“A STUDY TO ASSESS THE EFFECTIVENESS OF COLD

CABBAGE LEAVES Vs HOT APPLICATION ON BREAST

ENGORGEMENT AMONG POSTNATAL MOTHERS IN A
SELECTED HOSPITAL, KHARGONE”

By

Ms. PARIDHEE GUPTA

Dissertation Submitted to the

MADHYA PRADESH MEDICAL SCIENCE UNIVERSITY
JABALPUR, M.P.,

In Partial fulfillment of the requirements for the degree of

Master of Science

In

OBSTETRICS AND GYNAECOLOGICAL

NURSING

Under the guidance of:

Mrs. Leena Ester Adin (MSc nursing)

HOD in Obstetrics and Gynecological Nursing

RAHAT COLLEGE OF NURSING, KHARGONE

2020
1
 0.1. INTRODUCTION

"Mankind is unique in all of creation in being made in God's image"

(Genesis 1:26-27)

The birth of a baby is an important event in any family. It is therefore

important that for a mother to have a healthy baby, she gives her baby the best

nutrition. Breast milk is the best food for babies as breastfed babies are generally

healthier than formula fed babies. In recognition of the importance of breastfeeding,

the Baby-Friendly Hospital Initiative was launched by UNICEF/WHO in

1991.Breast feeding enhances the cognitive development and decreases the

problems such as obesity, hypertension and insulin dependent diabetes mellitus.

Given the strong evidence of the benefits of breastfeeding for women and babies the

WHO recommends that, in all parts of the world, babies should be exclusively

breastfed for the first six months “to achieve optimal growth, development and

health”1

Breastfeeding is widely encouraged in current obstetric practice. While its

advantages to mother and child are well recognized, there are a number of problems

associated with it. One common problem that is encountered is breast engorgement,

which makes continuation of breast feeding difficult. Breast engorgement occurs if

the baby removes less milk from the breast when feeding than the amount that the

mother produces. Breast engorgement is the overfilling of breast milk that causes

discomfort and pain to the mother whilst non-infectious mastitis is inflammation of

the breast due to milk duct blockage. 2

Correct breastfeeding technique is important to ensure successful breast

feeding. Incorrect technique may contribute to breast engorgement, and in particular

2
it

3
is important for the baby to latch on to the breast correctly during feeding so that it

can suck effectively. In order to do this the baby needs to be correctly positioned,

and new mothers may need advice on this. Breast engorgement may affect the area

around the nipple and areola only or the entire breast, and may affect one breast

only, or both. Once engorgement occurs, swelling around the nipple may make it

even more difficult for the baby to latch-on and feed successfully, and this may

make the engorgement worse. 3

Breast engorgement usually occurs within a week of the birth, but can occur

later. Primary engorgement occurs in the first few days after the baby is born, and it

occurs when the mother’s body is still trying to adjust to the amount of milk that the

baby demands. Secondary engorgement occurs later when the mother is not feeding

as frequently as she used to, or the baby removes less milk from the breast.4

Breast engorgement is associated with hard, painful, throbbing, aching and

tender breasts which may result in women needing analgesia, developing mastitis or

temporarily or permanently stopping breastfeeding. The distress associated with

breast engorgement may mean that women initiating breastfeeding may not

persevere beyond the first few days after the birth.5

This problem may be compounded if concern that the baby is not getting

enough milk, or breast pain and swelling, discourage women from continuing

breastfeeding. Women may also receive limited advice and support from health

professionals; lack of knowledge in managing this condition could be the reason for

limited or inappropriate advice.1

Once engorgements occurs application of moist heat on the breasts, hot

shower before breastfeeding, cold compresses for 10 minutes after feedings, gentle
massage and compress the breast when the baby pauses between sucks, frequent

feeding, correct positioning, jasmine flower, frozen pea and warm compresses to the

breast have been advocated to relieve symptoms along with analgesia to relieve

pain4.

Many literatures have been supported that cabbage leaves application and hot

application are effective on breast engorgement. It is not known which ones are

effective compared to the others. It is important that this topic be reviewed as the

review may have positive public health implications.

