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The Effect of Oketani Breast Massage on Successful Breastfeeding, Mothers’ Need for Breastfeeding Support, and Breastfeeding Self-Efficacy: an Experimental Study

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Background: The negative effects of cesarean section on breastfeeding are a major global concern. Purpose: This study aimed to determine the effect of Oketani breast massage on the maternal need for support during breastfeeding, breastfeeding success, and breastfeeding self-efficacy. Setting: Three hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, from April to July 2019. Study design: The participants in this experimental study were 113 pregnant women who were candidates for cesarean section. The mothers were selected using convenience sampling and randomly assigned. In addition to routine care, the mothers in the intervention group received Oketani breast massages twice. However, the mothers in the control group received routine care. The data were collected using the Infant Breastfeeding Assessment Tool (IBFAT), LATCH Assessment Score, and the Breastfeeding Self-Efficacy Scale (BSES). The data were analyzed with SPSS 20 software via the independent samples t test, the Mann-Whitney U test, and the chi-square test. Results: The results of the study suggested that the breastfeeding success rate, which was evaluated with IBFAT in both the first two breastfeeding stages and the last pre-discharge breastfeeding, was significantly higher for the mothers in the intervention group (p < .001). In addition, the mother's need for support, which was evaluated with LATCH in the first two breastfeeding stages (p = .044) and the last pre-discharge breastfeeding (p < .001) in the intervention group, was less. The total number of breastfeeding sessions from birth to discharge was higher in the intervention group (p = .002). Furthermore, the mothers in the intervention group breastfed their infants in a significantly shorter time interval (p = .002). Breastfeeding self-efficacy, according to the BSES, was significantly higher in the mothers of the intervention group (p < .001). Conclusion: Oketani massage can be used as a care intervention by nurses to improve breastfeeding in mothers who undergo cesarean sections.
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International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
RESEARCH
The Effect of Oketani Breast Massage on
Successful Breastfeeding, Mothers’ Need for
Breastfeeding Support, and Breastfeeding
Self-Efcacy: an Experimental Study
Background: The negative effects of
cesarean section on breastfeeding are a
major global concern.
Purpose: This study aimed to determine
the effect of Oketani breast massage on
the maternal need for support during
breastfeeding, breastfeeding success, and
breastfeeding self-efcacy.
Setting: Three hospitals affiliated to
Shahid Beheshti University of Medical
Sciences in Tehran, Iran, from April to
July 2019.
Study Design: The participants in this
experimental study were 113 pregnant
women who were candidates for cesarean
section. The mothers were selected us-
ing convenience sampling and randomly
assigned. In addition to routine care, the
mothers in the intervention group re-
ceived Oketani breast massages twice.
However, the mothers in the control group
received routine care. The data were col-
lected using the Infant Breastfeeding As-
sessment Tool (IBFAT), LATCH Assessment
Score, and the Breastfeeding Self-Efcacy
Scale (BSES). The data were analyzed with
SPSS 20 software via the independent
samples t test, the Mann–Whitney U test,
and the chi-square test.
Results: The results of the study sug-
gested that the breastfeeding success
rate, which was evaluated with IBFAT in
both the rst two breastfeeding stages
and the last pre-discharge breastfeeding,
was signicantly higher for the mothers in
the intervention group (p < .001). In addi-
tion, the mother’s need for support, which
was evaluated with LATCH in the rst two
breastfeeding stages (p = .044) and the
last pre-discharge breastfeeding (p < .001)
in the intervention group, was less. The
total number of breastfeeding sessions
from birth to discharge was higher in the
intervention group (p = .002). Furthermore,
the mothers in the intervention group
breastfed their infants in a signicantly
shorter time interval (p = .002). Breastfeed-
ing self-efcacy, according to the BSES,
was signicantly higher in the mothers of
the intervention group (p < .001).
Conclusion: Oketani massage can be
used as a care intervention by nurses to
improve breastfeeding in mothers who
undergo cesarean sections.
KEYWORDS: Oketani massage; cesarean
-
feeding support; breastfeeding success
INTRODUCTION
Despite global efforts to promote natural
-

developing countries.(1) In Iran, the number
of cesarean sections is much higher than
the world standard(2) to the extent that ce-
sarean sections count for more than 54.8%
of deliveries in some regions.(1) However,
the rate of cesarean sections in other ar-
eas of the world ranges from 10% to 15%.(1)
The excessive increase in the number of
cesarean sections, and its negative effects
on breastfeeding success and duration
of breastfeeding, has become a global
concern.(1,3)
One of the important complications of
cesarean sections is their negative impact
on breastfeeding success.(1) Successful
1 Manijeh Nourian, PhD,2*2
Maliheh Nasiri, PhD3
1Student of Neonatal Intensive Care Nursing, 2Department of Pediatric Nursing, School of Nursing and
Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2Department of Pediatric Nursing,
School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Thehran, Iran, 3Department of
Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
https://doi.org/10.3822/ijtmb.v14i3.625
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International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.
-
ing.(12)-

and positive relationship with increasing
the breastfeeding time,(6,10) and is consid-
ered as one of the important indicators
  (13,14)
-
tive effect on breastfeeding and can affect
all three factors: the mother’s need for
breastfeeding, breastfeeding success, and
(1,10,11) Therefore,
given the numerous problems suffered
  

measures to reduce these problems and
improve breastfeeding.
One of the standard nursing interven-
tions mentioned in the Nursing Inter-
  
