Compare the Effects of Ultrasound versus Taping in Lactating Mothers with Breast Engorgement

Abstract

Human milk has hundreds of milk proteins, which provides many benefits on breastfeeding. Breastfeeding is a mother’s gift to herself, her baby, and the earth, there is no substitute for mother’s milk. Milk protein is most important for baby’s growth, development and protects the baby from different illness. Colostrum is produced during early days immediately after child birth, which contains important nutrients and antibodies. Breast engorgement is a problem that is commonly encountered in breastfeeding mothers, which is to be addressed and treated to provide good milk proteins to baby, by relieving discomforts of lactating mothers. A randomized controlled trial was conducted with 30 subjects based on inclusion and exclusion criteria where the subjects are divided into two groups, which contain 15 lactating mothers in each group. The control group that is group-A was treated with ultrasound, and the experimental group that is group-B was treated with ultrasound and Taping Technique. The result of the study showed that there was a significant difference between the pre- and posttest intervention, and we conclude that the ultrasound therapy and Kinesio taping was effective in treating lactating mothers with breast engorgement.

1. Introduction

Milk protein is most important for baby’s growth, development and protects the baby from different illness. Whey proteins and Casein proteins are two types of proteins in breast milk; whey proteins contain antibodies, lactoferrin and lysozyme, which protect baby from infection and are easy to digest. Casein proteins are harder to digest with more complex molecules. Colostrum is produced during early days immediately after child birth, which contains important nutrients and antibodies [1]. During early stages, lactating mothers may produce small quantity of colostrum; later milk production will be increased to the maximum, which makes the breast fuller and firmer causing increased blood flow and lymph fluids [2] to the breast tissue. If baby is not fed properly or any problem in lactating, the breast milk is stored, and some mothers may face problems related to over production of milk; all these components make the breast heavy and later turns to very hard as rock, this uncomfortable condition is known as breast engorgement. Breast engorgement problem [3] should be addressed because if it is left untreated, that may lead to serious issues [4], and in future it may result in painful blebs, and plugged milk ducts may also lead to mastitis. Without the knowledge of identification, many lactating mothers are suffering with breast engorgement [5]. Severe engorgement may also rise body temperature around 99–100 degree F, and this rise in body temperature is termed as “Milk fever.” According to Academy of Breastfeeding Medicine Protocol Committee, breast engorgement is defined as “the swelling and distension of the breasts” [6]. Sometime engorgement results due to interrupted or infrequent or delayed milk from breast [7, 8]; this kind of problems may place the mother at high risk of engorgement [9], causing unhealthy growth and development of the infant. The infant may not get the required milk protein if the mother is facing problems of engorgement. This problem should definitely bring to the notice, which is troubling to both mother and infant where its incidence in the world is 1:8000 and in India is 1:6500. According to NFHS [10], painful breast problems are the most common reason for giving up breastfeeding. Treatment for breast engorgement can prevent future breast-related complication and also helps the baby to get proper milk proteins, which helps in proper growth and development of the baby. It is a major issue in early postpartum period as the breast under the influence of hormonal shift increased milk production rapidly. Interventions such as ultrasound therapy [11, 12, 13, 14] application of hot moist [15], gentle massage [16] before feeding are beneficial. Through, Kinesio taping at the engorgement area, it decreases the inflammation, pain and improves circulation and lymphatic drainage. Hence, this study was to determine whether taping offers any advantage over ultrasound.

2. Methods

An experimental study was conducted on 30 subjects using convenient sampling technique based on inclusion and exclusion criteria. Lactating mothers with breast engorgement and pain for at least 2–3 days in postpartum period between 20 and 35 years of age were included in the study. Non-lactating women, pregnant women, lactating mothers with soft breast, lactating mothers receiving lactating suppressants, and lactating mothers with breast abscess, breast infection, mastitis, broken skin of the breast, bleeding or cracked nipple were excluded from the study. After receiving informed consent from the subjects, detailed explanation of the study is provided to them. All the information related to outcome measures, i.e., Six-Point Self-rated Engorgement Scale (SPES) [17] and Visual Analogue Scale (VAS), is given in Figures 1 and 2.

Figure 1.

Six-point self-rated engorgement scale.

Figure 2.

Visual analogue scale.