Need for the study

Breast feeding is one of the first bonding experiences between mother and child.

Breastfeeding her child is the most natural thing for every mother.

Breastfeeding is a unique experience which should be valued and supported by both

maternity and neonatal caregivers. Breast pain during breastfeeding is a common

problem that interferes with successful breastfeeding leading to exclusive

abandonment of breastfeeding that result in breast engorgement. 6

The birth of the baby is an important event in any family. It is therefore

important that for a mother to have a healthy baby; she gives her baby the best

nutrition. Breast milk is the best food for babies as breastfed babies are healthier

than formula fed babies. In recognition of the immense importance of breastfeeding

the Baby-Friendly Hospital Initiative was launched by UNICEF and WHO in 1991.1

Breastfeeding technique goes a long way in ensuring successful

breastfeeding. Incorrect technique may contribute to breast engorgement. Support to

initiate breastfeeding and ongoing breastfeeding support is important because it has

been shown that breastfeeding rates decrease with a decrease in breastfeeding

support.
Lack of support results in problems of establishment of breastfeeding, breast

engorgement, sore or cracked nipples, usually due to poor technique. 4

The chief editor of “The Nursing Journal of India” in her key address on the

occasion of the Breastfeeding Week-2008 says lactating mothers face multifaceted

constraints and difficulties in breastfeeding. They need support from various

quarters

– family, society, work place and government.3

The most often stated reason for cessation of breastfeeding in the first two

weeks of postpartum is pain 5. Breast engorgement is a painful problem that can lead

to pre- mature weaning. It is a common complication of the early puerperium and

usually occurs between 3-6 days after delivery 6. Dr. Ruth Lawrence defines

engorgement as “the swelling and distension of breasts usually in the early days of
5
initiation of lactation, due to vascular dilation as well as the early arrival of milk”

The incidence rate of breast engorgement all over the world is 1:8000 and in

India it is 1:6500. Engorgement symptoms occur most commonly between days 3

and 5, with more than two – thirds of women with tenderness on day 5 but some as

late as days 9 – 10. Two – third of women experience least moderate symptoms.

More time spent breastfeeding in the first 48 hours is associated with less

engorgement. The 20% postnatal mothers especially primigravida mothers are

affected with breast engorgement from 0 – 4 days of postnatal period.7

Engorgement can develop if the baby’s demand for breast milk decreases

suddenly or the mother is unable to empty her breast resulting in her breasts

becoming overly full. Immediately after birth the mother produces colostrum which

provides nutrition and protect against infection. Breast engorgement usually

happens when the breast switch off from colostrums to mature milk.8 It can also

happen if lactating
women misses several nursings and not enough milk is expressed from breasts.

When the milk oozes out for the first time there will be swelling of breast tissue

occurs due to flooding of lymph fluid and blood. The swelling around the areola

may cause the nipple to become flat and making it difficult for the baby to latch-on

properly. Proper breastfeeding techniques will assist in minimising the discomfort

of engorgement and prevent the development of many breastfeeding problems.9

Breast engorgement occurs in 72% to 85% in postnatal mothers. It is a

painful unpleasant condition affecting large number of women in the early

postpartum. During a time when mothers are coping with demands of the baby it

may be particularly distressing. Breast engorgement inhibit the development of

successful breast feeding, leading to early breastfeeding cessation, associated with

more serious illness including breast infection.10

A study was conducted to document the breastfeeding problems encountered

in a rural community and to know the reason for starting top feeds in infants less

than 6 months of life in Chitradurga district in 2001. Using a stratified sampling

method 420 mother-infant pairs was enrolled from 224 villages of central

Karnataka. Out of them, 80.5% were practising exclusive breastfeeding; 19.5% had

started top feeds; and 1.7% mothers had completely stopped breastfeeding. Maximal

onset of breastfeeding problems was noted in the first two weeks of the neonatal

period. Breastfeeding problems were not uncommon even in a predominantly

breastfeeding rural community.11

A study on knowledge, cultural practice and reasons regarding postnatal care

adopted by the members of the family at postnatal mothers of a selected community

of Mangalore was conducted in 2004. The study revealed that only 7% of the

sample
instructed the mother to start breastfeeding soon after delivery whereas the majority

of the subject (93%) perceived that for the first 3 days there will not be any milk.

