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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 23  |  Issue : 1  |  Page : 49-53

Effectiveness of awareness programme regarding breastfeeding techniques on the prevention of nipple soreness amongst primipara mothers in a selected hospital at Mangaluru, Karnataka


1 M.Sc Nursing Student, Department of Obstetrics & Gynaecological Nursing, Father Muller College of Nursing, Mangaluru, India
2 Assistant Professor, Department of Obstetrics & Gynaecological Nursing, Father Muller College of Nursing, Mangaluru, India
3 Lecturer, Department of Obstetrics & Gynaecological Nursing, Father Muller College of Nursing, Mangaluru, India

Date of Submission21-Jan-2021
Date of Decision23-Mar-2022
Date of Acceptance08-Apr-2022
Date of Web Publication05-Jul-2022

Correspondence Address:
Ms. Sangeetha Crasta
Father Muller College of Nursing, Mangalure - 575 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_10_21

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  Abstract 


Breastfeeding is a crucial and unrivalled way of providing ideal food for the healthy growth and development of infants. Exclusive breastfeeding in the 6 months of life plays a pivotal role in child health. Faulty technique of latching causes nipple soreness or trauma. The WHO estimated that 33% of all women experienced breastfeeding problems in the first 2 weeks of post-partum. This study aimed to determine the effectiveness of awareness programme regarding breastfeeding techniques on the prevention of nipple soreness amongst primipara mothers. A non-equivalent, post-test only control group design was adopted on 60 primipara mothers who were selected using the purposive sampling technique. Awareness programme regarding breastfeeding techniques was given to the intervention group. A demographic pro forma and Nipple Soreness Rating Scale were used to collect the data. In the intervention group, the post-test nipple soreness mean score was 0.2, and in the control group, the post-test nipple soreness mean score was 2.2, and the mean difference was statistically significant. The calculated Mann–Whitney U-test P = 0.001 showed that there was a statistically significant difference in mean post-test nipple soreness scores between the intervention and control groups. There was no significant association between the mean post-test nipple soreness score and demographic variables in both intervention and control groups. The awareness programme regarding breastfeeding technique was effective in the prevention of nipple soreness amongst primipara mothers.

Keywords: Breastfeeding, exclusive breastfeeding, LATCH, nipple soreness, primipara


How to cite this article:
Crasta S, D'Souza P, Frank RW. Effectiveness of awareness programme regarding breastfeeding techniques on the prevention of nipple soreness amongst primipara mothers in a selected hospital at Mangaluru, Karnataka. Indian J Cont Nsg Edn 2022;23:49-53

How to cite this URL:
Crasta S, D'Souza P, Frank RW. Effectiveness of awareness programme regarding breastfeeding techniques on the prevention of nipple soreness amongst primipara mothers in a selected hospital at Mangaluru, Karnataka. Indian J Cont Nsg Edn [serial online] 2022 [cited 2022 Dec 7];23:49-53. Available from: https://www.ijcne.org/text.asp?2022/23/1/49/349814




  Introduction Top


Breastfeeding is the best way of providing ideal food for the healthy growth and development of infants. Exclusive breastfeeding (EBF) plays a pivotal role in child health which substantially lowers the risk of death from infectious diseases. The World Health Organization formed a goal to re-establish a global breastfeeding culture to promote EBF for the first 6 months of life.[1] Sore nipples in the 1st days of post-partum are common reason for the avoidance or termination of breastfeeding which primarily is the result of poor LATCH on and secondary to baby's improper sucking techniques.[2],[3] The incidence of nipple soreness during post-partum is significantly increasing than the other complication, such as mastitis, with the highest incidence in the 1st (36%) and 2nd (14%) weeks post-partum.[4] The study was conducted on 1,549 post-natal women visiting the breastfeeding clinic after delivery; most of the primipara mothers had nipple pain. The other reasons for nipple pain were inappropriate positioning and latching (72.3%), tongue-tie (23.2%) and oversupply (4.4%).[5] The best way to prevent nipple soreness is for the mother to make sure that the baby is properly positioned at the breast and has proper LATCH while breastfeeding. Planned structured education, demonstration and counselling on a one-to-one basis gradually reduce breastfeeding problems and sustain longer duration of feeding practices.[6] The investigator understood that it was necessary to educate the primipara mothers regarding breastfeeding techniques which will help them to prevent complications and promote breastfeeding. The aim of the study was to evaluate the effectiveness of an awareness programme (one-to-one training) regarding breastfeeding technique on nipple soreness amongst primipara women.

