300315416divya

A STUDY TO EVALUATE THE EFFECTIVENESS OF
SELF INSTRUCTIONAL MODULE REGARDING

EXPRESSION AND STORAGE OF BREAST
MILK AMONG EMPLOYED MOTHERS AT
ARAVINDAN NURSING HOME AND
PRIMARY HEALTH CENTRE,
KOVILPALAYAM,
COIMBATORE
By
Reg. No: 301421101
A DISSERTATION SUBMITTED TO THE TAMIL NADU

Dr. M. G. R. MEDICAL UNIVERSITY, CHENNAI IN
PARTIAL FULFILLMENT OF REQUIREMENT
FOR THE DEGREE OF MASTER OF
SCIENCE IN NURSING
OCTOBER 2016
KOVILPALAYAM,
COIMBATORE
By
Reg. No: 301421101
Approved by
_______________ _______________
EXTERNAL INTERNAL

SCIENCE IN NURSING
OCTOBER 2016
KOVILPALAYAM,
COIMBATORE
CERTIFIED THAT THIS IS THE BONAFIDE WORK OF
Reg. No: 301421101

PPG College of Nursing
Coimbatore
SIGNATURE : ________________________ COLLEGE SEAL
Dr. P. MUTHULAKSHMI, M.Sc(N)., M.Phil., Ph.D.,

Principal,
PPG College of Nursing,
Coimbatore - 35.

SCIENCE IN NURSING
OCTOBER 2016
KOVILPALAYAM,
COIMBATORE
APPROVED BY THE DISSERTATION COMMITTEE ON OCTOBER 2015
RESEARCH GUIDE :
Dr. P. MUTHULAKSHMI, M.Sc(N)., M.Phil, Ph.D.,
Principal,
Department of Obstetrics and Gynaecology,
Coimbatore.
SUBJECT GUIDE :
Prof. L. KALAIVANI, M.Sc(N)., Ph.D.,
Department of Obstetrics and Gynaecology,
Coimbatore-35.
MEDICAL GUIDE :
Dr. PADMAJA, M.D.,
Consultant,
Ashwin Hospital,
Coimbatore - 12.

SCIENCE IN NURSING
OCTOBER 2016
Dedicated to
Almighty God,
Lovable Husband,
Daughter,
Parents, Brother
& Friends
ACKNOWLEDGEMENT
Gratitude can never be expressed in words, but this is only a deep perception which
makes the words to flow from one’s inner heart
I bow in reverence to the lord almighty, the foundation of the knowledge and
wisdom whose salutary benign benison enabled me to achieve this target.
I would do injustice, if I fail to thank my husband Mr. P. Manikandan and
my daughter Alice for the psychological and economical support for completing this
study successfully. Words are beyond expression for the commendation and
meticulous care, fervent prayers of my parents and my brother for nurturing my
cherished dream into a reality through their continuous challenging encouragements.
I am grateful to Dr. L. P. Thangavelu, F.R.C.S., chairman and Mrs. Shanthi
Thangavelu, M.A., Correspondent, P.P.G groups of Institutions, Coimbatore who
helped us in making the project a great success.
It is my long felt desire to express my profound gratitude and exclusive thanks
to Prof. Dr. P. Muthulakshmi, M.Sc(N)., M.Phil.,Ph.D, Principal, Professor And
Head Of The Department Of Maternity Nursing. It is a matter of fact that without her
esteemed suggestions, highly scholarly touch piercing insight at every stage of the
study, this work could not have been presented in the manner it has been made. I also
express my gratitude for her valuable guidance and help in the statistical analysis of
data which is the core of the study.

It is a great privilege to express my sincere thanks and deep sense of
indebtedness to my esteemed subject co-guide Mrs. L. Kalaivani, Msc(N)., M.Phil.,
Ph.D, Professor In Obstetrics And Gynaelogy department for her keen support,
encouragement, guidance, valuable suggestions and constructive evaluation which
have enabled me to shape this research as a worthy contribution.
I express my sincere thanks to Dr. Kalavathi, MD., DGO., Aravindan
hospital and Dr. Kathiravan, Medical Officer, Primary Health Centre, Kovilpalayam,
Coimbatore for granting me permission to conduct the study in the their primary
health center and their staffs for their co-operation and help for completing my work
successfully.
I extend my thanks to the Dissertation Committee Members for their healthy
criticism, supportive suggestions which molded the research.
I take this opportunity to thanks the Experts who have done the content
validity and given valuable suggestion in the modifications of the tool.
I utilize this eventful opportunity to thank Mrs. J. Nagamala faculty of PPG
College of Nursing of their healthy criticism, supportive suggestions and tremendous
co-operation for completing my work successfully.
I extend my sincere thanks to all the Faculty Members of PPG College of
Nursing who have instructed and enlighten me in the field of education and rendered
me all possible help to achieve my target.

I thank all Librarians and Assistants for their kind co-operation in providing
the necessary materials.
I would also express my sincere thanks to Mr. N. Sivakumar of Nawal
Comtech solutions of for their patience, dedication and timely co-operation in typing
the manuscript.
I owe a great deal of thanks to my Dear Most Colleagues who encouraged
and supported me with their time and valuable suggestions throughout my study.
I extend my thanks to all the Participants in the study.
I thank all my Well Wishers who helped me directly and indirectly.

LIST OF CONTENTS
CHAPTER CONTENTS PAGE No.
I INTRODUCTION 1
Need for the Study 3
Statement of the Problem 6
Objectives 6
Hypothesis 6
Operational Definitions 6
Assumptions 7
II REVIEW OF LITERATURE 8
Conceptual Framework 17
III METHODOLOGY 20
Research Approach 20
Research Design 20
Setting of the Study 21
Variables 21
Population 22
Sample Size 22
Sampling Technique 22
Criteria for Selection of Samples 22
Description of the Tool 22
Testing of the Tool 24
Pilot Study 24
Data Collection Procedure 25
Plan for Data Analysis 25

CHAPTER CONTENTS PAGE No.
IV DATA ANALYSIS AND INTERPRETATION 27
V RESULTS AND DISCUSSION 51
VI SUMMARY, CONCLUSION, 54
NURSING IMPLICATIONS, LIMITATIONS AND
RECOMMENDATIONS
REFERENCES
ABSTRACT
APPENDICES
LIST OF TABLES
S.No. CONTENT PAGE No.
1. Distribution of Demographic Variables 28
2. Distribution of Statistical Value of Pretest and Post Test 42
Knowledge on Expression and Storage of Breast Milk Among
Employed Mothers
3. Distribution of Statistical Value of Pretest and Post Test 44
Knowledge on Practice on Expression and Storage of Breast
Milk Among Employed Mothers
4. Correlation Between Pretest Knowledge and Knowledge on 46
Practice Scores Regarding Expression and Storage of Breast
5. Correlation Between Post Test Knowledge and Knowledge on 46
Practice Scores Regarding Expression and Storage of Breast
6. Association of Employed Mothers Regarding Expression and 47
Storage of Breast Milk of Post Test Knowledge Score with
Demographic Variable
7. Association of Demographic Variables with Post Test Score of 49
Knowledge on Practice of Employed Mothers Regarding
Expression and Storage of Breast Milk

LIST OF FIGURES
S.No. CONTENTS PAGE No.
1. Modified Conceptual Framework Based on System Model 19

(1968)
2. The Schematic Representation of the Research Design 21
3. The Schematic Representation of the Variables 21
4. Distribution of Demographic Variable According to the Age 32
of the Mother
5. Distribution of Demographic Variable According to the 33
Occupational Status of the Mother
Religion
Education of Mother
Residence
Family Monthly Income of Mother
Type of Family
Working Hours
Feeding Utensils
Source of Information
14. Distribution of Mean Score of Pretest and Post Test on 43
Knowledge Regarding Expression and Storage of Expressed
Breast Milk
15. Distribution of Mean Score of Pretest and Post Test on 45
Practice Regarding Expression and Storage of Expressed
Breast Milk
LIST OF APPENDICES
APPENDIX TITLE
1. Letter seeking permission for conducting the study
2. Letter seeking permission from Experts for content validity of the
tool
3. Format for the content validity
4. List of experts for content validity
5. Questionnaire
English
Tamil
6. Teaching Module
English
Tamil
1
CHAPTER - I
Introduction
“The nature has desire the provision
that infant be fed upon their Mother’s Milk
- Rabindranath Tagore, (1972)
The well-being of the society is directly linked to health and survival of
mothers and children. Children are foundation of our nation and parents shape their
destiny by nurturing them with love, concern, attention, education and optimal
nutrition. Lactation is the characteristic in almost all the mammals and it is essential
to stimulate the production and flow of milk (Meharban Singh, 1995).
Breast milk is the best possible food for the baby and promotes babies
physical and emotional growth to the fullest. The breast feeding should be initiated
within an hour of birth instead of waiting several hours. Although milk at that time
help to establish feeding and a close relationship known as “bonding” (Park, 2000).
The first milk is the best possible food for the new-born and it is yellow in
colour. The shaustars call it “peeyusha” (equal to amrit, the liquor of life) and western
science uses the word colostrum. It is the infant’s first immunization. Exclusive breast
feeding for six months is more effective intervention to promote infant nutrition and
decreases their morbidity and mortality (World Health Organisation, 2006).
Neonatal sepsis is the leading cause of morbidity and mortality. More than
52% of neonatal death in India are due to infection of bottle feeding and poor feeding
2
rates between life and death and it is the infant “passport of life” customs supervision,
tradition and ignorance sometimes deprive the child from getting this benefit. The
scientific literature shows that breastfeeding currently saves 6 million infant lives
each year by preventing diarrhoea and acute respiratory tract infection alone, and is
alone responsible for infertility suppression (Arun Gupta, 2001).
Although the health benefits are well documented and initiation rates have
increased over the past 20 years, most mothers wean before the recommended 6
months, postpartum because of perceived difficulties with breastfeeding rather than
due to maternal choice. Women least likely to breast feed are those who are young,
low income, belong to ethic minority, unsupported, employed full time, have negative
attitude towards breastfeeding and have low confidence in their ability to breast feed.
These mothers can express her milk by manual massage or using breast pump and
keep it in freezer storage bags or bottle which is ready for use. Breast milk may be
kept at room temperature for up to four to six hours (Cindy. L, 2004).
Oghonnac (2008) conducted a study on work and infant feeding decision at
Chiang Mai, Thailand. It revealed that resumption of employment generally had
negative effects on breast feeding rates and duration. Among the 313 employed
mothers, 73% of the workers were back on the job before their infants were 13 weeks
old. This mother stated that full time employment with insufficient breaks to express
breast milk during work hours was the reason for their early weaning. Another study
conducted at Canada, breastfeeding difficulties among employed that those who
combined breast feeding and employment experience many difficulties. Among the
150 samples, 63 (42%) mothers had the problem of leaking milk, breast engorgement
3
and 19 (13%) mothers had the pressure from others to wean and found difficulty to
cope up with multiple expectations of home and work (Elizabeth, 2008).
Need for the Study
Women with infants are the fastest growing segment of today’s labour force.
50% of employed women return back to work, when their children are three months
old. The studies indicate that women who continued to breast feed while working,
missed less hours of work because of less baby related illness, compared with mothers
who do not breast feed (Susan, 2009).
Health promotion and disease prevention objectives stated that the proportion
of mothers who initiate breast feeding should increase at least 75% and that the
proportion of mothers to combine breastfeeding for 5 to 6 months should increase at
least to 50% by the year 2010 to reduce infant and child mortality, improve the health
and development of infant and young children. The tenth five year plan of
government of India (2003-2007) has set an ambitious target to increase exclusive
breastfeeding (Government of India, 2003).
In many areas of the world neonates are not hold to breast for varying periods
of time because of unfavourable maternity ward but also due to tradition that allow for
discarding colostrum and delaying to breastfeeding for one to three days during which
time infant receives formula or sugar water or honey (Meharbansingh, 1995).
An unfavourable working environment can make it difficult to improve
breastfeeding measures. An ecological frame work which includes the individual
social support and support groups are utilized supportive work environment and
4
facilities for breastfeeding. Health care providers can promote awareness among
working women by using social and community support for breastfeeding (Johnswon,
2006).
Patient teaching is one of the main aspect of holistic care to achieve a defined
outside of change in behaviour and attitude of mother. Nurses assist the mothers to
increase their knowledge and skill through planned teaching programme empowers
them to enhance the infant survival and reduce mortality and morbidity (World Health
Organisation, 1993).
Ryan (2006) stated that maternity leave provisions are essential for working
women to effectively complete the transition from pregnancy to motherhood.
Premature termination or too short maternity leave may have undesirable
consequences. Studies often cite early return to work as one of the reason for
premature termination of breastfeeding. Shorter maternity leaves were associated with
the infant and more maternal depressive symptoms.
In today’s world around 75% of women are working in urban area, out of
which 58% are working mothers. In Indian, the maternity benefit is given for 90 days
paid leave in Government setting but in private sectors the mother have to return back
to work after one and half month or two months. Also as per W.H.O rule exclusive
breast feeding should be given at least for 6 months. As the mother return back to
work the babies does not get proper feed’s thus she can express and store the breast
milk and many a times it gets spoiled and baby may became sick thus it is important
to know regarding proper expression and storage of breast milk, at proper
temperature. Breast feeding promotion network of India, (BPNI) says, the infant aged
5
(0 - 5 months) who are not breast feed have seven fold and fivefold increased risk of
death from diarrhoea compared to the infants who are exclusively breast feed. To
reduce the infant mortality rate and improvement in the health status and development
of infants and young children, breast feeding is very important.
Journal of Human Lactation, First published on November 12, 2009, a cohort
study, Conducted in Perth (Australia), the expression of breast milk allows a mother
to be away intermittently from her infant while continuing to breastfeed. The study to
investigate between expression of breast milk and breast feeding duration. Result: A
total of 587 mother, or 55% of those eligible, participated in the study. Of these 93%
were breastfeeding at discharge but after six month they discontinue as they started on
their work.
According to WHO and UNICEF, exclusive breastfeeding for 6 months is the
single most effective child survival intervention which reduces the under five children
death about 16% in India.
India has more than 400 million children. 2.5 million Children die in India
every year, accounting for one in five deaths in the world, with girls being 50 percent
more likely to die. One out of 16 children die before they attain one year of age, and
one out of 11 die before they attain five years of age. India accounts for 35 per cent of
the developing world’s low birth weight babies and 40per cent of child malnutrition in
developing countries, one of the highest levels in the world. Although India’s neonatal
mortality rate declined in the 1990s from 69 per 1000 live births in 1980 to 53 per
1000 live births in 1990, it remained static, dropping only four points from 48 to 44
per 1000 live births between 1995 and 2000.

