Pain Clinical Trial
Official title:
Empowering Women to Cope With Breastfeeding Pain: A Feasibility Randomized Controlled Trial of an Educational Anticipatory Guidance Intervention
The experience of breastfeeding-related pain is common for postpartum women, but is not often anticipated as part of the postpartum experience. This feasibility randomized controlled trial aims to examine the effectiveness of a nurse-led educational intervention using anticipatory guidance among pregnant women wishing to breastfeed on breastfeeding outcomes, breastfeeding-related pain, and maternal satisfaction.
Despite the relative ubiquity of breastfeeding-related pain, exploratory studies suggest
women are largely unprepared for breastfeeding-related pain in the early postpartum period
[1-3]. In turn, postpartum women often experience an incongruence between how breastfeeding
is idealized by Western society, and the reality of their early breastfeeding experiences.
Furthermore, painful breastfeeding experiences serve to intensify this incongruity and may
lead to disillusionment, feelings of negative self-worth and premature breastfeeding
cessation [1,3]. As such, the overarching goals of this one-year project are to compare usual
prenatal education to anticipatory guidance to: 1) examine the effectiveness of a
breastfeeding education session using anticipatory guidance on breastfeeding outcomes and
satisfaction during the postpartum period; and 2) test the feasibility of the methods and
procedures needed for the successful implementation and validity of a full-scale randomized
controlled trial (RCT). This one-year project has 5 objectives:
To fill a knowledge gap in nursing and allied health-related literature by examining the
effect of a one-hour, nurse-led, breastfeeding education session using anticipatory guidance
during pregnancy on: Objective 1: breastfeeding duration and exclusivity versus those
receiving usual prenatal education; Objective 2: overall satisfaction with the educational
experience versus those receiving usual prenatal education; Objective 3: breastfeeding
self-efficacy and infant feeding attitudes; Objective 4: postpartum breastfeeding-related
pain and; Objective 5: To determine if this intervention study protocol is practical (e.g.,
accrual rates, satisfaction, compliance, sample size) and to test the process, resources,
management and scientific basis [4] for a future, full-scale RCT.
Forty pregnant women enrolled in prenatal classes provided by the Middlesex London Health
Unit (MLHU) and who are intending to breastfeed will be enrolled in this feasibility
randomized controlled trial.
Following ethics approval, interested pregnant women who have enrolled in/awaiting antenatal
classes at the MLHU will contact the RA to discuss the study. Interested women will be
screened for eligibility, and if eligible and consenting, baseline data will be collected.
Participants will then be randomized to either intervention (n=20) or control group (n=20).
Randomization will be achieved by using sealed, opaque, sequentially numbered envelopes
containing randomly generated numbers, prepared by an RA external to the study. An RA will
open the next sequentially numbered envelope and reveal the group allocation to the
participant. The control group will receive usual antenatal education provided to all women
who enroll in MLHU prenatal classes. The intervention group will receive an additional
one-hour 'booster session' (by a perinatal RN) of antenatal education specifically focused on
the postpartum experience of breastfeeding, including anticipatory guidance around
breastfeeding-related pain, and management strategies. To control for contamination, women
who have peers/family already in the study will be excluded. An emailed link to a follow-up
questionnaire will be sent at 2 and 4 weeks postpartum to determine if they are breastfeeding
or not, breastfeeding exclusivity, level of breastfeeding-related pain, breastfeeding
self-efficacy, maternal attitudes toward infant feeding, and maternal satisfaction with
antenatal education.
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