1. PREVALENCE, CONTRIBUTING RISK FACTORS AND IMPACT ON QUALITY OF LIFE OF BREASTFEEDING POSITION RELATED MUSCULOSKELETAL PAIN (BPRMSP) IN POSTPARTUM WOMENAmy Wagner, PT, D PT, GCS

2. THEORY Breastfeeding is an occupational activity/ADL that requires physical endurance: Sustained posture Ergonomics is important to maintain position 8 to 10 episodes a day 10 to 45 minutes 3. THEORY Ergonomic and posture principles can be applied to task of breastfeeding mother sMany women bend their neck down, sit unsupported 4. BPRMSP: DEFINITIONMusculoskeletal pain associated with certain breastfeeding positions (Mbada, 2013) 5. BACKGROUND Breastfeeding recommended by AAP and WHO for 6 months or more: 4.5 million bir ths, 80% mothers attempt breastfeeding in US. Many barrier s exist to reaching these goals. Musculoskeletal pain may be associated with reduced ability to achieve the duration of this activity, but little is known Other occupations have been examined for ergonomic barrier s to par ticipation Gaps in the literature to examine demographic risk factors, and positions of mother and baby that are associated with increased incidence of BPRMSP. 6. PURPOSE This proposed work will use mixed methods, and have two distinct phases: survey (quantitative) and interviews (qualitative). Nonexperimental/primarily observational to gain awareness and understanding of the problem of BPRMSP This work will fill a gap in the literature in order to examine the problem of musculoskeletal pain associated with the occupation of breastfeeding. 7. HYPOTHESES The survey instrument to assess BPRMSP will have good reliability and validity: face validity and content validity good (> 0.95) test-retest reliability. Less strenuous positions such as sidelying and laid back will be associated with statistically significant lower pain ratings 8. RESEARCH QUESTIONS What is the point prevalence of Breastfeeding Position Related Musculoskeletal Pain (BPRMSP) in Postpartum Mothers? What are the risk factors for BPRMSP? What role does prior history of musculoskeletal pain, lifting of the child or wearing them in a sling play in the pain? How has this BRMSP played role in attitudes towards breastfeeding and willingness to continue? What role does the lactation consultant or ergonomic aids play in mitigating the ef fects of BRMSP? What is the impact on quality of life of BPRMSP on breastfeeding mothers and is it a perceived barrier to continued breastfeeding in the early postpartum period? How has this BRMSP played role in attitudes towards breastfeeding and willingness to continue? 9. INCIDENCE/PREVALENCE IN THE LITERATURE Mbada, et. Al (2013) 1 : n= 397 Lifetime prevalence of 39.4% Point prevalence: 15.9% Unsupported sitting: 20.5-39% Area of body: Neck (20.5%) Neck and shoulder (16.6%) Back and neck (12.6%) 1 Mbada,C. E., Oyinlola, F. C., Olatunbosun , T. O., Awotidebe , T. O., Arije, O. O., Johnson, O. E., & Fashote, E. O. (2013). Is Baby -Friendly Breastfeeding Mother -Friendly?. Journal of Womens Health Physical Therapy, 37(1), 19-28. 10. MORE LITERATURE General post-partum pain is common: 41% of post-partum women had pelvic girdle pain 3Suzanne Colson: Laid back breastfeeding has lower incidence of body pain. 4 (2010, n=12) OT: improved infant motor milestones-ventral feederWomen with fibromyalgia are more likely to be unsuccessful at breastfeeding due to musculoskeletal pain. 5M u k k a n n a v a r, P. , D e s a i , B . R . , M o h a n t y, U . , K u l k a r n i , S . , P a r v a t i k a r, V. , & D a i w a j n a , S . ( 2 0 1 3 ) . P e l v i c g i r d l e p a i n i n I n d i a n p o s t p a r t u m w o m e n : a c r o s s - s e c t i o n a l s t u d y. P h y s i o t h e r a p y theor y and practice, (0), 1-8. 4 Colson S. An introduction to biological nur turing: New angles on breastfeeding. Hale Pub; 2010. 5Schaefer KM. Breastfeeding in chronic illness: The voices of women with fibromyalgia. MCN: The American Journal of Maternal/Child Nursing . 2004;29(4):248-253. 3 11. THAI STUDY OF BACK PAIN WITH BREASTFEEDING 2 (2010); N= 122KlinpikulN, Srichandr P, Poolthong N, Thavarangkul N. Factors affecting low back pain during breastfeeding of thai woman. . 2010. 12. STUDY DESCRIPTION: SUBJECTS INCLUSION CRITERIA: 18 to 49 year old women who gave birth past 6 months, and are breastfeeding EXCLUSION CRITERIA: Women who have had musculoskeletal surgery or injury in the past 6 months, or have stopped breastfeeding RECRUITMENT: physician and midwife offices at postpartum visit. San Antonio, Austin, and Los Angeles to gain a wide diversity of socioeconomic and educational backgrounds. Interview recruitment: La Leche league, Lactation consultants, BF task forces, hospital outpatient lactation centers Preliminary analysis states that 247 surveys will be needed for an epidemiological survey. 