الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Puerperium is the period following childbirth during which the woman’s body in general and the genital organs in particular return to the prepregnant state. It’s beginning immediately after the placenta is expelled and lasts for approximately six weeks after delivery. It’s the most important period in the women’s and infants lives. Many times, breastfeeding becomes difficult due to various factors. One among them is breast engorgement, which can be defined as painful sensation due to expansion and pressure exerted by the synthesis and storage of breast milk usually during the third day after childbirth. Although the breast engorgement causes severe consequence, many studies have shown that women’s awareness regarding breast engorgement is low especially among primipara women. So; this study aims to assess self-care practices of primipara women regarding breast engorgement. To fulfill the study aim:- Settings: This study was conducted at postpartum departments, outpatient clinics and Neonatal intensive care units at Tanta University Hospital, El-Menshawy General Hospital and El-Mabara Hospital in addition to Maternal and Child Health Centers at Botros and Sager. Subjects: A convenience sample of 200 women were included in the study and fulfilling the inclusive criteria, postnatal women, Age range from 20 to35 years, breastfeed their infant within the first 6 weeks after delivery, free from breast infection, no neonate congenital malformation interfering with breastfeeding (cleft lip and cleft palate) and willing to participate in this study. Tools of data collection: To achieve the aim of the study the following tools were used. Tool I: Structured interview schedule, included data related to two parts as following: Part (1): Socio-demographic data of the women as age, educational level, occupation, residence, marital status, age at marriage, duration of the current marriage, type of family, number of family members and family income. Part (2): Reproductive history, included data related to: A. Obstetric history as gravidity, gestational age, number and place of antenatal visits, attendance of antenatal care classes, the mode of delivery, any problems during labor and previous history of breast engorgement. B. Clinical data of women as number of postpartum days, breastfeeding initiation time, duration of breastfeeding, frequency of breastfeeding and maternal position for breastfeeding. Tool II: Knowledge of primipara women regarding breast engorgement. It included seven items as definition, risk factors, signs and symptoms, complications, effect of breast engorgement on the infant, women’s practice to relief breast engorgement, source of knowledge and the role of nurse to relief breast engorgement. Tool III: Self-care practices of primipara women regarding breast engorgement: It included uses of hydrotherapy, gently massage and compress the breast when the neonate pauses between sucking, wear well fitted supportive brassiere, use of breast pump, apply cold cabbage leaves on the breasts, feed baby on demand, expressed her breast manually before putting the neonate to the breast, increase frequency of breastfeeding, feed the neonate at least 15 to 20 minutes at each breast or until breast become soft, ensuring correct latch and positioning of neonate during breastfeeding, use gel packs on the breast, use scraping technique (Gua Sha therapy), take analgesic drug to reduce pain, apply lavender or fennel oil to the breast . Tool IV: LATCH breastfeeding charting scale: It measured latch on, audible swallowing, type of nipple, comfort, and also holding. The results of the current study can be summarized as follows: - The socio-demographic characteristics of women. More than four fifth (81.5%) of women were 20 to less than 30 years old, less than three fifth (56%) of them from rural, nearly to three quarter (72.5%) of them were married at age of 18 to less 25 and the mean duration of current marriage was 1.94 years ±1.09. Nearly two fifth (37.0%) of the women had secondary school, the vast majority (90.0%) of them were housewife, nearly three fifth (58.0%) of them were from nuclear families. - Obstetric history of women. The majority (86.0%) of women were primigravida and attended for antenatal care regularly, sought initial antenatal visit at first trimester and had more than four antenatal visits at the private hospitals or clinics. The majority (88.0%) of the women didn’t attend antenatal care classes. - The reproductive clinical data of women. Nearly half (49.0%) of women initiated breastfeeding within two hours after delivery, the vast majority (98.0%) of them reported that the duration of breastfeeding was 10 minutes and slightly more than four fifth (81.5%) of women feed their infant as demand. All women used sitting position while feed their infant and the vast majority (96.0%) of them feed their infant from the both breasts. - Women’s knowledge regarding breast engorgement. More than three quarters (77.5%) of women had poor level of knowledge followed by 17.0% of them had fair level of knowledge and only 5.5% of them revealed good level of knowledge . Nearly half (46.5%) of women mentioned that their family was the primary source of knowledge regarding breast engorgement, while only 2.3 % stated that books and magazine was other source of knowledge regarding breast engorgement. The current study reported that there was significant relationship between women’s occupation, family income and their total knowledge scores, there was no significant relationship between women’s age, residence, age at marriage, educational level, type of family, number of family members and their total knowledge scores. - Self-care practices of women regarding breast engorgement. The majority (85.0%) of the women didn’t suffer from breast engorgement during postpartum period and only 15.0% of them actually suffered from it. Regarding their practices that was performed to relief breast engorgement all women (100%) express their breast manually before putting the infant to the breast and the vast majority of them increase the frequency of breastfeeding, use breast pump, nurse their infant on demand, use correct latch and positioning of infant during breastfeeding and feed their infant at least 15 to 20 minutes from each breast or until breast become soft, while (23.3%, 20.0% and 20.0% respectively) of them use moist heat on breast for few minutes before breastfeeding, do gently massage and compress the breast when the infant pauses between sucking, and take analgesic to reduce pain. The current study reported that significant relationship was found between total self-care practice scores about breast engorgement and both women’s educational level and occupation and there was no significant relationship between women’s age, residence, age at marriage, type of family, number of family members and their total self-care practice scores about breast engorgement. - LATCH breastfeeding charting scale: The current study reported that 27.0% of women had well effectiveness breastfeeding, 63.5% had fair effectiveness breastfeeding and only 9.5 had poor effectiveness breastfeeding. The current study illustrated that there was significant relationship between total latch breastfeeding charting scale scores and the following; women’s age, educational level, occupation , type of family and number of family members; in addition there was no significant relationship between women’s residence, age at marriage, family income and their total latch breastfeeding charting scale scores. Significant positive correlation was found between total knowledge scores and the number of antenatal classes and total LATCH breastfeeding charting scale scores. There was significant positive correlation between total self-care practice scores and the following; number of antenatal classes, total knowledge scores and total LATCH breastfeeding charting scale scores. There was significant negative correlation between total LATCH breastfeeding charting scale scores and the following; age of women, age at marriage and duration of current marriage. Conclusion: Based on the findings of the present study, it can be included that:- - Primpara postnatal women had a poor level of knowledge as well as unsatisfactory level of self -care practices regarding breast engorgement. Furthermore, this study also revealed that the total level of LATCH breastfeeding charting scale were fair among nearly two third of the studied women. Recommendations: Based on the findings of the present study, the following recommendations are derived and suggested I. Recommendations for basic nursing education: - Effective breastfeeding technique and prevention of breast engorgement should be included in the curriculum of basic nursing education and continuing education of nursing students. II. Recommendations for Hospital, and Maternal and Child Health Centers administration: - Planning and developing antenatal classes for all women to increase their knowledge and enhance their practice regarding breast engorgement. III. Recommendations for nurses: - Refreshing courses, preservice and in-service training programs especially for newly appointed nurses can be successful in improving nurse’s level of knowledge about breast engorgement and effective breastfeeding technique. - Nurses should be trained to apply the evidence based nursing approaches for managing breast engorgement. IV. Recommendations for public education: - Mass media should be utilized for dissemination of simple, correct and relevant information about breast engorgement, effective breastfeeding technique and its benefits to women, infant, families and communities. V. Recommendations for further studies: - Factors affecting women’s knowledge regarding breast engorgement. - The effect of prenatal health education program on women’s knowledge and practice regarding prevention of breast engorgement.