Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial

Abstract

Background: Biological nurturing is a neurobehavioral approach to breastfeeding support that encourages women to breastfed in a relaxed, laidback position. This approach has the potential to reduce breast problems (e.g., sore nipples), making good latch easier and thus facilitating the initiation of exclusive breastfeeding. However, its effects have not been adequately investigated in a real-life situation. The aim of this randomized controlled trial was to assess the effectiveness of biological nurturing, compared to usual hospital practices, on the frequency of breast problems and on the prevalence of exclusive breastfeeding at discharge from the maternity ward, after 1 week, and at one and 4 months. Methods: Open randomized parallel controlled trial carried out in a third level maternity ward (IRCCS Burlo Garofolo, Trieste, Italy) between March and December 2018. Two-hundred eight women who planned to give birth at the hospital and who expressed the intention to breastfeed were enrolled during pregnancy and randomized to receive breastfeeding support following either the biological nurturing approach or the usual care protocol based on the WHO/UNICEF 20-h course, in use at the hospital. The primary study outcome was the incidence of breast problems during hospital stay, defined as the presence of one or more of the following outcomes, collected separately: sore nipples, cracked nipples, engorgement and mastitis. The primary analysis was performed by intention to treat. The follow up lasted 4 months. Results: One hundred eighty eight out of 208 women (90.3%) were included in the analysis, 90 allocated to the biological nurturing group and 98 to the usual care group. At discharge from the maternity ward, biological nurturing significantly reduced the risk of breast problems (Relative risk [RR] 0.56, 95% Confidence Interval [CI] 0.40, 0.79), including cracked (RR 0.42, 95% CI 0.24, 0.74) and sore nipples (RR 0.59, 95% CI 0.40, 0.88). No statistically significant difference was observed for exclusive breastfeeding at discharge and up to 4 months. No adverse events occurred.

The Effectiveness of Laid-back Position on Lactation Related Nipple problems and comfort: A meta-analysis

“…Our meta-analysis showed that the experimental group) had a lower incidence than the control group (13.8% vs. 55.1%, RR = 0.24; 95% CI 0.14,0.40; p < 0.00001). This result is similar to study carried out in Italy [53], which has reported that biological nurturing signi cantly reduced the risk of sore nipples from 46.9% to 27.8% (RR 0.59, 95% CI 0.40, 0.88). These results may be explained by a higher proportion of successful latching and self-attachment with the laid-back position [53].…”

“…This result is similar to study carried out in Italy [53], which has reported that biological nurturing signi cantly reduced the risk of sore nipples from 46.9% to 27.8% (RR 0.59, 95% CI 0.40, 0.88). These results may be explained by a higher proportion of successful latching and self-attachment with the laid-back position [53]. Nipple pain was measured on rating scales which was developed based on general population.…”

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

“…The biological nurturing group showed a decreased incidence of sore nipples, cracked nipples, engorgement and mastitis at the time of hospital discharge, and this finding was confirmed 7 days post-discharge. Yet the incidence of these problems increased slightly in the biological nurturing group compared to usual care at 30 days post-discharge, with no change in breastfeeding rates either at discharge or up to 4 months post-birth [ 25 ]. A 2021 Chinese RCT of 504 pairs demonstrated that implementing baby-led self-attachment from birth resulted in a 12% increase in exclusive breastfeeding at day 3, and an 8 and 5% decrease in the number who reported nipple pain at 3 days and 3 months postpartum, respectively [ 26 ].…”

Prevalence of breastfeeding in a baby-friendly pediatric practice in Trieste, Italy: follow up to 36 months of age

“…First, when professional and peer support is provided, breastfeeding rates increase [ 14 ]. Second, biological nurturing and the laid-back position reduce breast problems [ 15 , 16 ], and can thus promote a better establishment and continuation of breastfeeding. As secular trends are unlikely to explain our results, the most likely explanation for our high breastfeeding rates is the application of our composite intervention.…”