Effect of the standard operating procedure introduction on decrease in the number of breastfeeding mothers with nipple damage on a hospital maternity ward

Abstract

Pain and nipple damage are one of the main causes of early breastfeeding cessation. Nipple damage can be prevented by early maternity ward staff intervention since the most common causes are poor breastfeeding positioning and latch. Having the standard operating procedures (protocols) in writing makes the work easier for staff members and improves clinical outcomes. The goal of our study was to see how the introduction of written protocol infl uenced the number of breastfeeding mothers with nipple damage being discharged from the hospital, with the fi nal goal of preventing early breastfeeding cessation. This prospective study was conducted on a hospital maternity ward. Protocol is a short document with clear instructions for midwives on how to approach a breastfeeding mother with nipple pain in order to prevent damage. In the fi rst phase (2 months), baseline data were collected by midwives; in the second phase (1 month), education about nipple damage and protocol use was started; and in the third phase (6 months), midwives were using the protocol. Data were collected on 1292 (62.5%) of 2067 deliveries. In the third phase as compared with the fi rst phase, there was less Mohrbacher grade >1 damage (4.8% vs. 9.8%; p=0.007), more mothers with poor positioning (5.2% vs. 1.5%; p=0,003) and latch (15.6% vs. 8.1%; p=0.0006). In the second phase in comparison to the fi rst one, there were more mothers with poor positioning (1.8% vs. 1.5%; p=0.003) and latch (18.9% vs. 8.1%; p=0.001). The use of nipple shield decreased with time (22.4%, 19.6% and 17.2% by phases of research; p=0.112). In conclusion, use of the written protocol led to a decrease in severe Mohrbacher nipple damage and the midwives’ awareness of positioning and latch. Key words: BREAST FEEDING; CLINICAL PROTOCOLS; MIDWIFERY; NIPPLES