Objectives of the study

  1. The objective of this study was to compare the post-test scores of nipple soreness between the intervention and control groups using Nipple Soreness Rating Scale
  2. To find the association between the demographic variables and post-test scores of nipple soreness in both intervention and control groups.



  Materials and Methods Top


An evaluative research approach was used for the study. A non-equivalent post-test only control group design was adopted. The study was conducted amongst the primipara mothers admitted in a maternity unit of general and private wards of a selected hospital. The sample size for the present study was calculated using the following parameter: alpha error probability of 0.05 and power of test is 0.8. Based on this, a total of 60 participants (30 in the intervention group and 30 in the control group) who fulfilled the inclusion criteria such as primipara mothers who underwent full-term normal vaginal delivery, instrumental delivery and caesarean section and who initiated breastfeeding from the 1st day of delivery were screened and selected for the study using purposive sampling technique.

Instruments

The instrument used for the study consisted of a demographic pro forma and Nipple Soreness Rating Scale, a standardized tool (NSR adapted from Storr, 1988)[7] [Table 1]. The permission was obtained from the author to use the tool. The content validity of each item was calculated by submitting to the experts from related fields. Pilot study was conducted on 10 samples having similar sample characteristics. The reliability coefficient of the tool was measured using Karl Pearson's correlation coefficient formula and is found to be 0.84 (r > 0.7).
Table 1: Nipple Soreness Rating Scale

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Data collection

The data were collected from 25 February 2020 to 21 March 2020. Ethical and hospital permission was obtained from the concerned authority before the data collection. The primipara mothers who fulfilled the sampling criteria were identified. A total of 30 subjects were selected to the intervention group using the purposive sampling technique. A demographic pro forma was administrated by face-to-face interview technique to collect demographic characteristics. The awareness programme regarding breastfeeding techniques LATCH, mother and child bonding and the importance of breastfeeding was given on a one-to-one basis to the participants of the intervention group using audiovisual aids such as flashcards, PowerPoint and bifold leaflet on 1st post-natal day. On 5th post-natal day, post-test was conducted by examining nipples for the presence of nipple soreness using standardized Nipple Soreness Rating Scale. On completing the entire data process in the intervention group, the investigator selected 30 subjects for the control group. The control group received routine hospital care, followed by post-test for assessing the level of nipple soreness on 5th post-natal day. The data collected were analysed using descriptive and inferential statistics. Frequency distributions were used to describe demographic characteristics. The “Mann–Whitney U” test was used to determine the effectiveness of awareness programme regarding breastfeeding techniques between the groups. The association between nipple soreness score and demographic variables and homogeneity of the group characteristics was assessed using Chi-square test.

Ethical consideration

The study was approved by the Institution Ethics Committee. The investigator introduced self to the subjects and the purpose of the study was explained to the participants using subject information sheet. The investigator assured confidentiality, and the written informed consent was obtained from participants in both interventional and control groups.


  Results Top


Description of the demographic characteristics

The description of demographic characteristics among the subjects is analysed in terms of frequency and percentage and presented in [Table 2].
Table 2: Frequency and percentage distribution of subjects of intervention and control groups according to their demographic characteristics (n=30+30=60)

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The present study reveals that the 60% of the subjects in the intervention group and 50% of the control group belong to the age group of 21–25 years of age. About 40% of the subjects in the intervention group and 60% of subjects in the control group had secondary education. Majority of the subjects (70%) in both intervention and control groups were homemakers. In the intervention group, 70% of the subjects were from nuclear families and 60% in the control group to joint families. Majority of the subjects (70%) had erect nipples and 30% subjects had flat nipples in both intervention and control groups. About 60% in the intervention and 70% of the subjects in the control group underwent lower segment caesarean section.

