Effects of Acupoint Massage Combined with Cupping Therapy on Postpartum Lactation and Mastitis in Puerpera

Fn Liyun (樊立云), Wu Youjun (吳優(yōu)娟), Sun Shnghui (孫尚繪)

aThoracic Department of Traditional Chinese Medicine, the Second People's Hospital of Hefei, Hefei 230011, China

bThe Second Department of Obstetrics and Gynecology, the Second People's Hospital of Hefei, Hefei 230011, China

ABSTRACT

OBJECTIVE: To explore the effects of acupoint massage combined with cupping therapy on postpartum lactation and mastitis. METHODS: A total of 360 women who had breastfeeding needs after hospitalization in the Second People's Hospital of Hefei were selected from August to December in 2018. A total of 180 women who had no contraindications and were willing to cooperate were included in the observation group, and 180 women who were unwilling to participate in the intervention were the control group. Routine postpartum care was performed on both groups of pregnant women,and acupoint massage and cupping therapy were performed on the maternal women in the observation group. During the hospitalization period, the starting time of lactation in the 2 groups, and the lactation volume at 1 day, 2 days, and 3 days after delivery, and the incidence of mastitis and cracked nipple, and the situation of exclusive breastfeeding were recorded and analyzed. Comparative analysis of the effects of acupoint massage combined with cupping therapy on postpartum lactation and mastitis in primipara were made. RESULTS: In the observation group, 145 women had a moderate amount of lactation 1 day after delivery, and the lactation amount of remaining 35 cases were small. There were 22 women with a high amount of lactation 2 days after delivery, and 132 women had a moderate amount of lactation, and the lactation amount of the remaining 26 cases were small. 138 women had a high amount of lactation 3 days after delivery, and 37 women had a moderate amount of lactation, and the lactation amount of the remaining 5 cases were small. All the women in the observation group did not have cracked nipple or mastitis, and the postpartum effect was significantly better than that of the control group (P < 0.05). CONCLUSION: Acupoint massage combined with cupping therapy can promote early lactation, increase breastfeeding rate, and reduce the incidence of mastitis.

KEYWORDS: Acupressure; Cupping; Maternity; Lactation; Mastitis

For newborns, breast milk is the most ideal natural foods. Compared with other infant diets, breast milk has its unique and irreplaceable advantages. Breastfeeding is also the best way to feed newborns, which can promote the intellectual and physical development of newborns and prevent the occurrence of infant obesity,allergies, sudden death and other symptoms. Therefore,breastfeeding is irreplaceable to newborns[1-4]. Postpartum mastitis is a common disease that occurs in puerperal mothers. It is an inflammatory disease caused by cracked nipples, blocked mammary ducts, and milk deposition.Compared with multipara women, the incidence in primipara is higher[5]. Studies have shown that the concentration of serum prolactin is low in puerpera with cesarean section, which affects the initiation time and amount of lactation[6]. Cupping therapy is simple and effective, and it is a treatment method of traditional Chinese medicine (TCM). It is widely used in clinical practice[7]. Massage also promotes postpartum milk secretion[8]. In this study, a total of 360 women who had breastfeeding needs after hospitalization in the Department of Obstetrics and Gynecology in the Second People's Hospital of Hefei were selected to investigate and analyze the effect of acupoint massage combined with cupping therapy on postpartum lactation and mastitis. The reports are as follows.

MATERIALS AND METHODS

General information

The study sample involved in this study was 360 selected parturient women who were hospitalized in the Department of Obstetrics and Gynecology in the Second People's Hospital of Hefei from August to December in 2018 and had breastfeeding needs. A total of one hundred and eighty parturient women who had no contraindications and were willing to cooperate were included in the observation group, and 180 parturient women who were unwilling to participate in the intervention were the control group. Among them, the age of the observation group was from 22 to 40 years old, and the average age was (29.2 ± 3.1) years old;there were 46 women with cesarean section and 134 with spontaneous delivery. The age of the control group ranged from 23 to 41 years old, with an average age of (29.5 ± 3.3) years old; there were 48 women with cesarean section and 132 with spontaneous delivery.There was no statistically significant difference between the 2 groups of pregnant women in terms of age, mode of delivery, etc., and they were comparable (P > 0.05).Inclusion criteria: ① Parturient women within 6 hours of delivery; ② Parturient women who were not lactating or whose lactation could not meet the needs of newborns;③ Parturient women who were willing to cooperate with the study. Exclusion criteria: ① Parturient women who already had lactation before birth; ② Parturient women who had contraindications to breastfeeding: mothers with active infectious diseases, who were receiving medications that would affect their infants, and who had inherited metabolic diseases, etc.; ③ Those with coagulopathy and mental disorders; ④ Parturient women who were unwilling to participate in the study.

