Effectiveness of Green Cabbage Leaves (GCL) and Hot Water Bag (HWB) Application on Breast Engorgement in Postnatal Mothers

Ms. Rekha Kumari

Assistant Professor HOD (Obstetrics and Gynecology Nursing),

School of Nursing, Sharda University. Plot No.32 Knowledge Park III, Greater Noida, U.P 201306

*Corresponding Author E-mail: rekhadobal@gmail.com

ABSTRACT:

PURPOSE OF THE STUDY: The purpose of the study was to determine the effectiveness of GCL and HWB application in reduction of breast engorgement and pain among the postnatal mother. METHODOLOGY: Quasi Experimental approach with Time Series Design was used as research design for the study. Sixty three postnatal mothers (32 in experimental group and 31 in control group) who fulfilled inclusion criteria were selected as sample consecutively and they were assigned randomly to experimental group and control group respectively. The data were collected by using Six point Engorgement scale and Numeric Pain scale. Intervention was given in the form of Green cabbage leave application in experimental group whereas, Hot water bag application in control group for 20 minutes in six interval of time. The obtained data were analyzed in terms of objectives and hypothesis using descriptive and inferential statistics. RESULTS: Majority of Postnatal mothers (94%) in Green Cabbage Leaves group and (97%) in Hot Water Bag group were initiated breast feeding after 24 hour of delivery. Majority of the mothers (94 %) had undergone LSCS in Green Cabbage Leaves and (97%) in the Hot Water Bag group. The homogeneity was checked in both the group by using chi square test, fisher’s exact test and ‘t’ test. It was found that except the educational status, the group were homogeneous in term of Age (p= 0.06), Parity ( p=0.36), Type of Delivery (p= 0.51), Initiation of Breast Feeding ( p=0.68), Frequency of Feeding (p=0.92), Duration of Breast Feeding (p=0.50), and Postnatal Day of engorgement (p= 0.62). The Analysis of effectiveness of Green Cabbage Leaves Vs Hot Water Bag for reducing breast engorgement and pain was checked by repeated measure ANOVA. It was showed that from baseline to 20 minutes, mean engorgement and pain score in both the groups were same and then after six hours to 36 hours the mean and SD was decreased in both groups. On Comparison of Engorgement score within subject effect and between subject effect the F value was (9.746) which is more than table value (4.0) at 0.05% level of significance which indicates that the reduction in engorgement was not by chance but because of the intervention. On Comparison of Pain score within subject effect and between subject effects as the calculated ‘F’ value was (0.058) which is less than table value (4.0) at 0.05% level of significance. Hence it predicts that there was no significance difference between pre and post interventional pain assessment in Green Cabbage Leaves and Hot Water Bag group. CONCLUSION: On the basis of findings the investigator concluded that Green Cabbage Leaves are more effective than Hot Water Bag in reducing breast engorgement whereas in Pain, there was reduction in both the groups gradually. Green Cabbage Leaves as well as Hot Water Bag application can be used in reducing pain due to breast engorgement. The Green cabbage leaves can be offered to every mother who have engorged breast as treatment until and unless they have allergy to cabbage leaves.

KEY WORDS: Breast engorgement, Pain, Postnatal mothers, Green Cabbage Leaves (GCL), Hot water bag (HWB).

INTRODUCTION:

Childbirth is a life changing event which is wonderful and gives joyful experience but it can also be difficult period bringing with it, new problems for suffering. In the most extreme case the mother, or the baby or both may have health problem either major or minor laid down in the postnatal period. The sufferings related to childbirth is a significant portion of the world’s overall tally of ill and death.¹The Best gift that a mother can give to her newborn child is breast milk. Perfectly formulated for the baby and full of wonderful antibodies, it is far superior to any other formula feeding. This has great benefits for the baby not only it is healthier but the action of feeding the child is a moment of love in which the baby learns to bond, smell, and cares with mother as she gives nourishment and affection.² A newborn baby has only three demands: they are warmth in the hands of its mother, food from her breasts, and security in the knowledge of her presence. Breast feeding satisfies all three demands.³Though breastfeeding is a natural way to bond with and nourish babies; it often doesn’t come without challenges. Mothers who are interested in breastfeeding or who are having trouble with establishing a solid breastfeeding relationship with their newborns often wonder where to turn for help and even contemplate giving up on nursing their babies out of frustration or fear⁴. In July 2010, WHO had reported that every infant and child has the right to good nutrition according to the Convention on the Rights of the Child. Globally, 30% (or 186 million) of under five children are estimated to be stunted and 18% (or 115 million) have low weight-for-height, mostly as a consequence of poor feeding and repeated infections, while 43 million are overweight. WHO and UNICEF recommended However many infants and children do not receive optimal feeding; for example, on average only around 35% infants of 0 to 6 months old are exclusively breastfed. Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. The risk of mortality due to diarrhoea and other infections can increase in infants who are either partially breastfed or not breastfed at all.⁵ Warm compress is a very safe and provide pain relief and easy express the milk without medication and don’t have to be concerned about side-effects. Heat therapy is the application of either moist or dry heat to the skin. Heat can be either superficial or deep.

