INTRODUCTION:

After meeting the fundamental needsfor establishing breathing and maintenance of body temperature, the subsequent efforts in the care of newborn babies should be directed towards the provision of adequate nutrition and prevention of infections. Breast milk is an opaque white liquid produced by the mammary glands of females. It provides the primary source of nutrition for newborn before they are able to digest other types of food. The early lactation milk is colostrum and carries the mother’s antibodies to the baby.

It can reduce the risk of many diseases in the baby. The importance of breast milk has been accepted since the time of Hippocrates, who has stated that one’s own milk is beneficial.¹

Breast feeding is the feeding of an infant with the breast milk directly from female human breasts rather than from a baby bottle or any other container. Breast milk promotes sensory and cognitive development, and protects the baby against the infectious and chronic diseases.²Human milk is unquestionably the best source of nutrition for neonates or infants by the virtue of uniqueness of its biological composition.³

Motherhood is the highest, holistic service assumed by human kind. It is the definition of selfless service. The divine role of motherhood is a gift from God. Being a mother is so much more than a biological process. Breast milk is a unique nutritional source that cannot adequately be replaced by any other food, including baby formula. Breast feeding offers protection against infectious diseases and enhances optimum growth and development. Therefore, any intervention that can increase breast milk will always be the interest of health care personnel.⁴

International organizations like the WHO and UNICEF recommend exclusive breast feeding that is feeding only breast milk to the infant without any additional food or drink, not even water for the first six months of life. WHO also recommends the initiation of breast feeding within first hour of life because colostrum, the yellowish sticky breast milk produced at the end of pregnancy is the perfect food for the newborn.⁵

India is a signatory to the target set by the World Health Assembly to increase the rate of exclusive breast feeding in the first six months up to at least 50% by 2025. Exclusive breast feeding in India increased from 46.4 % in 2006 to 54.9% in 2016 and early initiation of breast feeding almost doubled from 23.4% to 41.6% during the same period. Given the counting’s high burden of under nutrition and the fact that pneumonia and diarrhea are the leading causes of death in children under five years, there is a very strong case to promote breast feeding in India.⁵

Mothers of high risk babies run the problems of lactation failure as their babies are not able to suck the breast. This could be compensated by regular expression of breast milk. Breast massage is very much effective to improve the amount of milk production. Breast massage is a handy technique that has been studied for decades and praised for its multiple uses for establishing and sustaining lactation. It can stimulate the milk ejection reflex and improve the caloric content and volume of the milk supply.⁶

An experimental study was conducted to assess the effectiveness of breast massage and electric breast pump among the postnatal mothers who were admitted in selected hospitals in USA. Lactating women pumped their breasts simultaneously using an electric breast pump, while massaging only one breast and utilizing the other breast as a control. The procedure was repeated the following day with the women massaging the opposite breast. The result showed that the mean volume of milk pumped from the massaged breast was 4.8 ml greater than that from the non-massaged breast. Mean volume from the massaged breast was 1.92% higher than from the non-massaged breast. The result indicated that breast massage can increase the volume of breast milk.⁷

Throughout the world 14-20 million infants get admitted with intra uterine growth retardation and 21 million babies born with low birth weight. In India (2006), 7.5 million babies had a birth weight of less than 2,500 grams. Of these 7.5 million babies (60%) were born at term after foetal growth retardation, while the remaining 40% were born preterm. The prevalence of birth defects in the country is 6-7%, which translate to around 1.7 million birth defects annually. The common birth defects include congenital heart disease (8-10 per 1000 live birth), congenital deafness (5.6-10 per 1000 live birth), neural tube defects (4-11.4 per 1000 live birth) and others (7-10 per 1000 live birth).⁸

In Mangaluru from 2007-2012, the rate of NICU admission rose from 64.0 to 77.9 per 1000 live births. When stratified by weight category the rate of NICU admission (500grams-1499grams) hikedfrom 800.1per live birth in 2007 to 844.1 in 2012.⁹

The research studies have estimated that the most of the mothers in the initial post natal period find difficulties in the feeding because of insufficient breast milk. The common complaint of the postnatal mothers is insufficient milk. Sucking the breast is indispensable to increase the volume or the milk production.¹⁰The sick babies who all are admitted in NICU are unable to suck. The researcher opted the study as breast massage is a simple and inexpensive method to improve the volume of breast milk. Breast massage may help the mothers to feed their babies or to express the breast milk satisfactorily and with confidence.

