TOPICAL BREAST MILK FOR EPISIOTOMY WOUND HEALING: A SYSTEMATIC REVIEW OF CLINICAL AND MECHANISTIC EVIDENCE

Abstract

Background: Episiotomy is a routine obstetric surgical intervention frequently accompanied by acute perineal discomfort, delayed tissue approximation, edema, and secondary infection risks. Human breast milk (HBM) contains bioactive agents—such as epidermal growth factor (EGF), transforming growth factor-beta (TGF $\beta$), lactoferrin, lysozyme, and secretory IgA—which support cellular regeneration and anti-inflammatory pathways. Objectives: To systematically appraise clinical trial outcomes and mechanistic evidence published between 2020 and 2025 regarding the efficacy, safety, and cellular actions of topical breast milk application on episiotomy wound healing. Search Strategy: Independent electronic searches of PubMed/MEDLINE, Scopus, ScienceDirect, and Google Scholar were executed covering January 2020 through December 2025 using predefined Boolean search algorithms. Selection Criteria: Randomized controlled trials (RCTs), quasi-experimental studies, and in vitro laboratory assays evaluating topical human breast milk or colostrum for perineal/episiotomy wound healing were included. Data Collection & Analysis: Study selection, quality appraisal, and data extraction strictly adhered to PRISMA 2020 guidelines by two independent reviewers, with discrepancies resolved through consensus. Methodological quality was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for quasi-experimental studies. A qualitative narrative synthesis was conducted. Main Results: Eight primary studies met full inclusion criteria ($n = 4$ RCTs, $n = 2$ quasi-experimental clinical trials, and $n = 2$ in vitro mechanistic studies) comprising $N = 658$ clinical participants. Clinical studies consistently demonstrated that topical HBM significantly accelerates wound healing (statistically significant reductions in REEDA scores at days 5, 7, and 10; $p < 0.05$), lowers pain intensity on Visual Analog Scales (VAS), and decreases incidence of local infection compared to povidone-iodine, normal saline, or dry routine care. In vitro assays confirmed that HBM fractions stimulate human dermal fibroblast migration and suppress pro inflammatory cytokines (IL-6, TNF-$\alpha$). Conclusions: Topical application of maternal breast milk is a clinically effective, non-invasive, safe, and cost neutral adjunctive treatment for episiotomy repair. Standardized clinical protocols regarding dosing frequency and hygienic expression should be validated through large-scale, multicentre trials.