Harpreet Kaur, Parvesh Saini, Ujala Joshi
Abstract : Breast feeding is the most enriching and unique experience for every mother. It plants the seeds of mother child bonding but the common problem experienced by most of the mothers is breast engorgement. It involves three elements: congestion, increased vascularity & accumulation of milk. Managing breast engorgement has always been a challenge for nurses working with postnatal mothers. Objective: To assess the effectiveness of cold vs. warm compresses on reduction of breast engorgement among primi postnatal mothers.
Methodology:A quasi- experimental study was conducted to assess the effectiveness of cold vs. warm compresses on reduction of breast engorgement among primi postnatal mothers at SGRD hospital, Amritsar. Data was collected from 90 primi postnatal mothers(30 in each group i.e. cold compress, hot compress, control )by using convenience sampling technique. A standardized scale i.e. six point breast engorgement scale was used to assess engorgement. Results: The pre-test mean score of breast engorgement group I i.e. cold compresses (n=30) was 2.87± 0.63 and it decreased to 2.80±0.71 after cold compresses(‘t29’= 12.98, <0.01). The pre-test mean score of breast engorgement in group II i.e. warm compresses (n=30) was 2.80 ± 0.66 and it decreased to 2.10 ± 1.21 after warm compress (‘t29’= 14.69, p=< 0.01). Conclusion: It is concluded from the present study that hot compress is more effective than cold compress to relieve breast engorgement.
Keywords
Engorgement, cold compress, warm compresses, postnatal mothers.
Correspondence at
Mrs Parvesh Saini
Principal, SGRD College of Nursing, Amritsar
Introduction
Engorgement is a congestion and distension of breast with fluids. Literature refers to engorgement as the physiologic condition characterised by the painful swelling of the breasts associated with the sudden increase in milk volume, lymphatic and vascular congestion, and interstitial oedema during the first 2 weeks following birth. Engorgement is a normal physiologic process with a progression of events, not a result of trauma or injury to tissues1
Global rate of exclusive breast feeding according to WHO (2013) is 37%. Indian statistic suggests that 96% of the children are breastfed of that only 29% of urban and 21% of rural populations are breastfed within an hour immediately after birth.2 The prevalence of breast problems in the postnatal period is very high. It is evidenced that the incidence rate of breast engorgement in the world is 1:8000 and in India it is 1: 6500. About 20% postnatal mothers especially primigravida mothers are affected with breast engorgement within four days of postnatal period. In the Grampian study 33% of all women experienced breast problems in the first two weeks and 28% thereafter3. Studies had been conducted on reduction of breast engorgement like cabbage leave application; cabbage leaves vs. cold and hot application, breast massage, pharmacological and non- pharmacological method, hot application etc. As a researcher we felt that most of primi postnatal mothers are suffering from breast engorgement as breast feeding is very important for baby but due to breast engorgement mothers are unable to give feed properly. Thereby it was decided by the researcher to know that which method is more effective for reduction of breast engorgement either cold compresses or warm compresses. As nurse is primary care giver, she must be aware of the effective treatment of breast engorgement and use that method in daily practice for reduction of such problems.
Objective
- To assess and compare the effectiveness of hot and cold compresses in the treatment of breast engorgement.
Materials and Methods
The quantitative research approach was adopted with quasi experimental research design. This study was conducted at postnatal ward, SGRD Institute of Medical Science and Research, Vallah, Amritsar. The sample of the study comprised of 90 primi post natal mothers with breast engorgement who had fulfilled the inclusion and exclusion criteria. The subjects were selected using convenience sampling technique. They were allocated in three groups; as first 30 encountered mothers were kept in control group, second 30 subjects stumbled across were kept in warm compresses group and last 30 subject were comprised in cold compresses group. The informed written consent was obtained from mothers. Confidentiality and anonymity of the subjects was maintained while carrying out the study. The data was collected from 1st January to 19th February 2017. Ethical clearance was taken from the Research and Ethical Committee of the Shri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSR). A written permission was taken from the Principal, SGRD college of nursing, Amritsar and Head of Obstetrics and Gynaecology department for cold vs warm compresses on reduction of breast engorgement among primi postnatal mothers admitted at postnatal ward.