In this study, 30 subjects were divided into two groups, group-A and group-B. Fifteen subjects were allotted in each group. Pain parameter was measured with visual analogue scale in both groups before and after the treatment. Functional evaluation of both the groups was done with six-point self-rated engorgement scale before and after the treatment. Both the parameters were measured first day and after 1 week of treatment procedure. All the subjects received their treatment at the outpatient department of Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai. Every subject followed the treatment for required period of 1 week.

Group-A: Fifteen subjects were treated with ultrasound for 1 week. The subjects were made to lie in supine with the arm of the treated side placed behind the head. A continuous mode of therapeutic ultrasound was given using ultrasound transmission gel as the coupling agent, with the intensity of 1 W/cm² and frequency of 1MHZ passing the head of the ultrasound firmly over the breast from the periphery toward the areola, lightly back to the chest, and firmly down again to the areola, gradually working around the breast for 8 minutes.

Group-B: To the next 15 patients, continuous mode of therapeutic ultrasound was given using ultrasound transmission gel as the coupling agent, with the intensity of 1 W cm² and frequency of 1MHZ passing the head of the ultrasound firmly over the breast from the periphery toward the areola, lightly back to the chest, and firmly down again to the areola, gradually working around the breast for 8 min, then subjects are treated with the taping techniques by using Kinesio tape (KT). Breast was exposed to clean with wet cotton dipped in water and breast is allowed to dry for few seconds and after drying, two pieces of tape which was about 7–9 inches, were taken. Seven to nine inches of tape was further cut into five strips equally. Taping was done with minimal stretch of 10–5% without extra tension by avoiding axilla with an anchoring base and rounded corners. Patients were instructed to wear the tape for 42–72 hours and also instructed to remove the tape prior to the prescribed time only if any skin irritation occurs. At the day 3 follow-up, the skin was inspected and assessed their primary outcome measures and then taped with the same technique used previously for 1 week. After the end of 1 week post Visual Analogue Scale and Six-Point self-rated Engorgement Scale were taken, and results are analyzed.

3. Results

Database was statistically analyzed using descriptive and inferential statistics; mean and standard deviation were estimated using paired and independent t test. Paired t test was used to compare data sets within the groups, and independent t test was used to compare the data sets between the groups (Tables 1–4).

Groups	Mean Age(Yrs) + SD
Group-A	25.05 (± 2.04)
Group-B	25.25 (±1.82)

Table 1.

Mean age distribution.

GROUP-A		MEAN	STANDARD DEVIATION	t VALUE	P VALUE
SIX-POINT SELF-RATED ENGORGEMENT SCALE(SPES)	PRE TEST	4.53	1.06	11.3436	<0.0001
	POST TEST	1.20	0.41
VAS SCORE (VAS)	PRE TEST	7.00	1.25	13.6871	<0.0001
	POST TEST	1.80	0.77

Table 2.

Comparison of pre-test and post-test values of SPES and VAS in group-A.

(GROUP-B)		MEAN	STANDARD DEVIATION	t VALUE	P VALUE
SIX-POINT SELF-RATED ENGORGEMENT SCALE	PRE TEST	4.73	1.16	12.4335	<0.0001
	POST TEST	1.00	0.00
VAS SCORE	PRE TEST	7.00	1.13	17.4611	<0.0001
	POST TEST	1.40	0.51

Table 3.

Comparison of pre-test and post-test values of SPES and VAS in Group-B.

POST TEST		MEAN	STANDARD DEVIATION	t VALUE	P VALUE
SIX-POINT SELF-RATED ENGORGEMENT SCALE	Group A	1.20	0.41	1.8708	<0.0001
	Group B	1.00	1.16
VAS SCORE	Group A	1.80	0.77	1.8708	<0.0001
	Group B	1.40	0.51

Table 4.

Comparison of post-test values of SPES and VAS in groups A and B.

Age distribution:

The average age of the subjects in group-A was 25.05 ± 2.04 years and in group-B was 25.25 ±.

1.82 years. There was no significant difference between the mean ages of the subjects in both the groups

Pre-test and post-test values of SPES and VAS of subjects in group A. The pre-test mean value of SPES was 4.53, and post-test mean value was 1.20. This shows that the SPES was gradually decreasing significantly at p < 0.0001. The pre-test mean value of VAS was 7.0, and post-test mean value was 1.80.This shows that the VAS scores were gradually decreasing significantly at p < 0.0001.

Pre-test and post-test values of SPES and VAS of subjects in group-B. The pre-test mean value of SPES was 4.73, and post-test mean value was 1.00.This shows that the SPES scores were gradually decreasing significantly at p < 0.0001.The pre-test mean value of VAS was 7.00, and post-test mean value was 1.40.This shows that the VAS scores were gradually decreasing significantly at p < 0.0001.

