International Journal of Health Sciences and Research

www.ijhsr.org ISSN: 2249-9571

Original Research Article

A Comparative Study to Assess Problem of Inverted

Nipple and Its Relationship to Successful Breast
Feeding Among Antenatal Mothers
Shilpa Umesh Bagal1, Jyoti A. Salunkhe1, Avinash H. Salunkhe1, S. V. Kakade2,
Vaishali R. Mohite1
1
Krishna Institute of Nursing Sciences, Karad, Maharashtra, India.
2
Krishna Institute of Medical Sciences, Karad, Maharashtra, India.
Corresponding Author: Mrs. Jyoti A. Salunkhe

ABSTRACT

Background: The first feed is a profoundly important experience to the mother and her baby. Breast
feeding is the ideal form of feeding in the neonate. Artificial feeding exposes the infant to infection and
results in over a million deaths annually worldwide due to ill effects. Most of primi mothers are not able to
breastfeed their babies properly due to inverted nipples. The poor breastfeeding may not be always the
outcome of illiteracy; it can also be due to flat or inverted nipples.
Material and Methods: The comparative research approach with two group post- test only experimental
design was used. The independent variable was the cut disposable syringe technique in treating inverted
nipple and dependent variable was the successful breastfeeding (LATCH).Study was conducted on 60
mothers admitted in maternity ward of Krishna Hospital, Karad, by using purposive sample technique. The
data were collected, tabulated and analyzed by using descriptive and inferential statistics.
Result:
Demographic variables in both groups
In group I 27(45%) and 29(48%) mothers from group II belonged to 18- 25 years of age. The difference in
proportions was not significant (Fisher exact P = 0.6120). In group I 24(40%) and 22(37%) mothers from
group II were educated up to primary and secondary. The difference was not significant (P = 0.7611). In
group I 28(47%) and 29(48%) mothers from group II were housewives. The difference was not significant
(P= 1.0000). In group I 26(43%) and 26(43%) mothers from group II had their monthly income more than
5000 Rs. The difference was not significant (P =1.0000). In group I 30(50%) and 27(45%) mothers from
group II belonged to joint family. The difference was not significant (P = 0.2373).In group I 27(45%) and
30(50%) mothers from group II were Hindu by religion. The difference was not significant (P = 0.2373).
Supportive and teaching needs
There was no significant difference found in the mean score of supportive needs and teaching needs
between group I and group II (P=0.1595 and t=1.425).
Successful breastfeeding according to LATCH score
In both groups all the babies had LATCH score 7 and above and they were achieved successful
breastfeeding.
Weight loss of the babies on 4th day
The mean weight of the babies on 4th day was 2.4906 + 0.2409 Kg. in group I, 2.4671 + 0.3080 Kg. in
group II the difference was not significant as Unpaired t=0.3268, P=0.7450.
Problem of inverted and normal nipples
None of the mother was developed problem with inverted and normal.
Conclusion: The correction of inverted nipples with cut disposable syringe technique may be effective in
achievement of successful breastfeeding with inverted nipples.

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Shilpa Umesh Bagal et al. A Comparative Study to Assess Problem of Inverted Nipple and Its Relationship to
Successful Breast Feeding Among Antenatal Mothers

Key words: Cut disposable syringe, health education, LATCH, weight of the babies, supportive needs;
successful breast feeding; teaching needs.

INTRODUCTION breast feed at 16 or more hours after birth.

