Abstract / Summary
Introduction: Breastfeeding adequacy following caesarean section is often compromised due to physiological and psychological stressors that disrupt early lactation. Conventional interventions primarily focus on technical and educational support, with limited attention to psychophysiological processes influencing milk ejection. Aim: To assess the effectiveness of combined back massage and affirmation-based relaxation intervention on breastfeeding adequacy among post-caesarean mothers. Materials and Methods: A quantitative evaluative approach using a quasi-experimental two-group pre-test–post-test design was employed to conduct the study in the Obstetrics and Gynaecology wards of a secondary-level hospital in Uttar Pradesh, India, from October 2022 to March 2023. Among 220 post-caesarean mothers in a secondary-level hospital in India. Post-caesarean (n=220) mothers were allocated to experimental (n=110) and control (n=110) groups. The intervention consisted of structured back massage combined with guided affirmation relaxation, administered four times daily over three days. Primary outcomes included let-down reflex and breast milk secretion, while secondary outcomes comprised proxy indicators of breastfeeding adequacy (urination, stool frequency, satiety, and breastfeeding behaviour). Data were analysed using non parametric tests, ordinal logistic regression, and Analysis of Covariance (ANCOVA). Results: The intervention group demonstrated substantially greater improvements in let-down reflex (Δ=2.60 vs. 1.19) and breast milk secretion (Δ=5.81 mL vs. 3.01 mL) compared to controls (p<0.001). Secondary outcomes also improved significantly, indicating enhanced feeding adequacy. Adjusted analyses (ordinal regression and ANCOVA) further strengthened these findings, supporting an association between the intervention and improved lactation outcomes beyond baseline differences. Improvements occurred concurrently across physiological and functional domains, supporting a psychophysiological pathway of lactation response. The overall pattern is consistent with a psychophysiological mechanism linking maternal stress modulation and lactation response. Conclusion: A structured psychophysiological intervention is associated with improved breastfeeding adequacy among post-caesarean mothers, providing evidence for integrating psychophysiological approaches into postnatal lactation care. Its feasibility, low cost, and compatibility with nursing care highlight its potential for integration and scale-up in routine postnatal settings.