82% mother’s milk is not sufficient,18% religious practice. The study recommended

the need of education and how this faulty practice can bring breast engorgement in

most of these mothers.12

Numerous strategies have been adopted over the years in the treatment of

breast engorgement. But very few researches have been conducted to monitor the

effect of cabbage leaves on breast engorgement. Cabbage leaves have been used for

centuries as a folk remedy for a wide variety of ailments and received much

renewed interest from lactation professionals over the past ten years. 13 The common

green cabbage is used for engorgement therapy. Cabbage is known to contain

sinigrin (allylisothiocyanate) rapine, magnesium, oxylate and sulphur heterosides.

Herbalists believe that cabbage has both antibiotic and anti irritant properties. It

helps to decrease tissue congestion by dilating (opening) local capillaries (small

blood vessels), which improves the blood flow in and out of the area, allowing the

body to reabsorb the fluid trapped in the breasts. Cabbage may also have a type of

drawing, or wicking action that helps to move trapped fluid.14

Hot application reduces pain and causes relaxation of blood vessels, there

by opening vessels and increasing blood flow to the area. It causes vasodilatation

thereby increasing capillary permeability which reduces oedema by shift of fluid

from interstitial compartment to the intravascular compartment. It enhancing the

dispersion of fluid and decreasing the fluid accumulation in the local tissue. Rise in

temperature also causes circulation so necessary oxygen and nutritive materials are

supplied and waste products are removed which in turn removes pain .15
 A quasi experimental study was conducted in AIIMS, New Delhi to assess

and compares the efficacy of cold cabbage leaves and hot and cold application in

the treatment of breast engorgement. The study comprises of total 60 mothers; 30 in

experimental group and 30 in the control group. The control group received

alternate hot and cold compresses and experimental group received cold cabbage

leaf for relieving breast engorgement. Both the treatment i.e., hot and cold

applications were effective in decreasing breast engorgement and pain in postnatal

mothers (p≤0.001). Cold cabbage leaves and hot and cold application were equally

effective in decreasing breast engorgement. (p=0.07)16

Another review of literature revealed that nursing students during their

clinical work in maternal and child health observed that breast engorgement and

throbbing breast pain were the most frequent complaints during the postpartum

phase. In order to understand the factors affecting the discomfort and to devise

appropriate nursing care these complaints were experimented (n=62) during June 5th

to July 15th, 2001 at the Severanu Hospital. The study concluded that proper breast

care during antenatal period is needed for preventing postnatal breast complications

.17

In addition with review of literature and investigator’s own experience while

being posted in clinical setting motivated the investigator to use cold cabbage leaves

and hot application for relieving breast engorgement. The investigator is also

interested in comparing the effectiveness of cold cabbage leaves and hot application

and hence this particular problem was selected by the investigator.

Statement of the problem

A study to assess effectiveness of cold cabbage leaves Vs hot application on

breast engorgement among postnatal mothers in a selected hospital, Khargone.

Objectives of the study

The objectives of the study are to :

 assess the breast engorgement before and after cold cabbage leaves and hot

application among postnatal mothers.

 determine the effectiveness of cold cabbage leaves application on breast

engorgement among postnatal mothers.

 determine the effectiveness of hot application on breast engorgement among

postnatal mothers.

 compare the effectiveness of cold cabbage leaves and hot application on

breast engorgement among postnatal mothers

 find an association between the pre test breast engorgement level with

selected demographic variables among postnatal mothers.

Hypotheses: (all hypotheses will be tested at 0.05 level of significance)

 H1: There will be a significant difference between mean pre test and post test

breast engorgement score after cold cabbage leaves application among

postnatal mothers.

 H2: There will be a significant difference between mean pre test and post test

breast engorgement score after hot application among postnatal mothers.

 H3: There will be a significant difference in mean post intervention score

between hot application and cold cabbage leaves application among

postnatal mothers.

