Effect of A Structured Psychophysiological Intervention on Breast Milk Secretion among Post-Caesarean Mothers: A Quasi-Experimental Study with Mediation Analysis

Background: Physiological stress and psychological distress after caesarean section can lead to poor early breast milk secretion and thereby impact lactation of mothers who had a caesarean. Objective: To evaluate the impact of a structured psychophysiological intervention on breast milk production in post-caesarean women and to evaluate if the change in the psychological status of the mother was intervening in this effect. Methods: Quasi-experimental two group pretest-posttest study with 220 post-caesarean mothers. The intervention consisted of 12 in total sessions of back massage and affirmation based relaxation four times a day for three days. Breast milk output was quantified and psychological factors were evaluated using well-developed scales. Data were analysed with t-tests and adjusted linear regression with control of baseline milk secretion and covariates. The bootstrapping (5000 samples) PROCESS Model 4 was used to test mediation. Results: The intervention group had significantly higher increases in breast milk secretion: 2.95 ml (95% CI: 2.53-3.38, p<0.001). The adjusted effect remained significant (B = 2.90, 95% CI: 2.19-3.61; p<0.001). Psychological distress significantly decreased in the intervention group (depression: mean difference -1.29, 95% CI: -2.03 to -0.55; anxiety: -1.95, 95% CI: -2.58 to -1.31; stress: -3.49, 95% CI: -4.34 to -2.64; all p<0.001). Results: The intervention was linked with a higher output of breast milk. Results are consistent with a cumulative psychophysiological pathway between the psychological changes in the mother and lactation outcomes which warrants consideration of such strategies in the postpartum care.