Effect of Herbal Compresses for Maternal Breast Engorgement at Postpartum: A Randomized Controlled Trial.

BACKGROUND: Maternal breast engorgement is one of the most common problems in the postpartum period. There are several alternative treatments, but there have not been any randomized controlled trial studies about the effects of herbal compresses for breast engorgement. OBJECTIVE: The objective is to investigate the effects of herbal compresses for maternal breast engorgement. MATERIALS AND METHODS: A randomized controlled trial was conducted. The postpartum mothers who had breast engorgement were randomly assigned to herbal or hot compress treatments. The breast engorgement pain scores were assessed by visual analog scales pre- and post-treatment. The pain reduction scales of the herbal compress treatments were analyzed and compared with the hot compress treatments. The adverse effects of each treatment were recorded and collected after 24 hours from treatments. RESULTS: The data from 500 postpartum mothers with breast engorgement were available for analyses, 250 from the herbal compress group and 250 from the hot compress group. The baseline characteristics of both groups were similar except baseline breast engorgement pain score (herbal compress group higher than hot compress group). There were statistically significant mean differences of breast engorgement pain before and after treatment between the herbal and hot compress groups. No serious complications were found after treatment from herbal compresses. CONCLUSION: Among the postpartum mothers who had breast engorgement, the herbal compresses could decrease breast engorgement pain. The pain reduction after herbal compresses was found to be greater than with the hot compresses.

Comparison of Breastfeeding Outcomes Between Using the Laid-Back and Side-Lying Breastfeeding Positions in Mothers Delivering by Cesarean Section: A Randomized Controlled Trial.

BACKGROUND: The breastfeeding position routinely used following a cesarean section is the side-lying position. However, there have been few studies about the effect of breastfeeding positions, including laid-back position on breastfeeding outcomes. OBJECTIVE: To compare the breastfeeding outcomes between using laid-back and side-lying breastfeeding positions in mothers delivering by cesarean section. MATERIALS AND METHODS: A randomized controlled trial was conducted. The postpartum mothers delivering by cesarean section who delivered term newborns were randomly assigned to learn the use of a laid-back or side-lying breastfeeding position. The breastfeeding outcomes were assessed by LATCH scores at the second day postpartum and exclusive breastfeeding rates during the 6-week postpartum period. The mother's satisfaction of each breastfeeding position was collected before discharge from the hospital. RESULTS: The data from 152 postpartum mothers delivering by cesarean section were available for analysis, 76 from the laid-back position group and 76 from side-lying position group. The baseline characteristics of both groups were similar. There were no statistically significant differences of the breastfeeding outcomes, LATCH scores at the second day postpartum and the exclusive breastfeeding rates during the 6-week postpartum period. But the mothers had expressed more satisfaction from the side-lying than the laid-back position. CONCLUSIONS: Among the mothers who delivered by cesarean section, the use of the laid-back breastfeeding position had not shown different breastfeeding outcomes from the side-lying breastfeeding position. It might be an alternative breastfeeding position, which can be taught for mothers delivering by cesarean section along with the side-lying position.

Nipple Pain Incidence, the Predisposing Factors, the Recovery Period After Care Management, and the Exclusive Breastfeeding Outcome.

BACKGROUND: Nipple pain is the most common complaint of breastfeeding mothers during the immediate postpartum period. Persistent nipple pain is associated with low breastfeeding rate at 6 months postpartum. OBJECTIVE: To further explore the incidence of nipple pain, associated predisposing factors, time for recovery after management, and the impact on exclusive breastfeeding rates. MATERIALS AND METHODS: Included in this study were 1,649 singleton, pregnant women who delivered and had their 1-week follow-up at the breastfeeding clinic during the period of January 2013 to December 2015. The mothers who experienced nipple pain were analyzed for the incidence, the predisposing factors, and the recovery period after care management. The breastfeeding outcome comparison of both, mothers with and without pain, was measured by the exclusive breastfeeding rate at the sixth week postpartum. RESULTS: The incidence of nipple pain was at 9.6% by day 7. A predisposing factor of nipple pain was primiparity (relative risk = 1.8, 95% confidence interval 1.3-2.5). The reasons for nipple pain were inappropriate positioning and latching (72.3%), tongue-tie (23.2%), and oversupply (4.4%). The recovery period after care management was 1-2 weeks. There were no statistically significant differences between the 6-week exclusive breastfeeding rates of the mothers with nipple pain with treatment and the mothers without nipple pain. CONCLUSION: Persistent nipple pain was a common problem. The active management, including early detection and treatment, would help the mothers recover within a 2-week period and there was no significant difference of exclusive breastfeeding rates between the mothers who had early care management and the mothers without nipple pain.