Superficial heat can be applied using a warm shower, hot packs, hot moist suppress or warm wax (paraffin) or hot water bottle. ⁶A study was conducted in New Delhi to compare the effect of cabbage leaves and hot and cold compress in the treatment of breast engorgement. A sample of 60 mothers participated in the study, 30 in the experimental group and 30 in the control group. The control group received alternate hot and cold compress and the experimental group received cold cabbage leaves application. The pre and post-treatment scores of breast engorgement and pain were recorded. The study result revealed that, both treatments were effective in decreasing breast engorgement whereas, hot and cold compresses were found to be more effective than cold cabbage leaves ⁷

METHODOLOGY:

The study was conducted in a Postnatal ward of obstetric and gynaecological department. 63 mothers who were having breast engorgement as sample which were selected through consecutive sampling technique by assessing Six point Engorgement scale, Numeric Pain scale. Investigator taken 63postnatal mothers, thirty two in experimental group and thirty one in control group were selected as the subject of the study. The data was collected from 28^th Jan to 10^th March 2012 at selected Hospital. In the first phase, subjects who fulfilled inclusion criteria were selected consecutively and randomly assigned to either Experimental or Control group. Informed written consent was obtained from participants of the study after explaining the purpose of the study. Mother in experimental group was assed with Engorgement scale, Numeric Pain scale. The mother who were in experimental group the room temperature Green cabbage leaves was applied for 15 mints in six time for the six hour gap interval for two days duration . After each intervention of room temperature Green cabbage leave post assessment was done with Engorgement scale, Numeric Pain scale after each intervention Mother in control group were also assed with Engorgement scale, Numeric Pain scale . The mother who were in Control group the hot water bag was applied for 15 mints in six time for the six hour gap interval for two days duration .After each intervention hot water bag of post assessment was done with Engorgement scale, Numeric Pain scale after each intervention.

Data Analysis:

Figure 1 Method of warm foot bath

Sociodemographic characteristics were described using frequency and percentage. Trial version of Statistical Package for social science 16.0 was used to analyze the data. Inferential statistics involved comparison of both group by independent t test , ANOVA, Chi–square test and Spearman co-relation test.

RESULTS:

Sociodemographic characteristic of study participants are described in Table 1. There was no significant difference between control group and experimental group in terms of sociodemographic characteristics.

Table 1. Sociodemographic characteristics of study participants (N=63)

Characteristic

Experimental

Group

Control Group

Total

Chi Square and ‘t’ Value

p value

Age in years

· 20-30

· 31-40

1.98

0.056

Parity

· Primipara

· Multi para

· Grandmultipara

2.027

0.363

Type of delivery

· NVD

· LSCS

2.027

0.363

Educational status

· No formal education

· Primary

· Secondary

· Above secondary

11.31

0.003

Initiation of breast feeding

· Within half an hour

· After 24 hour

0.001

0.974

Duration of breast feeding

· 15-20minutes on both breast

· 15-20minutes on one breast

· less than 15 minutes

1.384

0.50

Frequency of breast feeding

· On demand

· Every two hourly

· Specific time(within 1 hr)

0.162

0.92

Postnatal day of engorgement

· 2- 4 days

· 5-7days

0.002

0.96

Analysis of effectiveness of GCL Vs HWB in relieving breast engorgement and Pain in Experimental and Control group.

