Effectiveness of Breast crawl in initiation and
maintenance of effective breast feeding among new borns in selected hospital at
Kollam
Shahana Shan
Lecturer,
Department of Child Health Nursing, Mount Zion Nursing College, Chalayodu
Adoor, Pathanamthitta District, Kerala, India.
*Corresponding Author Email:
ABSTRACT:
A
quantitative research study to assess the effectiveness of breast crawl in
initiation and maintenance of effective breast feeding among newborns in
selected hospital at Kollam. The objectives of the study were to assess the
effectiveness of breast crawl in initiation of breast feeding among newborns,
to assess the effectiveness of breast crawl in maintenance of effective breast
feeding among newborns and to find the association between the breast crawl of
new born with the socio demographic variables. A quasi experimental
non-equivalent control group design was used for the study. Purposive sampling
technique was used to select 60 newborns born by normal vaginal delivery who
were alternatively posted as experimental group and control group. The tools
were demographic proforma, observation checklist for breast crawl, observation
checklist for initiation of breast feeding and observation checklist for
maintenance of effective breast feeding. Breast crawl given to the experimental
group and assessed the initiation of breast feeding. Routine initiation of
breastfeeding given to control group. Continuation of breast feeding was
assessed equally in both groups, for six feeds in a day for 3days. The unpaired
‘t’ value was used to assess the effectiveness of breast crawl in initiation of
breast feeding. The calculated ‘t’ value, (14.47) was greater than table value,
(2.660). Effectiveness of breast crawl in maintenance of effective breast
feeding was assessed by using unpaired ‘t’ value. The calculated t value in Day
I (8.6551), Day II (18.55) and Day III (19.24) were greater than table value
(2.660) at 0.05 level of significance. It concludes that there was
effectiveness of breast crawl in initiation and maintenance of effective breast
feeding among newborns. There was also progressive increase in the second and
third day.
KEYWORDS: New born; breast crawl;
initiation; maintenance of effective breast feeding.
INTRODUCTION:
Mother’s
milk is a divine gift for a baby. Breast milk is only the food for the baby
which is natural, physiological way of feeding. Breast feeding could save the
lives of
1.3
million children a year. Breast milk provides the exact combination of
nutrients that a developing infant need.
Improved
breast feeding alone could save the lives of more than 3500 children every day,
more than any other preventive intervention. According to Global Health
Observatory (GHO) data, globally the infant mortality rate is 4.6 million and
49.81 in India. Increasing optimal breast feeding could save an estimated 1.5
million infant lives annually. Up to 55% of infant deaths from diarrheal
disease and acute respiratory tract infection may result from inappropriate
feeding practices. In the current scenario, the prevalent rate of
under-nutrition in young children is high 46% in India5. The first
hour after birth has a major influence on the survival, future health, and wellbeing
of a newly born infant. The basic needs of a baby at birth are warmth, normal
breathing, mother’s milk and protection from infection. Early initiation of
breast feeding serves as the starting point for a continuum of care for mother
and newborns that can have long lasting effects on health and development4.
Even
though there is lot of advantages to breast milk, the breast milk feeding
pattern of mothers should be good to get this benefit to the baby. Every
mammal breast feed their offspring. It is a natural instinct; they do by
themselves. It is same in human being also. So good to promote natural
instincts in new born. “Every newborn, when placed on the
mother’s abdomen soon after birth, has the ability to find mother’s breast all
on her/his own and to decide when to take the first breast feed”. This
is called the “Breast Crawl”. It was first described in 1987 at Karolinska
institute in Sweden. The Breast crawl is associated with a variety
of sensory, central, motor and neuro-endocrine components, all directly or
indirectly helping the baby to move and facilitate her survival in the new
world. The promotion of early imitation of breast feeding has great potential
16% of neonatal deaths could be saved if all infants were breastfeed from day 1
and 22% if breastfeeding were started within the first hour after birth. All
these advantages will obviously be maximally tapped with Breast crawl. The body
of scientific evidence is strong enough to recommend ‘Breast crawl’ as the
method for initiating breastfeeding. However, there has been no such widespread
recommendation. In fact, no particular method for initiation of breast feeding
has been recommended by the BFHI documents. The purpose of this study is to
strongly recommend evidence based workable method in form of the breast crawl
for initiation of breast feeding. The lessons from the brea.st crawl, like skin
to skin contact and the newborns’ spectrum of abilities would come handily in
this period. Some of the mothers whom we have seen initiation breastfeeding by
the breast crawl, continued to use the ‘crawling in position advantageously, so
as to establish successful breastfeeding2,3.
