[2026-11-04] Effectiveness of the 3H (Herb Heat Hand)  Breast Compress on Breast Engorgement and Breastfeeding Outcomes Among Postcesarean Mothers

Rattanaporn Niwasanon; Naruemol Angsirisak; Warunee Parai

doi:10.33165/rmj.2028.e282825

Authors

Rattanaporn Niwasanon Department of Maternal-Newborn and Midwifery, Faculty of Nursing, Siam University, Bangkok, Thailand
Naruemol Angsirisak Department of Maternal-Newborn and Midwifery, Faculty of Nursing, Siam University, Bangkok, Thailand https://orcid.org/0000-0002-0775-7343
Warunee Parai Department of Maternal-Newborn and Midwifery, Faculty of Nursing, Siam University, Bangkok, Thailand

DOI:

https://doi.org/10.33165/rmj.2028.e282825

Keywords:

Breastfeeding, Cesarean section, Complementary therapies, Postpartum period

Abstract

Background: Postpartum breast engorgement commonly interferes with breastfeeding, particularly among postcesarean mothers who often experience delayed lactogenesis, postoperative pain, and fluid overload.

Objective: To evaluate the effectiveness of the 3H (Herb Heat Hand) breast compress in reducing breast engorgement and improving breastfeeding outcomes among postcesarean mothers.

Methods: A quasi-experimental study with a nonequivalent control group pretest-posttest design was conducted in a provincial hospital in Thailand from March 2024 to November 2024. Sixty postcesarean mothers were recruited through purposive sampling and assigned to an experimental group receiving the 3H breast compress (n = 30) or a control group receiving routine nursing care (n = 30). The 3H intervention combined Herb (herbal compress), Heat (moist heat at 40 °C to 45 °C), and Hand (a manual pressing-and-lifting technique performed with the compress on the breast). Breast engorgement was operationalized through clinical indicators (breast pain, breast hardness, and milk flow). Additional outcomes included total nursing care time for the management of breast engorgement, and maternal satisfaction. Data were analyzed using descriptive statistics, independent t tests, Mann-Whitney U tests, and analysis of covariance.

Results: Compared with the control group, mothers receiving the 3H breast compress showed significantly greater milk flow (U = 30.00, Z = -6.405, P < .001) and required less total nursing care time for the management of breast engorgement (t = -13.02, P < .001). Breast pain and breast hardness decreased in both groups, with no significant between-group differences after adjustment for baseline values. Satisfaction with the 3H breast compress was high (mean [SD], 4.61 [0.54]).

Conclusions: The 3H breast compress is a feasible and practical nursing innovation that improves milk flow and reduces total nursing care time for the management of breast engorgement among postcesarean mothers. Its integration into routine postpartum care may enhance breastfeeding support.

References

1. Nguyen NT, Do HT, Pham NTV. Barriers to exclusive breastfeeding: a cross-sectional study among mothers in Ho Chi Minh City, Vietnam. Belitung Nurs J. 2021;7(3):171-178. doi:10.33546/bnj.1382

2. Roghair R. Breastfeeding: benefits to infant and mother. Nutrients. 2024;16(19):3251. doi:10.3390/nu16193251

3. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490. doi:10.1016/S0140-6736(15)01024-7

4. Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012;95(5):1113-1135. doi:10.3945/ajcn.111.030254

5. Tharana N. Promoting and supporting breastfeeding in postpartum mothers with cesarean section. Nursing Journal CMU. 2021;48(4):324-335.

6. Phon-Ngam K, Mankong R. The effects of hot moist gel pack breast compression combined with nipple stimulation on the onset of milk ejection and milk flow among cesarean section mothers with sick babies. TRC Nurs J. 2021;14(1):156-169.

7. Dhippayom T, Kongkaew C, Chaiyakunapruk N, et al. Clinical effects of Thai herbal compress: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015;2015:942378. doi:10.1155/2015/942378

8. Worasing K, Sungthong B, Phimarn W. Effectiveness of Zingiber montanum herbal compress remedy for pain management: an updated systematic review and meta-analysis. Sci Pharm. 2023;91(2):24. doi:10.3390/scipharm91020024

9. Kongma B, Putip P, Phanit P. Effect of Self Breast Massage Using Herbal Gloves on Pain Relief in Postpartum Mother. Master’s thesis. Ubon Ratchathani Rajabhat University; 2017.