500 surveys will be distributed with the goal of at least 50% return rate. 13. INSTRUMENTS/METHODS Questionnaire (500) to have women rate pain associated with certain positions. To be tested for reliability and validity (test -retest reliability and face/content validity-review by experts) in pilot studies Previous study (Mbada) showed agreement percentage of k = . 94 to 1.0 for questionnaire. To be translated into Spanish. Survey will be anonymous and single blinded; interview not blinded. Interviews with 50 women post-partum to determine what impact on quality of life is of BPRMSP. This survey modified from version used by Mbada which was tested for reliability (test -retest) and validity Study location: 3 metro areas, and interviews in SA , Austin private of fice 14. WHAT IS DIFFERENT? Demographic variables and questions added open ended component-qualitative ergonomic aids socioeconomic variables position used by mother babys position Pain with other activities Different geographic regions Ethnicity/language variables 15. ERGONOMIC AIDS FOR BREASTFEEDING 16. DEMOGRAPHIC VARIABLES Personal Information: Your DOB: Your present babys DOB: Occupation: How many births have you had? How many children do you have? Was your present birth: a.Vaginala.Cesarean sectionDo you exclusively breastfeed? Height and Weight Ethnicity Education level 17. SURVEY COMPONENTS _____ Lying down on my side_____ Lying down (laid back)_____ Sitting- Football hold_____ Child in sling_____ Sitting cradle hold_____Sitting: cross cradle hold_____Sitting-koala hold (baby upright)_____ Other: (please describe) 18. QUANTITATIVE RATING OF PAIN (0-10) PAIN SCALE Body AreaHead Neck Shoulder Elbow Wrist Upper BackLower Backpelvis General Body0= no pain12345= modera te pain678910 = worst pain possible 19. SAMPLE OF MORE SURVEY QUESTIONS 9. Which of the following has eased your aches or pains in your body while breastfeeding? Mark all that apply.a. _____ as friend b. _____ c. _____ d. _____ e. _____ counter or f. _____ g. _____ h. _____ i. _____ 11. Have you experienced musculoskeletal pain with any of the following activities currently (in the past week)?a. _____ Lifting or carrying child or other children? b. _____ Lifting car seat, stroller, or other equipment? c. _____ Using a baby wearing device or sling to carry child in? d. _____ Other daily activities such as household chores or driving? e. _____ Computer use f. _____ Other:Use of ergonomic aid such Boppy or my breast Use of regular pillows Use of footstool Alternating positions Medication-over the prescription Massage Stretching/exercise Abdominal corset or brace Other: ___________________10. Have you utilized any of the following services in regards to positioning with breastfeeding (circle all that apply)? a. b. c. group d. center e. f._____ Lactation Consultant _____La Leche League _____ Breastfeeding support _____ hospital based lactation_____Postpartum doula _____ Other: ______________________ 12. During your pregnancy, did you experience any symptoms of pain, ache or discomfort a. b.14. Is there anything else you would like to share about any muscle or body pain you may have experienced while breastfeeding?_____ Yes _____ No 20. METHODS: The paper survey will be distributed in person to physician (OB/GYN and pediatrician) of fices and nurse -midwife of fices in each of 3 large metropolitan cities (San Antonio, Austin, and Los Angeles). Self-addressed stamped envelopes will be given for return . Personal interviews will be conducted through recruitment via local La Leche League Groups, breastfeeding task force organizations, and hospital outpatient lactation centers. Interviews will be conducted in person in a private of fice setting in both San Antonio and Austin. 21. DATA ANALYSIS: SPSS AND NVIVO SOFTWARE Correlation coefficients will be determined for test-retest reliability, agreement between translated versions Descriptive statistics will be used to summarize data regarding prevalence of BPRMSP. Non-parametric tests such as chi-squared will be used to determine associations between BRMSP and sociodemographic variables of the participant (age, parity, type of birth, socioeconomic strata, education, BMI) NVIVO will be used to code, translate, verify and analyze qualitative data. 22. SUMMARY This proposed work will use mixed methods, and have two distinct phases: sur vey (quantitative) and inter views (qualitative). This work will fill a gap in the literature in order to examine the problem of musculoskeletal pain associated with the occupation of breastfeeding. This project may lead to increased knowledge of potential risk factor s and mitigating factor s for BPRMSP, as well as increase knowledge to be used for planning inter vention studies to decrease musculoskeletal pain in the postpar tum period.