Promoting self-management of breast and nipple pain in breastfeeding women: Protocol of a pilot randomized controlled trial

The effect of online breastfeeding education on breastfeeding motivation: A randomized controlled study

PURPOSE

The aim of this study was to examine the effect of online breastfeeding education on breastfeeding motivation.

DESIGN AND METHODS

The study had a single blind randomized, controlled, experimental design. The women in the online education group were primipara and in their postpartum 4-8 weeks and fulfilled inclusion criteria for the study. The study population comprised of the women presenting to the pregnancy outpatient clinic or giving birth in the gynecological and obstetrics clinic of a university hospital hospital in the West of Turkey and hearing about the Online Breastfeeding Education through social media. The sample size was calculated through a similar study. Data were collected between February 2022-November 2022. Simple random sampling was used and the study sample comprised of 50 women, of whom 25 were in the online breastfeeding education group and 25 were in the control group. Online breastfeeding education was given in groups of three or two, depending on availability, via the video communication platform (Zoom Video Communications). The control group received routine care. Data analysis was made with descriptive statistics, Wilcoxon rank sum test and Mann Whitney U test.

RESULTS

Integrative motivation (U = 284, p < .05) and intrinsic motivation-identified regulation (U = 196, p < .05) significantly increased compared to the control group.

CONCLUSION

Online breastfeeding education offered in the postpartum period can help to increase breastfeeding rates.

PRACTICE IMPLICATIONS

It is recommended that nurses monitor breastfeeding status in the postpartum period and motivate mothers with online breastfeeding training in cases where access is not available.

TRIAL REGISTRATION

Registered 12 February 2022 on www.

CLINICALTRIALS

gov (NCT05262231).

The effects of the breastfeeding problems management model on breastfeeding problems, breastfeeding motivation and breastfeeding success: A randomized controlled trial

PURPOSE

The majority of women experience breastfeeding problems and need professional support during the lactation period. We developed a Nurse-led Breastfeeding Problems Management Model to address this issue. The components of the model included meeting women face-to-face, giving education using a booklet, providing breastfeeding consultancy on the phone, and conducting home visits. This study aims to determine the effects of the Breastfeeding Problems Management Model (BPMM) on breastfeeding problems, motivation, and success.

DESIGN AND METHODS

This randomized controlled trial included 50 women (25 intervention and 25 control). The intervention group received BPMM under the leadership of a nurse during the early postnatal period, before discharge, and in the 1st, 2nd, 6th, and 8th weeks of the postpartum period. The control group received routine care. The Breastfeeding Experience Scale (BES) was applied to both groups in the 1st, 2nd, 6th, and 8th weeks of the postpartum period. LATCH Assessment Tool was administered to both groups before discharge and in the 8th week of the postpartum period. The Breastfeeding Motivation Scale (BMS) was administered to both groups in the 8th week of the postpartum period.

RESULTS

The LATCH post-test scores were significantly higher in the intervention group than in the control group (intervention 9.72 ± 0.54, control 8.60 ± 1.25). In all postpartum weeks, BES scores were significantly lower in the intervention group than in the control group. Except for the introjected regulation-social approval and introjected regulation-social pressure sub-scale mean scores of the BMS, all the other sub-scales in the intervention group were significantly higher than in the control group.

CONCLUSIONS

The BPMM was found to decrease and eliminate breastfeeding problems and increase breastfeeding motivation and breastfeeding success in women.

PRACTICE IMPLICATIONS

The BPMM leadership of a nurse should be considered as part of routine postpartum care for preventing and eliminating breastfeeding problems and increasing breastfeeding motivation and breastfeeding success.

CLINICAL TRIALS REGISTRATION

The study was registered at Clinical-Trials.gov (NCT05543902).

Comparison of Lanolin and Human Milk Treatment of Painful and Damaged Nipples: A Randomized Control Trial

BACKGROUND

Painful and damaged nipples are frequently associated with breastfeeding cessation in the early postpartum period. The results of researchers' studies utilizing different treatments have been inconclusive.

RESEARCH AIM

To compare the intensity of nipple pain and the healing of damaged nipples during the first 10 days postpartum using either lanolin or human milk treatments.

METHODS

This single-blind randomized controlled trial included participants (N = 206) who were primiparous with painful and damaged nipples. Participants were recruited from the tertiary teaching hospital within the first 72 hr after delivery and randomized to the intervention group with lanolin (n = 103) and a human milk control group (n = 103). Data were collected in the maternity ward, 3 and 7 days after randomization. The primary outcome was nipple pain intensity and quality measured 3 and 7 days after randomization by the McGill Pain Questionnaire - short form. The nipple damage self-assessment questionnaire was used for the assessment of nipple healing. Breastfeeding self-efficacy, breastfeeding duration, and exclusivity were assessed as secondary outcomes.

