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Effectiveness of Breast Massage on Expression of Breast Milk among Mothers

of Neonates admitted in Neonatal Intensive Care Unit

Article  in  Journal of SAFOG · March 2016

DOI: 10.5005/jp-journals-10006-1379

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 JSAFOG

10.5005/jp-journals-10000-0000
Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates
type of article

Effectiveness of Breast Massage on Expression of Breast

Milk among Mothers of Neonates Admitted in Neonatal
Intensive Care Unit
1
A Divya, 2Lekha Viswanath, 3Anju Philip

ABSTRACT Conclusion: The study findings conclude that the breast

massage is effective in increasing the volume of expressed
Massaging the breast may help a postnatal mother to improve breast milk, reducing the pain during breast milk expression and
breast milk production, alleviate breast engorgement and improving the experience of breast milk expression.
facilitate breast milk expression. The purpose of the present
study was to identify the effect of breast massage on breast Keywords: Breast massage, Experience of breast milk
milk expression in terms of volume of breast milk expressed, expression, Expression of breast milk, Neonates admitted in
pain during breast milk expression and experience of breast milk nicu, Pain, Volume.
expression among mothers of neonates admitted in neonatal How to cite this article: Divya A, Viswanath L, Philip A.
intensive care unit (NICU). Effectiveness of Breast Massage on Expression of Breast Milk
among Mothers of Neonates Admitted in Neonatal Intensive
Materials and methods: The quasi experimental study was Care Unit. J South Asian Feder Obst Gynae 2016;8(1):1-4.
conducted among 30 postnatal mothers whose babies were
admitted in NICU, selected as a sample of convenience. The Source of support: Nil
design used was time series research design. After the pretest, Conflict of interest: None
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
INTRODUCTION
expression is observed by the investigator using a checklist Breastfeeding high risk babies especially preterm, low
during the next expression. Volume of breast milk expressed and
birth weight babies, babies with congenital anomalies,
pain during breast milk expression were assessed three times
before and after the intervention using a standardized measuring etc. are often a challenge for the postnatal mothers.
cup and numerical pain scale respectively. The experience These babies may not be able to suck properly due
of breast milk expression was assessed before and after to physiological immaturity or physical problems.
intervention using breast milk expression experience measure. The nutritional needs of such babies are usually met
Analysis was done using mean, frequency, percentage, and
by expressed breast milk or formula feeds. Feeding
paired t-test.
with expressed breast milk is considered as a best
Major findings: The results show that the mean pretest volume alternative for such babies, as artificial feeds may lead
of milk expressed in milliliters was 7.33 ± 4.86, which increased
to problems like infections, possibility for producing
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
gas and constipation, vomiting, rashes, etc. Commercial
5.01 ± 1.37 (t = 11.73, p = 0.001) after the intervention. The formula feeds are designed close to the breast milk. The
experience of breast milk expression in post-test 37.6 ± 3.88 fat in the breast milk is more easily digested whereas
was significantly higher than pretest 28.4 ± 4.73 (t = 11.25, fat in formula is digested more slowly than breast milk
p = 0.001). 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
1
Postgraduate Nursing Students (2nd Year) is important when babies are sick or premature and
2
Associate Professor, 3Assistant Professor
may have higher chance of developing an infection. A
1-3
Department of Obstetrics and Gynecology Nursing, Amrita randomized and quasi randomized trial done by Oshom
College of Nursing, Amrita Vishwa Vidyapeetham Health
DA, Sinn Jon on formulas containing hydrolized protein
Sciences Campus, Amrita Institute of Medical Sciences, Kochi
Kerala, India for prevention of allergy and food intolerance in infants
found no evidence to support feeding with a hydrolized
Corresponding Author: Lekha Viswanath, Associate Professor
Department of Obstetrics and Gynecology Nursing, Amrita
formula for the prevention of allergy in preference to
College of Nursing, Amrita Vishwa Vidyapeetham Health exclusive breastfeeding.4
Sciences Campus, Amrita Institute of Medical Sciences, Kochi Mothers of those babies admitted in neonatal intensive
Kerala, India, Phone: 0484-6681234, e-mail: lekhaviswanath3@ care unit (NICU) are in severe stress because of poor
gmail.com
maternal child bond, disturbed physical appearance

Journal of South Asian Federation of Obstetrics and Gynaecology, January-March 2016;8(1):1-4 1

