Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2021 | Lactation | Research article

The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis

Authors: Zhi Wang, Qiuyue Liu, Lihua Min, Xiaorong Mao

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

The importance of breastfeeding for maternal and child health is agreed upon worldwide. However, lactation-related nipple problems are common and are important factors affecting breastfeeding. Multiple studies recommended laid-back breastfeeding, but they are of various levels of quality, and the results are inconclusive.

Methods

We systematically searched the following twelve databases from inception to January 28,2020: Cochrane Library, EMBASE, Medline, Ovid, PubMed, Web of Science, CINAHL, Scopus, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang, and VIP. All studies regarding laid-back breastfeeding or biological nurturing were considered, regardless of whether they were randomized controlled trials. Two trained investigators independently evaluated the quality of the selected articles and screened the data. All the data were analysed separately using Review Manager Version 5.3 and STATA/SE Version 15.1.

Results

A total of 12 studies involving 1936 groups of postpartum women and their newborns were included. The results of the meta-analysis showed that nipple pain (RR = 0.24; 95% CI 0.14, 0.40; p < 0.00001), nipple trauma (RR = 0.47; 95% CI 0.29, 0.75; p = 0.002) and correct latching position (RR = 1.22; 95% CI 1.11, 1.33; p < 0.0001) in the experimental groups were all better than those of the control groups, and the differences were statistically significant (p < 0.05), which indicates that the laid-back position has a positive effect on maternal breastfeeding. However, the results of position comfort showed that there was no statistical significance between the two groups (ES = 0.09; 95% CI -0.63, 0.81; p = 0.798).

Conclusion

Compared with traditional breastfeeding positions, the laid-back position has been proven to be related to a decreased incidence of nipple pain and nipple trauma and is seemingly conducive to the use of the correct latching position. It is suggested that the laid-back position is helpful in solving lactation-related nipple problems and can be recommended as a position for breastfeeding. However, no significant difference in position comfort was found between the two groups based on the current evidence, and further studies are still needed to validate these results due to the limitations of the included studies.

Available only for authorised users

World Health Organization. Infant and young child feeding. 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. Accessed 9 January 2021.

Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Group TLBS. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491–504. https://doi.org/10.1016/S0140-6736(15)01044-2.CrossRefPubMed

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90. https://doi.org/10.1016/S0140-6736(15)01024-7.CrossRefPubMed

World Health Organization. Global nutrition targets 2025: policy brief series (WHO/NMH/NHD/14.2). Geneva: World Health Organization. 2014. Available from: https://www.who.int/nutrition/publications/globaltargets2025_policybrief_overview/en/. Accessed 15 March 2020.

Bourdillon K, McCausland T, Jones S. The impact of birth-related injury and pain on breastfeeding outcomes. Br J Midwifery. 2020;28(1):52–61. https://doi.org/10.12968/bjom.2020.28.1.52.CrossRef

Gianni ML, Bettinelli ME, Manfra P, Sorrentino G, Bezze E, Plevani L, Cavallaro G, Raffaeli G, Crippa BL, Colombo L, Morniroli D, Liotto N, Roggero P, Villamor E, Marchisio P, Mosca F. Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients. 2019;11(10):2266. https://doi.org/10.3390/nu11102266.CrossRefPubMedCentral

Niazi A, Rahimi VB, Soheili-Far S, Askari N, Rahmanian-Devin P, Sanei-Far Z, et al. A systematic review on prevention and treatment of nipple pain and fissure: are they curable? J Pharmacopuncture. 2018;21(3):139.PubMedPubMedCentral

Buck Miranda L, Amir Lisa H, Meabh C, Donath Susan M, Team CASTLE Study. Nipple pain, damage, and vasospasm in the first 8 weeks postpartum. Breastfeed Med. 2014;9(2):56–62. https://doi.org/10.1089/bfm.2013.0106.CrossRefPubMedPubMedCentral

Hong P, Lago D, Seargeant J, Pellman L, Magit AE, Pransky SM. Defining ankyloglossia: a case series of anterior and posterior tongue ties. Int J Pediatr Otorhinolaryngol. 2010;74(9):1003–6. https://doi.org/10.1016/j.ijporl.2010.05.025.CrossRefPubMed

10.

de Barros NR, Dos Santos RS, Miranda MCR, et al. Natural latex-glycerol dressing to reduce nipple pain and healing the skin in breastfeeding women. Skin Res Technol. 2019;25(4):461–8. https://doi.org/10.1111/srt.12674.CrossRefPubMed

11.

