INTRODUCTION:
According to World Health
Organization, which reviewed 110,000 births from nine countries in Asia during
2007-2008, 27% births were delivered by C-section. A similar survey conducted
in Latin America found that 35% of pregnant women were delivered by C-section.
The
importance for initiation of breast feeding is, 1). Saves lives- Early
initiation ensures that a newborn receives colostrum,
the “first milk.”
Colostrum is
often considered the baby’s first immunization because of its high levels of
vitamin A, antibodies, and other protective factors; Helps establish breastfeeding, 2). Early
suckling is associated with successful establishment, 3). Maintenance
of breastfeeding throughout infancy, 4).Fosters
bonding between mother and child 5). Takes advantage of the newborn’s intense suckling reflex and 6). Alert
state and reduces risk of mother’s postpartum hemorrhage
In Nepal and Ghana suggest
that initiation of breastfeeding within the first hour could prevent 19-22
percent of neonatal deaths.
The prevalence of timely initiation of breast-feeding,
bottle-feeding in children aged 0-23 months,
exclusive breast-feeding and predominant breast-feeding in infants aged 0-5 months were 27·3 %,
32·1 %, 37·1 % and 18·7 %, respectively. Multivariate analysis indicated that
working mothers (OR = 1·48, 95 % CI 1·16, 1·87; P = 0·001) and mothers who
delivered by Caesarean section (OR = 1·95, 95 % CI 1·30, 2·90; P = 0·001) had
significantly higher odds for no timely initiation
of breast-feeding. Mothers from North West
Frontier Province were significantly less likely (OR = 0·37, 95 % CI 0·23,
0·59; P < 0·001) not to breast-feed their
babies exclusively. Mothers delivered by traditional birth attendants had
significantly higher odds to predominantly breast-feed
their babies (OR = 1·96, 95 % CI 1·18, 3·24; P = 0·009). The odds of being
bottle-fed was significantly higher in infants whose mothers had four or more
antenatal clinic visits (OR = 1·93, 95 % CI 1·46, 2·55; P < 0·001) and
belonged to the richest wealth quintile (OR = 2·41, 95 % CI 1·62, 3·58; P <
0·001).
Maternal pain, fear and stress, fatigue,
and prolonged recovery Mothers having
cesarean section more experience complication, pain, prolonged recovery,
readmitted to a hospital, fatigue, discomfort, stress and anxiety, and etc. then
the mothers with vaginal birth (Lauwers& Swisher,
2011,
However, the pain medication that is
received during and after surgery is passed in to mother’s milk. And, some post
surgery pain relief drugs suppress breastfeeding,
improve the amount of breastfeeding, and infant weight gain. Also, stress or
fatigue can also lead to a decreased milk supply. Mothers who delivered by
cesarean section often find it difficult to achieve a comfortable position for
breastfeeding (Francis, 2007; Smith, 2010).
Even though a mother experiences pain and
discomfort after a cesarean section, breastfeeding should be started as soon as
possible and should be help the mother put the baby to breast (Janke, 2008).
Mothers' breastfeeding
knowledge, attitudes and practices were evaluated using a structured
questionnaire. Twenty-five percent of women sampled initiated breastfeeding
within the first hour post-delivery. In total, 82% of women initiated
breastfeeding within the first 24 hours post-delivery, and 53% of women breastfed
exclusively for exactly the recommended 6 months' duration. Nine women who
reported exclusive breastfeeding for 6 months did not initiate breastfeeding
within the first 24 hours post-delivery, likely because of the cultural
practice of "roasting."
STATEMENT OF PROBLEM:
Identify the risk factors for initiation
of breast feeding among caesarian mothers in selected hospital, Erode
OBJECTIVES:
To identify the risk factors for initiation of breast
feeding among caesarian mothers
To find out the association between Risk factors scores
among caesarian mothers with their demographic variables
HYPOTHESES:
H1: There is
significant risk factor for initiation of breast feeding among caesarian
mothers
H2: There is a
significant association between Risk factors scores among caesarian mothers
with their demographic variables
MATERIALS AND METHODS:
Research
approach – Descriptive research approach
Research design -
The
research design selected for the present study was descriptive research design.
Variables
Research
variable - Risk factors for
initiation of breast feeding
Research setting
The
study was conducted in Government Head Quarters Hospital Erode.
Population
The
population for the present study was all the caesarean mothers in selected
hospital, Erode. Sample
The
sample consisted of 50 caesarean mothers admitted in Government Head Quarters
Hospital Erode.
Sampling technique: Purposive sampling technique was used to
select the sample for the study.
Development of tool
A
baseline Proforma, risk factors assessment check list
for initiation of breast feeding was prepared with the help of review of
literature, personal experience and discussion with experts.
Description of the tool
Section
A: Baseline Proforma of the samples
Section
B: Risk factors assessment check list for initiation of breast feeding
Section A: Baseline Proforma
It
contained items for obtaining information regarding Age, Education of mother,
Occupation of mother, Religion, Family Income, Residence, Parity, Frequency of Antenatal Visit.
Section B: Risk factors
assessment check list for initiation of breast feeding
It consists of 15 risk factors are, Maternal age below 18 years, Weight > 75 Kg,
Surgical wound pain, Anesthetic effect, Lack of milk supply, Baby with poor
sucking reflex, Breast/ nipple
abnormalities, Ignorance about colostrums, Lack of motivation from health care
team, Lack of privacy/ Hospital environment, Separation of mother and baby,
Inconvenience, Obstetrical complication during pregnancy such as PIH and DM,
Poor family support system and Lack of breast feeding knowledge received from
friends and family members. The maximum score was 30 and the minimum score was 15.