Level of nipple soreness in intervention and control groups

[Figure 1] shows that in the intervention group, 80% of the subjects had no tenderness and normal colour (Grade 0) nipples and 20% of the subjects had nipples slightly red or tender for first 5–10 s of feeding [Grade 1]. Whereas, in the control group, 10% of the subjects had nipples slightly red or tender for the first 5–10 s of feeding [Grade 1]. About 60% of the subjects had tender nipples between feedings that made the mother grimace when the baby started feeding [Grade 2] and 30% of the subjects had nipples beginning to crack with involuntary gasp of pain from the mother when the baby started feeding [Grade 3].
Figure 1: Diagram showing the distribution of subjects according to the level of nipple soreness in intervention and control group

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Comparison of nipple soreness between intervention and control groups

In the post-test, amongst the intervention group, 80% of the subjects had Grade 0 and 20% of the subjects had Grade 1. In the control group, 10% of the subjects had Grade 1. 60% of the subjects had Grade 2 and 30% of the subjects had Grade 3. Data in the [Table 3] depicts the significant (P = 0.001) difference between post-test nipple soreness scores between the intervention and control groups. It is inferred that the awareness programme regarding breastfeeding technique was effective in preventing nipple soreness amongst primipara mothers.
Table 3: Comparison of mean rank of post-test scores of nipple soreness in intervention and control groups

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Association between post-test nipple soreness score amongst primipara mothers and selected demographic variables in the intervention and control groups

The association was calculated using Chi-square and showed that (P > 0.05) no statistically significant association between the mean post-test nipple soreness scores and selected demographic variables in both intervention and control groups.


  Discussion Top


The aim of this study was to find out the effectiveness of awareness programmes regarding breastfeeding techniques on the prevention of nipple soreness amongst primipara mothers.

Level of nipple soreness in the intervention and control groups

In the present study, majority in the intervention group had no nipple soreness compared to all in the control group having different grades of soreness. These findings are congruent with the findings of the study conducted by Tamilselvi to assess the effectiveness of breastfeeding techniques in the prevention of nipple soreness amongst primipara mothers, which showed that in the post-test amongst the intervention group, 93.3% of the subjects had Grade 0 and 6.7% of the subjects had Grade 1. In the control group, 40% of the subjects had Grade 1, 26.6% of the subjects had Grade 2 and 33% of the subjects had Grade 3.[8]

In the present study, the mean post-test nipple soreness score in the intervention group was = 0.200 ± 0.407 and in the control group was = 2.200 ± 0.610. These findings are congruent with the findings of the study conducted by Tamilselvi to assess the effectiveness of breastfeeding techniques in the prevention of nipple soreness amongst primipara mothers, where the mean post-test nipple soreness score in the intervention group was = 0.30 ± 0.59 and in the control group was = 1.07 ± 0.94.[8]

Effectiveness of Awareness Programme regarding Breastfeeding technique on prevention of Nipple soreness between Intervention and Control groups

In the present study, the Mann–Whitney U value was 9.0, P = 0.001 (P < 0.05) showed that there is a statistically significant difference between the post-test nipple soreness score amongst intervention and control groups; hence awareness programme regarding breastfeeding techniques was effective in preventing nipple soreness amongst primipara mothers.

These findings are congruent to the study conducted by Tamilselvi to assess the effectiveness of breastfeeding techniques in the prevention of nipple soreness amongst primipara mothers showed that the independent t-test value was 3.76, P = 0.001 (P < 0.05) there was statistically significant difference between the post-test nipple soreness score amongst intervention and control group. Hence, the awareness programme was effective in preventing nipple soreness.[8]

Association between post-test Nipple soreness score amongst primipara mothers and selected demographic variables in both intervention and control groups

