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A descriptive study of Swedish women with symptoms of breast inflammation during lactation and their perceptions of the quality of care given at a breastfeeding clinic
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.ORCID iD: 0000-0003-3385-3731
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.ORCID iD: 0000-0001-7082-6834
2007 (English)In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 2, no 2Article in journal (Refereed) Published
Abstract [en]

Background

Women's perceptions of quality of care during episodes of breast inflammation have been scantily explored. It was the objective of the present study to describe a cohort of breastfeeding women with inflammatory symptoms of the breast during lactation regarding demographical variables, illness history and symptoms at first contact with a breastfeeding clinic and to explore their physical health status, psychological well-being and perceptions of quality of care received, at a six-week postal follow-up.

Methods

This is a descriptive study set at a midwife-led breastfeeding clinic in Sweden, which included a cohort of women with 210 episodes of breast inflammation. The women had taken part in a RCT of acupuncture and care interventions and were recruited between 2002 and 2004. Of the total cohort, 176 (84 %) responded to a postal questionnaire, six weeks after recovery.

Results

Of the 154 women for whom body temperature was recorded at the first visit, 80 (52%) had fever ranging from 38.1°C to 40.7°C. There was no significant difference between those with favourable outcomes (5 or less contact days) and those with less favourable outcomes (6 or more contact days) for having fever or no fever at first contact. Thirty-six percent of women had damaged nipples. Significantly more women with a less favourable outcome (6 or more contact days) had damaged nipples. Most women recovered well from the episode of breast inflammation and 96% considered their physical health and 97% their psychological well-being, to be good, six weeks after the episode. Those whose illness lasted 6 days or more showed less confidence in the midwives and in the care given to them. Twenty-one (12%) women contacted health care services because of recurring symptoms and eight of the 176 responders (4.5%) were prescribed antibiotics for these recurring symptoms. A further 46 women (26% of the responders) reported recurring symptoms that they managed without recourse to health care services.

Conclusion

Initial fever may not be indicative of outcomes for women with inflammatory breast symptoms and treatment by antibiotic therapy may be necessary less often than has been supposed. Women who are also suffering from damaged nipples may need special attention. Those with protracted symptoms were less satisfied with care and showed less confidence in caregivers. International research collaboration might help us find the optimal level of antibiotic therapy for this group of women. This is an important consideration for the global community.

Place, publisher, year, edition, pages
2007. Vol. 2, no 2
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-1885DOI: 10.1186/1746-4358-2-2OAI: oai:DiVA.org:kau-1885DiVA: diva2:4856
Note

I manuskriptform hade denna artikel titeln: "A descriptive study of breastfeeding mothers with breast inflammation: at initial visit to a breastfeeding clinic and at 6-week postal follow-up"

Available from: 2007-08-23 Created: 2007-08-23 Last updated: 2016-09-29Bibliographically approved
In thesis
1. Care and treatment of women with inflammatory symptoms of the breast during lactation
Open this publication in new window or tab >>Care and treatment of women with inflammatory symptoms of the breast during lactation
2006 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

Care and treatment of women with inflammatory symptoms of the breast during lactation

Inflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V).

Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved.

Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis

Abstract [sv]

Vård och behandling av kvinnor med inflammation i brösten under amningsperioden

Bröstinflammation orsakar stort obehag för ammande mödrar och innebär en risk för att amning avslutas i förtid. Det finns ringa kunskap om effekterna av interventioner, inkluderande akupunktur, som används vid vård av dessa kvinnor. Det saknas även kunskap om mödrarnas upplevelser av bröstinflammation. Syfte: att studera vård och behandling av kvinnor med bröstinflammation vid en amningsmottagning ledd av barnmorskor, att utveckla kunskap om mödrars upplevelser av att vara drabbad av bröst inflammation samt att undersöka faktorer som kan ha betydelse för utvecklandet av bröstabscess. Metoder: metodtriangulering användes för att studera olika aspekter av fenomenet bröstinflammation under amningsperioden; två randomiserade kontrollerade studier I (n = 88) and II (n = 210), en deskriptiv studie III (n = 210), en intervjustudie med en grounded theory ansats IV (n = 14) och en populationsbaserat registerstudie V (n = 1 454 068 enkelbörds förlossningar). Resultat: mödrarnas symptom lindrades mer effektivt med akupunktur akupunkturbehandling men förkortade inte deras kontakt med vården. Nio procent (I) respektive 15 % (II) av mödrarna fick antibiotika. Tolv procent fick recidiv vilket föranledde kontakt med vården inom 6 veckor (III). Sju mödrar (0,1 % av ammande mödrar) utvecklade bröstabscess (II), vilket överensstämde med resultat i den populationsbaserade studien (V). Förekomsten av Grupp B streptococcer i bröstmjölken var relaterad till längre vårdkontakt (II). Mödrarnas viljan att amma kan göra det möjligt för dem att uthärda fysiska och emotionella svårigheter som sjukdomen innebär (IV). Tillgång till klinisk expertis var en viktig del av vården för dessa kvinnor. Att vara förstföderska kan innebära en något större risk för utveckling av bröstabscess. Mödrar över 30 år samt de som föder efter graviditetsvecka 41 har också en ökad risk för abscess (V).

Slutsatser: mödrarnas symptom lindrades mer effektivt när akupunktur användes. Kontakten med vården blev dock inte förkortad av akupunkturbehandling. Interventioner som inkluderar akupunkturbehandling kan tillåta mödrar att invänta kroppens anti-inflammatoriska respons och kan därför möjliggöra en avsevärd minskning av antibiotika terapi för dessa mödrar. Resultaten visar behov av att bättre förstå hur amning påverkas av hormoner administrerade till kvinnor under förlossningsarbete och amningen. Tillgång till omedelbar klinisk expertis är en viktig faktor för dessa mödrar vilket hälso- och sjukvårdsplanerare bör vara medvetna om. Förbättrad information angående potentiella amningsproblem bör eftersträvas.

Nyckelord: akupunktur, amning, antibiotika, bröstabscess, bröstinflammation, interventioner, mastit, mjölkstockning

Place, publisher, year, edition, pages
Fakulteten för samhälls- och livsvetenskaper, 2006
Series
Karlstad University Studies, ISSN 1403-8099 ; 2006:28
Keyword
acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, breast inflammation, care, lactation mastitis, treatment, akupunktur, antibiotika, behandling, bröstinflammation, omvårdnad, mastit, amning, bröstabscess, interventioner, mjölkstockning
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-1082 (URN)91-7063-059-3 (ISBN)
Public defence
2006-09-23, Gejiersalen, 12A 138, Karlstads universitet, Karlstad, 09:00
Opponent
Supervisors
Available from: 2007-08-23 Created: 2007-08-23

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