Intervention Strategies for Successful Breast Feeding: Randomized Clinical Trial-Juniper Publishers
Juniper Publishers-Journal of Pediatrics
Abstract
Breastfeeding is one of the most natural and
beneficial acts a mother can do for her child. There are many possible
nipple problems that breastfeeding mothers may encounter. The 7mm nipple
length might be a possible screening indicator that would signal the
clinician to provide more intensive breastfeeding monitoring
(puapornpong, 2013).
Objectives: Comparison of selected nursing
interventions like manual technique, rubber band and syringe method on
successful breastfeeding pattern among the antenatal mothers.
Methodology: Randomized clinical trial study
was conducted among 90 women having nipple problem, 30 in each group
i.e., group I(manual technique), group II (rubber band) and group III
(syringe method) in the selected government maternity hospital,
Pondicherry, India. Samples were selected by simple random sampling. The
outcome of study was evaluated by Descriptive and Inferential
statistics.
Results: The demographic variables shows that
majority of the women 26(86.70%), 23(76.70%) and 23(76.70%) were in the
age group of 19-25 in group I, II, III respectively. 13(43.3%) women in
group I, 13(43.3%) in group II and 18(60% ) in group III, ware studied
up to High School level. Result on breast feeding pattern shows that
there was improvement in feeding. Mothers not faced any difficulties for
feeding the baby after delivery. Each intervention strategy shows
equally good in case of nipple problem.
Conclusion and recommendation: These
intervention strategies are very simple and cost effective, so this can
be practiced in all settings to correct the nipple problems.
Keywords: Nursing interventions; Successful breast feeding; Intervention strategies; Antenatal mothersIntroduction
Breast milk is best for the baby, and the benefits
ofbreastfeeding will extend well beyond basic nutrition. Breastfeeding
is one of the most natural and beneficial acts a mother can do for her
child. There is no other single action by which a mother can so impact
the present and future health of her baby [1].
Colostrums is the first milk, yellow in color secreted by breast soon
after delivery. Dramatic health benefits have been proven to pass from
mother to child through breast milk. Breast milk is packed with
disease-fighting substances that protect the baby from illness [2].
Breastfeeding currently saves six million of lives each year preventing
diarrhea and Acute Respiratory Tract Infections. A breastfed child is
14 times less likely to die from diarrhea, four times less likely to die
from respiratory disorders and 2.5 times less likely to die from other
infections compared to nonbreastfed infants [3]. Breast feeding the newborn is a satisfying and sometimes anxiety provoking task [4].
The 7mm nipple length might be a possible screening indicator that
would signal the clinician to provide more intensive breastfeeding
monitoring and support the postpartum mothers. If the nipple measure
less than 7mm, it should be cared and corrective measures should be
initiated [5].
The abnormalities of the nipple includes long nipple,
short nipple, abnormally large nipple, inverted nipple, flat nipple,
retracted nipple and cracked or damaged nipple [6-8].
The occurrence of inverted and flat nipples is not uncommon in the
practice of newborn care. Although such conditions should not preclude
breastfeeding if expert counseling and advice on proper positioning are
available, many mothers get frustrated and quit breastfeeding. Nipple
problems may lead to a delay in breastfeeding initiation and thus
deprive the baby from getting the benefits of colostrums. Inability to
attach at the breast causes infrequent suckling and may lead to breast
engorgement, and if the mother is not shown how to maintain an adequate
supply through expression of milk, the production of milk is likely to
decrease. It was estimated that about 10% of pregnant women have
inverted or non-projectile nipples, which hinder breast feeding [9].
The National Family Health Survey revealed that the breastfeeding rates
in different states were: Tamilnadu- 55.3%, Kerala- 55.4%, Maharashtra-
51.8%, Mizoram- 65.4%, Meghalaya- 58.6%, Orissa- 54.3%, Goa- 59.7% and
Assam-50.6%. Breastfeeding rates in Punjab, Uttar Pradesh, Bihar,
Rajasthan, Madhya Pradesh, and Delhi were below 40%.
The breastfeeding rate in Karnataka is 45% [10].
Various methods to correct flat and inverted nipples with varying
degrees of success and complications have been reported in the
literature. Some of them were prenatal exercises like Hoffman's exercise
[11], nipple stimulation techniques [12-14] and postnatal use of the Nipplette (Philips Avent, Andover, MA) etc [15]. The best simple method to date had been reported by Kesaree et al. [16]
the inverted syringe method to pull out the flat or retracted nipple as
well as using breast shells to make the nipple prominent [17].
Objectives
a) To assess the nipple condition in group I, II &
III women (mother with manual technique, Rubber band and syringe method)
mothers before and after the intervention.
b) To evaluate the effectiveness of strategies on successful breast feeding.
c) To assess the level of satisfaction among the women on the strategies.
d) To associate the post-test level of breastfeeding
pattern and level of satisfaction with the selected demographic and
obstetrical variables.
