Effects of amount of contact between mother and child on the mother's nursing behavior

Early skin-to-skin contact for mothers and their healthy newborn infants

BACKGROUND

Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior.

OBJECTIVES

To assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies.

SELECTION CRITERIA

Randomized controlled trials that compared immediate or early SSC with usual hospital care.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach.

MAIN RESULTS

We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact).

AUTHORS' CONCLUSIONS

Evidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult.

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

BACKGROUND

Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that women are provided with high-quality evidence to inform their feeding decisions.

OBJECTIVES

To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 February 2016), CINAHL (1981 to 23 February 2016), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (10 May 2016).

SELECTION CRITERIA

We planned to include randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form would have been eligible for inclusion if sufficient data were available. Studies using a cross-over design would not have been eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed for inclusion all potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary.

MAIN RESULTS

No studies were identified that were eligible for inclusion in this review.

AUTHORS' CONCLUSIONS

This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns. It is recommended that no changes are made to current practice guidelines without undertaking robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Future exploratory research is needed on baby-led breastfeeding that takes the mother's perspective into consideration.

Early Post-Partum Contact and Later Attitudes

In a randomized, prospective study the long-term effects of early post-partum skin-toskin and suckling contact was studied. In follow-up studies 36 hours, 3 and 12 months after delivery maternal behaviour, infant behaviour, the duration of breast feeding and certain attitudes towards child rearing procedures were shown to develop differently in a group of mothers and infants with early post-natal contacts as compared to a control group. Three years after delivery parents with early contact appreciated their children's language development to be faster; the number of siblings born in these families was greater than in controls. In the discussion, the relative importance of the immediate postnatal period is emphasized, a more family oriented development seems to occur in the presence of early post-delivery interaction.

Emotional Rejection of the Infant: Status of the Concept

Emotional rejection of the infant is a morbid, clinical phenomenon, central to mother-infant psychiatry. It occurs in about 1% of births in the general population, but much more often in mothers referred to specialist services. It has severe consequences for children, but responds well to treatment. It is now better recognized, but research is required, especially cohort studies and neuroscientific investigations.

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

BACKGROUND

Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that mothers are provided with high-quality evidence to inform their feeding decisions.

OBJECTIVES

To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2013), CINAHL (1981 to 13 November 2013), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (6 November 2013).

SELECTION CRITERIA

Randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form were eligible for inclusion if sufficient data were available. Studies using a cross-over design were not eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We independently assessed for inclusion all the potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary.

MAIN RESULTS

No studies were identified that were eligible for inclusion in this review.

AUTHORS' CONCLUSIONS

This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns, therefore no conclusions could be taken at this point. It is recommended that no changes are made to current practice guidelines without undertaking further robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Further research is needed to also evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding on successful breastfeeding, for healthy newborns. However, conducting such a study, particularly a randomised controlled trial is unlikely to receive ethical approval, as the issue of obtaining informed consent from new mothers or mothers-to-be for randomisation between baby-led and scheduled breastfeeding is a difficult one and it is likely that the Baby Friendly Hospital Initiative practices would prohibit such a study.

Early skin-to-skin contact for mothers and their healthy newborn infants

BACKGROUND

Mother-infant separation postbirth is common in Western culture. Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiologically 'sensitive period' for programming future physiology and behavior.

OBJECTIVES

To assess the effects of early SSC on breastfeeding, physiological adaptation, and behavior in healthy mother-newborn dyads.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), made personal contact with trialists, and consulted the bibliography on kangaroo mother care (KMC) maintained by Dr. Susan Ludington.

SELECTION CRITERIA

Randomized controlled trials comparing early SSC with usual hospital care.

DATA COLLECTION AND ANALYSIS

We independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Thirty-four randomized controlled trials were included involving 2177 participants (mother-infant dyads). Data from more than two trials were available for only eight outcome measures. For primary outcomes, we found a statistically significant positive effect of early SSC on breastfeeding at one to four months postbirth (13 trials; 702 participants) (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.06 to 1.53, and SSC increased breastfeeding duration (seven trials; 324 participants) (mean difference (MD) 42.55 days, 95% CI -1.69 to 86.79) but the results did not quite reach statistical significance (P = 0.06). Late preterm infants had better cardio-respiratory stability with early SSC (one trial; 31 participants) (MD 2.88, 95% CI 0.53 to 5.23). Blood glucose 75 to 90 minutes following the birth was significantly higher in SSC infants (two trials, 94 infants) (MD 10.56 mg/dL, 95% CI 8.40 to 12.72).The overall methodological quality of trials was mixed, and there was high heterogeneity for some outcomes.

