A Systematic Review of Breast Care for Postpartum Mothers

Ji-Ah Song; Myung Haeng Hur

doi:10.4069/kjwhn.2019.25.3.258

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Song and Hur: A Systematic Review of Breast Care for Postpartum Mothers

Original Article

Korean J Women Health Nurs 2019;25(3):258-272.

Published online: 19 September 2019

DOI: https://doi.org/10.4069/kjwhn.2019.25.3.258

A Systematic Review of Breast Care for Postpartum Mothers

Ji-Ah Song¹, Myung Haeng Hur²

¹Professor, Department of Nursing, Konyang University, Daejeon, Korea

²Professor, Department of Nursing, Eulji University, Daejeon, Korea

Corresponding author: Myung Haeng Hur Department of Nursing, Eulji University, 77 Gyeryong-ro 771beon-gil, Jung-gu, Daejeon 34824, Korea. Tel: +82-42-259-1714 Fax: +82-42-259-1709 E-mail: mhhur@eulji.ac.kr

Received 24 June 201926 August 2019 Accepted 28 August 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify nursing interventions for the postpartum breast care of mothers and determine the effectiveness of interventions for breast pain and engorgement by systematic review.

Methods

Eight national and international databases were reviewed to retrieve and collect randomized controlled trial and controlled clinical trial literature published up to March 2015. Two reviewers independently selected the studies and performed data abstraction and validation. The risk of bias was assessed using Cochrane criteria. A meta-analysis of the studies was performed to analyze the data.

Results

The meta-analysis showed that breast massage, along with routine breast care, resulted in a 3.52-point reduction in pain on a 10-point visual analogue scale. Meta-analysis of therapy with cold cabbage leaves and routine breast care showed a pain reduction of 0.54 points. Meta-analysis of cold cabbage leaf application in the experimental group versus cold compress therapy in the comparison group showed a pain reduction of 0.44 points. Meta-analysis of cold cabbage leaf application and routine breast care showed an engorgement reduction of 0.67 points.

Conclusion

The results of the analysis of 12 articles showed that hot and cold compresses, breast massage, and cabbage application were effective for postpartum breast pain and engorgement.

Keywords: Postpartum, Breast nursing care, Breast pain, Breast hyperemia, Systematic review

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Figure 1.

Flow chart of study selection process. PICO=Patient, Intervention, Comparator, Outcome.

Figure 2.

Reviewing authors’ judgements about each risk of bias item presented as percentages across all included studies. (A) Risk of bias graph and (B) risk of bias summary.

Figure 3.

Forest plot of the effects of breast care for breast pain and breast engorgement level. Effects of breast care for (A) breast pain and (B) breast engorgement level. M=mean; SD=standard deviation; CI=confidence interval; df=degrees of freedom; MD=mean difference; SMD=standardized mean difference.

Table 1.

Summary of RCTs and CCTs Examining Breast Care and Breast Engorgement in Postpartum Mothers

