الفهرس 
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Abstract
Identify the factors associated with Breast Problems during puerperal period is an important approach to earlydetection and prevention of breast problems.
The study aimed to:
Identify determinants ofBreast Problems among Lactating Puerperal Womenatwell baby Clinics in Alexandria.
The study was conducted at 4 well baby clinic; affiliated to4 hospitalthat will be randomly selected one from each health agencies in Alexandria. Subjects: The study was included (200) postnatal women who were attending the well-baby clinics affiliated to the previously mentioned hospitals.
Tool used in this study:
Three tools were used to collect the necessary data.Tool one was divided into two parts, first part was the bio-socio-demographic, reproductive history, second part was contains social and health care providers support. The level of perceived breast feeding supportwill determine bypercentageof each dimension as follows:
- Low breast feeding support 6 -> 12
- Moderatebreast feeding support 12 - >14
- Highbreast feeding support > 14
The second tool was the emotional distress scale, which was developed by Kelly (2011) to assess emotional distress problemsthat may ariseduringlactation among puerperal women, Itcomprised of 10 statement. The subject’s response to each statementwill be rated according to 4 point category scale where ranged from: not true (0), to true most of the time (3).The total score ranged from 0 to 30, with high values indicating emotional distress problems. Directions for scoring: Items 1, 6, & 10 are scored on a 0 - 3 scale. Items 2, 3, 4, 5, 7, 8, & 9 are reverse scored, so that the response sets are scored 3 – 0.
The third tools was the Breastfeeding self-efficacy scale (BFES) it wasadopted from Dennis & Faux (1999) to measure of breastfeeding self-confidence. This scale consists of 14 item, All items are preceded by the phrase “I can always” and anchored with a 3-point Likert-type scale where 1 = not at all confident and 3 = always confident. all items are presented positively, and scores are summed to produce a range from 14 to 42. The levels of breastfeeding self-efficacy will be determine as follows:
• High breastfeeding self-efficacy: 14 - > 24.
• Low breastfeeding self-efficacy <24
The main findings of the present study were:
A. Socio-demographic characteristics
• More than half (58.0%) of the mothers were from 25-35 years old.
• Nearly two third (60.5%) have secondary or higher education, while only 31.0% of them know how to read and write.
• The majority of study subjects (86.5%) were housewife andmore than half (52.0%) of them did not have enough income.
• More than two-thirds of the study subject (69.0%) lived in nuclear families, while almost two third (64.5%) of them were urban dwellers.
• One third of them (34.0%) had no social support compared to 37.0% &29.0 had a social support from her husband & her mother respectively.
B. Reproductive history
• Less than two thirds (60%) of the study subjects were primigravida.While two fifths (40.0%) of them were pregnant for two or three times.
• Approximately fourfifths (81.0 %) of the study subjectsgave birth one times and only 4.0% of them had delivered four times or more.
• More than three quarter (79.0%) of study subjects had more than two years inter pregnancy interval, and rest of them (21.0%) had lessthan two years interval.
• Almost three quarters (76.0%) had no previous history of abortion while only 15.5% & 8.5% had one and two or more abortion respectively.
C.Previous & recent pregnancy history
• Almost two third (67.5 %) had no previous history of complication during pregnancy while26.2%, 33.8% and63.1 % of them complained from Bleeding, Hypertension and eclampsia, PROM, anemia, Gestational diabetes, hyperemesis during previous pregnancy respectively.
• Almost two third (64.4 %) of study subject were cesarean-section in previous delivery, whilenearly one third (35.6 %) of them had previous vaginal delivery.
• The majority (90.0%) of study subjects had no previous delivery complications, while the rest of them had complication during delivery as pre mature labor, bleeding and hypertension.
• Nearly two third (62.0%) of study subject had cesarean-section, whereas three quarter (72.6%) of them had spinal anesthesia.
• The majority (93.5%) of study subjects had no complication during current delivery, only about(6.5%) had t complication during current delivery.
F. Infant general characteristics:
• Nearly one half (48.5%) of infants of thestudy subjectswere boys, compared to (50.5%) of them their infant sex were female.
• In addition (60.0%) and (61.5%) of infants of thestudy subjects were full-time, weighing 2500 gramsrespectively.
• Almost one thirds of postnatal women; number oftheir infants (32.0% &33.5% and (34.5%) were one, two and three or more.
• The majority (84.0%) of the study subjects had no still birth infant.
E.Current breast feeding technique
• About half (50.5%) of the study subjects initiate breastfeeding during the first day of birth compared to only (12.0%) of them initiate breastfeeding after the first day of birth.
• As regard infant feeding immediately after delivery(37.0%) of study subjects ’infant tokeartificial feeding instead of breast milk compared to 20.0% and 29.5%receive Glucose 5% or herbals fluid respectively.