Protocol first was used for application of cold compresses and hot compresses on reduction of breast engorgement. The cold compresses were applied to the engorged bwraetaesrt(Tbeymdpieprpaitnugrethbetwcoetetonn10c°loCth- 1in8°cCoalds assessed by lotion thermometer). The clothes were replaced after 5 minutes. This process was continued for 15 minutes. In tchloethseesco(tnedmpPerroattoucroelbewtawrememn o4i3s°tCs-p4o6n°gCe as assessed by lotion thermometer)were applied to the engorged breast, the clothes were replaced after 5 minutes. This process was also continued for 15 minutes. Both the treatments were performed two times a day for 3 continues days. While the group-III i.e. control group received routine care as per the hospital practice. The tools used were Socio demographic and clinical profile Proforma of mothers and the level of breast engorgement was measured by using six point breast engorgement scale (Hill&Humenick) a standardised tool to measure breast engorgement. Minimum score was 0 and maximum was 6. It was classified into 4 categories and scoring criterion measure i.e. No engorgement:1, mild engorgement: 2-3, moderate engorgement: 4-5, sever engorgement : 6 . Tools and protocols were prepared from extensive review of literature and validated by experts from the field of obstetric and gynaecological nursing and medical. Reliability of the tool was 0.73 as calculated by Inter-rater reliability.
Table I : Research Design
| Group | Observation | Intervention | Observation |
| Group I(cold compresses) | O1 | X1 | O2 |
| Group II(warm compresses) | O1 | X1 | O2 |
| Group III(control group) | O1 | – | O2 |
The pre and post treatment scores of breast engorgement were recorded after each treatment session. Breast engorgement was measured using a six point breast engorgement scale (Hill P.D &Humenick). In control group breast engorgement was measured on first and third day.The data was analyzed using the descriptive and inferential statistics. Analysis was carried out with the help of SPSS version 17.
Result
Table 2 : Demographic variables of primi postnatal mothers of intervention and control group.
N=60
| Clinical Variables | Groups | 2
z df P Value |
Groups | 2
z df P Value |
||
| Cold
Compresses |
Control
Group |
Warm
Compresses |
Control
Group |
|||
| f (%) | f (%) | f (%) | f (%) | |||
| 1) Age (in years)
a) 18-22 b) 22-26 c) 26-30 d) 30 |
05(16.7) 15(50.0) 06(20.0) 04(13.3) |
05(16.7) 15(50.0) 08(26.7) 02(06.7) |
0.94 3 0.812NS |
07(23.3) 14(46.7) 07(23.3) 02(6.7) |
05(16.7) 15(50.0) 08(26.7) 02(06.7) |
0.434 3 0.933NS |
| 2) Education status of mother
a) Primary b) Matric c) Senior secondary d) Graduate or above |
01(03.0) 08(26.7) 11(36.7) 10(33.3) |
05(16.7) 07(23.3) 12(40.0) 06(20.0) |
60.86 3 <0.01* |
02(06.7) 09(30.0) 09(30.0) 10(33.3) |
05(16.7) 07(23.3) 12(40.0) 06(20.0) |
2.96 3 0.397NS |
| 3) Occupation status of mother
a) Housewife b) Working |
26(86.7) 04(13.3) |
1.96
29(96.7) 01(03.3) |
1 0.16NS |
26(86.7) 04(13.3) |
1.96
29(96.7) 01(03.3) |
1 0.16NS |
| 4) Occupation status of husband
a) Generating income b) Not generating income |
30(100) – |
30(100) – |
– – |
30(100) – |
30(100) – |
– – |
| 5) Monthly income of family (in Rs.)
a) <5,000 b) 5,001-10,000 c) 10,001-15,000 d) >15,001 |
– 06(20.0) 12(40.0) 12(40.0) |
03(10.0) 08(26.7) 05(16.7) 14(46.7) |
7.46 3 0.05NS |
– 12(40.0) 07(23.0) 11(36.7) |
03(10.0) 08(26.7) 05(16.7) 14(46.7) |
4.49 3 0.213NS |
| 6) Habitat
a) Rural b) Urban |
26(86.7) 04(13.3) |
19(63.3) 11(36.7) |
4.355
1 0.03* |
22(73.3) 08(26.7) |
19(63.3) 11(36.7) |
0.69
1 0.405NS |
N.B. NS= non-significant *p<0.05 significant
Table 2 reveals the frequency and percentage distribution of demographic variables of primi postnatal mothers. It shows that majority of the primi postnatal mothers were in age group of 22-26 year in experimental group and control group. In educational status of mother majority of primi postnatal mothers had senior secondary education 11(36.7%) in cold intervention group, 10 (33.3%) graduate or above in warm intervention group and 12 (40%) had senior secondary education in control group. Occupation status of primi postnatal mother reveals that majority of mothers were housewives 26(86.7%) in both intervention group (cold and warm compresses) and 29 (96.7%) in control group. Occupation status of husbands depicts that all the husbands were generating income. According to monthly income of their family 40% subjects belongs to the income group 10,001-15,000 and equally 40% belong to the >15,000 in cold intervention group and out of all subjects 12(40%) belong to the 5,001-10,000 in warm intervention group and in control group majority of subjects having >15,000 income. Majority of subjects belongs to the rural area in both intervention (26 subjects in cold intervention, 22 in warm interventions) and control group i.e. 63.3%. The cold and hot compress group were matching with control group as per all socio demographic profile of mothers (p>0.05)
Table 3: Clinical variables of mothers of intervention and control group.