6
Statement of the Problem
A study to evaluate the effectiveness of self instructional module regarding
expression and storage of breast milk among employed mothers at Aravindan Nursing
Home and Primary Health Centre, Kovilpalayam, Coimbatore.
Objectives
 To assess the knowledge regarding expression and storage of breast milk
among employed mothers.
 To assess the knowledge on practice regarding expression and storage of
breast milk among employed mothers.
 To deliver self -instructional module regarding expression and storage of
breast milk.
 To evaluate the effectiveness of self-instructional module regarding expression
and storage of breast milk among employed mothers.
 To find out the association between knowledge and knowledge on practice
regarding expression and storage of breast milk with selected demographic
variables.
Hypothesis
There is a significant difference between pre-test and post-test score among
employed mothers regarding breast feeding and expression and storage of breast milk.
Operational Definition
Effectiveness
It refers to the expression and storage of breast milk by means of health
education to the employed mothers.

7
Knowledge
It is to the verbal response of respondents to knowledge items on
expression and storage of breast milk by this structured interviewed schedule.
Knowledge on Practice
It refers to the actual activity of employed mothers related to
expression and storage of breast milk.
Self -instructional Module
It refers to a systematically organized study material with the
information related to expression and storage of breast milk.
Expressed Breast Milk
It refers to the expression of the breast milk by means of manual
massage or breast pump.
Assumption
 Employed mothers have inadequate knowledge regarding about the expression
and storage of breast milk.
 Education will improve the knowledge regarding the expression and storage of
breast milk.
 Education will improve knowledge and knowledge on practice regarding the

8
CHAPTER - II
Review Of Literature
One of the major functions of review of literature is to ascertain what is
already known in relation to problem of interest.
Abdulla and Levine (1979) stated that the review of literature provide a basis
for further investigations, justifies the need for replication, throws light on the
feasibility of study to another.
This chapter deals with the review of published and unpublished research
studies and non-research literature related to present study.
Literature Relevant to the Present Study is Organised Under Following
Headings
 Literature related to breast feeding
 Literature related to expressed breast milk
 Literature related to container for collection of breast milk
 Literature related to storage of breast milk
 Literature related to feeding technique
Literature Related to Breast Feeding
Jennifer (2002) stated that breast feeding benefits preterm infants from a
nutritional, gastrointestinal, immunological, developmental and psychological
perspective. Despite the benefits of the incidents and duration of breast feeding
9
preterm infants continues to be less than of full term infants. The lower incidence is
probably related to breast feeding challenges that preterm infants and parents face,
including establishing and maintaining a milk supply and transfer from gavage
feeding to breast feeding. In order to increase the incidence and duration of breast
feeding preterm infants, researchers must examine breast feeding experiences
longitudinally. This way researchers and clinicians can begin to understand the
barriers to breast feeding at various time periods and begin implementing strategies to
remove these barriers.
Yeonbai (1999) conducted the study aimed to investigate the relative
importance of psychological factors under lying mother’s decision to continue
exclusive breast feeding for six months using the theory of planned behaviour. A
strong, positive correlation between intended and actual expressed breast feeding
duration, intervention programmes designed to positively influence mother’s attitude
and social support may be effective in improving intention thereby increasing
expressed breast feeding maintenance for 6 months.
The culture, belief and practice, mother’s employment and increasing
modernization are linked to breast feeding. Breastfeeding rises to mother’s both
positive and negative experiences mediated by mother’s health behaviours. Mothers
working full time experience breast feeding as rewarding as well as challenging.
Although they know the importance and value of breast feeding due to their working
circumstances they are unable to do this task (Naeem Z, 2005).

10
Hellen. M (2004) stated that breast feeding is undoubtedly best for both
mother and baby, many factors influences a women’s decision about whether to start
and when to cease feeding. In order to improve breast feeding rates, education for
both mothers and midwives must be targeted towards ensuring to independently
attach their baby on discharge from hospital. The findings also supports the
discouragement of artificial feeding unless there is a medical indication or the mother
has made an uninformed request.
Irene. S (2003) emphasized that primiparous women and women who
delivered by caesarean section consistently received more information about breast
feeding management than multiparous women and women who delivered vaginally.
However the study suggests that all women, regardless of parity or type of delivery
have information and support needs related to breast feeding.
Literature Related to Expressed Breast Milk
Colostrum is universally acknowledged as the perfect first food for infants.
Oxytocin is the hormone of both labour and lactation but the literature shows a review
of custom of expressing milk by all women is followed by the maternal and infant
medical reason for expressing and storing colostrum. A suggested designed for
expressing and storage of colostrum is included with advice about skin to skin contact
in the first 24 hours to maximize breast milk output in the long term.
Klien, M. J (2002) conducted that the expression of breast milk is an important
strategy to enable mothers to continue exclusive breast feeding. In some situations for
health or convince expressed breast milk is required and infants fed this way still fall
11
within the definition of exclusive breast feeding. Breast milk expression is very useful
skill to allow mothers to exclusively breast feed until 6 months and should be taught
to all mothers.
Women had an average of three children each and are most breast fed for less
than three months. The most common reason given for not breast feeding or breast
feeding less than 3 months is not enough milk. The four factors that makes the women
to shop breast feeding were personnel concern( body image, tired, return to work),
need help (want husband to help, child unwell, didn’t like breast feeding)
uncomfortable and not confident (Jennet. P).
Stockdale, H. J (2000) conducted the study regarding the breast feeding
experience of a mother who is having a child with cleft palate. The decision was made
to express breast milk long term and feed the baby by chuchu teat and squeeze bottle.
It provides the way to make long term expression of breast milk easier.
The technique of manually or hand expressing breast milk is fabulous
alternative to using a breast pump. In fact nothing can minimize the action of breast
feeding better than your own fingers (Melisakotlen, 2009).
Grahams (2008) emphasized that breast milk is often referred to as “liquid
gold”, store it safely in the freezer is very important. When freezing breast milk at
home after expressing its generally recommended that you pour the milk into a clean
bacteria free plastic containers or polyethylene bottle liner or simply keep it in pump
bottle.
12
The expression of breast milk allows a mother to be away intermittently from
her infant while continuing to breast feed. Mothers who express breast milk are more
likely to breast feed up to six months, the appropriate use of expressed breast milk
may be a means to help mothers to achieve six months of full breast feeding while
giving more life style options.
Van Greet (2007) suggested that when direct breast feeding is not possible a
mother can express (artificially remove and store) her milk. With manual massage or
using a breast pump woman can express her milk and keep it in freezer storage bags,
supplemental nursing system or a bottle ready for use. Breast milk may be kept at
room temperature for up to six hours, refrigerated for up to 8 days or frozen for up to
4 to 6 months.
Exclusive expressing or exclusive pumping are the terms for a mother who
feeds her baby exclusively on her breast milk while not physically breast feeding.
This may arise because her baby is unable or unwilling to latch on to the breast. With
good pumping habits, particularly in the first 12 weeks when the milk supply is being
established it is possible to produce enough milk to feed the baby for as long as the
mother wishes (Donzella, 2002).
Melissa. K (2009) emphasized that some women donate their expressed breast
milk to other either directly or through a milk bank. Some women dislike the idea of
feeding their own child with another women’s milk. Feeding of expressed breast milk
either from the donor or the baby’s own mother is method of choice for premature
13
babies. The transmission of some viral diseases through breast feeding can be
prevented by expressing breast milk as subjected to pasteurization.
Literature Related to Container Collection of Breast Milk
The way in which milk is collected and stored has a significant effect in milk
composition. Polyethylene storage bags should not be used to store milk for infants.
The glass containers fitted with an air-tight seal maintain immunoglobulin stability
and minimize fat loss (Slushed. T, 2007).
Greater volume of fat concentration was absorbed in milk collected by suction.
Vitamin A, zinc, iron, copper, sodium, protein, nitrogen and ascorbic acid
concentrations are more. These findingsindicate that collection methods and storage
procedures used for comparatively brief periods will affect the concentrations of
selected nutrients of mature human milk. Specific recommendation are made for the
collection and storage of milk (Garza, 2006).
Maternal milk has bactericidal capacity providing defences and protection
against infection for new born. This property can be altered during the storage of
milk. Consequently if storage is excess of 48 hours is required freezing is preferred to
refrigeration (Silvestre. D, 2006).
Literature Related to Storage of Expressed Breast Milk
Meharban Singh (2000) stated that the milk should be collected in a clean
container having as screw cap or tight lid. Milk can be safely stored for 8 hours in a
cool place of the room up to 24 hours in the refrigerator. It can be stored up to 3

14
months in a deep freezer up to -20 degree. The stored milk should never be boiled as
it will destroy the protective component of milk. It can be thawed or warmed by
placing the container in a bowl of warm water. The container should be gently shaken
to recombine the separated fat globules before feeding. Give expressed breast milk
with the spoon and strictly avoid the use of feeding bottle.
There are varieties of containers for breast milk storage. For most healthy,
term babies who get the bulk of their nutrition from direct breast feeding the storage
container is not as important as it might be for a hospitalized pre term or ill baby who
is getting only expressed milk. Glass is usually considered the best choice for freezing
the milk because the components of milk are better preserved in glass. The second
choice would be hard, clear plastic containers. Most moms find that plastic is
convenient and some day care centers will not accept glass because of the risk of
breakage. All containers should have a tight sealing with one piece lid (Berlin, C. M,
2005).
Storing breast milk in milk storage bags could present some problems. The
milk could cling to the slides of the storage bags, reducing the amount that gets to
baby. Milk bags are also more prone to contamination through leakage. Some pump
companies make milk storage bags that are convenient to use and are of a thicker
gauge plastic than those originally tested however, these can be expensive. If you do
use bags, it’s a good idea to double bag the inner ones and storage and bag in a hard
plastic storage container with a lid, in the freezer. This help to reduce the risk of small
tears in the bag (Bunkie, 2010).

15
McLaughlin (2002) suggested that when a baby is only receiving expressed
milk occasionally the type of storage container is not a major consideration. However,
if a baby is receiving most of his nourishment from expressed breast milk, the of
storage container used should be considered carefully. Plastic containers are the best
choice for storing breast milk in the refrigerator as more of human milk’s leukocytes
or white cells adhere to glass. If the milk is to be frozen, glass is the preferred choice
as it is less porous and offers the best protection. Most of the leukocytes in human
milk are killed while freezing. For this reason milk that can be used with in eight days
of expression should be refrigerator rather than frozen because the antimicrobial
properties of human are better preserved with refrigerator.
Shepherd, S. C (1982) another good choice for refrigerator is freezing is the
milk storage bags that are designed specifically for human milk. They are pre-
sterilized and are thicker, coated with polythene and lined with nylon which prevents
the fat from adhering to the sides. Hard plastic containers of any kind are also good
choices for both refrigeration and freezing. Other milk bags, sold specifically as bottle
liners are not as durable, making them an unacceptable alternative when freezing the
milk as the seams may burn during the freezing process perhaps causing a leak during
thawing.
If you are pumping breast milk to feed to your baby, it’s important to know
that storage guidelines. Pumped breast milk can be fed to a baby immediately after
pumping after short-term refrigeration or after long-term freezing. Each way of
storing milk has different guidelines for a safe storage and use (Nicki. H, 2007).
16
Literature Related to Feeding Technique
A study conducted on a cup feeding versus other forms of feeding for new
born, infant unable to fully breast feed. Bottle feeding cannot be recommended over
cup feeding assess supplement to breast feeding bottle feeding have more risk for
baby (Flint. A, 2008).
Cup feeding of breast milk provide optimal nutrition for new born and infant
who are unable to fully breast feed by the mother. It is ideal way for infants to receive
breast milk. Cup feeding has become a popular practice in many nurseries in an
attempt to improve breast feeding rate (Davis M.W, 2007).
Breast milk provides optimal nutrition for new born infants and the ideal way
for infants to receive breast milk is through sucking at the breast. Unfortunately this
may not always be possible as there are numerous reasons why a new born infant may
not be able to breast feed and as a result require supplemental feeding. Currently,
there are variety of ways in which new born infants can receive supplemental feeds.
Traditionally bottles and nasogastric tubes have been used. However more recently
cup feeding has become a popular practice in many nurseries in an attempt to improve
breast feeding rates (Lai C.T, 2006).

