Journal Reading

The Effectiveness of Laid-back Position on Lactation

Related Nipple problems and comfort: A meta-analysis

Presented by:
dr. Tegar Dwi Prakoso

Moderator:
dr. Hartati, Sp.OG, Subsp. Obginsos(K),M.Kes

DEPARTEMEN OBSTETRI DAN GINEKOLOGI

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
RSUP Dr. MOHAMMAD HOESIN PALEMBANG
2021
 Contents
1 BACKGROUND

2 METHODS

3 RESULTS

4 DISCUSSION

5 CONCLUSIONS
 Background

Breastmilk provides all the energy and nutrients that the infant needs for the rst months of life,
and it continues to provide up to half or more of a child’s nutritional needs during the second half
of the rst year, and up to one third during the second year of life.

Poor breastfeeding position may have an effect on the mother’s wellbeing and exacerbate issues
through a negative impact on the infant’s positioning, latch and duration of breastfeeding events

According to a study, around 70.3% of mothers experienced breastfeeding diculties,

including cracked nipples, perception of insucient amount of milk, pain, and fatigue.
And it was painful for many respondents to hold their infant to breastfeed, pick up
their infant, and sit comfortably to breastfeed.
 Background

Nipple pain caused by the incorrect position of latching is a common problem which can lead to
nipple trauma. Poor latching is associated with pain when breastfeeding, and correct positioning and
latch are essential for increasing milk supply and intake.

The laid-back position has not been popularized in breastfeeding health education in the world and
there is also a lack of high-quality research to support this approach in relation to the effects of
breastfeeding.

The objective of this paper was to evaluate the effect of laid-back breastfeeding
(Biological Nurturing) on the effect of breastfeeding by evidence-based methods, so as
to provide references for the formulation and specication of breastfeeding
position/positions.
Methods

Cochrane Library, EMBASE, Medline, Ovid, PubMed, Web of Science,

Search Strategy CINAHL, Scopus, SinoMed, Chinese National Knowledge Infrastructure
(CNKI), WanFang, and VIP, from inception to January 28,2020

All articles were imported into to a citation manager (EndNote X9) The criteria
Selection Process for the inclusion were articles:. The exclusion criteria were articles:
Inclusion criteria Exclusion criteria
• (1) all randomized controlled • (1) the mothers have
trials (RCTs) and quasi- pregnancy complications,
randomized controlled trials, childbirth complications or
• (2) Participating mothers basic breast diseases;
aged over 18 who are • (2) the mothers have
healthy and willing to disfunction of mental,
breastfeed and their newborn language, and limbs;
infants were healthy with full • (3) the mothers and family
term were included in our members were unwilling to
study; participate in this research.
Experimental group: Biological Nurturing is laid-back
breastfeeding (LBBF)
Control group: Traditional breastfeeding positions
included the cradle, cross cradle, side-lying and
football position;

Primary outcomes contained nipple trauma and

nipple pain.
Secondary outcomes contained the correct position
of latching and position comfort
 And the studies were excluded
if they:

(3) included
(5) were (6) were
the
(1) were published those of
(2) had no unextractable (4) lacked of
different from other than in reviews,
full-text raw data and outcome
the research English or editorials,
available; fail to contact indicators;
contents; Chinese books, thesis,
with the
language; news etc.
author;
 Methods

The risk of bias of each RCT was evaluated independently by two investigators
Quality Assesment using the RoB 2.0 tool excerpted from the Cochrane Handbook for Systematic
Reviews of Interventions (Version 6,2019)

Two reviewers independently assessed the studies for eligibility and extracted
Data Extraction the data using a standardized data extraction form and checked by the third
reviewer. Disagreements were resolved via discussion with a third author.

Statistical analyses were performed by Review Manager Version 5.3 and

STATA/SE Version 15.1 (StataCorp, College Station, TX, USA)
Statistical Analysis All the data were analyzed separately by two investigators using the different
software (ZW: STATA/SE and QL: RevMan)
 Results
Search Results
Initially, a total of 296 publications were retrieved from the following 12 electronic databases: Cochrane Library(n = 7), EMBASE(n = 13),
Medline(n = 14), Ovid (n = 122)􏰁PubMed(n = 12), Web of Science (n = 31), CINAHL(n = 22), Scopus(n = 11), SinoMed(n = 13), CNKI(n = 18),
WanFang(n = 17) and VIP(n = 16).
After eliminating duplicates, 214 references were included, then remain studies were screened by tittles titles and
abstracts yielding an additional 179 being excluded