N=60
| Clinical Variables | Groups | 2
z df P Value |
Groups | 2
z df P Value |
||
| Cold
Compresses |
Control
Group |
Warm
Compresses |
Control
Group |
|||
| f (%) | f (%) | f (%) | f (%) | |||
| 1) Type of delivery | 3.068 | 0.416 | ||||
| a) Normal Vaginal delivery | 11(36.7) | 05(16.7) | 1 | 07(23.3) | 05(16.7) | 1 |
| b) Caesarean section | 19(63.3) | 25(83.3) | 0.079NS | 23(76.7) | 25(83.3) | 0.518NS |
| 2) Time of initiation of breast | ||||||
| feeding within | ||||||
| a) 1 hour | 05(16.7) | 02(06.7) | 3.86 | 03(10.0) | 02(06.7) | 4.36 |
| b) 1 day | 04(13.3) | 03(10.0) | 4 | 03(10.0) | 03(10.0) | 4 |
| c) 2 days | 03(10.0) | 06(20.0) | 0.424NS | 05(16.7) | 06(20.0) | 0.359NS |
| d) 3 days | 11(36.7) | 15(50.0) | 09(30.0) | 15(50.0) | ||
| e) Not given within 3 days | 07(23.3) | 04(13.3) | 10(33.3) | 04(13.3) | ||
| 3) General condition of mother | ||||||
| a) Normal | 30(100) | 30(100) | – | 29(96.7) | 30(100) | – |
| b) sick | – | – | – | 01(03.3) | – | – |
| 4) Gestational age at the time | ||||||
| of delivery | ||||||
| a) Pre-term | 08(26.7) | 11(36.7) | 1.87 | 10(33.3) | 11(36.7) | 0.074 |
| b) Full-Term | 22(73.3) | 18(60.0) | 2 | 19(63.3) | 18(60.0) | 2 |
| c) Post- Term | – | 01(03.3) | 0.392NS | 01(03.3) | 01(03.3) | 0.963NS |
N.B. NS= non-significant *p<0.05 significant
Table 3 revealed that more than half of the subjects in intervention group undergone caesarean section 19(63.3) in cold intervention and 23(76.6%) in warm intervention, in control group majority of subjects 25(83.3%) undergone cesarean section less than half of the subjects 11(36.7%) were initiated breast feeding within 3 days in cold intervention and 10 subjects out of 30 not giving breast feeding within 3 days in warm intervention and in control group half of the subjects i.e. 50% initiated breast feeding within 3 days. All the subjects in cold intervention group having general condition of mothers normal and in warm intervention group only one subject was sick and in control group all the subjects having normal condition after delivery. More than half of the subjects were delivered full term baby in both intervention (73.3% in cold intervention, 63.3% in warm intervention group) and control group (60%). Both the group (worm and cold compress group) were matching with control group as per their clinical profile (p>0.05)
Figure 1: Level of breast engorgement before intervention both in interventional and control group.
Figure 1 depicts that majority of primi postnatal mothers had moderate type of breast engorgement in both intervention and control group i.e. 53.3% mothers in cold intervention group, 60% mothers in warm intervention and 43.3 % in control group. A very few number of mothers had sever breast engorgement i.e. 13.3% in cold intervention group and warm intervention group, 16.7% in control group .
Table 4 : Effectiveness of cold compresses v/s warm compress and control groups on reduction of breast engorgement among primi postnatal mothers.