 H4: There will be a significant association between pre intervention breast

engorgement score with the selected demographic variables among postnatal

mothers.

Operational definitions:

Effectiveness:

In this study effectiveness refers to the extent to which cabbage leaves and

hot application has produced desired effect on breast engorgement among postnatal

mothers as measured by breast engorgement checklist.

Cold cabbage leaves application:

In this study cold cabbage leaves refers to cabbage leaves which are

refrigerated in the freezer for 20-30 minutes before application. The cabbage leaves

contains sulfa compound which pass through the skin and constrict the vessels and

reduces inflammation. This reduction in inflammation and swelling allows the milk

to flow. Place the freezed cold cabbage leaves on the engorged breast, leaving the

nipple
exposed. Wrap bandage on the top of the leaves to keep them in place. Change leaves

as soon as they start to wet which should be about 15-20 minutes.

Hot application:

In this study hot application refers to applying hot compress using the

water with temperature 43-46 degree Celsius. The warm moist sponge cloth is

applied to engorged breast and the clothes are replaced frequently after 2 minutes,

the process continued for 15 minutes.

Breast engorgement:

In this study breast engorgement refers to symptoms experienced by

postnatal mothers assessed by breast engorgement checklist it includes swollen

breast, redness ,shiny skin ,prominent vein over breast ,flattened nipple ,firm

breast ,hard areola ,warmth in breast ,generalized malaise, rise of body temperature,

tenderness, and swollen lymph nodes.

Postnatal mothers:

In this study postnatal mothers refers to women who have delivered a baby

within three to five days of postnatal period and have the evidence of bilateral breast

engorgement.

Assumptions:

The study assumes that:

 complimentary therapies are cost effective methods..

 Delimitations:

The study is delimited to;

 study is confined to selected maternity hospitals of Mangalore

2. REVIEW OF LITERATURE

“Knowledge is of two kinds. We know a subject ourselves or

we know where we can find information on it” (Samuel
Johnson)

A literature review is a compilation of resources that provides the ground

work for further study. When the researcher is able to find the right number quality

of resource article to guide the study a door way is opened. This key group articles

may include research findings, theory articles and published review of literature.21

Literature review refers to the activities involved in identifying and

searching for information on a topic and developing a comprehensive picture of the

state of knowledge on that topic.21

The investigator carried out an extensive review of literature on the research

topic in order to gain deeper insight in to the problem and collect maximum relevant

information for building up the study in a scientific manner, so as to achieve the

desired results. The literature review has been organised and presented under

following headings:

Studies related to:

 prevalence of breast engorgement

 the effect of cold cabbage leaves application

 the effect of hot application
Studies related to prevalence of breast engorgement

A study on the breastfeeding practices and problems related to

breastfeeding among 327 rural women in Jammu and Kashmir revealed that

about one-quarter of mothers had lactational problems. The study found that

28.4% had initial suckling problems,8.6% had sore nipple, 8.6% had

engorgement, 9.8% had mastitis and abscess, 4.9% had less milk and 3.7% had no

milk.22

A descriptive study on breastfeeding problems in the first six months of life

in rural Karnataka among 420 mother-infant pairs showed that the onset of

breastfeeding problems occurred in 31.7% of women during the first month of life

and 76.9% in the first week, 7.7% in the second and 15.4% in the third week

respectively. Insufficient milk was reported by 53.6% while 23.1% of the mothers

had other problems like sore nipple, mastitis, breast engorgement, and breast

abscess. The study showed that the onset of breastfeeding problems was alarmingly

high in the neonatal period8.

