RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1. / NAME OF THE CANDIDATE / MS.M.SANGITA DEVI.2. / NAME OF THE INSTITUTION AND ADDRESS / A ECS MAARUTI COLLEGE OF
NURSING. NO.99, NEAR DENTAL COLLEGE, OFF BANNERGHATTA ROAD,KAMANAHALLI, BANGALORE- 76
3. / COURSE OF THE STUDY AND SUBJECT / IST YEAR MSc.NURSING OBSTETRICS AND GYNECOLOGICAL NURSING
4. / DATE OF ADMISSION TO THE COURSE / 17 MAY 2010
5. / TITLE OF THE TOPIC / “EFFECTIVENESS OF BREAST CRAWL TECHNIQUE TO INITIATE THE BREAST FEEDING AMONG NEWBORNS AT SELECTED MATERNITY HOSPITAL BANGALORE”.
INTRODUCTION
Breastfeeding is the feeding of a baby with milk directly from the mother’s breast, rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk.1 Human breast milk is the most healthful form of milk for babies. Breast milk, especially the first milk colostrum which contains antibacterial and antiviral agents that protects the infant against disease especially diarrhea. These are not present in animal milk or formula milk. Breast milk aids the development of infant’s own immune system.2
Breast feeding immediately after delivery encourages the “bonding” of the mother to her infant. Initiation of breastfeeding, it is the first contact and first breastfeed. The initiation of breastfeeding comprises of early skin-to-skin contact and opportunity to suck within the first hour or soon after birth are both important. Contact and sucking are closely interrelated with each other.3
Early initiation offers advantages to the mother and baby, helps to keep the baby warm leads to faster and effective achievement of feeding skills by the baby. The baby starts getting colostrum as the baby starts getting colonized by safe germs from the mother. Both these offer protection against infections and important for the survival of the baby.. It also helps mother to have good uterine contractions and fastens expulsion of placenta, decreases maternal blood loss and prevents anaemia. It maintains better sugar level and other biochemical parameters of the mother in the first few hours of birth.4
One of the method to initiate the breastfeeding is Breast Crawl. Breast crawl is the natural instinctive behavior of the human newborn. The mother and newborn dyad are mutually response in the most sensitive period of half to one hour following delivery for successful breast feeding. A baby is born with many instinctive abilities which enable her to performed. With all these innate programmes, the newborn seems to come into life carrying a small computer chip with the set of instructions. It appears that young humans, like other baby mammals, know how to find their mother’s breast.5
The Breast Crawl is associated with a variety of sensory, central, motor and neuro-endocrine components, all directly or indirectly helping the baby to move and facilitate her survival in the new world. The benefits accrued from the practice are innumerable, the most important being a significant reduction in mortality, morbidity and malnutrition among the children.6
Promotion of early initiation of breast feeding has great potential, worldwide 22 percentage of neonatal mortality can be prevented of breastfeeding initiated within an hour after birth .UNICEF,WHO, WABA and all other government agencies recommend that breast feeding should be initiated in the first hour of birth.7
6.BRIEF RESUME OF THE INTENDED WORK :
6.1 NEED FOR THE STUDY
Breast feeding is a natural human activity, difficulty are not uncommon. Breast crawl is important just after the delivery, the baby sucking reflex is strong and baby is more alert. Putting the baby to the breast as soon as possible after birth helps to avoid many problems.8
Proportions of babies breastfed by day 1 (median 72percent, interquartile range 60-82percent), and within the first hour (median 36percent, interquartile range 26-52percent)were low. For all countries combined, it was estimated that neonatal mortality could be reduced by 24percent if 99percent of babies initiated breastfeeding, on day 1 of life and by 31percent if 99percent of initiation was within the first hour.9
A global risk assessment of deaths and years of life lost due to suboptimal breastfeeding among children in the developing country revealed that attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55percent and 53percent, respectively, for the first six months of infancy, 20percent and 18percent for the second six months, and are 20percent for all-cause deaths in the second year of life. The authors concluded that globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. The study suggested that initiation of breastfeeding within 1 hour could cut 22percent all neonatal mortality. It calls for support to all mothers during the first hour to ensure early initiation of breastfeeding.10
A study is conducted for initiating of breastfeeding after birth. Breastfeeding was initiated within the first 24 hrs after birth in 71 percent of infants. The later the start of breastfeeding the greater the risk of neonatal death. Infants given any food or fluids before breastfeeding was established on day 1 of life also had higher risk of neonatal mortality. The authors estimated that 22 percent of neonatal deaths after 1 day of age could be prevented by starting breastfeeding within 1 hr of birth.11
Global incidence shows that optimal breastfeeding is the most important child survival intervention and the earlier the baby is breastfed, within the first hour of birth, the better. Only 25 percent of mothers in country initiate breastfeeding within the first hour after birth, whereas in Rajasthan is 14 percent, while in Bihar and Uttar Pradesh is 4 and 7 percent. The Government of India and international organizations recommend that infants be fed only breast milk for the first six months of life, with no other foods or fluids added, not even water.
