Life Science Journal 2013;10(4) http://www.lifesciencesite.com 2010 Prevention of Nipple Cracks with Peppermint Water versus Breast Milk in Lactating Primiparous Women Hala A. Thabet (1) Manal A. Mourad (2), Abdulrahaman M. Alahadal (3), Samira Alsenany (4), Amer Alsaif (5). Faculty of Nursing, El-Mansoura University (1) Medicine College King Abdul Aziz University (2) Faculty of Pharmacy King Abdulaziz university (3) Faculty of Nursing, Public Health Department, king Abdulaziz university (4) Physical Therapy, Physical Therapy Department, Faculty of Applied Medical sciences, King Abdulaziz University(5). ABSTRACT:?Introduction:Sore?n?ppIes?assoc?ated?w?th?breastfeed?ng?are?a?common?probIem,?w?th?an??nc?dence?rang?ng?from?11%?to?96%,?and?may?Iead?to?premature?wean?ng.?(1,?2)?Th?s?frequentIy?occurs?due?to?suct?on?trauma?to?the?n?ppIe?secondary?to??ncorrect?pos?t?on?ng?at?the?breast. (3, 8) Object?ve: To formuIate pepperm?nt water and to evaIuate the ef?cacy of pepperm?nt water versus breast m?Ik appI?cat?on ?n the prevent?on of n?ppIe cracks assoc?ated w?th breastfeed?ng. Sett?ng & Des?gn: Exper?mentaI research des?gn was ut?I?zed ?n th?s study to compare the above formuIat?on w?th expressed breast m?Ik. Th?s study was carr?ed out ?n post-partum wards ?n the Matern?ty and Ch?Id HeaIth Hosp?taI and the Azaz?a Matern?ty Hosp?taI, Jeddah. Mater?aI/Methods: One hundred ?fty pr?m?parous part?c?pants were ass?gned randomIy to three exper?mentaI groups. Group 1, the pepperm?nt water group, was ?nstructed to put soaked gauze w?th pepperm?nt water on and around the n?ppIes and areoIa after wash?ng the n?ppIes w?th water foIIow?ng every breastfeed from day 1 to day 14 and wash?ng before the next feed. The same ?nstruct?on was g?ven to Group 2, the expressed breast m?Ik group, w?th the d??erence that breast m?Ik was used to soak n?ppIes. Group 3 d?d noth?ng but keep the?r n?ppIes cIean and dry. Each woman was foIIowed for up to 3 v?s?ts or teIephone caIIs w?th?n 15 days and then by the teIephone caII at 30 days postpartum. The frequency of the n?ppIe and areoIa crack and the pa?n was evaIuated. ResuIts: In the present study, the appI?cat?on of pepperm?nt water was found to be an e?ect?ve method to prevent n?ppIe cracks. The reIat?ve r?sk of the overaII n?ppIe and areoIa cracks ?n the controI group (48% & 56%) and expressed breast m?Ik group (32% & 32%) was h?gher than ?n the pepperm?nt water group (4% & 2%) at 15 and 30-day postpartum. (p < 0.001). In add?t?on, at 15 and 30 days, ?t was observed that women ?n the pepperm?nt water group were Iess I?keIy to report no cracks (n = 2) than women ?n the expressed breast m?Ik group (n = 6 & 8) and controI group (n = 24 & 28). Women ?n the pepperm?nt water group exper?enced mostIy no pa?n (92% & 96% respect?veIy) compared to those ?n the expressed breast m?Ik group and the controI group (64% & 68%, 44% & 40% respect?veIy) (p < 0.001). ConcIus?ons: Pepperm?nt water ?n breastfeed?ng Iactat?ng women ?s assoc?ated w?th fewer cracks n?ppIe and ?s more e?ect?ve than expressed breast m?Ik. It couId be recommended, aIong w?th teach?ng better breastfeed?ng techn?que at the ?n?t?at?on of breastfeed?ng, for prevent?ng cracks n?ppIe. HaIa A. Thabet, ManaI A. Mourad, AbduIrahaman M. AIahadaI, Sam?ra AIsenany, Amer AIsa?f. Prevent?on of N?ppIe Cracks w?th Pepperm?nt Water versus Breast M?Ik ?n Iactat?ng Pr?m?parous Women. I?fe Sc? J 2013; 10(4):2010-2017. (ISSN:1097-8135). http://www.I?fesc?ences?te.com. 266 Key words: breastfeed?ng ?n?ppIe crack ?pepperm?nt water 1. Introduct?on Sore?n?ppIes?assoc?ated?w?th?breastfeed?ng?are?a?common?probIem,?w?th?a?prevaIence?rang?ng?from?11%?to?96%,?and?may?Iead?to?earIy?wean?ng.?1-2 ?Th?s?commonIy?happens?from?suct?on?trauma?to?the?n?ppIe?secondary?to??nappropr?ate?pos?t?on?ng?at?the?breast.?3-4 The?pos?t?on?ng?of?the?baby's?body??s?essent?aI?for?good?attachment?and?successfuI?breastfeed?ng.?Most?probIems?can?be?prevented?totaIIy??f?good?attachment?and?pos?t?on?ng?are?done?at?the??rst?and?earIy?feeds.?4?An?e?ect?ve?suck?ng?techn?que??s?re?ected?s?gn??cant?to?estabI?sh?breastfeed?ng,?to?ensure?m?Ik?transfer,?and?to?prevent?breastfeed?ng?d?f?cuIt?es.5,?6 It??s?a?dream?for?most?mothers?to?have?comfort??n?breastfeed?ng,?but?sore?n?ppIes?are?st?II?a?common?probIem?and?pa?n?or?cracks?frequentIy?occur?after Breastfeed?ng.7?8?when?the?n?ppIes?hurt,?breast?feed?ng??s??n?troubIe.?It??s?est?mated?that?80?to?90%?of?breastfeed?ng?women?exper?ence?some?n?ppIe?soreness,?w?th?26%?deveIop?ng?to?cracks?and?extreme?n?ppIe?pa?n.?9?10.?Up?to?be?one??th?rd?of?the?women?who?exper?ence?these?symptoms?may?change?to?repIacement?methods?of??nfant?nutr?t?on?w?th?n?the??rst?s?x?postnataI?weeks.?11?12?On?the?other?hand,?very?sore,?cracked,?bI?stered?or?bIeed?ng?n?ppIes?are?abnormaI.?7 SeveraI?techn?ques?of?heaI?ng?sore?and?n?ppIes?cracked?have?been?used,?conta?n?ng?the?use?of?woman?breast?m?Ik,?tea?bags,?Masse's?cream,?A?and?D?o?ntment,?IanoI?n?cream,?and?breast?sheIIs.?A?common?therapeut?c?approach?to?sore?n?ppIes?4,13-14?presentIy?conta?ns?dr?ed-on?human?m?Ik,?mod??ed?IanoI?n?(med?caI?grade),?and?the?wear?ng?of?breast?sheIIs?(hard?pIast?c?dev?ces?that?prov?de?an?a?r?barr?er
Life Science Journal 2013;10(4) http://www.lifesciencesite.com 2011 to?protect?the?sk?n?from?brush?ng?and/or?pressure?from?an?overIy?ng?dress?and?other?contacts).?In?none?of?the?pubI?shed?stud?es,?15-16?however,?has?any?method?been?totaIIy?ef?cac?ous,?and?sore?n?ppIes?stay?a?frustrat?ng?cI?n?caI?d?Iemma.?Th?s?encouraged?us?to??nvest?gate?other?treatment?methods?and?to?test?the?r?safety?and?ef?cacy. Nurses?are?often?the?pr?mary?prov?ders?who??nteract?w?th?the?women?dur?ng?the?antenataI?per?od?and?are?best?pos?t?oned?to?gu?de?women’s?through?the?avo?dance?and?soIv?ng?of?breastfeed?ng?d?f?cuIt?es.?AIthough?many?probIems?may?be?"common",?fa?Iure?to?therapy?cond?t?ons?that?cause?pa?n,?frustrat?on,?and?anx?ety?can?Iead?to?premature?wean?ng?and?the?prevent?on?of?breastfeed?ng?of?subsequent?ch?Idren.?17 W?th?the?resurgence?of??nterest??n?breast?feed?ng,?there??s?an??ncreas?ng?request?for?naturaI?therap?es?for?m?nor?probIems?that?accompany?nurs?ng,?yet?the?ef?c?ency?of?these?therap?es??s??nadequateIy?documented.?Desp?te?a?Iarge?number?of?preparat?ons?found?to?be?e?ect?ve,?there??s?st?II?a?cont?nuous?search?for??nd?ng?extra?preparat?ons?w?th??ncreas?ng?spec??c?ty.?18?It??s?essent?aI?to?do?someth?ng?about?n?ppIe?soreness?before??t?becomes?worse?and?n?ppIes?deveIop?pa?nfuI?cracks.?In?a?prev?ous?study,?we?found?that?s?mpIe?seIf?adm?n?stered?ord?nary?remed?es,?such?as?pepperm?nt?water,?are?e?ect?ve??n?the?avo?dance?of?sore?n?ppIes.?19 Pepperm?nt?(Mentha?p?per?ta),?wh?ch??s?used?as?a?popuIar??avor?ng?for?gum,?toothpaste,?and?tea,?has?a?reIax?ng?and?numb?ng?resuIt?and?has?been?used?to?reIease?sk?n??rr?tat?ons.?20?It?aIso?has?an?ant?sept?c??n?uence?and??ncreases?t?ssue??ex?b?I?ty,?mak?ng?t?ssues?res?stant?to?cracks.?21?The?present?study,?pepperm?nt?water?was?formuIated,?and??ts?e?ects?on?the?prevent?on?of?n?ppIe?cracks?reIated?to?breastfeed?ng?were?compared?w?th?that?breastm?Ik. Subjects and Methods: Research des?gn: An exper?mentaI research des?gn was carr?ed out ?n th?s study to compare the e?ect of two methods to prevent the n?ppIe cracks. Study sett?ng: The study was carr?ed out at the Matern?ty and Ch?Id HeaIth Hosp?taI and the Azaz?a Matern?ty Hosp?taI, Jeddah. Study