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The Relationship Between Maternal Intravenous Fluids and Breast Changes in the Postpartum Period: a Pilot Observational Study

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The Relationship Between Maternal Intravenous Fluids and Breast Changes in the Postpartum Period: a Pilot Observational Study THE RELATIONSHIP BETWEEN MATERNAL INTRAVENOUS FLUIDS AND BREAST CHANGES IN THE POSTPARTUM PERIOD: A PILOT OBSERVATIONAL STUDY SONYA MYLES RN IBCLC BScN Thesis submitted to the Faculty of Graduate and Postdoctoral Studies In partial fulfillment of the requirements for the Masters Degree in Nursing School of Nursing Faculty of Health Sciences University of Ottawa © Sonya Myles, Ottawa, Canada, 2014 BREAST ENGORGEMENT AND EDEMA PILOT STUDY ii Dedicated to Michael Durbin 25 April 1977 – 12 March 2013 BREAST ENGORGEMENT AND EDEMA PILOT STUDY iii Table of Contents List of Tables..............................................................................................................vii List of Figures........................................................................................................... viii List of Thesis Appendices.......................................................................................... ix Glossary……………………………………………………………………………..x Abstract..................................................................................................................... xii Acknowledgements................................................................................................... xiii CHAPTER 1 - Introduction Introduction…………………………………………………………………..…….. 1 Organization of the Thesis…………………………………………………….…… 1 Background Clinical Issue.................................................................................................. 2 Problem Statement......................................................................................... 2 Study Purpose and Objectives....................................................................... 3 Conceptual Framework.................................................................................. 4 Research Question and Study Hypotheses……………………………………….… 6 Research Question......................................................................................... 6 Study Hypotheses.......................................................................................... 6 CHAPTER 2 - Review of the Literature Review of the Literature…………………………………………………………… 7 Understanding Engorgement and Breast Edema Engorgement Versus Edema.......................................................................... 8 Theories of Engorgement............................................................................... 9 Mechanics of Edema...................................................................................... 10 Timing of Engorgement................................................................................. 11 Mothers Who are Most at Risk for Engorgement and Edema................................... 12 Intravenous Fluids During Labour............................................................................. 12 Knowledge Gap Relating to Engorgement and Edema............................................. 13 BREAST ENGORGEMENT AND EDEMA PILOT STUDY iv CHAPTER 3 - Methods Research Design.........................................................................................................16 Setting........................................................................................................................ 16 Participants Inclusion Criteria........................................................................................... 17 Sample Size ……………………................................................................... 17 Recruitment.................................................................................................... 18 Protection of Human Rights...........................................................................18 Procedure................................................................................................................... 19 Measurement of Variables Intravenous Fluids………….......................................................................... 20 Nipple and Areola Diameter, Height, and Shape…………..……………..... 21 Milk Maturation Index of Colostrum and Milk............................................. 21 Breast and Areola Edema…........................................................................... 23 Maternal Breast Self Assessment…………………………………..….……24 Latching……………………………………………………………….…… 24 Lactogenesis II………………………………………………....................... 25 Newborn Weight Measurement………………………………………….… 25 Pumping and Supplementing…………………………………………….… 25 Data Collection Developing Data Collection Sheets............................................................... 26 Data Collection.............................................................................................. 26 Managing the Data......................................................................................... 27 Rigour Controlling for Bias....................................................................................... 27 In-services and Information for Nurses......................................................... 29 Data Analysis............................................................................................................. 29 BREAST ENGORGEMENT AND EDEMA PILOT STUDY v CHAPTER 4 - Findings Findings………........................................................................................................ 31 Characteristics of the Participants…………………….……………………………. 31 Variables Intravenous Fluids………………………………………………………….. 33 Breast and Areola Edema………………………………………………...… 33 Peripheral Limb Edema……………………………………………….…… 34 Maternal Breast Self Assessment…………………………………………...36 Lactogenesis II…………………………………………………………....... 39 Newborn Weight Measurement………………………………………….… 40 Milk Maturation Index of Colostrum and Milk (MICAM)……………...… 42 Diameter of Areola and Nipple and Height of Nipple…………………...… 44 Latching and Nipple Shape on De-latching……………………………...… 45 Pumping and Supplementing…………………………………………….… 46 Research Questions - Analysis………………………………………………….......47 CHAPTER 5 - Discussion and Conclusion Discussion and Conclusions……………………………………………………….. 50 Knowledge Gathered from the Pilot Study……………………………………...… 50 Challenges in Measuring Variables………………………………………... 51 Participant Feedback………………………………………………………..52 Strengths of the Pilot Study……………………………………………….. 52 Limitations of the Pilot Study……………………………………………… 53 Questions to Consider in a Larger Study………………………………………...… 54 Implications Implications for Nursing Practice………………………………………….. 55 Implications for Nursing Research……………………………………….... 56 Implications for Nursing Policy……………………………………………. 57 BREAST ENGORGEMENT AND EDEMA PILOT STUDY vi Conclusions................................................................................................................ 58 References ................................................................................................................ 59 Appendices................................................................................................................ 65 BREAST ENGORGEMENT AND EDEMA PILOT STUDY vii List of Tables Chapter 1 Table 1 - Relationship Among Variables of Interest................................................. 4 Chapter 3 Table 2 - MICAM Patterns….................................................................................... 22 Table 3 - Measuring Edema……………………....................................................... 23 Chapter 4 Table 4 - Characteristics of Participating Mothers and Newborns............................ 32 Table 5 - Maternal IV Fluids Administered............................................................... 33 Table 6 - Breast Edema as Measured in Each Breast at 11 Time points................... 35 Table 7 - Maternal Breast Self Assessment as Reported in Each Breast.................. 38 Table 8 - Onset of Lactogenesis II............................................................................ 39 Table 9 - Descriptive Statistics of Daily Newborn Weight Measurements.............. 41 Table 10 - Average Weight Changes from Birth Weight.......................................... 42 Table 11 – Milk Maturation Levels........................................................................... 43 BREAST ENGORGEMENT AND EDEMA PILOT STUDY viii List of Figures Chapter 1 Figure 1 - Conceptual Framework Illustrating Relationships Among Variables…....5 Figure 2 - Mechanics of Edema............................................................................... 11 Chapter 4 Figure 3 - Line graph showing average level of edema in participants with IV Fluids vs. participants without IV fluids……..………………………….. 36 Figure 4 - Line graph showing average maternal breast self assessment scores and average edema ratings……………………………………………… 40 BREAST ENGORGEMENT AND EDEMA PILOT STUDY ix List of Thesis Appendices Appendix A - Thesis Proposal Approval.................................................................. 65 Appendix B - Table B1: Search Terms…………………………………………….66 Appendix C – Table C1: Literature Review Table................................................... 67 Appendix D - Research Ethics Board Approvals……………………………….… 74 Appendix E- Research Ethics Board Amendments………………………….….... 77 Appendix F - Participant Information Sheet and Consent Form..............................81 Appendix G - Amended Participant Information Sheet and Consent Form…...…. 85 Appendix H - Consent Form for Photography......................................................... 89 Appendix I - Breastfeeding Community Resources................................................ 90 Appendix J – Prenatal Questionnaire………………………………………………92 Appendix
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