الفهرس 
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Abstract
Cesarean Section (CS) is a surgical intervention, which is carried out to ensure the safety of mother and her baby when vaginal delivery is not possible. Although CS is effective in saving lives of the parturients and perinatal infants, it comes with challenges, one of which is breastfeeding. Lower breastfeeding initiation and insufficient breast milk is common in women subjected to CS. Inadequate milk production is often mentioned as an outstanding barrier for initiation and early cessation of breastfeeding. Non-pharmacological methods used to promote breast feeding and increase breast milk include the use of fenugreek, blessed thistle, fennel, and applying breast massage with almond oil. Almond oil is used in complementary medicine circles for its numerous health benefits. Almonds and almond oil have many properties including anti-inflammatory, immunity-boosting and anti-hepatotoxicity effects. Almond oil massage is a type of herbal traditional medicine which increases mothers’ milk by increasing the secretion of prolactin hormone. Almond oil massage over the breast with the goal of improving health, promotes relaxation and clears the milk ducts which in turn promotes lactation in breastfeeding mothers.
Aim of the study The present study aimed to determine the effect of almond oil breast massage on breast milk secretion among postnatal mothers after cesarean section. Research hypothesis: Postnatal mothers after cesarean section who apply almond oil massage to their breasts exhibit an increase in the secretion of breast milk than those who do not apply it.
Materials and method
Setting:
This study was conducted at the postnatal unit at Damanhour Medical National Institute.
Subjects:
The study subjects were selected from the above mentioned setting by using the non-probability sampling technique, where a convenient sample of 80 postnatal mothers to whom cesarean section had been performed according to Epi-info statistical program.
The subjects were selected according to the following inclusion criteria: 1. Post-natal mothers undergone CS
2. Mothers with single & appropriate weight for gestational age newborn.
3. Mothers whose newborns are full term with normal reflexes.
4. Mothers with normal breast nipples.
5. Mothers without chronic illness as diabetes and thyroid disorders (as confirmed by the mothers’ clinical record).
6. Mothers who have deficient breast milk secretion.
7. Mothers who are willing to breast feed their newborns.
The subjects were divided into two equal groups, study group (40) and control group (40).
Tools of data collection
Three tools were used for data collection
Tool I: Post-natal mothers’ Socio-demographic structured interview schedule and basic data:
This tool was developed and used by the researcher to collect basic data of the study subjects. It included five parts:
Part I: Socio-demographic characteristics such as age, level of education, occupation, religion, marital status, current residence, type of family and family income.
Part II: Reproductive history i.e. gravidity, parity, number of abortions, and number of living children& stillbirths.
Part III: Information about the current pregnancy and birth such as attendance of antenatal care, information received about breastfeeding during antenatal care, type of anesthesia, analgesia, antibiotics, and initiation of breastfeeding after giving birth.
Part IV: Breastfeeding history, such as breast feeding of previous children, reasons for not breastfeeding, dealing with breastfeeding problems, adequacy of breast milk in the first ten days after birth, and methods used to increase milk production.
Part V: Information about breastfeeding: It comprised 14 questions to assess mothers’ knowledge about breastfeeding. The answers of 12 questions were scored as correct and complete =2, correct and incomplete =1, and incorrect or don’t know= 0. The answers to the remaining 2 questions were scored as yes =1 and no= 0. The answers of all questions were scored and summed together; the total score was 26 categorized as follows:
Poor knowledge less than 13
Satisfactory knowledge from 13 to less than 20
Good knowledge from 20 to 26
Tool II: breast milk adequacy questionnaire:
This tool was adapted from Anusha (2015) to check milk adequacy before and after intervention . It consists of 20 questions regarding breast milk secretion. One of 2 responses was required. One mark was donated for the (yes) response and zero mark was donated for the (no) response. And the total score was classified as follows:
Adequate breast milk secretion 14 – 20
Moderate breast milk secretion 7 – 13
Inadequate breast milk secretion 1- 6
Tool III: UNICEF- based breast feeding assessment:
This tool was adopted and modified then translated into Arabic language. UNICEF has developed a breastfeeding assessment tool to assess the adequacy of breast milk by assessing the condition of breasts and nipples, color of the newborn, percentage weight loss of newborn, urinary output per day, stool frequency per day, number of feeds in 24 hours, behavior of the newborn during and after feeds etc. Breastfeeding assessment tool consists of 15 questions with responses scored from 1-5 (UNICEF, UK 2010). The total score obtained from the 15 questions was 75 score which were classified as follows:
Inadequate breast milk secretion: 15-35
Moderate breast milk secretion: 36-55
Adequate breast milk secretion: 56-75
- Tools were tested for content validity and applicability by jury of (5) experts in the field of obstetric and gynecological nursing, their suggestions and recommendations were taken into consideration.
