Evaluating the Effectiveness of Using a Progressive Muscle Relaxation Technique on the Self-Efficacy of Breastfeeding in Mothers With Preterm Infants

10.1097/jnr.0000000000000217

Soheila Karbandi；Seyedeh Maryam Hosseini；Seyedeh Asieh Hosseini；Farshad Sadeghi；Maryam Hesari；Reza Masoudi

breastfeeding self-efficacy ； relaxation ； postpartum period ； preterm infant

The Journal of Nursing Research

25卷4期（2017 / 08 / 01）

283 - 288

英文

Background: Breast milk is a God-given gift that conveys a mother’s love and compassion and that is made according to the needs and age of the child. Mothers who are interested in the welfare of their newborns tend to breastfeed their children. Training programs have been shown to improve breastfeeding self-efficacy in terms of both duration and amount. Purpose: The aim of this study was to evaluate the effect of using the progressive muscle relaxation (PMR) technique on the self-efficacy of breastfeeding in mothers with preterm infants. Methods: A clinical trial approach was used. Sixty mothers with preterm infants were randomly assigned to either the intervention or control group. The clinical trial ran for a period of 2 months for both groups. At 24-72 hours postpartum, the researcher used the Jacobson method to provide 30-45 minutes of individual training to the intervention group participants on PMR. Under the Jacobson method, mothers contract the 16 groups of muscles until they experience the feeling of pressure and then relax these muscles. The tools used in this study were the standard questionnaire of Dennis breastfeeding self-efficacy, which was completed by the participants at baseline, at the end of the fourth week, and during the eighth week. Data were analyzed using SPSS software. Results: No significant difference was observed between the intervention and control groups in terms of demographic variables (p ＞ .05). Independent t tests found no significant difference between the two groups (p = .45) in terms of mean score of maternal breastfeeding self-efficacy at pretest and significantly higher scores for the intervention group than the control group at both 4 (p = .001) and 8 (p ＜ .001) weeks posttest. Furthermore, the analysis of variance test showed significant differences in the mean score of breastfeeding self-efficacy for the intervention group between pretest and the first posttest and between the first posttest and the second posttest, respectively (p ＜ .001). Conclusions/Implications for Practice: Considering the effect of relaxation training on the breastfeeding self-efficacy of mothers with preterm infants, training and performing these exercises as an effective and low-cost method to improve the health of mothers, particularly mothers of preterm infants, are recommended. The PMR technique facilitates the self-efficacy of breastfeeding in mothers with preterm infants and should be considered as an effective strategy to improve nursing care and the provision of better support services for mothers who breastfeed their infants.

