Effect of Lactation Management Model on Breastfeeding Process
Condition: Lactation; Breastfeeding; Cesarean Section
Study type: Interventional

Summary: 
      Background: While caesarean sections are increasing, breast-feeding rates are decreasing. It
      is important to implement supportive programs to ensure mothers breast feed for the desired
      period and infants are fed by only mother's milk.

      Aim: In the research, it was aimed to evaluate the effects of lactation management models on
      mothers' breastfeeding process following a caesarean section.

      Methods: The research was conducted as a randomized controlled study and experimentally.
      Before implementation, Lactation Management Model was developed. Data collection was
      performed during gestation, first day after postpartum, pre-discharge, on 9th day in face to
      face interview and in the form of monthly phone interviews up to 6 months. While the
      experimental group exercised lactation management model, control group received routine
      lactation practices in clinic.

      Conclusions: Among the females in the experimental group, it was found that breastfeeding
      self-efficacy were higher, and breastfeeding techniques were accurate and successful and
      breastfeeding only and continuity rates were higher while breastfeeding related breast
      problems developed less frequently. Lactation management model should be used and expanded to
      increase breastfeeding rates.

      Keywords: Cesarean section, breastfeeding, mother milk, lactation management model,
      breastfeeding training
    

Detailed description: 
      It is a birth right of babies to be breast fed and nursed. However, approximately 7.6 million
      babies cannot be fed with breast milk in the world every year. United Nations International
      Children's Emergency Fund (UNICEF) declared in its statement that, breast milk access is
      decreased as household income increases and in nations with high income 1 out of every 5
      babies and for low or middle income nations 1 of every 25 babies never fed breast milk
      (UNICEF, 2018). Worldwide, among the infants under six months old, 40% is fed with breast
      milk only (UNICEF, 2017). According to Turkey Demographic and Health Survey data, it is found
      that in Turkey; breast milk feeding rate of infants under 6 months is 41% and in average
      breast milk feeding period is 1.8 months (TNSA, 2018).

      There are many factors affecting whether an infant is breastfed. Delivery method is among one
      of them. While in OECD nations and in UNITED STATES OF AMERICA 32% of every delivery was
      caesarean (Health İndicators, 2018; ACOG, 2019), in Turkey this rate is indicated as 52%
      (TNSA, 2018). Caesarean delivery compared to vaginal delivery is negatively affecting the
      initial lactation period, milk production and suckling instinct of the infant (Hobbs et al.,
      2016). Esencan et al. has determined that 42.4% of women who had spinal-caesarean deliveries
      did not breast feed (Esencan et al., 2018).

      Numerous factors are in effect for suckling and milk production. Various studies are
      performed in the literature it is emphasized that in order to stimulate and increase the milk
      production; apart from evidence based applications, breast stimulation and other techniques
      to cure nursing problems should be employed (Anderson et al., 2016). Becker et al. In their
      systematical compositions; determined that actions such as; resting, music, applying warmth
      to breast area, massaging, pump aided stimulations increased milk production clinically in a
      significant manner (Becker et al., 2016). Although applying warmth to breast area, massaging
      and relaxations techniques for increasing milk production and ensuring long term breast
      feeding are evidently lacking in the international manuals; early nursing, skin-to-skin
      contact together with education and support is stated to be positively affecting breast
      feeding (WHO, 2017; NICE, 2015). Despite all these actions taken national and international
      breast feeding data still is not at a favorable level. Because initiation of lactation
      contuniuty and increase in the period of breastfeeding depends on many factors. Education of
      mother starting from gestational period; care, support and consultancy services should be
      provided during pregnancy, birth and postpartum periods. This study has been planned in
      consideriation with the need for a model that includes all this service, maintenance and
      support, no similar study has been found in the literature that has all these components
      together.
    

Intervention name(s): Experiment
Intervention type(s): Other
Intervention description(s): The main components of the Lactation Management Model; breastfeeding training in the prenatal period (from the 30th week of pregnancy), early postpartum period (first 48 hours) skin to skin contact, early breastfeeding, relaxation using a dreaming technique, warm application to the breast, breast massage and for the first 48 hours after postpartum 6 months of continuous support (face to face, by phone, via social media).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Cesarean section; Breastfeeding; Mother milk; Lactation management model; Breastfeeding training