Effects of Traverse Bed Sheet Innovation to Promote Breastfeeding on Maternal-Infant Bonding and Attachment, Milk Flow, and Breastfeeding Success in Mothers after Cesarean Section

Abstract

Introduction Cesarean section affects maternal breastfeeding and serves as a major barrier to successful lactation. Specifically, it impedes early breastfeeding initiation within the crucial first hour postpartum and suppresses maternal-infant bonding. The application of a Traverse Bed Sheet Innovation allows mothers after cesarean section to engage in skin-to-skin contact immediately upon admission, thereby fostering maternal-infant attachment, facilitating prompt and sustained breastfeeding initiation, and promoting breastfeeding success.

Objective This study aimed to examine the effects of Traverse Bed Sheet Innovation in promoting maternal breastfeeding on maternal–infant bonding, the level of breast milk flow, and the success of breastfeeding prior to hospital discharge.

Design This study employed a quasi-experimental, posttest-only design with two groups. The intervention integrated concepts including breastfeeding positioning for mothers following cesarean section, the physiology of lactation and milk secretion, and the promotion of maternal–infant bonding through skin-to-skin contact. These were combined to enhance breastfeeding initiation and continuity during the first 24 hours postpartum.

Methodology The study participants comprised postpartum mothers who had undergone cesarean section and were admitted to the postpartum ward of a general hospital in a southern province between July and October 2024. Participants were purposively selected according to inclusion criteria: aged 20–45 years, full-term pregnancy, no postoperative complications, normal breast and nipple anatomy, and full-term newborns with a birthweight of 2,500–3,999 grams, with no sucking or swallowing difficulties, and no tongue-tie. All participants provided informed consent. Sample size was determined with a significance level (α) of .05, statistical power of .80, and effect size of 0.8, yielding a total of 60 participants randomly assigned to the experimental group (n = 30) and the control group (n = 30). The research instrument was the Traverse Bed Sheet Innovation for breastfeeding support. This bed sheet was designed with a slot for inserting a pillow to support the infant’s trunk and an additional cloth to wrap the infant and secure mother–infant positioning. The innovation facilitated alignment of the infant at the level of the maternal nipple, reduced maternal movement and pressure at the surgical site, and enabled breastfeeding in modified supine and side-lying positions while promoting skin-to-skin contact in the immediate postpartum period. Data collection instruments included: (1) personal and obstetric data questionnaire, (2) maternal–infant bonding assessment scale, (3) breast milk flow assessment scale, and (4) breastfeeding success assessment scale prior to hospital discharge. Content validity was examined by three breastfeeding experts, yielding content validity indices of 1.00 for both the milk flow and breastfeeding success scales. Interrater reliability was established between the researcher and ward nurses using Weighted Cohen’s kappa, with values of .80 for both scales, based on 15 mothers with similar characteristics to the study sample. The maternal–infant bonding scale demonstrated a Cronbach’s alpha coefficient of .88. Data collection was conducted by providing the experimental group with the Traverse Bed Sheet Innovation in conjunction with routine nursing care, promoting skin-to-skin contact and breastfeeding initiation within the first 24 hours postpartum every 2–3 hours for 10–15 minutes per breast. The control group received routine nursing care without innovation. Data analysis employed descriptive statistics for demographic information. Maternal–infant bonding was compared using Independent t-test, breast milk flow using Mann–Whitney U test, and breastfeeding success before discharge using Fisher’s exact test.

Results The majority of participants were aged 25–29 years (35.00%). Post-intervention comparisons revealed that the experimental group demonstrated significantly higher maternal–infant bonding scores (M = 109.53, SD = 11.85) than the control group (M = 77.30, SD = 12.06), with statistical significance (t =10.440, p < .001). Breast milk flow levels on Day 1 (M =1.57, SD = .77), Day 2 (M = 2.43, SD = .63), and at hospital discharge (M = 2.87, SD =.57) were significantly higher in the experimental group compared to the control group (M =.90, SD =.48; M = 1.50, SD = .51; M = 2.23, SD =.63) (p < .001). Breastfeeding success before discharge also differed significantly between groups (p = .009), with the experimental group 13.57 times more likely to achieve successful breastfeeding than the control group (95% CI: 1.63–113.16).

Recommendation The findings of this study indicate that the Traverse Bed Sheet Innovation, when combined with routine nursing care for mothers following cesarean section, effectively enhances maternal–infant bonding, promotes breast milk flow, and increases the likelihood of successful breastfeeding before hospital discharge. Health care personnel responsible for caring for mothers after cesarean may apply this innovation to promote breastfeeding practices more efficiently.