Marmet and Oxytocin Massage for Breast Milk Increase (RCT)

Ege University

Status: Begins enrollment this month

Conditions: Healhty

Treatments: Other: Plasebo; Other: Oxytocin Massage; Other: Marmet Technique

Study type: Interventional

Funder types: Other

Identifiers

NCT07077655

EgeUniAYalc001

Details and patient eligibility

About

This study is designed as a randomized controlled single-blind experimental study to examine the effectiveness of the oxytocin massage and Marmet technique applied to mothers who have undergone cesarean section on breast milk quantity and maternal state anxiety levels. The hypotheses of the study are as follows:

H0.1. There is no difference in the amount of breast milk among mothers in the Marmet technique, oxytocin massage, and control (placebo) groups.

H1.1. There is a difference in the amount of breast milk among mothers in the Marmet technique, oxytocin massage, and control (placebo) groups.

H0.2. There is no difference in the state anxiety scale scores among mothers in the Marmet technique, oxytocin massage, and control (placebo) groups.

H1.2. There is a difference in the state anxiety scale scores among mothers in the Marmet technique, oxytocin massage, and control (placebo) groups.

Participants:

Marmet technique, oxytocin massage, and control (placebo) groups will be informed about the study and asked to provide their consent. Participants will complete the descriptive questionnaire. Colostrum status will be checked and marked as "present" or "absent" on the "Breast Milk, Vital Signs, and Pain Level Form." Under researcher supervision, the mother will breastfeed her baby. Afterward, the State Anxiety Inventory will be administered.

Two hours later, mothers will express milk using a hospital-grade pump, with 15 minutes on each breast (total 30 minutes). Milk volume, vital signs, pain levels, and milk flow rate will be recorded on the relevant form. Following this, mothers in the Marmet group will receive 10 minutes of the Marmet technique, mothers in the oxytocin group will receive 5 minutes of oxytocin massage, and mothers in the control group will receive 5 minutes of light touch on their wrists and shoulders. Immediately after, milk expression will again be performed with 15 minutes per breast (30 minutes total). The State Anxiety Inventory will be re-administered, and milk amount, vital signs, pain levels, and flow rate will be recorded again.

All mothers will express milk using a hospital-grade breast pump, and the expression duration is standardized as 15 minutes per breast (30 minutes total) based on the literature. Two expressions will be performed - one before and one immediately after the intervention. Expressed milk will not be discarded and will instead be used to feed the babies via spoon or syringe under the researcher's supervision.

Full description

This randomized controlled, single-blind experimental study aims to explore the physiological and psychological outcomes of two non-pharmacological breast stimulation techniques-oxytocin massage and the Marmet technique-on mothers who have undergone cesarean delivery. Specifically, the study investigates their effects on breast milk volume and maternal state anxiety levels during the early postpartum period.

Breastfeeding challenges are more commonly observed following cesarean deliveries due to delayed lactogenesis II, postoperative pain, mother-infant separation, and increased maternal stress. Non-invasive breast stimulation methods, such as the Marmet technique (which includes a structured pattern of massage, compression, and milk expression by hand) and oxytocin massage (which involves light tactile stimulation of the upper back and shoulders to promote oxytocin release), may provide physiological and psychological benefits to these mothers. This study systematically evaluates the efficacy of these techniques within a controlled hospital setting using standardized procedures.

Breast milk expression will be standardized using a hospital-grade electric pump, with a fixed pumping duration of 15 minutes per breast. Milk volume will be measured using calibrated collection containers provided with the pump. Vital signs (e.g., heart rate, blood pressure), self-reported pain levels (via Visual Analog Scale), and observed milk flow rate (rated as slow, moderate, or fast) will be recorded at each session.

Psychological impact will be assessed using the State-Trait Anxiety Inventory (STAI), focusing on the state anxiety subscale. This tool is a validated measure to assess transient anxiety responses under stress or in new environments, such as hospitalization or breastfeeding initiation after surgery.

The oxytocin massage protocol consists of light, rhythmic touch applied to the mother's upper arms, shoulders, and back for 5 minutes, aiming to stimulate endogenous oxytocin release through sensory nerve activation. The Marmet technique, applied for 10 minutes, follows a structured sequence of circular breast massage, downward milk movement, and manual expression techniques. The control group will receive light touch (5 minutes) applied to non-breast-related areas (wrists and shoulders) without known physiological effects on lactation or oxytocin release.