• More than half (56.0%) study subjects wash their breast with soap and water, while(38.5%) of themwash it with water only compared to only 1.5% wash their breast by baby wet towels.
• More than three quarter (76.0%) of the study subjects breastfeed their infant from both breasts compared to (24.0%) of them breastfeed their infant from one breast.
• Nearly two fifth (38.5%)of lactating mother were using the middle fingers and forefinger in the form of the letter (V), on other hand (22.0 %) of them were using C shape position to support both breasts.
• Nearly two third of them (62.5%) make correct latch on, in the contrary (27.5 %) of them do not makecorrect latch on.
• Only 10.0% of the study subjects received information about breastfeeding during antenatal follow-up.
II- Postpartum Social Support factors associated with breast problems among lactating puerperal women
A- Social Support received from Health care provider
• Only (19.0%) of Health care provider always encourage the mother to start breastfeeding through an hour after delivery while (65.0%) never do it.
• Only (10.0%) of Health care provider; alwaysgive the mothers information about BF position while most of them (80.0%) never given any information about it.
• The majority (82.5%) of health care provider don’t give the study subject any advice when breast problem occurred who they deal with it while the remaining (7.5%) always help them.
• More than three quarter (79.0%) of the subjects do not received any teaching session regarding this topic. In the contrary, only (12.5%) of them received it.
• The majority of (84.5%) of study participants received low support for breastfeeding from a healthcare professional compared to only 4.5% and 11.0% of them received moderate to high support for breastfeeding, respectively.
B-Social Support received from Parent / Peer support
• More than half (57.5%) of the study subjects always receivesupport from their the mother and/or husband to continue breastfeeding while only (6.5%) do not receivesupport.
• Regarding the total score of the family support (Parent / husband/ Peer support) About two thirds of (63.5%) of study participants received high total score of family support (Parent / husband/ Peer support), while(29.0%) and (7.5%)of them received moderate to low support for breastfeeding, respectively.
III-Postpartum emotion distress associated with breast problems among lactating puerperal women
• Exactly one half (50.0%) of the subjects sometimes felt anxious when there was insufficient amount ofmilk in early days of breastfeeding, while nearly one quarter 24.5% often felt that.
• More than half (53.5%) sometimes Feeling stress and tension during pureperium and breastfeeding period.
• Nearly one half (45.0%) of the study subjects sometimeshave confidence to deal with breast problems like nipple trauma, nipple pain or cracking they can manage breast problems, while (16.5%) rarely have that.
• One half (50.5 %) of the study subjects sometimecoping with minor discomfort likeafter pain, while only 20.0% rarely coping with it.
• One half (47.5%) sometime can arrange their life to adapt with breastfeeding, in the contrary 31.0% often do this.
• Nearly one half (44.0%) of study subjects sometime stopped breastfeedingwhen breast problem occurred.
• Two thirds of (61.5%) of study participants experienced high emotional distress,while (38.5%) of them experienced low emotional distress during breastfeeding,.
IV- Postpartum women’ self-efficacy associated with breast problems among lactating puerperal women:
• More than three quarter (76.5% & 75.5%) of mothers cannot determine if my baby gets enough milkand consider it as a challenge in theirlife while breastfeeding, while only (13.0%&8.5%) of them alwayscan determine it respectively.
• More than half (59.0%) of study subject never wash breast before breastfeeding, in the contrary only (8.0%) always do that.
• More than three quarter (65.0%) of the study subjects never breastfeed continuously according to demand. Compared to (10.5%) always do that.
• The majority (81.5%) of study subjects never make sure that their baby make good latch on compared to 16.0% of them sometimes be sure.
• More than three third (75.0 %) of subjects never breastfeed in present of family member especially male. While only 6.5% of them always can do that.
• About four fifths (80.5%) of study subjects had Low breastfeeding self-efficacy while, (19.5%) of them had high breastfeeding self-efficacy during breastfeeding.
Recommendations:
Based on the findings of the present study, the following recommendations are suggested:
1- There is an urgent need to design periodic educational training programs to improve knowledge, skills of health care providers about breastfeeding practices as well as to improve their performance.
2- Clear job description should be made for health care providers who work as generally and in antenatal clinic specifically to update their knowledge and skills about breastfeeding and who to prevent breastfed mothers from breast problems.
For further researches:
1- Descriptive studied should be conducted to determine the factors associated with breast problems among puerperal lactating women in different settings.
2- Replication of the same study in different Egyptian governorates especially rural and upper Egypt to compare and validate the present study findings.
3- Health care providers knowledge, attitude and practices about BF toward increase health care providers support at antenatal clinics.