The
Breast crawl is associated with a variety of sensory, central, motor and
neuro-endocrine components, all directly or indirectly helping the baby to move
and facilitate her survival in the new world. The promotion of early imitation
of breast feeding has great potential 16% of neonatal deaths could be saved if
all infants were breast feed from day 1 and 22% if breastfeeding were started
within the first hour after birth. All these advantages will obviously be
maximally tapped with Breast crawl.
NEED
AND SIGNIFICANCE OF THE STUDY:
UNICEF,
WHO, WABA, BPNI strongly recommended initiate breast feeding with in half hour
of birth. Early initiation can prevent 22% of all deaths below 1month in
developing countries. This is due to the several advantages it affects to the
mother and baby. Such as, Prevent hypothermia, due to skin-to-skin contact with
mother, baby achieves effective feeding skill faster so chances of long term
breast feeding success increases, baby gets early protection from infections
from colostrum as the first feed, early feeding prevents hypoglycaemia and
helps in better maintenance of other biochemical parameters, it may have a role
in boosting development of the baby’s nervous system, it leads to better
mother-infant bonding. Maternal advantage of early initiation are better
uterine contractions due to oxytocin surge, leading to faster expulsion of the
placenta, reduction in maternal blood loss and thus prevention of anemia.11
The
body of scientific evidence is strong enough to recommend ‘Breast crawl’ as the
method for initiating breastfeeding. However, there has been no such widespread
recommendation. In fact, no particular method for initiation of breast feeding
has been recommended by the BFHI documents. The purpose of this study is to
strongly recommend evidence based workable method in form of the breast crawl
for initiation of breast feeding. The lessons from the breast crawl, like skin
to skin contact and the new borns’ spectrum of abilities would com handly in
this period. Some of the mothers whom we have seen initiation breastfeeding by
the breast crawl, continued to use the ‘crawling in position advantageously, so
as to establish successful breastfeeding. Through ‘Kangaroo Mother Care’ was
invented to care for low birth weight babies, Klaus visualized a unification of
this concept with the breast crawl, in this extended initiation period, for
normal full term newbornss.2
During
clinical experience, the investigator came across with many mothers reporting
inadequate breast feeding or lactation failure. On enquiry it was observed
there is a delay in initiation of breast feeding among most of the mothers.
Review of literature suggests many interventional studies to initiate effective
breast feeding. So the researcher thought of conducting an interventional
study of initiating breast feeding during the first half hour of delivery, by
breast crawl and assessing the outcome in initiation and maintenance of breast feeding.
OBJECTIVES:
The
objectives of the study are:
1.
To assess the effectiveness of breast crawl in initiation
of breast feeding among newborns.
2.
To assess the effectiveness of breast crawl in
maintenance of effective breast feeding among newborns.
3.
To find the association between the breast crawl of new
born with the sociodemographic variables.
HYPOTHESES:
The
following research hypotheses were formulated.
All
the hypotheses will be tested at 0.05 level of significance
H1-There will be significant difference between the process of
initiation of breast feeding among experimental group and control group.
H2-There will be a significant difference between the maintenance
of effective breast feeding among experimental group and control group.
H3-There will be significant association
between the breast crawl of new born with the sociodemographic
variables.
MATERIALS
AND METHODS:
The
quasi experimental non-equivalent control group post-test only design was
adopted for the study. The study was conducted in Victoria hospital Kollam.
Purposive sample technique was used to select 60 newborns, out of which, 30
samples were experimental group and 30 samples were in control group.
Researcher was present at the labour room at the time of delivery. Alternative
babies were assigned to experimental group for breast crawl. Made sure that
baby cried soon after delivery and established breathing. APGAR score was
checked. Baby was kept between the mother’s breast on prone position. Baby’s
hip was flexed and abducted in a frog like position. All care was taken to
prevent the baby from falling. Observe the baby for breast crawling. Baby
starts searching the mother’s nipple and makes grasping movement towards
nipple. Turning head towards the nipple. Attempting self to attach, catch and
hold the nipple. Once the baby realizes that breast milk is in close proximity,
it starts salivating. Mouthing movement’s starts. Sooner the baby reached the
nipple; baby raised her head and has nicely latched it with wide open mouth and
mouth full of areola of breast. In case the baby’s several attempts to latch on
the breast fail, then the baby can be gently moved nearer to the breast by
supporting the buttocks. Baby allowed to suck for 30 minutes. Normal initiation
of breast feeding given to the control group.
