Postpartum Acupressure Education and Breastfeeding Outcomes

Exclusive breastfeeding for the first 6 months and continued breastfeeding up to 12 months are strongly associated with improved maternal and infant health outcomes. Despite widespread implementation of Baby-Friendly Hospital Initiative practices, early postpartum challenges often compromise breastfeeding continuation. Scalable, low-cost, self-care-based interventions that enhance maternal confidence and perceived control may support sustained breastfeeding.

This study is a two-arm, parallel-group, randomized controlled trial designed to assess the effectiveness of postpartum acupressure education as an adjunct to standard breastfeeding care. Eligible mothers will be randomized in a 1:1 ratio to either an acupressure education plus standard care group or a standard care-only group. Acupressure education will include face-to-face instruction, printed visual materials, and a short instructional video, focusing on the acupoints CV17 (Shanzhong), ST18 (Rugen), SI1 (Shaoze), ST36 (Zusanli), and SP6 (Sanyinjiao).

The primary outcome is the rate of exclusive breastfeeding at 6 months postpartum, defined according to World Health Organization criteria. Secondary outcomes include any breastfeeding at 12 months, breastfeeding self-efficacy, breastfeeding quality, timing of complementary feeding introduction, breastfeeding-related adverse events, and maternal satisfaction. Analyses will be conducted using an intention-to-treat approach.

• Postpartum Acupressure Education Program (Other): Structured education on self-administered acupressure provided within 48 hours postpartum, including face-to-face instruction, printed visual materials, and a short instructional video. Participants are instructed to apply acupressure at specified points twice daily at home according to the study protocol.

Primary outcomes

• Exclusive breastfeeding rate at 6 months postpartum [At 6 months postpartum]: Proportion of participants exclusively breastfeeding at 6 months postpartum, assessed by maternal self-report using 24-hour recall with additional validation questions, consistent with World Health Organization definitions.

Secondary outcomes

• Any breastfeeding rate at 12 months postpartum [At 12 months postpartum]: Proportion of participants providing any breast milk at 12 months postpartum.
• Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) score [Baseline (≤48 hours postpartum), 1, 3, 6, and 12 months postpartum]: Total score on the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). The scale consists of 14 items rated on a 5-point Likert scale (1-5), yielding a total score ranging from 14 to 70, with higher scores indicating greater breastfeeding self-efficacy.
• Breastfeeding quality score (LATCH) [Baseline (≤48 hours postpartum) and 1 month postpartum]: Breastfeeding quality assessed using the LATCH breastfeeding assessment tool. The LATCH score consists of 5 components (Latch, Audible swallowing, Type of nipple, Comfort, Hold), each rated from 0 to 2, yielding a total score ranging from 0 to 10. Higher scores indicate better breastfeeding performance.
• Maternal breastfeeding satisfaction score [1 month, 3 months, 6 months, and 12 months postpartum]: Maternal self-reported satisfaction with the breastfeeding experience, assessed using a single-item numeric rating scale ranging from 0 to 10, where higher scores indicate greater breastfeeding satisfaction.
• Time to introduction of complementary feeding [From birth up to 12 months postpartum]: Time from birth to first introduction of any food or liquid other than breast milk, as reported by the mother.
• Bottle or pacifier use [1 week, 1 month, 3 months, 6 months, 9 months, and 12 months postpartum]: Maternal report of any bottle feeding and/or pacifier use by the infant.
• Breastfeeding-related adverse events [From baseline through 12 months postpartum]: Incidence of mastitis, plugged ducts, and breastfeeding-related healthcare visits.

Sex: Female, ages: 18 Years to 45 Years, accepts healthy volunteers

Inclusion Criteria:

* Age 18 to 45 years
* Term singleton birth (≥37 weeks of gestation)
* ≤48 hours postpartum at the time of enrollment
* Intention to breastfeed
* Ability to communicate in Turkish
* Access to a smartphone for educational materials and follow-up reminders
* Willingness to provide written informed consent

Exclusion Criteria:

* Contraindications to breastfeeding (e.g., infant galactosemia)
* Severe neonatal condition preventing breastfeeding
* Severe maternal medical or psychiatric condition interfering with breastfeeding
* Current opioid, alcohol, or substance dependence
* Multiple gestation pregnancy
* Severe breast injury or condition within the first 72 hours postpartum preventing breastfeeding