Effect of Banana Stem Supplementation on Serum Prolactin Levels among Postnatal Mothers: A Pilot Study

Pinky Devi Phougeishangbam1, Imran Khan1*, M. Rameshwar Singh2

1Sharda School of Nursing Sciences & Research, Sharda University, 201306 Greater Noida, India

2Department of Obstetrics and Gynae, RIMS Hospital, 795004 Imphal West, India

*Corresponding Author’s Email: Imran.khan8@sharda.ac.in

ABSTRACT

Background: Breastmilk is an ideal food for newborns. Healthcare experts continuously advise exclusive breastfeeding for six months. However, many women are unable to follow due to numerous challenges during the postnatal period, and lower breastmilk production is one among them. The study aims to identify the impact of a banana stem diet on blood prolactin level (BPL) among postnatal mothers and assess the level of satisfaction after nursing care. Methods: A quasi-experimental pilot study was conducted among 20 post-natal mothers. A 4th-day postnatal mother who delivered their baby vaginally was included in the study. Data collection was done in two phases – Phase 1 was the screening, and Phase 2 was the follow-up at the residence of the mothers. The Blood Prolactin Level (BPL) was measured on the 4th day and 12th days following childbirth in both groups. The experimental group received a banana stem diet for one week, while mothers in the control group consumed their usual diet. Results: The majority 4(40%) were under the age group of 21-25 years in the intervention group and 6(60%) were under the age group of 26-30 years in the control group. The majority 5 (50%) and 6(60%) of the mothers were primigravida in both groups. The mean value of blood prolactin level had increased by 153.2 ng/ml, p=0.001, with a high effect (Cohen’s d = 3.29) in the intervention group whereas in the control group, it increased by 21.4 ng/ml, p=0.080. with moderate effect (Cohen’s d =0.56). 70% of the mothers were satisfied with the nurse support during the time of study. Conclusion: The findings suggest that banana stem supplementation may enhance blood prolactin levels during the postnatal period, while the supportive presence of nurses reassures mothers, facilitating effective postpartum recovery and newborn care.

Keywords: Banana Stem Diet; Blood Prolactin Level (BPL); Lactation; Nursing Support; Postnatal Mother

INTRODUCTION

The World Health Organization (WHO, 2020) recommends exclusive breastfeeding continuously for at least six months of newborn life. According to the World Health Organization (2023) facts report, only 44% of newborns were exclusively breastfed, indicating that the majority of infants were not breastfed up to six months (Infant and young child feeding, 2023). Studies have identified that a lack of awareness and inadequate facilities in the work environment are significant barriers to exclusive breastfeeding (Al-Katufi et al., 2020; Ramani et al., 2019). The lactation process normally starts on day 4 or day 5 postpartum (Lawrence & Lawrence, 2008; Shah et al., 2024); however, many postnatal mothers face problems in breastfeeding due to less milk production. While nurturing the newborns, postnatal mothers face many challenges, such as mental stress (Maehara et al., 2017), depressed mood (Sharkey et al., 2016) and irritation of mothers, which are associated with failure in breastfeeding. Although there are effective pharmacological drugs available in the market to manage lactation problems, very few mothers take drugs. Many mothers cannot afford the cost and to overcome this issue, they opt for bottle feeding; further, it causes complications such as infection in the newborn. The banana stem diet is perfect for postnatal mothers and has galactagogue properties that enhance breast milk production (Gabay, 2002; Heryani et al., 2024; Yimyam et al., 2023; Yimyam & Pattamapornpong, 2022).

Breastmilk is the best food for newborns. Nutrition requirements during pregnancy and lactation increase (Harding, 1993) and postnatal mothers face breastfeeding problems due to various factors. Pituitary prolactin hormone (hPRL) levels in the blood stimulate breast milk production during the postnatal period (Wray & Prendergast et al., 2021). The food made from bananas is one of the popular diets in the North-Eastern regions of India. Many postnatal mothers consumed banana stems or flowers for more milk production. Most of the mothers used cow milk as a substitute for breast milk and bottle feeding or artificial feeding, which causes health issues for the newborn (Brahm & Valdés, 2017) and mothers adopt it as they don’t have any choice. It was identified that 8% of women stopped breastfeeding in less than one month of delivery and only 2% of the mothers continued breastfeeding till one year (Halken et al., 1995). A similar study in China & Somaliland found that many mothers were unable to maintain exclusive breastfeeding (Dong et al., 2022; Jama et al., 2020).