Vieira F, Bachion MM, Mota DDCF, Munari DB. A systematic review of the interventions for nipple trauma in breastfeeding mothers. J Nurs Scholarsh. 2013;45(2):116–25. https://doi.org/10.1111/jnu.12010.CrossRefPubMed

12.

Coca KP, Gamba MA, Silva RS, et al. Does breastfeeding position influence the onset of nipple trauma. Rev Esc Enferm USP. 2009;43(2):446–52. https://doi.org/10.1590/S0080-62342009000200026.CrossRefPubMed

13.

Amir LH. Managing common breastfeeding problems in the community. Bmj. 2014;348(may12 9):g2954. https://doi.org/10.1136/bmj.g2954.CrossRefPubMed

14.

Coca KP, Marcacine KO, Gamba MA, Corrêa L, Aranha ACC, Abrão ACFV. Efficacy of low-level laser therapy in relieving nipple pain in breastfeeding women: a triple-blind, randomized, controlled trial. Pain Manage Nurs. 2016;17(4):281–9. https://doi.org/10.1016/j.pmn.2016.05.003.CrossRef

15.

Santo LCE, De Oliveira LD, Giugliani ERJ. Factors associated with low incidence of exclusive breastfeeding for the first 6 months. Birth. 2007;34(3):212–9. https://doi.org/10.1111/j.1523-536X.2007.00173.x.CrossRefPubMed

16.

Jensen D, Wallace S, Kelsay P. LATCH: a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs. 1994;23(1):27–32. https://doi.org/10.1111/j.1552-6909.1994.tb01847.x.CrossRefPubMed

17.

Jackson Kimberley T, O’Keefe-McCarthy S, Tara M. Moving toward a better understanding of the experience and measurement of breastfeeding-related pain. J Psychosom Obstet Gynecol. 2019;40(4):318–25. https://doi.org/10.1080/0167482X.2018.1518421.CrossRef

18.

Bourdillon K, McCausland T, Jones S. Latch-related nipple pain in breastfeeding women: the impact on breastfeeding outcomes. Br J Midwifery. 2020;28(7):406–14. https://doi.org/10.12968/bjom.2020.28.7.406.CrossRef

19.

Colson S. Biological nurturing: the laid-back breastfeeding revolution. Midwifery Today Int Midwife. 2012;101:9–66.

20.

Colson S. An introduction to biological nurturing: new angles on breastfeeding: Hale Pub; 2010.

21.

Colson S. Biological nurturing: instinctual breastfeeding (2nd ed): Praeclarus Press; 2019.

22.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

23.

Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from https://training.cochrane.org/handbook/current/chapter-06. Accessed 20 February 2020.

24.

Yang ZR, Sun F, Zhan SY. Risk on bias assessment:(2) revised Cochrane risk of bias tool for individually randomized, parallel group trials (RoB2. 0). Chinese J Epidemiol. 2017;38(9):1285–91.

25.

Aromataris E, Munn Z. Joanna Briggs institute reviewer's manual: The Joanna Briggs Institute; 2017. p. 299.

26.

Anzures-Cabrera J, Sarpatwari A, Higgins JPT. Expressing findings from meta-analyses of continuous outcomes in terms of risks. Stat Med. 2011;30(25):2967–85. https://doi.org/10.1002/sim.4298.CrossRefPubMed

27.

Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from https://training.cochrane.org/handbook/current/chapter-10. Accessed 20 February 2020.

