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Han S, Kim B, Park H. Auricular Acupressure on Breast Pain Among Breastfeeding Mothers Receiving Gentle Hand Techniques: A Randomized, Single-Blind, Sham-Controlled Trial. J Hum Lact 2024; 40:248-258. [PMID: 38379313 DOI: 10.1177/08903344241228545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Auricular acupressure influences pain reduction in patients with diseases. However, study results on its influence on breast pain, common among breastfeeding mothers, are insufficient. RESEARCH AIM This study aimed to explore the effectiveness of auricular acupressure on breast pain among breastfeeding mothers who also received a standard gentle hand technique. METHODS This was a placebo-controlled study wherein auricular acupressure was provided for 4 weeks to 52 breastfeeding mothers consulting a local breastfeeding clinic. In the intervention group, auricular acupressure was applied to specific acupoints, including Shenmen, central rim, breast, and endocrine, which are related to breast pain and postpartum lactation. For the placebo control group, auricular acupressure was applied to acupoints not related to breast pain. The degree of breast pain was assessed using a numeric rating scale and a pressure algometer. RESULTS After 4 weeks of auricular acupressure, numeric rating scale pain scores did not show a significant change. However, the pressure pain threshold for the upper left (Z = -2.202, p = .028) and upper right (t = 2.613, p = .012) areas of the right breast increased significantly in the intervention group. CONCLUSION This study employed subjective and objective measurements to evaluate the efficacy of auricular acupressure in alleviating breast pain. The intervention shows potential as a nursing measure. Further research is required to determine the optimal intervention duration and frequency, particularly for breastfeeding parents with severe pain, and to evaluate long-term outcomes.
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Affiliation(s)
- Shinae Han
- The Graduate School of Clinical and Public Health Convergence, Ewha Womans University, Seoul, South Korea
| | - Bomi Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Hyojung Park
- College of Nursing, Ewha Womans University, Seoul, South Korea
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Abargil M, Irani M, klein Selle N, Atzil S. Breastfeeding at Any Cost? Adverse Effects of Breastfeeding Pain on Mother-Infant Behavior. BIOLOGY 2023; 12:636. [PMID: 37237450 PMCID: PMC10215422 DOI: 10.3390/biology12050636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
Breast milk is considered the ideal infant nutrition, and medical organizations encourage breastfeeding worldwide. Moreover, breastfeeding is often perceived as a natural and spontaneous socio-biological process and one of the fundamental roles of new mothers. While breastfeeding is beneficial, little scientific consideration has been given to its potential psychological challenges. Here, we investigate the phenomenon of breastfeeding pain in mothers and its association with maternal and infant behavioral regulation. During the postpartum weeks, the mother-infant dyad can be considered one allostatic unit directed at infant regulation and development. We hypothesize that pain comprises an allostatic challenge for mothers and will thus impair the capacity for dyadic regulation. To test this, we recruited 71 mothers with varying levels of breastfeeding pain and videotaped them with their infants (2-35 weeks old) during spontaneous face-to-face interactions. We quantified the individual differences in dyadic regulation by behaviorally coding the second-by-second affective expressions for each mother and infant throughout their interactions. We tested the extent to which breastfeeding pain alters affect regulation during mother-infant interactions. We discovered that mothers with severe breastfeeding pain express less affective expressions and less infant-directed gaze during interactive moments of engagement and play than mothers with no or moderate pain. Moreover, infants of mothers experiencing pain during breastfeeding express less affective expressions and more mother-directed gaze while interacting with their mothers than infants of mothers who are not in pain. This demonstrates that the allostatic challenge of maternal pain interferes with the behavioral regulation of both mothers and infants. Since the mother-infant dyad is a codependent allostatic unit, the allostatic challenges of one partner can impact the dyad and thus potentially impact child development, bonding, and mother and infant well-being. The challenges of breastfeeding should be considered in addition to the nutritional advances.
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Affiliation(s)
- Maayan Abargil
- The Department of Psychology, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Merav Irani
- The Department of Psychology, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | | | - Shir Atzil
- The Department of Psychology, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
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Stordal B. Breastfeeding reduces the risk of breast cancer: A call for action in high-income countries with low rates of breastfeeding. Cancer Med 2023; 12:4616-4625. [PMID: 36164270 PMCID: PMC9972148 DOI: 10.1002/cam4.5288] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/12/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
Women in the UK have a 15% lifetime risk of developing breast cancer. Like other high-income countries, women in the UK are having children later in life which increases their risk. The risk of breast cancer is reduced by 4.3% for every 12 months of breastfeeding, this is in addition to the 7.0% decrease in risk observed for each birth. Breastfeeding reduces the risk of Triple-Negative Breast Cancer (20%) and in carriers of BRCA1 mutations (22-55%). The mechanisms of reduced risk as a result of pregnancy are related to changes in RNA processing and cellular differentiation. The UK has a low rate of breastfeeding (81%) and this is contrasted to countries with higher (Sweden, Australia) and lower rates (Ireland). The low UK rate is in part due to a lack of experience in the population, todays grandmothers have less experience with breastfeeding (62%) than their daughters. An estimated 4.7% of breast cancer cases in the UK are caused by not breastfeeding. The UK only has 43% of maternity services with full Baby-Friendly accreditation which promotes compliance with the WHO 'Ten Steps to Successful Breast Feeding'. Legislation in the UK and Europe is far short of the WHO Guidance on restricting the advertising of formula milk. Expansion of the Baby-Friendly Hospital Initiative, stricter laws on the advertising of formula milk and legislation to support nursing mothers in the workplace have the potential to increase breastfeeding in the UK. Women with a family history of breast cancer should particularly be supported to breastfeed as a way of reducing their risk.
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Affiliation(s)
- Britta Stordal
- Department of Natural Sciences, Middlesex University London, London, UK
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Davie P, Bick D, Silverio SA, Chilcot J. Easier, but not easy: Testing a grounded theory of breastfeeding experiences among women with larger birthweight infants. Psychol Health 2023; 38:167-189. [PMID: 34498534 DOI: 10.1080/08870446.2021.1956495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Grounded Theory has previously been used to explore breastfeeding practices amongst average birthweight infants and these working hypotheses can be 'tested' in new contexts. A pre-existing Grounded Theory was applied to the context of women who gave birth to larger birthweight infants (≥4,000 g) to understand whether perceptions and practices of infant feeding were distinct. DESIGN A nested qualitative study analysed data from N = 10 women with a larger birthweight infant (≥4,000 g). Face-to-face, semi-structured interviews were audio-recorded and transcribed verbatim. Grounded Theory methodology was used to analyse data. RESULTS A pre-existing Grounded Theory of breastfeeding experiences derived from women with average birthweight infants did not hold true among women with larger birthweight infants. An alternative Grounded Theory was therefore proposed comprised of three discrete themes: Infant Ability to Breastfeed; Attenuating Maternal Concerns; and Reality of Breastfeeding. CONCLUSIONS Larger infant birthweight is potentially a protective factor against breastfeeding latch and lactation difficulties. It is associated with alleviating maternal concerns, helping to reduce disparities between expectations of breastfeeding and reality, but does not alleviate the demands breastfeeding places on women. Healthcare professionals help to attenuate women's concerns, however the support needs for women with larger birthweight infants may not differ from existing care recommendations.