RESULTS

Participants in both groups reported a statistically nonsignificant reduction in pain (quality and intensity of pain) as well as improved nipple healing 7 days after randomization. Participants in the lanolin group exclusively breastfed their infants 3 days after randomization-significantly more often than participants in the control group (p = .026). The study did not reveal any statistically significant differences for other secondary outcomes.

CONCLUSION

Both lanolin and human milk are equally effective in treating painful and damaged nipples.Registered with Clinicaltrials.gov (NCT04153513).

An Evaluation of the Signs of Nipple Trauma Associated With Breastfeeding: A Delphi Study

BACKGROUND

No consensus on the definitions of nipple trauma has been reported. Thus, different individuals assess identical events inconsistently.

RESEARCH AIMS

To establish clear definitions for the seven signs of nipple trauma related to breastfeeding-erythema, swelling, scabbing, blistering, fissure, purpura, and peeling-and to reach consensus among multiple specialists.

METHODS

We implemented a longitudinal, prospective survey design using a 3-step Delphi method. In the first survey we targeted specialists in breastfeeding, dermatology, and cosmetics, and we presented images as representative cases during a set of semi-structured interviews. In the second and third surveys, we questioned midwives who were certified as "advanced midwives" through mail, using a questionnaire prepared based on the results of the first survey. The agreement criteria of this study were as follows: (1) a median of 2.0 or below; (2) an interquartile range of 1.0 or below; and (3) at least 51% showing responses of either "strongly agree" or "agree."

RESULTS

Based on the responses of the 42 experts, we reached a consensus on 48 items: eight related to erythema, 10 to swelling, nine to scabbing, seven to blistering, seven to fissure, four to purpura, and three to peeling. We then classified these items based on the condition or possible mechanism of the wound. Finally, we developed an observation tool: "seven signs of nipple trauma associated with breastfeeding," along with images.

CONCLUSIONS

Application of this tool for breastfeeding support could improve objectivity in observing and evaluating nipple trauma.

A Qualitative Systematic Review of Family Support for a Successful Breastfeeding Experience among Adolescent Mothers

BACKGROUND: Family support for adolescent mothers is vital in making breastfeeding decisions and sustaining the feeding since many of these women struggle with identity crises. Therefore, it is essential to synthesize qualitative evidence about the types of family support provided to these young women. AIM: This study aims to identify, synthesize, and recognize the qualitative evidence of family support for successful breastfeeding among teen mothers. METHODS: A systematic review of qualitative studies was identified in six electronic databases published from 2000 to 2020. The quality of the reviewed studies was checked using The Critical Appraisal Skills Programs. The data were extracted by two investigators and analyzed using thematic analysis with three steps: coding the text line-by-line, developing the descriptive themes, and generating the analytical themes. RESULTS: This review includes eight eligible studies. The review founds that family significantly affect the success of breastfeeding practices among adolescent mothers through their appraisal, instrumental, emotional, and informational support. The family strengthens the adolescence’s breastfeeding decisions and confidence, provide financial assistance, share positive breastfeeding information and experience, encourage them to continue the feeding and motivate theme to pursue their study. CONCLUSION: Breastfeeding a baby and becoming a mother at a young age is not an easy process and need family support for a successful feeding. Health care professionals should actively involve the family in supporting adolescent mothers to breastfeed their babies optimally.

OXTR rs53576 Variation with Breast and Nipple Pain in Breastfeeding Women

BACKGROUND

Thirty percent of women who seek professional breastfeeding support require assistance with ongoing breast and nipple pain and < 50% of women report resolution of their pain. It is unknown if there is a molecular risk for ongoing breast and nipple pain during breastfeeding. Aim -To evaluate associations among breast and nipple pain sensitivity and candidate pain sensitivity single-nucleotide polymorphisms [SNPs], (COMT rs6269, rs4633, rs4818, rs4680 and OXTR rs2254298, rs53576) in breastfeeding women. Design - A secondary analysis of a pilot randomized controlled trial of a pain self-management intervention conducted over 6 weeks postpartum. Setting and Participants - Sixty women were recruited from two hospital settings after birth. Methods - All participants underwent standardized mechanical somatosensory testing for an assessment of pain sensitivity and provided baseline buccal swabs for genetic analysis. At 1, 2, and 6 weeks postpartum, women self-reported breast and nipple pain severity using a visual analogue scale. Results - Women with the minor allele OXTR rs53576 reported 8.18-fold higher breast and nipple pain severity over time. For every 1-unit increase in Mechanical detection threshold and windup ratio, women reported 16.51-fold and 4.82-fold higher breast and nipple pain severity respectively. Six women with the OXTR rs2254298 minor allele reported allodynia. Conclusion - The presence of OXTR alleles in women with enhanced pain sensitivity suggests a phenotype of genetic risk for ongoing breast and nipple with potential for pain-associated breastfeeding cessation. Somatosensory testing identified women who reported higher breast and nipple pain during the first weeks of breastfeeding.