A descriptive study on the prevention and management of postnatal

breast complications among 600 postnatal mothers at Allahabad showed that

20% of the mothers were found to have breast complications. Breast engorgement

(43.33%) was the most common complication followed by cracked nipples

(17.8%), retracted nipples (10%), cracked and sore nipples (8.33%), cracked and

retracted nipple (7.5%), failing lactation (7.5%) and breast abscess (3.33%).23

A descriptive study to assess the knowledge, attitude, practice and problems

regarding breastfeeding among 100 postnatal mothers in Chennai indicated that

65% of population knew how to prevent breast engorgement, 56% postnatal

mothers remarked that frequent suckling is essential to prevent breast
engorgement, 76% of the population knew the measures to get relief from breast

engorgement, 59% opined that manual expression will relieve breast

engorgement, and 12% knew that hot fomentation will relieve breast

engorgement. The above findings revealed that the mothers still lacked

knowledge regarding the management of breastfeeding problems.24

An exploratory study on the effect of the method of breastfeeding on

engorgement, mastitis and infantile colic was conducted on two groups of subjects

in South Australia. The sample size in the experimental group (prolonged

emptying of one breast at each feed) was 150 and that in the control group

(both breasts equally drained at each feed) was 152. Both the groups were

followed prospectively to six months after delivery. The study revealed that the

experimental group had lower incidence of breast engorgement in the first week

(61.4% v/s 74.3%, p < 0.002) and infantile colic over first six months 91.20%

v/s 23.4%, p < 0.02). In both groups perceived insufficient milk syndrome was

the main reason for cessation of breastfeeding. The study concluded that the

method of breastfeeding will influence breast engorgement and infantile colic. 25

A descriptive study to find out the breastfeeding problems and to know

the reasons for starting top feeds in infants less than six months was conducted

in rural Karnataka among 420 mother-infant pairs of 224 villages. The findings

showed that the onset of breastfeeding problems occurred in 31.7% of cases in

the first month of life. Further analysis showed that 76.9% occurred in the first week

of life, 7.7% in the and 15.4% in the third week. Not enough milk was responsible

for starting feeds in 53.6% of cases, and 23.1% of mothers had other problems

like sore nipples, , breast engorgement, breast abscess and other illnesses. The
study revealed that the onset of breastfeeding problems was alarmingly high in

neonatal period and early initiation of breastfeeding lessened the incidence of

breastfeeding problems.26

A randomized trial study conducted in St Petersburg to evaluate the

occurrence of breast engorgement during the first 3 days of postpartum ,the study

concluded that multiparous mothers had higher perception of physiological breast

engorgement and lower intensity of feeding blues than primiparous mothers.

(p<0.0001).2

A study was conducted in china to rate the level of breast engorgement for

first 14 days following child birth .Study comprise of 114 breast feeding mothers

and it is assessed by using six point breast engorgement scale. The study concluded

that engorged mother experience either a bell shaped pattern, a multi –modal

pattern, a pattern of intense engorgement or a pattern of minimal engorgement.27

A descriptive study was conducted at the Well Baby Clinic of National

Institute of Child Health, Karachi to assess the breast feeding problems. The result

shows that inadequate milk production was the commonest reason as stated by 71%

of mothers for not exclusively breastfeeding their infant, maternal employment

11.2%,baby not gaining weight 5.2%,loose stool or constipation 3.3%maternal

systemic illness 3.6%,breast engorgement 2.6%,and infantile colic 1.6%. 28

A study was conducted in Rajasthan on breast engorgement, its contributing

variables and variables amenable to nursing intervention. The focus of the study

was to identify variables that correlate significantly with breast engorgement and

that might be amenable to nursing. Data on the initiation of feeding, feeding

duration, rate
of milk maturation and supplementation were obtained from 54 women. These

variables were found to be significantly correlate with breast engorgement. 29

A survey was conducted in SNR Hospital, Kolar district, Karnataka to

identify the incidence of breast engorgement. A total of 986 deliveries were

conducted with caesarean section in the year 2007. Among this 45% to 50% have

been reported with the complaint of breast engorgement.30

A study was conducted in China on the occurrence of breast engorgement.

