@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2017;23(4):319-324

Background
Low-weight and premature infants are at high risk group of society, and experience lots of physical, emotional and psychological problems compared to normal infants [1].
Previous Studies
… [2-7].The probability of successful breastfeeding among mothers with premature infants whose infants are hospitalized in neonatal department is lower than mothers with healthy and mature infants [8]. The incidence of breastfeeding among mothers of term infants, among mother with newborns in weeks 32 to 36, and mothers with newborns in weeks 24 to 31 has been 77%, 70% and 63% respectively [9]. These infants are unable to suck milk due to the lack of physiological and neurodevelopment systems [10]. … [11-19]. Reflexology is one of the non-pharmacological and manual interventions that has been used in studies to provide satisfaction at start of lactation in postpartum primiparous women [20]. Since reflexology is a simple, accessible and non-invasive techniques, and does not require special equipment, today, it has attracted a wide range of mothers' satisfaction [21]. ... [22].
Aim(s)
No studies have been conducted on reflexology effects on the production of breast milk in mothers with premature infants. Considering the importance of breastfeeding in promoting maternal and child health, this study aimed to determine the effect of foot reflexology on milk production in mothers with preterm infants.
Research type
This study is a randomized, double-blind clinical trial.
Research society, place and time
This study was carried out among mothers with preterm infants with a fetal age of 28 to 34 weeks admitted to the neonatal intensive care unit at Shohada Hospital in Quchan City in 2016 who fed breast milk from nasal catheter.
Sampling method and number
The sample size was based on the similar study [23], taking into account that 80% test power and the confidence coefficient of 0.95, using the mean comparison formula for two independent societies, and considering 50% loss of samples due to ill health of the infant, general maladaptation of mothers, and failure of mothers after maternal delivery to the intensive care unit due to bad weather conditions, 15 samples were obtained for each group. The samples were selected through convenience sampling method and randomly divided into intervention and control groups. The criteria for entering the study included: age 17 to 40, inclination to breastfeeding, lack of smoking and narcotics, body mass index in the normal range, no history of serious and chronic illness, such as cardiovascular disease or psychological disorders, deep vein thrombosis, peripheral nervous illness, history of breast surgery, no history of injury and ulcer in the place of reflexology, and no problems with the mammary gland (breast breakdown, congestion, mastitis, and breast abscess). Exclusion criteria included the lack of willingness to continue to be present in the research, the incidence of the diseases in mother during the study, the use of medications that increase breast milk, the need of premature infants for intravenous intubation and poor general condition of the baby.
Used devices&materials
The data collection tool was a personal information questionnaire including information about the mothers such as education, occupation, maternal age, BMI, maternal delivery, type of delivery and information about the baby such as fetal age, sex, weight of body at the birth, and the checklist included breast milk volume in milliliters before and after intervention. The breast milk pump (Spectra; South Korea) was used to measure breast milk calibrated by hospital engineers. After approving the research by Ethics committee and obtaining a reference from the Gonabad University of Medical Sciences and presenting it to the Shohada Hospital, sampling was done in the convenient way i.e. by referring to the mother's room, any mother with natural or cesarean labor who had a premature infant and who was eligible for the conditions for entering the study, was explained about the purpose of the study. If they were satisfied, they would be asked to complete the questionnaire related to personal information. The intervention began on the morning of the fourth day of labor and at the beginning of the work, both groups were trained about the lactation technique. Then, the breast milk volume was measured by the contaminator for 15 minutes after two hours of last breast milking (where the mother's privacy was maintained). Reflexology was carried out by a researcher who had acquired the necessary skills with a complementary specialist. Reflexology was performed for the intervention group including preparation, warming, stimulation techniques, and massage. The location of the pituitary reflection point is in the middle of medial margin of the first thumb at the plantar surface and the location of solar network is at the end of first metatarsal bone of the foot (Pic. 1), and the breast location is at the base of the fingers on the foot (Pic. 2). Preparation and warming of the feet (after impregnating the hands of the researcher with one cc of sesame oil), including feet warming by hands through performing specific movements, taking over and under the feet by both hands, and creating backward bending movement, bending the sole of the foot, turning out and inside and movement on the heel. To stimulate the pituitary, solar network and breast, massaging was performed using fingers with sweep movements and pressure. The control group was placed under routine care. Having received written consent from the mothers in the intervention group, reflexology was performed for three consecutive days and for 10 minutes per foot for one minute of warming the foot and 3 minutes of massage and stimulation of each reflex point in each foot in each session. The mother's milk volume was measured after 2 hours of the last breast milking before the massage and 30 minutes after massage by the electric shower valve in the intensive care unit. In the control group, the volume of milk was measured by the same method without intervention. The research sampling took 6 months. The Kolmogorov-Smirnov test was used to test the normality of distribution. Data were analyzed using SPSS 22 software, chi-square, independent t-test and repeated measure analysis of variance
Findings by Text
There was no significant difference between the two groups in demographic variables, and the two groups of control and intervention were homogenous in terms of maternal age, type of delivery, education level, maternal BMI, fetal age, birth weight, and number of infants in one labor (p>0.05; Table 1). The mean of milk volume in the first day of the study after reflex massage was not statistically significant between the intervention group and the control group (p=0.79). However, on the third day, the mean volume of taped milk after reflex massage, was significantly different between the intervention and control group (p=0.02). The difference between the mean volume of breast milk in the intervention group with reflexive massage in the third day after the intervention and the mean volume of breast milk before the intervention was not significantly different (p=0.187; Table 2).
Main comparison to the similar studies
In a study in Ranachandra Hospital in India, the therapeutic effect of reflecting point was evaluated among 30 primiparous women admitted to the hospital in the two groups of intervention and control, and intervention was performed for 3 days each day 20 minutes three times a day at the breast point in the foot. The results showed that satisfaction at the beginning of the lactation in the mothers of intervention group was higher than the control group [21]. The difference between the results of this study and the present study may be due to difference in the number of points used and the frequency of massage per day in the intervention group. In another study in 1996, the effect of foot reflexology on 100 primiparous women whose reflexology was performed 30 hours after normal delivery for 10 to 15 minutes per day for 5 days was investigated and the same results were obtained [24]. In a study on 800 pregnant women in two intervention and control groups, reflexology and acupressure acne, on the fifth day after delivery, in the mothers of intervention groups increased breastfeeding, accelerated uterine remission and reduced complications of labor [25].
Suggestions
It is suggested that this study be done with a larger sample size and longer duration and reflective massage in the intervention group compared to other groups.
Limitations
Concerning the limitations of this study, factors such as individual differences, cultural, social and psychological factors of mothers, maternal nutrition during and after pregnancy, as well as disorders such as anemia and hypocalcemia in mothers can be mentioned that the control of all of them was practically difficult.
Conclusions
Reflexology massage is not effective in mothers with preterm infants
Acknowledgments
All dear mothers who participated in this study, the staff of the Neonatal Intensive Care Unit of Quchan Shohada Hospital, The Department of Educational and Research Affairs of Gonabad University of Medical Sciences, and supervisor and reader professors are appreciated and thanked for their sincere cooperation.
Conflict of interest
Non-declared
Ethical Permissions
The ethical confirmation of this study was obtained from the Ethics Committee of Gonabad University of Medical sciences with the code GMU.REC.1394.60 and it was registered at the Iranian Clinical Trial Database with code IRCT2015112425232N1.
Funding Sources
This article is the result of nursing student graduate thesis at Gonabad University of Medical Sciences.

TABLES and CHARTS

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