A Divya et al

of baby and inability to feed their baby. Depending on from Thesis Review Board of Amrita Institute of Medical
the conditions of the baby feeding may be started when Sciences, Kochi and the period of data collection was from
baby becomes stable usually with expressed breast November 2014 to January 2015. A detailed explanation
milk. Mothers may not be able to express enough breast of the study and nature of participation was given to
milk needed for the baby due to decreased breast milk the postnatal mothers who met the sampling criteria.
production. As the breastfeeding is not initiated in the Participation was based on willingness and written
initial days the mothers may develop many breastfeeding informed consent was obtained prior to enrolment.
problems. The most common among them is breast The demographic data were collected using a
engorgement. During direct breastfeedings the baby proforma prepared by the investigator. The volume
removes the needed milk through sucking which helps of breast milk expressed and pain during breast milk
to develop more milk and is a normal physiology. For expression were measured during three consecutive
mothers of high risk babies, the colostrums develop in the expressions. A measuring cup was used to measure the
breast is not removed out from the breast. This results in breast milk in milliliters and numerical rating scale was
plugged milk ducts, results in infection and engorgement. used to measure the pain score. The experience of
Breast engorgement causes discomfort to the mothers like breast milk expression was assessed using breast milk
pain, redness and hardening of breast tissues. It further expression experience measure after three observations.
decreases production of breast milk as emptying of milk Breast milk expression experience measure is a five point
does not take place. Facilitating emptying of breast of likert scale developed by Flaherman to evaluate women
milk would be an appropriate intervention to relieve experience of expressing breast milk. The tool consists
breast engorgement in such mothers. Often women may of three subscales, they are social support, learning
need assistance in expressing breast milk. Breast milk experience and personal experience. Reliability of the tool
expression helps not only to relieve problems related to is established by checking the internal consistency and
engorgement but also improve or maintain breast milk had a Cronbach’s alpha coefficient of 0.703.
production. After the pretest, the breast massage is taught to the
The present study was undertaken with a view to help mother with the help of a video showing breast massage
mother in expressing breast milk. Breast massage was and breast milk expression and was demonstrated to
selected as the intervention as it helps to open the plugged the mother by the investigator. Breast massage includes
milk ducts and improves the breast milk production. rubbing stroking and kneading each breast followed by
Breast massage acts as an external stimuli which opens massaging breast with finger pads, in a circular motion
the milk ducts whereas for a newborn who directly feeds around the whole breast in a clockwise manner. It also
lips of newborn act as massager. The objectives of the incorporates hot fomentation prior to the intervention
present study were as follows: and expression of breast milk using Marmet technique.
• Find out the effect of breast massage on volume of Breast massage is given for 5 minutes to each breast.
breast milk expression among mothers of neonates Then expression is done using Marmet technique for
admitted in NICU. 10 minutes. To ensure the correct method practiced
• Find out the effect of breast massage on pain during by the mother, the first expression after the teaching is
breast milk expression among mothers of neonates evaluated by the researcher with the help of a checklist.
admitted in NICU. The volume of breast milk and pain during expression
• Find out the effect of breast massage on experience for the next three expressions is measured, followed by
of breast milk expression among mothers of neonates measurement of experience of breast milk expression.
admitted in NICU. The pretest and post-test scores of volume of breast
milk, pain during breast milk expression and experience
materials and Methods of breast milk expression were compared using paired
The study used a Quasi experimental research approach t-test. Average of the three observations of volume and
with time series design. Sample consists of 30 postnatal pain before and after the intervention was considered as
mothers whose babies were admitted in NICU and pretest and post-test respectively.
were on expressed breast milk feeding, selected as a
Results
sample of convenience. Inclusion criteria were mothers
of neonates aged between 18 and 45 years, from third to Most of the mothers 18 (60%) of subjects were in age
eighth postpartum days and those who do not have any group 25 to 30 years, and 23 (76%) were graduates.
medical comorbidities. Ethical clearance was obtained Majority of mothers [21 (70%)] were primigravida and

2
 JSAFOG

Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates

underwent delivery above 36 weeks of gestation. About Table 1: Comparison of volume of milk expressed between
the type of delivery, 19 (64%) mothers underwent normal pretest and post-test
vaginal delivery and 11 (36%) underwent lower segment n = 30
cesarean section (LSCS). None of the mothers took any Mean SD Mean difference t-value p-value
medication to increase breast milk production. Pretest 7.338 4.86 8.22 4.22 < 0.001
The volume of the breast milk and the pain during Post-test 15.56 8.38
breast milk expression before and after breast massage is
presented in Graph 1 and it shows that following breast Table 2: Comparison of pain score between pretest and post-test
massage there is an increase in the volume of breast milk n = 30
and decrease in the pain during expression. Mean SD Mean difference t-value p-value
In order to find out the effect of breast massage on Pretest 7.50 1.42 2.49 11.73 < 0.001
breast milk expression, the pretest and post-test scores Post-test 5.01 1.37
were compared using paired t-test. The average of three
observations before the intervention is considered as the Discussion
pretest and average of the three observation following The present study finding is more or less consistent with
the breast massage is considered as post-test for volume the literature findings. The pretest volume of breast
of breast milk expressed and pain during breast milk milk expressed is 7.33 ± 4.86 and in post-test the volume
expression. increased to 15.56 ± 8.38. The study results interpret that
Table 1 shows that the post-test (15.56 ± 8.38) volume the breast massage is effective in increasing the volume of
of milk is significantly higher than the pretest (7.33 ± 4.86) breast milk at 0.001 level of significance. An experimental
volume of milk (t = 4.22, p = 0.001). study conducted on 36 postnatal mothers found that the
Table 2 shows that the post-test (5.01 ± 1.37) pain score volume of breast milk expressed was high with breast
is significantly lower than the pretest (7.50 ± 1.42) pain massage than without massage in sequential pumping
score (t = 11.73, p = 0.001). (78.71 vs 51.32 gm) as well as simultaneous pumping
Table 3 shows that the experience of breast milk ( 125.08 vs 87.69 gm). The above findings supports the
expression score is significantly higher in the post- results of the present study.
test than the pretest score. So breast massage helps in The result of the present study shows that post-test
improving breast milk expression experience. pain score (5.01 ± 1.37) is significantly lower than pretest
pain score (7.50 ± 1.42) at 0.001 level of significance. 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 significant decreases
in breast pain (p < 0.001), increases in number of times
newborns suckled after the first and second massage
(p < 0.001), and a decrease in breast-milk sodium after
the first 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
Graph 1: The volume of breast milk expressed and pain during breast milk expression, it improves the mothers comfort
breast milk expression and confidence 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

Journal of South Asian Federation of Obstetrics and Gynaecology, January-March 2016;8(1):1-4 3

A Divya et al

increasing the volume of breast milk it helps to avoid References

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