This study describe breast engorgement during day 1 to 14 of postpartum of 114

first time vaginal delivery and second time caesarean section delivery breastfeeding

mothers. Most mothers reported experiencing their most intense engorgement after

hospital discharge; previous breastfeeding experience mother is more critical

variables than the parity in predicting engorgement. Result showed that second time

breast- feeding mother experience engorgement sooner and more severely than the

first time breastfeeding mother regardless of delivery method.31

Studies related to the effect of cold cabbage leaves application

A quasi experimental study was conducted to evaluate the effectiveness on

mother’s perception on breast engorgement and the influence on this treatment on

breastfeeding practices. The subjects, 120 breastfeeding women 72 hours

postpartum, were randomly allocated to the experimental group who received

application of cabbage leaves on their breasts and to a control the group received

routine breast care. The experimental group reported less breast engorgement than

control group. At six weeks, the women who received cabbage leaves application

were more likely to be breastfeeding exclusively, 76% and 58% (35/46 vs

29/50;p=0.09) and their mean duration of exclusive breastfeeding was longer(36 vs

30days,p=0.04).32
 A quasi experimental study was conducted to compare the effectiveness of

chilled cabbage leaves and cold gel packs in reducing breast engorgement in

postpartum mothers. Thirty four lactating mothers with breast engorgement received

chilled cabbage leaves on one breast and chilled gel packs on the other breast up to

eight hours. Their pain levels were established pre treatment and compared post

treatment for both conditions. Both the treatment was equally effective in reducing

breast engorgement and pain. 68% obtained relief within one to two hours and the

majority preferred cabbage leaves 33.

A study was conducted in Australia to assess and compare the effectiveness

of cabbage leaf extract with that of a placebo in treating breast engorgement in

lactating mothers. The study comprises of 39 participants.21 participants received a

cream containing cabbage leaf extract while 18 received placebo cream. The study

found that both are equally effective on reducing breast engorgement34.

A quasi experimental study was conducted in Tamil Nadu to assess the

effectiveness of cabbage leaves application on breast engorgement among postnatal

mothers. The study comprises of twenty four mothers selected by using purposive

sampling method. Pre treatment level of breast engorgement is compared with post

treatment level (t=22.41,t23=2.069; p<0.05) .The study concluded that application of

35
cabbage leaves to relieve breast engorgement is very effective .

A study was conducted in Australia to compare the effectiveness of chilled

and room temperature green cabbage leaves in reducing discomfort of breast

engorgement among postnatal mothers. Twenty eight lactating women with breast

engorgement used chilled cabbage leaves on one breast and room temperature

cabbage leaves on the other breast for a two hour period. Pre treatment pain levels
were compared with post treatment levels for both the conditions. Mothers reported

less pain with both the conditions and majority of the mothers preferred cold

cabbage leaves36.

A study was conducted in South Africa to identify the best forms of

treatment for women who experience breast engorgement. They identified studies

for inclusion through the Cochrane Pregnancy and Childbirth Group's Trials

Register. They included eight Randomised and quasi-randomised controlled trials

with 744 women. Trials examined a range of different treatments for breast

engorgement: acupuncture (two studies), cabbage leaves (two studies), cold gel

packs (one study), pharmacological treatments (two studies) and ultrasound (one

study). For several interventions (ultrasound, cabbage leaves, and oxytocin) there

was no statistically significant evidence but in these studies women tended to have

improvements in pain and other symptoms. The study concluded that more research

is needed on treatments for this painful and distressing condition.37

An experimental study was conducted in Bangalore, to assess the

effectiveness of application of cabbage leaves over hot water in the management of

breast engorgement among postnatal mothers. The study sample consisted of 60

postnatal mothers selected randomly out of which 30 received cabbage leaves

application and 30 received hot water application to relieve breast engorgement.

Breast engorgement was assessed by using Storr scale. Result revealed that the

application of cabbage leaves was more effective in reducing breast engorgement38.

A study was conducted by Cochrane Pregnancy and Childbirth Group to

determine the effects of any proposed intervention to relieve symptoms of breast

engorgement among breastfeeding women. They included randomised and 'quasi-

randomised' controlled trials, to assess the effectiveness of treatments for the

alleviation of symptoms in breastfeeding women experiencing engorgement. Data

were extracted by one reviewer and verified by a second reviewer. Eight trials,

involving 424 women, were included. Three different studies were identified ,which

used cabbage leaves or cabbage leaf extracts and gel packs, ultrasound treatment

and placebo were equally effective in the treatment of breast engorgement.39

A study was conducted in China to assess the effectiveness of vegetables

like cabbage and broccoli on breast cancer. Researchers found that women who

consumed vegetables like broccoli and cabbage were 62 percent less likely to die of

breast cancer and 35 percent less likely to have a recurrence of the disease,

compared with those who consumed the least. This study suggests that cruciferous

vegetables and the bioactive compounds in them may be protective against breast

cancer.40

A study was conducted in China to assess the effectiveness of cruciferous

vegetables on breast cancer. The study involved almost 5,000 women between 20

and

75 years age who were part of the Shanghai Breast Cancer Survival Study.