The Association of Breastfeeding Practices with Neonatal Jaundice.

Background: Neonatal jaundice is a common problem in newborns. Inadequate breastfeeding jaundice is an important consideration for the neonatal jaundice. Early breastfeeding initiation and good breastfeeding practices may help to prevent neonatal jaundice. Objective: To find the association of breastfeeding practices, the time to initiate breastfeeding, the breastfeeding frequency, breast milk volume, and appropriate latching with neonatal jaundice at the early postpartum. Material and Method: The subjects were postpartum women and newborns who had normal deliveries without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok province between July 2013 and June 2014. During postpartum period, the time of the first neonatal suckling, the breastfeeding frequency per day, the breastfeeding duration for each instance, the breast milk volume, and appropriate latching were assessed. The newborns had routine microbilirubin evaluation done at 48 hours postpartum. The data of newborn with neonatal jaundice was collected, analyzed, and compared with no jaundice newborn. The demographic data and breastfeeding factors were analyzed by Chi-square, t-test, and the Fisher's exact test. Results: The data of 176 newborns (neonatal jaundice 88 cases and no jaundice newborn 88 cases) and mothers were analyzed. It had shown that the mean time for the initiation of breastfeeding was 1.57±0.6 hours in the no jaundice newborn group and 5.56±3.1 hours in the neonatal jaundice group. The percentages of 'breastfeeding frequency less than eight times per day' in the neonatal jaundice and no jaundice newborn groups were 92.0% and 1.1% at day 1 postpartum, and 42.0% and 0.0% at day 2 postpartum, respectively. The percentages of 'breastfeeding duration less than 10 minutes' per feeding in the neonatal jaundice group were 35.2% and 13.6% at day 1 and day 2 postpartum. No one in the no jaundice newborn group had breastfeeding durations of less than 10 minutes for each feeding. The percentages of mothers in the neonatal jaundice and no jaundice newborn groups having no milk were 84.1% and 1.1% at day 1, and 4.5% and 0.0% at day 2 postpartum, respectively. The percentages of 'latch scores greater than 8' in the neonatal jaundice and no jaundice newborn groups were at 15.9% and 50.0% at day 1, and 31.8% and 95.5% at day 2 postpartum. There were statistically significant differences in the breastfeeding parameters. Conclusion: The factors of the time of the initiation of breastfeeding, breastfeeding frequency, duration, breast milk volume, and appropriate latching are associated with neonatal jaundice at the second day postpartum.

Effect of Early Skin-to-Skin Contact to Breast Milk Volume and Breastfeeding Jaundice at 48 Hours after Delivery.

Objective: To evaluate effect of maternal-infant skin-to-skin contact in the first hour postbirth to breast milk volume and breastfeeding jaundice at 48 hours after delivery. Material and Method: This was a prospective cohort study. The subjects were 133 postpartum women, who delivered without complications between October 2013 and July 2014 at MSMC and was allocated into early skin-to-skin contact (SSC) and control groups. In the SSC group, the newborns were placed prone on mothers' bare chest after finishing routine newborn care for at least 30 minutes. The breast milk volume were collected at 16-24 hours, 40-48 hours postpartum and before discharge. The infants' microbilirubins were measured at 48 hours postbirth. Demographic data including age, parity, GA at delivery, birth weight and gender of the newborns were collected. Data were analyzed using descriptive statistics, Chi-square test and t-test. Results: The mean breast milk volume in the SSC group were 5.68+5.46, 16.98+11.09, and 31.44+20.06 milliliters at 16-24 hours, 40-48 hours postpartum and before discharge, respectively, while the mean breast milk volume in the control group were 6.19+5.77, 13.99+13.07 and 25.81+20.26 milliliters, respectively in the same period of time, and no statistically difference of the breast milk volume was found between the two groups. The percentage of mothers who had the onset of lactation within 24 hours postpartum in the SSC group (95.51%, 85/89) was significantly higher than the control group (77.27%, 34/44, p<0.01). The percentages of breastfeeding jaundice cases were 16.85 in the SSC group and 27.27 in the control group, and had no significant difference. Conclusion: Early skin-to-skin contact had no direct effect to breast milk volume and incidence of breastfeeding jaundice at 48 hours after delivery but related to the onset of lactation within 24 hours postpartum.

