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Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates
Journal of South Asian Federation of Obstetrics and Gynaecology, January-March 2016;8(1):1-4 1
JSAFOG
ABSTRACT
Massaging the breast may help a postnatal mother to improve
breast milk production, alleviate breast engorgement and
facilitate breast milk expression. The purpose of the present
study was to identify the effect of breast massage on breast
milk expression in terms of volume of breast milk expressed,
pain during breast milk expression and experience of breast milk
expression among mothers of neonates admitted in neonatal
intensive care unit (NICU).
Materials and methods: The quasi experimental study was
conducted among 30 postnatal mothers whose babies were
admitted in NICU, selected as a sample of convenience. The
design used was time series research design. After the pretest,
breast massage was taught to the mothers by the investigator.
Breast massage was performed for 10 minutes prior to each
expression. The practice of breast massage and breast milk
expression is observed by the investigator using a checklist
during the next expression. Volume of breast milk expressed and
pain during breast milk expression were assessed three times
before and after the intervention using a standardized measuring
cup and numerical pain scale respectively. The experience
of breast milk expression was assessed before and after
intervention using breast milk expression experience measure.
Analysis was done using mean, frequency, percentage, and
paired t-test.
Major ndings: The results show that the mean pretest volume
of milk expressed in milliliters was 7.33 ± 4.86, which increased
to 15.56 ± 8.38 (t = 4.22, p = 0.001) after the intervention. The
mean pretest pain score was 7.50 ± 1.42 which decreased to
5.01 ± 1.37 (t = 11.73, p = 0.001) after the intervention. The
experience of breast milk expression in post-test 37.6 ± 3.88
was signicantly higher than pretest 28.4 ± 4.73 (t = 11.25,
p = 0.001).
Conclusion: The study findings conclude that the breast
massage is effective in increasing the volume of expressed
breast milk, reducing the pain during breast milk expression and
improving the experience of breast milk expression.
Keywords: Breast massage, Experience of breast milk
expression, Expression of breast milk, Neonates admitted in
NICU, Pain, Volume.
How to cite this article: Divya A, Viswanath L, Philip A.
Effectiveness of Breast Massage on Expression of Breast Milk
among Mothers of Neonates Admitted in Neonatal Intensive
Care Unit. J South Asian Feder Obst Gynae 2016;8(1):1-4.
Source of support: Nil
Conict of interest: None
INTRODUCTION
Breastfeeding high risk babies especially preterm, low
birth weight babies, babies with congenital anomalies,
etc. are often a challenge for the postnatal mothers.
These babies may not be able to suck properly due
to physiological immaturity or physical problems.
The nutritional needs of such babies are usually met
by expressed breast milk or formula feeds. Feeding
with expressed breast milk is considered as a best
alternative for such babies, as articial feeds may lead
to problems like infections, possibility for producing
gas and constipation, vomiting, rashes, etc. Commercial
formula feeds are designed close to the breast milk. The
fat in the breast milk is more easily digested whereas
fat in formula is digested more slowly than breast milk
and may not be as well tolerated. Breast milk contains
antibodies from mother to protect babies from infection
whereas commercial feeds do not have. This protection
is important when babies are sick or premature and
may have higher chance of developing an infection. A
randomized and quasi randomized trial done by Oshom
DA, Sinn Jon on formulas containing hydrolized protein
for prevention of allergy and food intolerance in infants
found no evidence to support feeding with a hydrolized
formula for the prevention of allergy in preference to
exclusive breastfeeding.4
Mothers of those babies admitted in neonatal intensive
care unit (NICU) are in severe stress because of poor
maternal child bond, disturbed physical appearance
JSAFOG
TYPE OF ARTICLE
10.5005/jp-journals-10000-0000
Effectiveness of Breast Massage on Expression of Breast
Milk among Mothers of Neonates Admitted in Neonatal
Intensive Care Unit
1A Divya, 2Lekha Viswanath, 3Anju Philip
1Postgraduate Nursing Students (2nd Year)
2Associate Professor, 3Assistant Professor
1-3Department of Obstetrics and Gynecology Nursing, Amrita
College of Nursing, Amrita Vishwa Vidyapeetham Health
Sciences Campus, Amrita Institute of Medical Sciences, Kochi
Kerala, India
Corresponding Author: Lekha Viswanath, Associate Professor
Department of Obstetrics and Gynecology Nursing, Amrita
College of Nursing, Amrita Vishwa Vidyapeetham Health
Sciences Campus, Amrita Institute of Medical Sciences, Kochi
Kerala, India, Phone: 0484-6681234, e-mail: lekhaviswanath3@
gmail.com
A Divya et al
2
of baby and inability to feed their baby. Depending on
the conditions of the baby feeding may be started when
baby becomes stable usually with expressed breast
milk. Mothers may not be able to express enough breast
milk needed for the baby due to decreased breast milk
production. As the breastfeeding is not initiated in the
initial days the mothers may develop many breastfeeding
problems. The most common among them is breast
engorgement. During direct breastfeedings the baby
removes the needed milk through sucking which helps
to develop more milk and is a normal physiology. For
mothers of high risk babies, the colostrums develop in the
breast is not removed out from the breast. This results in
plugged milk ducts, results in infection and engorgement.