(15) Breast massage is a treatment
technique used throughout the world
and aims to relieve breastfeeding prob-

   
breastfeeding problems. Some of these
techniques include the Oketani breast
   
massage of breast tissue.(16,17)
One of the reasons for using a formula
instead of breast milk is the negative effect
 -

expenses. Lack of breastfeeding increases
-
eases, which are associated with increased
(6,14,18)

(9,19,20) that was

(20,21) Some
studies have addressed the effects of Oket-
ani breast massage on breastfeeding, but
its effect on breastfeeding success and the
mother’s need for support during breast-
feeding are still unknown. Studies have
underlined its effect on reducing breast
pain, increasing the speed of infant suck-
ing,(19,22)     
(19) increasing lipids
at the end of feeding,(23) reducing sodium
in breast milk,(19) increasing infant weight
gain,(9) and reducing breast congestion in
different communities.(24) While mothers
who are candidates for cesarean sections
are more prone to breastfeeding problems,

   
section, and studies addressing Oketani
breastfeeding means the successful
transfer of milk from the mother’s breast
to the infant’s mouth. Factors, such as
     
breastfeeding in 24 hours (which should be
between 8 and 12 times), affect its success.
Successful breastfeeding indicators are

and softening of the mother’s breast with
wet diapers, and weight loss/gain within
normal limits.(4) In cesarean sections, due
to the long-term separation of the mother

    
starting breastfeeding, and the breastfeed-

a result, these mothers need more support
 
(5,6,7) Further-
more, mothers who undergo cesarean sec-
tions are less interested in breastfeeding
their babies and also their babies make less

24 hours of birth. This reduces the mother’s
chance for successful breastfeeding(8) and
increases the likelihood of milk accumula-
tion and breast congestion.(9)
  
  
breastfeeding within one-half to one hour
of birth and its exclusive continuation for
at least six months,(1) the onset of breast-
-
nates born via cesarean sections compared
(3,5,6) This



 (8) One of
the most important factors affecting suc-
 
  



for support for breastfeeding and its on-
set. Thus, cesarean sections reduce the
    
self-esteem, and hinder successful breast-
feeding and its continuation.(3,6) Cesarean
sections also increase the mother’s need
for support during breastfeeding and re-
(10)
 
as the mother’s perceived breastfeeding
-
(3,11)

  
6
International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.
on breastfeeding; the unwillingness to
    

    
-
sage treatment.
Sample

to 44 women per group, following a similar
(27) and according to the equation
presented below with 95% confidence

selected as the members of each group
(intervention group (n = 55) and the control
group (n = 58).
Intervention
The mothers were selected using conve-


each hospital, the researcher determined
the group the mothers would be assigned
   
between mothers in the two groups, sam-



placed into the intervention group, and
then in the second week, the mothers
were assigned to the control group. This
process was repeated until all mothers
were assigned to one of the two groups.
breast massage have focused on both
groups of mothers with cesarean section
(9,19,22,24) The most im-
portant factor for the survival and health
-
vironment in which to start breastfeeding
is the hospital.(25,26) Given the importance

educating, and promoting breastfeeding,
and considering that Oketani massage is
a low-cost, independent nursing interven-
-
  
mothers,(9,26,16)
the effect of Oketani breast massage on
the need for support during breastfeeding,
breastfeeding success, and breastfeeding

cesarean section.
METHODS
Study Design and Participants
  -
perimental design with a control group.
The research population included all preg-
nant women who were candidates for ce-

Taleghani and Imam Hossein hospitals

of Medical Sciences in Tehran, Iran.
The inclusion criteria included: mothers
    
-
tal illness that prevented breastfeeding
based on the available medical records;
gestational age of 38 to 42 weeks; no his-
  
the absence of disorders such as placental
abruption, placenta previa, heart, and re-

  

   
   
score of above 7; the absence of the need
   
based on the medical records; and the

the infant.
The exclusion criteria were as follows:
infants in need of intensive care at birth
or admitted to the neonatal intensive care
   
inertia during cesarean sections; use of

  
Assessing themothers to be
inludedinthe study(140women)
Sample size:
130women
Randomization:
130women
Control group:
65 women
10 women
excluded
Finalanalysis:
55 women
Intervention
group: 65 women
7women
excluded
Finalanalysis:
58 women
Excluding6 personsnot meeting
theinclusion criteria andwomen
unwillingtoenter thestudy
 
