Effects of Warm Shower on Lactation, Fatigue, and Maternal Burnout (WARM-SHOWER)

The Effect Of Warm Showers On Exhaustıon, Fatigue, Lactation Onset Symptoms and Breast Milk Quantity In The First Three Postpartum Days: A Randomized Controlled Trial

Lactation is a physiological process in which various hormones, especially prolactin and oxytocin, play a role. Methods such as warm showers are preferred because they are easy to apply and have a quick effect, as well as being cost-effective. It increases the amount of milk by showing a direct effect on oxytocin and prolactin hormones in the breastfeeding process that strengthens the bond between mother and baby. It helps to make the breastfeeding process more enjoyable for mother and baby. Guidelines in the literature emphasize that the mother should be psychologically evaluated and that practices that can relax her according to her needs should be applied to increase breastfeeding success. In addition to hormonal regulation, a warm shower improves self-care. In this way, breastfeeding motivation increases. The aim of this study was to investigate the effect of warm showers in the morning and evening in the first 3 postpartum days on the amount of breast milk by shedding light on hormones and lactation process.

Study Overview

• Status: Completed
• Conditions: Breastfeeding; Maternal Burnout; Postpartum Fatigue
• Intervention / Treatment: Behavioral: Warm Shower

Detailed Description

This study is a single-center, parallel-group randomized controlled trial designed to evaluate the effects of warm shower application during the first three postpartum days on maternal burnout, fatigue, lactation onset indicators, and breast milk intake among women who underwent cesarean birth. The intervention is based on the premise that warm water exposure may promote relaxation, improve physical comfort, reduce fatigue and stress, and support physiological mechanisms associated with lactation. The study aims to determine whether a structured warm shower intervention can improve maternal well-being and breastfeeding-related outcomes during the early postpartum period.

Eligible participants for the study are first-time mothers who have had a cesarean delivery and meet the study's inclusion criteria. Following the baseline assessment, participants are randomly assigned in a 1:1 ratio to either the intervention group or the control group. Women in the intervention group receive routine postpartum care plus a standard warm shower (37-39°C, 10-15 minutes) once daily at 24, 48, and 72 hours after delivery, as well as on days 7 and 14 postpartum, while women in the control group receive only routine postpartum care. Outcome assessments are conducted at baseline, immediately following the intervention, at 24, 48, and 72 hours postpartum, and during follow-up visits on the 7th and 14th days postpartum.

Maternal burnout is evaluated using the Maternal Burnout Scale, while fatigue is assessed using the Visual Analogue Scale for Fatigue. Lactation onset indicators are assessed through breast fullness and milk secretion characteristics, and infant breast milk intake is evaluated using the IMDAT Breast Milk Intake Scoring System. Data are analyzed using appropriate repeated-measures statistical methods to examine changes over time, between-group differences, and group-by-time interactions. The study aims to provide evidence regarding the effectiveness, safety, and clinical applicability of a low-cost, non-pharmacological postpartum care intervention that may support maternal recovery and breastfeeding outcomes.

• Study Type: Interventional
• Enrollment (Actual): 64
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Karatay
    • Konya, Karatay, Turkey (Türkiye)
      • KTO Karatay University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Having given birth between 37 and 42 weeks of gestation
• Having had a cesarean delivery
• Being a primipara
• Being admitted to the postpartum ward within the first 6 hours
• No physical or cognitive limitations preventing the ability to shower
• Providing written informed consent

Exclusion Criteria:

• Premature infant or infant in the neonatal intensive care unit
• Maternal history of infection, complications, or psychiatric diagnosis
• Physiological condition preventing breastfeeding

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Warm Shower + Routine Postpartum Care; Participants receive routine postpartum care plus a standardized warm shower intervention during the first three postpartum days. Women in the intervention group are instructed to take a warm shower (37-39°C) once daily for 10-15 minutes following confirmation of clinical stability and mobilization readiness. The intervention is delivered in addition to routine postpartum care and is intended to promote relaxation, physical comfort, maternal well-being, and lactation-related outcomes during the early postpartum period.	Behavioral: Warm Shower; Participants receive routine postpartum care in addition to a standardized warm shower (37-39°C, 10-15 minutes) once daily during the first three postpartum days after cesarean birth.
No Intervention: Routine Postpartum Care (Control); Participants in the control group receive routine postpartum care according to hospital protocol, including standard maternal and newborn monitoring, breastfeeding support, and postpartum recovery care. No warm shower intervention is administered.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maternal Burnout	Maternal Burnout Scale (MBS). The Maternal Burnout Scale was used to assess maternal burnout levels. The scale consists of 15 items rated on a 4-point Likert scale and includes the dimensions of physical and emotional exhaustion, emotional distancing from the child, and reduced maternal accomplishment. Higher scores indicate higher levels of maternal burnout.	Assessed at baseline (6-12 hours postpartum), immediately after the intervention, and at 24, 48, and 72 hours postpartum, as well as on postpartum days 7 and 14.
Lactation Onset Indicators	Lactation onset indicators will be assessed as a composite outcome using the Lactation Assessment Form, which includes breast fullness, milk secretion characteristics, and post-feeding breast status.	Assessed at baseline (6-12 hours postpartum), immediately after the intervention, and at 24, 48, and 72 hours postpartum, as well as on postpartum days 7 and 14.
Postpartum Fatigue	Postpartum fatigue will be assessed using the Visual Analogue Scale for Fatigue (VAS-F), an 18-item instrument designed to assess fatigue. Higher scores indicate greater postpartum fatigue.	Assessed at baseline (6-12 hours postpartum), immediately after the intervention, and at 24, 48, and 72 hours postpartum, as well as on postpartum days 7 and 14.
Infant breast milk intake score	Infant breast milk intake will be assessed using the IMDAT Breast Milk Intake Scoring System. Higher scores indicate greater breast milk intake. Unit of	Assessed at baseline (6-12 hours postpartum), immediately after the intervention, at 24, 48, and 72 hours postpartum, and on postpartum days 7 and 14.

Collaborators and Investigators

• Sponsor: KTO Karatay University

Study record dates

Study Major Dates

• Study Start (Actual): October 10, 2025
• Primary Completion (Actual): April 10, 2026
• Study Completion (Actual): June 15, 2026

Study Registration Dates

• First Submitted: June 19, 2026
• First Submitted That Met QC Criteria: July 4, 2026
• First Posted (Actual): July 10, 2026

Study Record Updates

• Last Update Posted (Actual): July 10, 2026
• Last Update Submitted That Met QC Criteria: July 4, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Oxytocin; Lactation; Breastfeeding; Prolactin; Warm Shower
• Additional Relevant MeSH Terms: Behavior; Feeding Behavior; Breast Feeding
• Other Study ID Numbers: KaratayU-RCT-WarmShower-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No