The percentage of neonatal deaths could be prevented by initiating breastfeeding in the first hour of life was 41.3 percent This is equivalent to preventing 22.3 percent of all neonatal deaths Similarly, initiating breastfeeding on the first day could have saved 30.2 percent of neonatal deaths from days 2.12
Research has also found that feeding infants with water after breastfeeding is a popular practice in both urban and rural areas of India. In India, over 400,000 newborns die within the first 24 hours of their birth every year, the highest anywhere in the world, a study by an international non-government organisation, 'Save the Children', has declared. By reviewing the literature and advantages of early initiation of breast feeding by breast crawl technique and also by understanding the importance of breast feeding, the researcher felt the need for assessing the effectiveness of breast crawl to initiate the breast feeding.13
6.2 REVIEW OF THE LITERATURE
An experimental study was conducted on 702 mothers who were randomly selected and interviewed on maternal attitudes and trends in initiation of newborn feeding. 305 of the mothers were primipara and 297 were multipara. Most of the mothers 69percent fed the babies within 1 hour, but around 30.31 percent mothers breastfed the babies only after 1 hour. 58.32 percent mothers could not identify advantages of breastfeeding. The results shows that there is a need for educating about the early initiation of breastfeeding and the importance of colostrum to newborn.14
A study was conducted on 60 healthy, full-term babies were randomly assigned to group A with skin-to-skin contact and group B without, after birth, babies responses to the following odour stimuli were observed: own mother's milk, another mother's milk, formula, orange juice and distilled water. Statistical analyzing, comparing the frequency of mouthing movements with the five different odour exposures was performed to compare the breastfeeding rates between groups. Babies in both groups responded differently to mother's milk odour (either their own or another mother's milk)., Babies in group A demonstrated a larger difference in mouthing movements between their own and another mother's milk odour (2.6 +/- 1.6) compared to babies in group B (0.9 +/- 2.0, p = 0.01). Babies in group A were breastfed an average of 1.9 more longer than the others. The study provides evidence that mother-infant skin-to-skin contact for more than 50 min immediately after birth results in enhanced recognition of their own mother's milk.15
A study to assess the effectiveness of early initiation of breastfeeding on 111 primiparous women who had chosen to breast-feed their normal healthy term infants. They were assigned to one of four groups matched for age and social class. In that two groups the baby put to the breast within 10 min of delivery and the other two began breast-feeding 4--6 h after delivery. One of each pair of groups fed 2-hourly and the other 4-hourly. Follow-up over 18 months suggested that both early initiation and increased frequency of breast-feeding extended the nursing period, the former having the greater effect. 2-hourly feeding induced lactation at least 24 h earlier than did 4-hourly feeding.16
An experimental study was adopted for 22babies to assess the ability of newborn to initiate breastfeeding through breast crawl which is assessed by LATCH breastfeeding tool, soon after the delivery newborn were placed in breast crawl position and mothers were instructed to hold their newborn. The results found that, 91percent of newborns completed breast crawl within 80 minutes duration, average time taken by newborns to achieve the latch was 27minutes. The mother satisfied and agreed that breast crawl is the best method to initiate breast feeding.17
