RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Ms. RESHMA THOMAS

First Year M.Sc Nursing,

Sushrutha College of Nursing

Bangalore-85

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE

KARNATAKA

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE&ADDRESS
(IN BLOCK LETTERS) / Ms RESHMA THOMAS
I STYEAR MSc NURSING
SUSHRUTHA COLLEGE OF NURSING, BANGALORE.85
2 / NAME OF THE INSTITUITION / SUSHRUTHA COLLEGE OF
NURSING
3 / COURSE OF STUDY &
SUBJECT / MASTER’S DEGREE IN NURSING
OBSTERICS&GYNAECOLOGICAL
NURSING
4 / DATE OF ADMISSION OF COURSE / 11/05/2012
5 / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING BREAST FEEDING TECHNIQUES IN PREVENTION OF NIPPLE SORE AMONG PRIMI PARA MOTHERS IN A SELECTED HOSPITAL,BANGALORE.

(6.0) BRIEF RESUME OF INTENDED WORK.

INTRODUCTION.

“A newborn has only three demands. They are warmth in the arms of its mother, food from her breasts and security in the knowledge of her presence. Breastfeeding satisfies all three”

Grantly Dick Read

In almost all cases, breast milk is the most perfect food for your baby. It contains easily digestible proteins, many factors that support your new baby's immature immune system, and other factors that aid indigestion. It is also low in cost and requires no preparation. Breast fed babies are also less likely to have colic, upper respiratory infections, ear infections, constipation, asthma or allergies. And breastfeeding will burn up almost 500 calories each day, helping mothers return to their pre-pregnancy weight sooner.1

Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts (i.e; via lactation) rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or more, without the addition of infant formula or solid food. After the addition of solid food, mothers are advised to continue breastfeeding for at least a year and can continue for two years or more.2

The World Health Organization (WHO) and The American Academy of Pediatrics (AAP) emphasize the value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the first six months of life. The AAP recommends that this will be followed by supplemented breastfeeding for at least one year, while WHO recommends that supplemented breastfeeding continue up to two years or more. While recognizing the superiority of breastfeeding, regulating authorities also work to minimize the risks of artificial feeding.3

This is the worldwide accepted concept that exclusive breastfeeding was widely for four months only, but in 1992 onwards WHO has introduced a new act namely Breastfeeding initiative Act which suggests that exclusive breastfeeding should be done up to 6 months of age.4

World Breastfeeding Week is celebrated every year from 1st to 7th August to renew our commitment for the promotion of breastfeeding. Tenth five year plan of Government Of India (2003-2007) has set an ambitious target to increase exclusive breastfeeding. As breastfeeding is universally recognized as the natural and best way to feed babies is our responsibility to promote and encourage breastfeeding.5

The theme of World Breastfeeding Week 2012 is

“Understanding the Past - Planning the Future”

It highlights Celebrating 20 years WBW and 10 years of WHO/UNICEF's Global Strategy for Infant and Young Child Feeding

The objectives of World Breastfeeding Week 2012 are:

1. To take stock of lessons learnt and achievements from the past 20 years on infant and young child feeding (IYCF).

2. To assess the status of implementation of the Global Strategy (GS) for Infant and Young Child Feeding globally.

3. To celebrate successes and achievements nationally, regionally, and globally and showcase national work at the global level.

4. To call for action to bridge the remaining gaps in policy and programmes on breastfeeding and IYCF.

5. To draw public attention to the state of policy and programmes on breastfeeding and IYCF

Human breast milk is the healthiest form of milk for babies. There are few exceptions such as when the mother is taking certain drugs or is infected with human T-lymphotrophic virus or has active untreated tuberculosis. Maternal HIV infection is always an absolute contraindication to breastfeeding in developed countries with access to infant formula and cleans drinking water (regardless of maternal HIV viral load or antiretroviral treatment) due to risk for mother to child HIV transmission. Breastfeeding promotes health and helps to prevent disease. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries. Expert agree that breastfeeding is beneficial and have concerns about artificial formulas but there are conflicting views about how long exclusive breastfeeding remains beneficial.6