Post-test values of SPES and VAS of subjects in group-A and group-B. The post-test mean value of SPES in group-A was 1.20, and post-test mean value of SPES in group-B was 1.00.This shows group-B has greater improvement in reduction of engorgement than group A with the p value (0.0001). The post-test mean value of VAS in group-A was 1.80, and post-test mean value of VAS of group-B was 1.40.This shows group-B has greater improvement in reduction of pain than group-A with the p value (0.0001).

Quantitative data analysis revealed that there is a significant difference between group A and B and within the groups. SPES post-test mean value in group-A was 1.20, and in group-B was 1.00. SPES Scores in group-B were comparatively lesser than those of group-A, p < 0.0001. The post-test mean value of VAS in group-A was 1.80, and post-test mean value of VAS in group-B was 1.40. This shows VAS scores in group-B were comparatively lesser than those in group-A, p < 0.0001.Statistical analysis of post-test for pain and engorgement revealed that subjects who received ultrasound and taping in group-B showed marked improvement compared with patients who received only ultrasound in group-A.

4. Discussion

Milk proteins are very essential for the baby in the early age of life; breast engorgement is a condition that troubles the baby as well as the mother by creating difficulties in breastfeeding, which is considered as second most problem affecting the lactation. To provide milk proteins and nutrients to the child, breast engorgement has to be treated in lactating mothers. So this study was designed to compare the effect of ultrasound and taping in lactating mothers with breast engorgement, with the help of ultrasound and taping technique, which reduces pain, engorgement and also prevents further complications. Reduction of engorgement helps the mother to feed her child and to provide proper milk proteins to the child. Breast milk is most important for the babies to get benefits of milk proteins. Breastfeeding plays an important role in reproductive age of women and beneficial for mother and child as well [18]. Breastfeeding is a physiological process, and it has to be encouraged; numerous studies demonstrate the importance of breastfeeding in providing protection against various diseases and decreasing the incidence of infant morbidity and mortality [19]. “All health professional groups support breastfeeding as the ideal way to nourish an infant, but numerous surveys have shown that, in general, even perinatal health professionals are not prepared to provide lactation management as part of routine care” [12]. Ultrasound helps the tissue to heal more effectively as it gives: 1) essential micromassage for individual cells, 2) increases cellular activity, and 3) responsible for the effect of therapeutic benefits. Ultrasound frequency was selected based on the depth of the tissue to be treated. The depth of ultrasound penetration was usually described in terms of half-value depth for the specific ultrasound frequency. Through, Kinesio taping at the engorgement area, it decreases the inflammation, pain and improves circulation and lymphatic drainage. In recent years, the use of Kinesio Tape (KT) has become increasingly popular. KT has same thickness as the epidermis in the skin when stretched to 30–40% of its resting length longitudinally, which is suitable to human skin, and was designed to mimic the qualities of human skin. It has roughly the same thickness as the epidermis and stretched between 30% and 40% of its resting length longitudinally. Kenzo Kase [20] proposed many benefits of Kinesio taping, which depends on the stretch applied during taping. It provides positional stimulus, creates sensory stimulation to limit motion, and removes edema. It is latex-free,heat-activated, and 100% cotton fiber helps to dry quickly. The purpose of our study was to investigate whether KT has an effect on breast engorgement in breastfeeding mothers during the postpartum period and also to help lactating mothers in providing proper milk proteins to the infant. We hypothesized that breastfeeding mothers would experience a decrease in breast engorgement by using the KT method, which helps in lactation and also provides milk proteins to the baby. Hence, the present study was undertaken with an intention to compare the effect of ultrasound therapy with Kinesio taping in lactating mothers. The result of the study showed that there was a significant difference between the pre- and post-test intervention.

5. Conclusion

In this study by comparing the effects of ultrasound versus taping in lactating mothers with breast engorgement, the result of the study showed that there was a significant difference between the pre- and post-test intervention. Both the groups resulted in positive outcomes, but group-B with ultrasound and Kinesio taping showed a higher level of positive outcome in terms of decreasing pain and engorgement, when compared with group-A with ultrasound among lactating mothers. The study concluded that ultrasound and Kinesio taping help in reducing pain and engorgement, which helps the mother to provide proper lactation, which in turn helps the baby to get proper milk proteins without delaying the feeding.