AUTHORS' CONCLUSIONS

Limitations included methodological quality, variations in intervention implementation, and outcomes. The intervention appears to benefit breastfeeding outcomes, and cardio-respiratory stability and decrease infant crying, and has no apparent short- or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC with time of initiation and duration and include means, standard deviations and exact probability values.

An overlooked aspect of the human breast: areolar glands in relation with breastfeeding pattern, neonatal weight gain, and the dynamics of lactation

The early nursing-sucking relationship is not to be taken for granted in humans. A number of factors can either facilitate or mitigate its optimal establishment on the mother's or newborn's sides. Among these factors, a morphological feature of human mothers' breasts--the areolar glands (AG)--has been identified as potentially important. Three day-old infants display attraction during the presentation of the native secretions of the AG, suggesting that they could influence the newborn's behaviour during breastfeeding. The present study assessed this topic in a sample of 121 Caucasian mother-infant dyads. The areolae of these women were screened during the first 3 postnatal days in parallel with the infant's sucking performance, body weight fluctuations and time to lactation onset. On average, 97% of the women bore AG, 80.2% having 1-20 units per areola and 33% showing AG excreting a visible fluid. The endowment in AG appeared positively linked with neonatal growth after birth and with the speed of lactation onset: infants of primiparous women with lower AG numbers had a lower weight gain than those of mothers with higher AG numbers. Further, it took longer to primiparae with lower AG counts to set on lactation. This study confirms and extends the fact that AG, in interaction with maternal experience, might influence the initiation of the breastfeeding relationship.

The birth satisfaction scale

PURPOSE

The purpose of this paper is to develop a psychometric scale--the birth satisfaction scale (BSS)--for assessing women's birth perceptions.

DESIGN/METHODOLOGY/APPROACH

Literature review and transcribed research-based perceived birth satisfaction and dissatisfaction expression statements were converted into a scored questionnaire.

FINDINGS

Three overarching themes were identified: service provision (home assessment, birth environment, support, relationships with health care professionals); personal attributes (ability to cope during labour, feeling in control, childbirth preparation, relationship with baby); and stress experienced during labour (distress, obstetric injuries, receiving sufficient medical care, obstetric intervention, pain, long labour and baby's health).

RESEARCH LIMITATIONS/IMPLICATIONS

Women construct their birth experience differently. Views are directed by personal beliefs, reactions, emotions and reflections, which alter in relation to mood, humour, disposition, frame of mind and company kept. Nevertheless, healthcare professionals can use BSS to assess women's birth satisfaction and dissatisfaction. Scores measure their service quality experiences.

SOCIAL IMPLICATIONS

Scores provide a global measure of care that women perceived they received during labour.

ORIGINALITY/VALUE

Finding out more about what causes birth satisfaction and dissatisfaction helps maternity care professionals improve intra-natal care standards and allocate resources effectively. An attempt has been made to capture birth satisfaction's generalised meaning and incorporate it into an evidence-based measuring tool.

Neonatal handling affects durably bonding and social development

The neonatal period in humans and in most mammals is characterized by intense mother-young interactions favoring pair bonding and the adaptation of neonates to their new environment. However, in many post-delivery procedures, human babies commonly experience combined maternal separation and intense handling for about one hour post-birth. Currently, the effects of such disturbances on later attachment and on the development of newborns are still debated: clearly, further investigations are required. As animals present good models for controlled experimentation, we chose domestic horses to investigate this issue. Horses, like humans, are characterized by single births, long lactating periods and selective mother-infant bonds. Routine postnatal procedures for foals, as for human babies, also involve intense handling and maternal separation. In the present study, we monitored the behavior of foals from early stages of development to "adolescence", in a normal ecological context (social groups with adults and peers). Experimental foals, separated from their mothers and handled for only 1 hour post-birth, were compared to control foals, left undisturbed after birth. Our results revealed short- and long-term effects of this unique neonatal experience on attachment and subsequent social competences. Thus, experimental foals presented patterns of insecure attachment to their mothers (strong dependence on their mothers, little play) and impaired social competences (social withdrawal, aggressiveness) at all ages. We discuss these results in terms of mother-young interactions, timing of interactions and relationships between bonding and subsequent social competences. Our results indicate that this ungulate species could become an interesting animal model. To our knowledge, this is the first clear demonstration that intervention just after birth affects bonding and subsequent social competences (at least until "adolescence"). It opens new research directions for studies on both humans and other animals.