The
maintenance of effective breast feeding was assessed by six feeds in a day for
three days. Each time pre breast feeding weight and post breast feeding weight
assessed. On the second- and third-day post assessment
of maintenance of effective breast feeding were measured with checklist for
maintenance of effective breast-feeding assessment tool for both the groups.
Assessing six feeds for three days. Average difference between pre breast
feeding weight and post breast feeding weight calculated by breast milk
estimator. Both descriptive and inferential statistics was used to compute the data.
RESULT:
Demographic
data was analysed using frequency and percentage. Frequency, mean, standard
deviation and unpaired t value was computed to show the effectiveness of breast
crawl in initiation and maintenance of effective breast feeding and chi square
test was done to determine the association between the breast crawl of new born
with socio demographic variables.
Sections
were analyzed under following headings:
Section I: - Description of the
demographic data of the newborns (N
= 60)
Figure: 1 Percentage wise distribution of newborns
according to gestational age (N =60)
Figure 2: Percentage wise distribution of newborns according
to sex (N=60)
Figure 3: Percentage wise distribution of newborns according
to
birth weight (N=60)
Figure 4: Percentage wise distribution of newborns
cried immediately after birth (N=60)
Figure 5: Percentage wise distribution of newborns
based on APGAR at one minute (N=60)
Figure 6: - percentage wise distribution of newborns
regarding
APGAR score at five minutes
Section II: Evaluation of the
effectiveness of breast crawl in initiation of breast feeding among newborns:
•
H1: There will be significant different between the process of initiation of breast feeding among
experimental and control group.
Table 1: Mean, standard deviation and unpaired t value
of initiation of breast feeding among newborns in experimental and control group: (N=60)
|
|
Mean
|
SD
|
T value
|
|
Experimental group
|
16.133
|
0.83
|
14.47*
|
|
Control group
|
12.433
|
1.14
|
t(58) = 2.660 p value – 0.0001 * significant at
0.05 level of significance
Table
1 describes the initiation of breast feeding among newborns in experimental and
control group. The mean score value of experimental group was 16.133 and SD was
0.83 In control group, the mean was 12.433 and SD was 1.14. When computed the
data and calculated unpaired t value, calculated value was 14.47. At 0.05 level
of significance the table value is 2. 660.Calculated value (14.47) is greater
than table value (2.660). Hence H1,
there will be significant difference between the process of initiation
of breast feeding among experimental group and control group was accepted. It
can be concluded that there is a significant effectiveness of breast crawl in
initiation of breast feeding among newborns.
Section III: Effectiveness of
breast crawl in maintenance of effective breast feeding among newborns in each
feed among experimental and control group.
H2: -There will be significant difference
between the maintenance of effective breast feeding among the
experimental and control group
It
is analyzed and represented in following headings:
·
Day wise analysis and distribution
of newborns in terms of maintenance of effective breast feeding status on day1,
day 2 and day 3.
·
Evaluation of effectiveness of
breast crawl in maintenance of effective breast feeding in terms of six feed
per day.
For
this, the researcher assessed six feeds in a day in both experimental and
control group. The researcher had compared, day 1score with day 2, and day 2
score with day 3, to assess the maintenance of effective breast feeding among
newborns.
The
data in table 2 shows the maintenance of effective breast feeding on 1st
day and continuation of assessment on day 2 and day 3 were graded as poor
maintained, moderate maintained and well maintained. On day 1, in control
group, 13.33% had poor maintenance in breast feeding whereas, In experimental
group, 93.33% had moderate maintenance and 6.67% had well maintenance of breast
feeding.