Pregnancy causes major physiological changes in a woman’s body. These changes are mainly due to hormonal, metabolic and mechanical factors. Breasts are accessory reproductive organs, where major changes occur. These changes are due to increased level of hormones like estrogen, progesterone and prolactin. The changes breast undergoes is increase in size, which makes it feel heavy and tender, along with that nipples also become tender. Many women due to these changes feel some sensation in their breasts such as tingling and soreness.7

Sore nipples are probably the most common complaint after the birth. They are generally reported by the second day after delivery but improve within five days. Pain beyond the first week, severe pain, cracking, fissures or localized swelling is not normal. The mother should see a doctor for further evaluation. Sore nipples, a common cause of pain often comes from the baby if latching is not proper. Sore nipples in the first days and weeks of postpartum are usually the result of poor latch on or baby’s sucking techniques. Sore nipples that persist beyond the early weeks of post partum or that occur after weeks or months of pain-free Breastfeeding may have other causes such as a candidia infection.8

Sore nipples are usually due to one or both of two causes.Either the baby is not positioned and latched properly, or the baby is not suckling properly, or both.Incidentally, babies learn to suck properly by getting milk from the breast when they are latched on well. (They learn by doing). Fungal infection due toCandida albicans, may also cause sore nipples. The soreness caused by poor latching and ineffective suckle hurts most as you latch the baby on and usually improves as the baby nurses. The pain from the fungal infection goes on throughout the feed and may continue even after the feed is over. Women describe knifelike pain from the first two causes. The pain of the fungal infection is often described as burning, but may not have this character.Sudden, unexplained onsetof nipple pain when feedings had previously been painless is a tipoff that the pain may be due to a yeast infection, but the pain may come on gradually or may be superimposed on pain due to other causes. Cracks maybe due to a yeast infection.9

The best way to prevent sore nipple is the mother to make sure the baby is properly positioned at the breast and has latched on correctly, taking all the nipple and as much of the areola (colored part of the breast) as possible in to his mouth. Check to see that the baby is turned in to mother, tummy to tummy, his mouth at the level of mother’s nipple, and that he does not have to turn his head to grasp the nipple. When we help him latch on, gently touch his lower lip with mother’s nipple and wait until he opens his mouth, as if yawning. Then hug him quickly on to the breast. Ninety (90%) percent of sore nipples complaints are caused by poor positioning and poor latching. Nursing mother’s counselor can help to evaluate and make adjustments in getting the baby to breast.10

Many women avoid breast-feeding their newborns simply because they are afraid they will suffer from sore nipples. The most difficult period of nursing is during the first few days and weeks as mothers are forming a relationship with their newborn. They are most likely tired from the lack of sleep and if this is their first breast-feeding experience, they could be struggling to find the right positioning for their baby during feeding time. One of the best ways to prevent sore nipples is to get their baby positioned properly. There are several different positions that they can choose from, the cradle hold, cross-cradle hold, the football or clutch hold or both are lying down. Regardless of which position they choose, there is some things mothers need to do to be sure that both are in a comfortable position.11

(6.1) NEED FOR THE STUDY.

.

Breast feeding is natural method of giving nourishment to the infant. The milk from the mother is fed directly from her breast rather than using a baby bottle. Aside from being the most healthful form of milk, it also contains antibodies which cannot be found in infant formulas. These antibodies are best defence against diseases. Breast feeding can also help a lactation mother and helps to prevent from post natal depression.12

According to National Family Health Survey, 2008 report on exclusive breast feeding shows that the overall percentage of exclusive breast feeding in India is only 46% and in Karnataka it is 58 %.13

A sore nipple associated with breast-feeding is a common problem, with an incidence ranging from 11% to 90% and may lead to premature weaning. This frequently occurs from incorrect positioning at the breast. In addition traumatized nipples can readily become super infected with bacteria or yeast, the presence of which can delay healing, even when positioning and latching on are corrected. 14

A study was conducted at Swaroop Rani Nehru and Kamala Nehru memorial hospital Allahabad to know the complications associated with breast in the postnatal period and to promote early breast feeding and to teach advantages of demand feeding. The samples consisted of 600 postnatal mothers, the results of the study showed that 20% mothers had breast complications. 43.33% had breast engorgement, 15.83%had cracked nipples, 10% had retracted nipples, 8.33%had cracked and sore nipples.7.5%had cracked and retracted nipple, 7.5% had fail in lactation and 3.33% had breast abscess. Hence it is felt that to teach the postnatal mothers on prevention and management of breast complications helps for successful breast feeding15.

