A Study to Assess the effectiveness of Structured Teaching Programme on Knowledge regarding prevention of Breast Engorgement among postnatal mothers with Caesearean section admitted in selected government hospital of Dehradun, Uttrakhand

 

Ms. Anubha Prakash

Lecturer, Shri Swami Bhumanand College of Nursing, Ranipur, Haridwar

 

ABSTRACT:

A pre experimental study was carried out to evaluate the effectiveness of structured teaching programme on knowledge regarding prevention of breast engorgement among postnatal mothers with caesarean section. A pre- experimental one group per test posttest design was used to evaluate the effectiveness of structured teaching programme knowledge regarding prevention of breast engorgement among postnatal mothers with caesarean section, Uttrakhand. The sample consists of 50 postnatal mothers with caesarean admitted in District Dun female hospital, who are available at the time of study. Purposive sampling technique was used for the selection of samples. The data collected through self-developed questionnaire. Result shows the major findings indicated that postnatal mother with caesarean section had inadequate knowledge. structured teaching programme was found to be very effective method of provide knowledge regarding prevention of breast engorgement The mean post-test level of knowledge is significantly higher than the mean pre-test knowledge score that is 11.02  in pre-test and  19.48 in post-test with paired “t” =30.34 (df 49) at P= 0.05 significance. There was no association between the knowledge and demographic variables estimated by unpaired t test and annova test. Findings of the study showed that the knowledge scores of postnatal mother were very less before the administration of structured teaching programme. On the basis of findings, it is recommended that a similar study may be replicated using a large number of participants. More intervention studies should be carried out for improving the knowledge regarding prevention of breast engorgement.

 

 

INTRODUCTION:

Human milk is the ideal food for new-borns. Exclusive breast feeding in the first 4 months of life fosters antibiotic formation to environmental pathogens and support immune system development. The process of breast feeding fosters maternal infant interaction and bonding. The close contact between mother and baby during breastfeeding results in enhanced feeling of security and benefits future development.¹

 

There are various problems associated with the breast feeding which have adverse effect on the health of mother and her new born; breast engorgement is one of them.

 

Breast engorgement is due to exaggeration normal venous and lymphatic engorgement of breast which precedes lactation. This is in turn preventing escape of milk from the lacteal system. The primiparous patient and the patient with inelastic breasts are likely to be involved. Engorgement is an indication that the baby is not in step with the stage of lactation³

 

third day after delivery. If feeding is delayed or infrequent or the baby is not well positioned at the breast, the milk accumulates in the alveoli. As milk production increases the amount of milk in the breast exceeds the capacity of the alveoli to store in comfortably. Such a breast become swollen, hard, warm, and painful and is termed as an engorged breast.²

 

Short frequent feeds were shown to increase engorgement in one study (Moon and Humenick, 1989) probably because abbreviated feeds for as short as two minutes did not allow sufficient drainage of the breast to prevent the accumulation. Robson (1990) found that mothers in a non-engorged group were more likely to have never experienced engorgement following previous births than mothers in the engorged group.⁴

 

McLachlan et al. (1993) found that 70% of multiparous mothers experiencing engorgement in a current lactation had also experienced engorgement with previous babies. Some degree of breast engorgement is normal. Minimal or no engorgement in the first week postpartum has been associated with insufficient milk (Neifert et al. 1990, Newton and Newton 1951). Excess infant weight loss was shown to be 7.1 times greater if the mother experienced delayed onset of lactation (Dewey et al. 2003). Rates of delayed engorgement over 72 hours post birth ranges between 22% (Dewey et at. 2003) and 31% of breast feeding mothers.⁵

 

Sever engorgement can make it difficult for baby to latch on to the breast properly and feed well. This can make the problem worse. Without treatment, severe engorgement can lead to blocked milk ducts and breast infection which is called mastitis.