10. Meng S, Deng Q, Feng C, Pan Y, Chang Q. Effects of massage treatment combined with topical cactus and aloe on puerperal milk stasis. Breast Dis. 2015;35(3):173-178. doi:10.3233/BD-150401

11. Khosravan S, Mohammadzadeh-Moghadam H, Mohammadzadeh F, Fadafen SA, Gholami M. The effect of hollyhock (Althaea officinalis L) leaf compresses combined with warm and cold compress on breast engorgement in lactating women: a randomized clinical trial. J Evid Based Complementary Altern Med. 2017;22(1):25-30. doi:10.1177/2156587215617106

12. Ketsuwan S, Baiya N, Paritakul P, Laosooksathit W, Puapornpong P. Effect of herbal compresses for maternal breast engorgement at postpartum: a randomized controlled trial. Breastfeed Med. 2018;13(5):361-365. doi:10.1089/bfm.2018.0032

13. Trainapakul C, Chaiyawattana M, Kanavitoon W, et al. Effect of milk ejection performance of postpartum mothers after breast massage and compression with mini hot bag and herbal compress. Journal of Nursing and Education. 2010;3(3):75-91.

14. Pinyapirom P, Sinsuksai N, Phahuwatanakorn W. The effect of breast compression with warm moist cloth on the first milk secretion among primiparous mothers with cesarean section. Nurs Sci J Thai. 2023;41(2):93-104.

15. Chiu JY, Gau ML, Kuo SY, Chang YH, Kuo SC, Tu HC. Effects of Gua-Sha therapy on breast engorgement: a randomized controlled trial. J Nurs Res. 2010;18(1):1-10. doi:10.1097/JNR.0b013e3181ce4f8e

16. Becker GE, Smith HA, Cooney F. Methods of milk expression for lactating women. Cochrane Database Syst Rev. 2016;9(9):CD006170. doi:10.1002/14651858.CD006170.pub5

17. Cash JC, Drummond S, Reed CC. Postpartum breast engorgement. In: Cash JC, Glass CA, eds. Family Practice Guidelines. 4th ed. Accessed 15 September 2026. Springer Publishing Company; 2017.

18. Guerra J. ILCA news brief: clinical guidelines for the establishment of exclusive breastfeeding, 4th edition. J Hum Lact. 2024;40(3):476. doi:10.1177/08903344241252646

19. Dumrongwongsiri O, Winichagoon P. Update knowledge in breastfeeding and its applicability in Thailand. Journal of Nutrition Association of Thailand. 2020;55(2):15-28.

20. Jiratchaikul R. Effect of the online breastfeeding self-efficacy promotion program in post-cesarean section mothers at Health Promotion Center 5 Hospital, Ratchaburi. Thailand Journal of Health Promotion and Environmental Health. 2024;47(Suppl):S40-S52.

21. Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice. 11th ed. Wolters Kluwer; 2021. Accessed 15 September 2026. https://nursology.net/resources/books/nursing-research-generating-and-assessing-evidence-for-nursing-practice

22. Anggraini YD, Rahmawati RSN, Indriani R, Sendra E. The effectiveness of herbal ingredients to relieve breast engorgement: literature review. HEALTHY : Jurnal Inovasi Riset Ilmu Kesehatan. 2022;1(4):176-191. doi:10.51878/healthy.v1i4.1674

23. Alshakhs FH, Katooa NE, Badr HA, Thabet HA. The effect of alternating application of cold and hot compresses on reduction of breast engorgement among lactating mothers. Cureus. 2024;16(1):e53134. doi:10.7759/cureus.53134

24. El-Saidy TMK, Aboushady RMN. Effect of two different nursing care approaches on reduction of breast engorgement among postnatal women. J Nurs Educ Pract. 2016;6(9):18-27. doi:10.5430/jnep.v6n9p18

25. Nagel EM, Howland MA, Pando C, et al. Maternal psychological distress and lactation and breastfeeding outcomes: a narrative review. Clin Ther. 2022;44(2):215-227. doi:10.1016/j.clinthera.2021.11.007