In the present study, there was no significant (P > 0.05) association between the post-test nipple soreness score and selected demographic variables in both intervention and control groups. These findings are contradictory to the findings of the study conducted by Parneet K, Prabhjot S to assess the effect of planned teaching programme on the prevention of nipple sores amongst post-natal mothers which showed that there was a significant (P < 0.05) association found between the educational status and post-test scores regarding prevention of nipple sore. There was no significant (P > 0.05) association found with other selected demographic variables.[9]

Breastfeeding is an another umbilical cord, which creates a strong bond between the mother and a baby, but for some mothers, breastfeeding can be a painful and stressful experience. To prevent nipple soreness, primipara mothers should be observed during breastfeeding to accurately assess and correct the poor positioning. The promotion and support of breastfeeding is a global priority and an important child survival intervention. Planned structured education and counselling significantly improve EBF practices up to 2 years along with weaning. As this study has shown, focused individual awareness programme, especially on the technique of breastfeeding, with a focus to improve latch on and proper sucking, helps in reducing soreness of nipples and prevents dropouts from breastfeeding. Provision of printed or audiovisual educational material is not enough, healthcare workers, especially nurses, consultants should make every effort to have at least one face-to-face encounter to discuss regarding breastfeeding issues and solutions and educate the mothers to reduce breastfeeding problems.

Limitations

The sample size was small. The study was conducted in only the maternity unit of one hospital, thereby restricting the generalisation of findings.


  Conclusion Top


The present study assessed the effectiveness of awareness programmes about breastfeeding techniques amongst primipara mothers. The results revealed that the awareness programme regarding breastfeeding techniques had a significant effect in preventing nipple soreness. Majority of the primipara mothers in the intervention group were prevented from nipple soreness than the mothers in the control group who experienced breastfeeding-induced nipple soreness. Therefore, it is important that healthcare providers should demonstrate the breastfeeding technique appropriately while providing post-natal care.

Acknowledgements

The author is extremely grateful to the study participants, Organisation for permitting to conduct the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Infant and Young Child Feeding; 20l8. Available from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. [Last accessed on 2021Jan 14].  Back to cited text no. 1
    
2.
Australian Breastfeeding Association. Sore/Cracked Nipples. References – Scientific Research Publishing; 2020. Available from: https://www.breastfeeding.asn.au/bf-info/common-concerns–mum/sore-cracked-nipples. [Last accessed on 2020 Aug 16].  Back to cited text no. 2
    
3.
HealthLinkBC. (n.d.). Breastfeeding: Sore Nipples. Available from: https://www.healthlinkbc.ca/health topics/hw103462. [Last accessed on 2020 Aug 16].  Back to cited text no. 3
    
4.
Emedicine. (n.d). Breast Infection. Available form: https://www. emedicinehealth.com/breast_infection/article_em.htm. [Last accessed on 2020 Aug 16].  Back to cited text no. 4
    
5.
Puapornpong P, Paritakul P, Suksamarnwong M, Srisuwan S, Ketsuwan S. Nipple pain incidence, the predisposing factors, the recovery period after care management, and the exclusive breastfeeding outcome. Breastfeed Med 2017;12:169-73.  Back to cited text no. 5
    
6.
Mattar CN, Chong YS, Chan YS, Chew A, Tan P, Chan YH, et al. Simple antenatal preparation to improve breastfeeding practice: A randomized controlled trial. Obstet Gynecol 2007;109:73-80.  Back to cited text no. 6
    
7.
Storr GB. Prevention of nipple tenderness and breast engorgement in the postpartal period. J Obstet Gynecol Neonatal Nurs 1988;17:203-9.  Back to cited text no. 7
    
8.
Tamilselvi, S. Effectiveness of breast feeding technique in prevention of nipple soreness. Int J Pharma Bio Sci 2017;8:515-8.  Back to cited text no. 8
    
9.
Kaur P, Singh P. Effect of planned teaching programme on knowledge regarding prevention of nipple sore among postnatal mothers in Gian Sagar Medical College and Hospital, Ram Nagar, Rajpura, Punjab. Asian J Nurs Educ Res 2015;5:67-72.  Back to cited text no. 9
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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