N=30
| Level of breast engorgement/ Groups | Pre-test | Post-test | ||
| Day 1 | Day 2 | Day 3 | ||
| f(%) | f(%) | f(%) | f(%) | |
| Cold compresses Group | ||||
| No (1) | – | – | 05(16.7) | 12(40.0) |
| Mild (2-3) | 08(26.7) | 11(36.7) | 13(43.3) | 13(43.3) |
| Moderate(4-5) | 18(60.0) | 17(56.7) | 11(36.7) | 05(16.7) |
| Severe (6) | 04(13.3) | 02(06.7) | 01(03.3) | – |
| Warm compresses Group | ||||
| No (1) | – | 03(10.0) | 15(50.0) | 22(73.3) |
| Mild (2-3) | 10(33.3) | 19(63.3) | 14(46.7) | 08(26.7) |
| Moderate(4-5) | 16(53.3) | 08(26.7) | 01(03.3) | – |
| Severe (6) | 04(13.3) | – | – | – |
| Control Group | ||||
| No (1) | – | – | 04(13.3) | 08(26.6) |
| Mild (2-3) | 12(40.0) | 10(33.3) | 07(23.3) | 10(33.3) |
| Moderate(4-5) | 13(43.3) | 16(53.3) | 18(58.0) | 11(36.6) |
| Severe (6) | 05(16.7) | 04(13.3) | 01(03.3) | 01(03.3) |
Table 4 revealed that 60% mothers in cold intervention had moderate breast engorgement, 26.7% mothers undergone mild breast engorgement and a very few numbers13.3% of mothers had severe breast engorgement in pre interventional whereas in post test scores of Day 1 of cold compresses, 56.7% had moderate breast engorgement, 36.7% had mild breast engorgement, only few mothers 6.7% had sever breast engorgement. Day 2 results show majority of mothers had (43.3%) mild breast engorgement, 16.7% had no engorgement, and only one mother had severe breast engorgement. Day 3 post test score shows that majority of mothers (43.3%) had mild breast engorgement, 40% had no engorgement, and only 16.7% had moderate breast engorgement. Results of pre and posttest Day 3 score show that cold compresses is effective in reducing the breast engorgement.
In warm compressor group majority of mother (53.3%) had moderate breast engorgement, less than half of mothers (33.3%) had mild breast engorgement and few numbers of mothers (13.3%) had sever breast engorgement in pre-test score. Where as in post test scores after giving warm compresses, Day 1 post test results shows 63.3% of mothers had mild breast engorgement, 26.7% had moderate breast engorgement and rest of the mothers (10%) had no engorgement. Day 2 shows that half of mothers (50%) had no engorgement, 46.7% had mild engorgement and only one mother (3.3%) had moderate engorgement. Day 3 results reveal more than half of mothers (73.3%) had no engorgement and rest of mothers (26.7%) had mild engorgement. Results of pre-test and post- test score shows that warm compresses is effective in reduction of breast engorgement In control group pre test values shows that 43.3% mothers had moderate breast engorgement, 40% had mild breast engorgement and only16.7% mothers had severe breast engorgement. The post test after routine care shows that on Day 1 53.3% mothers had moderate breast engorgement,33.3% had mild engorgement and 13.3% had severe breast engorgement. Day 2 values reveals that 58.0% had moderate breast engorgement, 23.3% had mild engorgement, 13.3% had no engorgement and only 3.3% had severe breast engorgement. Day 3 depicted that 36.6 %had moderate breast engorgement, 33.3% had mild engorgement, 26.6 % had no engorgement and only 3.3% had severe breast engorgement. Thereby it is concluded that there were no specific difference in pre and post test of control group.
Table 5 : Comparison of effectiveness between cold Vs warm compresses on reduction of breast engorgement among primi postnatal mothers
N=30
| Groups | Pre test score | Post test score (day 3) | t ,df p-value | ||||
| Mean | SD | Mean
% age |
Mean | SD | Mean
% age |
||
| Group I
(Cold compresses) |
2.87 | 0.63 | 70.6 | 2.80 | 0.71 | 35.0 | 12.98, 29
<0.01** |
| Group II
(warm compresses) |
2.80 | 0.66 | 67.8 | 2.10 | 1.27 | 21.1 | 14.69, 29
<0.01** |
| Group III (control group) | 2.77 | 0.73 | 66.7 | 2.17 | 0.87 | 49.4 | 4.04, 29
<0.01** |
N.B. **P <0.01 highly significant
The data revealed that pre-test mean score of group I i.e. cold compresses (n=30) was 2.87± 0.63 and after cold compresses mean score of breast engorgement decreased to 2.80±0.71 and statistically there is a highly significant difference between pre and post test scores of breast engorgement (‘t’= 12.98, df=29, <0.01. group II i.e. warm compresses (n=30) pre- test score was 2.80 ± 0.66 after warm compresses mean of post test score was decreased to 2.10 ± 1.21 and statistically there is a highly significant difference between pre and post test score of breast engorgement (‘t’= 14.69, df=29, p= <0.01. Whereas in control group (n=30) pre- test mean score was 2.77±0.73 and post – test day 3 mean score was 2.17±0.87. However there is statistical significant difference between pre and post-test mean score (‘t’= 4.002, df=29, p=<0.01
Table 6: Comparison of effectiveness between cold vs warm compresses on reduction of breast engorgement among primi postnatal mothers with unpaired ‘t’ test. N=30
| Groups | Unpaired t test t ,df
p value |
|
| Pre-test | Post-test | |
| Cold & warm compresses groups | 0.3992, 58 | 3.2005,58 |
| 0.580NS | <0.01** | |
