Professional Documents
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05 N002 46800
05 N002 46800
BANGALORE,KARNATAKA
4. DATE OF 2-05-2013
ADMISSION TO THE
COURSE
5. TITLE OF THE EFFECTIVENESS OF BREAST
STUDY MASSAGE ON LACTATION
AMONG IMMEDIATE
POSTNATAL MOTHERS.
Mothers milk, time tested for millions of years, is the best nutrient for babies because it is
Early breast milk is liquid gold (colostrum) which is very rich in nutrients and
antibodies to protect the baby1. The ideal food for the young infant is human milk, which has the
specific characteristics that match the growing infants nutritional requirements during first year of
life. It has diverse and compelling advantages to infants, mothers, families and society. These
environmental benefits.2
antibodies pass to the baby via the milk. This is one of the most important features of colostrums,
the breast milk created for newborns. The main targets for these antibodies are probably
microorganisms in the baby's intestine. There is some uptake of IgA to the rest of the body, but this
amount is relatively small. Also, breast milk contains several anti-infective factors such as bile salt
stimulated lipase (protecting against amoebic infections) and lactoferrin (which binds to iron and
child at a small cost to the mother. Frequent and exclusive breastfeeding usually delays the return of
fertility through lactational amenorrhea, though breastfeeding is an imperfect means of birth control.
During breastfeeding beneficial hormones are released into the mother's body and the maternal bond
can be strengthened. 3
Malnutrition kills one out of three infants in India. 4 Children who are not breastfed are
almost six times more likely to die by the age of one month than children who receive at least some
breastmilk.3 66% of these death occur during the first year of life and is often caused by
About one-fourth to one half of all infant deaths in developing countries occurs in the
first week of life. Immediate breast feeding within the first hour, followed by early exclusive
breastfeeding, improves the health & survival status of newborns. 5Proper breastfeeding exercise
could prevent millions of death every year. Promotion of early initiation of breastfeeding has the
potential to make a major contribution to the achievement of the child survival millennium
development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day1 and
22% if breastfeeding started within the first hour. Breastfeeding promotion programs should
Exclusive breastfeeding during early months of life reduces infant morbidity and
mortality. World Health Organization (WHO) defines exclusive breastfeeding as, feeding an infant
only with breast milk, excluding solids or any other fluids (including infant formulas) except
medicines, vitamins, and minerals. WHO recommended infants to be exclusively breastfed during
UNICEF says that despite compelling evidence that exclusive breastfeeding prevents
diarrhea and pneumonia, global rates of breastfeeding have remained relatively stagnant in the
developing world, growing from32% in 1995 to 39% in 2010. If breastfeeding were promoted more
effectively, we would see more children survive, with lower rates of disease and lower rates of
In India, practices like discarding the colostrums, giving pre-lacteal feeds, early/late
weaning and use of formula feeds are still widely prevalent. The issue becomes an area of concern
since large numbers of babies born in India are low birth weight. Breastfeeding is the first
fundamental right of a child. The initiation of breastfeeding and the timely introduction of adequate,
safe and appropriate complementary foods in conjunction with continued breastfeeding are of prime
importance for the growth, development, health and nutrition of infants and children
everywhere. The prevalence of breastfeeding in India is still high (99% in rural areas and 96% in
urban areas). However, there are many cultural practices associated with infant feeding of which
Lactation is affected by large number of maternal factors like mode of delivery, body
mass index, surgery, illness, breast and nipple abnormality and labor experiences. Psychological
stress resulting from pain and fatigue after labor, lack of support to mother and difficulties
Breast massage is defined as the technique entails specific kneading, rubbing, and or
squeezing strokes applied to the soft tissue of the breast to increase lymph and blood flow. Before
nursing, gentle massage toward the nipple allow some milk to flow out and help to soften the nipple
for easier latch. During nursing, gentle compress and massaging will stimulate the letdown of milk.
