Press Needle Acupoint Stimulation Combined with Breast Massage on the Initiation of Lactogenesis II
Description
A randomized controlled trial with 132 post-cesarean mothers compared an experimental group (EG) receiving press needle acupoint stimulation combined with breast massage intervention to a control group (CG) with standard care. Outcomes measured were the onset of Lactogenesis II, breastfeeding sessions and formula supplementation within 72 hours, exclusive breastfeeding rates, and breast milk composition at 72 hours postpartum. Inclusion Criteria: Mothers included in the study were required to be: (a) ≥18 years old; (b) expecting their first live-born child via cesarean delivery; (c) having a singleton pregnancy; (d) intending to breastfeed with no major contraindications like hepatitis B, HIV, or other infectious diseases; (e) having newborns with Apgar scores above 8 at 1 and 5 minutes, robust sucking reflex, and no neonatal transfer required; (f) able to understand and respond to questions; and (g) accessible for follow-up via telephone or WeChat. Exclusion Criteria: Mothers were excluded if they were: (a) having previous breast surgeries like biopsies or augmentations; (b) having nipple inversions that complicate breastfeeding; (c) taking medications affecting lactation; (e) experiencing severe perinatal complications, such as serious pre-eclampsia or grade 3 or higher cardiac issues per NYHA standards, (f) having severe local skin damage at the acupoint and massage sites, (g) having newborns with critical conditions like cardiopulmonary insufficiency, galactosemia, or phenylketonuria. Intervention: Key acupoints were identified for selection: Dan zhong (RN17), bilateral Ru gen (ST18), bilateral Shao ze (SI1), bilateral Zu san li (ST36), and bilateral San yin jiao (SP6). Instructions were then given to mothers and their family members to stimulate the acupoints pulsatively every 3-4 hours for 20-30 minutes per session, removing the press needles after 24 hours. Additionally, a specialized nurse with over ten years of experience in obstetrics massaged the back, both breast areas, and armpits for 10-15 minutes, three times daily over three days, using a circular and oscillating breast massage device. Primary Outcome Measurement: The main outcome indicators included the sensation of milk coming in, defined as the time to stage II lactogenesis. Participants were asked to report the approximate time they noticed their breasts feeling 'noticeably fuller' using a numeric scale: 1 indicated ‘no change since giving birth’, 3 denoted ‘noticeably fuller’, and 5 represented ‘uncomfortably full’ . Additionally, milk quality was assessed 72 hours after birth, focusing on the content of protein, fat, lactose, minerals, and water. Secondary Outcome Measurements: Secondary outcomes tracked include the number of breastfeeding sessions within the first 72 hours, the milliliters of formula provided to the infant during this period, and the percentage of mothers exclusively breastfeeding after 72 hours.