Effectiveness of Breast Massage on Lactation Among Immediate PostnatalMothers- A Randomized Controlled Trial

INTRODUCTION

Breast milk is universally accepted as the best food for a newborn. Mostly all the mothers find difficulty in establishing & maintenance of lactation in early postpartum period. Any kind of stress may postpone milk ejection by hormone inhibition for a few days after delivery and this will result in the newborn weight loss & failure of nursing by the mothers. Immediate breast feeding within the first hour, followed by early exclusive breastfeeding, improves the health & survival status of newborns¹.Proper breastfeeding exercise could prevent millions of death every year.²

Lactation is affected by large number of factors like mode of delivery, body mass index, surgery, illness, breast and nipple abnormality and labour experiences. Psychological stress resulting from pain and fatigue after labour, lack of support to the mother and difficulties encountered on initiation of breast feeding causes neuroendocrine dysregulation leading to irregularities in hypothalamus – pituitary – adrenal axis function, leading to delayed onset of milk production and insufficient milk. These factors cause anxiety in the mother and they go for supplementary feeding, and slowly mothers stop producing milk. During lactogenesis mothers need to breast feed the baby frequently to stimulate the production of milk, which many mothers are unaware.³

Mothers need encouragement and support for breast feeding and also they require measures to improve the production and flow of milk for the first 3-4 days to prevent excessive weight loss of the newborns, physiological jaundice, dehydration and hypoglycemia. Breast massage is a simple and inexpensive method to improve lactation.⁴ The effect of breast massage on lactation may help the post-natal mothers to feed their babies satisfactorily and with confidence.

OBJECTIVES

1. To assess the effectiveness of breast massage on lactation among the immediate postnatal mothers

2. To determine the association between the effects of breast massage on lactation with selected baseline variables

MATERIALS AND METHODS

A quantitative approach, a randomized control trial was adopted to assess the effectiveness of breast massage on lactation among immediate postnatal mothers. The study was conducted in the postnatal ward of St. John’s Medical College Hospital after obtaining ethical clearance from the institutional ethical review board. Forty-six(46) postnatal mothers who fulfilled the inclusion criteria were selected for the study. Informed consent from postnatal mothers was obtained to assure the confidentiality. Postnatal mothers with live babies weighing more than 2.kg after the initiation of breast feeding in the labour room soon after the delivery were selected for the study. Mothers whose babies were separated after birth and admitted in NICU with complications, healthy newborn with cleft palate and abnormalities in oral cavity and postnatal mothers and neonates who were participating in other research studies were excluded from the study. 

Computer-generated random numbers were used for the random assignment of the subjects to either experimental or control group. Allocation concealment was done by the sequential numbered opaque sealed envelope technique. Baseline information were collected through semistructured interview schedule.

In experimental group, Breast massage was administered for 5 minutes by maintaining the privacy, thrice a day (morning, afternoon and evening) for three days. The steps of massage included circular massage, longitudinal strokes towards the nipple and shaking of breasts. After the massage the babies were allowed to breastfeed. Pre and post feed weight of the baby with the same clothes was checked with each intervention. Routine care was given to mothers and neonates in the control group. Babies were weighed before and after a normal breast feed in the same way as the babies in the experimental group Mothers in both groups were instructed to maintain a record of number of urination and stools per day and duration of sleep for the respective three days. The data were analyzed using Mann Whitney ‘U’ test and independent t-test to detect a difference between the two groups. A p value of 0.05 was considered as significant

RESULT

I. Baseline characteristics of the mothers

In all, 46 postnatal mothers with their babies were included in the study, with 23 babies in each group. Baseline characteristics were similar in both groups

II. Effect of breast massage on neonatal parameters

Table 1 shows that the Post feed weight gain in experimental group neonates is significantly higher compared to control group (p<0.05) for all three days. Data presented in table 2 depicts the mean difference of birth weight and third day weight of neonates in both groups are significant (p<0.05). The mean weight loss in the control group was 0.180 is greater when compared to the experimental group (0.080).