Considering the ease of implementation and obvious lack of adverse effects, non
pharmacologic measures are attractive option over pharmacologic measures for improving
lactation.Motivation for breastfeeding, social support; nursing frequency and good breast feeding
experience are other factors have positive impact on lactation. Research has demonstrated that
mothers require active support for establishing and sustaining appropriate breastfeeding practices.11
The researcher during her clinical experience recognized that most of the post natal
mother in the initial period find difficulties in the feeding because of insufficient breast milk. The
common complain of the post natal mother was not enough milk. The researcher opted the study as it
is a simple and inexpensive method to improve lactation. The effect of breast massage on lactation
may help the post natal other to feed their babies satisfactorily and with confidence.
The organizer will organize the review under the following headings:
-Factors affecting lactation.
Breast milk is considered the optimal food source for newborns through 1 year of age.
Many factors influence overall maternal production, including maternal pain, illness, balance of time
when returning to work, anxiety, or emotional stress. Several common problems that may arise
during the breastfeeding period, such as breast engorgement, plugged milk duct, breast infection and
insufficient milk supply, originate from conditions that lead the mother to inadequate empty the
breasts. Incorrect techniques, not frequent breastfeeding and breastfeeding on scheduled times,
pacifiers and food suppliers are important risk factors that can predispose to lactation problems. The
adequate management of those conditions is fundamental, as if not treated they frequently lead to
early weaning. There are specific measures that should be taken to empty the breasts effectively.12
cells to become flattened & occlude the capillary blood circulation surrounding the alveolar cells.
Congestion contributes to edema & obstructs lymphatic drainage of the breasts, stagnating the
system that rid the breasts of toxins & bacteria, & leading to mastitis. In very severe cases can cause
numbness or tingling of the hands from pressure on the nerves.In addition, a protein called the
feedback inhibitor of lactation (FIL) accumulates in the mammary gland during milk stasis. It acts as
a major trigger of apoptosis, that causes involution of the milk-secreting gland, collapse of the
in vaginal & LSCS deliveries among 300 parturient mothers. There was a meaningful difference
between average time of milk-ejection in groups with different types of delivery. The study suggest
that any kind of stress including LSCS may postpone milk ejection by hormonal inhibition for few
days after delivery and this will result in newborn weight loss and failure of nursing by mothers. 14
A cross-sectional study was conducted among 240 mothers to study the socio-cultural
factors affecting breastfeeding practices and decision among rural women. It was found that 56.6%
of mothers initiated breastfeeding within first 24 hours of delivery. Shorter duration of breastfeeding
was observed among mothers with higher socio economic status. Literacy status had little effect on
continuation of breastfeeding for more than six months.81.19% mothers had no knowledge regarding
exclusive breastfeeding.15
Complementary and alternative therapies have been proposed to assist with lactation in
mothers. These methods for increasing breast milk supply include herbal galactagogues, kangaroo
mothering, and relaxation therapies. Metoclopramide, oxytocin, fenugreek, and milk thistle have
Fenugreek seed has been used to support healthy milk production since biblical times.
The benefits of fenugreek in breastfeeding are believed to stem from diosgenin, a compound that is
similar to the female hormone estrogen. More specifically, diosgenin has been shown experimentally
to increase milk flow. As such, the use of fenugreek to encourage lactation could offer help to
women with insufficient supply. However, there needs to be more scientific evidence of the herb's
effectiveness in increasing milk production. Breast compression is a technique that is used to help
drain the milk from breast, improve let-down response, and encourage a sleepy baby to keep
sucking at the breast. These actions will help foster an increase in milk supply.17
The Marmet Technique of manual expression recommends assisting the milk- ejection
reflex by massaging the milk producing cells and ducts in a circular motion similar to that used in a
breast examination. This massage technique is used in conjunction with light stroking motions from
the base of the breast to the nipple and shaking the breast while leaning forward so gravity will help
between acupoint Tuina and simple instruction and education to improve the lactation of the
parturient after delivery. Fifty-six cases of primipara were divided into an acupoint Tuina group (28
cases) and a control group (28 cases) according to the order of entering group, the acupoint Tuina
group was treated with Tuina intervention at local acupoint of the breast and distant acupoint on the
basis of the instruction and education of breast feeding; the control group was treated with simple
instruction and education of breast feeding. The study concluded that parturient had sufficient milk
in acupoint Tuina group after treatment, and the time start to lactate was earlier than that of control
group. The acupoint Tuina is good for parturient to lactate early and lactate more.18
A quasi experimental study was conducted for a period of 16 months, to assess the
effectiveness of back massage on lactation among immediate postnatal mothers.220 mothers were
enrolled and lactation was assessed on the based on various parameters. The result was significantly
higher post feed weight gain, higher mean number of urinations and stools passed per day and better
One of the most powerful stimulants to the secretion of milk is massage of the breast.