MATERIAL AND METHOD:

Statement of the Problem:

Effectiveness of breast massage on the volume of expressed breast milk among mothers of neonates admitted in NICU in selected hospitals, Mangaluru.

Objectives of the Study:

· To determine the volume of expressed breast milk among the mothers of neonates admitted in NICU in experimental and control group.

· To identify the difference in the volume of expressed breast milk among experimental and control group.

· To find out the association between the effectiveness of breast massage on the volume of expressed breast milk with the selected demographic variables.

HYPOTHESES:

All the hypotheses will be tested at 0.05 level of significance.

H₁: There will be a significant difference in pre-test and post-test volume of expressed breast milk among the experimental group.

H₂: There will be a significant difference in volume of expressed breast milk among the experimental and control group.

H₃: There will be a significant association of volume of breast milk expressed with the selected base line variables.

The present study is aimed to assess the effectiveness of breast massage on the volume of expressed breast milk among post natal mothers.

Research approach:

An evaluative approach was adopted for the study to determine the effectiveness of breast massage on volume of expressed breast milk among mothers of neonates.¹¹

Research design:

The research design used in this study was quasi experimental design. (Interrupted time series design).¹¹

Research setting

The present study was conducted in:

Lady Goshen Hospital, Mangaluru Nursing Home and Athena Hospitals Mangaluru.

Sample:

The sample consists of 60 post natal mothers whose babies were admitted in NICU (30 in the experiment group and 30 in the control group)

Sampling technique:

Non-probability purposive sampling technique was used.

Description of tools:

Tool 1: A demographic proforma was prepared by the researcher consisting of 5 items: age, religion, education, monthly income of the family and type of delivery.

Tool 2: Breast milk volume diary is a diary prepared by the investigator to record the amount of expressed breast milk in ml. It consist of 2 columns, ie day and amount of expressed breast milk in ML (morning, afternoon, evening) and 4 rows, i.e., day 1 (initial assessment) pre-test volume of expressed breast milk, Day 1 (post-test), Day 2, and Day 3 post-test volume of expressed breast milk in ML.

Plan for data analysis:

It was decided to analyse the data by both descriptive and inferential statistics on the basis of objective and hypothesis of the study. To compute the data a master data sheet was prepared by the investigator. The plan of data analysis was as follows:

· Computation of frequencies and percentages.

· ANOVA to find the significant difference of mean volume of expressed breast milk in the experimental group.

· Unpaired t test to find the significance of difference in the volume of expressed breast milk between control and experimental group.

· Chi square test to find the association between the volume of expressed breast milk with the selected demographic variables

RESULTS:

Section 1: Description of the baseline Proforma:

Age in years:

Majority of samples in the experimental group (53.3%) and control group (56.7%) were in the age group of 18-25 years and the least samples in the experimental group (10.0%) and control group (3.3%) were in the age group of 31-35years.

Religion:

Maximum number of samples from the experimental group (53.3%) and control group (90.0%) were Hindus.

Education:

Most of the samples in the control group (43.3%) had high school education, where as in experimental group (40%) had primary education and theleast samples in the experiment group (3.3%) and control group (6.7%) had non-formal education. None were educated up to post graduation in both groups.

Income:

Majority of the samples (46.7%) in the experimental group and (63.3%) in the control group had an income of Rs 5001–10000, 30% of the samples in experimental group and 10% of the control group had an income of Rs 10001–15000 and 3.3% of control group had an income of above Rs 15000 per month.

Type of delivery:

Highest percentage of samples in the experimental group (56.7%) had normal delivery and (43.3%) the control group had LSCS under spinal anaesthesia.

Section2: Description of the effectiveness of breast massage in terms of improvement in the amount of breast milk volume among the experimental group.

To test the significant difference in mean pre and post-test amount of breast milk volume in the experiment group, following the null hypothesis was stated

H₀₁: There will be no significant difference in pre-test and post-test volume of expressed breast milk among the experimental group.

Figure 1: Cylindrical diagram showing the mean value of volume of expressed breast milk in the experimental group

The data depicted in Figure 1 comparesthe quantity of the Mean breast milk volume at different time intervals in the experimental group. On day 1, morning, initial assessment of the mean breast milk volume was 17.4ml±5.53 and in the morning post test mean amount of breast milk volume was 18 ml±5.89. In the afternoon, the quantity increased to 22.2 ml±6.26and in evening it was 25.6 ml±6.21. On day 2 and day 3 also the mean breast milk quantity increased from morning till evening. The mean amount of breast milk was 19.633ml±6.04, 23.3 ml±6.08, 26.9 ml±6.26 and 20.5ml±5.78, 24.7±5.97, 28.9 ml±5.92, respectively. The calculated ANOVA value (F= 11.48, 10.53, 15.23) was significantly more than the table value (Fcritical value 2, 87=3.1) at 0.05 level of significance. Thus the null hypothesis H₀₁ was rejected and the research hypothesis H₁was accepted.

