Promoting self‐management of breast and nipple pain in breastfeeding women: Protocol of a pilot randomized controlled trial

Abstract

The majority of women experience pain during breastfeeding initiation with few strategies to manage breast and nipple pain. In fact, women cite breast and nipple pain as among the most common reasons for breastfeeding cessation. To address this important issue, we developed a breastfeeding self‐management (BSM) intervention, based on the Individual and Family Self‐Management Theory Framework. In this framework, self‐management is conceptualized as a process in which women use knowledge, beliefs, and social facilitation to achieve breastfeeding goals. The purpose of this longitudinal pilot randomized controlled trial was to test the feasibility, acceptability, and preliminary efficacy of the BSM intervention with women initiating breastfeeding. Recruitment of 60 women intending to breastfeed occurred within 48 hr of delivery and women were randomized to either the intervention or usual care group. The BSM intervention group received BSM education modules that included information of how to manage breast and nipple pain and self‐management support through biweekly texting from the study nurse, and were asked to complete a daily breastfeeding journal. Primary outcomes measured at baseline, 1, 2, and 6 weeks will be used to (a) evaluate feasibility, acceptability, and preliminary efficacy of the BSM intervention, and (b) assess the influence of protective and risk factors of breastfeeding pain (including individual genetic polymorphisms related to pain sensitivity) on process variables for self‐management of breastfeeding and breastfeeding pain, and on proximal (breastfeeding pain severity and interference, breastfeeding frequency) and distal outcomes (breastfeeding exclusivity and duration and general well‐being).

Exclusive Breastfeeding at 6 Weeks Related to Pain Self-Management, Emotion and Self-Efficacy: A Secondary Analysis of a Pilot Randomized Control Trial

“…Mothers understand that breastfeeding is pivotal for the infant’s health, maternal-infant attachment, and is culturally important 23 . In our larger study, although mothers experienced pain during breastfeeding at 1 and 2 weeks, there was no significant relationship between early discomfort and exclusive breastfeeding at 6 weeks 15 . This result suggests that mothers may continue breastfeeding despite experiencing pain and discomfort that endures for multiple weeks.…”

“…Participants completed assessments of breast and nipple pain intensity using a horizontal visual analogue scale with fixed intervals between 0-100, and reported frequency and type of daily feedings (breast, human milk in a bottle, or formula) at baseline and 6 weeks. 15…”

“…Our pilot randomized trial (RCT) used a breastfeeding pain self-management (BSM) intervention to target pain self-management and to support EBF. 15 The goal of the study was to decrease mothers’ breast and nipple pain using self-management strategies. The BSM intervention significantly decreased breastfeeding pain during the first two weeks postpartum.…”

OXTR rs53576 variation with breast and nipple pain in breastfeeding women

“…To visualize the effect of each SNP on breast and nipple pain severity, graphs with nonparametric smoothing curves were generated for pain severity over time by groups of alleles. Lucas et al (2019) used a Linear Mixed Model (LMM) to evaluate the effect of the BSM intervention on reducing breastfeeding pain over 6 weeks. The model contained pain severity at week 1, 2, and 6 as the outcome, and baseline pain severity, week, BSM intervention group, and time by group interaction as covariates (Lucas, Zhang, et al, 2019).…”

Perceptions of Mothers regarding the Importance of Breastfeeding

“…10 Moreover, inadequate latching/sucking can cause injury, pain and discomfort, which can lead mothers to discontinue breastfeeding if the problem is not corrected. 12,13 Another considerable challenge is the reconciliation between work and breastfeeding, 14,15 which is often associated with the need to generate income for the subsistence of the family. Health professionals should not limit their actions to the sharing of information on the benefits of breast milk to the health of the infant.…”