Early skin-to-skin contact for mothers and their healthy newborn infants

BACKGROUND

Mother-infant separation postbirth is common in Western culture. Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, covered across the back with a warm blanket, prone on the mother's bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiologically 'sensitive period' for programming future behavior.

OBJECTIVES

To assess the effects of early SSC on breastfeeding, behavior, and physiological adaptation in healthy mother-newborn dyads.

SEARCH STRATEGY

Cochrane Pregnancy and Childbirth Group's and Neonatal Group's Trials Registers (August 2006), Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (1976 to 2006).

SELECTION CRITERIA

Randomized and quasi-randomized clinical trials comparing early SSC with usual hospital care.

DATA COLLECTION AND ANALYSIS

We independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Thirty studies involving 1925 participants (mother-infant dyads), were included. Data from more than two trials were available for only 8-of-64 outcome measures. We found statistically significant and positive effects of early SSC on breastfeeding at one to four months postbirth (10 trials; 552 participants) (odds ratio (OR) 1.82, 95% confidence interval (CI) 1.08 to 3.07), and breastfeeding duration (seven trials; 324 participants) (weighted mean difference (WMD) 42.55, 95% CI -1.69 to 86.79). Trends were found for improved summary scores for maternal affectionate love/touch during observed breastfeeding (four trials; 314 participants) (standardized mean difference (SMD) 0.52, 95% CI 0.07 to 0.98) and maternal attachment behavior (six trials; 396 participants) (SMD 0.52, 95% CI 0.31 to 0.72) with early SSC. SSC infants cried for a shorter length of time (one trial; 44 participants) (WMD -8.01, 95% CI -8.98 to -7.04). Late preterm infants had better cardio-respiratory stability with early SSC (one trial; 35 participants) (WMD 2.88, 95% CI 0.53 to 5.23). No adverse effects were found.

AUTHORS' CONCLUSIONS

Limitations included methodological quality, variations in intervention implementation, and outcome variability. The intervention may benefit breastfeeding outcomes, early mother-infant attachment, infant crying and cardio-respiratory stability, and has no apparent short or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC and include means, standard deviations, exact probability values, and data to measure intervention dose.

Early skin-to-skin contact for mothers and their healthy newborn infants

BACKGROUND

Early skin-to-skin contact involves placing the naked baby prone on the mother's bare chest at birth or soon afterwards (< 24 hour). This could represent a 'sensitive period' for priming mothers and infants to develop a synchronous, reciprocal, interaction pattern, provided they are together and in intimate contact. Routine separation shortly after hospital birth is a uniquely Western cultural phenomenon that may be associated with harmful effects including discouragement of successful breastfeeding.

OBJECTIVES

To assess the effects of early skin-to-skin contact on breastfeeding, behavior, and physiology in mothers and their healthy newborn infants.

SEARCH STRATEGY

The Cochrane Pregnancy and Childbirth Group and Neonatal Group trials registers (December 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002), MEDLINE (1976 to 2002).

SELECTION CRITERIA

Randomized and quasi-randomized clinical trials comparing early skin-to-skin contact with usual hospital care.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials.

MAIN RESULTS

Seventeen studies, involving 806 participants, were included. We found statistically significant and positive effects of early skin-to-skin contact on breastfeeding at one to three months postbirth (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.10 to 4.22), breastfeeding duration (weighted mean difference (WMD) 41.99, 95% CI 13.97 to 70.00), maintenance of infant temperature in the neutral thermal range (OR 12.18, 95% CI 2.04 to 72.91), infant blood glucose (WMD 11.07, 95% CI 3.97 to 18.17), infant crying (OR 21.89, 95% CI 5.19 to 92.30) and summary scores of maternal affectionate love/touch (SMD 0.73, 95% CI 0.36 to 1.11) during an observed breastfeeding within the first few days postbirth. We found no statistically significant benefit of early skin-to-skin contact for other major clinical variables: breastmilk maturation, maternal chest circumference, infant heart rate.

REVIEWER'S CONCLUSIONS

Limitations included the methodological quality of the studies, variations in the implementation of the intervention and outcome variability. Early skin-to-skin contact appears to have some clinical benefit especially regarding breastfeeding outcomes and infant crying and has no apparent short or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis of the data, future research in this area should involve outcome measures consistent with those used in the studies included here. Published reports should also clearly indicate if the intervention was skin-to-skin contact and include means, standard deviations and exact probability values.