The Number of Infant Feeding Positions and the 6-Month Exclusive Breastfeeding Rates.

BACKGROUND: Appropriate infant feeding positions will help with latching. Good latching will help decrease cracked nipple and complication leading to early breastfeeding cessation. OBJECTIVE: To investigate the association of the number of infant feeding positions on exclusive breastfeeding during the first six months postpartum period. MATERIAL AND METHOD: The subjects were primiparous women who delivered without complications and intended to breastfeed their newborns at least six months at the HRH Princess Maha Chakri Sririndhorn Medical Center in Nakhon Nayok Province, Thailand, between May 2012 and April 2013. On the first day postpartum, the mothers had received instructions on four infant feeding positions. These included the cradle, cross cradle, football carry, and side-lying positions, and all were practiced. The mothers were assessed on their use of the numbers of infant feeding positions at the second day postpartum prior to their discharge. Telephone follow-ups at the second, fourth, and sixth month postpartum periods were collected and used for exclusive breastfeeding data collection following discharge. Demographic data and exclusive breastfeeding rates were analyzed by Chi-square test, one-way ANOVA test, and relative risk with a 95% confidence interval (CI). RESULTS: Five hundred forty five primiparous women were enrolled in the present study. The data showed that the 6-month exclusive breastfeeding rates of the studied group who could breastfeed by one, two, three, and four positions, had statistically signifcant differences (p-value < 0.05). The relative risks for exclusive breastfeeding rates between the mothers who used two infant breastfeeding positions or more and the mothers who used only one position were 1.68 (95% CI 1.45-1.95) at the 2-month, 1.69 (95% CI 1.38-2.09) at the 4-month, and 1.51 (95% CI 1.18-1.94) at the 6-month postpartum periods. CONCLUSION: The number of infant breastfeeding positions had an association with the exclusive breastfeeding rates during the six months postpartum period.

Comparisons of Latching on between Newborns Fed with Feeding Tubes and Cup Feedings.

BACKGROUND: Feeding tubes and cup feedings were used as alternative feedings. There is scant data regarding the facilitation of latching on by newborns with the use of these alternative supporting techniques. OBJECTIVE: The comparison of the latching on of newborns when fed with the additional support of feeding tubes or cup feedings. MATERIAL AND METHOD: The subjects were 120 normal, postpartum women, who delivered without complications at the HRH Princess Maha Chakri Sririndhorn Medical Center in the Nakhon Nayok Province between October 2012 and September 2013. No breast milk was expressed by the mothers at day 2, postpartum. They were divided into two groups by simple randomization. In the first group, the newborns were fed with a feeding tube in support of breastfeeding. In the second group, the newborns were fed by cup feedings. Latch scores were assessed at the end of postpartum day 3. Demographic data and latch scores were collected and analyzed by Chi-square, t-test and Mann-Whitney U test. RESULTS: No differences in the demographic data of mothers and newborns between the two groups were found. Latch scores for the feeding tube group were significantly higher than the latch scores in the cup feeding group (p < 0.05). CONCLUSION: Latching of newborn after feeding tube method is better than latching of newborn after cup feeding.

Teenage pregnancy and exclusive breastfeeding rates.

