Project Summary
Every year, 1 million women cease breastfeeding (BF) before 6 months, the minimum time required for optimal
maternal well-being and infant’s health, physical growth, and development. The highest rate of BF cessation
occurs within 3 weeks after delivery, with 30% of women ceasing BF due to acute breast and nipple pain (BNP).
BNP is a complex and understudied biobehavioral phenomenon involving nociceptive signaling that stimulates
multiple pathways - somatic, visceral, and the autonomic nervous system. Women who experience BNP beyond
BF initiation report lower BF self-efficacy a key predictor of BF at 6 months, increased maternal distress
symptoms, which contribute to early BF cessation, decreased maternal well-being, and maternal self-efficacy.
Our team developed and tested a 6-week nurse-led and participant-informed, Breastfeeding and Breast and
Nipple Pain Self-Management (BSM) intervention guided by the Individual and Family Self-Management Theory.
Aligned with the NINR’s strategic themes of symptoms science and self-management and the CDC HEAR HER
campaign and the needs and preferences elicited from a diverse sample of BF women, we used a cloud-based
platform, to deliver BF knowledge and skills, and provided support through nurse led text-based communication
to decrease BNP, increase BF self-efficacy, decrease burdensome face-to-face visits and risk for illness, such
as COVID-19, and increase adaptive coping behaviors. The BSM intervention provides specific strategies for
behavioral and active self-management of BNP and BF challenges. Women in the BSM intervention group
reported significantly reduced BNP intensity and pain interference at 1 and 2 weeks which predicted increased
BF self-efficacy and decreased anxiety at 6 weeks. BNP intensity was associated with pain sensitivity single
nucleotide polymorphisms (SNPs) (Oxytocin receptor (OXTR) rs53576, rs2254298), suggesting a genetic risk
profile of heightened BNP which may be used to identify women at high risk of early BF cessation and general
pain sensitivity. Based on these promising results, we propose to examine the efficacy of the BSM intervention
in a RO1 RCT, Promoting Self-Management of Breast and Nipple Pain with Biomarkers and Technology
(PROMPT) for Breastfeeding Women to decrease BNP intensity and interference and increase BF exclusivity.
Using state-of-the-art methods for assessing pain sensitivity and genetic risk for BNP, the study will reproduce
and extend our pilot findings by exploring pain genetics influence on BNP in order to screen prenatally women
at-risk for pain-associated BF cessation and enhance pain sensitivity. The study will explore the moderating role
of BNP, and maternal well-being symptoms of fatigue, depressive symptoms, anxiety, and sleep, and BF, pain,
and maternal self-efficacy, on BF exclusivity. Women (N = 280) intending to breastfeed will be randomized to
the BSM intervention or the attention control group with assessments performed at baseline, 1, 2, 3, 6, 9, 12, 18,
and 24 weeks. Study results will advance knowledge on the BSM intervention, with direct implications for nurse-
designed and nurse-led self-management interventions in clinical settings or health care systems.