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Affiliation(s)
- Philippa Davie
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Guy's Hospital, King's College London, London, UK
| | - Debra Bick
- Clinical Trials in Maternal Health, Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sergio A Silverio
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, St Thomas' Hospital, King's College London, London, UK.,Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, School of Life and Medical Sciences, University College London, London, UK.,Department of Psychological Sciences, Institute of Life and Human Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Guy's Hospital, King's College London, London, UK
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5
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Douglas P. Re-thinking lactation-related nipple pain and damage. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221087865. [PMID: 35343816 PMCID: PMC8966064 DOI: 10.1177/17455057221087865] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 04/14/2023]
Abstract
Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple-areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple-areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.
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Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- Possums & Co., Brisbane, QLD, Australia
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Marshall J, Ross S, Buchanan P, Gavine A. Providing effective evidence based support for breastfeeding women in primary care. BMJ 2021; 375:e065927. [PMID: 34725097 DOI: 10.1136/bmj-2021-065927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joyce Marshall
- Division of Maternal Health, University of Huddersfield, UK
| | - Sam Ross
- School of Medicine, Dentistry and Nursing, University of Glasgow and NHS Greater Glasgow and Clyde, UK
| | | | - Anna Gavine
- School of Health Sciences, University of Dundee, UK
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Coentro VS, Lai CT, Rea A, Geddes DT, Perrella SL. Breast Milk Production in Women Who Use Nipple Shields for Persistent Nipple Pain. J Obstet Gynecol Neonatal Nurs 2021; 51:73-82. [PMID: 34648751 DOI: 10.1016/j.jogn.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To examine relationships between nipple pain scores and 24-hour milk production volumes, breastfeeding and pumping frequencies, and breastfeeding duration in women using nipple shields for persistent nipple pain. DESIGN Secondary outcome analysis of a prospective cohort study. SETTING Research laboratory and participants' homes. PARTICIPANTS Twenty-five breastfeeding women (6 ± 4 weeks after birth) who used nipple shields for persistent nipple pain. METHODS We conducted a randomized trial to investigate the primary outcome of milk transfer with and without nipple shields among participants with and without nipple pain. Here, we report secondary outcomes of associations between 24-hour milk production, breastfeeding and pumping frequencies, breastfeeding durations, and intake in participants using a nipple shield for nipple pain. Participants completed demographic, health and breastfeeding questionnaires and, at two monitored breastfeeding sessions, completed a pain visual analogue scale and Brief Pain Inventory-Short Form (BPI-SF; total and subscale scores for pain interference with General Activity, Mood, Sleep, and Breastfeeding). Milk production (milliliters per 24 hours), feed volumes, and percentage of available milk removed were calculated from data and milk samples obtained by participants over one 24-hour period and at study visits. Participants logged 24-hour data on a customized research website. We used descriptive statistics as well as simple and multiple linear regression for analyses. RESULTS Milk production and feeding duration were not associated with nipple pain scores (visual analogue scale: p = .80, BPI-SF: p = .44). An increase in BPI-SF Breastfeeding subscale score of 1 unit, indicating pain interference with breastfeeding, was associated with a 0.28 decrease in breastfeeding frequency (p = .02) and an 18.8-ml decrease in 24-hour breastfeeding intake (p = .04). CONCLUSION Persistent nipple pain was associated with reduced breastfeeding frequency; therefore, continuing professional support is required to ensure adequate milk removal and pain management.
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Geddes DT, Gridneva Z, Perrella SL, Mitoulas LR, Kent JC, Stinson LF, Lai CT, Sakalidis V, Twigger AJ, Hartmann PE. 25 Years of Research in Human Lactation: From Discovery to Translation. Nutrients 2021; 13:3071. [PMID: 34578947 PMCID: PMC8465002 DOI: 10.3390/nu13093071] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023] Open
Abstract
Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.
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Affiliation(s)
- Donna Tracy Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Sharon Lisa Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Leon Robert Mitoulas
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
- Medela, AG, Lättichstrasse 4b, 6340 Baar, Switzerland
| | - Jacqueline Coral Kent
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Lisa Faye Stinson
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Vanessa Sakalidis
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | | | - Peter Edwin Hartmann
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
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The effect of vernix caseosa in preventing nipple problems among early postpartum women: A randomized-controlled single-blind clinical trial ☆. Complement Ther Clin Pract 2021; 45:101475. [PMID: 34411802 DOI: 10.1016/j.ctcp.2021.101475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE Vernix caseosa, a natural substance similar to mother's milk with protective effects on the skin, might be effective in preventing nipple problems. The purpose of this study was to examine the potential efficacy of vernix caseosa compared to the conventional use of mother's milk in the prevention of postpartum nipple problems. MATERIALS AND METHODS This randomized, controlled, single-blind experimental study involved 64 primipara mothers who underwent cesarean section and were randomly and equally divided between the vernix caseosa group and the mother's milk group. All mothers received nipple care four times daily during the first postpartum week. Data were collected using personal information and nipple monitoring forms. RESULTS The incidence of nipple pain, rashes, and an abnormal appearance was similar in both groups on the first day postpartum (p = 0.132, p = 0.516, and p = 0.132, respectively), and none of the mothers had nipple cracks. On the seventh day, mothers in the vernix caseosa group had significantly less pain (p = 0.042), significantly reduced rash (p = 0.048), significantly higher satisfaction (p = 0.023), and no nipple cracks. CONCLUSION Nipple care with vernix caseosa is more effective than with mother's milk in preventing postpartum nipple pain, rashes, and cracks.
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Davie P, Bick D, Pasupathy D, Norton S, Chilcot J. Infant feeding practices among macrosomic infants: A prospective cohort study. MATERNAL AND CHILD NUTRITION 2021; 17:e13222. [PMID: 34060713 PMCID: PMC8476408 DOI: 10.1111/mcn.13222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022]
Abstract
The health benefits of breastfeeding are well recognised, but breastfeeding rates worldwide remain suboptimal. Breastfeeding outcomes have yet to be explored among women who give birth to macrosomic (birthweight ≥4000 g) infants, a cohort for whom the benefits of breastfeeding may be particularly valuable, offering protection against later‐life morbidity associated with macrosomia. This longitudinal prospective cohort study aimed to identify whether women who give birth to macrosomic infants are at greater risk of breastfeeding non‐initiation or exclusive breastfeeding (EBF) cessation. A total of 328 women in their third trimester were recruited from hospital and community settings and followed to 4 months post‐partum. Women gave birth to 104 macrosomic and 224 non‐macrosomic (<4000 g) infants between 2018 and 2020. Longitudinal logistic regression models calculated odds ratios (ORs) and 95% confidence intervals (CIs) to assess likelihood of EBF at four timepoints post‐partum (birth, 2 weeks, 8 weeks, and 4 months) between women who gave birth to macrosomic and non‐macrosomic infants, adjusted for maternal risk (obesity and/or diabetes), ethnicity and mode of birth. Macrosomic infants were more likely to be exclusively breastfed at birth and 2 weeks post‐partum than non‐macrosomic infants with adjusted OR = 1.94 (95% CI: 0.90, 4.18; p = 0.089) and 2.13 (95% CI: 1.11, 4.06; p = 0.022), respectively. There were no statistically significant associations between macrosomia and EBF at 8 weeks or 4 months post‐partum. Macrosomia may act as a protective factor against early formula‐milk supplementation, increasing the likelihood of EBF in the early post‐partum period, but rates of exclusive breastfeeding continued to decline over the first 4 months post‐partum.