28.

Thongprayoon C, Khoury NJ, Bathini T, Aeddula NR, Boonpheng B, Leeaphorn N, Ungprasert P, Bruminhent J, Lertjitbanjong P, Watthanasuntorn K, Chesdachai S, Mao MA, Cheungpasitporn W. BK polyomavirus genotypes in renal transplant recipients in the United States: a meta-analysis. J Evid Based Med. 2019;12(4):291–9. https://doi.org/10.1111/jebm.12366.CrossRefPubMed

29.

Shihong ZHANG. Subgroup analysis and sensitive analysis should be set up reasonably in meta-analysis. Chinese J Contemp Neuro Neurosurg. 2016;16(1):1.

30.

Zwetsloot PP, Van Der Naald M, Sena ES, et al. Standardized mean differences cause funnel plot distortion in publication bias assessments. Elife. 2017;6:e24260. https://doi.org/10.7554/eLife.24260.CrossRefPubMedPubMedCentral

31.

Tiansong ZHANG, Shengjie DONG, Zhirui ZHOU. Advanced meta-analysis in Stata. Shanghai: Fudan University Press; 2015. p. 327–31.

32.

Xiantao ZENG. Do meta-analysis by STATA. Beijing: Military Medical Science Press; 2014. p. 156–9.

33.

Chiengthong K, Cheungpasitporn W, Thongprayoon C, Lertjitbanjong P, Cato LD, Bathini T, Ungprasert P, Mao MA, Chokesuwattanaskul R. Vitamin D deficiency is not associated with graft versus host disease after hematopoietic stem cell transplantation: a meta-analysis. J Evid Based Med. 2020;13(3):183–91. https://doi.org/10.1111/jebm.12383.CrossRefPubMed

34.

Boonpheng B, Thongprayoon C, Mao MA, Wijarnpreecha K, Bathini T, Kaewput W, Ungprasert P, Cheungpasitporn W. Risk of hip fracture in patients on hemodialysis versus peritoneal dialysis: a meta-analysis of observational studies. J Evid Based Med. 2019;12(2):98–104. https://doi.org/10.1111/jebm.12341.CrossRefPubMed

35.

Sterne JAC, Sutton AJ, Ioannidis JPA, Terrin N, Jones DR, Lau J, Carpenter J, Rucker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JPT. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. Bmj. 2011;343(jul22 1):d4002. https://doi.org/10.1136/bmj.d4002.CrossRefPubMed

36.

Mekonnen AG, Yehualashet SS, Bayleyegn AD. The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies. Int Breastfeed J. 2019;14(1):12. https://doi.org/10.1186/s13006-019-0206-0.CrossRefPubMedPubMedCentral

37.

Minying ZHUANG. The effects of laid-back breastfeeding position on the success rate of breastfeeding and the degree of nipple pain. Chinese J Rural Med Pharm. 2019;26(18):26–7.

38.

Xiaona SHI, Yin C, Zhang X. The effects of laid-back breastfeeding position on nipple trauma, nipple pain and satisfaction. Chinese J Woman Child Health Res. 2017;28(S4):5–6.

39.

Meng LI, Xiaolei WANG, Tingting WANG, et al. Observation on the effects of laid-back breastfeeding position to relieve nipple pain. Zhejiang Clin Med J. 2017;19(9):1726–8.

40.

Ruihua YU, Ping PAN, Jinkui HUANG. Application of semi-lying breast-feeding posture on breast-feeding after cesarean section. China Pract Med. 2019;14(13):147–9.

41.

Liling ZENG, Wenji ZHOU, Jingjing GUO, et al. Evaluation of the effect of semi-lying breast-feeding posture on breast-feeding of depressed nipple mothers. Med Innov China. 2019;16(16):82–6.

42.

