Background & Aims

The World Health Organization recommends infants be exclusively breastfed for the first 6 months for optimal health and development. However, according to the Singapore Department of Statistics fewer than 1% of mothers continue to exclusively breastfeed at 6-months of age (Chua & Win, 2013). Reasons for breastfeeding cessation have been attributed to low milk supply, breast or nipple problems, difficulties in breastfeeding, lack of support, and pain. The Breastfeeding Pain Reasoning Model (BPRM) was developed to assist clinicians’ reasoning by promoting a multidimensional conceptualisation of pain and consists of three domains based on pain mechanisms: “Local stimulation”, “External Influences” and “Central Modulation” (Amir, Jones & Buck, 2015). The aim of this study is to explore the perspectives of women regarding the causes and influences of the pain experienced with lactation, using the framework of the BPRM.

Methods

This study adopted phenomenological approaches to explore Singaporean women’s lived experiences of pain associated with lactation (breastfeeding and breastmilk expression). Participants were required to be >21 years of age and be Singaporean or Permanent Residents of Singapore and have current or recent (in the last 4 months) painful breastfeeding experience. Eligible participants were recruited from a Singapore-based online breastfeeding support group and semi-structured interviews conducted online using guiding questions related to the BPRM domains. Audio recordings of the interviews were transcribed and transcripts were initially coded deductively, with reference to the three categories of the BPRM. Further inductive analysis was performed to extend the findings beyond the BPRM constructs and to include broader aspects of women’s breastfeeding experiences that will not be reported here.

Results

Data were collected from 19 semi-structured online interviews. Women reported extreme levels of pain (up to 10/10 on verbal numeric pain rating scale), at various stages of their breastfeeding journey. Some degree of pain was experienced by most women during the initiation and subsequent days of breastfeeding. Pain was reported to be associated with poor latch, infection, engorgement, blocked ducts, abrasions, poor circulation/exposure to cold and using ill-fitting or wrong sized equipment, and was described as sharp, shooting, burning, tingling and aching, often provoked by internal or external pressure applied to the breast or nipple. Some women also shared the belief that their nipples needed to get “used to” breastfeeding. Some women indicated that tiredness, low mood and stress could make their pain experience worse, including by reducing their tolerance to pain. Many participants reported periods where they felt overwhelmed and distressed by their painful lactation experiences.

Conclusions

Pain mechanisms aligned with the “Local Stimulation” and “External Influences ” domains of the BPRM were well represented in the data. The women’s stories included a number of features that, based on contemporary understanding, could be argued to contribute to a pain experience but were not associated with the women’s conception of pain, including fever, prolonged nociception, traumatic birth experiences, lack of support in establishing breastfeeding, perceived injustice, fear of pain associated with breastfeeding and low mood or anxiety. These would align with the “Central Modulation” domain of the BPRM. Our findings indicate there may be value in educating clinicians and peer supporters about pain mechanisms including the broad influences on pain, and promoting a biopsychosocial approach to pain assessment and management of the breast and nipple pain associated with lactation.

References

Amir, L. H., Jones, L. E., & Buck, M. L. (2015). Nipple pain associated with breastfeeding: incorporating current neurophysiology into clinical reasoning. Australian Family Physician, 44(3), 127-132.
Chua, L., & Win, A. M. (2013). Prevalence of breastfeeding in Singapore. Statistics Singapore Newsletter, 10, 15.

Presenting Author

Lester E. Jones

Poster Authors

Lester Jones

PhD, MScMed(PainMgt)

Singapore Institute of Technology

Lead Author

Lisa H. Amir MBBS

MMed

La Trobe University

Lead Author

Zubair Amin MBBS

MHPE

Department of Neonatology - National University Health System

Lead Author

Yvonne Peng Mei Ng MBBS

MRCP

Department of Neonatology - National University Health System

Lead Author

Doris Fok BA

PgDipEd

Lead Author

Nicole Shi En Chew BSc(Physiotherapy)

Lead Author

Shi Yun Low BSc(Diagnostic Radiography)

Lead Author

Victoria Yu Ting Woo BSc(Physiotherapy)

Lead Author

Topics

  • Assessment and Diagnosis