17
Conceptual Framework
Conceptual framework for this study was derived from system theory 1968. It
serves as a model for viewing people as interacting with environment. System can be
opened or closed. Open system have varying degree of interaction with environment
from which the system receives. Input and output in the form of matter, energy or
information. The feedback may be positive, negative or neutral. This study aims at
determining the effectiveness of self-instructional module regarding the expressed
breast milk among employed mothers. Present study is based on ‘system model’. The
components of system are input, through put, output and feedback.
Input
It is the information needed by the system based on the demographic
variables like age of mother, religion, residence, source of information, education,
type of the family, occupation, and monthly income of the mother. In this study
the input is the assessment of knowledge and knowledge on practice regarding
Throughput
Throughput is the security phase where a self-instructional module was
administered regarding expressed breast milk among employed mothers.
Output
Information are continuously processed through the system and revealed
as output in an altered state. In this study the output is the expected gain in the
knowledge and knowledge on practice of employed mothers regarding expressed
breast milk which was post tested after self-instructional module.

18
Feed back
The feedback is the environment responsible for the system. System
feedback may be mutual, positive or negative. If the feedback is negative the
process is again reassessed. In this present study the feedback was not included.
19
INPUT THROUGHPUT OUTPUT
Demographic Variables
Mother’s Age, Religion, POST TEST

Educational Status, Indications Advantages Adequate
Occupational Status, Knowledge
Monthly Income, Type
Employed
of Family, Residence, Expression
mothers
Source of information And
regarding
Storage of
Pretest to assess the expression
Breast
knowledge and and storage
Milk
knowledge on practice of breast Inadequate
Storage
among employed of Breast Methods milk Knowledge
mothers regarding Milk
expression and storage
of
breast milk
Figure. 1 Modified Conceptual Framework Based on System Model (1968)

20
CHAPTER - III
Methodology
This chapter consist of research approach, research design, setting of the
study, population, same size, sampling technique, criteria for selection of the sample,
description of the tool, content validity, reliability, pilot study, procedure of the data
collection and plan for data analysis.
Research Approach
The experimental approach is a sub-type of quantitative approach was used for
the present study.
Research Design
The research design helps the researcher in the selection of subjects
manipulation of experimental variables procedure for data collection and the type of
statistical analysis to be used to interpret the data.
The research design was pre experimental one group pre test, post test design
was adopted in the study. In the present study a pre test was administered by means of
questionnaire method depicted as O 1 and then a planned teaching programme was
delivered as X. A post test was conducted by using the same questionnaire depicted as
O2.
21
Q1 X Q2
Assessing the Assessing the

Pretest Knowledge Self Posttest Knowledge
and knowledge on Instructional and knowledge on
practice regarding Module practice regarding
Expressed Breast Regarding Expressed Breast
Expressed
Milk Among Milk Among
Breast Milk
Employed Mothers Employed Mothers
Figure. 2 The Schematic Representation of the Research Design
Setting of the study
The study was conducted among employed mothers who visited for their
regular check-up at Aravindan nursing home and primary health centre Kovilpalayam.
Variables
The independent variable was self-instructional module on expressed breast
milk. The dependent variable was knowledge and knowledge of practice of employed
mothers regarding expression and storage breast milk and the influencing variables
were demographic variables.
Influencing Dependent Independent

Variables Variables Variables
Demographic Knowledge and

variables such as knowledge on
Age, Education, practice of Self-instructional
module on
Income, Type of employed mothers
expressed breast
Family, Working regarding milk.
Hours, Religion, expression and
Residential Place storage of breast
milk
Figure. 3 The Schematic Representation of the Variables

22
Population
The assessable population of the study includes employed mothers who come
for the monthly check up at Aravindan Nursing Home and Primary Health Centre,
Kovilpalayam.
Sample Size
Sample size of the present study is 40.
Sampling Technique
Non- probability convenient sampling technique was used to select the
samples. The mothers who fulfilled the sample criteria were selected till the sample
size was obtained for the present study.
Criteria for the Selection of the Samples
Inclusive Criteria
 Mothers belong to the age group between 22 to 30 years
 Mothers who were able to understand both Tamil and English
 Who were willing to participate in the study
Exclusive Criteria
 Mothers who were unemployed
Description of the Tool
The researcher has developed a questionnaire to assess the knowledge
regarding expressed breast milk. The instrument contains the following sessions.
23
Part - A Distribution of Demographic Variables
It includes the sample numbers, age of the samples, educational status,
type of family, area of residence, occupational status of the mother, family income
and source of information regarding expression and storage of breast milk
Part - B Questions Regarding Knowledge on Expression and Storage of
Breast Milk
It consist of 40 questions related to assessment of the knowledge of
employed mothers regarding expression and storage of breast milk.
Interpretation of the Questionnaire
Each question had one correct answer and was given a score of one mark,
for wrong answer a score of zero was given. The total score for this section
was 40.
Part - C Questions Regarding Knowledge on Practice Regarding
It consists of 10 questions related to assessment of the knowledge on
practice of mothers regarding expression and storage of breast milk.
Interpretation of the Questionnaire
One mark was given for yes answer and zero mark for no answer. The
total score allotted for this section was 15.

24
Testing of the Tool
Content Validity
The tool was given to the experts to the field of nursing and medicine for
content validity. All comments and suggestion given by the experts were daily
considered and the corrections were made.
Reliability
The reliability of the tool was determined by spearman brown split half
technique.
Item Split Half Reliability
Self instructional module +0.8
The reliability of the tool was satisfactory
Pilot Study
The pilot study was conducted to make sure that the tool was capable of
eliciting responses. It was conducted among four employed mothers in Aravindan
nursing home for a period of one week. The employed mothers were selected for the
pilot study. The knowledge and knowledge on practice regarding expression and
storage of breast milk were assessed with the prepared questionnaire. The education
module was prepared to enhance the knowledge and knowledge on practice regarding
expression and storage of breast milk. Health education was given with the help of
videos. The result of the pilot study showed that there was positive correlation
between knowledge and knowledge on practice.

25
Data Collection Procedure
Prior permission was obtained from chairman of Aravindan Nursing Home,
Coimbatore by submitting an application giving assurance to abide by the rules and
regulations. The study was done for a period of 4 weeks. The investigator identified
the mother that fulfilled criteria. The mother were explained about the purpose of the
study in a compassionate manner and informed consent was taken. Necessary
precautions were taken to provide privacy and confidentiality.
In pretest the knowledge and knowledge on practice of mother regarding
expression and storage of breast milk was asses following pre test by using the same
questionnaire. On the same day structured teaching module was educated by showing
videos. Post test was conducted on the 5th day by using the same questionnaire to find
out the effectiveness.
Plan for Data Analysis
 Data was planned to be analysed by using descriptive and inferential statistics.
 Descriptive statistics were used to analysis the frequency, percentage, mean,
standard deviation for the following variables.
 Demographic variables of mothers
 Knowledge regarding expression and storage of breast milk
 Knowledge on practice regarding expression and storage of breast
milk.
 Inferential statistics were used to determine the relationship and comparison to
identity the difference,
 To identify the relationship between knowledge and knowledge on
practice regarding expression and storage of breast milk.

26
 Paired ‘t’ test used to compare the knowledge and knowledge on
practice regarding expression and storage of breast milk.
Chi-square test
Chi-square test was computed to find out the association between knowledge
and knowledge on practice with selected demographic data.

27
CHAPTER - IV
Data Analysis and Interpretation
This chapter deals with the analysis and interpretation of data collected from
the working mothers regarding expressed breast milk.
The findings based on the descriptive and inferential statistical analysis
tabulated as follows
Section – I Distribution of demographic variables of working mothers
Section – II Description about knowledge regarding expression of breast milk
among working mothers
Section - III Description about knowledge on practice regarding expression and
storage of breast milk
Section - IV Description about the correlation between knowledge and knowledge
on practice regarding expression and storage of expression and
storage of breast milk
Section - V Association of selected demographic variables with post test score of
knowledge and knowledge on practice regarding mothers.

28
SECTION - I
Table. 1 Distribution of Demographic Variables
(n = 40)
Frequency Percentage
S. No. Demographic Variables
(f) (%)
1. Age in years
a) 22-24 years 9 22.5%
b) 25-26 years 23 57.5%
c) 27-28 years 5 12.5%
d) 29-30 years 3 7.5%
2. Occupational status of the mother

a) Self employed 5 12.5%
b) Labour 22 55%
c) Office worker 8 20%
d) Government employee 5 12.5%
3. Religion
a) Hindu 47 94
b) Muslim - -
c) Christian 3 6
4. Educational level
a) Basic education up to 10th std 6 15%
b) Diploma 4 10%
c) Graduate 20 50%
d) Post graduate 10 25%
(Table 1 continues)
29
(Table 1 continued)
Frequency Percentage
S. No. Demographic Variables
(f) (%)
5. Residential area
a) Urban 9 30%
b) Rural 21 70%
6. Total family income per month

a) Below `. 5,000 10 25%
b) `. 5001 to `. 8000 15 37.5%
c) `. 8001 to `. 10,000 8 20%
d) `. 10,000 and above 7 17.5%
7. Type of family
a) Nuclear family 33 82.5%
b) Joint family 7 17.5%
8. Working hours
a) Less than 4 hours - -
b) 4-6 hours 6 20%
c) 6-8 hours 14 46.6%
d) More than 8 hours 10 33.4%
9. Feeding utensils
a) Feeding bottle 16 53.4%
b) Spoon & cups 8 26.6%
c) Paladai 6 20%
10. Source of information

a) Relatives 5 16.6%
b) Friends 3 10%
c) Media 3 10%
d) Health personnel 19 63.4%
30
 Table 1 shows the distribution of demographic variables of age group was
between 22-24 years was 9 (22.5%) between 25-26 was 23 (57.5%) and above 30
was 3(7.5%).
 With regard to occupation of the mother it showed that 5(12.5%) were self
employed, 22(55%) were labour, 8(20%) were office workers and 5(12.5%) were
government employee.
 With regard to religion, 47(94%) mothers were Hindu and 3(6%) were Christian.
 Regarding educational qualification of the mother it was 6(15%) were basic
education up to 10th , 4(10%) were diploma, 20(50%) were graduate and 10(25%)
were post graduate.
 About monthly income of the mother it showed that 10(25%) were under `. 5000,
15(37%) were under `. 5001 to `. 8000, 8(20%) were `. 8001 to `. 10,000 and
7(17.5%) were above `. 10001.
 Regarding area of living 9(30%) mothers are living in urban area 21(70%)
mothers are living in rural area.
 Regarding the type of the family 33(82.5%) mothers were belongs to nuclear
family, 7(17.55%) were belongs to joint family.

31
 About working hours there are no mothers working less than 4 hours, 6(20%)
mothers are working for 4-6 hours, 14(46.6%) mothers are working for 6 -8 hours,
10(33.4%) mothers are working for more than 8 hours.
 Regarding feeding utensils 16(53.3%) mothers are using feeding bottles, 8(26.6%)
are using spoon and cups, 6(20%) are using paladai for feeding their babies.
 About source of information 5(16.6%) collected from the relatives, 3(10%) from
friends, 3(10%) from media, 19(63.4%) from health personnel’s.

32
70
22-24 years
25-26 years
60 57.5% 27-28 years
29-30 years
50
Percentage (%)
40
30
22.5%
20
12.5%
10 7.5%
0
22-24 years 25-26 years 27-28 years 29-30 years
Age in years
Figure. 4 Distribution of Demographic Variable According to the Age of the Mother

33
70
Self employed
Labour
60
55% Office worker
Government employee
50
Percentage (%)
40
30
20%
20
12.5% 12.5%
10
0
Self employed Labour Office worker Government employee
Occupational status of the mother
Figure. 5 Distribution of Demographic Variable According to the Occupational Status of the Mother
34
100 94%
Hindu
90 Muslim
80 Christian
70
Percentage (%)
60
50
40
30
20
10 6%
0%
0
Hindu Muslim Christian
Religion
Figure. 6 Distribution of Demographic Variable According to the Religion

35
80
Basic education up to 10th std
70 Diploma
Graduate
60 Post graduate
50%
Percentage (%)
50
40
30 25%
20 15%
10%
10
0
Basic education up to Diploma Graduate Post graduate
10th std
Educational level
Figure. 7 Distribution of Demographic Variable According to the Education of Mother

36
80
Urban
70%
70 Rural
60
Percentage (%)
50
40
30%
30
20
10
0
Urban Rural
Residential area
Figure. 8 Distribution of Demographic Variable According to the Residence

37
40
37.5%
Below `. 5,000
35 `. 5001 to `. 8000
`. 8001 to `.
`. `. 10,000
30 `.`. 10,000 and above
25%
Percentage (%)
25
20%
20
17.5%
15
10
0
Below `. 5,000 `.
`. 5001 to `. 8000 `.
`. 8001 to `. 10,000 `.
`. 10,000 and above
Total family income per month
Figure. 9 Distribution of Demographic Variable According to the Family Monthly Income of Mother
38
90
82.5% Nuclear family
80 Joint family
70
60
Percentage (%)
50
40
30
20 17.5%
10
0
Nuclear family Joint family
Type of family
Figure. 10 Distribution of Demographic Variable According to the Type of Family

39
60
Less than 4 hours
4-6 hours
50 6-8 hours
46.6% More than 8 hours
40
Percentage (%)
33.4%
30
20%
20
10
0%
0
Less than 4 hours 4-6 hours 6-8 hours More than 8 hours
Working hours
Figure. 11 Distribution of Demographic Variable According to the Working Hours

40
60
Feeding bottle
53.4%
Spoon & cups
50 Paladai
40
Percentage (%)
30 26.6%
20%
20
10
0
Feeding bottle Spoon & cups Paladai
Feeding utensils
Figure. 12 Distribution of Demographic Variable According to the Feeding Utensils

41
100
Relatives
90 Friends
Media
80 Health personnel
70
63.4%
Percentage (%)
60
50
40
30
20 16.6%
10% 10%
10
0
Relatives Friends Media Health personnel
Source of information
Figure. 13 Distribution of Demographic Variable According to the Source of Information

42
SECTION - II
Table. 2 Distribution of Statistical Value of Pretest and Post Test Knowledge on
Expression and Storage of Breast Milk Among Employed Mothers
(n = 40)
Standard Level of
S. No. Knowledge Mean ‘t’ value
Deviation Significance
1. Pre test 16 3.35
9.35* 0.05
2. Post test 29 2.54
* significant
Table 2 shows the table value of ‘t’=9.35* at p=0.05 for 39 degree of freedom
and calculated value of ‘t’=9.35 which is greater than the value. This shows that there
is a significant difference on knowledge reporting expression and storage of breast
milk before and after delivering health education.