Table No.2: Analysis of effectiveness of GCL Vs HWB in relieving breast engorgement in Experimental and Control group. N=63

GROUPS

Engorgement score

(Mean ± SD)

p value

(within the group)

Baseline

After 20 min

After 6hrs

After 12hrs

After 24hrs

After 30hrs

After 36hrs

Experimental Group

(GCL)

5.59

0.49

5.59

0.49

5.31

0.64

4.44

0.56

3.78

0.65

3.13

0.33

3.03

0.18

0.000

Control

Group

(HWB)

5.65

0.48

5.65

0.48

5.64

0.48

5.06

0.62

4.64

0.48

4.51

0.50

4.19

0.54

0.000

Table 3 shows the baseline and after 20 minutes mean pain score in both the groups were same i.e 6.218±1.03 in GCL group and 6.19±0.90 in HWB group. After 6 hrs, the mean and SD was 5.37±1.00 in GCL Group and in HWB group 5.38±0.80. After 12hrs hrs, 24hrs 30hrs, 36hrs the mean and SD was decreasing in both the GCL Group and in HWB group. Hence the researcher accepted alternative hypothesis which indicates that the reduction in engorgement was not by chance but because of the intervention.

Figure No.2 shows line diagram showed that the mean initial pain score for both the groups from baseline to after 20 minutes were same. Then there was steadily decline in both the groups throughout six intervals of time. The result showed that there was equal reduction in pain score in the GCL group and the HWB group.

DISCUSSION:

Beast engorgement after delivery is the common breast problem in this era due to maternal and child ill health. The implication of Green cabbage leaves helps in quick relieve of engorgement without any side effect to mother and newborn.

CONCLUSION:

This study showed that GCL are more effective than HWB in relieving breast engorgement among the postnatal mothers. GCL as well as HWB application both can be used in relieving pain due to breast engorgement. The Green cabbage leaves can be offered to every mother who have engorged breast as treatment until and unless they have allergy to cabbage leaves

REFERENCES

1. The world health report .Risking Death to Give Life.[article]2005, [cited on 2012 Oct19]2. Available from: http://www.who.int/whr/2005/chapter4/en/index1.html

2. Greene C. Breastfeeding Health Canter. [Article] 2013,[cited on 2012 Oct30].Available from: http://www.drgreene.com/breastfeeding-health-center/.

3. UK Essays .The Goals of Treatment For Breast Engorgement Health Essay.[article] , [cited on 2012 Oct25]Available from: http://www.ukessays.com/essays/health/the-goals-of-treatment-for-breast-engorgement-health-essay.php .

4. Cygnus J. Best Chicago Lactation Consultants.CBS Chicago.2010 October 5, [cited on 2012 Dec 19]: [4]. Available from: http://chicago.cbslocal.com/top-lists/best-chicago-lactation-consultants/

5. World health organization report .Infant and young child feeding. 2010 July [cited on 2013April] .Available from, 342 URL: http://www.who.int/mediacentre/factsheets/fs342/en/.

6. Martin C. Engorged Breast. Advanced paediatric associates. [699-6200].2000[cited on 2012nov14].Availablefrom:URLhttp://www.advancedpediatricassociates.com/newbornandbabycare/pw11_engorged breasts. asp.

7. Smriti A, Manju V, Vatsla D. A comparison of cabbage leaves vs hot and cold compresses in the treatment of breast engorgement .IJCM. [1998-3581]. 2008 may 15 [cited on 2012mar]. 33 ( 3) :[160-162]. Available from:URL:http://www.ncbi.nlm.nih. gov/pmc/articles/PMC 2763679/.

Received on 03.09.2016 Modified on 21.12.2016

Int. J. Adv. Nur. Management. 2017; 5(1): 28-32.

DOI: 10.5958/2454-2652.2017.00007.5

GROUPS	Pain score (Mean ± SD)							p value (within the group)
GROUPS	Baseline	After 20min	After 6hrs	After 12hrs	After 24hrs	After 30hrs	After 36hrs	p value (within the group)
Experimental Group (GCL)	6.218±1.03	6.218±1.03	5.37±1.00	4.53±0.94	3.75±0.74	2.78±0.65	2.25 ±0.43	0.000
Control Group (HWB)	6.19±0.90	6.19±0.90	5.38±0.80	4.61±0.71	3.87±0.71	3.06±0.62	2.41±0.50	0.000