INTRODUCTION:

Human milk is the only recommended and complete food for the new-born. It is an unequalled way of providing ideal food for the healthy growth and development of infants.¹ Breastmilk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life.²

Positioning of the baby’s body is very important while feeding. There are different ways to position the baby that make it easier for him or her to latch on properly. Cradle, cross cradle, football and lying down positions are the four breast feeding positions.³ Among the different breastfeeding methods, the cross cradle position is the most common one, in which the baby is held close to the mother: the ear, shoulder, and hip of the baby are aligned, the head and shoulder of the baby are supported, and the infant’s nose faces the breast opposite the nipple.⁴ Football hold was also reported as the second most practice hold technique among the mothers.⁵ Football position is similar to tucking the baby under the arm like a football with the baby’s feet extending across the body. The baby’s head and shoulders are supported with the hand on the same side of the feeding breast.⁶

A high level of breastfeeding self-efficacy can increase a mother's confidence to be able to provide exclusive breastfeeding.⁷ Breast feeding self-efficacy is a mothers confidence in her ability to breastfeed her new infant and has been positively associated with breast feeding duration and exclusivity.⁸ Breast feeding self efficacy components are positioning, attachment, sucking, swallowing and comfort.⁹ Breastfeeding self-efficacy is also associated with the mother’s perception of the adequacy of milk for her baby.¹⁰

BFSE has been highlighted as an important psychometric factor for improving breastfeeding outcomes and it also supports breast feeding initiation and duration. BFSE interventions are important for improving breastfeeding outcomes. Proper positioning and the attachment of the infant to the breast also protect, promote and support breast feeding.¹¹ Breastfeeding self-efficacy is a modifiable factor that practitioners can target to improve breastfeeding rates in mothers of full-term infants.¹²

So the present study focuses on the breastfeeding self-efficacy among postnatal mothers with cradle and football position.

MATERIAL AND METHODS:

A quasi experimental post-test only design was adopted to study the breastfeeding self-efficacy among postnatal mothers with cradle and football position. The study was conducted in a reputed Medical College Hospital of South India after getting approval from institutional ethics committee. 87 postnatal mothers were enrolled on the first postnatal day using convenience sampling. Informed consent was taken and information provided regarding the foodball and cradle positions with the help of breast feeding protocol during the immediate postnatal period with in 24 hrs. The subjects were assisted in feeding their newborns in cradle hold position during morning feeds and to adopt football position during nursing in the afternoon time. This pattern of feeding was continued for three days and breastfeeding self-efficacy was assessed on the third day for both positions using breastfeeding self-efficacy scale. Data obtained were analyzed using SPSS Version 20.

RESULTS:

Section A: Description on Demographic profile

Table 1: Frequency and percentage distribution of subjects based on their demographic variables n =87

Sl. No.

Variable

Frequency(f)

(%)

Age

a) 21-25 yrs

b) 26-30yrs

c) 31-35 yrs

37.9%

47.2%

14.9%

Marital status

a) Married

b) Divorces

98.9%

1.1%

Education

a) HSS

b) UG

c) PG

27.6%

50.6%

21.8%

Occupation

a) Home maker

b) Employed

c) Daily wages

53.1%

30%

16.9%

Family

a) Nuclear

b) Joint

74.7%

25.3%

No of children

a) 1

b) 2

c) >2

67.8%

26.4%

5.7%

Income

a) Less than 20000 Rs/-

b) Greater than 20000 Rs/-

66.7%

33.3%

The table 1 shows that majority of the subjects (47.2%) were in the age group of 26-30yrs followed by the age group 21-25 yrs (37.9%). A small percentage (14.9%) belonged to 31-35 yrs. regarding the marital status a negligible percentage (1.1%) belonged to the category of divorcee. More than Half percentage (50.6%) had UG education and around a quarter of subjects had HSS (27.6%) and PG education (21.8%). Around half of Subjects (53.1%) were home makers and remaining were either employed (30%) or worked on daily wages (16.9%). Near three quarters of subject’s belonged to nuclear family and one quarter belonged to joint family. Majority (67.8%) were primi mothers and 26.4 % had 2 children and a small percentage (5.7%) had more than 2 children. Majority (66.7%) had an income of less than 20000 Rs/month

SECTION B: Description based on objectives

Objective 1: To compare the breast feeding self-efficacy with two different breast feeding positions among postnatal mothers.

Table 1: Comparison of BFSE in Cradle position and Football position n=87

Breast feeding Self efficacy(BFSE)

Median ±IQR

Test statistic

(Wilcoxon signed rank)

BFSE in Cradle Position

56.(1.29-3)

Z=8.094

P<0.001**

BFSE IN Football Position

31(1.35-3)

The table 2 shows that there was a statistically significant difference in the breast feeding self-efficacy score between football and cradle position among postnatal mothers at p value<0.001.

DISCUSSION:

In the present study the median scores of Breast feeding self-efficacy in cradle and football position were 56 and 31 repectively. There was a statistically significant difference in the breast feeding self-efficacy score between football and cradle position among postnatal mothers at p value<0.001.

A study conducted to assess the effectiveness of football hold position breastfeeding techniques and upright position on decreasing regurgitation frequency in newborn revealed that both positions are effective in reducing the Frequency of regurgitation in Newborns .¹³

A study conducted in Nigerian mothers revealed that 72.3% practiced advisable breastfeeding posture. Sitting on a chair to breastfeed was common (62.4%) and comfort of mother/baby (60.8%) and conveniences (29.5%) were the main reasons for adopting breastfeeding positions. Cross-cradle hold (80.4%), football hold technique (13.3%), breast-to-baby (18.0%) and baby-to-breast latch-on (41.3%) were the common breastfeeding techniques¹⁴

Football BF position may pose less risk of BF-related musculoskeletal disorders in nursing mothers, as compared to the cradle and cross-cradle BF positions.¹⁵ In a prospective study of 13 preterm twins, most mothers preferred simultaneous breast-feeding, using the football hold.¹⁶

A systematic review to identify and summarize the available evidence on the effect of side-lying position on oral feeding outcomes in preterm infants compared four studies on the effect of the side-lying position with either the semi-upright, cradle-hold, or semi-reclined positions on various feeding outcomes. The findings were conflicting because 2 studies found the side-lying position to be beneficial for supporting physiologic stability during feeding compared with the semi-upright position whereas 2 studies did not find significant differences in any of their outcomes between the side-lying position and other feeding positions.¹⁷

Very few studies are available on breastfeeding self-efficacy. Most of the studies support cradle position and in special circumstances football too. The present study also identified more breast feeding self-efficacy on cradle position.

CONCLUSION:

Human milk is the best available source of nutrition for new-borns. Since the study found that BFSE is different in both cradle and football position, it is the responsibility of midwives to counsel mothers to establish breastfeeding in the effective position. Cradle position is found to be effective one in the present study as well as most of the available studies except in special situations such as twin delivery and Caesarean section.

ACKNOWLEDGEMENT:

Here we extend our sincere thanks to all the postnatal mothers who participated in the study.

CONFLICT OF INTEREST:

The authors declare no conflict of interest in the study

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Received on 10.07.2021 Modified on 29.07.2021

Int. J. of Advances in Nur. Management. 2021; 9(4):400-402.

DOI: 10.52711/2454-2652.2021.00092