7
International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.
in the Step 8, expression is done in four
different directions for the outside surface,
lower part, inside of the breast and inside

and inside, lower part, outside surface, and
   
breast. Manual operations are performed

The researcher performed Oketani mas-
sage on both right and left breasts. The
    
  

    -

The breastfeeding success rate and
mother’s need for support during breast-
feeding were measured and recorded once

the last breastfeeding (22 to 28 hours af-
ter the cesarean sections) for all mothers
in both intervention and control groups
before discharge. The Breastfeeding Self-
   
the mothers themselves once after the
last breastfeeding. The number of breast-
feeding times from birth to the last breast-


Ethical Consideration
  -
  
  
   
   
were explained to all participants and writ-
ten consent was obtained from them. The
participants were reassured that their in-



Data Measurement
The following instruments were used to
collect the data.
1. The Demographic Characteristics Ques-
tionnaire: The questionnaire contained
two maternal and neonatal sections.
The maternal information section was


and the information in her medical

  

The sampling procedure was performed

The mothers in the control group re-
ceived routine care including measuring

-
tendant who transferred the infant to the
mother’s room under the supervision of a


breastfeeding and instructions on how to

The mothers in the intervention group,
in addition to receiving routine care, un-

researcher twice before the mother en-
tered the operating room and once before
the mother’s first breastfeeding in the
  -
ing the intervention in both stages, the
researcher did her best to maintain the
-
-
ments of the hospital and the ward. To this
end, she pulled the curtains in the room
and performed Oketani massage on the
massage site using a cotton towel. She also
gave the mothers a package containing a
cotton towel (to cover the massage site), a
training brochure about Oketani massage
  
comprehensive explanations were given

the massage. The mothers were also told


period, and the mothers were forbidden
to do the massage themselves during
this period.
Oketani breast massage was performed
using eight different manual techniques.
Steps 1 to 7 are called “course of treatment”

operations and expressing are completed
within one minute and this is repeated for

Steps 1, 2, and 3 involve manipulations to
separate the hard portion of the breast
from the fascia of the pectoralis major
   
causing discomfort to mothers. Steps 4 to
6 involved pulling the whole breast with
     
both hands. In Step 4, the whole breast is
pushed down towards the umbilicus. Steps
5 and 6 are techniques to isolate the hard
  

clockwise with stretching of its base and,
8
International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.

feeding.(37)
 
Short Form (BSES-SF): This scale was
 (38) and
contains 14 statements(10,38) that are
scored on a 5-point Likert scale rang-
     

and maximum possible scores on this
      

al.,(39) 
the scale was reported to be higher
than 0.7.(39) In various other studies,

instrument was reported from 0.86 to
0.94.(6,40)
scale was estimated to be 0.94 in the

Statistical Analysis

SPSS software (version 20) via descrip-
tive statistics (mean, standard deviation,
 -
tial statistics including the independent
samples t
and the chi-square test.
RESULTS

as the independent variable, and the breast-
feeding success rate, the mother’s need
for support during breastfeeding, and the
 
manipulated as the dependent variables.
 
success rate, the number of breastfeeding
-
feeding were recorded and evaluated. The
results showed that the mean age of the
participants in the intervention and control
groups was 29.85 ± 4.43 and 28.95 ± 5.33
  -

groups in terms of the mothers’ and infants’
demographic characteristics (Table 1). It
was also shown that, in both breastfeed-

before discharge), the number of mothers



in the control group (p < .001) (Table 2).
Furthermore, it was noted that the mean
 

nurse called Deborah Jensen and her
group, to document the assessment
of breastfeeding,(5,6,28) The total score


less than ten shows the mother’s need
for more support during breastfeeding.
-
ignate separate areas of assessment: L
(Latch) for how well the infant latches

refers to the amount of audible swal-



of comfort related to the breast and
nipple; and H (Hold) refers to whether
or not the mother needs help in posi-
   

statements.(28)   -

(5,28-30)
Karimi et al.(31)
the tool using the Cronbach’s alpha co-


this tool was evaluated in the present

15 mothers and its Cronbach’s alpha

 
   
scored items assessing the infant state:


to latch to the breast), and (4) the
sucking pattern. Each item is scored
on a scale of 0–3, with the minimum
and maximum scores of 0 to 12, re-
   

-
cessful breastfeeding, and a score of
0–6 shows unsuccessful breastfeeding.
(32,33) This tool has been used in vari-

 (34-36)

 
concurrent observation of 15 participat-
  

-

and focuses on the mother’s role in the
process of breastfeeding, whereas the
9
International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.
 