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Affiliation(s)
- Philippa Davie
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Guy's Hospital, King's College London, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Dharmintra Pasupathy
- Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Women and Children's Health, Faculty of Life Sciences and Medicine, St Thomas' Hospital, King's College London, London, UK
| | - Sam Norton
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Guy's Hospital, King's College London, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Guy's Hospital, King's College London, London, UK
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11
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Laageide L, Radke S, Santillan D, Ten Eyck P, Powers J. Postpartum Nipple Symptoms: Risk Factors and Dermatologic Characterization. Breastfeed Med 2021; 16:215-221. [PMID: 33337281 PMCID: PMC8418445 DOI: 10.1089/bfm.2020.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Nipple discomfort inhibits breastfeeding goals, particularly between 0 and 8 weeks postpartum (PP), and yet the specific dermatologic entities that contribute to nipple soreness have not been clearly delineated. Moreover, there remains a lack of evidence-based guidelines for nipple symptoms and skin diseases. Methods: A survey was distributed to 6-8-week PP women, 18-50 years of age, with an intent to exclusively or partially breastfeed ("at the breast" or "pump"). The study aimed to characterize nipple skin symptoms (pain and itching) and lesions (eczema, redness, cuts, or wounds) and any association between these nipple problems and past dermatologic history, breastfeeding outcomes, and the ability to meet her breastfeeding goals. Results: Findings paralleled Centers for Disease Control and Prevention (CDC) statistics with a 25% decline in breastfeeding rates between birth, 86.3% (189), and 6-8 weeks PP, 64.5% (145). By 6-8 weeks PP, exclusive "formula" and "exclusive feeding at the breast" showed the largest increase (+16.4%) and decrease (-22.9%), respectively. Although no significant difference was found in comparison of nipple problems to feeding methods or skin history, women who reported pumping or PP redness/eczema had higher odds ratios of a change in feeding practice, history of eczema, and sensitive skin. Strong pumping intentions were also associated with the highest risk of unmet breastfeeding goals. Conclusion: Regardless of feeding method, product, or provider use, PP nipple problems predominantly arose between 1 and 3 weeks PP. Clinical Trial Registration number 201901737.
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Affiliation(s)
- Leah Laageide
- Department of Internal Medicine, University of Iowa - Des Moines, Des Moines, Iowa, USA
| | - Stephanie Radke
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Donna Santillan
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Patrick Ten Eyck
- University of Iowa Institute for Clinical and Translational Science, Iowa City, Iowa, USA
| | - Jennifer Powers
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- VA Medical Center, Iowa City, Iowa, USA
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Management of nipple pain or trauma in breastfeeding mothers in a hospital setting: a best practice implementation project. JBI Evid Implement 2021; 19:236-244. [PMID: 34491923 DOI: 10.1097/xeb.0000000000000272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIMS Breastfeeding is one of the best ways to ensure healthy growth and development of an infant. Nipple pain and trauma are common complications associated with breastfeeding, which render it difficult for the mother to continue breastfeeding. The aim of this project was to promote evidence-based practice in the management of nipple pain or trauma for breastfeeding mothers in a large tertiary hospital in China. METHODS The project was conducted using the Joanna Briggs Institute framework and Practical Application of Clinical Evidence System. Six audit criteria were applied in baseline and follow-up audits to assess compliance in practice with best practice recommendations. The Getting Research into Practice tool was used to help analyze barriers to the fulfillment of each audit criterion based on the baseline audit results. Implementation strategies were discussed and then undertaken to overcome the barriers and bring changes to the current practice. RESULTS The baseline audit results demonstrated poor compliance in nipple pain or trauma management practice with all of the six criteria. Significant improvements were achieved in the follow-up audit. Specifically, the compliance rate increased from 15 to 100% for criterion 1 and from 2 to 93% for criterion 2. For criteria 3, 4, 5 and 6, the compliance rate increased from 0 to 90, 85, 100 and 86%, respectively. CONCLUSION The current evidence-based implementation project was successfully conducted and achieved great improvement in the management of nipple pain or trauma associated with breastfeeding. Continuous effort is required to maintain changes and further improve practice.
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13
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Lucas R, Zhang Y, Walsh SJ, Starkweather A, Young E. OXTR rs53576 Variation with Breast and Nipple Pain in Breastfeeding Women. Pain Manag Nurs 2020; 22:369-376. [PMID: 33303340 DOI: 10.1016/j.pmn.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Ruth Lucas
- University of Connecticut School of Nursing, Storrs, Connecticut.
| | - Yiming Zhang
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Stephen J Walsh
- University of Connecticut School of Nursing, Storrs, Connecticut
| | | | - Erin Young
- University of Connecticut School of Nursing, Storrs, Connecticut; University of Kansas Medical Center, Kansas City, Kansas
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Coentro VS, Perrella SL, Lai CT, Rea A, Murray K, Geddes DT. Effect of nipple shield use on milk removal: a mechanistic study. BMC Pregnancy Childbirth 2020; 20:516. [PMID: 32894074 PMCID: PMC7487699 DOI: 10.1186/s12884-020-03191-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concerns about reduced milk transfer with nipple shield (NS) use are based on evidence from studies with methodological flaws. Milk removal during breastfeeding can be impacted by infant and maternal factors other than NS use. The aim of this study was to control electric breast pump vacuum strength, pattern and duration across multiple study sessions to determine if NS use reduces milk removal from the breast. METHODS A within-subject study with two groups of breastfeeding mothers (infants < 6 months) were recruited; Control Group (CG): no breastfeeding difficulties; Pain Group (PG) used NS for persistent nipple pain. Mothers completed three randomised 15 min pumping sessions using the Symphony vacuum curve (Medela AG); no NS, fitted NS, and a small NS. Sessions were considered valid where the applied vacuum was within 20 mmHg of the set vacuum. Milk removal was considered as pumped milk volume, and also percentage of available milk removed (PAMR), which is calculated as the pumped volume divided by the estimated milk volume stored in the breast immediately prior to pumping. RESULTS Of 62 sessions (all: n = 31 paired sessions) a total of 11 paired sessions from both PG (n = 03) and CG (n = 08) were valid (subset) with and without a fitted NS. Only 2 small shield sessions were valid and so all small shield measurements were excluded. Both pumped volumes and PAMR were significantly lower with NS use for all data but not for subset data. (All: Volume and PAMR median: no NS: 76.5 mL, 69%, Fitted NS: 32.1 mL, 41% respectively (volume p = 0.002, PAMR p = 0.002); Subset: Volume and PAMR median: no NS: 83.8 mL, 72%; Fitted NS: 35.2 mL, 40% (volume p = 0.111 and PAMR p = 0.045). The difference in PAMR, but not volume, was statistically significant when analysed by linear mixed modelling. A decrease of 10 mmHg was associated with a 4.4% increase in PAMR (p = 0.017). CONCLUSIONS This experimental data suggests that nipple shield use may reduce milk removal. Close clinical monitoring of breastfeeding mothers using nipple shields is warranted.