Table 2: Distribution of newborns in experimental and
control group in terms of maintenance of effective breast feeding on day1, day2
and day 3
|
Sl No
|
Day
|
Item
|
Control group
|
Experimental group
|
|
Freq
|
%
|
Freq
|
%
|
|
1.
|
Day 1
|
Poor
|
4
|
13.33%
|
0
|
-
|
|
Moderate
|
26
|
86.67%
|
28
|
93.33%
|
|
well
|
0
|
-
|
2
|
6.67%
|
|
2.
|
Day 2
|
Poor
|
8
|
26.67%
|
0
|
-
|
|
Moderate
|
22
|
73.33%
|
24
|
80%
|
|
well
|
0
|
-
|
2
|
20%
|
|
3.
|
Day 3
|
Poor
|
4
|
13.33%
|
0
|
-
|
|
Moderate
|
26
|
86.67%
|
14
|
46.67%
|
|
well
|
0
|
-
|
16
|
53.33%
|
On
day 2, in control group, 26.67% had poor maintenance of breast feeding and
73.33% had moderate maintenance of breast feeding where as in experimental
group, 80% had moderate maintenance of breast feeding and 20% had well
maintenance of breast feeding. On day 3, in control group, 13.33% had poor
maintenance of breast feeding and 86.67% had moderate maintenance of breast
feeding. In Experimental group 46.67% had moderate maintenance of breast
feeding and 53.33% had well maintenance of breast feeding.
Table 3: - Mean, standard deviation and ‘Unpaired t’
value in maintenance of effective breast-feeding scores of experimental and
control groups. (N=60)
|
Day
|
Group
|
Mean
|
SD
|
t value
|
|
Day 1
|
Experimental
|
125.30
|
8.82
|
8.655*
|
|
Control
|
106.37
|
8.11
|
|
Day 2
|
Experimental
|
134.10
|
6.19
|
18.55*
|
|
Control
|
104.30
|
6.25
|
|
Day 3
|
Experimental
|
138.90
|
7.80
|
19.24*
|
|
Control
|
106.27
|
5.04
|
t(58) = 2.660 p value -0.0001
* Significant at 0.05 level of significance
Table
3 describes the maintenance of effective breast- feeding scores of newborns
in experimental and control group. IN Day-I, the mean value of experimental
group was125.30 and SD was 8.82and mean value of control group was 106.37 and
SD was 8.11. In Day –II, the mean value of experimental group was134.10 and SD
was 6.19, in control group, the mean value was 104.30 and SD was 6.25.In Day
–III, the experimental group was 138.90
and SD was 7.80.In control group the mean was 106, 27 and SD was 5.04. At 0.05
level of significance the table value is 2.660. Calculated value in Day I -
8.65, Day II -18.55 and Day III - 19.24 are greater than table value, 2.660. Hence H2,
there will be significant difference between the maintenance of
effective breast feeding among experimental and control group is accepted It
can be concluded that there is significant effectiveness of breast crawl in
maintenance of effective breast feeding. Also, there is progressively increase
on the second day and from there to third day.
Section IV: - Association between
the breast crawl of newborn with sociodemographic variables
This
section deals with the association between breast crawl of newborns with
selected demographic variables like gestational age, sex, birth weight, baby
cried immediately after birth, APGAR at one minute and APGAR at five minutes.
In
order to find out the association between breast crawl of newborns with
sociodemographic variables, the following research hypothesis is formulated.
H3 – There will be significant association
between the breast crawl of newborns with the sociodemographic variables
at 0.05 level of significance.
Table
above shows that the association between the breast crawl of newborns with
socio demographic variables including gestational age, sex, birth weight, baby
cried immediately after birth, APGAR score at one minute and APGAR score at
five minutes.
Table 4: - Chi-square value showing association between the breast crawl of new born with the sociodemographic variables: (n =30)
|
Demographic variables
|
Breast crawl
|
Chi square
|
df
|
Level of significance
|
|
Adequate
|
Inadequate
|
|
Gestational Age
38 weeks 39weeks
|
26
4
|
0
0
|
16.12*
|
1
|
S
|
|
Sex Male
Female
|
18
0
|
0
-
|
6*
|
1
|
S
|
|
Birth weight
2.6 -3 kg 3.1 -3.5kg
|
20
10
|
0
0
|
3.2
|
1
|
NS
|
|
Baby creied immediately after birth
Yes
|
30
|
0
|
30*
|
1
|
S
|
|
APGAR at 1 min
8
7
|
14
16
|
0
0
|
.12
|
1
|
NS
|
|
APGAR at 5min
9
8
|
12
18
|
0
0
|
.12
|
1
|
NS
|
*Significant at 0.05 level of significance S =Significant NS
=Not Significant
The
association between breast crawl with socio demographic variables were computed
by chi square. The calculated value in gestational age (16.12), sex (6) and
baby cried immediately after birth (30) is greater than table value (3.82). The
results show that the demographic variables such as gestational age, sex and
baby cried immediately after birth have significant association with breast
crawl of new born.