Material and Methods
After getting ethical clearance from the concerned
authority this study was conducted in the government maternity hospital,
Pondicherry All antenatal women with nipple problem who came for
delivery were considered as sample for this study. The sample size was
90 women with nipple problems out of which 30 mothers were selected by
simple random technique for each three group. All the women were
selected based on the inclusion criteria. Reliability of the tool was
checked by the inter rater reliability technique and it was found that
the tool was reliable. The correlation was calculated by using the
formula Cronbach's Alpha for Internal Consistency. The obtained
reliability coefficient r=0.9 was highly reliable. Data collection was
done in the antenatal wards, those who admitted for safe confinement,
willing to participate, had any nipple problem. Oral and written
informed consent was obtained from each mother and purpose was
explained. Before starting the pre-test the researcher got introduced to
all the mothers. First the nipple condition (which type of nipple
problem) was assessed. To each group mothers the concern technique was
demonstrated (group 1-manual technique, group 2- application of rubber
band and group 3-syringe method) and instructed them to repeat the
techniques 3-4 times a day for 5 minutes for 7 consecutive days.
The effectiveness of the interventions assessed in
the postnatal period with the help of Christi Breastfeeding assessment
scale to assess the breastfeeding pattern [18,19]. Inferential and Descriptive statistic was used for analysis (Table 1).
Results
The demography pattern shows that, majority of the
women 26(86.70%), 23(76.70%), 23(76.70%) were in the age group of 19-25
years and 13(43.3%), 13(43.3%), 18(60%) had high school level of
education, 18(60%), 20(66.6%), 13(43.3%), mothers were from urban area
in the group I, II & III respectively. None of the mother in each
group 30(100%) had done any type of nipple erection exercise throughout
the antenatal period. The obstetrical data revels that 27(90%),
26(86.7%), 28(93.3%) mothers undergone vaginal delivery in the group I,
II and III respectively The mean level of breastfeeding pattern was
6.57+1.50 in group I mothers. In group II & III mothers, the mean
level of breastfeeding pattern was 6.03+0.76 & 6.00+1.00
respectively. All the mothers in each group were satisfied while feeding
the baby. There was no association found between the feeding pattern
and to their demographic variables.
Discussion
The mean level of breastfeeding pattern was 6.57+1.50
in group I mothers. In group II & III mothers, the mean level of
breastfeeding pattern was 6.03+0.76 & 6.00+1.00 respectively. Dr
Kamalendru Chakarabarti, [20]
conducted a study on "Managing the nipple problem" among mothers in
Kolkata, who came for clinic. She compared the two methods for nipple
problem. The standard method of treating nipple problem with syringe
technique has some problems. The nipple does not protrude after
syringing in most cases. It has always to be done under medical
supervision. In case of rubber band, the nipple stays protruded and
though it is always better to done under supervision. Once the mother
learns the procedure, she may not require strict supervision.
Jain S [21]
"newer innovation in treatment of retracted nipple” in VCSGGMS&RI,
Govt. Medical college at Srinagar from march to august 2011, in which
213 women having retracted nipple, 71 in each of the three groups was
carried out. Group A (syringe method) Group B (rubber band method) and
Group C (sucking by the husband). Highest success rates were seen in
group C (vigorous sucking by the husband), being 52, 88 and 94% on days
3, 7 and 14 days respectively. Success rates in group B were lower,
being 43.66 and 74% respectively and lowest in group A i.e., 33.47 and
64%, respectively on corresponding days.
Conclusion
Breastfeeding has been important since the beginning
of mankind. In approximately 1800 BC Hammurabi's code regulated the
behavior and the health of wet nurses. In Sparta, Greece, Spartan women
were required to nurse their eldest son. This was the child who was
expected to inherit the family name. At other times during history
breastfeeding has been seen as something that only lower class or poor
people did [21].
Encouraging women to breastfeed presents a major challenge to health
care professionals. Despite attempts to increase the number of women
choosing to breastfeed, rates of initiation and continuation in many
countries remain less than optimal. A focus both on initiating and
continuing breastfeeding is important, since many women fail to maintain
breastfeeding for recommended period [22].
The study result showed that all the three methods (i.e.) manual
technique, rubber band and disposable syringe technique were effective
in improving breastfeeding pattern. Although Disposable syringe has
improved the breastfeeding pattern for postnatal mothers with nipple
problem, Rubber band and manual technique was found to be more effective
when compared to Disposable syringe method for successful breastfeeding
pattern among postnatal mothers with nipple problem. So this selected
technique can be applied as an adjunct intervention by nurses in their
day to day caring the postnatal mothers in hospital and community
setting.
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