Variables Categories
Groups
P
value
Intervention
(Mean ± SD)
Control
(Mean ± SD)
Maternal and Neonatal Data Maternal age 29.85±4.43 28.95±5.33 .33a
Gestational age 38.42±0.71 38.52±1.06 .56a
Infant’s height 49.81±2.22 50.03±2.24 .608a
Infant’s chest circumference 33.36±0.78 33.17±1.12 .300a
Infant’s head circumference 34.76±0.89 34.61±1.14 .436a
Infant’s weight 3245.9±323.64 3248.1±469.17 .977a
 9.00±0.00 8.97±0.26 .332a
 10.00±0.00 9.98±0.13 .332a
Previous breastfeeding duration 21.62±17.45 17.38±17.50 .20a
Mother’s Education Categories N (%) N (%)
Illiterate 3(5.5) 2(3.4) .377b
 20(36.4) 27(46.6)
Diploma 22(40) 22(37.9)
Higher education 20(18.2) 7(12.1)
Occupation  2(3.6) 4(6.9) .440c
Housewife 53(96.4) 54(93.1)
Household Income Low 12(21.8) 12(20.7) .753b
Good 43(78.2) 35(77.6)
 0 (0.00) 1(1.7)
Place of Residence  52(94.5) (53(91.4) .512c
Rural areas 3(5.5) 5(8.6)
Pregnancy Planning Yes 37(67.3) 46(79.3) .148c
No 18(32.7) 12(20.7)
Number of Pregnancies One 6(10.9) 10(17.2) .129c
Two 28(50.9) 33(56.9)
Three 21(38.2) 15(25.9)
Maternal Diseases No disease 29(52.7) 36(62.1) .892c
Diabetes 8(14.5) 6(10.3)
 2.(36) 3(5.2)
 12(21.8) 9(15.5)
 0(0.00) 1(1.7)
 1(1.8) 1(1.7)
 1(1.8) 1(1.7)
Other diseases 1(1.8) 1(1.7)
Neonatal Gender Female 25(45.5) 21(36.2) .317c
Male 30(54.5) 37(63.8)
Breastfeeding Decision(before
C-section)
Exclusive 50(90.9) 46(79.3) .188c
Non-inclusive (0.00) 1(1.7)
Mixed 5(9.1) 11(19.00)
Type of Anesthesia General 4(7.3) 1(1.7) .152c
Spinal 51(92.7) 57(98.3)
Epidural 0(0.00) 0(0.00)
aIndependent samples t test
b
cChi-square test
10
International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.

in the intervention group according to the

in the control group (p < .001) (Table 4)
DISCUSSION
-
ani massage on breastfeeding success,
the need for breastfeeding support, and
 
mothers of term infants born via cesarean

suggested that Oketani massage has posi-
tive effects on the mother’s breastfeeding
success and can improve it in different re-
spects, including readiness to feed, rooting,

in various earlier studies.(9,19,22,24,41) Cho et
al.(19) found that Oketani breast massage,
in addition to reducing breast pain and
increasing the pH of breast milk, increased
the sucking speed and breast milk volume
   
  

   
  
not focus on the problems of cesarean
section mothers. Postoperative pain after
cesarean sections is one of the reasons for
scores for all dimensions of breastfeeding
success, including readiness to feed, root-

breastfeeding mothers in the intervention
    
higher than those of the participants in the
control group (p < .001).
    
significant difference between the two
groups in terms of the need for breast-
feeding support in both breastfeeding
rounds. The mothers in the intervention

less support compared to the participants
in the control group (p < .001) (Table 2).
It was also shown that the number of
breastfeeding times for the participants
in the intervention group from the time

was higher compared to that of the par-
ticipants in the control group (p < .001). In
addition, the mothers in the intervention
group breastfed their infants within less


comparison with the participants in the
control group (p
to the hospital protocol, after the cesarean
section, the infant was placed next to the
mother (in both groups) and there was no
prohibition on breastfeeding for one hour
at birth. The results also indicated that the
 -
feeding Success
Breastfeeding Phase The First Breastfeeding
(After Cesarean)
The Last Breastfeeding
(Before Discharge)
Groups
Variables
Intervention
(n = 55)
Control
(n = 58) P
value
Intervention
(n = 55)
Control
(n = 58) P
value
Number % Number % Number % Number %
Need for
breastfeeding

Need for
support
49 89.1 57 98.3 .044a12 21.8 41 70.7 <.001a
No need for
support
6 10.9 1 1.7 43 78.2 17 29.3
Total 55 100 58 100 55 100 58 100
Breastfeeding
success score

10–12
(Successful)
37 67.3 18 31 <.001a49 89.1 26 44.8 <.001a

successful)
14 25.5 12 20.7 59.1 19 32.8
0–6
(Unsuccessful)
47.3 28 48.3 1 1.18 13 22.4
Total 55 100 58 100 55 100 58 100
a
11
International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.
   