sampIe: The study sampIe cons?sted of l50 pr?m parous women w?th normaI n?ppIes who were breastfeed?ng after a vag?naI deI?very at 38 or more weeks of gestat?on .who were consecut?veIy chosen from the prev?ousIy ment?oned sett?ng. They were random?zed ?nto two ?ntervent?on groups and one controI group. Group l, the pepperm?nt water group, was ?nstructed to pIace gauze saturated w?th pepperm?nt water on and around the n?ppIes and areoIa after wash?ng the n?ppIes w?th water subsequent each breastfeed from day one to day fourteen. The same ?nstruct?on was g?ven to Group 2 concern?ng us?ng expressed breast m?Ik to soak the n?ppIes. Group three d?d noth?ng but keep the?r n?ppIes cIean and dry. Each part?c?pant was foIIowed for up to three v?s?ts or teIephone caIIs w?th?n fourteen days and then by the teIephone caII at week s?x postpartum. The data were coIIected from Sept. 2009 to Jan. 20l0; the sampIe of th?s study const?tuted onIy women’s w?th heaIthy fuII-term bab?es. Women d?scharged before the ?nterv?ew or who had a preterm b?rth, post-partum h?gh temperature, breast ?nfect?on, and n?ppIe abnormaI?t?es, had tw?ns, took med?c?nes at n?ght, d?d not have a teIephone I?ne or were ?II?terate or Iess than l8 years of age, were excIuded. In add?t?on, ?nfants that were fed ?nfant formuIa or used a pac??er, or who had a mouth ?nfect?on were excIuded from the study sampIe. Data were coIIected concern?ng women’s personaI character?st?cs and to ensure the?r su?tab?I?ty for the research purpose. AII seIected women rece?ved comprehens?ve hosp?taI breastfeed?ng ?nstruct?on before the ?nfant began breastfeed?ng. After tak?ng the women h?story, the researcher carr?ed out a phys?caI exam?nat?on of the ?nfant and the mother’s breasts and evaIuated the breastfeed?ng techn?que for aII women After g?v?ng ?nformed consent, aII women groups were g?ven adequate wr?tten and verbaI ?nstruct?ons on breastfeed?ng. The ?nvoIved groups were requested to do the?r d?str?buted ?ntervent?on w?th pepperm?nt water or expressed breast m?Ik 4 t?mes a day after breastfeed?ng. Outcomes were evaIuated on days one to seven. TooI for data coIIect?on: The present study, the researchers were used three tooIs for data coIIect?on based on rev?ew of reIevant updated I?terature to accompI?sh the a?m of the study. Three tooIs were used for th?s study. I. An ?nterv?ew quest?onna?re sheet was used for women to coIIect data: cons?sts of two parts: Part I. Demograph?c character?st?cs of women: Th?s sect?on was deveIoped to assess the generaI character?st?cs of women such as the age of the mother, IeveI of educat?on, occupat?on and mar?taI status Part II. Concerned w?th the women’s ?nformat?on regard?ng breastfeed?ng .Th?s part was des?gned to assess knowIedge regard?ng frequency and durat?on of breastfeed?ng and n?ppIe cracks w?th?n 24 hours after b?rth. II. FoIIow up Quest?onna?re: Quest?onna?re was used to determ?ne the presence and sever?ty of n?ppIe damage and pa?n Iactat?ng pr?m?parous women. Each mother scored her own pa?n dur?ng breastfeed?ng. Rat?ng scaIes were used to determ?ne the IeveI of pa?n as foIIows: no pa?n, m?Id (d?scomfort?ng), moderate (d?stress?ng), and severe (excruc?at?ng). Data were recorded and foIIow-up of aII mothers dur?ng the study per?od by teIephone or by arrang?ng an appo?ntment for the v?s?t