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Affiliation(s)
- Viviane Silva Coentro
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, M310, 35 Stirling Highway, Western Australia, 6009, Crawley, Australia
| | - Sharon Lisa Perrella
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, M310, 35 Stirling Highway, Western Australia, 6009, Crawley, Australia.
| | - Ching Tat Lai
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, M310, 35 Stirling Highway, Western Australia, 6009, Crawley, Australia
| | - Alethea Rea
- Mathematics and Statistics, School of Engineering and Information Technology, Murdoch University, 90 South Street, Western Australia, 6150, Murdoch, Australia
| | - Kevin Murray
- School of Population and Global Health, Faculty of Health and Medical Sciences, Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Western Australia, 6009, Crawley, Australia
| | - Donna Tracy Geddes
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, M310, 35 Stirling Highway, Western Australia, 6009, Crawley, Australia
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Davie P, Chilcot J, Jones L, Bick D, Silverio SA. Indicators of 'good' feeding, breastfeeding latch, and feeding experiences among healthy women with healthy infants: A qualitative pathway analysis using Grounded Theory. Women Birth 2020; 34:e357-e367. [PMID: 32888859 DOI: 10.1016/j.wombi.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breastfeeding behaviour remains a public health priority worldwide. Despite evidence-based guidelines, healthy women who give birth to healthy, term infants continue to face barriers to breastfeeding. Understanding women's experiences of feeding in the early postnatal period is crucial to identify how support may be better tailored to improve breastfeeding outcomes, including women's experiences. QUESTION To understand women's experiences of infant feeding amongst healthy women who give birth to healthy, average-weight, term infants. METHODS Grounded Theory methodology was used to analyse data from a nested qualitative interview study. Twelve women between four and twelve months postpartum were recruited from a longitudinal cohort study and public advertisements. Semi-structured face-to-face interviews were audio-recorded and transcribed for analysis. FINDINGS Three distinct themes were found, subsuming identified super-categories: Perceived indicators of 'good' feeding (infant 'output'; infant crying; weight gain; feeding frequency and duration); Women's experiences of breastfeeding latch ('good' latch; 'bad' latch with pain and discomfort); and Overall breastfeeding experience (positive; negative; and uncertain). Data suggest women give precedence to their latch experiences over indicators of 'good' feeding, highlighting breastfeeding latch as a possible mediating factor to the overall breastfeeding experience. Feeding experience can be achieved through four distinct pathways. DISCUSSION The physical and psychological impacts of latch pain were pronounced. Even amongst healthy women with healthy infants, a positive breastfeeding experience overall was uncommon, highlighting the difficulties women continue to encounter. Understanding women's perceptions of 'good' feeding, and ensuring a pain-free latch, may better support women to have a positive breastfeeding experience.
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Affiliation(s)
- Philippa Davie
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Guy's Hospital, King's College London, SE1 9RT, United Kingdom.
| | - Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Guy's Hospital, King's College London, SE1 9RT, United Kingdom. https://www.twitter.com/joe_chilcot
| | - Louise Jones
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Guy's Hospital, King's College London, SE1 9RT, United Kingdom
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom. https://www.twitter.com/DebraBick
| | - Sergio A Silverio
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, St Thomas' Hospital, King's College London, United Kingdom; Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, School of Life and Medical Sciences, University College London, United Kingdom; Department of Psychological Sciences, Institute of Life and Human Sciences, Faculty of Health and Life Sciences, University of Liverpool, United Kingdom. https://www.twitter.com/Silverio_SA_
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16
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Wagner LPB, Mazza VDA, Souza SRRK, Chiesa A, Lacerda MR, Soares L. Strengthening and weakening factors for breastfeeding from the perspective of the nursing mother and her family. Rev Esc Enferm USP 2020; 54:e03563. [PMID: 32401890 DOI: 10.1590/s1980-220x2018034303564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the strengthening and weakening factors for breastfeeding. METHOD This is a descriptive multiple case qualitative study, conducted in Curitiba, Parana, with members of 17 families with children between 6 and 12 months old, through semi-structured interview and construction of genograms, analyzed by the strategy of cross case synthesis. RESULTS 28 people participated in the study. Strengthening factors for breastfeeding were: the desire to breastfeed; child with facility for breastfeeding; mother with time available to the child; previous breastfeeding experience and family history of breastfeeding; the support and encouragement to breastfeed. Weakening factors were: negative expectations; the myth of weak milk; child's disease; maternal illness; negative experiences of the mother; the absence of family history of breastfeeding; lack of a support network. CONCLUSION Breastfeeding is a family and social phenomenon. Therefore, practices that go beyond the mother-baby dyad are necessary. The care process should include the social and subjective dimension, strengthening the support network of nursing mothers, in order to obtain more satisfactory professional practices that promote breastfeeding.
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Affiliation(s)
| | | | | | - Anna Chiesa
- Departamento de Enfermagem em Saúde Coletiva, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Ribeiro Lacerda
- Programa de Pós-graduação em Enfermagem, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Larissa Soares
- Programa de Pós-graduação em Enfermagem, Universidade Federal do Paraná, Curitiba, PR, Brazil
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17
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Delfino E, Netto R, Cena A, Faraoni L, Gogna D, Montagnani L. Novel use of a continuous PECS II block for mastitis pain treatment. Reg Anesth Pain Med 2020; 45:557-559. [PMID: 32371498 DOI: 10.1136/rapm-2019-101183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 11/03/2022]
Abstract
Nipple trauma and mastitis (an inflammatory condition of the breast) are common causes of intense pain during breast feeding. Although such pain normally results in early weaning, which has negative impacts on both maternal and child health, little is understood about the treatment of pain experienced during breast feeding. Here, we describe our experience with a woman who presented at 26 days post partum with a 15-day history of deep nipple wounds that caused bilateral mastitis and excruciating pain that radiated dorsally. Antibiotic, antifungal and non-pharmacological therapies were unsuccessful, and she wished to suspend breast feeding. We performed a bilateral pectoralis nerve block type II and inserted intrafascial catheters between the pectoralis minor and serratus muscles for continuous analgesia. Following block completion, the pain in her torso resolved immediately. The local anesthetic infusion continued for 40 hours and the patient had sustained analgesia with rapid healing of nipple lesions and her breast feeding commencing at 36 hours after block placement.