To study the effectiveness of Alternate Breast Massage, the researcher took two
groups of 30 mothers each: one group was taught the massage, and the other group was not taught
the technique. The babies of mothers in both groups were weighed before and after feeding to
determine the amount of milk ingested. Babies in the massage group consumed an average of 22.3
gm more per feeding than the babies in the non-massage group. When the daily totals were
compared, the babies in the experimental group received an average of 4.5 ounces of milk more than
In a study was done in lactating women pump their breasts simultaneously using an
electric breast pump, while massaging only one breast and utilizing the other breast as a control. The
procedure was repeated the following day with the women massaging the opposite breast. This
resulted in 36 pairs of samples for comparison. Mean volume of milk pumped from the massaged
breast was 4.8 ml greater than that from the non- massaged breast. Mean creamatocrit from the
massaged breast was 1.92% higher than from the non-massaged breast. These results indicate that
breast massage can increase volume and fat content of breast milk. Increasing fat content
A cross-sectional study milk samples took immediately before and after breast
massage from healthy, exclusively breastfeeding mothers. Breast massage significantly increased
total solids, lipids, casein concentration, and gross energy. Other studied the effect of breast massage
on breast-milk protein. Analyzing milk samples from 39 healthy breastfeeding mothers, they
volume and fat content of expressed milk, as well as the effect of breast massage on milk volume
and fat content. Their results showed that simultaneous pumping is more effective in producing milk
than sequential pumping, and that breast massage has an additive effect, improving milk expression
by both methods. 10
A study done on hands-on pumping technique in which the mother used bilateral
pumping with an electric breast pump while simultaneously compressing the breasts and massaging
firmer areas. They demonstrated that pump-dependent mothers of preterm infants and mothers
otherwise at risk for insufficient milk production can attain and sustain good milk volumes using
hands-on pumping and breast massage. They concluded that increased milk production results from
more effective breast emptying rather than increasing the frequency or duration of the pumping
sessions. They recommended that studies of pumping effectiveness should factor in the use of breast
massage. Mortons video, Hand Expression of Breast milk, demonstrates the use of gentle breast
massage before hand expression to stimulate the flow of milk. The video, how to Use Your Hands
When you pump, demonstrates the use of breast massage and compression during pumping to
improve emptying of the breast to increase milk production. This technique emphasizes the
A study to assess the effectiveness of breast massage on lactation among immediate postnatal
1. To assess the effectiveness of breast massage on lactation among the immediate postnatal mothers.
EFFECTIVENESS:
In this study effectiveness refers to the extent in which breast massage enhance the
lactation as evidenced by post feed weight gain of neonates, number of urinations and number of
stools.
BREAST MASSAGE:
A method of stroking, rubbing, kneading and manipulating the breast to stimulate milk production.20
In this study it refers to the art of massaging the milk producing cells and ducts before
feeding. Massage start at the top of the breast and press firmly in a circular motion on the skin of
chest wall then spiral around the breast toward the areola (2min). Stroking the breast from the chest
wall to the nipple with a light tickle-like stroke ( 2min) and shaking the breast gently while leaning
forward so that gravity will help the milk ejection (1 min). (Marmet C.Lactation Institute) It will be
done for three times per day (morning, afternoon and evening).
LACTATION:
The period during which the infant is nourished from the breast.20
In this study it refers to the process of production of milk from the mammary gland
following and continued removal of accumulating milk from the breast as and when necessary.