Section 3: Description of difference in the volume of expressed breast milk among mothers of neonates in the experimental and control group.

To find the statistical significance between thevolume of expressed breast milk in the experimental and control group, unpaired “t” test was computed and the following null hypothesis was stated.

H₀₂: There will be no significant difference between the mean volume of expressed breast milk in the experimental and control group.

Figure 2: Bar diagram showing the comparison of Mean volume of Breast milk between the groups at different time intervals

The data presented in Figure 2 depicts that the mean amount of breast milk was compared between the cases and controls at different time interval. On day 1, morning, initial assessment of the mean breast milk volume in control group was 15.7ml±3.83, whereas in the experimental group it was 17.400ml±5.53 and in the morning post test mean amount of breast milk volume was 16.267ml±3.22 in control group and 18.033ml±5.89 in experimental group. In the afternoon, the quantity increased to 16.767ml±3.40 in control groupand 22.267ml±6.26 in experimental group but there was no significance between the two. On day 1, evening onwards the difference between the control and experimental group was found to be highly significant. On the first day evening in the experimental group it was 25.6ml±6.21 and in control group it was 17.467ml±3.87. On day 2 also the mean breast milk quantity increased in experimental group from morning till evening. The mean amount of breast milk was 19.633±6.04, 23.300±6.08, and 26.900±6.26 respectively. Even on the third day the mean amount was increasing from morning till evening, whereas in control group it did not. Here the difference was found to be significant (p<0.001). The “t” value(initial =1.356, day 1 =1.439, 4.224, 6.084 day 2=2.789, 4.499, 7.140 day 3 = 2.679, 5.506, 9.031) was greater than table value (58=2.01).Thus the H₀₂ was rejected and the research hypothesis H₂ was accepted.

Section4: Description of the Association between the volume of expressed breast milk with the selected demographic variables

The data shows that there was no significant association of the amount of breast milk volume with age (χ²=1.227, p<0.05), education (χ²=1.875, p<0.05), Income (χ²=1.875, p<0.05), type of delivery (χ²=3.326, p<0.05), at 0.05 level of significance. Thus, it shows that there was no significant association between the volumes of expressed breast milk with the selected demographic variables.

DISCUSSION:

The mean amount of breast milk was compared between the cases and controls at different time interval. The difference was found to be significant (p<0.001).The “t” value (initial =1.356, day 1 =1.439, 4.224, 6.084 day 2 = 2.789, 4.499, 7.140, day 3 = 2.679, 5.506, 9.031) was greater than the table value (58=2.01) Thus, it can be concluded that there was a significant difference in the volume of expressed breast milk between the experimental and control group.

CONCLUSION:

Nutrition is vital in the maintenance of the body system throughout the life cycle. This is especially true during the years of growth and development. Breast massage is a simple and inexpensive method to improve the volume of breast milk. Breast massage may help the mothers to feed their babies or to express the breast milk satisfactorily and with confidence.

LIMITATION OF THE STUDY:

The study was conducted on mothers whose babies where admitted in NICU. Hence generalization of the data is limited.

There were drop outs of subjects because of shift of new-born to another hospital for further management and other subjects had to be selected.

SUGGESTIONS:

Massage therapy should be practiced continuously if a woman has a problem in the volume of breast milk.

Selection of the mothers with the same parity and post natal day.

RECOMMENDATIONS:

Based on the finding of the present study, recommendations offered for further research are:

1 A similar study can be conducted for a longer duration.

2 The study may be replicated on a larger sample.

3 A study can be conducted using other alternative methods or techniques like acupressure, heat application, almond oil massage, and music therapy to improve the volume of breast milk.

4 A similar study may be conducted in community setting.

5 A planned teaching program for the nurses on the knowledge and skill of massage therapy can be carried out.

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Received on 11.10.2018 Modified on 10.11.2018

Asian J. Nursing Education and Research. 2019; 9(1):135-139.

DOI: 10.5958/2349-2996.2019.00027.2