J Perinatol 41(S01):e2313–e2325. 10.1055/s-0043-1771255 McGovern LM, O’Toole L, Laws RA et al (2024) Behavioral interventions for breastfeeding. Int J Behav Nutr Phys Act 21:95. 10.1186/s12966-024-01641-3 Ramadan OME, Alshammari AM, Alruwaili AN et al (2025) Structured counseling and breastfeeding outcomes. BMC Pregnancy Childbirth 25:1066. 10.1186/s12884-025-08236-1 Acheampong AK, Abukari AS (2021) Community-based breastfeeding education. Int Breastfeed J 16:74. 10.1186/s13006-021-00421-0 He Y, He X, Bao X et al (2025) Telehealth lactation follow-up by nurses. BMC Pregnancy Childbirth 25:1030. 10.1186/s12884-025-08094-x Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Despite strong global recommendations, exclusive breastfeeding rates remain suboptimal in many regions. In India, fewer than two-thirds of infants are exclusively breastfed for the recommended duration, indicating persistent gaps in breastfeeding support and maternal education.\u003c/p\u003e \u003cp\u003eNurses and midwives occupy a central position in maternal and newborn care and are uniquely placed to influence breastfeeding practices through education, counseling, and sustained follow-up. Evidence suggests that mothers receiving professional breastfeeding counseling from nurses or midwives are significantly more likely to initiate and maintain exclusive breastfeeding. In recent years, peer support models and digital health technologies have expanded the scope of lactation counseling beyond traditional face-to-face interactions.\u003c/p\u003e \u003cp\u003eThis systematic review evaluates the effectiveness of nurse- and midwife-led lactation counseling in improving exclusive breastfeeding rates and identifies intervention characteristics that enhance maternal and infant outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy\u003c/h2\u003e \u003cp\u003eA comprehensive systematic search was conducted in PubMed (MEDLINE), Scopus, and Google Scholar to identify relevant studies published between January 2020 and December 2025. These databases were selected to ensure broad coverage of biomedical, nursing, and public health literature. The review adhered to PRISMA 2020 reporting guidelines.\u003c/p\u003e \u003cp\u003eThe search strategy combined Medical Subject Headings (MeSH) and free-text terms. The PubMed search strategy was:\u003c/p\u003e \u003cp\u003e(\u0026ldquo;exclusive breastfeeding\u0026rdquo; OR \u0026ldquo;breastfeeding\u0026rdquo; OR \u0026ldquo;infant feeding\u0026rdquo;) AND\u003c/p\u003e \u003cp\u003e(\u0026ldquo;nurse-led\u0026rdquo; OR \u0026ldquo;midwife-led\u0026rdquo; OR \u0026ldquo;nursing intervention\u0026rdquo; OR \u0026ldquo;lactation counseling\u0026rdquo;) AND\u003c/p\u003e \u003cp\u003e(\u0026ldquo;counseling\u0026rdquo; OR \u0026ldquo;education\u0026rdquo; OR \u0026ldquo;support\u0026rdquo;).\u003c/p\u003e \u003cp\u003eThe strategy was adapted for Scopus and Google Scholar. Reference lists of included studies were manually screened to identify additional eligible articles.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eNurse- or midwife-led breastfeeding interventions\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStructured counseling, peer support, or digital/telehealth interventions\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQuantitative, qualitative, or mixed-methods studies reporting exclusive breastfeeding outcomes\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEnglish-language publications\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies without nursing or midwifery involvement\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies not reporting exclusive breastfeeding outcomes\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEditorials, commentaries, or opinion pieces without primary data\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNon-English publications\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eScreening and Selection\u003c/h3\u003e\n\u003cp\u003eScreening and selection were conducted independently by the author. Thirty-three records were identified through database searching. No additional records were identified through other sources. After removal of duplicates and title/abstract screening, 17 full-text articles were assessed for eligibility. Four studies were excluded due to lack of nursing involvement (n\u0026thinsp;=\u0026thinsp;2), absence of exclusive breastfeeding outcomes (n\u0026thinsp;=\u0026thinsp;1), or editorial format (n\u0026thinsp;=\u0026thinsp;1). Thirteen studies were included in the final review. The study selection process is presented in Fig.\u0026nbsp;1 in accordance with PRISMA 2020 guidelines.\u003c/p\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eData extracted included author, year, country, study design, sample size, intervention description, outcome measures, timing of outcome assessment, and key findings.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuality Assessment\u003c/h2\u003e \u003cp\u003eMethodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools appropriate to each study design. All included studies met minimum quality criteria.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Synthesis\u003c/h3\u003e\n\u003cp\u003eDue to heterogeneity in study designs, intervention components, outcome measures, and timing of assessment, meta-analysis was not feasible. A narrative synthesis was therefore undertaken.\u003c/p\u003e\n\u003ch3\u003eProtocol Registration\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eProtocol Registration\u003c/div\u003e \u003cp\u003eThis review was not prospectively registered; however, PRISMA 2020 guidelines were followed.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of Included Studies\u003c/h2\u003e \u003cp\u003eThe 13 included studies were conducted in Asia, Europe, Africa, and North America. Study designs included randomized controlled trials (n\u0026thinsp;=\u0026thinsp;6), quasi-experimental studies (n\u0026thinsp;=\u0026thinsp;3), cross-sectional studies (n\u0026thinsp;=\u0026thinsp;2), and cluster randomized controlled trials (n\u0026thinsp;=\u0026thinsp;2). Sample sizes ranged from 120 to 382 participants.