Effectiveness of Breast Feeding Techniques

Review of literature provides a strong foundation of research project. According to Basvanthappa review of literature refers to an extensive, exhaustive and systemic examination of publications relevant to the research project. A familiarization with the previous studies can be useful in suggesting a research topic, identifying various aspects of the problem and aids in selection of appropriate methodology.

The literature relevant to this study was reviewed and arranged under the headings:

• Literature about knowledge of breast feeding technique.
• Literature about new born care

LITERATURE ABOUT BREAST FEEDING TECHNIQUE

Vijayalaksmi [2008] conducted a study and investigated the effectiveness of appropriate breastfeeding technique in prevention of nipple sore to the primi-postnatal mothers of Sir Ivan Stedeford Hospital, Chennai. An intervention (structured demonstration of Breastfeeding technique) was applied to experimental group and control group. Results showed the knowledge gain and skill gain in experimental group and that the nipple sore is high in control group than in experimental group.

K Madhu [2003] conducted a descriptive cross-sectional study on Breast feeding practices and newborn care in rural areas. The primary objective of this study was to describe the breastfeeding and newborn care practices in rural areas and the secondary objective was to describe the factors affecting the initiation and duration of breastfeeding. The study was conducted in primary health care center (PHC) that is attached to a medical college in Kengeri, rural Bangalore, and Karnataka. Mothers with children who were 9 months old who came to the PHC for measles vaccination were included in the study and data were collected using the pre-tested questionnaire on breastfeeding and newborn practices. Our study shows 97% of the mothers initiated breastfeeding, 19% used pre lacteal feeds, 90% had hospital deliveries and 10% had home deliveries, and 50% used a house knife to cut the umbilical cord among home deliveries. This study emphasizes the need for breastfeeding intervention programs especially for the mother during antenatal and postnatal check-ups and practices like discarding the colostrums and early/late weaning are still widely prevalent and need to be addressed.

Ailli [2002] emphasized the national health objectives increasing the rate of initiation and duration of breast feeding in United States. In the hospital breast feeding initiation rate was 64% and duration rate was 29%. This percentage falls short of healthy people of the 2010 goal of breast feeding which states that we should increase the proportion of mothers who initiate breast feeding to at least 50% to increase the initiations and prolong the duration should be given importance.

J Pediatr, [2001] The study was investigated the influence of breast feeding technique on the frequency of exclusive breast feeding and nipple trauma in the first month of lactation. We searched for unfavourable parameters of breast feeding (five related to mother/baby positioning and three related to baby's latch on) in 211 mother-baby pairs in the maternity ward and at day 30, at home. We 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. The number 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. New studies may help to elucidate whether an improvement in breastfeeding practices over time helps the maintenance of exclusive breastfeeding or whether the introduction of bottle-feeding determines a negative effect on breastfeeding.

Kronborg H, [2000] conducted a study on effective breastfeeding technique and pacifier use according to breastfeeding problems and breastfeeding duration. Data were collected from mother by health visitors with the help of randomized trial. Positioning, latch, sucking, and milk transfer were included in effective technique. The sample of the study was 570 mother-baby pairs. In the first observation one half of the mother showed ineffective breast feeding technique., most frequently latch (52%) ineffective position (61%). Sucking and milk transfer were associated with breastfeeding duration. This study conclude that in the ineffective technique was significantly related to the breastfeeding problem. Pacifier use had an independent negative impact on duration of breastfeeding.