1. Aghdas, K.,Talat, K.,Sepideh, B.(2014).Effect of immediate and continuous mother-infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomised control trial.Women and Birth,27(1),37-40.
2. Bastable, S. B.(2003).Nurse as educator: Principles of teaching and learning for nursing practice.Philadelphia, PA:Jones and Bartlett.
3. Blyth, R.,Creedy, D. K.,Dennis, C. L.,Moyle, W.,Pratt, J.,De Vries, S. M.(2002).Effect of maternal confidence on breastfeeding duration: An application of breastfeeding self-efficacy theory.Birth,29(4),278-284.
4. Carter, J. D.,Mulder, R. T.,Darlow, B. A.(2007).Parental stress in the NICU: The influence of personality, psychological, pregnancy and family factors.Personality and Mental Health,1(1),40-50.
5. Cernadas, J. M.,Noceda, G.,Barrera, L.,Martinez, A. M.,Garsd, A.(2003).Maternal and perinatal factors influencing the duration of exclusive breastfeeding during the first 6 months of life.Journal of Human Lactation,19(2),136-144.
6. Chuang, L. L.,Lin, L. C.,Cheng, P. J.,Chen, C. H.,Wu, S. C.,Chang, C. L.(2012).Effects of a relaxation training programme on immediate and prolonged stress responses in women with preterm labour.Journal of Advanced Nursing,68(1),170-180.
7. Conrad, A.,Roth, W. T.(2007).Muscle relaxation therapy for anxiety disorders: It works but how?.Journal of Anxiety Disorders,21(3),243-264.
8. Dai, X.,Dennis, C. L.(2003).Translation and validation of the breastfeeding self-efficacy scale into Chinese.Journal of Midwifery & Women's Health,48(5),350-356.
9. De Rouck, S.,Leys, M.(2009).Information needs of parents of children admitted to a neonatal intensive care unit: A review of the literature (1990-2008).Patient Education & Counseling,76(2),159-173.
10. Dennis, C. L.(1999).Theoretical underpinnings of breastfeeding confidence: A self-efficacy framework.Journal of Human Lactation,15(3),195-201.
11. Gijsbers, B.,Mesters, I.,Knottnerus, J. A.,Van Schayck, C. P.(2006).Factors associated with the initiation of breastfeeding in asthmatic families: The attitude-social influence-self-efficacy model.Breastfeeding Medicine,1(4),236-246.
12. Griffin, T.(2006).Family-centered care in the NICU.Journal of Perinatal & Neonatal Nursing,20(1),98-102.
13. Keith, D. R.,Weaver, B. S.,Vogel, R. L.(2012).The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants.Advances in Neonatal Care,12(2),112-119.
14. Kim, B. H.,Newton, R. A.,Sachs, M. L.,Glutting, J. J.,Glanz, K.(2012).Effect of guided relaxation and imagery on falls self-efficacy: A randomized controlled trial.Journal of the American Geriatrics Society,60(6),1109-1114.
15. Krol, K. M.,Kamboj, S. K.,Curran, H. V.,Grossmann, T.(2014).Breastfeeding experience differentially impacts recognition of happiness and anger in mothers.Scientific Reports,4,7006.
16. Lowe, N. K.(1993).Maternal confidence for labor: Development of the childbirth self-efficacy inventory.Research in Nursing & Health,16(2),141-149.
17. Maguire, C. M.,Bruil, J.,Wit, J. M.,Walther, F. J.(2007).Reading preterm infants' behavioral cues: An intervention study with parents of premature infants born<32 weeks.Early HumanDevelopment,83(7),419-424.
18. Martin, R. J.,Fanaroff, A. A.,Walsh, M. C.(2010).Fanaroff and Martin's neonatal-perinatal medicine: Diseases of the fetus and infant.St. Louis, MO:Mosby.
19. Masoudi, R.,Soleymani, M. A.,Moghadasi, J.,Qorbani, M.,Mehralian, H.,Bahrami, N.(2011).The effects of progressive muscle relaxation on self-efficacy and quality of life for caregivers of patients with multiple sclerosis.The Journal of Qazvin University of Medical Sciences,15(2),41-47.
20. McQueen, K. A.,Dennis, C. L.,Stremler, R.,Norman, C. D.(2011).A pilot randomized controlled trial of a breastfeeding self-efficacy intervention with primiparous mothers.Journal of Obstetric, Gynecologic, and Neonatal Nursing,40(1),35-46.
21. Netshandama, V. O.(2002).Breastfeeding practices of working women.Curationis,25(1),21-27.
22. Noel-Weiss, J.,Bassett, V.,Cragg, B.(2006).Developing a prenatal breastfeeding workshop to support maternal breastfeeding self-efficacy.Journal of Obstetric, Gynecologic, and Neonatal Nursing,35(3),349-357.
23. Otsuka, K.,Dennis, C. L.,Tatsuoka, H.,Jimba, M.(2008).The relationship between breastfeeding self-efficacy and perceived insufficient milk among Japanese mothers.Journal of Obstetric, Gynecologic, & Neonatal Nursing,37(5),546-555.
24. Trombini, E.,Surcinelli, P.,Piccioni, A.,Alessandroni, R.,Faldella, G.(2008).Environmental factors associated with stress in mothers of preterm newborns.Acta Paediatrica,97(7),894-898.
25. Varaie, S.,Mehrdad, N.,Bahrani, N.(2009).The relationship between self-feeding and breastfeeding mothers.Life Fall,3(15),31-38.
26. Work Group on Breastfeeding(1997).Breastfeeding and the use of human milk.Pediatrics,100(6),1035-1039.
27. Wu, D. S.,Hu, J.,McCoy, T. P.,Efird, J. T.(2014).The effects of a breastfeeding self-efficacy intervention on short-term breastfeeding outcomes among primiparous mothers in Wuhan, China.Journal of Advanced Nursing,70(8),1867-1879.
28. Younger, J. B.,Kendell, M. J.,Pickler, R. H.(1997).Mastery of stress in mothers of preterm infants.Journal for Specialists in Pediatric Nursing,2(1),29-35.
29. Yu, E. A.,Thomas, J. S.,Owais, A.,Tirmizi, N.,Faruque, A.,Das, S. K.,Stein, A. D.(2015).Maternal prenatal attitudes and postnatal breast-feeding behaviours in rural Bangladesh.Public Health Nutrition,18(4),679-685.
30. Zelkowitz, P.,Papageorgiou, A.,Bardin, C.,Wang, T.(2009).Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months.Early Human Development,85(1),51-58.
31. Zhu, J.,Chan, W. C.,Zhou, X.,Ye, B.,He, H. G.(2014).Predictors of breast feeding self-efficacy among Chinese mothers: A cross-sectional questionnaire survey.Midwifery,30(6),705-711.