Australian breastfeeding rates fall significantly in the months following birth, often as a result of breastfeeding complications.
To explore the potential risk factors for nipple trauma and breast engorgement in a group of women who were referred to the in home breastfeeding service in Melbourne, Australia.
A retrospective, cross-sectional analyses of the maternal–infant records (n = 653) from 2003 to 2007 including demographic characteristics; pregnancy, labour and birth data; the presenting complications and observational and diagnostic results. Bivariate and logistic regression analyses were conducted to explore the predictors of nipple trauma and engorgement.
Nipple trauma was the most common presenting complication (62.9%). Logistic regression analyses identified four statistically significant predictors: facio-mandibular asymmetry (AOR 4.21, 95% CI [1.25–14.20]), inflammatory mastitis (AOR 2.99, 95% CI [1.57–5.68], nipple malignment (AOR 2.51, 95% CI [1.13–5.55]) and the cross-cradle technique (AOR 1.90, 95% CI [1.03–3.50]). Engorgement was associated with the first postpartum breastfeed being less than one-hour duration (AOR 2.01, 95% CI [1.07–3.79]).
Nipple trauma was associated with commonly taught techniques that involved the cross-cradle hold and manoeuvres of the breast, nipple and baby that resulted in nipple malalignment and facio-mandibular asymmetry. This practice, appeared to interfere with the baby's intra-oral function by restricting movement of the cranio-cervical spine and nuchal ligament. The combination appeared to limit the baby's instinctive ability to activate neuro-sensory mammalian behaviours to freely locate and effectively draw the nipple and breast tissue without causing trauma. Changes to the first and early breastfeeding techniques are recommended.
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- The bioactive nature of human breastmilk.Breastfeed Rev. 2007; 15
- Evolution of lactation: nutrition V. protection with special reference to five mammalian species.Nutr Res Rev. 2008; 21: 97-116
WHO. World Health Organisation: Exclusive breastfeeding for six months best for babies everywhere. [Statement] 2011 15 January 2011 [cited 2012 Aug 18].
- Short-term effects of breastfeeding. A systematic review on the benefits of breastfeeding on diarrhoea and pneumonia mortality.World Health Organisation, 2013
- Breastfeeding and maternal and infant health outcomes in developed countries.Evid Technol Asses (Full Rep). 2007; 153: 1-186
- World Health Organisation: Exclusive breastfeeding for six months best for babies everywhere.2014 ([Statement]. Available from: http://www.who.int/topics/breastfeeding/en/)
- Interventions for treating painful nipples among breastfeeding women.Cochrane Database Syst Rev. 2014; (Retrieved from Cochrane Database of Systematic Reviews: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007366.pub2/abstract)
- The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis.Pediatrics. 2010; 125 (e1048–e56)
- Cost analysis of maternal disease associated with suboptimal breastfeeding.Obstet Gynecol. 2013; 122: 111-119https://doi.org/10.1097/AOG.0b013e318297a047
- Growing up in Australia: the longitudinal study of Australian children. Breastfeeding [annual report 2006–2007] [Feb 6, 2014 August 9, 2013]; Growing Up in Australia, Waves 1 and 2].2011 (Available from: http://www.aifs.gov.au/growingup/pubs/ar/ar200607/breastfeeding.html)
- 2010 Australian national infant feeding survey: indicator results.Australian Institute of Health and Welfare, Canberra, ACT2011
- Management of nipple pain and/or trauma associated with breast-feeding.JBI Rep. 2003; 1: 127-147
- Nipple pain in breastfeeding women: causes, treatment, and prevention strategies.J Midwifery Womens Health. 2000; 45: 212-215
- Aetiology of sore nipples.Midwifery. 1986; 2: 172-176
- The ‘anatomy’ of infant sucking.Midwifery. 1986; 2: 164-171
- Tongue movement and intra-oral vacuum in breastfeeding infants.Early Hum Dev. 2008; 84: 471-477https://doi.org/10.1016/j.earlhumdev.2007.12.008
- The mother-baby dance: positioning and latch-on.Leaven. 2000; 36: 63-68
- Clarifying the confusion over cross-cradle hold.Leaven. 2008; 44: 16-17
- The world of latch-on: one leader's journey.LEAVEN. 2004; 40 (p3-6LLLI)
- Treatments for breast abscesses in breastfeeding women.Cochrane Database Syst Rev. 2015; 8https://doi.org/10.1002/14651858.CD010490.pub2
- Australia's mothers and babies 2007.Australian Institute of Health and Welfare, Canberra2009: p123
- Encylopedia of research design.in: Knowledge S. Yates's correction. Sage Publications, Inc., Thousand Oaks, CA2010: 1146
- Applied logistic regression.2nd ed. 2000: 392
- Purposeful selection of variables in logistic regression.Source Code Biol Med. 2008; 3
- Australia's mothers and babies 2007.Perinatal statistics series no. 23. Cat. no. PER 48. Australian National Perinatal Statistics Unit, Sydney2009
- Attachment-the key to successful breastfeeding.Pamphlet, Australia1994
- La Leche League International [electronic].2008 (Available from: http://www.llli.org/llleaderweb/lv/lvaugsep00p63.html [cited 2008 November])
- Breastfeeding your baby: positioning [video recording].Medela ©, McHenry, IL1991
- A breastfeeding teaching tool using a sandwich analogy for latch-on.J Hum Lact. 1998; 14: p51
- Cross cradle position for left breast.2009, November (Available from: http://www.nbci.ca/index.php?option=com_content&view=article&id=75:when-latching&catid=5:information&Itemid=17)
- How do I position my baby to breastfeed? Cross-cradle position.2010 (Available from: http://www.llli.org/faq/positioning.html)
- Ligaments of the craniocervical junction.J Neurosurg: Spine. 2011; 14: 697-709
- Supporting sucking skills in breastfeeding infants.in: Genna C. Sandora L. Breastfeeding: normal sucking and swallowing. 2nd ed. Jones & Bartlett Publishers, 2013: 408
- Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding.Early Hum Dev. 2008; 84: 441-450
- Physiology and endocrine changes underlying human lactogenesis II.Nutrition. 2001; 131: 3005S-3008S
- Midwives’ knowledge of newborn feeding ability and reported practice managing the first breastfeed.Breastfeed Rev. 2004; 12: 25-33
- Supporting sucking skills in breastfeeding infants: sensory integration and breastfeeding.2007 ([chapter 10])
- The sacred hour: uninterrupted skin-to-skin contact immediately after birth.Newborn Infant Nurs Rev. 2013; 13: 67-72
- Effect of delivery room routines on success of first breast-feed.Lancet. 1990; 336: 1105-1107
- Breastfeeding: a nature-culture hybrid.J Pediatr (Rio J). 2004; 80: 119-125
- Sensitive midwifery.Heinemann Midwifery, London1986: 247
- Promotion of breastfeeding initiation and duration evidence into practice briefing.NHS, 2006: 73
- The functional neuroanatomy of the evolving parent–infant relationship.Prog Neurobiol. 2010; 91: 220-241
- Effects of skin-to-skin contact and breastfeeding at birth on the incidence of PPH: a physiologically based theory.Women Birth. 2014; 27: 250-253
Published online: February 16, 2016
Accepted: January 12, 2016
Received in revised form: January 12, 2016
Received: November 4, 2015
Publication stageIn Press Corrected Proof
© 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.