43
40
Pre test
35 Post test
30 29
25
Mean
20
16
15
10
0
Pre test Post test
Knowledge
Figure. 14 Distribution of Mean Score of Pretest and Post Test on Knowledge Regarding
Expression and Storage of Expressed Breast Milk

44
Table. 3 Distribution of Statistical Value of Pretest and Post Test Knowledge on
Practice on Expression and Storage of Breast Milk Among Employed Mothers
(n = 40)
Standard Level of
S. No. Practice Mean ‘t’ value
Deviation Significance
1. Pre test 1.8 0.6
23.22* 0.05
2. Post test 4.31 0.59
* significant
Table 3 shows the table value of ‘t’= 1.694 at P=0.05 for 34 degree of freedom
and calculated value of ‘t’= 23.22 which is greater than the table value. This shows
that there is a significant difference on practice regarding expression and storage of
breast milk. Hence the null hypothesis is accepted.

45
5
Pre test
4.31 Post test
4
3
Mean
2 1.8
0
Pre test Post test
Practice
Figure. 15 Distribution of Mean Score of Pretest and Post Test on Practice Regarding Expression and Storage of Expressed Breast Milk
46
SECTION - III
Table. 4 Correlation Between Pretest Knowledge and Knowledge on Practice Scores
Regarding Expression and Storage of Breast Milk Among Employed Mothers
(n = 40)
S. No. Pre-test Mean S.D r
1. Knowledge 20.13 7.64

+ 0.50
2. Knowledge on practice 9.1 3.34
Table 4 shows there was a positive correlation between knowledge and
knowledge on practice in pretest regarding expression and storage of breast milk
among employed mothers.
Table. 5 Correlation Between Post Test Knowledge and Knowledge on Practice
Scores Regarding Expression and Storage of Breast Milk Among Employed Mothers
S. No. Post Test Mean S.D r
1. Knowledge 32.2 2.97

+ 0.715
2. Knowledge on practice 13.96 2.0
Table 5 shows there was a positive correlation between knowledge and
knowledge on practice regarding expression and storage of breast milk among
employed mothers.
47
SECTION - IV
Table. 6 Association of Employed Mothers Regarding Expression and Storage of
Breast Milk of Post Test Knowledge Score with Demographic Variable
(n = 40)
Above Below Degree of

S.No. Demographic Variables 2
Mean Mean Freedom
1. Age in years
a) Below 20 years 2 0
b) 21-30 years 13 15 5 4
c) Above 31 years 0 0
2. Education status
a) Primary 1 3
b) Secondary 9 1 3 11.72*
c) Higher secondary 4 11
d) Graduate 1 0
3. Family income
a) Below `. 2000 8 2
b) `. 2001 - `. 5000 10 5 2 5.46
c) Above `. 5001 3 2
4. Religion
a) Hindu 15 15
b) Christian 3 6 2 3.45
c) Muslim 0 0
(Table 6 continues)
48
(Table 6 continued)

Mean Mean Freedom
5. Occupation
a) Self employed 15 11 2 3.40
b) Private 0 3
6. Type of family
a) Nuclear 5 6 1 9.2*
b) Joint 10 9
7. Area
a) Urban 7 2 1 5.275*
b) Rural 8 13
a) Health personnel 11 5
b) Relative 3 8 3 3.712
c) Mother 1 2
d) Media 0 0
*significant
Table 6 show that there is significant association of post test knowledge score
of employed mothers regarding expression and storage of breast milk with
demographic variables like educational status, type of family and area at 0.05 level. It
reveals that there is no significant relationship with age, religion, income, occupation
and source of information.

49
Table. 7 Association of Demographic Variables with Post Test Score of Knowledge
on Practice of Employed Mothers Regarding Expression and Storage of Breast Milk
(n = 40)

Mean Mean Freedom
1. Age in years
a) Below 20 years 2 0
b) 21-30 years 7 28 2 0.638
c) Above 31 years 0 0
2. Education status
a) Primary 1 3
b) Secondary 8 2 3 13.617*
c) Higher 13 2
secondary
1 0
d) Graduate
3. Family income
a) Below `. 2000 5 5
b) `. 2001 - `. 5000 14 1 2 7.385
c) Above `. 5001 4 1
4. Religion
a) Hindu 15 15
b) Christian 3 6 2 0
c) Muslim 0 0
5. Occupation
a) Self employed 15 11 2 6.89*
b) Private 0 3
(Table 7 continues)
50
(Table 7 continued)

Mean Mean Freedom
6. Type of family
a) Nuclear 16 3 1 10.88*
b) Joint 7 4
7. Area
a) Urban 9 0 1 3.912*
b) Rural 14 7
a) Health personnel 14 2
b) Relative 8 3 3 4.131
c) Mother 1 2
d) Media 0 0
*significant
Table 7 shows the association of demographic variables like educational
status, family income, occupation, type of family, area with post test knowledge on
practice scores of employed mothers regarding expression and storage of breast milk
and significant at 0.05 level. It reveals that there is no significant association of
demographic variables like age, religion, source of information with the post test
scores of knowledge on practice of employed mothers regarding expression and
storage of breast milk.

51
CHAPTER - V
Result and Discussion
This is a pre experimental study intended to assess the effectiveness of self-
instructional module regarding expression and storage of breast milk among
employed mothers. The result of study was discussed according to these objectives.
The First Objective of this Study was to Assess the Knowledge Regarding
Expressed Breast Milk Among Employed Mothers
The pretest score of knowledge regarding expression and storage of breast
milk was 16 and in post test was 29. It shows the difference in pretest and post test. It
implies that there was lack of knowledge regarding expression of breast milk among
employed mothers in pretest which was enhanced by self instructional module.
A similar type of study was conduced by Jennifer Cullen in the year 2008. The
pretest score of self-care activities was 9.5 and post test was 15.7. It revealed that the
long term effect of providing education regarding expression and storage of breast
milk among employed mothers was found to be more effective in continuing the
breast feeding by practicing the expression of breast milk.
The Second Objective of the Study was to Assess the Knowledge on Practice
Regarding Expression and Storage of Breast Milk Among Employed Mothers
The pre test is conduced by using structures interview method, pre test
findings reveals that the mother have inadequate knowledge regarding expression and
storage of breast milk. Among the selected aspects the mean value was low in
52
regarding to knowledge on expression and storage of breast milk in pre test. This
result reveals that the women don’t have knowledge on expression and storage of
breast milk.
The pre test findings of practice reveals that majority of the mothers had low
practice on the selected aspects of postnatal care. This reveals that expression and
storage of breast milk has to be further increased through health education and
publicity.
The post test is conducted by using the same structured interview method for
the employed mothers. The data findings shows that there is an improvement in
knowledge on practice regarding expression and storage of breast milk.
From the above findings it is clear that repeated health education programme,
reinforcement and encouragement can enhance the knowledge on practice of
employed mothers regarding expression and storage of breast milk.
The Third Objective of the Study was to Deliver Self-Instructional Module
Regarding Expression and Storage of Breast Milk
The self-instructional module was given by LCD to all the employed mothers
and was found to be effective as they clarified their doubts related to expression of
breast milk.
A similar type of the study was done by Helen Mc Alistair (2006) providing
education to all mothers and revealed that the education improved mothers knowledge
53
about expression of breast milk and led to reduce the incidence of disease in new born
due to lack of breast milk.
The Third Objective of the Study was to Evaluate the Effectiveness of
Self-Instructional Module Regarding Expression and Storage Breast Milk
The obtained ‘t’ value for expressed breast milk was 9.35 significant at 0.05
levels. It revealed that there was significant improvement in expression and storage of
breast milk among employed mothers. The pretest mean score was 16 and post test
mean score was 29.
A similar type of study was conducted by Susan (2007) showed that education
to mothers about breast feeding and storage as an improvement of ‘t’ value 9.35
degree of freedom.
The Fourth Objective was to Find Out the Association Between Knowledge and
Knowledge on Practice Regarding Expression and Storage of Breast Milk
Structured interview method was used to assess the post test practice on
expression and storage of breast milk and the subject mean score was 9.46. the
standard deviation score was0.54. the obtained ‘t’ value for practice was 9.35
significant at 0.05 level. It implies that there was significant difference on practice
after the education regarding expression and storage of breast milk.

54
CHAPTER - VI
Summary, Conclusion, Nursing Implication,
Limitations and Recommendations
Summary
The study was conducted to evaluate the effectiveness of self-instructional
module regarding expression and storage of breast milk among employed mothers at
selected hospitals.
The purpose of the study was to initiate the employed mothers regarding
expression and storage of breast milk which will be useful for the growth and
development of their babies.
The Following Objectives were Set for the Study
 To assess the knowledge regarding expressed breast milk among employed
mothers.
 To deliver self-instructional module regarding expressed breast milk.
 To evaluate the effectiveness of self- instructional module regarding expressed
breast milk among employed mothers.
 To find out the association between knowledge and knowledge on practice
regarding expression and storage of breast milk with selected demographic
variables.
55
The Alternative Hypothesis Set for The Study
There is a significant knowledge of working mothers regarding expression and
storage breast milk.
Major Findings of the Study were as Follows
 The knowledge mean score of working mothers in pre test was 16 and post test
was 29
 The obtained standard deviation value in present was 3.35 and post test
was 2.54.
 The obtained ‘t’ value of comparison was 9.35.
 The pre test knowledge on practice mean score was 9.1
 The post test mean score of knowledge on practice was 13.96
 The correlation between pre test knowledge and knowledge on practice
was +0.5
 The correlation between post test knowledge and knowledge on practice
was +0.715
Conclusion
 The knowledge and practice of expression and storage of breast milk among
employed mothers was improved after the teaching programme.
 The demographic variables such as religion, occupation has showed no
association with knowledge and knowledge on practice. Age, education,
family income, type of family and area was associated with post test
knowledge on practice.
56
Nursing Implications
The finding of the study has implications in various areas of nursing
education, practice, administration and nursing research.
Nursing Education
 The curriculum of nursing education consists of knowledge related to
health information and appropriate strategy and for imparting the
knowledge.
Nursing Education Should Emphasize on,
 Preparing the prospective nurse to know about the expressed breast milk
and impart the health information.
 Assisting communities in developing their health care potentials.
 Enhance nursing curriculum with dissemination of health information
using methods of education of education technology.
Nursing Practice
 Several implications may be drawn from the present study for nursing
practice, nurses play a vital role.
 Health information can be imparted through various method like lecture,
mass media, pamphlet, displays etc.
 Any teaching strategy which is simple, clear and attractive provides the
interest for the learners to follow the instructions easily.
 Nurses have to gain knowledge regarding expressed breast milk and apply
it in all areas of practice to help children in leading a healthy life.

57
Nursing Administration
 The nurse administrator need to motivate and initiate the health personnel
in organizing, conducting and participating in various educational
programmes that would contribute to better health care delivery.
 System, planning and organizing such a programme require efficient team
work, man power, money, material, method and time to conduct successful
educational programme.
 The health care system is responsible to provide patient educational
service as an integral part of high qualities and cost effectivess.
Nursing Research
 There are various opportunities for the nurse to conduct the research on the
expression and storage of breast milk and educated mother regarding
Limitations
 The sample size was same comprising only 40 mothers.
 Convenient sampling technique was used.
 This study was limited to duration of one month.
Recommendations
 A similar study can be conducted using a large population of community.
 An intensive teaching state protocol may be developed in all aspects
separately.
58
 A study can be made to assess the effectiveness of any teaching method of
 A comparative study can be made to assess the effectiveness of hand method
and pump method of expressing breast milk.
 A study also can be made on policies regarding expression of breast milk in
institutions.
 Nursing curriculum should include breast feeding with special emphasis on

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 Wagle, C.S (1993). “Short Textbook of paediatrics” (1st edition). Bombay: Vorasa
Medical publications.
Journals
 AIMS. (2006). Feeding of Normal and Low Birth Weight babies, Nightingale
Nursing Times 6(2). 4-8.
 Ambedkar. N.et.al (1999). Use of Commercial feeding formula among urban
Children in Nagpur. 24(1) 69-74.
 American Association of Pediatrics (1997), Breast Feeding and the use of health
workers, pediatrics, 100.103-109
 AnitaMalden (2001), Breast feeding by employed women’s paediatrics,73(644-
648).
 Arinda Fernandez. (2006). Breast feeding. Prim’s Nursing practice. 1 (3). 111-
118.
 ArunPhatak (2010). The ten steps and baby friendly hospital initiative.
Nightingale Nursing Times.6 (5) 3.
 Avery.D.Mellisa, (1998). Maternal employed and breast feeding. Journals of
diseased child.138.58-60.
 Bhavani. (2009). Breastfeeding practice of working mothers in an urban area,
Indian Pediatrics. 834-838.
 Chalatte(2009). Expressed breast milk: Safety on hospital. American Journal of
Nursing, 109(2) 54-55.
 Devadass, (1999). Trends in breast feeding practices, Journal of Indian Nutrition
and Dietetics. 13(4) 1-11.