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Affiliation(s)
- Enrica Delfino
- Department of Anesthesia, Intensive Care, and Out-of-Hospital Emergency, AUSL Aosta, Aosta, Italy
| | - Roberta Netto
- Department of Anesthesia, Intensive Care, and Out-of-Hospital Emergency, AUSL Aosta, Aosta, Italy
| | - Alessandra Cena
- Department of Anesthesia, Intensive Care, and Out-of-Hospital Emergency, AUSL Aosta, Aosta, Italy
| | - Lorella Faraoni
- Poison Control and Toxicology Center, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Daniela Gogna
- Department of Anesthesia, Intensive Care, and Out-of-Hospital Emergency, AUSL Aosta, Aosta, Italy
| | - Luca Montagnani
- Department of Anesthesia, Intensive Care, and Out-of-Hospital Emergency, AUSL Aosta, Aosta, Italy
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18
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Emidio SCD, Dias FDSB, Moorhead S, Deberg J, Oliveira-Kumakura ARDS, Carmona EV. Conceptual and operational definition of nursing outcomes regarding the breastfeeding establishment. Rev Lat Am Enfermagem 2020; 28:e3259. [PMID: 32321045 PMCID: PMC7164926 DOI: 10.1590/1518-8345.3007.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/07/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to construct conceptual and operational definitions of Nursing Outcomes "Breastfeeding establishment: infant (1000)" and "Breastfeeding establishment: maternal (1001)". METHOD integrative literature review in the following databases: PUBMED (United States National Library of Medicine); LILACS (Latin American and Caribbean Health Sciences Literature); CINAHL (Cumulative Index to Nursing and Allied Health Literature); SciVerse SCOPUS; Web of Science; BDENF (Brazilian Nursing Database) and EMBASE (Excerpta Medica Database). The gray literature was explored to elucidate topics not covered by the articles. Of 3242 articles, 96 were selected to be read in full, and 43 were used for constructing the definitions. Five theses, three dissertations, three books and two manuals were selected. RESULTS all the results were reviewed. The definitions facilitated the improvement of the content proposed by the Nursing Outcomes Classification, favoring its application in clinical practice and supporting the development of research and teaching. CONCLUSION it was proposed to change the definition of the two outcomes, as well as to change the title of one of them to "Breastfeeding establishment: newborn & infant" (1000), modifying seven of its indicators and excluding one. For the outcome related to the mother, it was proposed to modify two indicators and exclude one.
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Affiliation(s)
- Suellen Cristina Dias Emidio
- Universidade Estadual de Campinas, Faculdade de Enfermagem, Campinas, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Grant # 38P-4842/2018, Brazil
| | | | - Sue Moorhead
- University of Iowa, College of Nursing, Iowa, IA, United States of America
| | - Jennifer Deberg
- University of Iowa, Hardin Library for the Health Sciences, Iowa, IA, United States of America
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19
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Camargo BTS, Coca KP, Amir LH, Corrêa L, Aranha ACC, Marcacine KO, Abuchaim ÉDSV, Abrão ACFDV. The effect of a single irradiation of low-level laser on nipple pain in breastfeeding women: a randomized controlled trial. Lasers Med Sci 2020; 35:63-69. [PMID: 31030379 DOI: 10.1007/s10103-019-02786-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 04/10/2019] [Indexed: 01/25/2023]
Abstract
Photobiomodulation with low-level laser therapy (PBM-LLLT) has been introduced as a new tool to relieve nipple pain and repair nipple damage in breastfeeding women; however, evidence is needed to assess its effectiveness. The aim was to evaluate the effect of a single application of PBM-LLLT for breastfeeding women with nipple pain and damage; side effects were also collected. We conducted a randomized double-blinded controlled trial with women with nipple damage who were exclusively breastfeeding and rooming-in at Amparo Maternal maternity service, São Paulo, Brazil (May 2016 to May 2017). Women were randomly assigned into laser (n = 40) or control group (n = 40). Intervention was a single irradiation (660 nm, 100 mW, 2 J, 66.66 J/cm2, 3.3 W/cm2, 20 s of irradiation, punctual, and continuous mode) applied directly. Women reported pain levels at recruitment (before and immediately after irradiation), 6 and 24 h after the treatment. Pain level during a breastfeed was assessed using the Visual Analogue Scale (0 to 10). The primary outcome was the level of nipple pain immediately after the laser irradiation. Data were analyzed using hierarchical model and Wald test. At baseline, pain levels were similar (mean of 7.4 in laser group and 7.1 in control group). Women's perception of pain reduced approximately one point in both groups. Thirty-one percent of participants in the laser group (11/36) reported secondary effects, such as tingling (10/36) and pricking (2/36). The laser protocol of a single application was not effective in reducing pain in women with damaged nipples. Tingling sensation may be experienced by women receiving laser treatment for nipple damage.
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Affiliation(s)
- Bárbara Tideman Sartorio Camargo
- Women's Health Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, R. Napoleão de Barros, 754 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Kelly Pereira Coca
- Women's Health Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, R. Napoleão de Barros, 754 - Vila Clementino, São Paulo, SP, 04024-002, Brazil.
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
| | - Lisa Helen Amir
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
- Breastfeeding Service, Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Luciana Corrêa
- Department of Oral Pathology, School of Dentistry, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Cecília Corrêa Aranha
- Department of Restorative Dentistry Special Laboratory of Lasers in Dentistry (LELO), School of Dentistry, Universidade de São Paulo, Sao Paulo, Brazil
| | - Karla Oliveira Marcacine
- Women's Health Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, R. Napoleão de Barros, 754 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Érika de Sá Vieira Abuchaim
- Women's Health Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, R. Napoleão de Barros, 754 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Ana Cristina Freitas de Vilhena Abrão
- Women's Health Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, R. Napoleão de Barros, 754 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
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20
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Jackson KT, O'Keefe-McCarthy S, Mantler T. Moving toward a better understanding of the experience and measurement of breastfeeding-related pain. J Psychosom Obstet Gynaecol 2019; 40:318-325. [PMID: 30324846 DOI: 10.1080/0167482x.2018.1518421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Purpose: Despite how commonly breastfeeding-related pain is experienced in the postpartum period, and its frequent implication in breastfeeding cessation, this unique type of pain is not well evaluated nor assessed. The purpose of this study was to gain a comprehensive description and understanding of breastfeeding-related pain among postpartum breastfeeding women. Methods: This study employed a mixed methods approach using a descriptive-interpretive qualitative approach, in addition to administering the Short-Form McGill Pain Questionnaire, second version, to comprehensively gain both quantitative and qualitative descriptors of breastfeeding-related pain. Fourteen partnered and educated women living in Southern Ontario with experience of breastfeeding-related pain took part in this study. Results: The results from this study suggest that breastfeeding-related pain is often experienced as severe and distressing, and comprises various elements of pain including continuous, intermittent, neuropathic, and affective components. Conclusion: Breastfeeding-related pain is multidimensional and can be severe and distressing for women. Current measurement tools may not adequately reflect the multidimensional components of this unique type of pain, which may limit the effectiveness of health care providers to help with its identification and management.