CONCLUSION:
In
order to strengthen the step 4 of Baby Friendly Hospital Initiative, that is
Help the mothers to initiate breastfeeding with in half hour of birth5,
by focusing on natures miraculous way of initiating breastfeeding by a
phenomenon called breast crawl. This is a marvellous tool to assist in
establishing when and how a new born is first nourished. Breast crawl is the
natural instinctive behaviour of the human newborns. The mother and the
newborns dyad are mutually responsive in the most sensitive period of help to
one hour following delivery. This period is crucial for laying the foundation for
successful breast feeding13. Breast crawl offers proper
acclimatization from the intrauterine to extra uterine environment it is an
innate and instinctive process with other mammalians; so why not in human
beings.
ACKNOWLEDGEMENT:
The
researcher owes grateful acknowledgment to all who contributed their valuable
time perseverance and thought-provoking ideas provided throughout the study.
She is thankful to all mothers who participated in the study for their whole
hearted co-operation.
REFERENCES:
1.
Lawrence A R, Lawrence M R. Breast
feeding. A guide for medical profession.7th ed. Missouri: Elsevier
publications; 2005.p.1-3
2.
Klaus M. Mother and infant: early
emotional ties. Pediatrics. (Internet).[cited 2010]; Mar 1]: Available from http://www.pediatrics.org/cgi/ content/full/1021515E1/1244
3.
Marasco L. Common breast-feeding
myths. LLLI.N.p.n.d.Web. (Internet) 2013 May. Available from http://www.llli.org/nb/Ivapramay98p21nb.html.
4.
Gangal P. Breast crawl. Initiation
of breast feeding by breast crawl. 1sted. UNICEF Maharashtra,
Mumbai: 2007. Available from WWW.breast crawl.org.
5.
Global Health Observatory Data.
Infant mortality [internet} 2013.Available from www.infant mortality rate.com.org
6.
Klaus M. Mother and infant: early
emotional ties. Pediatrics. (Internet). [cited 2010]; Mar 1]: Available from http://www.pediatrics.org/cgi/ content/full/1021515E1/1244
7.
Marasco L. Common breast-feeding
myths. LLLI.N.p.n.d.Web. (Internet) 2013 May. Available from http://www.llli.org/nb/Ivapramay98p21nb.html.
8.
Mehler H, Jusczyk P, Lambertz G.A
precursor of language acquisition in young infants cognition (internet).
9.
Walter M, Boggs M, Ludington S,
Morrison B. Kangaroo Care at birth for full term infants. American Journal for
maternal child nursing [internet].[cited 2007 Nov]; 32 (60) : 375-81.Available
from: URL:- www.ncbi.nih.gov/pubmed/15841774.
10.
Al-Sahab, Lanes A, Feldman M, Tamim
Prevalence and predictors of 6-month exclusive breast feeding among Canadian
women: a national survey. [Internet]BMC Pediatrics. [cited 2010 Apr 8]:10- 20
11.
Chadurvedi Breast crawl, to
initiate breast feeding within half an hour after birth.
[Internet].JMGIMS.[cited 2008 sep]; 13( 2):9-14.
12.
Jones G, Steketee R W, Black E R,
Butta AZ, Morris S Show many child deaths can we prevent this year. Child
survival study group. [Internet]. The lancet.2003 July 5; 362: 65-71
13.
Wadhawani N. Initiation of breast
feeding through breast crawl (online). Available from:URL: http://www.breast crawl
.orgl/references.htm.
14.
Chan S M, Nelson E A, Leung S S, Li
C Y. Breast feeding failure in a longitudinal postpartum maternal study in Hong
Kong. Pediatric child health [internet].2000 oct; 36(5):466-71.
Received on 26.05.2021 Modified
on 29.06.2021
Accepted on 23.07.2021 ©A&V Publications All right reserved
Asian J. Nursing
Education and Research. 2021; 11(4):565-570.
DOI:
10.52711/2349-2996.2021.00132