“The nature has designed the provision that The initial satisfying breast feeding
infants be fed upon their mother‟s milk. experience acts as a reinforces for
They find their food and mother at the same subsequent feedings (Johnson, 1976). This
time. It is complete nourishment for them early breast feeding has an imprinting effect
both for their body and soul”. [1] - (Riordan and countryman, 1980). It
Rabindranath Tagore reinforces not only the infant‟s sucking
The new born infant requires dietary reflex and pattern but also the mother‟s self-
energy for adequate growth and esteem. [4]
development. Infant nutrition research Breast feeding is the ideal form of
repeatedly concludes that human milk and feeding in the neonate. Artificial feeding
breast feeding are gold standard to which all exposes the infant to infection and results in
other forms of infant feeding alternatives over a million deaths annually worldwide
should be compared. In addition to provide due to ill effects. [5]
essential nutrients breast feeding provides Breast Feeding Promotion Network
unique opportunities for positive of India (BPNI) 2002, says, infant aged (0-
interactions and bonding between infants 5) months who are not breast feed have
and mother‟s decision to breast feed is seven fold and fivefold increased risk of
determined by many factors. Feeding her death from diarrhea compared with infants
new infant can be an exciting, satisfying and who are exclusively breast feed. At the same
personally empowering experience for many age, nonexclusive breast feeding results in
women. The nurse can provide vital support. more than two-fold increased risk of dying
[2]
from diarrhea. [5]
The first feed is a profoundly All newborn that cry soon after birth
important experience to the mother and her and do not show any signs of illness must be
baby. Unless individual circumstances kept close to mother and put to the breast
indicate otherwise, the mother should have soon after birth. This will ensure warmth
her baby with her immediately after delivery initiation of breast feeding and emotional
and breast feeding should begin as soon as bonding. [6] The motivation and preparation
possible. [3] for breast feeding should begin during
Mother milk is best suited to serve antenatal period. Awareness, willingness,
the biological needs of her baby! Breast keenness and confidence on the part of
feeding is natural and instinctive. Every mother are crucial for successful
mother wants to breast feed her baby and establishment of lactation. Early bonding
she must be provided with necessary soon after delivery promotes breast feeding.
guidance, support and encouragement by Healthy infants should be roomed - in with
family members and health care the mother and should never be separated
professionals. And, every mother can from the mother by keeping him in the
successfully breast feed and provide a best nursery. Early breast feeding in all babies,
start in life to her baby. Like mother‟s love irrespective of the mode of delivery and
there is no substitute for mothers, milk. [1] avoidance of prelacteal and prolacteal feeds
It is important that the mother and are essential to establish successful breast
infant have the opportunity to breast feed as feeding. Active support to the mother, use
soon after delivery as possible. Mother who of proper technique and good attachment of
feed during the first hour of life, breast feed the baby to the breast facilitates breast
longer and have more positive comments feeding. [1]
about their experience than women who first

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Shilpa Umesh Bagal et al. A Comparative Study to Assess Problem of Inverted Nipple and Its Relationship to
Successful Breast Feeding Among Antenatal Mothers