Breast engorgement causes discomfort to the mothers like
pain, redness and hardening of breast tissues. It further
decreases production of breast milk as emptying of milk
does not take place. Facilitating emptying of breast of
milk would be an appropriate intervention to relieve
breast engorgement in such mothers. Often women may
need assistance in expressing breast milk. Breast milk
expression helps not only to relieve problems related to
engorgement but also improve or maintain breast milk
production.
The present study was undertaken with a view to help
mother in expressing breast milk. Breast massage was
selected as the intervention as it helps to open the plugged
milk ducts and improves the breast milk production.
Breast massage acts as an external stimuli which opens
the milk ducts whereas for a newborn who directly feeds
lips of newborn act as massager. The objectives of the
present study were as follows:
• Find out the effect of breast massage on volume of
breast milk expression among mothers of neonates
admitted in NICU.
• Find out the effect of breast massage on pain during
breast milk expression among mothers of neonates
admitted in NICU.
• Find out the effect of breast massage on experience
of breast milk expression among mothers of neonates
admitted in NICU.
MATERIALS AND METHODS
The study used a Quasi experimental research approach
with time series design. Sample consists of 30 postnatal
mothers whose babies were admitted in NICU and
were on expressed breast milk feeding, selected as a
sample of convenience. Inclusion criteria were mothers
of neonates aged between 18 and 45 years, from third to
eighth postpartum days and those who do not have any
medical comorbidities. Ethical clearance was obtained
from Thesis Review Board of Amrita Institute of Medical
Sciences, Kochi and the period of data collection was from
November 2014 to January 2015. A detailed explanation
of the study and nature of participation was given to
the postnatal mothers who met the sampling criteria.
Participation was based on willingness and written
informed consent was obtained prior to enrolment.
The demographic data were collected using a
proforma prepared by the investigator. The volume
of breast milk expressed and pain during breast milk
expression were measured during three consecutive
expressions. A measuring cup was used to measure the
breast milk in milliliters and numerical rating scale was
used to measure the pain score. The experience of
breast milk expression was assessed using breast milk
expression experience measure after three observations.
Breast milk expression experience measure is a ve point
likert scale developed by Flaherman to evaluate women
experience of expressing breast milk. The tool consists
of three subscales, they are social support, learning
experience and personal experience. Reliability of the tool
is established by checking the internal consistency and
had a Cronbach’s alpha coefcient of 0.703.
After the pretest, the breast massage is taught to the
mother with the help of a video showing breast massage
and breast milk expression and was demonstrated to
the mother by the investigator. Breast massage includes
rubbing stroking and kneading each breast followed by
massaging breast with nger pads, in a circular motion
around the whole breast in a clockwise manner. It also
incorporates hot fomentation prior to the intervention
and expression of breast milk using Marmet technique.
Breast massage is given for 5 minutes to each breast.
Then expression is done using Marmet technique for
10 minutes. To ensure the correct method practiced
by the mother, the rst expression after the teaching is
evaluated by the researcher with the help of a checklist.
The volume of breast milk and pain during expression
for the next three expressions is measured, followed by
measurement of experience of breast milk expression.
The pretest and post-test scores of volume of breast
milk, pain during breast milk expression and experience
of breast milk expression were compared using paired
t-test. Average of the three observations of volume and
pain before and after the intervention was considered as
pretest and post-test respectively.
RESULTS
Most of the mothers 18 (60%) of subjects were in age
group 25 to 30 years, and 23 (76%) were graduates.
Majority of mothers [21 (70%)] were primigravida and
Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates
Journal of South Asian Federation of Obstetrics and Gynaecology, January-March 2016;8(1):1-4 3
JSAFOG
Graph 1: The volume of breast milk expressed and pain during
breast milk expression
underwent delivery above 36 weeks of gestation. About
the type of delivery, 19 (64%) mothers underwent normal
vaginal delivery and 11 (36%) underwent lower segment
cesarean section (LSCS). None of the mothers took any
medication to increase breast milk production.
