Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial

Mariarosa Milinco, Laura Travan, Adriano Cattaneo, Alessandra Knowles, Maria Vittoria Sola, Enrica Causin, Caterina Cortivo, Maura Degrassi, Francesca Di Tommaso, Giuseppa Verardi, Laura Dipietro, Maria Piazza, Sabrina Scolz, Martina Rossetto, Luca Ronfani, Trieste BN (Biological Nurturing) Investigators, Graziella Andreassich, Antonietta Antonino, Silvia Bidoli, Maria Bonelli, Pierpaolo Brovedani, Jenny Bua, Donatella Bubnich, Maria Chignoli, Valentina Ciacci, Rosaria Cirillo, Aurora Colombera, Gabriele Cont, Elisabetta Crismani, Cristiana Delli Carri, Enrica Dovier, Filippa Favuzza, Claudia Ferro, Claudia Flaiban, Chiara Garofalo, Marina Giugovaz, Simona Guerrera, Erika Imbrogno, Izabella Kis, Valentina Liut, Carla Marandola, Miriana Marzullo, Antonella Mottola, Silvia Nider, Matteo Pavan, Annalisa Pelaschiar, Emma Persic, Maria Petruzzelli, Rosa Piccirillo, Angela Pirrone, Tiziana Pucci, Marzia Rabusin, Davide Scattorin, Tanja Sedmak, Patrizia Semenzato, Giulia Silvestri, Valentina Speranza, Cristina Sustersich, Lorella Tormena, Flora Torretta, Antonella Trappan, Virginia Tropiano, Chiara Zanon, Dolores Zollia, Mariarosa Milinco, Laura Travan, Adriano Cattaneo, Alessandra Knowles, Maria Vittoria Sola, Enrica Causin, Caterina Cortivo, Maura Degrassi, Francesca Di Tommaso, Giuseppa Verardi, Laura Dipietro, Maria Piazza, Sabrina Scolz, Martina Rossetto, Luca Ronfani, Trieste BN (Biological Nurturing) Investigators, Graziella Andreassich, Antonietta Antonino, Silvia Bidoli, Maria Bonelli, Pierpaolo Brovedani, Jenny Bua, Donatella Bubnich, Maria Chignoli, Valentina Ciacci, Rosaria Cirillo, Aurora Colombera, Gabriele Cont, Elisabetta Crismani, Cristiana Delli Carri, Enrica Dovier, Filippa Favuzza, Claudia Ferro, Claudia Flaiban, Chiara Garofalo, Marina Giugovaz, Simona Guerrera, Erika Imbrogno, Izabella Kis, Valentina Liut, Carla Marandola, Miriana Marzullo, Antonella Mottola, Silvia Nider, Matteo Pavan, Annalisa Pelaschiar, Emma Persic, Maria Petruzzelli, Rosa Piccirillo, Angela Pirrone, Tiziana Pucci, Marzia Rabusin, Davide Scattorin, Tanja Sedmak, Patrizia Semenzato, Giulia Silvestri, Valentina Speranza, Cristina Sustersich, Lorella Tormena, Flora Torretta, Antonella Trappan, Virginia Tropiano, Chiara Zanon, Dolores Zollia

Abstract

Background: Biological nurturing is a neurobehavioral approach to breastfeeding support that encourages women to breastfed in a relaxed, laidback position. This approach has the potential to reduce breast problems (e.g., sore nipples), making good latch easier and thus facilitating the initiation of exclusive breastfeeding. However, its effects have not been adequately investigated in a real-life situation. The aim of this randomized controlled trial was to assess the effectiveness of biological nurturing, compared to usual hospital practices, on the frequency of breast problems and on the prevalence of exclusive breastfeeding at discharge from the maternity ward, after 1 week, and at one and 4 months.

Methods: Open randomized parallel controlled trial carried out in a third level maternity ward (IRCCS Burlo Garofolo, Trieste, Italy) between March and December 2018. Two-hundred eight women who planned to give birth at the hospital and who expressed the intention to breastfeed were enrolled during pregnancy and randomized to receive breastfeeding support following either the biological nurturing approach or the usual care protocol based on the WHO/UNICEF 20-h course, in use at the hospital. The primary study outcome was the incidence of breast problems during hospital stay, defined as the presence of one or more of the following outcomes, collected separately: sore nipples, cracked nipples, engorgement and mastitis. The primary analysis was performed by intention to treat. The follow up lasted 4 months.

Results: One hundred eighty eight out of 208 women (90.3%) were included in the analysis, 90 allocated to the biological nurturing group and 98 to the usual care group. At discharge from the maternity ward, biological nurturing significantly reduced the risk of breast problems (Relative risk [RR] 0.56, 95% Confidence Interval [CI] 0.40, 0.79), including cracked (RR 0.42, 95% CI 0.24, 0.74) and sore nipples (RR 0.59, 95% CI 0.40, 0.88). No statistically significant difference was observed for exclusive breastfeeding at discharge and up to 4 months. No adverse events occurred.

Conclusions: The biological nurturing approach applied in the real-life situation of a third level hospital was effective in preventing breast problems.

Trial registration: Clinicaltrials.gov NCT03503500. Date of First Submission: 28 March 2018.

Keywords: Biological nurturing; Breast problems; Breastfeeding; Exclusive breastfeeding; Public health.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT study flow chart
Fig. 2
Fig. 2
Study results, intention-to-treat analysis
Fig. 3
Fig. 3
Patterns of infant feeding during the study

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Source: PubMed

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