Breast feeding success depends on majority of flat / non protractile nipple can
appropriate attachment of the infant at the be corrected antenatally (75%). [11]
breast, in which the nipple and much of the A study was conducted to assess the
areola are drown well into the baby‟s prevalence of inverted and non-protractile
mouth. Anatomical variations of the breast, nipples in pregnant women who were
including flat nipple, inverted nipple, large intending to breast feed. Among 3006
breast and large nipple may act as barriers women examined, the overall prevalence
for the baby to latch on to the breast was found to be 9.8% the three factors
effectively. Babies need to have good which cause a reduction in the prevalence of
attachment to the breast for successful inversion and non-protractility are
breast feeding and potential maternal increasing gestation, increasing maternal
problems such as these variations can make age and previous breast feeding. Parity
good attachment hard to achieve. Also, appears to have no effect. The mechanism
infant problems, such as tongue tie can be of influence which these factors prevalence
important. Alexander et al considered may be in biological, but other influences
inverted and non – protractile nipples as which have bearing on a women‟s choice of
leading to problems establishing and infant feeding method. [12]
maintaining breast feeding. [7] Nipple problems may lead to a delay
Most women with inverted nipples in breast feeding initiation and thus deprive
who give birth are able to breast feed the baby from getting the benefits of
without complication, but inexperienced colostrum. Inability to attach at the breast
mothers may experience higher than causes infrequent suckling and may lead to
average pain and soreness when initially breast engorgement, and if the mother is not
attempting to nurse. When a mother uses shown how to maintain an adequate supply
proper breast feeding technique, the infant through expression of milk, the production
latch onto the areola, not the nipple, so of milk is likely to decrease. [10]
women with inverted nipples are actually Dewey et al. in their study showed
able to breast feed without issue. An infant that inverted and flat nipples were one of
that latches on well may be able to slush out causes, along with many other factors, of
an inverted nipple. [8] delayed onset of lactation. Breast variations,
The occurrence of inverted and flat such as flat nipples, inverted nipples, large
nipples is not uncommon in the practice of breast and large nipples among first time
newborn care. Although such conditions mothers have been shown to act as
should not preclude (prevent) breast feeding important barriers to weight gain among
if expert counseling and advice on proper breastfed neonates in the early days of life.
positioning are available, many mothers get Maternal factors like breast conditions,
frustrated and quit breast feeding. [9] The nutrition, parity, and feeding practices for
inverted nipple is a relatively common previous babies, lactation gap and infant‟s
problem, with a large majority of cases initial refusal to suckle at the breast did not
attributable to congenital causes. Inverted influence the outcome variables according
nipples should not preclude breastfeeding; to one study, as long as repeated suckling
they often seriously hamper initiation and was ensured and if the mothers had
continuation of breastfeeding. [10] Inverted education and motivation as well as strong
and flat nipples are common with an skilled support of health workers. [10]
incidence of 16.3% among nulliparous A prospective cohort study was
women attending antenatal clinics. Large conducted to assess the effect of maternal
majority (90.2%) of them exclusively breast breast variations on neonatal weight gain in
fed with satisfactory weight gain with the first seven days of life, in 100 newborns
adequate support. Incidence of flat / non identified that Neonates born to mothers
protractile inverted nipple is 9.6%. Large without the specified breast variations had a

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Shilpa Umesh Bagal et al. A Comparative Study to Assess Problem of Inverted Nipple and Its Relationship to
Successful Breast Feeding Among Antenatal Mothers

mean weight gain of (+) 53 ± 154.4 g at day Correction of inverted nipples with help of
seven., Not only there was no increase in the cut disposable syringe technique. O1 = Post
mean weight of neonates in the other group, intervention assessment of the effectiveness
but they had a mean decrease of weight of of cut disposable syringe technique in
(-) 162 ± 125.5 g by the seventh day of their treating inverted nipple for successful breast
life compared to birth weight. Thus, feeding in primipara mothers. In the study,
neonates born to mothers without breast the intervention (treatment) was introduced
variations had significantly greater weight to group – II with 20 ml disposable syringe.
gain than neonates born to the mothers with 20 ml plastic syringe was used after cutting
the specified variations (p < 0.01). Breast the barrel 1 centimeter from the nozzle and
variation among first-time mother‟s acts as the piston inserted from the cut end of the
an important barrier to weight gain among barrel. The other opening of the barrel was
breastfed neonates in the early days of life. placed around the nipple and withdrawn the
[9]
piston gently. The nipple was slowly
It was estimated by Alexander et al. protruded in to the barrel. After 30 – 60
that about 10% of pregnant women have seconds, piston was pushed back gently to
inverted or non-projective nipples, which release the hold of the syringe on the nipple.
hinder breast feeding apart from flat and This procedure was repeated before each
retracted nipples, they also documented breast feeding. As soon as the nipple
other anatomical problems of nipples that becomes prominent, the nipple and areola
they had observed. Various methods to held between index finger and thumb to
correct flat and inverted nipples with form an erect nipple and the baby was put to
varying degrees of success and the breast. Both the groups were provided
complications have been reported in the health education about techniques and
literature. The best simple method to date importance of breast feeding.
had been reported by Kesaree et al. the Independent variable is cut
inverted syringe method to pull out the flat disposable syringe technique in treating
or retracted nipple. [10] inverted nipple and dependent variable is
However, the practical problems successful breast feeding (LATCH).
with breastfeeding remain and despite much Research setting was maternity ward
effort it is still increasing. Most of primi of Krishna Hospital Karad. Population
mothers were not able to breastfeed their comprises of antenatal mothers admitted in
babies properly due to inverted nipples. The maternity ward of Krishna Hospital, Karad.
poor breastfeeding may not be always the Samples were 60 primi antenatal mother
outcome of illiteracy; it can also be due to with inverted nipple and normal nipples
flat or inverted nipples. Whichever may be admitted in maternity ward of Krishna
the cause, the final result of poor breast Hospital, Karad by using purposive
feeding is the hindered growth and sampling technique which is a type of non-
development of child in all aspect. probability sampling technique.
A tool comprised section I includes
MATERIALS AND METHODS demographic variables and section II
The comparative and evaluative includes – part I assessment of breasts and
research approach was used. The research nipple, part II includes interventions for
design adopted for the study was inverted nipples, and part III includes tool
experimental with two group post- test only for assessment of successful breast feeding.
design. (Group – I (N=30) Health Education The tool used was a standardized
O1) (Group – II (N=30) X + Health observation scale (LATCH scale) and
Education O1) Group – I = Antenatal electronic weight machine for taking weight
mothers with normal nipple. Group – II = of the babies (same weight machine used for
Antenatal mothers with inverted nipple. X = all the babies).