| Control & cold compresses groups | 0.5769,58 | 1.9258,58 |
| 0.57NS | 0.015* | |
| Control & warm compresses group | 0.1853,58 | 5.0138,58 |
| 0.8537NS | <0.01** | |
N.B.NS= non-significantly, **p<0.01 highly significant, *p< 0.05 significant
Table 6 The data also revealed that during pre-test , there was no significant difference between cold & warm score had highly significant with ‘t’ value (3.2005) at p<0.01 level of significant. Comparison between pre-test score of compresses with the ‘t’ value (0.3992), control &cold compresses among primi whereas the comparison between post-test postnatal mothers had non-significant difference with ‘t’ value (0.5769), whereas the comparison between post-test score had significant with ‘t’ value (1.9258) at p<0.05 level of significant. Comparison between pre-test score of control &warm compresses among primi postnatal mothers had non-significant difference with ‘t’ value (0.1853), whereas the comparison between post-test score had highly significant with ‘t’ value (5.0138) at p<0.01 level of significant.
Discussion
Breast feeding is the most enriching experience for every mother; it plants the seeds of mother child bonding. It was found that breast engorgement is one among the several common problems that may arise during breast feeding and adequate management is fundamental. Different kind of managements are suggested by health professionals such as cold compress, warm compress cabbage leaves etc. But which is most effective and comfortable for mother is important. Keeping it in mind researcher investigated the effectiveness of cold vs warm compresses on reduction of breast engorgement among primi postnatal mothers.
This study revealed that as per pre- inter ventional scores of breast engorgement among primi postnatal mothers that majority of mothers had moderate type of breast engorgement in both intervention and control group i.e. 53.3% mothers in cold intervention group, 60% mothers in warm intervention and 43.3 % in control group. A very few number of mothers were having severe type of breast engorgement i.e. 13.3% in cold intervention group and warm intervention group, 16.7%\ in control group. The similar study supported byTawheda Mohamed Khalefa EI Saidy (2016) on 90 postnatal mothers to assess the effect of two different nursing care approaches on reduction of breast engorgement, the findings of study revealed that in cold cabbage leave application majority of the mothers had moderate breast engorgement (40%). In warm compresses group also majority of mothers had (43%) moderate breast engorgement.4
In this study result shows that during pre-test, mean ±SD was 2.87±0.63. After giving intervention mean ± SD was 2.80±0.71. So, statistically (t=12.98, p=0.00) proved that there was significant difference in the effectiveness of intervention in cold compresses group on reduction of breast engorgement. This was supported by Nanthini R (2013) who conducted a study among 60 postnatal mothers to assess the effectiveness of cold cabbage leaves on breast engorgement, the findings of the study revealed that there was significant (p<0.001) difference in the effectiveness of intervention on reduction of breast engorgement.5 In the present study to assess the effect of warm compresses on reduction of breast engorgement. The results show the pre-test mean±SD 2.80±0.66 after giving intervention mean ±SD was 2.10±1.27. So statistically proved that there was significant difference in effectiveness of intervention in warm compresses on reduction of breast engorgement. Resmy V (2014) conducted a similar study among 60 primiparous mothers to assess the effect of lukewarm water compresses on prevention of nipple pain and breast engorgement, the findings of the study revealed that there was significant difference in the effectiveness of intervention on reduction of nipple pain and breast engorgement6.
In the present study to compare the effectiveness between cold vs. warm compresses on reduction of breast engorgement. The results revealed significant improvement in reduction of breast engorgement. The average reduction of breast engorgement scores in warm compresses group was 2.10 and mean score of warm compresses group was 1.27. This study finding depicted that warm compresses are more effective than cold compresses.Moumita Manna et al (2016) conducted similar study to assess the effectiveness of hot fermentation versus cold compresses on breast engorgement among postnatal mothers. Findings of this study was that average reduction in breast engorgement score in cold compresses group was 3.6, in hot fermentation it was 3.4(p=0.001)7.
It is concluded from the present study that warm compresses is more effective than cold compresses to relieve breast engorgement. The researcher also felt while collecting data from the postnatal mothers that they feel more comfortable to have warm compresses than cold. This can be incorporated in routine practice. Further studies are needed to validate the result.
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