breastfeeding indicates breastfeeding
success and, as an interactive process, will
  
(6)
    -
gested that Oketani massage can facilitate

-
-

role in exclusive feeding and increasing the
duration of breastfeeding.(5)

duration of breastfeeding after the mother

  -
pants in the Oketani massage group com-
pared to the members of the control group.

of the first postoperative breastfeeding
in the mothers who underwent cesarean
   
greater compared to mothers with normal
(47)   

(8)
    

the two groups in terms of the need for
breastfeeding support in both breastfeed-
ing rounds, as the mothers in the interven-

and last breastfeeding before discharge
compared to the participants in the con-
trol group. Oketani massage reduced the


the amount of audible swallowing noted,

(1) which
makes mothers experience more pain in
the breast and the breasts are more prone
to congestion.(24,42)
Massage can be used as an effective
intervention to control mothers’ postop-
erative pain.(19,41,43) However, each massage
-
tive effects, brings about some complica-
tions and side effects including muscle
pain, fatigue, and damage to muscle tissue
and peripheral nerves.(44,45,46) Nevertheless,
since Oketani massage is based on mas-
saging all breast muscles—the base, as well

     
-
fects. It can even reduce the pain of breast
congestion and increase the breastfeeding
  
(9,21,24)
   -
ani massage had a positive effect on the
    
average number of breastfeeding times

in mothers who received Oketani massage
-
pants in the control group who received
. Mean and Standard Deviation for Mothers’

Variable Groups M±SD P valuea
Breastfeeding

(BSES)
Intervention 59.04±0.52
<.001
Control 53.29±0.12
aIndependent samples t test
M = mean; SD = standard deviation.
 

Variables
Groups
P
valuea
Intervention Control
Number % Number %


Less than 10 times 19 34.5 37 63.8 .002
10 times and more 36 65.5 21 36.2
Total 55 100 58 100


Less than 1 hour 35 63.6 20 34.5 .002
More than 1 hour 20 36.4 38 65.5
Total 55 100 58 100
a
12
International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.
 
addition, mothers’ characteristics, their
mental status, and the level of spousal
support were factors that could affect the
success of breastfeeding, and which were

CONCLUSION
   -
ani massage has a positive effect on the
breastfeeding success rate and can in-
crease the number of breastfeeding times
in addition to the number of breastfeed-

reduces the breastfeeding onset time and

mother’s need for further support and im-

can be performed as an independent and
  

have completed a short training course.
Therefore, it is recommended to teach this
massaging technique to nurses and mid-
wives who are in contact with the mother
   
  -
duce breastfeeding problems.
ACKNOWLEDGMENTS
We are thankful to all the mothers who


for the support provided during the con-

CONFLICT OF INTEREST NOTIFICATION
The authors declare there are no con-

COPYRIGHT
Published under the CreativeCommons

.
REFERENCES
1. Chen H, Tan D. Cesarean section or natural child-

Front Psychol. 2019;10:351.
position of holding the infant while breast-
feeding. However, previous studies have
suggested that mothers who undergo
cesarean sections need more support to
start and continue breastfeeding, and
the cesarean section is one of the most
important risk factors for breastfeeding
problems.(5,6,7,48)
It seems that, since postpartum breast
   
breastfeeding and mothers with breast
congestion will need more support, Oket-
ani breast massage can reduce breast
congestion in mothers and thus dimin-
ish their need for breastfeeding support.
(41) and Kraleti
et al.(49) showed that Oketani massage in-
-
lactin, increased blood circulation in the
breasts, facilitated the exit of milk from the
breast, and increased milk volume which,
in general, can reduce the mother’s need
for support in breastfeeding.
   (24) showed
that Oketani massage has a greater reliev-
-

    (17)
(24) indicated
that lower breast engorgement scores in
women who had received Oketani mas-
sage than those who had received routine
care; but the true effect is unclear because,
 -
ported per breast instead of per woman, so
-
sis. Thus, it is uncertain if Oketani breast
massage is more effective than routine care
for breast engorgement, and it cannot be


    -
 
  
higher than those in the control group.
    
effective variables of exclusive breastfeed-
ing and its continuation,(39,40) and refers to

(50) Since the evidence shows
   
   
breastfeeding,(51,52)
    -
  
   
requires further attestation and research.

was the use of self-report questionnaires
13
International Journal of Therapeutic Massage and Bodywork—Volume 14, Number 3, September 2021
MAHDIZADEH-SHAHRI: EFFECTS OF OKETANI BREAST MASSAGE.
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breast massage in the treatment of women with
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Corresponding author: Manijeh Nouri-
an, PhD, Department of Pediatric Nursing,
  