DATA
COLLECTION PROCEDURE:
The
data on demographic variables and Risk factors assessment check list for
initiation of breast feeding were collected from caesarean mothers admitted at
Government Head Quarters Hospital Erode. The data were collected for one week
in the month of July 2013. Permission was sought and obtaining from Medical
Superintendent. The caesarean mothers were selected using purposive sampling
method among those who fulfilled the sample selection. Informed consent was
obtained from the caesarean mothers. The questionnaires were asked to the
caesarean mothers regarding risk factors for initiation of breast feeding.
Confidentiality of the information shared was assured. The mothers were co
operative. On an average, it took 20 – 25 minutes to complete one sample.
PLAN
FOR DATA ANALYSIS:
The
data were analysed by using both descriptive and inferential statistics
Ø Baseline proforma of the samples were described by frequency and
percentage distribution
Risk factors for initiation of breast feeding among
caesarian mothers were analyzed by using mean, standard deviation
and mean percentage.
The association between Risk factors scores among
caesarian mothers with their demographic variables was analyzed by Chi –square
test.
RESULTS:
Section A: Most (48%) of the mothers were in the age group of 24 - 29 years. However similar
30% of the mothers had primary and secondary education, 76% of mothers were
unemployed. The highest percentage (96%) of mothers were Hindus and 70% of them
were in the family income of Rs< 5000/- . Similar percentage (56% and
56%) of mothers
wereprimipara and lived in urban area. All (100%) the
mothers attended regular antenatal checkup.
Section B:
The risk factors of initiation of breast feeding shows that
|
S. NO |
RISK FACTORS |
Percentage (%) |
|
1. |
Surgical wound pain |
92% |
|
2. |
Inconvenience |
78% |
|
3. |
Anesthetic effect |
74% |
|
4. |
Lack of milk supply |
36% |
|
5. |
Ignorance about colostrum
|
32% |
|
6. |
Breast/ nipple abnormalities |
20% |
|
7. |
Separation of mother and baby |
20% |
|
8. |
Lack of motivation from health care team |
18% |
|
9. |
Lack of breast feeding knowledge received from
friends and family members |
16% |
|
10. |
Baby with poor sucking reflex |
14% |
|
11. |
Obstetrical complication during pregnancy such as
PIH and DM |
14% |
|
12. |
Poor family support system |
14% |
|
13. |
Lack of privacy/ Hospital environment |
10% |
|
14. |
Weight > 75 Kg |
4% |
Section
D: There
was no significant association between the risk factors of initiation of breast
feeding scores and variables like age (χ2 = 1.294), education
(χ2 = 0.637), occupation (χ2
= 0.017), Religion(χ2 = 0.397),
Family Income (χ2 = 0.056), Residence (χ2 =
3.624), Parity (χ2 = 1.24), and
Frequency of antenatal visit (χ2 = 0.723).
DISCUSSION:
The
risk factors of initiation of breast feeding based on Risk factors Assessment scale revealed that the majority (78%) of the samples
had mild risk and 22% of mothers had moderate risk factors. The Mean, SD and
Mean Percentage were calculated to know the risk factor for initiation of
breast feeding. The value for mean and SD are 8.8 and 2.75 and Mean percentage
is 29.3%. This indicates majority of caesarian mothers were not find any difficulty for the initiation of breast feeding.
But majority of caesarian mothers find difficulty to give breast milk to their
newborn due to surgical wound pain and discomfort in position. B.M. Newman
& P.R. Newman, 2009; Smith, 2010).Karlström et al.(2007) study found that women with cesarean section
reported high levels of experienced pain during the first 24 hours. There was
no difference between elective and emergency cesarean births in the levels of
pain. Postoperative pain negatively affected breastfeeding and infant care.
Therefore, mothers who had cesarean delivery need more post surgery pain relief
drugs. The pain medication is also important for mother’s comfort.
REFERENCE:
1.
Darryl J. Holman
and Michael A. Grimes. Patterns for the Initiation of Breastfeeding in Humans
2.
Hazir T, Akram DS, Nisar YB, Kazmi N, Agho KE, Abbasi S, Khan AM, Dibley MJ. Determinants of suboptimal breast-feeding practices in Pakistan. Public Health Nutr. 2013 Apr;16(4):659-72. doi: 10.1017/S1368980012002935. Epub 2012 Jul 4.
3.
Kehler HL, Chaput KH, Tough SC.
Risk factors
for cessation of breastfeeding prior to six months postpartum among a community
sample of women in Calgary, Alberta. Can J Public
Health. 2009 Sep-Oct;100(5):376-80.
4.
Wren H, Chambers
L. Breastfeeding in Cambodia: mother knowledge, attitudes and practices. World
Health Popul. 2011;13(1):17-29.
5.
Francis, M.
(2007). The Everything Health Guide to
Postpartum Care, Adams Media, an F+W Publications Company, ISBN 13:
978-1-59869- 275-4, Avon, USA.
6.
Janke, J. (2008). Newborn Nutrition, In: Perinatal Nursing, Simpson KR., Creehan PA., (Eds.), pp. 582-607, Lippincott Williams &
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Smith, L.J.
(2010). Impact of Birth Practices on
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Received on 07.08.2013 Modified
on 10.11.2013
Accepted on 20.12.2013
© A&V Publication all right reserved
Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 114-116