 Gandhimathi, Mother- Mother approach to breast feeding promotion, Prim’s
Nursing Practice.(2) 1. 22-24.
 Okla (1999). Factors influencing excessive breast feeding, Journal of obstetrics
and gynecology and neonatal nursing.22.25-31.
 Ryan A.S, (1997). Breast feeding and working mothers. Paediatrics 83.524-531.
 Seugal, et.al., (2006). Breast feeding practice, Journal of obstetrics and
gynecology today 9(4).240-243.
 SwaranLatha, (2001). Breast feeding practice among female health functions
Aries, The nursing journal of india.No.4.25-28.
 Wang. Y.S, (1999). The effect of exclusive breast feeding on development and
incidence of infection, journal of human lactation,12.2-35.
Online Abstract
 Arnsberg, M.B. (2006). The effect of employment status on breast feeding in the
United States, retrieved from www.pubmed.com.
 Bedair, R. F, et.al (2005). Stored expressed breast milk on alternative for working
Egyptian mothers, retrieved from www.medline.com.
 Cindy. L, (2004). Expression of milk by manual massage, using breast pump,
retrieved from www.pubmed.com.
 Dickson. (2004). Breast milk expression in the work place, retrieved
fromwww.pubmed.com.
 Garstien, (2003). Expression and storage of colostrums with advice about skin to
skin contact in the first 24 hours, retrieved from www.pubmed.com.
 Garza, 2006). Specific recommendation and storage of milk, retrieved
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 Graham S, (2008). Breast feeding referred to as “liquid gold”, retrieved
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mothers in the United States, retrieved from www.pubmed.com.
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factors to continue breast feeding, retrieved from www.pubmed.com.

ABSTRACT
Statement of the Problem : A Study To Evaluate The Effectiveness Of Self-
instructional Module Regarding Expression And Storage Of Breast Milk Among
Employed Mothers At Selected Hospitals. Study Objectives : (a) To assess the
knowledge regarding expression and storage of breast milk among employed mothers.
(b) To assess the knowledge on practice regarding expression and storage of breast
milk among employed mothers. (c) To deliver self-instructional module regarding
expressed breast milk. (d) To evaluate the effectiveness of self-instructional module
regarding expression and storage breast milk among employed mothers. (e) To find
out the association between knowledge and knowledge on practice regarding
expression and storage of breast milk with selected demographic variables.
Methodology : Experimental study design. The sample for the study consists of 40
employed mothers selected by convenient sampling technique. A structured
questionnaire was used to assess the knowledge attitude respectively.
Result : Descriptive statistics were used to analyse the values. The obtained “t” value
was 9.35. Conclusion : The study revealed that there is a significant difference in pre
test and post test among employed others.

To
Ashwin Hospital,
Coimbatore.
Through
The Principal,
Coimbatore – 35.
Respected Sir,
Sub : Seeking permission for conducting research study
I am a student of M.Sc Nursing in PPG College of Nursing. Our college is affiliated to

the Tamilnadu Dr. M. G. R Medical University, Chennai. I have taken the
specialization in Obstetrics and Gynaecology Nursing.
Topic : A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF-

INSTRUCTIONAL MODULE REGARDING EXPRESSION AND
STORAGE OF BREAST MILK AMONG EMPLOYED MOTHERS
AT SELECTED HOSPITALS
I request you to kindly permit me to conduct my study in your Hospital. Hope you
will consider my requisition and do the needful.
Thanking you,
Yours sincerely,
Date :
Place : Coimbatore
Requisition Letter for Content Validity
From
M.Sc (N) II Year,

Coimbatore – 35.
To
Through : Principal, PPG College of Nursing
Respected Sir/Madam,
Sub : Requisition for expert opinion and suggestion for content validity of tool
I am a student of M.Sc (N) II year, PPG College of Nursing affiliated to the

Tamilnadu Dr. M. G. R. Medical University, Chennai. As a partial fulfillment of the
M.Sc (N) programme. I am conducting.
A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF-

INSTRUCTIONAL MODULE REGARDING EXPRESSION AND STORAGE
OF BREAST MILK AMONG EMPLOYED MOTHERS AT SELECTED
HOSPITALS
Herewith I have enclosed the developed tool for content validity and for the
expert opinion and possible solution. It would be very kind of you to return the same
as early as possible.
Thanking you,
Yours faithfully,
Format for the Content Validity
Name of the expert :
Address :
Total content for the tool :
Kindly validate each tool and tick wherever applicable
No. of Strongly Not Need

S.No Agree O.K Remarks
Tool/Section Agree Applicable Modification
Remarks Signature of the Expert with Date

LIST OF EXPERTS
1. Prof. S.RENUKA, M.Sc.,
Department of Obstetrics & Gynaecology,
KMCH College Of Nursing,
Coimbatore.
2. Prof. MUMTAZ, M.Sc.,
Department of Obstetrics & Gynaecology,
Annai Meenakshi College Of Nursing,
Coimbatore.
3. Prof. CHARMINI JEBAPRIYA, M.Sc.,
Principal,
Texcity College Of Nursing,
Coimbatore.
4. Prof. ESTHER JOHN, M.Sc.,
Principal,
Ganga college of nursing,
Coimbatore.
5. Prof. SHEEBA, M.Sc.,
Department of obstetrics & gynaecology,
KG college of nursing,
Coimbatore.
PART - A
Demographic Data
Instructions
Kindly go through each item of the questionnaire carefully and indicate your
response by placing a () tick mark in the given box
Sample No. ____________
1. Age of the mother
a) 22 to 24 years 
b) 24 to 26 years 
c) 26 to 28 years 
d) 28 to 30 years 
2. Educational status of the mother
a) Basic education upto 10thstd 
b) Diploma 
c) Graduate 
d) Post Graduate 
3. Occupational status of the mother
a) Self employed 
b) Labour 
c) Office work 
d) Government employee 
4. Total family monthly income
a) Below `. 8000 
b) `. 8001 to `. 10000 
c) `. 10001 to `. 15000 
d) `. 15000 and above 
5. Type of family
a) Nuclear family 
b) Joint family 
6. Working hours
a) Less than 6 hours 
b) 6 to 8 hours 
c) 8 to 10 hours 
d) More than 10 hours 
7. Feeding Utensils
a) Feeding bottles 
b) Spoon and cup 
c) Paladai 
8. Source of Information
a) Relatives 
b) Friends 
c) Media 
d) Health personnel's 
PART – B
Knowledge Questionnaire
Instructions
Read the following questions carefully and give tick () in a given boxes for
correct answers
1. Breast feeding is ------------
a) Artificial feeding 
b) Bottle feeding 
c) Natural feeding 
d) Spoon feeding 
2. Breast feeding meets the nutrition as well as ---------
a) Emotional need 
b) Physiological needs 
c) Psychological needs 
d) Emotional needs 
3. Breast feed protect the mother from---------
a) Stomach cancer 
b) Blood cancer 
c) Breast and ovarian cancer 
d) Bone cancer 
4. Rooming in is--------
a) Only baby in the room 
b) Only mother in the room 
c) Both baby and mother together in the room 
d) Baby with relatives 
5. In rooming in the baby stays with the mother----------
a) Partial time 
b) Entire time 
c) When needed 
d) Partial attachment 
6. Bonding is the -----------
a) Extense attachment 
b) Intense attachment 
c) No attachment 
d) Partial attachment 
7. Bonding develops relationship between--------
a) Relatives and baby 
b) Parents and baby 
c) Neighbour and baby 
d) Father and baby 

8. The nerve fibre transmit the message to------
a) Hypothalamus 
b) Medulla oblongata 
c) Cerebrum 
d) Cerebellum 
9. Reflexes related to breast feeding--------
a) Only sucking reflex 
b) Only swallowing reflex 
c) Both sucking and swallowing reflex 
d) Gag reflex 
10. Expressed breast milk is -------
a) Natural method 
b) Mechanical method 
c) Manual and mechanical method 
d) Natural and mechanical method 
11. An expressed breast milk is--------
a) Squeezing the milk from breast 
b) Sucking the milk by baby 
c) Stored breast milk 
d) Natural breast milk 

12. Exclusive breast feeding should be given for-----------
a) 1 month 
b) 3 months 
c) 6 months 
d) 1 year 
13. Mother express the milk for
a) Baby needs extra milk 
b) Baby may not able to suck 
c) Mother is going back to work 
d) All the above 
14. Before expressing the breast milk the mother should-----------
a) Pump the milk 
b) Massage the breast 
c) Do exercise 
d) Take heavy meals 
15. The amount of milk produced in first 24 hours is---------
a) 200-300ml 
b) 300-500ml 
c) 400-600ml 
d) 350-650ml 
16. The amount of milk produced in 2-3 weeks is------
a) 200-400ml 
b) 400-500ml 
c) 500-600ml 
d) 600-700ml 
17. The time taken for expressing the breast milk by hand is----
a) 15 minutes 
b) 10 minutes 
c) 20 minutes 
d) 30 minutes 
18. Expressed breast milk can be given to the baby by--------
a) Feeding bottle 
b) Paladai, spoon 
c) Small vessel 
d) Bowl 
19. The cheapest method of expressing the breast milk is------
a) By electric breast pump 
b) By hand 
c) Hand help breast pump 
d) Artificial method 
20. The most time saver method is------------
a) By hand 
b) Hand-held breast pump 
c) Electric breast pump 
d) Other instruments 
21. The best choice of a storage container for expressed breast milk in the refrigerator
in-------
a) Closed plastic container 
b) Closed glass container 
c) Steel or metallic containers 
d) Any containers 
22. The temperature maintained in the fridge to store expressed breast milk is --------
a) Above 4º C 
b) 4ºC or lower 
c) 4º C or 8ºC 
d) Above 8ºC 
23. The milk that can be used within 8 days of expression should be stored in-------
a) Refrigerator 
b) Freezer 
c) Room temperature 
d) Any container 
24. Antimicrobial properties are better preserved in----------
y) Freezer 
z) Room temperature 
aa) Refrigerator 
bb) Boiled breast milk 
25. It is necessary to leave about an inch at the top of the container because-------
a) The bottle burst when frozen 
b) When frozen the milk will expand 
c) For adequate air supply 
d) To prevent the decaying of milk 
26. Refrigerate the breast milk within-------
a) Immediately after expression 
b) Within 15 minutes 
c) Within 1 hour 
d) With a day 
27. If the milk is used in 3-5 days it should be kept in-------
a) At the fridge door 
b) In the back of the fridge 
c) Freezer inside the fridge 
d) Freezer separate from fridge 

28. Expressed breast milk can be kept in ---------
a) Oven 
b) Freezer 
c) Refrigerator 
d) Room temperature 
29. The type of container can be used to express the breast milk
a) Small bottle 
b) A cup with wide mouth 
c) Low neck bottle 
d) Small glass 
30. While combining the fresh expressed breast milk with previous expressed breast
milk we should---------
a) Cool 
b) Heat 
c) Thawing 
d) Not mix 
31. The amount of breast milk expressed at once in---------
a) 1-3 ounce 
b) 2-4 ounce 
c) 4-6 ounce 
d) 5-8 ounce 
32. To warm the breast milk place the container in---------
a) Bowl with warm water 
b) Microwave oven 
c) Steaming 
d) Normal room temperature 
33. Freshly expressed breast milk can be stored in room temperature for-------
a) 3 hours 
b) 6 hours 
c) 12 hours 
d) 24 hours 
34. Frozen breast milk can be stored in room temperature for-------
a) 1 hour 
b) 4 hours 
c) 12 hours 
d) 24 hours 
35. Before serving the stored milk to the baby it should be swirl in order to--------
a) Bring its normal appearance 
b) Redeposit the fats that separate from the milk 
c) Make it thicker 
d) Prevent spoilage 
36. The milk should be scald before storing in order to-----------
a) Preserve it for more days 
b) To keep the antimicrobial properties 
c) Keep the milk from spoiling 
d) To reduce soring of milk 
37. Thawing is--------
a) Boiling 
b) Freezing 
c) Cooling 
d) Boiling 
38. Thaw the frozen breast milk by---------
a) Boiling it 
b) Keeping it in hot water 
c) Moving it from freezer to fridge 
d) Keeping it under running water 
39. The milk should not be over heat, because-------
a) It will cause hot spots in the milk 
b) It will destroy some of the nutrients 
c) It will remove the fat from the milk 
d) It will change the taste of the milk 

40. Micro waved breast milk causes--------
a) Hot spots in milk 
b) Decaying of milk 
c) Warm the milk 
d) Change in the taste of milk 