 

Breast engorgement can be prevented by breastfeeding 8-12 times in 24 hours. Unless it is recommended by health care provider, avoid supplements of water or formula for first 3-4 weeks.⁶

 

Robson (1990) found that mothers in a non-engorged group were more likely to have never experienced engorgement following previous births than mothers in the engorged group.⁷

 

The successful promotion of breastfeeding practice requires more than knowledge of the theoretic benefits of breast feeding. In addition, the health care provider needs the practical knowledge and counselling skills required to facilitate first the initiation and then the maintenance of breast feeding.⁸

 

Tara Haelle, 2016, Au contraire, says women, lactation consultants and health care providers. The painful swelling of engorgement can lead to medical problem and reduce milk supply. And it can make it extremely hard to focus on the job.⁹

 

Becky flora, 2016 Breast fullness may develop into engorgement if the baby has not been feeding often or long enough. It may affect the areolar tissue only the body of breast or bolt. The key to preventing engorgement is to nurse frequently and unrestricted after birth i.e. every 2-3 hours with one longer sleep span in a 24 hour period even if waking the baby is necessary to do so.¹⁰

 

Paulo apr. 2012 Breast engorgement affects breastfeeding and leads to early weaning. The objectives of the study were to identify and analyse the evidence found in the literature regarding non- pharmacological treatment to relive breast engorgement symptoms during breastfeeding.¹¹

 

OBJECTIVES:

Objectives of the study is to

·      Develop a tool and structured teaching program on prevention of breast engorgement.

·      Assess the knowledge regarding prevention of breast engorgement among postnatal mother with caesarean section.

·      Administer the structured teaching program on prevention of breast engorgement

·      Determine the effectiveness of planned teaching program on knowledge regarding prevention of breast engorgement.

·      Find out the association between the knowledge score regarding prevention of breast engorgement and their socio demographic variables.

 

RESEARCH HYPOTHESIS:

H1: There will be a significant difference between pre-test and post-test knowledge score regarding prevention of breast engorgement among postnatal mothers with caesarean section.

H2: There will be significant association between the knowledge score regarding prevention of breast engorgement and the selected demographic variables of the postnatal mothers with caesarean section.

 

REVIEW OF LITERATURE:

A literature review is a body of text that aims to review the critical points of current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic. Literature reviews are secondary sources, and as such, do not report any new or original experimental work. Also, a literature review can be interpreted as a review of an abstract accomplishment.

 

Review of literature related to breast feeding problems:

BushraNajem, 2011 study was conducted to identify the breast-feeding problems in primipara mother in early postnatal period. 251 mothers, primiparous in early postnatal period attending Al-Yermouk teaching hospital were selected in the study. The result shows that lacking of antenatal education of primigravida about breast feeding only 8% of mother received breast feeding education reflecting real breast-feeding problems especially in early postnatal period which is critical period in starting and continuation of breast feeding. Among these problems, mother had no experience to put the baby in the right positing (27.5%), refusal of baby to breast fed (21.9%) and believing that she has inadequate milk (19.5%). The lack of health education about breast feeding during antenatal visit was very clear in this study and this represents problem which leads to failure of establishment and continuation of breast feeding, in addition to different problems.¹²

 

Denise Conall, 2011A study was conducted on breast feeding in which breast-feeding related literature was undertaken to provide background for the quantitative study that explores how osteopaths promote effective breastfeeding. This topic was considered relevant to osteopathic practice and it is presented with the aim of informing and stimulating discussion and further inquiry. The theoretical literature and studies that have investigated the biomechanics of breastfeeding provide a rational for osteopathic treatment to facilitate effective breast feeding; however a little supportive research has been undertaken. Further well-designed studies are needed to determine the role that osteopaths might play in supporting a mother baby dyad to successfully breastfeed.¹³

 

