Mastitis Clinical Trial
Official title:
A RCT in Sweden of Acupuncture and Care Interventions for the Relief of Inflammatory Symptoms of the Breast During Lactation
The objective of the study was to test the hypothesis that acupuncture treatment hastens recovery time from inflammatory symptoms of the breast during breastfeeding. 205 mothers with 210 cases of breast inflammation (commonly called "mastitis") during breastfeeding were randomly assigned to one of three treatment groups. There were two groups where acupuncture was used and one without acupuncture. The mothers symptoms were recorded at the onset of health care contact and daily until recovery. All care interventions given, including antibiotic therapy, were monitored. Women who participated were asked to leave a breast milk sample to test for bacterial growth. It was found that acupuncture did not shorten the women's contacts with health care services but did improve their symptoms on contact days 3 and 4. It was seen in this study that only 15 % of women were prescribed antibiotics which was a very low rate of prescription compared to USA, Canada, Australia, Turkey and New Zealand where up to 100% are given antibiotics. Seven women (3.3% of those in the study) developed a breast boil and this is a similar number to a study in Australia where many more were treated by antibiotics. This could mean that many women throughout the world are given antibiotics when in fact they may recover without them. This is an important finding in relation to the fight against antibiotic resistant bacteria.
Objectives: to further compare acupuncture treatment and care interventions for the relief
of inflammatory symptoms of the breast during lactation and to investigate the relationship
between bacteria in the breast milk and clinical signs and symptoms.
Design: randomised, non-blinded, controlled trial of acupuncture and care interventions.
Setting: a midwife-led breast-feeding clinic in Sweden.
Participants: 205 mothers with 210 cases of inflammatory symptoms of the breast during
lactation agreed to participate. The mothers were randomly assigned to one of three
treatment groups, two of which included acupuncture amongst the care interventions and one
without acupuncture. All groups were given essential care. Protocols, which included scales
for erythema, breast tension and pain, were maintained for each day of contact with the
breast-feeding clinic. A Severity Index (SI) for each mother and each day was created by
adding together the scores on the erythema, breast tension and pain scales. The range of the
SI was 0 (least severe) to 19 (most severe).
Findings: There was no significant difference in numbers of mothers in the treatment groups
with the lowest possible score for severity of symptoms on contact days 3, 4 or 5. There
were no statistically significant differences between the treatment groups for number of
contact days needed until the mother felt well enough to discontinue contact with the
breast-feeding clinic or for number of mothers prescribed antibiotics. There were
significant differences in the mean SI scores on contact days 3 and 4 between the
non-acupuncture group and the two acupuncture groups. Mothers with less favourable outcomes
(≥ 6 contact days, n = 61) were, at first contact with the midwife more often given advice
on correction of the baby’s attachment to the breast. An obstetrician was called to examine
20 % of the mothers and antibiotic therapy was prescribed for 15 % of the study population.
The presence of Group B streptococci in the breast milk was related to less favourable
outcomes.
Key conclusions and implications for practice: If acupuncture treatment is acceptable to the
mother, this, together with care interventions such as correction of breast-feeding position
and babies’ attachment to the breast might be a more expedient and less invasive choice of
treatment than the use of oxytocin nasal spray. Midwives, nurses or medical practitioners
with specialist competence in breast feeding should be the primary care providers for
mothers with inflammatory symptoms of the breast during lactation. The use of antibiotics
for inflammatory symptoms of the breast should be closely monitored in order to help the
global community reduce resistance development among bacterial pathogens.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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