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Life Science Journal 2013;10(4) http://www.lifesciencesite.com 2012 III. An op?n?onna?re Quest?onna?re: was des?gned to evaIuate mothers’ att?tude toward the appI?ed measures to prevent cracked n?ppIes. Eth?cs approvaI The Med?caI Eth?cs Comm?ttee of the M?n?stry of HeaIth at Jeddah approved the research study; aII part?c?pants were g?ven adequate ?nformat?on, and consent was obta?ned from each woman. Data coIIect?on Demograph?c and antepartum ?nformat?on was abstracted from the med?caI records. An ?nterv?ew was conducted dur?ng the postnataI stay. The foIIow-up teIephone ?nterv?ews were conducted by a tra?ned m?dw?fe at days four, e?ght and fourteen postnataI. AII mothers were asked about the frequency and durat?on of breastfeed?ng at 24 hours, and the data were recorded. A foIIow-up v?s?t was organ?zed for both groups l week after recru?tment (day 8) or at any t?me dur?ng the tr?aI course ?n the c?rcumstance of n?ppIe cracks or pa?n. A teIephone ?nterv?ew was conducted w?th aII women at week s?x. A quest?onna?re was used to determ?ne the presence and sever?ty of n?ppIe damage and pa?n. Each woman scored her own pa?n dur?ng breastfeed?ng. Rat?ng scaIes were used to determ?ne the IeveI of pa?n as foIIows: no pa?n, m?Id (d?scomfort?ng), moderate (d?stress?ng), and severe (excruc?at?ng). l0 The ma?n outcome measures ?ncIude responses to quest?ons about n?ppIe pa?n at week s?x and object?ve outcomes from the phys?caI exam?nat?on at each v?s?t. An op?n?onat?ve was des?gned to assess mothers’ acceptance of measures to prevent n?ppIes cracked. Operat?onaI des?gn:- A p?Iot study was conducted on 5 women from each group to assess the vaI?d?ty and reI?ab?I?ty of tooIs accord?ng to the stat?st?caI anaIys?s of the p?Iot resuIts. The necessary mod??cat?ons were made (?ncIuded ?n the sampIe). Adm?n?strat?ve des?gn:- A Ietter of a proposaI was wr?tten and presented to the Cha?rman of the Obstetr?cs and GynecoIogy Department to obta?n h?s approvaI to conduct th?s study. ResuIts Part (A): Character?st?cs of the study sampIe TabIe (l) Shows that most women ?n aII ?ntervent?ons (us?ng expressed breast m?Ik ; pepperm?nt water ); controI groups were age – matched (20 to 29 years, respect?veIy ) d??erence between groups as a regard educat?onaI status, empIoyment ; mar?taI status were not stat?st?caIIy s?gn??cant (p=0.055,p=0.l3,p=0.55 respect?veIy. Part (B) knowIedge of women concern?ng breastfeed?ng shows that knowIedge of women ?n ?ntervent?on groups (us?ng expressed breast m?Ik ; pepperm?nt water) ; controI group was mostIy sat?sfactory (88%, 90% . and 76%, respect?veIy) . However, the?r knowIedge about breastfeed?ng pos?t?ons mostIy sat?sfactory ?n an expressed breast m?Ik group than other groups (pepperm?nt group ; controI group) were stat?caIIy s?gn??cant (P=0.0l5*) respect?veIy. The d??erence between ?ntervent?on group ; controI group regard the knowIedge about causes of cracked n?ppIe were not stat?st?caIIy s?gn??cant (p=0.l2) AII women (l00%) ?n the group of breast m?Ik had unsat?sfactory knowIedge about opt?ons w?II heIp to resoIve the cracked n?ppIe. D??erence between groups as a regard these ?tems of knowIedge was stat?caIIy s?gn??cant (P=.002 respect?veIy. TabIe (III) Shows that at l5 ; 30-day women ?n the pepperm?nt water group were Iess I?keIy to report no cracked (n = 2) than women ?n the expressed breast m?Ik group (n =6 ; 8) ; controI group ( 24 ; 28 ) regards areoIa crack (p ; 0.00l). Women ?n the controI group were more I?keIy to report severe n?ppIe crack (l8 ;20) than women ?n the expressed breast m?Ik group (8 ; 8) respect?veIy .Wh?Ie the major?ty of women ?n the group of us?ng pepperm?nt water were I?keIy to report no n?ppIe crack (44 ; 46 respect?veIy) ( p ; 0.00l). The controI group had a h?gher odd of exper?enc?ng overaII n?ppIe ; areoIa crack (24; 28) than the expressed breast m?Ik group (l6 ;l6 respect?veIy). D??erences between groups as regard areoIa crack, n?ppIe crack ; OveraII areoIa ; n?ppIe crack were extremeIy s?gn??cant (p=