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Successful Breast Feeding Among Antenatal Mothers

LATCH scale: As L is for latch, zero weighing machine and zero error was
indicated to sleepy or reluctant, no latch adjusted before weighing. Infant‟s weight
achieved, one is repeated attempts to hold was measured daily on first four days at
nipple in mouth, stimulate to suck and two morning 9:00 am. Only one weight machine
is for grasp breast tongue down lips flanged, was used for all babies.
rhythmic sucking. A is for audible The ethical clearance and permission
swallowing – zero for none, one for a few obtained from ethical committee of
with stimulation and 2 for spontaneous and KIMSDU Karad and informed consent was
intermittent < 24 hrs. old, spontaneous and taken from each participant. Assessment of
frequent > 24 hrs. old. T is for type of nipple antenatal mothers was done on the day of
– zero for inverted, one for flat and two for admission by using tool. After assessment
everted. C is for comfort (breast / nipple) – the samples divided into group – I (antenatal
zero indicated engorged, cracked, bleeding, mothers with normal nipple) and group – II
large blisters or bruises, severe discomfort, (antenatal mothers with inverted nipple)
one for filling, reddened / small blister or immediately after delivery, intervention
bruises, mild / moderate discomfort, two for with cut disposable syringe was given to
soft non tender. H is for hold (positioning) – group - II and routine health education
zero indicates full assist (staff holds infant about techniques of breast feeding given to
and breast, one for minimal assists), (staff both the groups. After interventions the data
holds and then mother takes over), two for was collected up to 4 days by using tool for
no assist from staff, mother able to position assessment of successful breastfeeding.
/ hold infant. Data was tabulated and analyzed by using
Scoring done according to APGAR descriptive and inferential statistics.
score 0 -3 poor, 4-6 fair and 7- 10 good. The Inferential statistics - Fisher exact test,
success of breast feeding during first 4 days Paired „t‟ test, Unpaired „t‟ test and
of life was determined by using the LATCH computation of „t‟ and „p‟ values were used
technique as described by Jensen et al. The for comparison of pattern of weight loss of
LATCH score of 7 or higher was considered the babies on 1st day and 4th day between
as successful, and score below 7 considered group - I and group - II and also for
as unsuccessful. comparison of score of supportive needs and
Weight: The infant was weighted nude. The teaching needs between both groups.
weight was recorded on an electronic