Neonatal intensive care: communication and attachment

Birth has traditionally been recognized as a family-centred event where immediate exposure to the infant occurs and where the family begins, through direct contact, touch and voice, to form an attachment to the infant. In high-risk pregnancy and delivery, medical and technological advances distance the family from the birth event. This article describes some aspects of a research project with identified factors that facilitate and hinder family and mother attachment to the infant during periods of separation subsequent to premature delivery or other problems which require management in a neonatal intensive care unit (NICU). The project was exploratory. It involved observation of care, participation in care, individual unstructured interviews, focus group interviews and also use of Leske's (1986, 1991a,b) critical care family needs inventory, which was modified and responded to by family members (n = 109) in an attempt to quantify and validate their needs. Six constructs were derived from the inventory and then ranked by mothers (n = 100). The findings from this process were triangulated to observation and interview data in order to confirm factors that facilitate and hinder the process of attachment during family and mother-infant separation. The results of the study imply that when the family and mother are supported by an individualized approach to care and appropriate communication is used, attachment can be facilitated.

The psychobiology of parenting in mammals

Parental behavior denotes a variety of genetically programmed activities in which parents help their young to survive to maturity. A highly successful research has been devoted to the psychoneuroendocrine bases of parenting in two species, rat and sheep. As a result empirical data along with conceptual formulations have been obtained which provide a model for generating hypothesis for the study of other species. This review was written to draw the attention to this research because of its enormous potential significance for problems pertaining to human infant care. It discusses the current status of research on the physiological bases of parental behavior.

Effect of delivery room routines on success of first breast-feed

72 infants delivered normally were observed for 2 h after birth. In the separation group (n = 34), the infant was placed on the mother's abdomen immediately after birth but removed after about 20 min for measuring and dressing. In the contact group (n = 38) contact between mother and infant was uninterrupted for at least 1 h. After about 20 min the infants began to make crawling movements towards the breast; the rooting reflex soon came into play, and at an average of 50 min after birth most of the infants were sucking at the breast. More infants in the contact group than in the separation group showed the correct sucking technique (24/38 vs 7/34). 40 (56%) of the 72 mothers had received pethidine during labour; the infants were also sedated and most of them (25/40) did not suck at all. It is suggested that contact between mother and infant should be uninterrupted during the first hour after birth or until the first breast-feed has been accomplished, and that use of drugs such as pethidine should be restricted.

Effect of early suckling on term neonates' core body temperature

The purpose of this study was to determine whether the practice of early suckling, through an effect on maternal behaviour, would improve neonatal temperature control. One hundred and sixty mothers having daytime spontaneous deliveries of healthy babies at term were randomized into two groups. The treatment group were encouraged to put the baby to the breast immediately after delivery. In the control group, the baby was placed in a cot immediately after birth and breastfeeding occurred some time later at a time of the mother's choice. Observations of the mother's behaviour towards her baby and the baby's core body temperature were recorded at 2 and 4 hours after birth and at 8 a.m. the next day. The early suckling group mothers were observed breastfeeding their babies more often than those of the control group. Significantly more of the control babies had temperatures below 36.5 degrees C at 8 a.m. the next day. Women of either group who were breastfeeding immediately prior to temperature recording were significantly less likely to have a baby with a low body temperature. It is concluded that a policy of early suckling, when compared with one of delayed contact, appears to reduce the incidence of low body temperature in the neonate.

Regulation of nursing in chimpanzees

The regulation of nursing was studied in captive chimpanzees from birth to 6 months of age. It was asked whether regulation was predictable or timing was irregular. A search for unimodal frequency distributions resulted in a distinction among nursing bouts, nursing episodes (bouts with brief interruptions) and nursing pauses. The frequency distributions of these types were either normal with very large standard deviations or exponential (i.e., randomly terminated). This implies a very irregular timing. Longer nursing episodes were followed by somewhat longer pauses; pauses with daytime sleep (that were relatively long) were followed by longer nursing. However, these regulatory effects were only slight. Most of this loose regulation of nursing was due to the infant, as the mothers did not put the infant on the breast and usually were permissive. Comparisons with humans suggest a similarly loose organization as well as frequent feeding in societies that provide relatively unlimited access to the breast. The regular 4-hr, meal-like schedule in industrial countries seems mainly to be due to human mothers and their advisors.

Successful breast feeding: the mother's dilemma

A content analysis of 141 articles on breast feeding by discipline revealed differences in the factors considered necessary for breast feeding success and in the criteria used to determine success. Whereas medical articles focused on maternal factors prenatally and infant health post-natally, or the length of time breast feeding was maintained, lay articles focused on the relationship of the mother with her infant (the nursing couple) and the mother's ability to manage breast feeding within the family context. The implications of this discrepancy for nursing practice and research are discussed.