Ingram J [1996], conducted a study on teaching the effectiveness of breast feeding technique to determine whether a specific 'hands-off' breastfeeding technique, based on the physiology of suckling and clinical experience, if taught to mothers in the immediate postnatal period, improves their chances of breastfeeding successfully and reduces the incidence of problems. To investigate the factors associated with breastfeeding at two and six weeks prospective cohort phased intervention postpartum using logistic regression analysis. A non-randomised study. Subjects recruited from one postnatal ward in St. Michael's Hospital, Bristol from October 1996 to November 1998.1400 South Bristol mothers who were breastfeeding on discharge from hospital. Three hundred and ninety-five of these mothers were scored for efficiency of using the breastfeeding technique. a 'hands-off' breastfeeding technique was taught to midwives in hospital who subsequently taught mothers in their care. Frequencies of exclusive and 'any breastfeeding' at two and six weeks from questionnaires sent to mothers at home, and incidence of breastfeeding problems. Significant increases were observed in the proportion of mothers exclusively breastfeeding at two weeks (P < 0.001) and six weeks (P=0.02) in 'any breastfeeding' rates (P=0.005) at two weeks after the technique intervention. The incidence of mothers feeling that they did 'not have enough milk' (perceived milk insufficiency) decreased significantly after the breastfeeding technique had been taught (P=0.02).

Righard and Alade [1992] investigated the prognostic value of shaking technique, faulty relationship corrected during the first week after birth in relation to the long term success of breast feeding. In this study, correct technique was described as the infant having a wide opening mouth, with the tongue under the areola and expressing milk from the breast by deep slow sucks. Faulty technique was defined as superficial nipple sucking. The population of 82 healthy mother infant pairs was divided into 3 groups. One in which faulty sucking technique was corrected when observed, one with faulty but incorrect technique one month follow up assessment , the faulty but incorrect group was characterized by great proportions of mothers with breast feeding problem and early cessation of breast feeding than the other group.

Abakaliki [1990] conducted a study on breast feeding and mother child relationship, and the aim of the study is was to determining the relationships that exist between a mother and child and different breastfeeding habits. The primary method of data collected by comprehensive questionnaire, which was given to women at the post-natal unit of the Gynecology Department of Ebony State University Hospital in Nigeria. A simple random sampling procedure of data collection was adopted in selecting the sample of 190 women. A chi-square method of analysis was used. A 5% level of significance was considered. , the findings of this study suggested that mothers should be equally recommended to alternate between feeding their children both semi-solid food and exclusive breast milk, because a significant relationship exists between a mother's decision to feed breast milk and semi-solid food as well as breastfeeding exclusively.

LITERATURE ON NEW BORN CARE

In India pediatric health problems are similar to those of other developing countries. Care of the newborn must be the first concern as children ferm the basis of the development of social and economic welfare of the future generation.

Ravendra K. Sharma, [2010] presents a review of micro level studies conducted in undivided Madhya Pradesh state and wherever needed these results are supported or compared with the national and state level statistics. The study demonstrates that utilisation of maternal and child health services are very poor among the tribes of central India. Clinically acceptable maternal and newborn care practices for delivery, cord cutting and care, bathing of mother and newborn and skin massage are uncommon. Therefore, newborns remain at high risk of hypothermia, sepsis and other infections. Prelacteals, supplementary feeding practices and delay in breastfeeding are very common, although colostrum is less frequently discarded. Malnutrition is a severe problem among tribes and many tribal children and women are severely malnourished as well as anaemic.

Binu Margrate [2009] had undertaken a research project in Udupi to find out the effectiveness of an awareness programme in new born care. 30 samples was collected from postnatal ward. In this study 46.7 % of mothers had average knowledge in new born care whereas in the posttest 100% of the mothers had good knowledge , this study conclude the awareness programme with appropriate AV aids is an effective strategy in imparting knowledge to postnatal women on new born care whereas in the posttest 100% of the mothers had good knowledge , this study conclude the awareness programme with appropriate AV aids is an effective strategy in imparting knowledge to postnatal women on new born care.

Santhi [2009] has done a study on effectiveness of compact disc on knowledge and practice of neonatal care among primipara mothers.50 samples were taken up for this study, the mean post test knowledge score of mother was found to be significantly higher than their mean pre test knowledge score 9. 98 as evident from value 49 =37.3 p <0.05 level. This suggested the effectiveness of CD (compact disc) in increasing the knowledge of mother on neonatal care.