RESULTS

Table No. -1: Comparison of antenatal mothers according to demographic variables in both groups N= 60
Sr.No. Demographic Variable Group 1 (30) Group 2 (30) Fisher exact test
1 Age
18-25 Yrs 27(45%) 29(48%) 0.6120
>26 Yrs 3(5%) 1(2%)
2 Education
Primary and Secondary 24(40%) 22(37%) 0.7611
Graduates and Postgraduates 6(10%) 8(13%)
3 Occupation
Housewife 28(47%) 29(48%) 1.0000
Others 2(3%) 1(2%)
4 Monthly income
>5000 Rs. 26(43%) 26(43%) 1.0000
<5000 Rs. 4(7%) 4(7%)
5 Type of family
Joint Family 30(50%) 27(45%) 0.2373
Nuclear Family 3(5%)
6 Religion
Hindu 27(45%) 30(50%) 0.2373
Buddhist 3(5%) -

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Successful Breast Feeding Among Antenatal Mothers

Group - I 27(45%) mothers and =1.0000).In group - I 26(43%) mothers and

29(48%) mothers from group - II were 26(43%) mothers from group - II had their
belonged to 18- 25 years of age. The monthly income more than 5000 Rs. The
difference in proportions was not significant difference in proportions was not significant
(Fisher exact P = 0.6120). (Fisher exact P = 1.0000). In group - I
In group - I 24(40%) mothers and 30(50%) mothers and 27(45%) mothers
22(37%) mothers from group - II were from group - II were belonged to joint
having education up to primary and family. The difference in proportions was
secondary. The difference in proportions not significant (Fisher P = 0.2373).
was not significant (Fisher exact P = In group - I 27(45%) mothers and
0.7611).In group - I 28(47%) mothers and 30(50%) mothers from group - II were
29(48%) mothers from group - II were Hindu by religion. The difference in
housewives. The difference in proportions proportions was not significant (Fisher exact
was not significant (Fisher exact P P = 0.2373).

Table No. - 3: Comparison of mothers according to score of supportiveand teaching needs by using Unpaired ‘t’ test N= 60
Mean SD Minimum Maximum Unpaired ‘t’ value P value
Group - I 23.33 0.9942 22 25 1.425 0.1595
Group-II 23.73 1.172 22 26

There was no significant difference found in – II (P=0.1595 and t = 1.425). The total
the mean score of supportive needs and score of supportive needs and teaching
teaching needs between group - I and group needs successful were 26.

Table No. - 4: Distribution of respondents according to LATCH score in both groups N= 60

LATCH Score Group - I Group - II
Frequency Percentage Frequency Percentage
> 7 (breastfeeding) 30 100 30 100
< 7 (Unsuccessful breastfeeding) - - - -

From both the groups all the babies had was 2.4671 + 0.3080 Kg. in group – II and
LATCH score 7 and above and they were the difference was statistically significant.
achieved successful breastfeeding.
Comparison weight of the babies on first
Table No. - 5: Assessment pattern of weight loss of the babies
between 1st and4th day by using Paired ‘t’test in group - I
day between group - I and group – II by
N=30 using unpaired‘t’ test
Group-1 Mean + S.D. Mean ‘t’ P value The data presented in table 5 and 6
Difference value
st
1 day 2.7184 + 0.2518 0.2280 15.418 <0.0001 indicates that the mean weight of the babies
4th day 2.4906 + 0.2409 on 1st day was 2.7184 + 0.2518 Kg. in
group - I and 2.7059 + 0.3547 Kg. in group
The mean weight of the babies on1st day - II. Thus the difference in mean weight of
was 2.7184 + 0.2518 Kg. and on 4th day the babies on 1st day between group - I and
was 2.4906 + 0.2409 Kg. in group – I and group - II was statistically not significant as
the difference was statistically significant. t=0.1578 (Unpaired „t‟ test)and P=0.8751.
Table No. - 6: Assessment pattern of weight loss of the babies
between 1st and4th day by using Paired ‘t’ test in group - II Comparison pattern of weight loss of the
N=30 babies on fourth day between group - I
Group-II Mean + S.D. Mean ‘t’ P value
Difference value and group - II by using unpaired‘t’ test
1st day 2.7059 + 0.3547 0.2388 16.458 <0.0001 The data presented in table 5 and 6
4th day 2.4671 + 0.3080
indicates that the mean weight of the babies
on 4th day was 2.4906 + 0.2409 Kg. in
The mean weight of the babies on1st day group - I and 2.4671 + 0.3080 Kg. in group
was 2.7059 + 0.3547 Kg. and on 4th day - II. Thus the difference in mean weight of