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Article
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Background: Breastfeeding is a critical, evidence-based intervention that addresses malnutrition, improves early childhood development outcomes, and influences long-term maternal and infant health by reducing the non-communicable disease risk. Scaling up breastfeeding is an indisputably strong action countries can take to prevent suboptimal maternal and infant health outcomes. The Becoming Breastfeeding Friendly (BBF) initiative assists countries with scaling up breastfeeding policy and programs. BBF has been successfully implemented within Latin America, Africa, Europe and South-East Asian regions. This study assessed its application in Samoa. Methods: In 2018, BBF was implemented in Samoa by a 20 member committee of breastfeeding experts who participated in collecting and utilizing national level data to score the degree of friendliness of Samoa's breastfeeding environment, identify gaps, and propose policy recommendations to address those gaps. This eight-month process resulted in a public event where priority recommendations were widely disseminated to decision makers and actions agreed upon. Results: The total BBF Index score for Samoa was 1.6 out of 3.0, indicating a moderate breastfeeding friendly environment for scaling up policies and programs that protect, promote, and support breastfeeding. Gear total scores indicated that seven of the eight gears were moderately strong within Samoa, while the eighth gear, funding and resources, was weakest in strength. Six prioritized recommendations emerged: 1) development and implementation of a National Breastfeeding Policy and Strategic Action Plan; 2) strengthening monitoring and evaluation of all breastfeeding activities; 3) ratifying the International Labour Organization's Maternity Protection Convention 2000 (No 183); 4) identifying high-level advocates to champion and serve as role models for breastfeeding; 5) creation of a national budget line for breastfeeding activities; and 6) hiring of a national breastfeeding coordinator and trainer. Decision makers demonstrated commitment by signing the breastfeeding policy for hospitals ahead of the BBF dissemination meeting and electing to move forward with establishing lactation rooms within government ministries. Conclusion: Implementation of BBF in Samoa yielded important policy recommendations that will address current gaps in national level breastfeeding support. The BBF consultation process can be successfully applied to other countries within the Western Pacific region in order to strengthen their breastfeeding programs.
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Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants’ shorter and longer‐term health. Exclusive breastfeeding to six months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation and duration compared to women with normal weight. This systematic review aimed to examine evidence of i) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, ii) support shown to be effective in increasing breastfeeding initiation and duration among these women, and iii) perceptions of healthcare professionals, peer supporters, partners and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public and experiencing stigma of obesity were also described. Support from healthcare professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence‐based support to women who are overweight or obese who want to breastfeed. Research on healthcare professionals, partners and family members’ experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.
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The increasing popularity of Cesarean birth has become a social concern in many countries. This paper reviews the literature on the effects of Cesarean section on children’s psychological health. The results show that Cesarean birth may have adverse effects on children’s sensory perception, sensory integration ability, neuropsychiatric development, and the infant-mother relationship. However, there remain deficiencies in extant research methods, research content, subject groupings, and interpretation of research results. Future research should improve research methods, broaden the research content, and refine the grouping of children born by Cesarean section. The exploration of neural mechanisms is also needed, as well as research directed toward suggesting effective interventions to reduce unnecessary Cesarean sections.
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Background: Increasing the prevalence of optimal breastfeeding practices, including exclusive breastfeeding for 6months, could prevent an estimated 823,000 child deaths annually. Self-efficacy is an important determinant of breastfeeding behaviors. However, existing measures do not specifically assess exclusive breastfeeding self-efficacy, but rather self-efficacy for any breastfeeding. Hence, we sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy. Methods: We modified and added items from Dennis’Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). It was then implemented in an observational cohort in Gulu, Uganda at 1 (n= 239) and 3 (n= 238) months postpartum(clinicaltrials.govNCT02925429). We performed inter-item and adjusted item-test correlations, as well as exploratory factor analysis and parallel analysis at 1 month postpartum to remove redundant items and determine their latent factor structure. We further applied confirmatory factor analysis to test dimensionality of the scale at 3 months postpartum. We then assessed the reliability of the scale and conducted tests of predictive and discriminant validity. Known group comparisons were made by primiparous status and correct breastfeeding knowledge. Results: The modification of the original BSES-SF to target exclusive breastfeeding produced 19 items, which were reduced to 9 based on item correlations and factor loadings. Two dimensions of the adapted scale, the BreastfeedingSelf-Efficacy Scale to Measure Exclusive Breastfeeding BSES-EBF emerged: Cognitive and Functional subscales, with alpha coefficients of 0.85 and 0.79 at 3 months postpartum. Predictive and discriminant validity and known group comparisons assessments supported its validity. Conclusions: This version of the Breastfeeding Self-Efficacy scale, the BSES-EBF Scale, is valid and reliable for measuring exclusive breastfeeding self-efficacy in northern Uganda, and ready for adaptation and validation for clinical and programmatic use elsewhere.
