Beyond Delivery: Midwife Support as a Determinant of Exclusive Breastfeeding Practices —A Scoping Review

Abstract

Background: Despite robust evidence of its benefits, global exclusive breastfeeding (EBF) rates remain below the World Health Assembly target of 50% by 2025. While midwives are the primary healthcare professionals accompanying women throughout the perinatal continuum, their role as a determinant of EBF is rarely examined beyond the moment of birth. This review sought to map how midwifery support influences EBF practices globally. Methods: A scoping review was conducted following the PRISMA-ScR framework. Systematic searches were performed across ScienceDirect, Scopus, Springer Nature, EBSCOhost, and Google Scholar, retrieving studies published within the past ten years that examined midwifery support in relation to EBF outcomes. Eight studies from six countries met the inclusion criteria and were subjected to thematic analysis. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools appropriate to each study design. Results: Three major themes emerged: (1) structural models of extended postnatal support, in which continuity of care, home-based, and community-based midwifery interventions were associated with higher EBF rates; (2) the nature of support, revealing that holistic, relational care was more effective than task-oriented technical guidance in fostering maternal self-efficacy; and (3) determinants and barriers, including workforce shortages, heavy workloads, shortened hospital stays, and sociocultural family dynamics that constrain effective midwifery support. Conclusions: Midwifery support is a multidimensional and modifiable determinant of EBF that extends far beyond delivery. Realising its full potential requires structurally sustained care models, self-efficacy-informed practice, adequate workforce resourcing, and family-inclusive counselling approaches.