Objective: To evaluate an innovative nursing strategy called kangaroo care before and during breastfeeding (KB) on breastfeeding success as measured by visual analog scales. Maternal perception of breastfeeding success, breast pain, and nipple pain during postpartum hospitalization of mothers with a history of breastfeeding difficulty will be measured following breastfeeding experienced while in kangaroo care.
Design: An evaluation study of 90-120 breast feedings in the kangaroo care position, called kangaroo breastfeeding (KB).
Population, Sample, Setting, Years: Thirty term mother-infant dyads who report breastfeeding difficulty within 12 hours of delivery will attempt three-to-four breast feedings (at which nutritive intake may or may not occur) each while in the kangaroo care position prior to discharge, yielding 90-120 feedings which will be scored. Mother-infant dyads are patients in a tertiary level University Hospital in the Midwest. Data collection is in progress and will be completed by May 2002.
Variables: In this study, all mothers place the infant in the kangaroo care position (the diaper-clad infant is placed skin-to-skin, midline on the mother’s chest 30-60 minutes before anticipated feedings and covered across the back with the mother’s clothing and a blanket.) Breastfeeding occurs during skin-to-skin placement. The outcome variables chosen for this report are maternal perception of breastfeeding success, maternal breast pain, and maternal nipple pain. These variables will be measured by self-report using visual analog scales for each outcome.
Methods: Mothers identified as having breastfeeding difficulty by a self-report score of 7 or less on a verbal version of the Mother Baby Assessment (Mulford, 1992) begin kangaroo care positioning 30-60 minutes before anticipated feeding and breastfeed in the kangaroo care position following signed consent. Mothers allow infants to move freely towards the breast and remain alert for hunger cues. If after one hour of kangaroo care the infant has not obtained a successful latch and is exhibiting hunger cues, the nurse researcher will provide assistance to obtain a successful latch. Using a serial posttest-only design, mothers will complete three visual analog scales (VAS) (one measuring “success”, one for “breast pain”, and one for “nipple pain”) before and after the first KB, after the next two KB’s, and at discharge. Instrument. VAS are single-item measures used to obtain an individual’s perception of a particular concept such as breastfeeding success or pain. The single item measure allows the subject to relate to the concept in a way that is personally relevant and therefore is discriminating of individual differences (Youngblut & Casper, 1993). Mothers place a mark on a 10 cm dichotomous scale indicating their perception of breastfeeding success, breast pain and nipple pain. VAS have been shown to be reliable, valid, and sensitive to change in the concept being studied. Because the VAS just requires placing a single mark on a 10 cm scale, it is easy to complete and appropriate for samples of diverse age, education, and acuity. Data will be analyzed using descriptive statistics.
Findings: Maternal perceptions of breastfeeding success or failure, breast pain and nipple pain have been identified as salient factors related to discontinuation of breastfeeding (Kearney et al., 1990). This evaluation will use VAS to examine the effects of breastfeeding in the kangaroo care position on maternal perception of breastfeeding success and how soon after initial breastfeeding in the kangaroo care position success occurs and continues. The study will also describe maternal perception of breast and nipple pain in this position to determine if pain persists and if it may play a role in continuing breastfeeding success.
Conclusions & Implications: Reports of case studies suggest that breastfeeding in the kangaroo care position enhances breastfeeding success by improving the latch and decreasing breast and nipple pain. If the results of this survey support the case study findings, breastfeeding in the kangaroo care position will be proposed as an intervention for testing in a randomized controlled clinical trial.
Kearney MH, Cronenwett LR, Barrett JA. 1990. Breastfeeding Problems in the first week postpartum. Nurs Res 39(2), 90-95. Mulford, C. 1992. The Mother-Baby Assessment (MBA): An “Apgar Score” for breastfeeding. J Hum Lact 8(2), 79-82. Youngblut JAM, Casper GR. 1993. Focus on psychometrics. Single-item indicators in nursing research. Res Nurs Health, 16, 459-465.`
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