PART - C
Practice Questionnaire
Instructions
Read the following questions carefully and give tick () in a given boxes for
correct answers
S.No. Questions Yes No
1. Do you breast feed your baby?
2. Do your express the milk regularly?
3. Do you maintain breast feeding hygiene before feeding?
4. Do you sterile the bottle before each expression?
5. Do you store the milk at correct temperature?
6. Do you massage your breast before expressing the milk?
7. Do you store the milk in refrigerator?
8. Do you feel any difficulty in expressing the milk?
9. Do you provide the milk to the baby at regular intervals?
10. Do you discard off feed the remaining milk which is in the bottle?
SECTION - II
Answer Keys
S.No. Answer Score

1. a 1
2. c 1
3. d 1
4. a 1
5. a 1
6. b 1
7. b 1
8. d 1
9. a 1
10. b 1
11. c 1
12. d 1
13. a 1
14. d 1
15. a 1
16. b 1
17. d 1
18. b 1
19. c 1
20. a 1
21. d 1
22. c 1
23. d 1
24. a 1
25. b 1
26. b 1
27. c 1
28. b 1
29. d 1
30. a 1
31. d 1
32. b 1
33. c 1
34. d 1
35. a 1
36. b 1
37. b 1
38. a 1
39. d 1
40. a 1
PART - C
Question Number Answer Keys Score
1. Yes 1
2. Yes 1
3. Yes 1
4. Yes 1
5. Yes 1
6. Yes 1
7. Yes 1
8. No 1
9. Yes 1
10. Yes 1
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m) ghy;Gl;b 
M) ghyhilf; fuz;b 
,) rpwpa ghj;jpuk; 
<) fpz;zk; 
19. ntspf;nfhz;L te;j jha;g;ghiy Fsph; rhjdg;ngl;bapy; vt;tsT
Neuk; itg;gJ
m) 4’ Nky; 
M) 4’ my;yJ Fiwthf 
,) 4’ – 8’ 
<) 8’ Nky; 
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m) kpd;hru khh;gf ,ae;jpuk; 
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<) nraw;if Kiw 
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Nrkpf;fyhk;?
m) ifapd; %yk; 
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rpwe;j Kiw vd;gJ
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vjd; %yk; Nrfhpg;gJ?
m) Fsph;rhjdg;ngl;bapy; 
M) jha;g;ghiy nfhjpf;f itg;gjd; %yk; 
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m) ciwe;j ntg;gepiy 
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m) ghy;Gl;b 
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m) mLg;gpy; 
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Rw;Wtjpd; mtrpak;
m) xOq;fhd Kiwapy; nfhz;L tUtjw;F 
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M) nraw;if mLg;G 
,) ePuhtp 
<) miw ntg;gepiy 
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itg;gJ
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itg;gJ
m) 1 kzp Neuk; 
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m) mjpf ehs; Nrkpj;J itf;fyhk; 
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vg;gb nfhz;L tUtJ
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KOVILPALAYAM,
COIMBATORE
HEALTH EDUCATION
ON
EXPRESSION AND STORAGE BREAST MILK
Topic : Expressed Breast Milk
Group : Employed Antenatal Mothers
Place of Teaching : Aravindan Nursing Home
Duration : 45 minutes
Method of Teaching : Lecture and Discussion
Teaching AID : Video

Central Objective
Employed antenatal mothers will acquire knowledge to practice in their life.
Specific Objective
 define breast feeding
 define bonding
 enlist the advantage of breastfeeding
 explain the physiology of lactation
 explain the reason for expressing breast milk
 enlist the ways of expressing breast milk
 explain the collection of breast milk
 describe the storage of breast milk
 enumerate about the appearance of stored milk
 describe about sored or off milk
 explain about thawing of breast milk

Teacher’s
Specific Objectives Content
Activity
Introduction E
Breast feeding is the best natural feeding and breast milk is the best milk. Breast feeding is the X
most effective way to provide a baby with a caring environment and complete food. It meets the P
L
nutritional as well as emotional needs of the infant.
A
I
Define breast feeding Definition
N
The national association of paediatric nurse practitioner (NAP), the AAP American college and
I
gynaecology, the American dietetic association and the US breast feeding committee of department of
N
health and human service all recommend that, “ Breast feeding as the natural and preferred method of
G
new born and infant feeding.”
Rooming in
Rooming in after birth is when your baby stays in your room with you, as opposed to spending the
majority of time in the hospital’s nursery.
Rooming in has Many Benefits Including, X
 Baby cries less and easier to clam. P
L
 Moms get more rest.
A
 Ability to respond to baby’s feeding cries.
I
 Make more breast milk.
N
 Ability to ensure the care you want for baby.
I
 No fear of baby switching.
N
G
Rooming in can be done in variety of ways. A lot of women choose to have full rooming in where
the baby stays with you the entire time. Even if you choose this you will still have to care from the
nursery, they will simply do the vast majority of the test and procedures at your bedside.
Define bonding Bonding
Bonding is the intense attachment that develops between parents and the baby. It makes the E
parents to shower the love and affection towards the baby and to protect and nourish their little bonding
X
gets parents up in the middle of night to feed their hungry baby and make them attentive to baby’s wide
P
range of cries
L
Enlist the advantages Advantages of Breast Milk A
of For baby I
breast feeding  Breast milk is natural, always fresh, convenient, inexpensive, easily digestible and optimum for
N
baby’s growth and development.
I
 Breast milk is a complete food and it provides all the nutrients that baby needs during first six
N
months of life.
G
 Breast milk contains a number of anti-infective substance and antibodies which protects the baby
against the development of diarrhea, respiratory illness and other infections (specially ear
infection).
 Breast fed babies have been shown to develop better protective response to various vaccines
compared to bottles fed babies.
 Breast fed babies are smarter and have been shown to have higher quotient (IQ). High
E
concentration of two keys long chain fatty acid and lactose promote brain growth and X
development. P
 Sterile and readymade breast milk is sterile and ready for use. There is no risk of external L
contamination as the milk passes directly from mother to baby. A
 Breast fed babies are less likely to suffer from diabetes, high blood pressure, heart attack and I
certain cancer in adulthood. N
 Less smelly nappies of babies. I
N
 Better mouth formation and straighter teeth.
G
 Breast feeding provides emotional security and close bonding between mother and baby.
 Breast feeding has been shown to associated with higher cognitive ability in adolescence.
For mother
Psychological Satisfaction
 Nursing the baby gives the mother psychological satisfaction and sense of fulfilment.
E
X
Rapid Involution of Uterus P
 Breast feeding ensures earlier termination of post-partum bleeding and better involution of post- L
partum uterus. A
Spacing of Pregnancy N
 Breast feeding delays ovulation and onset of menstruation which provides nature mean to ensure I
N
spacing of children.
G
 Breast feeding is convenient and less time consuming.
 Mothers who breast fed their babies enjoy a very low incidence of cancers of breast and ovary.
Faster Return to Pre-pregnancy Figure
 Breast feeding helps to maintain and regain the pre-pregnancy body weight earlier because energy
stores let down during pregnancy are consumed faster during lactation.
 It has been shown in various studies bones are stronger in later life in mothers who has breast fed
E
their babies.
X
P
Mnemonics of breast feeding L
 B – BREAST FOR BABY A
 R – REDUCE INCIDENCE OF ALLERGY I
 E –ECONOMICAL N
 A -ANTIBODIES I
 S- STOOL OFFENSIVE N
G
 T-TEMPERATURE
 F- FRESH MILK
 E – EMOTIONAL BONDING
 E- ECOLOGICALLY SOUND
 D- DIGESTED EASILY WITHIN 2 HOURS
 I- IMMEDIATELY E
 N- NUTRITIONALLY OPTIMAL X
 G- GASTRO ENTERITIS AVOIDED P
Explain the Physiological Bases of Lactation A
physiology of Sucking is the beast stimulus to enhance milk production. As per baby sucks vigorously, several I
lactation hormones are realized to produce milk and eject it out. Sucking movements stimulates nerve fibres in the N
nipple. These nerve fibres transmit messages to the hypothalamus in the brain. The pituitary gland I
N
responds to these messages by release of two hormones prolactin and oxytocin. Oxytocin stimulates tiny
G
muscles surrounding the breast. The contraction of these tiny muscles squeezes the ducts and ejects the
milk into reservoir under the areola. When the baby sucks frequently and vigorously the production is
enhanced.
Sucking Reflex
Elicit the sucking reflex by placing the nipple or non-latex gloved finger in the infant’s mouth.
The infant should elicit a strong vigorous suck. It persist throughout the infancy.
E
Let Down Reflex X
The release of oxytocin during sucking also causes involution or contraction of the uterus so that P
it rapidly shrinks in size to pre pregnancy status. The release of prolactin inhibits ovulations that there is L
the state of relative infertility during breast feeding. A
Explain the reason Expressed Breast Milk N
for expressing breast Mothers Express the Breast Milk for Variety of Reasons I
milk  The baby needs extra breast milk as “top up food” following a breast fed. N
 The baby may not be able to suck well at the breast. G
 The mother is going to work.
 The mother may prefer to feed using bottle.

 The mother is going out or simply wants a break from responsibility of feeding the baby.
 Some women regularly express to maintain or increases their milk production.
Enlist the ways of Three Ways to Express the Breast Milk E
expressing breast In the first week of delivery it is expressed to produce about 300 to 500ml of milk in 24 hrs X
milk period. This should increase to about 600 to 700ml over the following 2 to 3 weeks. P
A
Breast milk can be expressed by,
I
By hand
N
Expressing milk by hand is a cheap and convenient method it may take little practice to learn this
I
skill but it is worth and comfort.
N
G
Before preparing to hand express,
 Wash your hands thoroughly with soap and water.
 Try to relax
 Massage your breast by the flat of your hand working towards each nipple. Place the finger and
your thumb either side of the nipple at the base and gentle stretch and roll the nipple.
 Place your thumb above your nipple at the edges of the areola (dark around the nipple) and the E
first finger below. X
 Using your thumb, gently press your breast tissue back towards your chest wall and squeeze. P
 Drop of milk soon bred on your nipple. Gently rub the first drop into your nipple. L
A
 This will further stimulate your let down reflex and increases the milk flow.
I
 Continuously press and squeeze in rhythmic massaging movement. The milk will soon begin to
N
flow sometimes even squirting hand regularly.
I
 Once the milk dwindles to a few drops, move your finger on to another of your breast and
N
continue to press and squeeze.
G
Expressing by Hands Takes Time
Repeat the above technique in each breast for a total of 30 minutes. If you express three times
each for 5 times, it will not take more than half an hour.
Hand Held Breast Pump
It is a quicker method and produces more milk each time. Mothers mat prefer this method because
they don’t have to handle their own breast to express milk. It is important not to use any kind of pump
until your breast milk has ‘come in’ and your supply is established. Also avoid using a pump is you have E
nipple damage or edematous areola. X
P
A hand pump must be,
L
 Effective
A
 Comfortable I
 Easy to use N
 Safe to use that is, it should not damage the nipple or areola or cause muscle strain I
 Economical N
G
Suggestion for Using Hand Held Pumps are as Follows
 Stimulate the let down reflex by hand once the milk has started to flow switch to the pump.
 Place the fling of the pump directly over your nipple and hold it firmly against your breast.
 Adjust the strength so that it is comfortable and not causing any pain or discomfort.
 Finish expressing by hand for few moments to remove the drop of rich milk.
Electric Breast Pump E
Many mothers choose electric breast pump. This is the real time saver when expressing full time. X
Suggestions Include, L
A
 Choose the model with adjustable suction that is too high can be painful and can cause nipple
I
damage and will not remove any extra milk from the breast.
N
 Stimulate the let down reflex by hand and once the milk flow has started switch to the pump start
I
with the low pressure and slowly increase the pressure to your level comfort. If it is painful check
N
that the pump is centered directly over your nipple and reduces the suction.
G
 Finish by expressing by hand to remove the last rich drops of milk.
 These can be very convenient, has they are small and light. However they are not designed for
heavy use if it is going to express frequently over a prolonged period of time, it will need a
steadier electric motor breast pump.
Explain the Collection of Breast Milk E
collection of breast  Wash hands with soap and water X
milk  Wash breast pump parts that come in contact with the breast or milk, as well as the collection P
containers, in either anavent steam sterilizer in a dish water or by hand using hot soapy water. L
A
 Rinse with cold water and air dry on a clean towel. Check with your health care for any other
I
instructions.
N
 When to pump depends on your baby schedule your milk supply is usually plentiful in the
I
morning so that it is good time to pump.
N
 Try to schedule pumping mid-way between when a baby feeds.
G
 Be flexible if your baby skips a feeding, nurses for a shorter time than usual or nurses on one side,
pump the remaining milk and safe it, if you are planning to return and continue breast feeding
being pumping one or two weeks before you start to work.
 Try to duplicate what your pumping schedule will be once you are back to work. Before pumping
get comfortably seated and relaxed. Pump your breast according the breast pump manufactures
instructions.
 There are several containers available for storing the breast milk, including specially designed E
plastic bags and glass containers. X
 There are advantages to each use the type which is most functional for you. The amend mother’s P
milk freezing bag is especially designed with multi-play constructions to provide maximum L
A
protection for storing breast milk.
I
 Pump express breast milk into clean collection container.
N
 It is not normal human milk to vary in colour, consistency and odour, depending on mother’s diet
I
and type of storage container used.
N
G
Choice of Storage Container
When a baby is only receiving milk occasionally type of container is not a major consideration
however, if a baby is receiving most of his nourishment from the expressed breast milk the type of
storage container used should be considered carefully. Plastic containers are best. Choice for storing
breast milk in the refrigerator as more of human milks leukocytes or white cells adhere to glass. If the
milk frozen glasses are preferred choice as it is less porous and offers the best production. Most of the
leukocytes in human milk are killed with freezing. For this reason milk that can be used within eight days E
of expressing should be refrigerated rather than frozen because antimicrobial properties of human milk X
are better preserved with refrigerated. P
A
Another good choice for refrigerated is the milk storage bags that are designed especially for
I
human milk. They are pre sterilized and are thicker, coated with polythene lined with nylon which
N
prevents the fat from adhering to the sides. Hard plastic container of any kind is also good choices for
I
both refrigeration and freezing. Other milk bags sold specifically at bottle liners or not as durable making
N
them anon acceptable alternative when freezing the milk as the seams may burst during the freezing
G
process perhaps causing a leak during thawing. Also one study found that there was a sixty percentage
decrease in the milks antibodies and loss of fat that adhere to the sides of these bags. If this type of bag is
still chosen, the milk can be better protected by placing the liner bags in a larger gallon size freezer bag or
in a hard plastic container.

