Abstract
In response to the Letter to the Editor 1 submitted by Diane Spatz, PhD and Nina Juntereal, PhD Candidate on March 1, 2023 concerning our article “Education and Experiences of Antenatal Breast Milk Expression: A Systematic Review.” 2
The main concerns appear to be that the review was presented as a systematic review rather than an integrative review and that similar work by the letter authors had not been included. We feel that on the first point, the authors are making an academic distinction, specifically between how nursing and medicine approach and label reviews. The review published could certainly be considered an integrative review given evidence from the nursing literature. Whittemore and Knafl note an “integrative review method is an approach that allows for the inclusion of diverse methodologies (i.e., experimental and non-experimental research).” 3 However, Whittemore also notes that these are reviews best designed for nursing and reviewing theories or defining concepts. M.E. Broome also focuses on integrative reviews in nursing and notes that they are “a review method that summarizes past empirical or theoretical literature to provide a more comprehensive understanding of a particular phenomenon or healthcare problem.” 4
By contrast systematic reviews in their most basic sense combine all pertinent studies found with a systematic search and standardized process of bias minimization. As stated in the Cochrane Handbook “A systematic review attempts to collate all the empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. 5 It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made.” Since we used a systematic approach to both collecting data and minimizing bias, this study fits the definition of a systematic review as found in the medical literature.
To the authors' second point of the studies not included in our review, the authors may have noted that our original search was done in March 2021, and as stated in our methods section we included titles from inception to March 21, 2021. Both of the authors' mentioned studies were published after this date, one in August 2021 and the other in September/October 2021, which explain why they were not included in our review. If the search had been updated before submission, these studies probably would have been found in the search strategy; however, there was less than a year between the search and the data pull, so it was deemed unnecessary. It may be noted that our search was also focused more on education, which may have also excluded these articles. The third study mentioned by Forster, et al. was found in the initial review and a full-text review was performed, but it was noted to be a wrong publication type. 6
Per the concerning errors in the article, the authors are correct to point out that the Soltani and Scott article is indeed a 2012 publication. 7 Upon review we noted that it is listed as such in our Rayyan database and our draft article, and appreciate them pointing out the clerical error that must have occurred before publication. We would also like to point out in agreement, that there is an error in table 4 of our article; that hand expression education was given between 20 and 36 weeks but that actual expression and storage did not start until 36 weeks, as stated later in the article by Connolly et al. 8 We do agree that this is important to note because all published research (as seen in the remainder of Table 4 articles) focus on starting antenatal milk expression at 36 or 37 weeks gestation.
We appreciate the time the authors took to read our review and provide feedback. We do acknowledge their concerns with our clerical errors and would like to provide the feedback aforementioned in agreement and correction. We appreciate that the field of Breastfeeding and Lactation Medicine and research on human milk is currently growing and developing and would never intentionally publish incorrect data or information that is not evidenced based.