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Successful Breast Feeding Among Antenatal Mothers

the babies on 4th day between group - I and -II majority mothers 29(96.66%) were house
group - II was statistically not significant as wives. These findings were similar to the
t=0.3268 (Unpaired‟t‟ test) and findings of study conducted by JuliNaz at
P=0.7450.So there is no significant Government Hospital, Dharapuram, where
difference in mean weight of the babies on majority primi mothers 27(90%) were house
4th day in group - I and group - II. Thus the wives. [7]
correction of inverted nipples with cut In the group - I maximum mothers
disposable syringe technique may be 26 (86.66%) having monthly income more
effective in achievement of successful than 5000 Rs. and in group - II also
breastfeeding. Extra uterine life presents a maximum mothers 26 (86.66%) having
challenge to the newborn infant.5 there was monthly income more than 5000 Rs.
weight loss of 7-10% in the first week of In the group - I all the mothers 30
life.3 the weight loss is normal in first few (100%) were from joint family, and in group
days because newborn exposes to extra - II maximum number of mothers 27 (90%)
uterine life. In present study weight loss were from joint family.
were present in both the groups. In the group - I maximum mothers
Assessment of problems with 27 (90%) were belongs to Hindu religion
inverted and normal nipples was done and in group - II all the mothers 30 (100%)
among both groups like failing lactation, were belongs to Hindu religion. These
Suppression of lactation, Poor latch, findings are similar to the findings of study
Ineffective breastfeeding, Mastitis, conducted by JuliNaz at Government
Engorged breast. None of the mother was Hospital, Dharapuram, where majority primi
developed any problem during first four mothers 24(80%) were belongs to Hindu
days of postpartum among both the groups. religion. [7]
Comparison of samples according to
DISCUSSION demographic variables
Findings related to demographic In the present study it was observed
variables that distribution of demographic variables
In the group - I out of 30 mothers, for both groups were similar with majority
majority mothers 15 (50%) belonged to 18- of samples in the age group of 18– 25 years.
21 years of age and in group - II out of 30 The educational status in both the groups
mothers, majority mothers 18 (60%) comparable, as many of samples being
belonged to 22-25 years of age. These secondary educated, professionally majority
findings were similar to the findings of of samples were housewives, most of the
study conducted by JuliNaz at Government samples were having monthly income
Hospital, Dharapuram, where majority primi >5000 Rs. and most of mothers belongs to
mothers 23(76.67%) were belongs to the joint family and Hindu by religion.
age group of 18-25 years. [7] There was no significant difference
In the group - I majority mothers found in the proportions between group - I
20(66.66%) were educated up to secondary and group - II.
education and in group - II majority mothers Comparison of respondents according to
12(40%) were educated up to secondary score of supportive needs and teaching
education. These findings were contradicted needs
to the findings of study conducted by In the present study there was no significant
JuliNaz at Government Hospital, difference found in the mean score of
Dharapuram, where majority primi mothers supportive needs and teaching needs
20 (66.67%) were having higher education. between group - I and group – II(P=0.1595
[7]
and t = 1.425).
In the group - I majority mothers Findings related to LATCH score:
28(93.33%) were house wives and in group

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Successful Breast Feeding Among Antenatal Mothers