III.Differencebetween experimental and control group neonates in the number of urination and stools passed per day 

The number of urinations in the experimental group was significantly higher compared to the control group for all three days.The difference in the number of stool between experimental and control group was significant on the 3rd day (table 3).The neonates in experimental and control group had no significant difference in the duration of sleep after breastfed on the first day. Whereas on second (t=2.76,p=0.008) and third(t=44,p=0.02) day, duration of sleepwas statistically significant at 0.05 level after breastfeedingbetween two group (Table 4). There was no significant association between maternal baseline variables and post feed weight gain in neonates

DISCUSSION

The study revealed that breast massage was effective in reducing the weight loss in the first week of life in exclusively breast fed neonates. The mean weight loss in the control group 0.180(t=11.92)was greater when compared to the experimental group neonates 0.080(t=4.37) in the first three days.Post intervention weight of the neonates was compared with birth weight, weight difference between two groups was statistically significant at 0.05 level(p<0.001).

Similar findings have been observed in a study on alternate breast massage to determine the amount of milk ingested, the babies in the massage group consumed more per feeding than the babies in the non-massage group.⁵ Other studies have shown similar effects, though the site of massage was different.⁶ 

The findings of the present study revealed that the number of urinations passed by the neonates with experimental group during 2nd day (6.37) and 3rd day(7.43) of life was significantly higher than the neonates in the control group (4.43 & 4.91) (p<0.05) after implementation of breast massage. This indicated that increased lactogenesis in postnatal mothers in the experimental group may be responsible for more frequent urinations in their neonates.

Similar findings have been observed in a previous study in which the mean number of urinations in experimental group on first day was (3.28), on second day (5.67) and on third (7.19);where as in control group on first day it was(2.92), on second day (5.26) and on third day (6.08). The computed t value on first, second and third day is 0.68,0.77 and 2.1 respectively. It showed statistically significant difference between experimental and control group at 0.05 level7.

In the present study, there was no significant statistical difference in the number of stool passed by the neonates in the experimental group and control group on the first and second day of birth. Whereas on the third day the mean number of stool passed by the neonates in the experimental group was 6 and by the control group neonates was 3.56 which showed a statistically significant difference at 0.05 level (table.3). This indicates improving lactation in immediate postpartum mothers was responsible for more frequent stools. A similar findings was observed in an experimental group where the mean number of stools on first day ( 2.68), second day (2.43) and on third day was (3.98); where as in the control group it was on the first day (2.33), second day (2.07) and on third day (2.07)⁷.

The findings of both urine and stool passed by neonate in the present study can be correlated with a single study data from 242 exclusively breastfeeding mother-infant pairs, newborn elimination patterns were analyzed. Median number of diapers(wet /soiled) on days 1,4 and 7, respectively, was 2/3,5/4,and 7/6. The most efficient day 4 predictor of breastfeeding inadequacy was soiled diaper output ≤3 (Se=.75,Sp=.66)⁸.

Findings related to duration of sleep in minutes of neonates after breast feeding, the neonates in experimental and control group had no significant difference in the duration of sleep after breastfed on the first day whereas on second and third day neonate’s in the experimental group duration of sleep after breastfeeding was significantly longer than in control group.The findings of the present study prove the research hypothesis that there will be a significant effect of breast massage on lactation. In a related study the chi-square value of duration of sleep in all subsequent three days were 20.19, 22.08 and 31.71 which was found statistically significant at p<0.05 level on three days⁷.

The study showed that lactation in postnatal mothers can be improved with simple measures like breast massage which can leave the mothers at ease and gain confidence in caring for their neonates. The gastric motility also has increased in neonates which may lead to increased bilirubin excretion thus reducing the intensity of neonatal jaundice.

LIMITATIONS

Samples were selected from St. John’s Medical College Hospital and the study was confined to a small number of subjects and shorter period which limits the generalization 

CONCLUSION

Lactation among postnatal mothers is significantly improved by using a “handy” technique” called breast massage. By adopting this method it helps toestablishing and sustaining lactation, overcoming breast feeding difficulties and preventing or treating maternal and infant problems.