title: Potential predictors of nipple trauma from an in-home breastfeeding programme: A cross-sectional study.
abstract: BACKGROUND
  Australian breastfeeding rates fall significantly in the months following birth, often as a result of breastfeeding complications.
  
  
  OBJECTIVE
  To explore the potential risk factors for nipple trauma and breast engorgement in a group of women who were referred to the in home breastfeeding service in Melbourne, Australia.
  
  
  METHODS
  A retrospective, cross-sectional analyses of the maternal-infant records (n=653) from 2003 to 2007 including demographic characteristics; pregnancy, labour and birth data; the presenting complications and observational and diagnostic results. Bivariate and logistic regression analyses were conducted to explore the predictors of nipple trauma and engorgement.
  
  
  RESULTS
  Nipple trauma was the most common presenting complication (62.9%). Logistic regression analyses identified four statistically significant predictors: facio-mandibular asymmetry (AOR 4.21, 95% CI [1.25-14.20]), inflammatory mastitis (AOR 2.99, 95% CI [1.57-5.68], nipple malignment (AOR 2.51, 95% CI [1.13-5.55]) and the cross-cradle technique (AOR 1.90, 95% CI [1.03-3.50]). Engorgement was associated with the first postpartum breastfeed being less than one-hour duration (AOR 2.01, 95% CI [1.07-3.79]).
  
  
  CONCLUSIONS
  Nipple trauma was associated with commonly taught techniques that involved the cross-cradle hold and manoeuvres of the breast, nipple and baby that resulted in nipple malalignment and facio-mandibular asymmetry. This practice, appeared to interfere with the baby's intra-oral function by restricting movement of the cranio-cervical spine and nuchal ligament. The combination appeared to limit the baby's instinctive ability to activate neuro-sensory mammalian behaviours to freely locate and effectively draw the nipple and breast tissue without causing trauma. Changes to the first and early breastfeeding techniques are recommended.
authors.affiliation: Midwifery Research Unit, Mater Research Institute and The University of Queensland, 14 Seves Street, Altona, VIC 3018, Australia. Electronic address: midwifeconsultant@gmail.com.
authors.forename: Robyn
authors.initials: R
authors.lastname: Thompson
authors.affiliation: Institute of Urban Indigenous Health, School of Nursing, Midwifery and Social Work, The University of Queensland, QLD 4072, Australia. Electronic address: sue.kruske@uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: University Centre for Rural Health, The University of Sydney, NSW 2006, Australia. Electronic address: lesley.barclay@sydney.edu.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
authors.affiliation: Darebin City Council, Melbourne, VIC 3072, Australia. Electronic address: klinden@darebin.vic.gov.au.
authors.forename: Karin
authors.initials: K
authors.lastname: Linden
authors.affiliation: Midwifery Research Unit, Mater Research Institute and The University of Queensland, School of Nursing, Midwifery and Social Work, The University of Queensland, QLD 4014, Australia. Electronic address: yu.gao@mater.uq.edu.au.
authors.forename: Yu
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Midwifery Research Unit, Mater Research Institute and The University of Queensland, School of Nursing, Midwifery and Social Work, The University of Queensland, QLD 4014, Australia. Electronic address: sue.kildea@mater.uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
mesh_terms: D000328:Adult; D001315:Australia; D001942:Breast Feeding / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D009558:Nipples; D059408:Pain Management / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
keywords: Breastfeeding; Engorgement; Mastitis; Midwifery; Nipple trauma