The commonest reason for not feeding their baby is due to less breastmilk secretion (Khasawneh & Khasawneh, 2017). Galactagogue foods have proven their effectiveness in enhancing breast milk during the lactation period (Buntuchai et al., 2017; Kumari et al., 2023). A Study has proven that the herbal galactagogue present in Moringa oleifera helps in breastmilk production (Fungtammasan & Phupong, 2021). A traditional diet prepared from the banana stem is easy to prepare, cost-effective, and affordable. Researchers strongly felt the need to systematically investigate the traditional diet and its benefits in breastmilk production. The study aims to find out the effects of the banana stem diet on blood prolactin levels among postnatal mothers. The banana stem diet is a popular diet among the tribes of northeastern India. This diet is consumed during the postnatal period in a belief that it enhances breastmilk production. While the practice of a banana stem diet during the postnatal period has been followed for decades in Manipur, India, there is a notable scarcity of similar research in European and other developed countries. Furthermore, very few studies on this practice have been documented in Southeast Asian nations.

Aim

To identify the impact of a banana stem diet on blood prolactin level (BPL) among postnatal mothers and assess the level of satisfaction after nursing care.

Objectives

1. To assess the pre-test and post-test blood prolactin levels among postnatal mothers in the Experimental and Control group.

2. To find out the association between pre-interventional prolactin level and selected demographic variables among postnatal mothers in the experimental and control groups.

3. To find out the level of satisfaction after nursing care by the postnatal mother regarding intervention among the experimental group.

Null Hypotheses

H01 : There is no significant difference between the pre-interventional and post-interventional mean BPL among postnatal mothers in the experimental and control groups.

H02: There is no significant association between the pre-interventional BPL with selected demographic variables among postnatal mothers in the experimental and control group.

Research/Alternative Hypothesis

H1 : There is a significant difference between the pre-interventional and post-interventional mean blood prolactin levels among postnatal mothers in the experimental and control groups.

H2: There is a significant association between the pre-interventional blood prolactin level with selected demographic variables among postnatal mothers in the experimental and control groups.

METHODOLOGY

Target Population

Postnatal mothers on the fourth day following delivery who are experiencing breastfeeding difficulties.

Accessible Population

All fourth-day postnatal mothers residing within the Imphal West district who are experiencing breastfeeding difficulties.

Study Design and Setting

A pilot study was conducted from February to March 2024, involving 20 postnatal mothers who underwent normal vaginal deliveries. A quasi-experimental design was employed, with data collection occurring in two phases. Phase one involved data collection within the postnatal ward, while phase two was conducted at participants' residences.

Inclusion Criteria

Day 4 postnatal mother who has a breastfeeding problem due to less breast milk production (Primi and multi para mother, normal vaginal delivery)

A mother who did not take any medicine for breast milk production is willing to participate.

Exclusion Criteria

Lower Segment Caesarean Section (LSCS) mothers with risk of bleeding or anaemia, those with psychiatric issues or refusal of consent, and mothers with newborn complications (special care, congenital anomalies, lactose intolerance, intrauterine death, or stillbirth) are considered high-risk in the postnatal period.

Data Collection Procedure

The researcher screened 30 postnatal mothers using a checklist which comprised 10 items related to breastfeeding failure and out of those mothers, 20 postnatal mothers were recruited. The banana stem was incorporated into the diet, and it was administered in the experiment group whereas control group took a normal diet. The study was supported by a similarly conducted at Indonesia and Thailand (Wahyuningsih et al., 2017;Yimyam & Pattamapornpong, 2022). A blood sample (2ml) was taken following all the aseptic techniques in a 2 ml syringe for serum prolactin on the 4th day and 12th day following delivery in both groups. It was taken in plain vial and carefully transferred to the diagnostic center. The Electrochemiluminescence Immunoassay (ECLIA) method assessed Blood Prolactin Levels (BPL). All the collected data was recorded carefully and entered in the Excel sheet, and confidentiality was maintained. The researcher took support from four accredited social health activity workers (ASHA) during the study.

