PEARLS 109, August 2008, written by Brian R McAvoy

Clinical question
Is antenatal breast examination effective in promoting breastfeeding?

Bottom line
There is no evidence to support the notion that antenatal breast examinations are effective in promoting breastfeeding, nor any evidence of other potential beneficial effects, such as detection of breast anomalies, or satisfaction with care.

Caveat
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.

Context
Breastfeeding is beneficial for both mother and infant.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. However, no evidence has been found to support breast examination by a doctor, nurse or the woman as a primary screening technique for breast cancer.

Cochrane Systematic Review
Lee SJ and Thomas J. Antenatal breast examination for promoting breastfeeding. Cochrane Reviews 2008, Issue 3. Article No. CD006064. DOI: 10.1002/14651858. CD006064.pub2. No randomised controlled trials were identified by this review.