Breastfeeding Self-Management for Nipple and Breast Pain

Breastfeeding (BF) is one of the most important early determinants of infant health and
development. Duration of BF is significantly related to reduced incidence of infantile
respiratory and gastrointestinal tract infections, obesity and asthma. However, over 35% of
mothers cease exclusive BF during the first 6 weeks due to nipple and breast pain. While 90%
of mothers report acute nipple and breast pain during the first week of BF initiation,
approximately 30% will experience persistent pain (>10 days). Due to the significant impact
of nipple and breast pain on BF duration, pain is a significant barrier for achieving public
health outcomes.

The following pilot project will test the feasibility of a Breastfeeding Self-Management
(BSM) Intervention on BF outcomes in mothers with nipple and breast pain. In addition, the
proposed study will provide a preliminary examination of genetic, psychological and
somatosensory factors that predict nipple and breast pain and possibly, early cessation of
BF.

Individual factors, including genetic polymorphisms of pain sensitivity genes and the
individual's interpretation of pain can influence pain facilitation or inhibition at the
molecular level of pain processing. Moreover, maternal anticipation of pain may increase pain
catastrophizing, perceived stress and reactivity contributing to increased peripheral and
central sensitivity. Identifying strategies to increase mothers' BF knowledge, pain
self-efficacy and self-regulation skills could lead to increased SM behaviors. Therefore,
this pilot study was designed to target pain SM process factors (self-monitoring, knowledge
of breast care, BF self-efficacy, pain self-efficacy, and problem solving) relevant to
mothers who experience pain during BF. The overarching goal of this program of research is to
improve nipple and breast pain SM in BF mothers and enhance their BF self-efficacy to achieve
their BF goals.

The proposed study will address a major barrier of BF duration by identifying factors that
contribute to nipple and breast pain. The proposed SM intervention will specifically target
pain information, pain self-efficacy and problem-solving as central components of the SM
process. In addition, the investigators will examine the influence of peripheral and central
sensitivity and frequency of catechol-O-methyltransferase (COMT) single-nucleotide
polymorphisms (SNPs), on SM process and outcome variables over time to gain knowledge about
the precise influence of the molecular context of pain on risk of nipple and breast pain and
BF outcomes.

Inclusion Criteria:

- Have just given birth (<48 hours)

- Intention to breastfeed for 6 weeks

- Has daily access to a computer with internet

- Access to a phone

- Read and speak English

- Delivered a healthy singleton infant born >37 weeks gestational age

Exclusion Criteria:

- Infants with congenital anomalies

- Mothers with major mental health issues (i.e Schizophrenia, Mania, Bipolar Disorder)

- Complications during delivery requiring intervention

- Mothers with major health issues that are not associated with pregnancy as determined
by principal investigator (i.e. infection illness such as HIV+, hepatitis, diabetes,
history of seizures, current diagnosis of cancer).