Vijayalaksmi, 2008, A study was conducted to investigate the effectiveness of appropriate breastfeeding technique in preventing the nipple soreness to the Primi postnatal mothers of Sir Ivan Stedeford Hospital, Chennai. An intervention (structured demonstration on breast feeding technique) was applied to experimental and control group. Results showed that the knowledge gain and skill gain in experimental group and the nipple soreness are high in control group than in experimental group.¹⁴

 

Jharna Elizabeth Neupane, 2014, The study was conducted with the purpose to investigate types of primigravida knowledge regarding exclusive breastfeeding to explore their attitudes towards and identify the possible challenges they experienced during exclusive breastfeeding period. The research methodology was literature review with content analysis. A primigravida attitude depends up on the level of confidence, intention, and previously breastfed oneself. The result of the study can be used to improve information and care provided to the mother through the midwives. The recommendations include solution in improving exclusive breastfeeding result amongst primigravida.¹⁵

 

Sonya kujawa-myles 2015, A prospective, longitudinal, observational cohort pilot study with repeated measures was conducted to assess the maternal intravenous fluids and postpartum breast changes. Participants were first time mothers who have a single, healthy newborn and had a spontaneous vaginal birth. Descriptive statistics are reported and linear regression analysis was used to model the relationship between IV therapy and postpartum breast edema Twenty-five women were recruited eight participants did not continue to meet the inclusion criteria following birth leaving 17 mothers remaining in the study. The attrition rate of 33% was higher than the expected 25% and mostly due to mother baby separation (n = 5) and participants having a Caesarean section (n = 3). The majority of women (12; 71%) had IV therapy, an epidural, and oxytocin. IV fluids can be discontinued after a vaginal birth once the mothers’ fundus is firm and vaginal bleeding is within normal limits. One participant had only IV therapy, and 4 participants had no interventions during their labour and birth. In total 13 of the 17 (76%) participants had IV fluids in labour and post birth. Result of the study shows that Women who received intravenous fluids during labour had higher levels of breast edema postpartum and rated their breasts as firmer and tenderer than women who did not receive intravenous fluids. Participants who had intravenous fluids described patterns of fullness that appeared to be related to edema as opposed to fullness associated with engorgement and lacto genesis II.¹⁶

 

Sharma Poonam, 2013, A non-experimental, exploratory study was conducted in selected hospital of Ludhiana. The study accessible population was postnatal mothers admitted in the selected hospital of Ludhiana. 100 postnatal mothers were selected by purposive sampling technique. Data was collected from postnatal mothers by questionnaire. Data was analyzed by descriptive and inferential statistics and presented through tables and figures. Findings revealed that majority of postnatal mothers (52%) had average knowledge regarding breast engorgement. Mean percentage of knowledge score was highest in symptoms (64.16%) and lowest in area of factors leading to breast engorgement (42.62%). Education variable was found to be associated with knowledge of postnatal mothers none of the other variables were found significantly related with the knowledge of postnatal mothers.¹⁷

 

RESEARCH METHODOLOGY:

RESEARCH APPROACH:

This study attempts to find the effectiveness of structured teaching programme on knowledge regarding prevention of breast engorgement among postnatal mothers with caesarean sections. The investigator has employed the survey approach (descriptive approach).  The survey approach is a non-experimental approach in which the researcher investigates a community or a group of people. This may be done by asking questions, by interviewing, by observing what people are doing. The investigator employed survey approach in this study to assess the effectiveness of structured teaching programme on knowledge regarding prevention of breast engorgement among postnatal mothers with caesarean sections.

 

RESEARCH DESIGN:

The investigator has employed the non-experimental design sometimes called survey. The design used in descriptive studies where the aim of the research is to generate new facts is largely non experimental. It is especially suited to such studies since description implies natural observation of the characteristics of research subjects without deliberate manipulation of the variables or control over the research setting.

 

The study has analysed the effectiveness of structured teaching programme on knowledge regarding prevention of breast engorgement among postnatal mothers with caesarean sections.