Allisyn Moran [2009]. A study was conducted by Allisyn Moran about new born care practices among urban slums in Dhaka . A quantitative baseline survey was conducted in six urban slum areas to measure newborn care practices among recently delivered women (n=1,256).Thirty-six in-depth semi-structured interviews were conducted to explore newborn care practices among currently pregnant women (n=18) and women who had at least one delivery (n=18). In the baseline survey, the majority of women gave birth at home (84%).Most women reported having knowledge about drying the baby (64%), wrapping the baby after birth (59%), and cord care (46%). In the in-depth interviews, almost all women reported using sterilized instruments to cut the cord.

Sonia Puri, [2008] conducted a comparative study was conducted about the home based newborn care practices among slum and urban area of Chandigarh and to compare the practices in both setups. There are 226 Women, who had children below 3 months at the time of data collection .The result shows (38.4%) Women gave birth at home only. (45.1%) deliveries were conducted by skilled birth attendant as compared to (7.1%) by traditional birth attendants. (61.9%) of newborn infants had been bathed within the 0-12 hours. Number of infants who were given colostrums were (80.9%) and (26.9%) were put on breast feed within 1-2 hours of birth.

Chandrasekar, [2006] conducted a study on home delivery and new born care practices among urban women in Nepal A total of 240 mothers were interviewed. Only 6.2% of deliveries conducted by skilled birth attendant. and 38 (15.8%) mothers gave birth alone. The umbilical cord was cut after expulsion of placenta in 154 (64.2%) deliveries and cord was cut using a new/boiled blade in 217 (90.4%) deliveries. Mustard oil was applied to the umbilical cord in 53 (22.1%) deliveries. Birth place was heated throughout the delivery in 88 (64.2%) deliveries. Only 100 (45.8%) newborns were wrapped within 10 minutes and 233 (97.1%) were wrapped within 30 minutes. Majority (93.8%) of the newborns were given a bath soon after birth. Mustard oil massage of the newborns was a common practice (144, 60%). Sixteen (10.8%) mothers did not feed colostrum to their babies. Prelacteal feeds were given to 37(15.2%) newborns. Initiation rates of breast-feeding were 57.9% within one hour and 85.4% within 24 hours.

Liji [2002] conducted a study to assess the effectiveness of structure teaching programme on knowledge of primi mothers regarding the care of neonates. In this study the pre test knowledge score revealed that 70% of primi mothers had average knowledge. The post test knowledge score revealed that most of them (90%) had above average knowledge. The present study revealed that STP was effective in improve the knowledge of mothers regarding the care of neonates.

David Osrin, [2002] conducted a cross sectional, community based study of care of newborn infants in Nepal. The Participants were 5411 married women aged 15 to 49 years who had given birth to a live baby in the past year. The result showed that 4893 (90%) women gave birth at home. Attendance at delivery by skilled government health workers was low (334, 6%), as was attendance by traditional birth attendants (267, 5%). Only 461 (8%) women had used a clean home delivery kit, and about half of attendants had washed their hands. Only 3482 (64%) newborn infants had been wrapped within half an hour of birth, and 4992 (92%) had been bathed within the first hour. 99% (5362) of babies were breast fed, 91% (4939) within six hours of birth

Upul Senarath [2001] conducted a study on the effect of hospital based intervention on newborn care. The purpose of the present study was improving newborn care practices after hospital discharge through essential newborn care training programme for maternity staff. The samples were selected from hospitals in the puttalum district in sri lanka. The intervention was a 4 day training programme was given to improve the knowledge and skill of essential new born care. Before the intervention, 144 sample pairs were observed and interviewed. Within 28 – 35 days of delivery and with intervention 150 sample pairs were observed at home. Results showed that there was a significant improvement in umbilical cord practices and application of surgical spirit on umbilical cord has reduced 71.5% before intervention to 45.3% in the after intervention. This study shows that 35% declined undesirable health events to the new born.

Waldemar [1994] A and first breath study of group conducted a study on new born care training and perinatal mortality by giving local instruction to birth attendants in six countries [Argentina, Demographic Republic of Congo, Gutaemala, India , Pakistan and Zambia] by the World Health Organization. The essential new born care intervention was assessed among 57, 643 with the use of before and after design. The result was 99.2% after 7 days follow up. No significance reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth or in the rate of perinetal death. There was significant reduction in the rate of still birth