37 completed gestational age and mothers include first postnatal day up to three days.
BASELINE VARIABLES:
Age, Education, Body mass index, Parity, Nature of delivery, Source of information.
6.6 ASSUMPTIONS:
-Postnatal mothers may experience inadequate lactation during the 1st week after delivery.
6.7 DELIMINATION:
The study is limited to immediate postnatal mothers in SJMCH with a live term baby in the
postnatal wards.
The study will help to enhance lactation thereby facilitate weight gain of neonates and also early
6.9 HYPOTHESIS
H1: There will be significant effect between the breast massage and lactation at 0.05 level of
significance.
H2: There will be a significant association between lactation and selected baseline variables at 0.05
level of significance.
The data will be collected from mothers within third postnatal day and their live baby in SJMCH.
The study will be conducted in the postnatal ward of St. Johns medical college hospital, Bangalore.
It is a tertiary care teaching institute and 1200 bedded multispecialty hospital with obstetrics and
gynecological department. Obstetrical ward is 75 bedded, in which the postnatal ward consists of 26
7.1.3 POPULATION:
The population in this study includes all the postnatal mothers with a live baby admitted in St. Johns
The sample will be selected by purposive sampling technique and the subjects will be assigned to the
experimental and control group. Computer-assisted random sequences is using for the random
experimental group and 22 postnatal mothers in control group, which is calculated from the previous
-Term postnatal mother with a live baby with weight of more than 2.5kg.
-Postnatal mothers after the first initiation of breast feeding (normal delivery1 hr, L S C S 2 hr).
-Mothers whose baby is separated after birth and admitted in NICU with any complication.
-Healthy newborn with cleft palate and abnormalities in oral cavity.
-Postnatal mothers and neonates who are participating in other research studies.
SECTION A: A structured interview for collecting the baseline variables of postnatal mother.
confidentiality.
In control group, pre feed weight and post feed weight of the baby will be assessed without giving
breast massage for three times a day, for consecutive three days.
Frequency of urination and stools will be recorded for the respective three days.
In experimental group, Intervention in the form of breast massage will be administered for 5min,
thrice a day for three consecutive days before feeding the baby.
Pre feed weight and post feed weight of the baby will be assessed after each breast feeding for
value, chi square) on the basis of objectives and hypothesis of the result. The result will be presented
Yes, The researcher needs to evaluate the effect of breast massage on lactation among postnatal
INCASE OF 7.3?
4. World breastfeeding week (2012) The importance of breastfeeding india.com health aug
1,2012.
5. Baker EJ, Sanei LC, Franklin N. Early initiation of and exclusive breastfeeding in large
at www.pediatrics.org/cgl/dol/10.1542/peds-2005-1996delayed.
7. World health organization. World breast feeding week.aug 2008.
8. India lags behind in breastfeeding practices:report. 2012 dec6;25:157,newdelhi/agency
IANS.
9. Patel U, Gedam S. Back massage on lactation among postnatal mothers. International
13. Mary KS, New perspectives on engorgement. 1999 dec- 2000 jan;35(6):134-36.
14. Sakha k, Behbahan AGG. The onset of time of lactation after delivery. Medical journal of the
16. Complementary and alternative therapies for increasing breast milk supply for lactating
mothers of infants in NICU. Neonatal netw 2010 July August; 29(4): 222- 30.
17. Jensen R. Fenugreek-overlooked but not forgotten. UCLA alumnae Association Newsletter
18. Lu P, Qui J, Yao F ,Zheng J J. Effect of acupoint tuina on lactation among for parturient.
19. Foda M.I, Kawashima T, Nakamura S, Kobayashi M, Oku T. Composition of milk obtained
from unmassaged versus massaged breasts of lactating mothers. J pediatr Gastroenterol Nutr,
2004 may;38(5):484-7.
20. Baillieres nurses dictionary. 24th ed. Barbara F. Eeller;2002. Elsevier; p. 127,244,226.
21. Oxford English dictionary.9th ed. Sara Hawker;2006. Oxford university press; p. 534.