Time-Specified Marmet Technique on Early Lactation Among Mothers After Cesarean Section: A Randomized Controlled Trial

Abstract

Background:

Cesarean birth is often associated with delayed milk onset and reduced early milk volume. Although the Marmet technique is widely used to stimulate milk flow, its original form does not specify the duration for each step, which could affect consistency and effectiveness.

Research aim:

To evaluate the effectiveness of a time-specified Marmet technique on the onset of milk flow and early milk production during the first 4 postpartum days.

Methods:

A randomized controlled trial was conducted in a postpartum unit in northern Thailand. Eighty-four mothers were randomly assigned to an intervention group receiving bedside instruction in the time-specified Marmet technique or a control group receiving routine breast-massage advice. Daily milk volume, expression frequency, and onset of milk flow were recorded from postoperative Day 1 to 4. Between-group comparisons used Mann–Whitney U and χ² tests.

Results:

The intervention group showed an earlier onset of milk flow (p = .022) and a greater total human milk volume (p = .002) than the control group. In exploratory analyses, day-specific target attainment on Days 2 to 4 correlated moderately with total volume (ρ = 0.47–0.52; all p < .01), whereas expression frequency did not (ρ = 0.08; p = .45).

Conclusion:

Applying fixed time limits to each step of the Marmet technique enhances early milk production. This time-structured approach aligns maternal behavior with lactation reflexes and provides a simple, low-cost framework for nurse-led lactation counseling.