BACKGROUND: Teenage pregnancy is an important health issue globally and in Thailand Younger age mothers decide on the breastfeeding practices ofthe first 6-month. OBJECTIVE: To find the rates of 6-month exclusive breastfeeding practices of teenage mothers and compare them with the rates of 6-month exclusive breastfeeding practices in mothers who are 20 years of age or more. MATERIAL AND METHOD: Three thousand five hundred sixty three normal, postpartum women, who delivered without complications at the HRH Princess Maha Chakri Sirindhorn Medical Center in the Nakhon Nayok Province between 2010 and2013 were included in this study. At the second daypostpartum, the data of latch scores and the data of the practice of exclusive breastfeeding were collected Telephone follow-ups on the seventh, fourteenth, and forty-fifth postpartum days and at the second, fourth, and sixth month postpartum month were collected and used for exclusive breastfeeding data following discharge. Demographic data included the maternal age, parity, gestational age, marital status, occupation, religion, route ofdelivery, estimated blood loss, body mass index, nipple length, and the childs birth weight. The collected data was analyzed by the t-test, Chi-square, and odds ratio with 95% confidence interval. RESULTS: The percentage of teenage pregnancies was at 14.8% (527 cases). On postpartum day 2, the percentage of latch scores of 8 or less was 66.4%. At the seventh, fourteenth, and forty-fifth day and at the second, fourth, and sixth months postpartum, the exclusive breastfeeding rates were 88.5, 78.5, 57.6, 43.1, 32.9, and27.0%, respectively. Comparison of the 6-month exclusive breastfeeding rates between teenage mothers and mothers 20 years ofage or older were not statistically significant (p<0.05). CONCLUSION: The 6-month exclusive breastfeeding rate of teenage mothers was at 27.0% and had no significant differences from the rates of mothers 20 years of age or more.

Comparisons of the latching on between newborns with tongue-tie and normal newborns.

BACKGROUND: Breastfeeding is recommended as the exclusive feeding for the first six months of the newborns life. Difficulty in latching and breastfeeding resulting from tongue-tie are believed to be a problem. OBJECTIVE: To compare the latching on between newborns with tongue-tie (ankyloglossia) and normal newborns. MATERIAL AND METHOD: The subjects were 833 normal, postpartum women who delivered without complications at HRH Princess Maha Chakri Sririndhorn Medical Center in Nakhon Nayok Province between January and June 2013. Their newborns oral cavities' were checked for tongue-tie screening and diagnoses using Kotlow's criteria. Latch scores were used for latch-on assessment at the second day postpartum. Demographic data and latch scores were collected and analyzed by the t-test, Chi-square test, Odds ratio with 95% confidence interval and One-way of ANOVA test. RESULTS: The data shows that the incidence of tongue-tie was 13.4% (6.2% with mild tongue-tie, 5.5% with moderate tongue-tie, and 1.7% with severe tongue-tie). The mean of latch scores in the tongue-tied groups were significantly lower than that in the normal group, especially in the moderate and severe tongue-tie subgroups. The odds ratios for latch scores were < or = 8 compared between the moderate and severe tongue-tied subgroups and the score in the normal and mild tongue-tied subgroups was 1.4. CONCLUSION: The latch scores in tongue-tied newborns were significantly lower than those in normal newborns.

Nipple length and its relation to success in breastfeeding.

OBJECTIVE: To find the critical cut-off point of nipple length that facilitates success in breastfeeding. MATERIAL AND METHOD: The subjects were 449 postpartum women, who delivered at HRH Princess Maha Chakri Sirindhorn medical center in Nakhon Nayok province between October, 2010 and March, 2011. Data regarding nipple length and its relation to success in breastfeeding were collected and analyzed by a receiver operating characteristic curve (ROC curve). This is a graphical method of assessing the characteristics of a diagnostic test. RESULTS: The data shows that 7-millimeters in nipple length had been shown to be the cut-off point that facilitates successful breastfeeding. Sensitivity was at 72.5%. Specificity was at 46.2%. The positive predictive value was at 97.8% and the negative predictive value was at 4.9%. CONCLUSION: The cut-off point for nipple length that facilitates successful breastfeeding has been measured at 7 millimeters. Nurses and health personnel may use 7 millimeters of nipple length as a criteria for a successful breastfeeding screening test and give close breastfeeding support if postpartum women have less than 7 millimeters in nipple length.