Measurements

Normal BPL during lactation is between 200 – 400 ng/ml as per the University of California San Francisco, UCSF Health, 2024. In this study, the blood prolactin levels below 200 ng/ml was considered as low and above 400 ng/ml was considered as high.A structured maternal satisfaction scale (5-point Likert scale) which comprises of 10 items was used. The instrument was validated by eight experts, and reliability testing was conducted using Cronbach's alpha, yielding a value of 0.732. The score was classified as Strongly Disagree (SD)-1, Disagree (D)-2, Undecided (UD)-3, Agree (A) -4 and Strongly Agree (SA)-5. Item no 3, 8 & 10 were negative attitude-based questions, therefore reverse scoring was done (SD- 5, D – 4, UD – 3, A-2, SA -1). A score between 1-24 was considered as unsatisfactory and a score between 25-50 was considered as well-satisfied. Breastfeeding practice assessment and maternal satisfaction level were assessed on the 8th day of data collection.

Ethical Consideration

The researchers obtained ethical clearance from the Research Ethical Board Regional Institute of Medical Sciences (RIMS) Imphal, India, with reference number A/206/REB/Prop (FP) 207/135/13/2023 on 24th August 2023 and the study was also registered in the Clinical Trial Registry of India (CTRI), with reference number REF/2024/03/080585 on 24th August 2023.

RESULTS

The findings are presented in the tables and a description is added.

Table 1: Socio-demographic Profile of the Postnatal Mothers (N = 20)

Table 1 shows the summary of demographic characters- Most of the mothers were in the age group between 21 to 25 years 4 (50%) whereas in the control group, the majority were under the age group of 26-30 years which is 6 (60 %). In both groups all the participants had delivered babies at term (37 weeks and above) and the baby weight was above 2500 gm and also had normal nipple conditions. The majority 5 (50%) and 7 (70%) of the participants, have only one child in both the groups.

Table 2: Comparing the Pre-Test and Post-Test Levels of Blood Prolactin Level among Postnatal Mothers in Both Groups (N= 20)

Table 2 shows the effects on blood prolactin level after intervention. In the experimental group, the mean difference between pre-test and post-test BPL scores was 153.2 ng/ml, with a standard deviation of 14.9, a t-value of -8.49, a p-value of <0.001 and Cohen’s d = 3.29, which mean a high effect. In contrast, the control group showed a mean difference of 21.4 ng/ml, a standard deviation of 29.031, a t-value of -1.642, a p-value of <0.080 and Cohen’s d = 0.56, which is medium

Table 3: Association between experimental group pre-test level of Blood Prolactin level (BPL) with Demographic Profile (n =10)

a indicates that the finding is not statistically significant at level (p > 0.05)

Table 3 displayed data regarding an association between the participants and their blood prolactin levels. No statistically significant association was found between the pre-test BPL levels and the demographic profile in the experimental group.

Table 4: Association between Control Group pre-test Level of Blood Prolactin Level (BPL) with Demographic Profile (n=10)

a indicates that the finding is not statistically significant at level (p > 0.05)

Similarly, table 4 revealed no statistically significant association was observed between the control group's pre-test BPL levels and their demographic profile.

Table 5: Distribution of Mothers According to Maternal Satisfaction Score Component Responses(n=10)

Table 5 displayed regarding maternal level of satisfaction on nursing support. The majority 80% of the mother were very much comfortable with the traditional diet. All the participants expressed satisfaction with the nursing care, and 70 % of them strongly expressed comfortable and satisfied on the supportive care provided by the Nurse. The overall result was found to be 3.99±0.65 which indicates that the mothers were satisfied on this traditional practice as well as they are comfortable with the Nursing support.