First author (year)	Study design sample size	Intervention group (regime)	Control group (regime)	Main outcome measures	Intergroup difference	Author’s conclusion
Kim (1975)^†	Nonequivalent pre-posttest 138 postpartum mothers	(A) Hot compression and massage (n=69), Not described, 5 times/day for 7 days	(B) No treatment (n=69)	(1) Pain (10-point score)	(1) p<.005	‘Early breast care, massage is effective in reduction breast pain...’
Kim (1975)^†	Nonequivalent pre-posttest 138 postpartum mothers		(B) No treatment (n=69)	(2) Amount of breast milk (mL)	(2) NS
Ahn et al. (2011)^†	Nonequivalent pre-posttest	(A) Oketani lactation massage (n=23) 30 minutes, 1 time/day for 2 days	(B) Routine care (n=21)	(1) Pain (10 cm-VAS)	(1) p<.001	‘Breast massage may have effects on relieving breast pain, decreasing breast milk sodium...’
Ahn et al. (2011)^†	44 postpartum mothers (normal vaginal delivery)		(B) Routine care (n=21)	(2) Breast milk Na⁺ (mmol/L)	(2) p=.034
Cho et al. (2012)^†	Nonequivalent pre-posttest	(A) Oketani lactation massage (n=22) 30 min, once	(B) Routine care (n=25)	(1) Pain (10 cm-VAS)	(1) p<.001	‘Breast massage is effective in relieving breast pain...’
Cho et al. (2012)^†	47 postpartum mothers	(A) Oketani lactation massage (n=22) 30 min, once	(B) Routine care (n=25)	(2) Breast milk pH (pH meter)	(2) p<.001	‘Breast massage is effective in relieving breast pain...’
Cho and Ahn (2014)^†	Nonequivalent pre-posttest 53 postpartum mothers (cesarean section)	(A) Oketani lactation massage (n=26) 30 minutes, 1 time/day for 2 days	(B) Routine care (n=27)	(1) Discomfort (0–5 score)	(1) p<.001	‘Promotion program is effective in reducing breast engorgement...’
				(2) Breast milk Na⁺ (mmol/L)	(2) p=.016
					(3) p=.031
Lim (2013)^†	Nonequivalent control group posttest design	(A) Cold cabbage leaves (n=20) 20 minutes, 3 times/day for 2 days	(C) Routine care (n=20)	(1) Pain (0–10 score: NRS)	(1) p=.032	‘Early breast care and cabbage compress in this study were effective in relieving breast pain and breast hardness...’
	60 postpartum primiparous mothers (cesarean section)	(B) Early breast care; massage (n=20) 10 minutes before breast feeding for 2 days		(2) Breast hardness (durometer)	(2) p<.001
	60 postpartum primiparous mothers (cesarean section)				(3) NS
Nikodem et al. (1993)	RCT 120 postpartum mothers 72 hours after delivery	(A) Cabbage leaves (n=60) 20 minutes, 3 times/day for 1 day	(B) Routine care (n=60)	(1) Perception of breast engorgement (%)	(1) NS	‘Cabbage leaves tended to report less breast engorgement, but not statistically significant.’
Roberts (1995)	Quasi-randomized trial 34 postpartum mothers with breast engorgement	(A) Chilled cabbage leaves (n=34) 1 breast, 4 hours, 2 times/day for 1 day	(B) Chilled gelpacks (n=34) other breast, 4 hours, 2 times/day for 1 day	(1) Pain (10 cm-VAS)	(1) NS	‘Chilled cabbage leaves and gelpacks may alleviate discomfort arising from breast engorgement...’
Roberts et al. (1995)	RCT 28 postpartum mothers with breast engorgement	(A) Chilled cabbage leaves (n=28) 1 breast, 2 hours, Not described	(B) Room temperature cabbage leaves (n=28) other breast, 2 hours, Not described	(1) Pain (10 cm-VAS)	(1) NS	‘Cabbage leaves may offer some relief for discomfort of breast engorgement...’
Roberts et al. (1998)	RCT 39 postpartum mothers with breast engorgement	(A) Cabbage leaf extract cream (n=21) 2 hours, Not described	(B) Placebo cream (n=18) 2 hours	(1) Pain (10 cm-VAS)	(1) NS	‘Both groups mothers perceived the creams as having some efficacy...’
			(B) Placebo cream (n=18) 2 hours	(2) Breast engorgement (0–5 score: Hill and Humenick Scale)	(2) NS
				(3) Chest circumference size (cm)	(3) NS
Arora et al. (2008)	Nonequivalent control group	(A) Cold cabbage leaves (n=30) 30 min, 3 times/ day for 2 days	(B) Hot and cold compresses (n=30) replace 1–2 minutes, total 20 minutes	(1) Pain (0–10 score: NRS)	(1) NS	‘Hot and cold compresses are more effective in decreasing pain, cabbage leaves.’
Arora et al. (2008)	60 postpartum mothers with breast engorgement			(2) Breast engorgement (0–5 score: Hill and Humenick Scale)	(2) NS
Gagandeep and Mamta (2013)	Quasi-experimental study 58 postpartum mothers with breast engorgement	(A) Cold cabbage leaves (n=29) 20 minutes, 3 times/day for 3 days	(B) Routine care (n=29)	(1) Breast consistency scale	(1) p=.003	‘Application of cabbage leaves were effective in reducing breast engorgement.’
Gagandeep and Mamta (2013)			(B) Routine care (n=29)	(2) Breast tenderness scale	(2) p=.001
Chaithanya (2014)	Quasi-experimental pretest-posttest design 40 postpartum primiparous mothers with breast engorgement (normal vaginal delivery)	(A) Cold cabbage leaves (n=20) 15–20 minutes, 3 times/day for Not described	(B) Routine care (n=20)	(1) Breast engorgement (12-point score)	(1) p<.001	‘Cabbage leaves application was effective in control of breast engorgement.’

RCT=randomized controlled trial; CCT=controlled clinical trial; VAS=Visual Analogue Scale; NS=not significant; NRS=Numeric Rating Scale.

Table 2.

Summary of General Characteristics

Characteristics	Category	n(%)
Year	1975	1 (8.3)
	1993	1 (8.3)
	1995	2 (16.7)
	1998	1 (8.3)
	2008	1 (8.3)
	2011	1 (8.3)
	2012	1 (8.3)
	2013	2 (16.7)
	2014	2 (16.7)
Patient	Type
	Primipara	2 (16.7)
	Primipara/Multipara	10 (83.3)
	Delivery type
	Cesarean section	2 (16.7)
	Normal	2 (16.7)
	Cesarean section/normal	8 (66.7)
Intervention	Type
	Cabbage	7 (58.3)
	Massage	4 (33.3)
	Cabbage and massage	1 (8.3)
	Duration
	Not described	1
	10 minutes	1
	20–30 minutes	8
	2 hours	2
	8 hours	1
	Frequency
	Non	3
	Once	1
	1 time/day for 2 days	2
	2 times/day for 1 day	1
	3 times/day for 1 day	1
	3 times/day for 2 days	2
	3 times/day for 3 days	1
	5 times/day for 7 days	1
Comparator	Routine care	8 (66.7)
	Hot/cold compression	2 (16.7)
	Cabbage	1 (8.3)
	Placebo cream	1 (8.3)
Outcome	Pain	10
	Engorgement	7
	Temperature	1
	Breast milk pH	2
	Breast milk Na⁺	2
	Amount of breast milk	1

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