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Affiliation(s)
- Kimberley T Jackson
- Arthur Labatt Family School of Nursing, Western University , London , Canada
| | | | - Tara Mantler
- School of Health Studies, Western University , London , Canada
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21
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Coca KP, Amir LH, Alves MDRDS, Barbieri M, Marcacine KO, Abrão ACF. Measurement tools and intensity of nipple pain among women with or without damaged nipples: A quantitative systematic review. J Adv Nurs 2019; 75:1162-1172. [DOI: 10.1111/jan.13908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/04/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Pereira Coca
- Judith Lumley Centre La Trobe University Melbourne Victoria Australia
- Department of Nursing Woman's Health Universidade Federal de São Paulo São Paulo Brazil
| | - Lisa H. Amir
- Judith Lumley Centre La Trobe University Melbourne Victoria Australia
- Breastfeeding Service Royal Women's Hospital Parkville, Melbourne Victoria Australia
| | | | - Márcia Barbieri
- Department of Nursing Woman's Health Universidade Federal de São Paulo São Paulo Brazil
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22
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Vieira F, Mota DDCF, Castral TC, Guimarães JV, Salge AKM, Bachion MM. Effects of Anhydrous Lanolin versus Breast Milk Combined with a Breast Shell for the Treatment of Nipple Trauma and Pain During Breastfeeding: A Randomized Clinical Trial. J Midwifery Womens Health 2017; 62:572-579. [DOI: 10.1111/jmwh.12644] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 11/29/2022]
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As’adi N, Kariman N, Mojab F, Pourhoseingholi MA. The effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women. Electron Physician 2017; 9:4952-4960. [PMID: 28979728 PMCID: PMC5614278 DOI: 10.19082/4952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/16/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nipple fissure is a common problem in breastfeeding women, and the main reason for the early discontinuation of breastfeeding. OBJECTIVE To determine the effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women. METHODS This randomized clinical trial was conducted on 100 subjects admitted to the health centers in Tehran, Iran from mid-July to mid-November 2015. The subjects were randomly divided into two equal groups of 50 for the Saqez ointment group and the control group. The subjects were divided into the two groups through random allocation in Excel. The subjects were monitored on day 1, 3 and 7. Data were analyzed in SAS using the Cumulative Logit model and in SPSS-21 using Mann-Whitney, independent-samples t-test, the Chi square and Fisher's exact test. RESULTS No significant differences were observed between the two groups in terms of their demographic and fertility characteristics. The Cumulative Logit model showed that high levels of nipple fissure and pain were significantly less frequent in the Saqez group compared to the control group (p<0.001). There was about 83% reduction in the severity of fissure and 85 %in the severity of pain in the Saqez group compared to the control group (p<0.001). CONCLUSION Saqez ointment is more effective in the treatment of nipple fissures and pain than breast milk. As this study was done for the first time, judgment about the conclusive efficacy of Saqez ointment on the nipple fissure, needs further similar studies. TRIAL REGISTRATION The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015080723535N1. FUNDING The authors received no financial support for the research, authorship, and/or publication of this article.
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Affiliation(s)
- Nayereh As’adi
- M.Sc. of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nourossadat Kariman
- Ph.D. of Reproductive Health, Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faraz Mojab
- Ph.D. of Pharmacognosy, Professor, Department of Pharmacognosy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Pourhoseingholi
- Ph.D., Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Madlala SS, Kassier SM. Antenatal and postpartum depression: effects on infant and young child health and feeding practices. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2017. [DOI: 10.1080/16070658.2017.1333753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- SS Madlala
- Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - SM Kassier
- Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Alvarenga SC, Castro DSD, Costa Leite FM, Gomes Brandão MA, Zandonade E, Caniçali Primo C. Fatores que influenciam o desmame precoce. AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.1.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objetivos: identificar en la literatura científica los principales factores asociados al destete temprano. Materiales y método: se trata de una revisión sistemática realizada en las bases de datos LILACS y MEDLINE con artículos completos del periodo de 2004 a 2013, en inglés, español y portugués, desde la pregunta orientadora: “¿Cuáles son los factores que influyen el destete temprano?”. Resultados: se identificaron 1.481 artículos y 39 atendieron a los criterios de inclusión. Entre los principales factores que influyen el destete temprano, se encontraron trabajo materno (33,3 %); uso de chupo de entretención (30,8 %); leche materna débil (17,9 %); trauma y dolor mamilar (17,9 %); introducción de otros tipos de leche (15,4 %) y nivel educacional de la madre o del padre (15,4 %). Conclusiones: diversos factores están relacionados al destete temprano, lo que apunta fuerte determinación sociocultural e histórica que se puede evidenciar por la comparación de los estándares de lactancia entre diferentes poblaciones y a través de los tiempos.
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Herzhaft-Le Roy J, Xhignesse M, Gaboury I. Efficacy of an Osteopathic Treatment Coupled With Lactation Consultations for Infants' Biomechanical Sucking Difficulties. J Hum Lact 2017; 33:165-172. [PMID: 28027445 DOI: 10.1177/0890334416679620] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite well-known recommendations from national and international bodies including the World Health Organization, few mothers achieve the goal of breastfeeding exclusively for 6 months. Half of mothers stop breastfeeding due to biomechanical issues in the first month, despite increasing support from lactation consultants. Osteopaths worldwide work with these babies, but there is little empirical evidence for this type of treatment. Research aim: This study aimed to determine the efficacy of an osteopathic treatment coupled with usual lactation consultations on infants' ability to latch. Secondary objectives included assessment of nipple pain and mothers' perceptions of the effect of treatment. METHODS We conducted a single blind, randomized controlled trial at a mother-to-mother support group between January and December 2015. Data were collected at four different times over a 10-day period (T0-T10) from 97 mother-infant dyads using the LATCH assessment tool, a visual analog scale (VAS) to document mothers' nipple pain, and a de novo questionnaire for breastfeeding management and potential treatment side effects. RESULTS There were consistent statistical and clinical differences in the mean LATCH scores between the treatment and the control groups ( p < .001). However, no significant differences in the VAS scores were reported over time ( p = .713). Mothers reported no serious or unexpected side effects during the follow-up period. CONCLUSION This study is one of the first to bring together lactation consultants and osteopaths to address infants with biomechanical sucking difficulties. Findings support the hypothesis that the addition of osteopathy to regular lactation consultations is beneficial and safe.
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Affiliation(s)
- Juliette Herzhaft-Le Roy
- 1 Entraide Naturo-Lait, Québec, Canada.,2 Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada
| | - Marianne Xhignesse
- 2 Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada
| | - Isabelle Gaboury
- 2 Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada
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Abstract
Pain has been documented as a major concern for women in the postpartum period. Management of postpartum pain, however, is a relatively neglected area of clinical research. As a result, evidence to support interventions to alleviate the discomforts associated with childbirth is sparse. This paucity of research on postpartum pain management is particularly surprising given that in the United States alone nearly 4 million women give birth each year. Inadequate pain relief in the hours to months following childbirth can interfere with maternal-newborn bonding and feeding and, by impeding mobility, can increase the risk of postpartum complications. In addition, pain that is not adequately managed may increase the risk of chronic pain that lasts beyond the postpartum period. In this article, the more common causes of pain following childbirth are reviewed and recommendations for pain management based on available evidence are outlined. Considerations for pain management in lactating women and for hospital discharge are discussed.