 

INSTRUMENT:

An instrument termed as “self-structured questionnaire on knowledge regarding prevention of breast engorgement” was used to assess the knowledge regarding prevention of breast engorgement and other section consist of socio demographic variables. In this way there were two tools used

1.    Socio demographic variables

2.    Self-structured questionnaire on knowledge regarding prevention of breast engorgement

 

Data collection:

Prior written permission was obtained from the concerened authority. Informed consent obtained from the participants. Data was collected from 50 postnatal mothers with caesarean section, who are available at the time of study. Purposive sampling technique was used for the selection of samples. The data was collected through self- developed questionnaire.

 

Table no.1: Percentage wise distribution of demographic variables.

S. No	Demographic variables			Frequency	Percentage
1	Age
A	18-26			34	68%
B	27-34			16	32%
2	Parity
A	Primipara			18	36%
B	Multipara			30	60%
C	grand multipara			2	4%
3	Religion
A	Hindu			38	76%
B	Muslim			9	18%
C	Sikh			1	2%
D	Christian			2	4%
4	Area of residence
A	Urban			23	46%
B	Rural			27	54%
5	Education of mother
A	No formal education			11	22%
B	Primary education			23	46%
C	Senior secondary			8	16%
D	Graduation and above			8	16%
6	Occupation
A	Home maker			44	88%
B	Government job			2	4%
C	Private job			3	6%
D	Daily wages			1	2%
7	Previous health education on prevention of breast engorgement
A	Yes	5			10%
B	No	45			90%
8	If yes, source of information
A	Health care personnel		1		2%
B	Family members		4		8%
C	Media		0		0
D	Any other		0		0

 

RESULT:

The data was tabulated analysed and interpreted using inferential and descriptive statistics methods.

 

Table 1 shows the major findings indicated that postnatal mothers according to their age majority 68% of the respondents were in the age group of 18-26 years. Higher percentage 58% of the respondents were multipara. Majority of respondent 76% were Hindu. 56% belongs to the rural area. Higher percentage 43% of respondent had primary education. Majority of respondent 88% were home maker and higher percentage of the respondents 91% does not have any previous health education on prevention on breast engorgement. There was no association found between the knowledge score and socio demographic variables of the study

 

 

 

Table no 2 comparison of pre-test and post-test level of knowledge

Pertest		Posttest		Df	‘t’-value
Mean	sd	Mean	sd
11.02	3.58	19.48	2.79	49	30.34*

 

The data presented in the table No.2 shows that the calculated’ value of pre-test and post-test of knowledge regarding prevention of breast engorgement were 30.34.which was higher than the table value at 0.05 level of significance.it reveals that there was a difference in the pre-test and post-test level of knowledge score regarding prevention of breast engorgement among postnatal mothers with caesarean section and the study result is significant.

 

CONCLUSION:

The study concluded that the structured teaching programme on knowledge regarding prevention of breast engorgement was an effective method for providing knowledge regarding prevention of breast engorgement. Findings of the studies showed that knowledge score of postnatal mothers with caesarean section were very less before the administration of the structured teaching programme. This study has a great implication in nursing practice, education, research and administration. The result of the study shows the great need for the health personnel to educate the antenatal and postnatal mothers about prevention of breast engorgement. Use of pre experimental design and small sample size executes limits to generalization of the result. On the basis of findings, it is recommended that a similar study may be replicate during a large number of participants and experimental design. More intervention studies should be carried out for improving the knowledge regarding prevention of breast engorgement.

 

RECOMMENDATION:

This study can be replicated with different population on large sample there by generalizing the study for large population.

The study can be conducted in different parts of the country.

A study can be carried out using other teaching strategies like video teaching programme and computed assisted instruction on prevention of breast engorgement.

A comparative study can be conducted to assess the level of patient’s knowledge regarding breast engorgement and its management with selected treatment measures.

 

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Received on 27.06.2019                Modified on 11.08.2019

Accepted on 19.09.2019       ©AandV Publications All right reserved