An experimental study was conducted about the influence of breastfeeding techniques on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation Among 211 unfavorable parameters of breastfeeding mother-baby pairs in the maternity ward and at day 30, at home. This study compared the frequencies of these parameters between mothers practicing or not exclusive breastfeeding at days 7 and 30, and between mothers with or without nipple trauma at the hospital. This study shown the number of unfavorable parameters in the maternity ward was similar for mother-baby pairs practicing or not exclusive breastfeeding at day 7 and 30. However, at day 30, it was on average, lower among those under exclusive breastfeeding, regarding positioning. This study concluded that the frequencies of exclusive breastfeeding in the first month and of nipple trauma were not influenced by the breastfeeding technique in the maternity ward, but there was an association between a better technique at day 30 and the practice of exclusive breastfeeding. 16

A specialized breast feeding unit at the hospital in Stockholm south general hospital- Sodersjukhuset has describe the most common complications in breast feeding are 1) problems in breast feeding techniques e.g. nipple wounds cause breast feeding difficulties 2) breast engorgement both with and without bacterial infection 3) pain of unknown etiology. Nipple soreness is one of the most common reasons women gives for early weaning. Research report that between 11 to 96 % of mothers experience nipple soreness. Clinical impression indicate that early onset nipple discomfort is caused by poor positioning and attachment of the newborn.17

The investigator came across, Primipara mothers those who are Breastfeeding immediately after delivery they are not practicing proper breastfeeding techniques. So, they are more risk of getting nipple sore. This insisted me to take this study. The investigator felt that it is a need to educate mothers on proper breast feeding techniques to prevent nipple sore.

(6.2)REVIEW OF LITERATURE

1. Studies related to knowledge of mother regarding breast feeding techniques

2. Studies related to breast complications due to improper breast feeding techniques.

3. Studies related to effectiveness of structured teaching programme.

1.  STUDIES RELATED TO KNOWLEDGE OF MOTHER REGARDING BREAST FEEDING TECHNIQUES

The advantages of breastfeeding are well organized and breastfeeding is increasing in popularity. Mothers require information and support in their efforts to establish breastfeeding. The nurse plays an important role in this process. The optimal time for initiating breastfeeding depends on mother’s physical and physiological status and on her vision.18

The study was conducted among Danish adults born between 1959 and 1961 on the “ association between duration of breastfeeding and intelligence” proved that babies who are breast fed for longest grow up to have significantly increased intelligence as adult.19

The present study was conducted to document the breastfeeding problems encountered in a rural community and to know the reasons for starting top feeds in infants less than 6 months of life. Using the stratified sampling method, 420 mother infant pairs were enrolled from 224 villages of Central Karnataka. Out of these 338 (80.5%) were practicing exclusive breastfeeding, 82 (19.5%) had started on top feeds. Seven (1.7 %) mothers had completely stopped breastfeeding. Bottle feeding was practiced by 39% of mothers. Maximal onset of breastfeeding problem was noted in the first two weeks of neonatal period. Breastfeeding problems are not uncommon even in a predominantly breastfeeding rural community20.

A descriptive study was conducted at tertiary hospitals in Pondicherry regarding antenatal counseling on breastfeeding. Every third primigravida mothers admitted in the maternity ward from June to December 2005 was recruited. Among these 144 primigravida mothers, 108 who had a minimum of three antenatal visits were booked. These 108 mothers were administered a pre-test semi structured questionnaire on breast feeding. The awareness among mothers (both counseled and not counseled) regarding health information pertaining to breast feeding was assessed. The findings of the study of the booked mothers, 21 %( n=23) had received some antenatal counseling about breast feeding while 79 % (n=85) had not received any such counseling. Awareness related to breastfeeding among mothers in the counseled group was better than those in ‘not counseled’ group. Even in the counseled group awareness among mothers with regard to correct breast feeding techniques and concept of continuing breast feeding during illness in the baby was no different from those in the ‘not counseled group’. Therefore existing antenatal counseling on breast feeding is inadequate in the population studied and needs to be strengthened.21