\u003c/p\u003e \u003cp\u003eThe characteristics of the included studies are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Included Studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntervention description\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOutcome measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTiming of outcome assessment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKarimi \u0026amp; Maleki (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStructured nurse-led antenatal and postnatal breastfeeding counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF rate, maternal confidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1, 3, 6 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eŞimşek-\u0026Ccedil;etinkaya et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMidwife-led individualized counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF, breastfeeding self-efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 weeks, 3 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFallah Karimi et al. 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(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003ea)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCluster RCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMidwife-led structured antenatal counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF, maternal satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1, 6 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRodr\u0026iacute;guez-Gallego et al. 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(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFacility-based nurse counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBengough et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQuasi-experimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurse-coordinated peer support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF continuation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKeenan-Devlin et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCluster RCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMulticomponent nurse-led support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDischarge, 6 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMcGovern et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIreland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMidwife-led behavioral intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF, maternal behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3, 6 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRamadan et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEgypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurse-led structured counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 weeks, 3 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcheampong \u0026amp; Abukari (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunity nurse education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHe et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNurse-led telehealth follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEBF rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1, 3, 6 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eEffectiveness of Nurse- and Midwife-Led Counseling\u003c/h2\u003e \u003cp\u003eStructured counseling delivered by nurses or midwives consistently improved exclusive breastfeeding rates, with reported increases ranging from 10% to 30%. Interventions initiated antenatally and continued postnatally were more effective than postnatal-only counseling.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePeer and Digital Interventions\u003c/h2\u003e \u003cp\u003ePeer-supported and group-based counseling enhanced maternal confidence and self-efficacy and reduced postpartum anxiety. Digital and telehealth interventions improved access and continuity of lactation support, though challenges related to digital literacy were noted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eBarriers and Facilitators\u003c/h2\u003e \u003cp\u003eBarriers included high workload, limited training, cultural misconceptions, and institutional constraints. Facilitators included ongoing education, supportive policies, peer mentorship, and digital tools.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review shows that nurse- and midwife-led lactation counseling is effective in improving exclusive breastfeeding rates and maternal confidence. Structured interventions consistently demonstrated positive outcomes across different settings. Interventions that began during the antenatal period and continued postnatally were more effective than those limited to the postnatal period, highlighting the importance of continuity of care. Peer support and digital interventions also contributed to improved breastfeeding practices by enhancing accessibility and ongoing support.\u003c/p\u003e \u003cp\u003eHowever, challenges such as high workload, limited training, and cultural misconceptions may affect the implementation of these interventions. Addressing these barriers through better training, institutional support, and integration into routine maternal care is important. Overall, strengthening nurse- and midwife-led lactation counseling can help improve breastfeeding outcomes and support maternal and child health.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eHeterogeneity in study designs and outcome measures limited meta-analysis. Restriction to English-language publications may have excluded relevant studies. Although not registered in PROSPERO, methodological rigor was maintained through PRISMA-guided reporting and structured quality appraisal.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIntegrate structured nurse- and midwife-led counseling into routine care\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eUse peer and digital support to enhance continuity\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eInvest in professional lactation training\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Research\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStandardize outcome measures\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eConduct long-term and implementation studies\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eNurse- and midwife-led lactation counseling significantly improves exclusive breastfeeding rates and maternal self-efficacy. Multimodal, continuity-based approaches should be integrated into routine maternal healthcare to optimize breastfeeding outcomes globally.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEBF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExclusive breastfeeding\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIBCLC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Board Certified Lactation Consultant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJoanna Briggs Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRISMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch3\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eNot applicable. Ethical approval was not required for this study as it is a systematic review based on previously published literature.