페이지 정보작성자 오케타니 작성일13-02-20 14:25 조회6,970회 댓글0건
Effects of Breastfeeding Promotion Program on Breast discomfort, Level of Sodium in Breast Milk, and Type of Feeding in Women with Breast Engorgement following Cesarean Birth
Department of Nursing
Chungnam National University
Directed by Professor Ahn, Sukhee, PhD, RN.
This study was to develop the breastfeeding promotion program including the Oketani’s Breast Massage and to test effects of the program on breast discomfort, breast size, level of sodium in breast milk, and type of feeding in lactating women with breast engorgement following cesarean birth.
This study used a non-synchronized non-equivalent control group pretest-post test design. The period of the research was from September 1 to December 31, 2011. The subjects were postpartum mothers who experienced breast engorgement following cesarean birth. Breast discomfort score of 3 points or less from the mother underwent a preliminary investigation. Inclusion criteria was women who had no complications during pregnancy and delivery, had 37 to 42 weeks of gestation, age from 20 to 40, and delivered healthy baby over 2,500g of the birth weight, and admitted in a postpartum care center in D metropolitan city. First, 35 postpartum lactating women were selected for control group and the other 35 women for experimental group. Final subjects were 26 women for experimental group and 27 for control group after the intervention period.
The treatment, a planned nursing intervention, was the breastfeeding promotion program consisting of the Oketani’s breast massage, breast-feeding education, counselling, and emotional support.
The first day of the program started at 6th day after the cesarean birth and mainly to motivate the subjects about the breast-feeding by distributing a small information booklet and watching a videotape of the breast-feeding. On the second day of the program, which is equivalent to the 7th or 8th day since the delivery, the researcher who is a professional Oketani Breast Massager provided breast massage to the subjects once in the morning for two days. The massage took 30 minutess with 8 different types of massage on both sides of the breast and at the same time the massager provided breastfeeding education and emotional support to the subjects.
To test the effects of the breast-feeding promotion program, breast discomfort was measured by Hill and Humenick’s (1996) breast emgorgement scale; breast size for Geissler’s (1967) Roberts Durometer method; and the breast circumference was measured diameter between the ends points of the basilar portion that is 2.5 cm far from the nipple the side where congestion is.
At pretest, data were collected about subjects’ and babies’ characteristic, the breast discomfort, breast size, the level of sodium in breast milk, and type of feeding.
For experimental group, the breast massage was given once a day for two days (at 7th and 8th postpartum day), and individual breast-feeding education and problem-solving education based on the individual circumstance in the afternoon was provided from 9th postpartum day to 15th postpartum day. During the week, counselling for breast-feeding and support were also given.
Data were entered and analyzed via SPSS WIN 19.0. Chi-squre test (χ2-test) and t-test were used to identify the homogeneity between the experimental and control group. To test group effects on outcome variables, the difference score between pretest and posttest were calculated before the main analysis. T-tests were used to test the effect of experiment on outcome variables. Chi-square test was used to see a difference in type of feeding after the experiment. Moreover, the McNemar test was used to test the pre- and post-test changes in the type of feeding for each group.
There were no significant group differences in subject’s and baby’s characteristics. However, there were significant group differences in breast discomfort and breast size at pretest. Therefore, difference scores were calculated for all outcomes variables. Lactating women who participated in breastfeeding promotion program reported greater decrease in breast discomfort than that of control group (t=5.01, p<.001). Women who participated in the program also reported greater decreases in breast size than those of control group: Exterioral superior (t=2.06, p= .044), interioral superior (t=2.20, p= .032), and the breast circumference (t=2.21, p= .031).
Women in the program also experienced greater decrease in level of sodium in breast milk that that of control group (t=2.49, p= .016).
Women in the program also performed breastfeeding more than that of control group (χ2=5.29, p=.021). In the experimental group, the change from the artificial milk feeding to the breast-feeding from pretest to posttest was significantly different (χ2=2.52, p= .002) while there was no pre- and post-test difference in control group.
In conclusion, Breastfeeding promotion program including the Oketani’s breast massage for lactating women with breast engorgement following cesarean birth may be effective nursing intervention to the reduction of the breast engorgement and level of sodium in breast milk and promotion for breastfeeding practice.
Therefore, this program can be applied to lactating women who have breast engorgement problems to solve them, to provide breastfeeding education, counselling, and support in order to enhance their breast-feeding practice at 3 to 4 days of postpartum at hospitals or first and second week of postpartum while women are admitting at the postpartum care center,
Key words : Breastfeeding, Breast massage, Discomfort,
Breast engorgement, Breast milk sodium,
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