Puapornpong P, Raungrongmorakot K, Laosooksathit W, Hanprasertpong T, Ketsuwan S. Comparison of breastfeeding outcomes between using the laid-back and side-lying breastfeeding positions in mothers delivering by cesarean section: a randomized controlled trial. Breastfeed Med. 2017;12(4):233–7. https://doi.org/10.1089/bfm.2016.0193.CrossRefPubMed

43.

Haixia LIU, Li CHEN, Huimin DI. Intervention of semi-lying breast-feeding on breast injury and maternal satisfaction during lactation. China Pract Med. 2019;14(31):24–6.

44.

Jiaojiao ZHANG. The effects of Laid-back Posture on Lactation Related Nipple Pain and Breastfeeding in Primiparas. PhD thesis: Hainan Medical University; 2019.

45.

Lei ZHAO. Application of semi-reclining breastfeeding position in 3 days after delivery of healthy full-term infants. J Bengbu Med Coll. 2019;44(07):979–81.

46.

Xiaohui LIANG, Hongchun ZHANG, Jing LIU, et al. The semi-lying position in combination with kangaroo mother care promoted the success rate of breastfeeding. World Latest Med Inform. 2017;17(A1):49–50.

47.

Dongyan WANG. Observation of the effect of promoting breastfeeding and evaluation of the impact of success rate by the semi-lying position in combination with kangaroo mother care. Healthmust-Readmagazine. 2019;36:137.

48.

Ping LU, Jiamin MAO. The effects of semi-lying position care on maternal breastfeeding, nipple damage and satisfaction. Today Nurse. 2019;26(06):72–5.

49.

Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics. 2013;131(3):e726–32. https://doi.org/10.1542/peds.2012-1295.CrossRefPubMed

50.

Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev. 2014;(12). https://doi.org/10.1002/14651858.CD007366.

51.

Milinco M, Travan L, Cattaneo A, Knowles A, Sola MV, Causin E, et al. Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial. Int Breastfeed J. 2020;15(1):1–10.CrossRef

52.

Nakamura M, Asaka Y, Ogawara T, Yorozu Y. Nipple skin trauma in breastfeeding women during postpartum week one. Breastfeed Med. 2018;13(7):479–84. https://doi.org/10.1089/bfm.2017.0217.CrossRefPubMed

53.

Kent JC, Ashton E, Hardwick CM, et al. Nipple pain in breastfeeding mothers: incidence, causes and treatments. Int J Environ Res Public Health. 2015;12(10):12247–63. https://doi.org/10.3390/ijerph121012247.CrossRefPubMedPubMedCentral

54.

Teich AS, Barnett J, Bonuck K. Women's perceptions of breastfeeding barriers in early postpartum period: a qualitative analysis nested in two randomized controlled trials. Breastfeed Med. 2014;9(1):9–15. https://doi.org/10.1089/bfm.2013.0063.CrossRefPubMedPubMedCentral

55.

Kolcaba K. Evolution of the mid range theory of comfort for outcomes research. Nurs Outlook. 2001;49(2):86–92. https://doi.org/10.1067/mno.2001.110268.CrossRefPubMed

56.

Vinall R. The value of introducing laid-back breastfeeding. NCT’s Journal on Preparing Parents for Birth and Early Parenthood. 2015;12(29). https://www.nct.org.uk/sites/default/files/related_documents/Vinall%20The%20value%20of%20introducing%20laid-back%20breastfeeding_0.pdf. Accessed 20 Apr 2020.

Title: The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis
Authors: Zhi Wang
Qiuyue Liu
Lihua Min
Xiaorong Mao
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Lactation
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03714-8

2024 ASCO Annual Meeting

Springer Medicine

The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis

Abstract

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Evidence for HPV DNA in the placenta of women who resorted to elective abortion

Conjoined twins in dichorionic diamniotic triplet pregnancy: a report of three cases and literature review

Is the National Health Insurance Scheme helping pregnant women in accessing health services? Analysis of the 2014 Ghana demographic and Health survey

Appraisal of systematic reviews on interventions for postpartum depression: systematic review

Association between halitosis and female fecundability in China: a prospective cohort study

The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester