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Efficacy of a Breastfeeding Pain Self-Management Intervention

A Pilot Randomized Controlled Trial

Lucas, Ruth; Zhang, Yiming; Walsh, Stephen J.; Evans, Heather; Young, Erin; Starkweather, Angela

doi: 10.1097/NNR.0000000000000336

Background Over 90% of women experience pain during breastfeeding initiation and lack strategies to self-manage breast and nipple pain. Guided by the Individual and Family Self-Management Theory, a breastfeeding self-management (BSM) intervention targeted women's knowledge, beliefs, and social facilitation to manage their breast and nipple pain and achieve their breastfeeding goals.

Objectives The purpose of this longitudinal pilot randomized control trial (RCT) was to test the preliminary efficacy of the BSM intervention on general and specific pain related to breastfeeding.

Methods Sixty women intending to breastfeed were approached within 48 hours of delivery to participate in this pilot RCT (30 randomized to the BSM intervention and 30 randomized to the control group). All participants provided baseline data before discharge and pain and breastfeeding measures at 1, 2, and 6 weeks. Participants in the BSM intervention group received educational modules addressing breast and nipple pain and biweekly, text-based nurse coaching and completed a daily breastfeeding journal.

Results Women in the BSM intervention group reported significantly less breast and nipple pain at 1 and 2 weeks using a visual analog scale (p < .014 and p < .006) and at 2 weeks using the Brief Pain Inventory intensity scale (p < .029), but no difference in breastfeeding duration.

Discussion The BSM intervention pilot demonstrates a positive effect on breastfeeding specific and overall generalized pain. Future investigation is needed to identify at-risk women of ongoing breastfeeding pain and develop precision interventions to sustain this beneficial health behavior for mothers and infants.

Ruth Lucas, PhD, RNC, CLC, is Assistant Professor, University of Connecticut School of Nursing, Storrs.

Yiming Zhang, MS, is Graduate Student, University of Connecticut Department of Statistics, University of Connecticut School of Nursing, Storrs.

Stephen J. Walsh, ScD, is Associate Professor, University of Connecticut School of Nursing, Storrs.

Heather Evans, PhD, is Assistant Professor, School of Interdisciplinary Health & Science, Department of Nursing, University of Saint Joseph, West Hartford, Connecticut.

Erin Young, PhD, is Assistant Professor, University of Connecticut School of Nursing, Storrs.

Angela Starkweather, PhD, ACNP-BC, FAAN, is Professor, University of Connecticut School of Nursing, Storrs.

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Accepted for publication November 6, 2018.

The research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health (NIH-NINR), Grant Number NIH-NINR P20NR016605.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors confirm that any aspects of the work reported in this manuscript has been conducted by the ethical conduct of research and approved by the University of Connecticut Institutional Review Board.

The study was registered with Clinical (NCT03392675). Data were collected from April 2017 to November 2017.

The authors have no conflicts of interest to disclose.

Corresponding author: Ruth Lucas, PhD, RN, University of Connecticut, School of Nursing, Storrs Hall, Room 209, 231 Glenbrook Rd. U-4026, Storrs, CT 06269 (e-mail:

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