Post-intervention, mothers will perform a second round of milk expression under the same standardized conditions. Milk will not be discarded but will be fed to the infant using a spoon or syringe under researcher supervision, in accordance with neonatal nutrition safety standards.

This study is designed not only to measure lactation outcomes but also to consider maternal comfort and emotional state during the early postpartum phase, recognizing the interconnected nature of physiological milk production and maternal mental well-being. This study utilizes evidence-based lactation assessment methods and validated psychological scales. Data will be analyzed using IBM SPSS 20.0. Within-group and between-group comparisons will be conducted using paired t-tests and one-way ANOVA where appropriate. The study is approved by the relevant ethics committee and will adhere to Good Clinical Practice (GCP) guidelines.

Enrollment: 123 estimated patients

Sex: Female

Ages: 18 to 35 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Aged between 18-35 years
• Literate
• Fluent in Turkish
• Volunteering to participate in the study
• Primiparous (first-time mothers)
• Within the first 2 hours postpartum (mothers performing their first breastfeeding under researcher supervision)
• Have a single baby with an appropriate birth weight for gestational age (>2500 gr)
• Have their baby with them
• Received spinal anesthesia
• Neither the mother nor the baby has any acute or chronic illness
• Exclusively breastfeeding their baby
• Had a term (37 weeks gestation or more) and cesarean delivery
• Experienced no complications after the cesarean section
• No issues preventing breastfeeding
• Willing to breastfeed

Exclusion criteria

• Are under 18 or over 35 years old
• Are multiparous (have given birth before)
• Are encountered more than 2 hours postpartum
• Received general anesthesia
• Have any acute or chronic illness themselves or their baby
• Have conditions requiring mother and baby to be separated
• Report experiencing severe pain
• Formula-feed their baby or consume any milk-increasing medication or tea
• Gave birth before 37 weeks gestation or had a vaginal delivery
• Have an anatomical breast issue (absence of nipple, inverted nipple)
• Have swelling, ecchymosis, or wounds on their back (for the oxytocin massage group)
• Have a baby with a congenital anomaly
• Have an issue preventing breastfeeding
• Have a psychological issue
• Are unwilling to breastfeed

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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123 participants in 3 patient groups, including a placebo group

ARM1 (Marmet)

Active Comparator group

Description:

One of the traditional and natural methods mothers can use to facilitate breast milk production after childbirth is the Marmet technique. Ensure hand hygiene and make sure the hands are warm. Ask the mother to remove her clothing/bra (assistance will be provided at this stage). Gently stroke the breast downward toward the nipple to trigger the let-down reflex. Starting from the armpit, move toward the breast, continuing the massage with circular finger movements around and toward the nipple. Ask the mother to lean forward slightly to allow gravity and gentle breast shaking to create mild vibrations and facilitate milk flow and drainage. After the procedure, assist the mother in adjusting her position assist the mother in adjusting her position and help her get dressed. Perform hand hygiene again. This procedure will be performed for 5 minutes on each breast, totaling 10 minutes, to ensure the technique is effective and standardized according to the literature.

Treatment:

Other: Marmet Technique

ARM2 (Oxct.)

Active Comparator group

Description:

Oxytocin massage is a technique applied to increase breast milk production. In this study, the following steps will be followed when performing oxytocin massage (Sari et al., 2017): Ensure hand hygiene and make sure the hands are warm. Ask the mother to remove her clothing/bra (assistance will be provided at this stage). Position the mother in a comfortable way (since all mothers in the oxytocin massage group will be within the first 2 hours post-cesarean, they will be positioned in bed, and if necessary, supported with pillows or rolled sheets). Using both thumbs facing forward, apply massage from the spine to the area beside the fifth and sixth ribs in a clockwise direction, first downward then upward. After the massage, gently wipe the mother's back with a paper towel (if she expresses discomfort). Assist the mother in adjusting her position and help her get dressed. Perform hand hygiene again. The massage will be applied for 3 minutes.

Treatment:

Other: Oxytocin Massage

ARM3 (Plasebo)

Placebo Comparator group

Description:

A light touch will be applied to the women's wrists, elbows, and shoulders.

Treatment:

Other: Plasebo