Potential predictors of nipple trauma from an in-home breastfeeding programme: A cross-sectional study

Background: Australian breastfeeding rates fall significantly in the months following birth, often as a result of breastfeeding complications.

Aim: To explore the potential risk factors for nipple trauma and breast engorgement in a group of women who were referred to the in home breastfeeding service in Melbourne, Australia.

Method: A retrospective, cross-sectional analyses of the maternal-infant records (n=653) from 2003 to 2007 including demographic characteristics; pregnancy, labour and birth data; the presenting complications and observational and diagnostic results. Bivariate and logistic regression analyses were conducted to explore the predictors of nipple trauma and engorgement.

Results: Nipple trauma was the most common presenting complication (62.9%). Logistic regression analyses identified four statistically significant predictors: facio-mandibular asymmetry (AOR 4.21, 95% CI [1.25-14.20]), inflammatory mastitis (AOR 2.99, 95% CI [1.57-5.68], nipple malignment (AOR 2.51, 95% CI [1.13-5.55]) and the cross-cradle technique (AOR 1.90, 95% CI [1.03-3.50]). Engorgement was associated with the first postpartum breastfeed being less than one-hour duration (AOR 2.01, 95% CI [1.07-3.79]).

Conclusion: Nipple trauma was associated with commonly taught techniques that involved the cross-cradle hold and manoeuvres of the breast, nipple and baby that resulted in nipple malalignment and facio-mandibular asymmetry. This practice, appeared to interfere with the baby's intra-oral function by restricting movement of the cranio-cervical spine and nuchal ligament. The combination appeared to limit the baby's instinctive ability to activate neuro-sensory mammalian behaviours to freely locate and effectively draw the nipple and breast tissue without causing trauma. Changes to the first and early breastfeeding techniques are recommended.