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

Abstract

Background The importance of breastfeeding for maternal and child health has become an international consensus. However, it has been found that lactation-related nipple problems are common and there are some important factors affecting the breastfeeding. Multiple studies recommended the laid-back breastfeeding, but they are on various levels of quality and the results are inconclusive. Methods We systematically searched the following twelve databases: Cochrane Library, EMBASE, Medline, Ovid, PubMed, Web of Science, CINAHL, Scopus, SinoMed, Chinese National Knowledge Infrastructure (CNKI), WanFang, and VIP from inception to January 28,2020. All studies regarding the laid-back breastfeeding or biological nurturing were considered, regardless of whether they are randomized controlled trials or not. Two trained investigators independently evaluated the quality of the selected articles and screened the data. All the data were analyzed separately using Review Manager Version 5.3 and STATA/SE Version 15.1.Results A total of 12 studies involving 1,936 groups of postpartum women and their newborns were included. The results of meta-analysis showed that nipple pain (RR = 0.24; 95% CI 0.14,0.40; p < 0.00001), nipple trauma (RR = 0.47; 95% CI 0.29,0.75; p = 0.002), the correct position of latching (RR = 1.22; 95% CI 1.11,1.33; p < 0.00001) and position comfort (ES = 0.09; 95% CI -0.63,0.81; p = 0.000) of experimental groups were all better than that of the control groups, and the differences were statistically significant (p < 0.05), which indicate that the laid-back position has a positive effect on maternal breastfeeding.Conclusion Laid-back position has been proved to related with decreasing the incidence of nipple trauma and nipple pain compared with traditional breastfeeding positions, and it appears that laid-back position is conducive to the correct position of latching. However, current evidence does not show different breastfeeding outcomes in the two groups of position comfort. Laid-back position is helpful to solve lactation-related nipple problems and it can be used as a recommended position for breastfeeding.

Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women

“…12 In an RCT of 103 of mothers with babies up to 16 weeks of age with severe latch-on difficulties, a 'baby-led' or skin-to-skin intervention did not make it more likely that the infant would latch-on, 16 despite evidence that the 'baby-led' approach when applied from birth modestly decreases the risk of developing nipple pain. [13][14][15] This article proposes that overtreatment with antifungal medications is one of a number of examples of overmedicalisation of nipple pain, which result from failure of current approaches to fit and hold to effectively resolve repetitive micro-trauma during breastfeeding. 34 Other examples include overtreatment with infant frenotomy for diagnoses of oral connective tissue restrictions.…”

“…12 When women are taught baby-led or laid-back breastfeeding in hospital immediately after the birth (also known as skin-toskin or the physiologic initiation of breastfeeding), the incidence of nipple pain and damage decreases. 13,14 A 2021 Chinese randomized controlled trial (RCT) of 504 pairs demonstrated that implementing baby-led self-attachment from birth results 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. 15 However, baby-led approaches have not been demonstrated effective as therapeutic interventions for breastfeeding problems.…”