When milk freezes it expands so it is necessary to leave about an inch at the top of the container
tallow for expression. For this reason bottle caps or container lid should not be tightened until the milk is
completely frozen.
Describe the storage Storage of Breast Milk E
of breast milk Breast milk must be stored correctly to reduce the potential for bacterial growth. X
P
Suggestions include,
L
 Use fresh breast milk whenever possible.
A
 Express into clean and sterile container. There may be a glass, plastic or reliable plastic bags. I
 Label each container with the time and date the breast milk was expressed. N
 Refrigerate the breast milk within one hour of expressing stored breast milk in the back of the I
fridge where it is coolest(4ºc or lower), not in the fridge door if you are going to use it within the N
next 3 to 5 days. G
 Freeze excess breast milk if you produce more milk than your baby requires.
 Freeze refrigerator breast milk immediately if you are going to use it in the next few days.
 Do not top up refrigerated or frozen breastmilk with fresh breast milk unless it has been chilled
first.
 If the freezer is inside the fridge storage time is 2 weeks if it is separated from the fridge with its
own door, storage time is upto 3 months. E
 Breast milk can be stored for 6 to 12 months in a deep freezer (-18ºc or lower). X
Freshly Expressed Breast L

Thawed Breast Milk
A
Milk
I
 Room temperature up to 77ºf/26º 6 to 8 hours Do not store
N
 Refrigerated (39ºf/4ºc) Up to 5 days 24 hours
I
 Insulated cooler bags with ice 24 hours Do not store
N
 Freezer inside of refrigerated 2 weeks Never refreeze the thawed
G
(5ºf/15ºc) milk
 Freezer with separate doors 3 to 6 months Never refreeze the thawed

milk
 Deep freezer (rarely opened) 6 to 12 months Never refreeze the thawed
milk E
One way to keep milk from spoiling so quick is to halt the breakdown of fats by scalding the milk P
L
just prior to soring. It scalding the milk involves allowing small bubbles to appear on its surface but
A
removing it from the heat before and actual boil occurs. The milk should then be stored immediately
I
either in the refrigerator or freezer. Sometimes odours from the refrigerator or freezer can enter stored
N
breast milk. To avoid this be careful about storage container adding a box of baking soda to the unit,
I
throughout old let over’s and make sure any newer food is covered or wrapped tightly and check that the
N
temperature of refrigerator or freezer is set low enough.
G
Enumerate about the Appearance of Stored Milk
appearance of stored The appearance of stored milk can take on many forms. After a while the fat in the milk begin to
milk separate from the body of it they may raise to the top or settle on the sides of the storage container.
Before emptying the milk into the baby’s bottle or cup and right before serving it to the baby be sure to E
gentle swirl the milk so that the fat can be redeposit back in to the rest of the milk. Milk that has been X
expressed can look thin less white in appearance than that of cow’s milk because it has not been P
L
homogenized
A
Describe about sored Soured or Off Milk I
or off milk Milk is not spoiled unless it has a sour odour or tastes bad this is thought to a result of milk having N
an excess of lipase an enzyme which helps the breakdown of fats in human milk. I
G
Hygiene is Important
Hygiene suggestions include,
 Wash your hands thoroughly before expressing.
 Make sure all equipment’s including the breast pump and the bottles are clean.
 If you are using your own expressing equipment and are not sharing it to anyone else there is no
need to sterilize the equipment after each use. Washing thoroughly in hot soapy water rinsing in
hot water and storing in clean covered container are adequate.
Explain about Thawing of Breast Milk E
thawing of breast  The breast milk must be thawed correctly to reduce the potential for bacteria growth. X
milks  Thaw frozen breast milk by moving from the freezer to the fridge for slow thawing for 24 hours. P
 Run cold water over the container and gradually increase the temperature of the water. L
A
 Do not over heat the milk as it will destroy some of the nutrients and may burn the baby’s mouth.
I
 Never use the microwave as it cause ‘hot spot’ in the milk that may burn the baby’s mouth.
N
 Frozen breast milk that is thawed in fridge will last 24 hours in the fridge and 4 hours in the room
I
temperature. It cannot be frozen.
N
 If milk has been thawed outside the fridge using warm water it will last for 4 hours in the fridge
G
but it cannot be refrozen.
Summary
Breast feeding is having many advantages for infant, mother, family and society which includes
reduce morbidity and mortality of the child.
Conclusion
Breast feeding after returning to work is a way to tie the two halves of your child. The best
possible beginning and in return you will gain in yourself as a mother.

jha;g;ghy; ntspNaw;Wjiy gw;wpa fy;tpj; njhFg;G
jiyg;G : jha;g;ghy; ntspNaw;Wjy;
FO : fh;g;gpzp jha;khh;fs;
fhy msT : kzp Neuk;
,lk; : kUj;Jtkid
fy;tp cgfuzq;fs; : fzpg;nghwp

nghJthd Nehf;fq;fs;
ehq;fs; vLf;Fk; fy;tpj; njhFg;gpd; %yk; fh;g;gpzp jha;khh;fSf;F jha;g;ghy; ntspg;gLj;Jk; Kiwia gw;wp
njhpe;J nfhs;tjw;fhf ,;e;j fy;tpj; njhFg;G mspf;fg;gLfpwJ.
rpwg;G Nehf;fq;fs;:
 jha;khh;fs; njhpe;J nfhs;tJ vd;dntd;why;
 jha;g;ghy; Cl;ljy; vd;why; gpizg;G vd;gJ vd;d?
 jha;g;ghy; Cl;Ljypd; ed;ikfs; ahit?
 khh;gf mstpy; Vw;gLk; mzpr;ir nray;fs; ahit?
 jha;khh;fs; jha;g;ghiy ntspg;gLj;Jtjw;fhd fhuzq;fs; ahit?
 jha;g;ghiy ntspg;gLj;Jtjw;fhd topfs; ?
 jha;g;ghiy ntspg;gLj;Jtjw;fhd Kiwfs; ahit ?

Mrphpah;
rpwg;G Nehf;fq;fs; nghUslf;f;k
fUj;J
jha;gg
; hy; Cl;Ljy; Kd;diu
vd;why; vd;d? xU rj;jjhd czthf kl;l;k my;yhky; kdhPjpahfTk; kw;Wk; Foe;ijapd;
NjitfisAk; G+h;j;jp nra;fpwJ
tiuaW f
Njrpa Foe;ij nrtpypah; mikg;G mnkhpf;f kUj;Jt fy;Y}hp kw;Wk; kfg;NgW w;
kUj;Jtk; mnkhpf;f jpl;l czT mikg;G kw;Wk; A.v]; jha;g;ghy; mspj;jy; FOTk; gp
cly; eyKk; kdpj Nea NritAk;
j;
j
$wpajhtJ
y;
“jha;g;ghy; Cl;Ljy; vd;gJ Fioe;ijf;F ,,aw;ifahf fpilf;Fk; czthfTk;
cs;sJ”
jhAk; NrAk; xNu miwapy;
 Foe;ij gpwe;j gpd;G Foe;ijAk; jhAk; xNu miwapy;
 mjpfkhd Neuk; nrytpLtjhy; vw;gLk; gad;fs;:
 Foe;ij mOtij jtph;f;fyhk; jha; mjpf Neuk; Xa;ntLf;fyhk;
 Foe;ijap;d; grpia fz;lwpayhk;
 jha;g;ghy; mjpfkhf Ruf;Fk; mjdhy;
 jha; Foe;ijia ghJfhg;ghd Kiwapy; tsh;f;f cjTfpwJ
gpizg;G vd;gJ gpizg;G f

vd;d? gpizg;G vd;gJ Foe;ij kw;Wk; ngw;NWhh;fSf;Fk; ,ilapy; Vw;gLk; cwT w;
KiwNa gpizg;G vdg;gLk; gp
j;
ngw;Nwhh;fs; jq;fs; Foe;ijfis ghrj;NjhLk; ghJfhf;fTk; itj;Jf;
j
nfhs;thh;fs; mg;nghOJ Foe;ijapd; gytpjkhd mOifapd; NjitAk; njhpe;J
y;
nfhs;thh;fs;
jha;g;ghy; Cl;lypd; jha;g;ghy; Cl;lypd; ed;ikfs;
ed;ikfs; ahit? Foe;ijf;F
jha;g;ghy; vd;gJ ,aw;ifahfTk; GJikahfTk; vspjhfTk; nrhpkhdj;jpw;fhfTk;

kw;Wk; Foe;ijapd; tsh;r;rpf;fhfTk; nfhLf;fg;gLfpwJ.
 Foe;ijf;F Kjy; MW khjk; jha;g;ghy; kl;Lk; nfhLf;fg;gl Ntz;Lk;.

f
 jha;g;ghy; cl;nfhs;Sk; Foe;ijfs; mwpTj; jpwdpy; kpfTk; rpwe;J tpsq;Fth;
w;
 jha;g;ghy; Rj;jkhfTk; vg;nghOJk; nfhLf;f $bajhf ,Uf;Fk;
gp
 jha;g;ghy; cl;nfhs;Sk; Foe;ijfSf;F rh;f;fiu Neha; tUk; tha;g;G FiwT
j;
 Foe;ijapd; miz Milapd; Jh;ehw;wk; FiwAk;
j
 tha; kw;Wk; gw;fs; rPuikg;G rhpahf ,Uf;Fk;
y;
jha;f;F
 jha;g;ghy; mspf;Fk; jha;khh;fSf;F kdepiwT Vw;gLk;.
 jha;g;ghy; mspf;Fk; jha;khh;fSf;F f;fh;g;gig mjDila epiyf;F jpUk;Gk
 jha;g;ghy; nfhLf;Fk; jha;khh;fSf;F khh;gf kw;Wk; fh;g;gg;ig rhh;e;j cWg;Gfdpy;

Vw;gLk; Gw;W Neha;f;fhd tha;g;G FiwAk;
 gioa jha;g;ghy; nfhLf;Fk; jha;kh;hfs; jq;fs; gioa cly; rPuikg;igAk;
kw;Wk; gioa cly; ,ilAk; ngWthh;f;s.
 jha;g;ghy; nfhLf;Fk; jha;kh;hfs; jq;fs KJik fhyq;fspy; Vw;gLk; vYk;G
rk;ge;jkhd Neha;f;fhd tha;g;G FiwT
jha;khh;fs; cwpQ;Rk; mzpr;ir nray; f

jhag;ghy;  cwpQ;Rk; mzpr;ir nray; vd;gJ fhk;G my;yJ if tpuy; Foe;ijapd; thapy; w;
ntspg;gLj;Jtj;wfhd itg;gjhy; Vw;gLtJ mg;nghOJ gp
rpy fhuzq;fs;  Foe;ij jplkhf cwpQ;Rk; j;
vd;d?  ,J Foe;ij gUtk; KOtJk; ePbf;Fk; j
y;
fPo; cj;juT nfhLf;Fk; mzpr;ir nray;
 Foe;ij cwpQ;Rk; nghOJ Mf;]pNlh]pd; vd;Dk; `hh;Nkhd; ntsptUfpwJ.
,jdhy; fh;g;gg;ig RUq;FtJ kl;Lk; my;yhky; mjDila gioa epiyikf;F

 tUFwJ g;nuhyhf;bd; vd;Dk; `hh;Nkhd; tpLtpg;gjhy; fUKl;ilfspd; cw;gj;jp
jlf;fg;glfpwqJ. vdNt ,JT;k xU FLk;gf; fl;g;ghL Kiwahf ,Uf;fpwJ.
ghY}l;ljyhy; cly; hPjpahd khw;wq;fs; f

 ghy; Rug;gjw;F cwpQ;Rjy; xU kpf rpwe;j J}z;LNfh;s Fo;eij jha;g;ghiy w;
jplkf cwpQ;Rk; nghOJ gy `hh;Nkhd;fs; cjtpahy;ghy; Ruf;fpwJ.
gp
 Foe;ij cwpQ;Rtjpdhy; fhk;Gfspy; cs;s euk;Gfs; J}z;lg;glfpwJ. gpl;A+l;hp
j;
Rug;gpapd; cjtpahy; g;Nuhhyf;bd;
j
 Mf;]pNlh]pd; J}z;Ltjhy; ghy; Ruf;fpwJ.
y;
 ,jdhy; m;ej prW jirfspy; Vw;glk; mOj;jj;jpdhy; ghy; Ruf;fpwJ. ,jdhy;
Foe;ijapd; Njitf;Nfw;g jplkhf cwpQ;Rtjhy; ghy; cw;gj;jpAk; $LfpwJ.
khh;gf mstpy; ntspg;gLj;Jfpd;w jha;g;ghy; jha;khh;fs; ghiy ntspg;gLj;Jtjw;fhd rpy ghuzq;fs;

mzpr;ir nray;?  Foe;ijf;F jha;g;ghiy ghiy ntspNaw;Wfpwhh;fs;.
 Jha;g;ghy; cwpQ;r Kbahj Foe;ijfs;