- The reliability of the tools was tested using the internal consistency test (Cronbach’s alpha test).
- A pilot study was carried out on 10 % of the sample (8 postnatal mothers) to ensure the clarity and applicability of the tools.
The main findings yielded by the present study were as follows:
A. Subjects’ socio demographic data:
A. Concerning age, it was found that more than one half (55%) &more than three- fifth (62.5%) of the study and control groups respectively were 20 to less than 30 years old,
B. More than one half (55%) of the study group had secondary education or its equivalent, compared to more than two fifth (42.5%) of the control group
C. Most of the study and the control groups (97.5% & 92.5) respectively were housewives
D. Less than one half (45.0%) of the study group had extended family, compared to more than two thirds (70%) of the control group.
E. More than two thirds (67.5%) of the study group were rural dwellers, compared to 85% of the control group
B. Subject’s reproductive history:
F. One half (50%) of the study group had 2-4 pregnancies and parities, compared to less than three quarters (72.5%) of the control one.
G. The majority of the study and the control groups (92.5% & 82.5% respectively) had no abortions.
H. There was a statistically significant difference between the two groups in relation to their gravidity, parity, and number of living children where, P= (0.028, 0.028, & 0.030, respectively).
C. Subject’s breastfeeding history :
I. Less than one half (45%) of the study group reported that they breast fed their previous children, compared to more than three quarters (77.5%) of the control group.
J. Concerning adequacy of the breast milk to satisfy the baby in the first ten days after birth, the majority (88.9% & 93.5%) of the two groups, respectively reported that they didn’t have adequate breast milk to satisfy the baby in the first ten days after birth.
K. No statistically significant difference was found between the two groups in relation to their breastfeeding history
D. Subject’s data of current birth :
Regarding type of anesthesia, it was found that all (100%) & the majority (97.5 %) of the study and the control groups respectively received spinal anesthesia.
All (100%) of the study and the control groups received analgesics like ketolac and cataflam with a dose of 1cm as needed, in addition to 1 tablet of the same drug every 8hrs.
As regards initiation of breast feeding after birth, approximately an equal proportion (42.5% & 40%) of the study and the control groups respectively initiated breast feeding after 2hrs
No statistically significant difference was found between the two groups in relation to their type of anesthesia and initiation of breast feeding where, p= (1.000 &0.060, respectively).
E. Subject’s knowledge about breast feeding:
Nearly three quarter (72.5% & 70%) of the study and the control groups, respectively had satisfactory knowledge about breastfeeding, compared to more than one quarter (27.5% & 30%) of them, respectively who had poor knowledge.
No statistically significant difference was observed among the two groups in relation to their total score of knowledge about breastfeeding where, P=0.805.
F. Subjects breast milk adequacy before and after intervention
All subjects (100%) of the study and the control groups had inadequate breast milk secretions before intervention on the 4th day. While the majority (80%, & 87.5%) of the two groups respectively, had moderate breast milk secretions after intervention on the 5th day.
No statistically significant difference was found between the two groups regarding the total score of breast milk adequacy before intervention on the 4th day and after intervention on the 5th day.
It was found that on the 6th day after intervention, more than three quarters (77.5%) of the study group had moderate breast milk secretion, compared to the majority (90%) of the control group, while more than one fifth (22.5%) of the study group had adequate breast milk secretion compared to only (10%) of the control group.
No statistically significant difference was found regarding adequacy of breast feeding between the two groups on 6th day of intervention, where (p=0.130).
The majority (85%) of the study group had adequate breast milk secretion compared to slightly less than one third (32.5%) of the control group.
A highly statistically significant difference was found between the two groups in relation to adequacy of breast milk secretion on the 8th day after intervention, where (P=0.000).