Extra early physical contact and aspects of the early mother-infant relationship

We tested the hypothesis that extra early physical contact between mother and infant enhances aspects of their early relationship. Healthy, middle-class mothers and their healthy, firstborn, singleton infants delivered vaginally at full-term were randomly assigned to receive either regular contact (RC; N = 39) or extra early physical contact (EC; N = 39) following delivery. RC infants remained in cribs beside their mothers' beds, while EC infants and mothers had a mean of 46 min of physical contact in the recovery room. There was no difference between EC and RC subjects for the following outcome measures: amount of time mothers chose to have infants with them during the postpartum hospital stay; quality of mother-infant interaction at two days and one month; concern mothers expressed for the infant at one month; mothers' perception of their postpartum adjustment; mothers' perception of the infant at two days and one month, and of the infant's temperament at eight months; and extent of mothers' assisting with and soothing the child during a physical examination at 13 months. EC children cried significantly less during the examination at 13 months. These findings do not support the hypothesis that extra early physical contact between mother and infant enhances their relationship.

Influence of early mother-infant contact on dyadic behaviour during the first month of life

An experimental group of 30 newborn infants had contact with their mothers for half an hour in the delivery room, and a control group followed the usual hospital routine, being shown briefly to their mothers before being taken to the nursery. In both groups permanent rooming-in began from the sixth hour of life. The infants' behaviour was assessed one, three and 28 days after birth by means of the Brazelton scale, and the behaviour of the dyad was observed during feeding on the third and 28th day. Infants in the experimental group interacted significantly better on days three and 28, and their mothers had higher scores for affectionate behaviour on the 28th day.

Mother-to-infant bonding

The concept of maternal 'bonding', i.e. rapid mother-to-neonate attachment, appears frequently in psychiatric, paediatric and social work discussions of childhood psychopathology and child abuse. 'Bonding' is used as a diagnostic concept, and one which has to bear the weight of important explanatory, descriptive and predictive statements. In turn, it is related aetiologically to post-partum contact and separations of mother and infant. The authors present a critical review of the concept, exploring its empirical basis, and the implications (logical and illogical) that flow from its application in practice. They conclude that the usage of the term 'bonding' is often misleading, because of a tendency to reify and simplify attachment phenomena; in addition, there are no indications from animal investigations and no evidence from human studies which directly support the notion of a 'sensitive period' in the formation of mother-to-infant attachments. They also describe the negative and pessimistic implications of using this concept in social work and clinical practice. Alternative ways of conceptualising these early parent-child events are suggested.

Aspects of the mother-infant relationship during nursing, 1 and 6 weeks after early extended post-partum contact

Two groups of mothers receiving different amounts of contact with their infants immediately after delivery were compared. Three aspects of the mother-infant relationship during breastfeeding were selected for analysis: (1) the behaviour of the mother when the baby was attached versus unattached to the nipple, (2) maternal behaviour when the baby's eyes were open/closed, (3) the behaviour of the mother before, during and after the baby had been fretting or crying. Significant differences on all three measures were found between the two groups during the first week after delivery. No differences were observed six weeks post-partum.

Effects of father-infant postpartum contact on their interaction 3 months after birth

One group of fathers were allowed to handle their newborn infant immediately after its Caesarean-section delivery, while another group were not permitted to do so. In a play situation performed 3 months later, the contact-group showed more touching behaviour towards their infants than the other group.

Father-infant interaction at the first contact after delivery

The behavior exhibited by human fathers at their first contact with the young was studied on 15 fathers of full-term infants delivered by cesarean section. The naked infant was presented to the father approximately 15 min after delivery, and photographs were taken every second during the first 7 min of contact. An orderly progression of behavior was observed: the father began touching the extremities, and then proceeded to touch the infant with his fingers and fingertips, then to use his palms and finally the dorsal side of his fingers. An increase in eye-to-eye contact over time was observed. It was concluded that the father displayed a very similar behavior, in his first contact with the young, as has been described previously for the mother.

Mother-infant interaction; effects of sex of infant on feeding behaviour

Mother--child interaction was studied on the 2nd and 4th days after delivery. Mothers with girls showed more distal contact behaviour such as talking, smiling, and 'en face' responses. They also displayed more skin-to-skin contact behaviour (patting, rubbing, kissing, and touching) toward girl babies. Mothers with boys, on the other hand, showed more types of behaviours directed to clothed parts of the infant such as patting and adjusting clothes. These findings were statistically significant only on the 2nd day after delivery. On day 4 differences between male and female infants both in the frequency and in the pattern of sucking were observed.