\u003c/p\u003e\n\n\u003ch3\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\n\u003ch3\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\n\u003ch3\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe author declares that she has no competing interests.\u003c/p\u003e\n\n\u003ch3\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eNo specific funding was received for this study.\u003c/p\u003e\n\u003ch3\u003e\u003c/h3\u003e\n\u003ch3\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eMM conceptualized the study, conducted the literature search, screening, data extraction, and quality appraisal, performed the data synthesis, and drafted the manuscript. The author read and approved the final manuscript.\u003c/p\u003e\n\n\u003ch3\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe author acknowledges institutional access to electronic databases and thanks colleagues who provided methodological guidance during the review process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKarimi M, Maleki A, Rastegari L (2024) Effect of structured breastfeeding counseling on exclusive breastfeeding. BMC Pregnancy Childbirth 24:376. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12884-024-06572-2\u003c/span\u003e\u003cspan address=\"10.1186/s12884-024-06572-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŞimşek-\u0026Ccedil;etinkaya Ş, G\u0026uuml;m\u0026uuml;ş \u0026Ccedil;alış G, Kıbrıs Ş (2024) Effectiveness of midwife-led breastfeeding counseling. J Hum Lact 40(1):101\u0026ndash;112. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/08903344231210813\u003c/span\u003e\u003cspan address=\"10.1177/08903344231210813\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFallah Karimi S, Robabi H, Khalilzadeh Farsangi Z (2025) Nurse-led breastfeeding education and outcomes. 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Int Breastfeed J 19:7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13006-024-00614-3\u003c/span\u003e\u003cspan address=\"10.1186/s13006-024-00614-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeybasso HA, Begi SK, Lenjiso BD et al (2024) Facility-based breastfeeding counseling. SAGE Open Med 12:20503121241256810. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/20503121241256810\u003c/span\u003e\u003cspan address=\"10.1177/20503121241256810\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBengough T, Dawson S, Cheng HL et al (2022) Peer-supported breastfeeding continuation. 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Int Breastfeed J 16:74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13006-021-00421-0\u003c/span\u003e\u003cspan address=\"10.1186/s13006-021-00421-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe Y, He X, Bao X et al (2025) Telehealth lactation follow-up by nurses. BMC Pregnancy Childbirth 25:1030. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12884-025-08094-x\u003c/span\u003e\u003cspan address=\"10.1186/s12884-025-08094-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Exclusive breastfeeding, nurse-led counseling, midwife-led interventions, lactation support, maternal self-efficacy, digital health","lastPublishedDoi":"10.21203/rs.3.rs-9398160/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9398160/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eExclusive breastfeeding (EBF) for the first six months of life provides optimal nutrition and immune protection for infants; however, global adherence remains suboptimal. Nurses and midwives play a pivotal role in promoting breastfeeding through structured counseling and continuous support.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo systematically evaluate the effectiveness of nurse- and midwife-led lactation counseling on exclusive breastfeeding rates and to identify intervention components associated with improved maternal and infant outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA systematic search of PubMed (MEDLINE), Scopus, and Google Scholar was conducted for studies published between January 2020 and December 2025. Eligible studies included nurse- or midwife-led structured counseling, peer support, or digital/telehealth interventions reporting measurable exclusive breastfeeding outcomes. Study selection followed PRISMA 2020 guidelines. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Due to heterogeneity in study designs, intervention modalities, and outcome assessment time points, findings were narratively synthesized.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThirteen studies conducted across Asia, Europe, Africa, and North America met the inclusion criteria. Study designs included randomized controlled trials, quasi-experimental studies, cross-sectional studies, and cluster randomized trials. Structured nurse- and midwife-led counseling was associated with a 10\u0026ndash;30% increase in exclusive breastfeeding rates at follow-up periods ranging from six weeks to six months postpartum. Interventions combining antenatal and postnatal counseling demonstrated greater effectiveness than isolated postnatal interventions. Peer-supported and group-based counseling enhanced maternal breastfeeding self-efficacy and confidence, while digital and telehealth interventions improved accessibility and continuity of lactation support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNurse- and midwife-led lactation counseling is an effective strategy for improving exclusive breastfeeding rates and maternal psychosocial outcomes. Multimodal interventions integrating structured counseling with peer and digital support appear most beneficial. Strengthening nurse- and midwife-led breastfeeding support within routine maternal care may contribute to improved maternal and child health outcomes. These findings support integration of structured nurse- and midwife-led lactation interventions into routine maternal care systems.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Nurse- and Midwife-Led Lactation Counseling on Exclusive Breastfeeding Rates: A Systematic Review and Evidence Synthesis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 15:14:02","doi":"10.21203/rs.3.rs-9398160/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f0b9dfe-22e0-406b-a210-bc110be3f2cc","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":66175714,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2026-04-14T15:14:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 15:14:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9398160","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9398160","identity":"rs-9398160","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}