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Cannon AM, Sakalidis VS, Lai CT, Perrella SL, Geddes DT. Vacuum characteristics of the sucking cycle and relationships with milk removal from the breast in term infants. Early Hum Dev 2016; 96:1-6. [PMID: 26964010 DOI: 10.1016/j.earlhumdev.2016.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The importance of an infant's intra-oral vacuum in milk removal from the breast has been established. However, the relationship between the vacuum curve and milk transfer is not well understood. AIMS To investigate the parameters of the infant suck cycle in relation to the volume of milk removed from the breast. STUDY DESIGN Cross-sectional study to elucidate the role of infant intra-oral vacuum in efficient milk removal from the breast. SUBJECTS Nineteen fully breastfed term infants. METHODS Intra-oral vacuum was recorded during monitored breastfeeds using a pressure transducer. Ultrasound imaging (milk flow) and respiratory inductive plethysmography (swallowing) were used to determine the nutritive sucking (NS) portion of the feed. Milk intake was determined by weighing infants before and after feeds. Vacuum traces of the first and next 2min of NS from the first breast were analysed. RESULTS The volumes of milk removed during both NS periods were negatively associated with peak vacuum (p<0.001) and rate of vacuum application (p<0.001), and positively related to area under first half of the suck cycle (p<0.001). Most parameters changed significantly from the first 2min of NS to the next 2min including significant reduction in peak vacuum and area under first half of the suck cycle. CONCLUSION These results further support the role of intra-oral vacuum, specifically optimal peak vacuum, in effective and efficient milk removal during breastfeeding. It also appears that infants modify their sucking dynamics to adapt to changes in milk flow during milk ejection as the breast empties.
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Affiliation(s)
- Anna Maria Cannon
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Vanessa Susanna Sakalidis
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia; Medela AG, Baar, Switzerland
| | - Ching Tat Lai
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Sharon Lisa Perrella
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Donna Tracy Geddes
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
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de Sousa TM, dos Santos LC, Peixoto ÉF, Lopes LMC, de Andrade LB, Frois MC, Santiago MA, Bouzada MCF. Factors Associated with Nipple Lesions in Puerperae. J Trop Pediatr 2016; 62:63-8. [PMID: 26330461 PMCID: PMC4892383 DOI: 10.1093/tropej/fmv056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This retrospective cross-sectional study aimed to evaluate the factors associated with nipple lesion development in puerperae. Analyses were performed using the Poisson regression with robust variance. The level of significance was set at 5% (p < 0.05). We evaluated 1270 puerperae, among whom 193 (15.4%) presented with nipple lesions. The condition was more prevalent among the mothers who did not receive information about breastfeeding [PR, 1.69; 95% confidence interval (CI), 1.19-2.42], those who underwent cesarean delivery (PR, 1.48; 95% CI, 1.02-2.16), those who used a pacifier (prevalence ratios (PR), 2.04; 95% CI, 1.05-3.95), those who used baby formula only (PR, 1.61; 95% CI, 4.82-5.36) and those who used baby formula combined with breastfeeding (PR, 1.61; 95% CI, 1.06-2.45). A lower incidence of nipple lesions was observed among those who did not receive information on hand expression of breast milk (PR, 0.65; 95% CI, 0.46-0.93) and those who did not breastfeed in the first hour of life (PR, 0.61; 95% CI, 0.38-0.97).
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Shanazi M, Farshbaf Khalili A, Kamalifard M, Asghari Jafarabadi M, Masoudin K, Esmaeli F. Comparison of the Effects of Lanolin, Peppermint, and Dexpanthenol Creams on Treatment of Traumatic Nipples in Breastfeeding Mothers. J Caring Sci 2015; 4:297-307. [PMID: 26744729 PMCID: PMC4699508 DOI: 10.15171/jcs.2015.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/27/2015] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Traumatic nipple is among the most common problems of the breastfeeding period which leads to early cessation of breastfeeding. The study aimed to compare the effects of the lanolin, peppermint, and dexpanthenol creams on the treatment of traumatic nipples. METHODS This double-blind randomized controlled trial was carried out on 126 breastfeeding mothers. The mothers had visited at the health centers and children's hospitals in Sanandaj City. The selected participants were randomly divided into the following three groups of lanolin, peppermint, and dexpanthenol cream groups. Nipple pain was measured using the Store scale while trauma was measured with the Champion scale. Analyses were carried out through the Kruskal-Wallis test, Chi-square, ANOVA, and repeated measures ANOVA by using SPSS software ver. 13. RESULTS The result showed that the mean score of nipple pain and nipple trauma at the prior to intervention stage, third, seventh, and fourteenth days of intervention was not significantly different between three groups. But, repeated measures ANOVA showed a significant difference in comparison of the four time periods of intervention in each group. CONCLUSION RESULTS of this study revealed that the lanolin, peppermint, and dexpanthenol medicines had similar therapeutic effects on traumatic nipple.
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Affiliation(s)
- Mahnaz Shanazi
- Department of Midwifery, Nursing and Midwifery Faculty, Tabriz University of
Medical Sciences, Tabriz, Iran
| | - Azizeh Farshbaf Khalili
- Department of Midwifery, Tabriz Health Services Management Research Centre,
Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahin Kamalifard
- Department of Midwifery, Nursing and Midwifery Faculty, Tabriz University of
Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Biostatistics & Epidemiology, Road Traffic Injury Research
Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kazhal Masoudin
- Department of Midwifery, Nursing and Midwifery Faculty, Tabriz University of
Medical Sciences, Tabriz, Iran
| | - Fariba Esmaeli
- Information Technology, Faculty of Nursing and Midwifery, Tabriz University of
Medical Sciences, Tabriz, Iran
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Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12247-63. [PMID: 26426034 PMCID: PMC4626966 DOI: 10.3390/ijerph121012247] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/10/2015] [Accepted: 09/23/2015] [Indexed: 11/17/2022]
Abstract
Background: Persistent nipple pain is one of the most common reasons given by mothers for ceasing exclusive breastfeeding. We aimed to determine the frequency of nipple pain as a reason for consultation, the most common attributed aetiologies, and the effectiveness of the advice and treatment given. Methods: All consultations at the Breast Feeding Centre of Western Australia (WA) were audited over two six-month periods in 2011 (n = 469) and 2014 (n = 708). Attributed cause(s) of nipple pain, microbiology results, treatment(s) advised, and resolution of pain were recorded. Results: Nipple pain was one of the reasons for consultation in 36% of cases. The most common attributed cause of nipple pain was incorrect positioning and attachment, followed by tongue tie, infection, palatal anomaly, flat or inverted nipples, mastitis, and vasospasm. Advice included correction of positioning and attachment, use of a nipple shield, resting the nipples and expressing breastmilk, frenotomy, oral antibiotics, topical treatments, and cold or warm compresses. Pain was resolving or resolved in 57% of cases after 18 days (range 2–110). Conclusion: The multiple attributed causes of nipple pain, possibly as a result of a cascade of events, suggests that effective early lactation management for prevention of nipple pain and early diagnosis and effective treatment are crucial to avoid early weaning.