The rest 35 articles were screened for full text, of which 22 were excluded as they
were not appropriate study designs (n = 18) or interventions (n = 4).

one article was excluded because the data was dicult to

extract and we failed to contact with the author.
Finally, 12 articles were fullled
the eligibility criteria and
included in the meta-analysis.
Characteristics of the includes studies
Countries • China and thailand

Time • From 2018 up to 2019

published
Time • Ranged from 3 days to 8 weeks
intervention
• Nipple trauma (n=7)

Outcomes Nipple pain (n=8)

•
• Correct position of latching (n=3)
• Position comfort (n=4)
Risk of Bias Assesment
 Nipple trauma
• Seven studies, which included
1,274 groups of postpartum
women and their newborns,
reported nipple trauma.
• The result showed that the
experimental group had a lower
incidence of nipple trauma than
the control group (p = 0.002).
Nipple pain
• Eight studies, with a total of 1,076
groups of postpartum women and
their newborns, compared
traditional breastfeeding positions
vs laid-back breastfeeding in
nipple pain.
• The experimental group had a
lower incidence of nipple pain
than the control group (p <
0.00001)
 Posisi latching yang benar
• The results showed that the
experimental group had a
higher incidence of correct
position of latching than the
control group (p < 0.00001)
Position comfort
• Four studies reported the
data of position comfort, and
these studies including 660
couples of postpartum
women and their newborns.
• The result showed that there
was no statistical signicance
in the two groups (p= 0.000)
Publication bias
• Egger linear regression was used to detect the publication bias arising

The p-values of the correct position of latching (p = 0.152) and

position comfort (p = 0.138) were greater than 0.05, which indicates
that there is no signicant publication bias
To sum up, the results showed no signicant risk of publication bias among the studies
that were included
Discussion

The results of this study showed
that the experimental group had
a lower incidence of nipple
trauma (22.4% vs 38.5%) and
nipple pain (22.0% vs 59.9%)
than the control group.
Nipple pain or trauma is reported
as one of the main causes for
giving up breastfeeding
prematurely.
Nipple cracks is the most
common type of nipple trauma in Correction of positioning and
this study and there were 4 attachment is the most common
studies among the 7 studies experience-based
reported data, which showed that recommendation for treatment of
laid-back position can help to nipple pain. One of the major
reduce the incidence of nipple ndings of this meta-analysis was
cracks (4.2% vs 19.8%). the effect of laid-back position on
Similarly, there were 4 studies the correct position of latching.
among the 8 studies reported the
data of nipple pain and the
results show that the
experimental group had a lower
incidence (25.7% vs 51.8%) than
the control group
Laid-back-breastfeeding is benet to both mothers and their babies.
Breastfeeding is biology-based nurturing rooted in instinct. Laid-back
breastfeeding can be adopted even if there is early separation after the birth
or the mother was suffering problems with breastfeeding. And not only did
babies display instinctive breastfeeding behaviors when placed skin-to-skin on
their mothers, but mothers themselves demonstrated reexive behaviors that
helped their babies reach and attach to the breast
Limitations
All RCTs and quasi- RCT in English and Chinese. The timing of the interventions was not identical.
And there were some methodological limitations in the included studies, which increase the risk of
potential selection and publication bias;

The heterogeneity in some comparations is signicant and it may inuence the pooled results

The quality of included studies was moderate and the results should be interpreted with caution
because this meta-analysis represented only studies reported from two countries

Three subgroups analysis were undertaken according to the intervention, deliver mode and
maternal category, but other factors that could inuence the outcome might exist;

In this study, only quantitative indicators were analyzed and the vast majority of the documents
included were Chinese articles for the reason that most of the studies were qualitative reports in
other countries.
 Conclusion

Laid-back position has signicant advantages in decreasing the incidence of nipple trauma and
nipple pain compared with traditional breastfeeding positions,

However, current evidence does not show different breastfeeding outcomes in the two groups of
position comfort and further study remains to be done.

In order to provide advice and reference for formulating and standardizing breastfeeding
position/position, further researches with high-quality and large-scale RCTs and more evidence
are required to determine the effects of laid-back breastfeeding on lactation-related nipple
problems.
THANKYOU