DISCUSSION

This pilot study successfully explored the feasibility of using banana stem supplements to address low milk production in postnatal mothers in Imphal, India. High levels of cooperation by the mothers showed that the intervention was accepted culturally. The fact that the intervention is feasible to apply in this community makes it a crucial finding for further study. Nurse visits at their residence as a follow-up care during the postnatal period also proved highly effective, with mothers expressing high satisfaction with the personalized support and guidance provided. This demonstrates that home visits are effective and successful approach to providing nutritional interventions and postpartum care in traditional settings. Preliminary data from the study revealed promising trends related to Blood Prolactin Levels (BPL). Specifically, the mean difference of 153.2 ng/ml in the experimental group suggests a potential positive effect, which indicate further investigation. This initial finding aligns with similar outcomes reported in a previous study from Indonesia (Wahyuningsih et al., 2017; Yimyam & Pattamapornpong, 2022). Bananas consist of approximately 3.50% protein, 0.75% fats, and 22.12% carbohydrates, along with adequate minerals and vitamins (Kumari et al., 2023). The study further observed improvements in milk production expressed by the lactating mothers in the experimental group, corroborated by similar outcomes reported in an Indonesian study (Buntuchai et al., 2017; Yimyam & Pattamapornpong, 2022). Banana stems, being widely available and culturally favoured and were positively received by participants. Although WHO (2020) and UNICEF (2025 recommend initiating breastfeeding within one hour postpartum (UNICEF, 2025), a study has identify that 20% of mothers commenced breastfeeding beyond this recommended timeframe (Table 1).

The research also highlighted mothers' confidence and comfort with the traditional dietary recommendations, emphasizing the significance of culturally relevant nutritional practices in promoting maternal health—a finding supported by parallel studies conducted in Asian countries (Buntuchai et al., 2017; Yimyam et al., 2023; Aisya et al., 2020; Pohan & Margolang, 2020). A notable outcome of the study was the high satisfaction among mothers regarding nurse home visits. Nurses played a critical role in guiding dietary practices and offering emotional support, with mothers appreciating comprehensive explanations regarding dietary benefits for postpartum recovery. Together with the intervention's successful feasibility, these early trends offer a solid basis for carrying out a large-scale randomised controlled trial to validate the effectiveness of banana stem supplements in enhancing lactation.

CONCLUSION

This study highlights that banana stem supplementation has the potential to significantly enhance blood prolactin levels and improve breastfeeding outcomes among postnatal mothers. The intervention was not only effective but also culturally acceptable, affordable, and easy to integrate into daily diets. Mothers expressed high satisfaction with both the dietary practice and the supportive role of nurses during postpartum care, which contributed to greater confidence and comfort in breastfeeding. Overall, the findings reinforce the value of combining traditional dietary practices with professional nursing support to promote maternal recovery and ensure optimal nourishment for newborns.

Further research is required to strengthen the evidence base. Large-scale, multi-centre randomized controlled trials should be conducted to validate the findings and ensure generalizability across diverse populations. Future investigations should also aim to identify the bioactive compounds in banana stem responsible for its galactagogue effect, explore long- term outcomes on maternal and infant health, and compare its effectiveness with other herbal or pharmacological galactagogues. Cross-cultural studies may assess its acceptance in non- traditional contexts, while policy-level integration could help establish banana stem as a low- cost, culturally sensitive intervention for lactation support. Additionally, future research should continue to explore the synergistic role of nursing interventions alongside dietary supplementation in optimizing postpartum care.

Limitations

The study faced challenges such as difficulties in recruiting and consistently monitoring participants, especially Lower Segment Caesarean Section (LSCS) mothers due to early discharge and travel issues. A small sample size, single location, limited resources, and manpower affected generalizability and follow-up. Logistical constraints impacted data consistency, and the short study duration limited assessment of long-term effects. Additionally, the exact mechanism of how banana stem enhances breast milk production remains unclear, affecting the study’s overall comprehensiveness

Conflict of Interest

The authors declare that they have no competing interests.

ACKNOWLEDGEMENT

The authors extend sincere gratitude to the Accredited Social Health Activist (ASHA) workers, Urban Primary Health Centre, Imphal West, India, laboratory technician, Babina Diagnostics, Imphal and statistician Mr. Kartiken, Shanmuga College of Nursing, Tamil Nadu, India, for their crucial contributions to the study. Appreciation is also given to the participants and their families for their cooperation, as well as to the hospital authorities and Diagnostic Center for their support and facilities.

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