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Abstract
BACKGROUND Leading health authorities all recommend exclusive breastfeeding to six months' postpartum. While most women initiate breastfeeding, many discontinue due to difficulties encountered rather than maternal choice. One common breastfeeding difficulty is painful nipples. Research has identified poor infant positioning or latch as a common cause of painful nipples. While many different interventions designed to reduce nipple pain in breastfeeding women have been evaluated, it is unclear which intervention is the most effective treatment. An understanding of nipple pain and treatment options are needed to improve breastfeeding duration and exclusivity rates and to address systematically one of the most frequent difficulties encountered by breastfeeding women. OBJECTIVES To assess the effects of all interventions in the resolution or reduction of nipple pain and the impact of the interventions on other outcomes such as nipple trauma, nipple infections, breast mastitis, breastfeeding duration, breastfeeding exclusivity, and maternal satisfaction. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and scanned secondary references. SELECTION CRITERIA All randomised or quasi-randomised controlled trials designed to evaluate any intervention for treating nipple pain among breastfeeding women. Trials using a cluster-randomised design were eligible for inclusion. Cross-over trials were not eligible for inclusion. The following interventions were eligible for inclusion compared with each other or usual care (i.e. education only): pharmacological (e.g. antifungal creams); non-pharmacological topical treatments (e.g. lanolin); dressings (e.g. hydrogel dressings); nipple protection devices (e.g. breast shells), phototherapy, and expressed breast milk. Nipple pain in women who are feeding with expressed breast milk (i.e. women of infants in neonatal units) is associated with other methods of removing milk from the mother's breast such as manual expression and various types of breast pumps. Nipple pain and subsequent treatment is different in this unique maternal population and thus we excluded women solely feeding with expressed breast milk from this review. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data, evaluated methodological quality, and checked data for accuracy. We sought additional information from several trial researchers. MAIN RESULTS We included four trials of good methodological quality involving 656 women in the review. The four included trials evaluated five different interventions including glycerine pads, lanolin with breast shells, lanolin alone, expressed breast milk, and an all-purpose nipple ointment. All studies included education to position the infant at the breast correctly as part of routine postpartum care to both treatment and control groups.Pooled data existed only for the comparison of lanolin versus usual care. We did not pool data for other outcomes due to either heterogeneity in outcome measures or differing interventions.There was no evidence that glycerine gel dressings or breast shells with lanolin significantly improved nipple pain. One trial found no clear differences in nipple pain (at one to three days, four to five days, or six to seven days' post-treatment) between women who applied lanolin or nothing to their nipples. In contrast, the same trial found that women who applied expressed breast milk had significantly lower perceptions of nipple pain following four to five days of treatment than women who applied lanolin. However, this beneficial effect was not maintained after six to seven days of treatment. There were no group differences in nipple pain perceptions at any assessment between women who applied expressed breast milk and women who applied nothing. Women who applied an "all-purpose nipple ointment", in comparison to women who applied lanolin, had no improvement in nipple pain after seven days of treatment. There was insufficient evidence that glycerine gel dressings, lanolin with breast shells, lanolin alone, expressed breast milk, or all-purpose nipple ointment improved maternal perceptions of nipple pain.Overall, there was insufficient evidence to recommend any intervention for the treatment of nipple pain. However, one important finding was that regardless of the treatment used, for most women nipple pain reduced to mild levels after approximately seven to 10 days' postpartum. The provision of anticipatory guidance regarding usual time to pain reduction may be a useful strategy in assisting women to continue to breastfeed and to do so exclusively. The overall quality of the evidence for the primary outcome of nipple pain as assessed using GRADE was of low quality, mainly because single studies with few participants contributed data for analysis. AUTHORS' CONCLUSIONS There was insufficient evidence that glycerine gel dressings, breast shells with lanolin, lanolin alone, or the all-purpose nipple ointment significantly improved maternal perceptions of nipple pain. The results from these four trials of good methodological quality suggested that applying nothing or just expressed breast milk may be equally or more beneficial in the short-term experience of nipple pain than the application of an ointment such as lanolin.The quality of the evidence for this review did not lead to robust conclusions regarding the objectives assessed. We included only four trials, incorporating 656 women, in the review and all four trials compared varying interventions, participants, study outcome measures, and standards of usual care. The methodological quality of the included studies was good but the overall quality of the evidence for the primary outcome of nipple pain was of low quality, mainly because single studies with few participants contributed data for analysis.
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Affiliation(s)
- Cindy-Lee Dennis
- University of Toronto andWomen’s College Research Institute, 155 College Street, Toronto, ON, M5T 1P8, Canada.
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Abstract
Many mothers stop breastfeeding because of breast and/or nipple pain, despite recommendations by the World Health Organization to exclusively breastfeed for the first 6 months. Most commonly, such pain is thought to be caused by fungal or bacterial infection; however, many women do not respond to usual treatments for such diagnoses. Furthermore, there is much dispute in the literature about these diagnoses and treatments. We submit a series of 3 cases of mothers who presented with severe mastalgia (breast pain) and who did not respond to conventional treatments. After treating the patients with pectoral muscle massage and stretching, they each had complete resolution of their pain. We suggest that each of these mothers experienced constriction of the upper thoracic muscles on their mammary neurovasculature.
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Affiliation(s)
- Edith Kernerman
- International Breastfeeding Centre, Toronto, Ontario, Canada Newman Breastfeeding Clinic, Toronto, Ontario, Canada
| | - Eileen Park
- International Breastfeeding Centre, Toronto, Ontario, Canada
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Abstract
BACKGROUND Nipple pain and damage are common in the early postpartum period and are associated with early cessation of breastfeeding and comorbidities such as depression, anxiety, and mastitis. The incidence of nipple vasospasm has not been reported previously. This article describes nipple pain and damage prospectively in first-time mothers and explores the relationship between method of birth and nipple pain and/or damage. SUBJECTS AND METHODS A prospective cohort of 360 primiparous women was recruited in Melbourne, Australia, in the interval 2009-2011, and after birth participants were followed up six times. The women completed a questionnaire about breastfeeding practices and problems at each time point. Pain scores were graphically represented using spaghetti plots to display each woman's experience of pain over the 8 weeks of the study. RESULTS After birth, before they were discharged home from hospital, 79% (250/317) of the women in this study reported nipple pain. Over the 8 weeks of the study 58% (198/336) of women reported nipple damage, and 23% (73/323) reported vasospasm. At 8 weeks postpartum 8% (27/340) of women continued to report nipple damage, and 20% (68/340) were still experiencing nipple pain. Ninety-four percent (320/340) of the women were breastfeeding at the end of the study, and there was no correlation between method of birth and nipple pain and/or damage. CONCLUSIONS Nipple pain is a common problem for new mothers in Australia and often persists for several weeks. Further studies are needed to establish the most effective means of preventing and treating breastfeeding problems in the postnatal period.
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Affiliation(s)
- Miranda L Buck
- 1 Mother and Child Health Research, La Trobe University , Melbourne, Victoria, Australia
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