Health experts agree: breastfeeding leads to optimal health for infants and their mothers. According to the Centers for Disease Control and Prevention, infants who are breastfed are less likely to suffer from infant illnesses like croup or diarrhea; asthma; obesity; and Type 1 diabetes, among other issues. Breastfeeding can also lower a mother’s chance of being diagnosed with ovarian and breast cancers, high blood pressure, and Type 2 diabetes.

But a lot of women do not breastfeed their children for the recommended minimum of six months, because the process can be painful. School of Nursing faculty member Ruth Lucas has dedicated her research to supporting women in their breastfeeding journeys and helping them manage their breast and nipple pain, or BNP. Recently, she received a High Priority, Short-Term Project Award (R56) from the National Institutes of Health to aid this research.

“Most women who stop breastfeeding do so within three weeks after giving birth, and 30% stop due to breast and nipple pain,” Lucas says. “We’ve found that women who experience this pain also report lower self-efficacy — belief in themselves that they are capable of breastfeeding and caring for their child — as well as higher rates of anxiety, depression, stress, and fatigue.”

Discontinuing breastfeeding before three weeks also costs society about $3 billion a year, due to formula purchases, increased health visits and infant illness rates, and lost wages. Around $2.3 billion of that total comes at the cost of mothers.

“Women will continue to breastfeed even with unresolved pain because they want to provide the best for their baby.” Lucas says. “However, unsolved breast and nipple pain triggers a complex pain feedback loop which may result in enhanced pain sensitivity. As a result of this study, we may be able to use enhanced pain sensitivity to identify women at high-risk for ceasing breastfeeding due to pain and future risk for chronic pain, which will help us create targeted interventions for breast and nipple pain.”

Working with the School of Nursing’s P20 Center for Accelerating Precision Pain Self-Management, Lucas has developed a method — the Breastfeeding and BNP Self-Management (BSM) intervention — to empower mothers and teach them how to cope with their pain.

“We use a cloud-based platform to deliver breastfeeding information and skills to the women, and have nurses provide support through text messaging,” Lucas says. Her first study to test the method was successful, with women reporting less pain one to two weeks after beginning breastfeeding, which led to increased self-confidence and decreased anxiety at six weeks.

Now, with that preliminary data in hand, Lucas is replicating and expanding the study. With the R56 grant from the NIH, she plans to recruit more than 200 women for a randomized controlled trial. The women will be randomly divided into two groups: one that receives Lucas’ specialized BSM intervention and one that receives general postpartum and infant care. After establishing each woman’s baseline of pain, Lucas and her team will reassess them eight times over the course of 24 weeks. At each check-in, the researchers will evaluate the women’s breast and nipple pain, whether they’re still breastfeeding exclusively or are supplementing with formula, and their feelings of self-efficacy and well-being.

“We suspect the women who receive the BSM intervention will report lower breast and nipple pain intensity and interference in their daily lives within the first three weeks,” Lucas says. “They should also have a lower cumulative pain score over time, compared to the group who receives general support.”

Her team also believes the group who receives the BSM method will have more women who are exclusively breastfeeding throughout the 24 weeks than the control group and will also report higher well-being and self-efficacy throughout.

“This study could potentially lead to new nurse-led breastfeeding support initiatives in clinical settings,” Lucas says. “The BSM intervention is easily accessible for women, as the texting and cloud-based learning can be conducted at home and could easily be translated to large-scale health care settings.”

Support for this research is provided by the National Institutes of Health’s National Institute of Nursing Research Grant R56NR020041. Visit ninr.nih.gov for more information.

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