There was good latching and profuse effectiveness of this device and its
breast milk secretion even from first day as advantages over other measures. The study
effect of early initiation of breast feeding says the modified syringe technique is
among both the groups and effect of simple, inexpensive, and easily learned by
intervention with cut disposable syringe mothers. The syringe is portable, safe, and
among group - II. can be used as often as required. [15]
Similar findings were noted in the These findings contradicted with
study conducted by Nirmala Kesaree where findings in the study conducted by Reza
seven mothers who had inverted nipples Vazirinejad Shokoofeh Darakhshan. In their
were helped to breastfeed their infants with prospective cohort study, 100 healthy term
the assistance of disposable syringe. These neonates were followed from birth to day
women were able to successfully breastfeed seven in two groups; Group A: fifty
within one week. On follow-up, these neonates born to mothers with specified
mothers were able to sustain adequate breast variations and Group B: fifty
breastfeeding. [13] neonates born to mothers without such
Findings related to assessment pattern of breast variations ("normal breasts"). All
weight loss of the babies: neonates were the first child of their
There was significant difference in weight families and there was no sex ratio
of the babies on first day (birth weight) and difference between the two groups.
fourth day among both the groups. Neonates' weight at birth and day seven
Findings related to comparison of mean were measured and the mean weight
weight of the babies on first day: differences in the two groups were
There was no significant difference found in compared using paired t-test. Neonates born
the mean weight of the babies on first day to mothers without the specified breast
between group - I and group - II. variations had a mean weight gain of (+) 53
Findings related to comparison pattern of ± 154.4 g at day seven. Not only there was
weight loss of the babies on fourth day no increase in the mean weight of neonates
There was no significant difference in the other group, but they had a mean
found in the mean weight of the babies on decrease of weight of (-) 162 ± 125.5 g by
fourth day between group - I and group - II. the seventh day of their life compared to
Thus, the correction of inverted nipples with birth weight. Thus, neonates born to
cut disposable syringe technique may be mothers without breast variations had
effective in achievement of successful significantly greater weight gain than
breastfeeding. neonates born to the mothers with the
Similar findings were noted in the specified variations including inverted
study conducted by Indian pediatrics nipples (p < 0.01). Breast variation among
regarding using a simple device (disposable first-time mothers acts as an important
syringe) for management of inverted nipple barrier to weight gain among breastfed
in 35 cases of inverted nipple and in 34 has neonates in the early days of life. [9]
been successful in establishing breast Findings related to problem with inverted
feeding. The time interval between use of and normal nipples:
syringe and establishment of full breast None of the mother was developed
feeding varied from 3 to 7 days in all except any problem with inverted and / or normal
one case. On follow up, all the babies were nipples such as failing lactation, suppression
continuing to breastfeed and nipples had of lactation, poor latch, ineffective
permanently everted. [14] breastfeeding, mastitis and engorged breast
Similar findings were noted in the etc., during first four days of postpartum
study conducted by Gillian to assess the among both the groups. These findings are
effectiveness of using disposable syringe to contradictory with the study conducted by
treat inverted nipple, it shows the Kamalendu Chakrabarti and Subhra Basu in

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Shilpa Umesh Bagal et al. A Comparative Study to Assess Problem of Inverted Nipple and Its Relationship to
Successful Breast Feeding Among Antenatal Mothers

their study all the mothers faced some Delmar learning publications, Canada,
amount of distress at not being able to 2005.
3. Jacob Annamma, A Comprehensive text
breastfeed their babies due to nipple book of midwifery, 2nd ed., Jaypee Brothers
problems. [10] Medial Publishers, New Delhi, 2008.
4. Martha Ann Auvenshine, Martha Gunther
CONCLUSION Enriquez, Maternity Nursing Dimensions of
Based on the findings of the study change, Wadsworth Health Sciences
Division publishers, Monterey, California,
the following conclusions were drawn. A Division of Wadsworth, Inc. 1985.
-There was no significant difference found 5. Julinaz, A study to assess the knowledge,
in the mean score of supportive needs and attitude and practice regarding breastfeeding
teaching needs between group - I and group among primi mothers in government
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How to cite this article: Bagal SU, Salunkhe JA, Salunkhe AH et al. A comparative study to assess
problem of inverted nipple and its relationship to successful breast feeding among antenatal
mothers. Int J Health Sci Res. 2017; 7(4):280-288.

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International Journal of Health Sciences & Research (www.ijhsr.org) 288

Vol.7; Issue: 4; April 2017