Researchers interviewed the women within six months of their diagnosis to gather

information about diet, lifestyle and such clinical factors as tumour stage. They also

asked about their intake of cruciferous vegetables at 18 and 36 months after their

diagnosis. The study found that women whose consumption of cruciferous

vegetables (cabbage, broccoli.cauliflower) was in the top 25 percent were 62

percent less likely to die of breast cancer during the roughly five-year study period

than women in the bottom 25 percent. Recurrence was 35 percent less likely among

women in the top consumption compared to those in the bottom 25 percent. The
researchers also found
that women in the top quarter for consumption were 62 percent less likely to die of

any cause than those in the bottom 25 percent. 41

Studies related to effect of hot application

A quasi experimental study was done in Christian Medical College (CMC),

Vellore to compare the effectiveness of manual expression of milk and warm bottle

application in mothers with breast engorgement in the postnatal wards. Based on

random sampling, 30 mothers were studied in each group. Group I consisted of 30

mothers with breast engorgement on whom moist compress was applied and then

breast milk was manually expressed. Group II consisted of 30 mothers for whom

breast milk was expressed with a warm bottle. The findings of the study showed

that both the methods were effective in reducing the breast engorgement as well as

the pain expressed by the mother. On comparing both methods, it was found that

mothers in group II where breast milk was expressed using a bottle had significant

reduction of breast engorgement (p value < 0.01) than the mothers in Group I who

had a moist compress application and manual expression of milk. Pain was

significantly reduced in mothers belonging to Group I than mothers in Group II.42

A comparative study was conducted in Portland on the effect of warm

application versus thrombophob gel on resolution of infiltration. Tool included the

demographic data to know the sample characteristics, infiltration measurement

chart, observation checklist and visual analogue scale The pre test mean score

related to peripheral intravenous infiltration were 61.23 and post test mean pain

scores were

13.27 in treatment with warm application which was found to be most effective than

thrombophob gel(p<0.01). The findings reveal that application of warm to sites of

intravenous infiltration produced faster resolution than did thrombophob gel. 43
 A comparative study was conducted in Pune on effectiveness of hot

fomentation versus cold compress for reducing intravenous infiltration. The sample

size was sixty patients (30 for hot fomentation and 30 for cold compress) with mild

to moderate degree of infiltration stayed in hospital for 8-14 days and data was

analyzed using descriptive and inferential statistics. Findings prove that the pre-

treatment mean score was 7.1667 reduced to 0.7071 on the third day of treatment

with hot fomentation. In cold compress pre-treatment mean score 6.9333 reduced to

0.70571. The study concluded that both hot fomentation and cold compress were

effective in treatment of intravenous therapy related infiltration.44

A comparative study was conducted at the Monarch University on effect of

elevation, warmth and cold on infiltration. Nursing interventions used to treat

intravenous infiltration generally included application of warmth and cold. The

study concluded that effect of warmth versus cold on infiltration showed that

warmth is better than cold in decreasing the symptoms or speeding re-absorption of

the infiltrate.45
 METHODOLOGY

“Thinking well is wise; planning well is wiser, doing well is best of all”

Research methodology is a way of systematically solving the research

problem. It explains the various steps that are generally adopted in studying the

research problem along with the logic behind it. It deals with defining the problem,

formulation of hypotheses, methods adopted for data collection and statistical

techniques used for analyzing the data with logical reason behind it. 46

Research approach

Research approach indicates the basic procedures for conducting research.