The volume of the breast milk and the pain during
breast milk expression before and after breast massage is
presented in Graph 1 and it shows that following breast
massage there is an increase in the volume of breast milk
and decrease in the pain during expression.
In order to nd out the effect of breast massage on
breast milk expression, the pretest and post-test scores
were compared using paired t-test. The average of three
observations before the intervention is considered as the
pretest and average of the three observation following
the breast massage is considered as post-test for volume
of breast milk expressed and pain during breast milk
expression.
Table 1 shows that the post-test (15.56 ± 8.38) volume
of milk is signicantly higher than the pretest (7.33 ± 4.86)
volume of milk (t = 4.22, p = 0.001).
Table 2 shows that the post-test (5.01 ± 1.37) pain score
is signicantly lower than the pretest (7.50 ± 1.42) pain
score (t = 11.73, p = 0.001).
Table 3 shows that the experience of breast milk
expression score is significantly higher in the post-
test than the pretest score. So breast massage helps in
improving breast milk expression experience.
DISCUSSION
The present study nding is more or less consistent with
the literature ndings. The pretest volume of breast
milk expressed is 7.33 ± 4.86 and in post-test the volume
increased to 15.56 ± 8.38. The study results interpret that
the breast massage is effective in increasing the volume of
breast milk at 0.001 level of signicance. An experimental
study conducted on 36 postnatal mothers found that the
volume of breast milk expressed was high with breast
massage than without massage in sequential pumping
(78.71 vs 51.32 gm) as well as simultaneous pumping
( 125.08 vs 87.69 gm). The above ndings supports the
results of the present study.
The result of the present study shows that post-test
pain score (5.01 ± 1.37) is signicantly lower than pretest
pain score (7.50 ± 1.42) at 0.001 level of signicance. A
study conducted among 60 postnatal mothers evaluate
the effect of breast massage on breast pain and new
born sucking. Compared to the control group, women
in the intervention group reported signicant decreases
in breast pain (p < 0.001), increases in number of times
newborns suckled after the rst and second massage
(p < 0.001), and a decrease in breast-milk sodium after
the rst massage (p = 0.034).10 These studies suggest that
breast massage is effective in reducing the pain.
As an intervention breast massage requires no
additional equipments or cost. It just requires training
the postnatal mothers on breast massage and expression.
By reducing the pain and improving the experience of
breast milk expression, it improves the mothers comfort
and condence in an extremely stressful situation. By
Table 3: Comparison of experience of breast milk expression between pretest and post-test
n = 30
Pretest Post-test Mean difference t-value p-value
Social support 7.56 ± 1.38 8.13 ± 1.38 0.57 3.458 < 0.002
Learning experience 9.40 ± 2.38 14.46 ± 2.52 5.06 9.98 < 0.001
Personal experience 11.43 ± 2.81 15.06 ± 2.75 3.63 6.46 < 0.001
Total score 28.4 ± 4.73 37.6 ± 3.88 9.2 11.25 < 0.001
Table 1: Comparison of volume of milk expressed between
pretest and post-test
n = 30
Mean SD Mean difference t-value p-value
Pretest 7.338 4.86 8.22 4.22 < 0.001
Post-test 15.56 8.38
Table 2: Comparison of pain score between pretest and post-test
n = 30
Mean SD Mean difference t-value p-value
Pretest 7.50 1.42 2.49 11.73 < 0.001
Post-test 5.01 1.37
A Divya et al
4
increasing the volume of breast milk it helps to avoid
the problems related to formula feeds. The ndings of
the study highlight the role of the nurse in the postnatal
care especially the mothers of high risk babies.
CONCLUSION
Based on the ndings of the study, it can be concluded
that breast massage is effective in increasing the volume
of breast milk expressed, reduces the pain during breast
milk expression and improves the breast milk expression
experience among mothers. Breast massage can be
incorporated as an intervention for the care of postnatal
mothers not only to facilitate the breast milk expression
but also to relief breast engorgement.
ACKNOWLEDGMENT
I extend my sincere gratitude towards Dr Radhamany K,
Professor and Head of Obstetrics and Gynecology
Department, Amrita Institute of Medical Sciences, Kochi
for their full support, inspiration and suggestions in
completing this work successfully. I also thankful to
Thesis Review Committee of Amrita Institute of Medical
Sciences, Kochi, Kerala.
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