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Background: Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. Various treatments have been studied but little consistent evidence has been found on effective interventions. Objectives: To determine the effectiveness and safety of different treatments for engorgement in breastfeeding women. Search methods: On 2 October 2019, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. Selection criteria: All types of randomised controlled trials and all forms of treatment for breast engorgement were eligible. Data collection and analysis: Two review authors independently assessed trials for eligibility, extracted data, conducted 'Risk of bias' assessment and assessed the certainty of evidence using GRADE. Main results: For this udpate, we included 21 studies (2170 women randomised) conducted in a variety of settings. Six studies used individual breasts as the unit of analysis. Trials examined a range of interventions: cabbage leaves, various herbal compresses (ginger, cactus and aloe, hollyhock), massage (manual, electromechanical, Oketani), acupuncture, ultrasound, acupressure, scraping therapy, cold packs, and medical treatments (serrapeptase, protease, oxytocin). Due to heterogeneity, meta-analysis was not possible and data were reported from single trials. Certainty of evidence was downgraded for limitations in study design, imprecision and for inconsistency of effects. We report here findings from key comparisons. Cabbage leaf treatments compared to control For breast pain, cold cabbage leaves may be more effective than routine care (mean difference (MD) -1.03 points on 0-10 visual analogue scale (VAS), 95% confidence intervals (CI) -1.53 to -0.53; 152 women; very low-certainty evidence) or cold gel packs (-0.63 VAS points, 95% CI -1.09 to -0.17; 152 women; very low-certainty evidence), although the evidence is very uncertain. We are uncertain about cold cabbage leaves compared to room temperature cabbage leaves, room temperature cabbage leaves compared to hot water bag, and cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. For breast hardness, cold cabbage leaves may be more effective than routine care (MD -0.58 VAS points, 95% CI -0.82 to -0.34; 152 women; low-certainty evidence). We are uncertain about cold cabbage leaves compared to cold gel packs because the CIs were wide and included no effect. For breast engorgement, room temperature cabbage leaves may be more effective than a hot water bag (MD -1.16 points on 1-6 scale, 95% CI -1.36 to -0.96; 63 women; very low-certainty evidence). We are uncertain about cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. More women were satisfied with cold cabbage leaves than with routine care (risk ratio (RR) 1.42, 95% CI 1.22 to 1.64; 152 women; low certainty), or with cold gel packs (RR 1.23, 95% CI 1.10 to 1.38; 152 women; low-certainty evidence). We are uncertain if women breastfeed longer following treatment with cold cabbage leaves than routine care because CIs were wide and included no effect. Breast swelling and adverse events were not reported. Compress treatments compared to control For breast pain, herbal compress may be more effective than hot compress (MD -1.80 VAS points, 95% CI -2.07 to -1.53; 500 women; low-certainty evidence). Massage therapy plus cactus and aloe compress may be more effective than massage therapy alone (MD -1.27 VAS points, 95% CI -1.75 to -0.79; 100 women; low-certainty evidence). In a comparison of cactus and aloe compress to massage therapy, the CIs were wide and included no effect. For breast hardness, cactus and aloe cold compress may be more effective than massage (RR 0.66, 95% CI 0.51 to 0.87; 102 women; low-certainty evidence). Massage plus cactus and aloe cold compress may reduce the risk of breast hardness compared to massage alone (RR 0.38, 95% CI 0.25 to 0.58; 100 women; low-certainty evidence). We are uncertain about the effects of compress treatments on breast engorgement and cessation of breastfeeding because the certainty of evidence was very low. Among women receiving herbal compress treatment, 2/250 experienced skin irritation compared to 0/250 in the hot compress group (moderate-certainty evidence). Breast swelling and women's opinion of treatment were not reported. Medical treatments compared to placebo Protease may reduce breast pain (RR 0.17, 95% CI 0.04, 0.74; low-certainty evidence; 59 women) and breast swelling (RR 0.34, 95% CI 0.15 to 0.79; 59 women; low-certainty evidence), whereas serrapeptase may reduce the risk of engorgement compared to placebo (RR 0.36, 95% CI 0.14 to 0.88; 59 women; low-certainty evidence). We are uncertain if serrapeptase reduces breast pain or swelling, or if oxytocin reduces breast engorgement compared to placebo, because the CIs were wide and included no effect. No women experienced adverse events in any of the groups receiving serrapeptase, protease or placebo (low-certainty evidence). Breast induration/hardness, women's opinion of treatment and breastfeeding cessation were not reported. Cold gel packs compared to control For breast pain, we are uncertain about the effectiveness of cold gel packs compared to control treatments because the certainty of evidence was very low. For breast hardness, cold gel packs may be more effective than routine care (MD -0.34 points on 1-6 scale, 95% CI -0.60 to -0.08; 151 women; low-certainty evidence). It is uncertain if women breastfeed longer following cold gel pack treatment compared to routine care because the CIs were wide and included no effect. There may be little difference in women's satisfaction with cold gel packs compared to routine care (RR 1.17, 95% CI 0.97 to 1.40; 151 women; low-certainty evidence). Breast swelling, engorgement and adverse events were not reported. Authors' conclusions: Although some interventions may be promising for the treatment of breast engorgement, such as cabbage leaves, cold gel packs, herbal compresses, and massage, the certainty of evidence is low and we cannot draw robust conclusions about their true effects. Future trials should aim to include larger sample sizes, using women - not individual breasts - as units of analysis.