Research methods

The control group was given routine care which included early contact, early sucking, early milking, and breastfeeding instructions. In addition to routine care, the pregnant women in the observation group began to accept the first acupoint massage combined with cupping therapy within 6 hours after delivery, and the following acupressure massage was given once a day. With the parturient woman lying on the bed, ignite the alcohol cotton ball, which should be quickly removed after rotated in the cupping port and tank, so as not to burn puerpera's skin, and put the cup on Jianjing (GB 21), Tanzhong (CV 17), nipple,Ashi and other acupoints, so that the cupping tightly suck the breast, and remove the cup 5-10 min later. For acupoint massage, use the thumb or the palm root to push along the direction of the breast duct, from the breast root to the areola direction, and massage Rugen (ST 18) and Ruzhong(ST 17) for 30-60 s, and repeat 3-5 times for 10-15 min.

Research indicators

Lactation initiation time: Extruding areola with clear milk exudation is regarded as lactation. Lactation initiation time refers to the initial time when milk is extruded from the breast using the correct milking technique after delivery.Milk secretion: Refer to Guiding Principles for Clinical Research of New Chinese Medicines. Milk secretion can be divided into none, less, medium, and more. More: after breast-feeding, the maternal breast is squeezed and there is milk discharge; medium: after breast-feeding, maternal breasts are squeezed and no milk is excreted; less: after breast-feeding, the baby continues to cry; none: squeeze areola without milk discharge. Exclusive breast feeding: No food or drink, or even water, other than breast milk was given to infants. However, infants are allowed to take drops and syrups (vitamins, minerals, and medications).Exclusive breastfeeding rate = number of exclusively breastfed parturient women/number of parturients women × 100%. Mastitis: An acute suppurative infection occurs in breast duct with inflammation of the connective tissue in and around the breast ducts, which is common in postpartum lactating women. Incidence of mastitis = number of cases with mastitis/number of cases × 100%. Cracked nipple: Main manifestations are nipple epidermal shedding, nipple root cracks or peripheral ulcers, occurring in early breastfeeding period which often result from abnormal nipples or incorrect posture. Incidence of cracked nipple = number of cases with cracked nipple/number of cases × 100%. Inpatient satisfaction: satisfaction questionnaire is designed by the Second People's Hospital of Hefei with a total of ten items, which is divided into very satisfied (10 points), satisfied (7 points), more satisfied (5 points), basically satisfied (3 points), dissatisfied (0 points).Patients scored according to the attitude, nursing technology,knowledge level and other aspects of nurses.

STATISTICAL METHODS

Statistical software SPSS 17.0 was used for statistical process of the collected data, and the measurement data conforming to the normal distribution was tested by t-test and indicated by. And χ2is taken for counting data test, and described in (%). The difference of the above test method was statistically significant when P < 0.05.

RESULTS

General information of 2 groups of patients

Comparing the general data of maternal age and mode of delivery between the observation group and the control group, the differences were not statistically significant and the 2 groups were comparable (P < 0.05). See Table 1.

Table 1. General information of 2 groups of patients

Table 1. General information of 2 groups of patients

Number of natural labor Observation group 29.2±3.1 46 134 Control group 29.5±3.3 48 132 χ2/t 0.104 1.055 1.232 P 0.927 0.309 0.283 Group Age (years) Number of cesarean sections

Comparison of lactation initiation time and lactation volume between 2 groups

Compared with the control group, the lactation initiation time in the observation group was significantly earlier. In the observation group, 145 women had a moderate amount of lactation one day after delivery,and the lactation amount of remaining 35 cases were small. 22 women had a high amount of lactation 2 days after delivery, and 132 women had a moderate amount of lactation, and the lactation amount of the remaining 26 cases were small. A total of 138 women had a high amount of lactation three days after delivery, and 37 women had a moderate amount of lactation, and the lactation amount of the remaining 5 cases were small.The amount of lactation recorded at 1 d, 2 d, and 3 d after delivery was significantly higher in the observation group than that in the control group, and the differences were statistically significant (P < 0.05). See Table 2.

Table 2. Comparison of lactation initiation time and lactation between 2 groups

Comparison of occurrence of mastitis and exclusive breastfeeding rate between 2 groups of parturient women

Mastitis did not occur in observation group. In the control group, there were 18 cases of cracked nipple and the incidence of mastitis was 8.9%. The maternal status of the observation group was significantly better than that of the control group. In the observation group, 65 cases chose exclusive breastfeeding and the exclusive breastfeeding rate was 91.7%. The observation group was only 47.8%. The exclusive breastfeeding rate in the observation group was significantly higher than that in the control group, and the differences were statistically significant (P < 0.05). See Table 3.