A cross sectional study was conducted for the effective of separation on the Breast Crawl in 72 infants. In the separated group (n=34), the infant was placed on the mother's abdomen immediately after birth but removed after 10 minutes for measuring and wrapping. These routines took about 10 minutes after which the infant was returned to the mother. In the contact group (n=38) contact between mother and infant was uninterrupted for at least one hour after birth. The sucking ability technique was studied in both the groups. In the separation group (n=34), 7 infant has sucking reflex and in the contact group (n=38), 24 infants suck correctly. The study concluded that brief separation of the infant from the mother during the first hour after birth had a strong effect on the success of the first breastfeed, Thus, the two determinants for a successful start to breastfeeding seem to be uninterrupted contact with the mother until after the first feed.18
A study is conducted to assess the effectiveness of breast crawl technique among 34 babies. In the contact group (n=17) babies kept in the Breast Crawl position and in uninterrupted skin-to-skin contact for 1 hour, in that 16babies attached to the breast correctly. In the separated group (n=17), babies were separated after about 20 minutes for routine measuring and weighing procedures. After an interval of approximately 20 minutes, babies were returned to the mother. In separated group Only 7 babies attached correctly . These findings shows that the uninterrupted skin to skin contact for 1hour will enhanced for the success of breastfeeding.1 9
PROBLEM STATEMENT
“Effectiveness of Breast crawl technique to initiate breast feeding among newborns at selected Maternity Hospital, Banglore.”
6.3 OBJECTIVES
· To assess the ability of newborn to initiate breastfeeding by LATCH breast feeding assessment tool.
· To find out the effectiveness of breast crawl technique to initiate breast feeding among newborn by comparing with control group.
· To find out the association between initiation of breast feeding and selected demographic variables.
OPERATIONAL DEFINITION :
Effectiveness : It refers to early initiation of the breast feeding by the newborn with breast crawl technique.
Breast crawl technique : It refers to the method of finding the ability of newborns to search for mother’s breast on their own and to decide when to take breastfeed, when placed on the mother’s abdomen soon after birth with the help of crawling movement
Initiation of Breastfeeding : In this study it refers to the first contact and the first breastfeed within the first hour.
Newborn : It refers to the babies who were full term and delivered normally.
HYPOTHESIS
H1- there is a significant difference in initiation of breast feeding among experimental group and control group.
H2- there is significant association between initiation of breastfeeding and selected demographic variables.
VARIABLES
Independent variable : Breast crawl technique
Dependent variable: Initiation of breast feeding by newborn
Demographic variables : In this study demographic variables for mother such as age, parity, education, occupation, religion, type of family, place of residence, sources of information.and for baby such as sex, weight, height, APGAR score, religion.
DELIMITATION
The study is limited to selected full term newborn who delivered normally.
7.MATERIALS AND METHODS
7.1 Source of data:
The data will be collected from the mothers who are in labour and by observation of newborn at the selected maternity hospitals of Banglore.
7.2 Methods of collection of data:
A prior permission will be obtained from the concerned hospital authorities for conducting study. An informed consent will be obtained from the subject, the process of the study will be explained to the subjects.
The investigator will use the structure interview schedule to collect demographic data. Initiation of breast feeding will be assessed by the LATCH breast feeding assessment tool.
L- latch
A- Amount of audible swallowing
T- Type of nipple
B- Mother’s level of comfort
H- Hold
7.3 Research approach:
Experimental approach.
7.4 Research design:
post test with experimental and control group design.
E / X ( breast crawling technique) / O1C / - / O1
E= experimental group
C= control group
O1= observation
7.5 Research setting:
Study will be conducted in selected maternity hospitals of Banglore
7.6 Population:
The population of the study comprises of full term newborn who had delivered normally in the maternity, Hospital.
7.7 Sample:
Newborn who has full term and delivered by normal vaginal delivery at selected maternity, Hospital.
7.8 Sampling technique:
Non probability purposive sampling technique will be used.