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Aim: The aim of the study was to analyse the impact of delivery on breastfeeding at 6 months, with special focus on caesarean section combined with established breastfeeding at 2 months. Methods: Delivery mode and breastfeeding at 2 and 6 months were studied in a database of 130,993 infants from two Swedish counties between 1990–2011. Results: The difference in breastfeeding rates at 6 months between children delivered by caesarean section and children delivered vaginally was smaller in a subpopulation of children with established breastfeeding at 2 months compared to all children. The impact of delivery method on breastfeeding at 6 months was independent of child gender, mother’s first child, maternal smoking and maternal education. Conclusions: Breastfeeding in mothers giving birth by caesarean section is more likely to continue until (at least) 6 months if established early (at 2 months). It may be worthwhile to promote breastfeeding for mothers who deliver by caesarean section.
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Objectives: This study was conducted to compare the breastfeeding outcomes and self-efficacy in the early postpartum period of women who had given birth by cesarean under general (GA) or spinal anesthesia (SA). Methods: This descriptive study was conducted with 190 women who had given birth under GA and SA at a training and research hospital. The data of the study were collected with the “Data Collection Form”, “LATCH Breastfeeding Assessment Tool” and the “Breastfeeding Self-Efficacy Scale- Short Form (BSES-SF)”. Results: The time to first breastfeeding of the newborns was 78.71 ± 126.9 min and 23.7% of the women breastfed within 30 min. Those who gave birth under SA breastfed their newborn infants statistically significantly earlier (p < .05). However, there was no statistical difference between women giving birth by cesarean under GA and SA and their score medians from the LATCH or the BSES-SF (p > .05). Conclusion: The percentage of women breastfeeding their infants within the first half hour and the self-efficacy and success rate was higher among women who gave birth under SA than those who had cesarean under GA. However, breastfeeding behaviors were not at the desired level in either group. Health care professionals should therefore support women who undergo a cesarean and especially those who give birth under GA to increase their breastfeeding success and self-efficacy.
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In this article, I describe the effects of home interventions on latching difficulty that persisted for 27 days for a mother-neonate dyad. The neonate manifested latching difficulty immediately after cesarean birth, and it became worse when nipple shields, bottles, and pacifiers were introduced. Manual expression and an electric pump were implemented when the neonate started losing weight, resulting in reduced frequency of breastfeeding directly at the breast. Additionally, the neonate continued to have latching difficulty after frenotomy. The use of home-based interventions supported ongoing educational opportunities for optimal latch, and I recommend that this type of health education be consistent among health professionals.
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Introduction Women commonly use massage therapy during pregnancy for pregnancy-related health conditions such as lower back and neck pain; however, there is little to no research related evidence on the side effects or mother or child physical harm of massage during pregnancy and the postnatal period. Objectives This study aims to report on the side effects and mother or child physical harm of massage during pregnancy and the postnatal period. Design An observational study methodology. Setting and time frame Two massage clinics, one in Sydney and one in Melbourne recruited participants from December 2016 to December 2017. Intervention Massage. Main outcome measure Side effects and mother or child physical harm from massage. Results One hundred and one participants were recruited to the study. Two fifths of the participants (n = 32, 40%) experienced one of more post-massage side effects. There were no mother or child physical harm events. Low back pain was the most common condition women sought massage treatment for 34 (33.7.%). A significant benefit (p < 0.001) was seen pre-massage to post-massage and pre-massage to 1-week post massage in decreasing stress, decreasing pain, increasing range of motion and improving sleep Discussion Similar to previous research, low back pain was the most common condition that women sought massage treatment for followed by hip pain, shoulder pain, neck pain and to improve mental health. Ninety-seven percent of the cohort received a full body massage including the feet leading credence that ‘massage on the feet during pregnancy is harmful’ is mythic in nature. Conclusion While our findings lead credence that massage on the feet during pregnancy is a myth the study was not powered to determine the safety of pregnancy massage and further research is needed. Massage was commonly sought for low back pain with promising benefits in decreased pain and improved range of movement and further research on the effectiveness of massage for low back pain in pregnancy.