 Ntiyf;F nry;Yk; jha;khh;fs;
 Ghy; Rug;gij mjpfkhf;Ftjw;fhfTk; ntspNaw;Wfpwhh;fs;.
jha;g;ghiy ntspg;gLj;Jtjw;fhd %d;W topfs;

gpurtkhd Kjy; thuj;jpy; xU ehisf;F 300-500 kp.yp tiu ghy; cw;g;gjpjp
MfpwJ ,J Nghy; 600-700 kp.yp tiu 2 Kjy; 3 thuq;fspy; cau Ntz;Lk;
jha;kh;fs; jha;g;ghy; jha;g;ghiy ntdsp vLf;Fk; Kiwfs; f

ntspg;gLj;Jtjw;fhd iffspd; %yk; w;
rpy fhuzq;fs; ghiy ifapd; %yk; vLg;gjw;F Kd; iffis Rj;jkhf;Fk; Kiwfs; gp
vd;d?  Nrhg; kw;Wk; jz;zPuhy; iffis Rj;jkhf fOt Ntz;Lk;. j;
 ve;j xU gjw;wKk; ,y;yhky; mikjpahf ,Uf;fTk; j
 ifia itj;J khh;ig krh[; nra;a NTz;Lk; y;
 tpuyhYk; fl;il tpuyhYk; hfk;G gFjpia nghEWikahf Nja;f;fTk;
 khh;G fhk;ig njhlh;e;J gpoptjkhy; ghy; mjpfkhf Ruf;Fk;

 ghy; ntsp te;jJk; iffis vLf;fhky; njhle;he
; ;J mkpj;jp gpopaTk;
 iffsp;d %yk; gpoptJ mjpf Neuk; vLf;Fk;.
 ,e;j nraiy ,uz;L khh;gpYk; khw;wp khw;wp 30 epkplq;fs; nra;J nfhz;Nl

,Uf;f Ntz;Lk;
jha;gg
; hiy ifia nfhz;L mOj;Jk; Foha; f
ntspg;glj;Jtjw;fhd  ,J kpfTk; Ntfkhf Kiw kw;WK; fkhf ghiy vLf;fTk; kha; khh;fs; ,e;j w;
topf;s ahit? Kiwia cgNahfg;gLj;Jthh;fs; gp
 fhk;gpy; Gz; kw;WK; tPjk; fhzg;gl;lhjy; ,e;j Kiwia gad;gLj;jf; $lhJ j;
j
ifFoha; vg;gb ,Uf;f Ntz;Lk;
y;
 nrayhw;wy; kpFe;jJ
 trjkpahdJ
 vspjhf cgNahfpf;fyhk;
 ghJfhg;ghdJ
 rpf;fdkhdJ
jha;g;ghiy ntsp ifFoaha; cgNahfpg;gjd; fUj;Jf;fs; f

vLg;gjw;fhd fPNo tUk; mzpr;ir nrayl; njhlq;fpaJk; ifFohia cgNahfpf;f Ntz;Lkk; w;
Kiwfds;: ifFohia khh;Gf;kpy; rhpahf itj;J mKf;f Muk;pgpf;f Ntz;Lk; mg;nghOJ ,ilapy; gp
typ tuhky; mKf;f Ntz;Lk;
j;
j
kpd;rhu khh;G Foha;
y;
,J if vspjhd Kiw ,jd; %yk; jha;khh;fs; mjpfkhd
Neuj;ij Nrkpf;fpwhh;fs;
tpjp Kiwfs;
 fhk;G FJ ,e;j topahf ,Uf;f Ntz;Lk; ,jdhy; typ Vw;glhky; jLf;fyhk;
 Kjypy; Fiwe;j mOj;jk; nfhLj;J gpd;dh; gb gbahf mOj;jj;ij cah;j;j

Ntz;Lk;
 mOj;jk; nfhLf;Fk; typ Vw;gl;lhy; fhk;G gFjpia ghpNrhjpj;J rpfpr;ir
Nkw;bnfhs;s TNz;LK; filrp nrhl;Lghy; tUk; tiu Fohia cgNahfg;gLj;j

Ntz;Lk;
f
jha;g;ghy Nrfhpj;jy;
w;
 iffs; kw;Wk; iff;Fohapd; cWg;Gfis Nrhg;G kw;Wk; RL kz;zPuhy; Rj;jkhf
gp
fOt Ntz;Lk; gpd;dh; Rj;jkhf Jz;lhy; Jilf;f TNz;Lk;
j;
 jhia mikjpashf cl;fhu itj;J itff;Foha; cgNahfg;gLj;jp ghiy vLf;f
j
NTz;LK; gpd;G iff;Fopha; cgNahfg;gLj;jp ghiy vLf;f TNz;Lk; gpd;G me;j
y;
ghiy gpsh];bf; my;yJ fz;zhb ghj;jopuj;jpy; Nrfhpj;J itj;J Fsph;rhjdg;
ngl;bapy; itf; TNz;Lk;.
 Vnddpy; nfl;L Nghfhky; ,Ug;gjw;fhfTk; kw;Wk; ghypy; Fgop Vw;glhky;
,Ug;gjw;fhfTk; itf;f Ntz;Lk;
 fpsh;rhjdg; ngl;Bapy; ghiy itf;Fk; nghOJ ve;j tpjkhd thilAk; tuhky;
ghJfhf;f Fdsph;rhjd;g;gngl;bapy; ghiy itf;Fk; nghOJ ve;j tpjkhd

thilAk; tuhky; ghJhff;f Fsph;rhjdg; ngl;bapy; itj;jpUf;Fk; nghUl;fisAk;
%b itjl;\J \F Fsph;rhjd ngl;bapy; itj;jpUf;Fk; nghUl;fisAk; %b
itj;J Fsph;rhjd ngl;bap;d epiyia mjpfkhf;f TNz;Lk;.
f
Nrfhpg;gjw;hfd ghj;jhpuk;
w;
vg; nghOjhtJ ghy;Fbf;Fk; Foe;ijfSf;F hgy; RNfhpf;FK; ghj;jpuk;
gp
Njitapy;iy vdpDk; gpsh];bf; ghj;jpuj;ij cgNahfpf;yhk;, Vnddypy; g[pah[;bf;
j;
Fsph;rhjd ngl;bapyu; itf;Fk; nghOJ nts;is mZf;fs; ghj;jpuj;jpy;
j
Nrfjhpg;gjdhy; ghypy; cs;s nbts;is mzf;fs; mopfpwJ. Ghypd; Neha; vjph;g;G rf;jp
y;
Fiwtjpy;iy
Rj;jj;jpd; Njitfs;
ghiy ntspf; nfhxz;L tUtjw;F Kd;G iffisak; ghy; itg;gjw;F
Njirtahd rhjdq;fSk; Gl;bfSkl; fOtp itf;f NTz;Lk;.
jha;g;ghiy cUf;FtJ
 ciwe;j jha;g;ghiy cUf;FtJ rhpahd Kiwpy; ,Uf;f Ntz;Lk;
,y;liynad;why; mjpy; Ez:zpapjhfs; tsUk;
 Fsph;e;j jz;zPiu me;j ciwe;j ghyp;y Cw;wp 24 kzp Neuj;jpw;Fs; cUf f

itf;fyhjk; w;
 Ghiy mjpfkhf #lhf;f $lhJ. Vnddpy; Foe;ija[pd; thia Gz;zhf;f gp
thsa;g;Gs;ssJ.
j;
j
Gjg;gLj;jpap hgpyd; Njhw;wk;
y;
Gjg;gLj;jpa ghy; jdpahfTk; nfhOg;G epiw;ejjhfTk; gphpe;j epioyapYk; kw;WK;
nfhOg;G ghyp;d NkYk; my;yJ Xukhf fhzg;gKLk; ,mjdhy; ghiy Foe;iujf;F

nfhLf;Fk; ngh\OJ ed;whf fygf;fp mnfhLf;f |z;Lk;.
Gspj;j ghy;
Ghy; nhfLg;gjw;hfd fhuzq;fs; ghypy; nfhOg;G jd;’ik $Ljyhf ,Ug;gJk;

my;yJ ghiy rhpajhhf Nrfhpf;fhky; ,Ug;gJk; my;yJ ghiy rhphahf Nrfhpf;fhky;
,Ug;gJk; my;yhJ Gspj;j thil ,Uel;jhOk; ghy; ngl;L tpl;lJ vd;W mh;j;jk;
KbTiu f
ntspg;gLj;Jk; jha;g;ghy; vspjhd kw;Wk; cgNahfkhd Kiwahf ,Uf;Fk;. w;
Foe;ijf;F ve;j tpjkhd ghjpg;Gk; Vw;glhJ. ,e;j Kiw Ntiyf;F nry;Yk; gp
jha;khh;fSf;F kpfTk; cjtpahf ,Uf;Fk;. Foe;ijAk; Muhf;fpa epiyapy; ,Uf;Fk;.
j;
ntspg;gLj;Jk; jha;g;ghy; vspjhd Kiw ,ij Ntiy nra;Ak; jha;khh;fSf;F nrhy;yp
j
nfhLg;gjd; %yk; Foe;ijapd; vjph;g;G rf;jp Fiwtjpy;iy. mjdhy; jha;khh;fs;
y;
kdhPjpahd mstpYk; Kd;NdWfpwhh;fs;. ,jdhy; ,e;j Kiw Foe;ijf;Fk;
jha;khh;fSf;Fk; cjtpahf ,Uf;Fk;.

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A STUDY TO EVALUATE THE EFFECTIVENESS OF

SELF INSTRUCTIONAL MODULE REGARDING

A DISSERTATION SUBMITTED TO THE TAMIL NADU

A DISSERTATION SUBMITTED TO THE TAMIL NADU

CERTIFIED THAT THIS IS THE BONAFIDE WORK OF

Reg. No: 301421101

SIGNATURE : ________________________ COLLEGE SEAL

Dr. P. MUTHULAKSHMI, M.Sc(N)., M.Phil., Ph.D.,

A DISSERTATION SUBMITTED TO THE TAMIL NADU

APPROVED BY THE DISSERTATION COMMITTEE ON OCTOBER 2015

A DISSERTATION SUBMITTED TO THE TAMIL NADU

makes the words to flow from one’s inner heart

wisdom whose salutary benign benison enabled me to achieve this target.

I would do injustice, if I fail to thank my husband Mr. P. Manikandan and

meticulous care, fervent prayers of my parents and my brother for nurturing my

cherished dream into a reality through their continuous challenging encouragements.

I am grateful to Dr. L. P. Thangavelu, F.R.C.S., chairman and Mrs. Shanthi

Thangavelu, M.A., Correspondent, P.P.G groups of Institutions, Coimbatore who

helped us in making the project a great success.

It is my long felt desire to express my profound gratitude and exclusive thanks

to Prof. Dr. P. Muthulakshmi, M.Sc(N)., M.Phil.,Ph.D, Principal, Professor And

data which is the core of the study.

indebtedness to my esteemed subject co-guide Mrs. L. Kalaivani, Msc(N)., M.Phil.,

encouragement, guidance, valuable suggestions and constructive evaluation which

have enabled me to shape this research as a worthy contribution.

I express my sincere thanks to Dr. Kalavathi, MD., DGO., Aravindan

I extend my thanks to the Dissertation Committee Members for their healthy

criticism, supportive suggestions which molded the research.

validity and given valuable suggestion in the modifications of the tool.

I utilize this eventful opportunity to thank Mrs. J. Nagamala faculty of PPG

College of Nursing of their healthy criticism, supportive suggestions and tremendous

co-operation for completing my work successfully.

I extend my sincere thanks to all the Faculty Members of PPG College of

me all possible help to achieve my target.

the necessary materials.

I would also express my sincere thanks to Mr. N. Sivakumar of Nawal

I owe a great deal of thanks to my Dear Most Colleagues who encouraged

I extend my thanks to all the Participants in the study.

I thank all my Well Wishers who helped me directly and indirectly.

CHAPTER CONTENTS PAGE No.

Need for the Study 3

Statement of the Problem 6

Setting of the Study 21

Criteria for Selection of Samples 22

Description of the Tool 22

Testing of the Tool 24

Data Collection Procedure 25

Plan for Data Analysis 25

IV DATA ANALYSIS AND INTERPRETATION 27

V RESULTS AND DISCUSSION 51

NURSING IMPLICATIONS, LIMITATIONS AND

S.No. CONTENT PAGE No.

1. Distribution of Demographic Variables 28

2. Distribution of Statistical Value of Pretest and Post Test 42

Knowledge on Expression and Storage of Breast Milk Among

3. Distribution of Statistical Value of Pretest and Post Test 44

Knowledge on Practice on Expression and Storage of Breast

Milk Among Employed Mothers

4. Correlation Between Pretest Knowledge and Knowledge on 46

Practice Scores Regarding Expression and Storage of Breast