Research approach is a systematic, controlled, empirical and critical investigation of

natural phenomena guided by theory and hypothesis about the relation among such

phenomena.46

The focus of the study was to compare the effect of two different modalities

of treatment for the management of breast engorgement and find out which will be

the most effective. The investigator keeping in mind the objectives of the study and

chosen the quantitative approach.

Research design

The research design provides the backbone structure of the study .It is the

researchers overall plan for obtaining answer to the research questions or for testing

the research hypothesis.47 The research design selected for the study is quasi

experimental pre-test post test design.

Setting of the study

Setting refers to the area where the study is conducted. It is the physical

location and condition in which data collection takes place in a study. The selection

of an appropriate setting for conducting a study is crucial for its successful

completion.47

The present study was conducted in postnatal wards of selected Hospital

which is a 200 bedded Maternity Hospital.

Variables under study

Variables are qualities, properties or characteristics of a person, things or

situations that change or vary. Variables are attributes that vary. Variability in the

dependant variable is presumed to depend on the variability in the independent

variable.47

Independent variable: An independent variable is the variable that is believed to

cause or influence the dependent variable 46. In this study, cold cabbage leaves and

hot application are the independent variables.

Dependent variable: A dependent variable is the variable hypothesized to depend on

 46
or be caused by another variable (the independent variable) . In this study breast

engorgement is the dependent variable.

Population

Population is a complete set of individuals or objects that possess some

common characteristics of interest to the researcher47 .In this study population

consist of postnatal mothers with breast engorgement in postnatal wards of selected

hospital khargone.
Sample

A subset of a population, selected to participate in a study 47. In this study,

sample consisted of 30 mothers who developed bilateral breast engorgement and

participated in the study.

Sample size

Sample size refers to the number of sampling units included in the study. In

other words, the sample size refers to a decision on how many items from the

universe are to be subjected for data collection.46

1. The sample consisted of thirty (30) mothers.

2. The sample was divided in to two groups. 15 mothers in cold cabbage leaves

application group (group 1) and remaining 15 in hot application group (group 2).

Sampling technique

Sampling technique is the process of selecting a portion of the population to

represent the entire population 47. The sample was selected using non probability

purposive sampling technique.

Sampling criteria:

Inclusion criteria

Inclusion criteria for sampling refer to;

 postnatal mothers with moderate to severe bilateral breast

engorgement within five days of postnatal period.

 subjects who are willing to participate in study .

Exclusion criteria

Exclusion criteria for sampling includes

 postnatal mothers who developed allergy to cabbage leaves

 postnatal mothers with infection in breast

Pilot study

A pilot study is a small scale version or trial run of the main study. The pilot

study was conducted with the purpose of testing and refining the research process. It

is conducted to obtain information for improving the project or for assessing its

feasibility. The principle focus is the assessment of the adequacy of measurement. 46

The investigator conducted the pilot study among six postnatal mothers with

breast engorgement from 25 th to 28th of dec 2019 in selected hospital khargone.

Permission from the DMO of the hospital was obtained before conducting the

study .The purpose and the usefulness of the study were explained to the concerned

authorities before taking permission. The investigator carried out the pilot study

with one-tenth of the total sample. The non probability purposive sampling

technique was used for the selection of sample. A total six postnatal mothers were

taken for the pilot study. Three postnatal with breast engorgement were selected for

each intervention.

Data collection procedure for the main study

The investigator conducted the main study from 01.02.2020 to 27.02.2020 in

selected hospital, khargone. The permission from the DMO of the hospital will be

obtained before conducting the study. Based on inclusion criteria, thirty samples
were selected and fifteen samples were assigned in cold cabbage
application group (Group 1) and fifteen in hot application group (Group 2) using

non probability purposive sampling technique.

Plan for data analysis

The investigator planned to analyze the data on the basis of the objective and

the hypothesis of the study.

 Organize data in master data sheet.

 Demographic data will be analyzed using descriptive statistics-percentage,

frequency mean, median and standard deviation

 Effectiveness of intervention before and after the treatment will be analyzed by

using paired ‘t’ test

 Compare the effectiveness of intervention will be analyzed by using

independent‘t’ test.

 Chi-square test will be used to find out association between pre-test breast

engorgement level with selected demographic variables.