Table 3. Comparison of occurrence of mastitis,cracked nipple and exclusive breastfeeding rate between the 2 groups [n (%)]

C omparison of maternal hospitalization satisfaction between 2 groups of parturient women

The rate of satisfaction of the mothers in the observation group was as high as 98.6%, and that of the control group was only 9.3%. Maternal hospitalization satisfaction in the observation group was significantly higher than that in the control group. The difference was statistically significant (P < 0.05). See Table 4.

Table 4. Comparison of satisfaction of maternal hospitalization between 2 groups (%)

DISCUSSION

The active ingredients in breast milk include lysozyme, lactoferrin, and taurine, which can effectively promote the development of brain tissue and significantly enhance immunity. It is the most cost-effective diet[9,10].And consensus has also been reached globally on this infant diet. The World Health Organization and the UNICF advocated that exclusive breastfeeding is best for infants 6 months after birth to ensure that the infant can develop normally and healthily. However, due to the occurrence of diseases such as insufficient lactation and mastitis during primiparity, it is easy to fail to feed breast milk. At present, the rate of exclusive breastfeeding of infants at 6 months is only about 37% worldwide, and there is still gap between the situation and the WHO's"Goal Five in the Global Goal for the Full Implementation of Maternal and Infant Nutrition Program"--to increase the rate of exclusive breastfeeding in the first 6 months of life to at least 50% by 2025[11]; and with the "China Children's Development Outline (2011-2020)"--to increase exclusive breastfeeding rate of 0 to 6 months to more than 50%[12].

Cracked nipple or milk deposition during lactation is the main cause of postpartum mastitis. The main symptoms of mastitis are breast swelling, impaired milk secretion, pain sensation, and affecting the appetite of the patient. This problem can affect infant feeding and development[13,14]. When the baby sucks the nipple, the nipple tissue is fragile and vulnerable, resulting in the occurrence of infection[15], and the patient has a strong feeling of pain, resulting in delayed feeding, and in severe cases mothers are resistant to infant sucking. At the same time, the amount of lactation is reduced, which can affect breastfeeding. Therefore, it is very necessary to increase postpartum lactation and reduce the incidence of mastitis.In summary, postpartum care is of great importance[16].Routine postnatal care is currently widely used, but routine care is still unable to meet the current needs.

According to a previous study[17], acupoint massage for parturient women has a significant effect on those with insufficient lactation. TCM believes that liver qi stagnation or qi and blood deficiency is the main reason of insufficient lactation, and mastitis is an inflammatory disease caused by blockage of the breast ducts and milk deposition. The treatment should be based on the principles of clearing heat and toxic materials, and promoting blood circulation and lactation. Massage has the function of relaxing muscles and tendons and activating meridians, activating blood circulation to remove blood stasis, and regulating function of organs[18]. In this study, massage was performed on the Ruzhong (ST 17) and Rugen (ST 18), of which Ruzhong(ST 17) was located in the center of the nipple, and Rugen(ST 18) was located in the fifth intercostal space below the nipple. They belonged to the Stomach Meridian of Foot-Yangming, which has the function of promoting the ventilation of lung qi, and activating lactation and removing blood stasis[19-21]. Both of them are very important acupoints for the treatment of lactation insufficiency.

The main effects of cupping therapy include activating meridians, expelling wind and coldness,promoting qi and blood circulation, and relieving pain and swelling. That is, to use pumping, burning high temperature or steam, etc. to make the cup is under negative pressure,and there is congestion in the cupping area, and the pathological substance in the human body is sucked out from the skin, which can effectively clear the breast meridians and blood, reduce the chance of bacterial growth and reproduction. Studies have shown that[22,23]the use of cupping therapy can clear the meridians and blood stasis of the breast and adjust the secretory function of the breast,promote lactation while preventing and treating mastitis.

The initiation time of lactation is the time when the mother squeezes milk in the breast for the first time through the correct technique. After delivery, the secretion of progesterone and estrogen in the blood is reduced, thereby losing the inhibitory effect on serum prolactin, resulting in the initiation of lactation activity in the mother. At the same time, acupoint massage and cupping therapy can promote the lactation. The results of this study showed that compared with the control group,the lactation initiation time in the observation group was significantly earlier, and the lactation amount recorded in the observation group was significantly higher than that of the control group at 1 d, 2 d, and 3 d after delivery.Acupoint massage combined with cupping therapy had a significant effect on early lactation. In observation group,mastitis did not occur, the situation was significantly better than that of the control group. And compared with the control group, the exclusive breastfeeding rate of observation group was significantly higher, and the satisfaction of observation group was significantly higher than that of the control group.

In summary, acupoint massage combined with cupping therapy can promote early lactation, increase breastfeeding rate, and significantly reduce the incidence of mastitis, which is worthy of clinical promotion.

ACKNOWLEDGEMENT

This work was supported by The Health and Family Planning Commission of Hefei (Hefei Health TCM[2018]No.72)