Effective suckling in relation to naked maternal-infant body contact in the first hour of life: an observation study

Preparation and validation of a predictive model of breastfeeding initiation in the first hour of life

OBJECTIVE

The objective was to develop and validate a predictive model of initiation of breastfeeding in the first hour after delivery.

METHODS

Retrospective cohort study on women who gave birth between 2013 and 2018 in Spain. For data collection, an ad hoc questionnaire was designed to be filled in by the mothers, which was distributed to the different Spanish breastfeeding associations which, in turn, shared it with their associate partners. The development of the predictive model was made on a cohort of 3218 women (2/3) and was validated on a cohort of 1609 women (1/3). Mothers whose children were admitted to hospital at the time of birth were excluded. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC).

RESULTS

81.0 % (2608) women started breastfeeding in the first hour in the derivation cohort, and 80.1 % (1289) in the validation cohort. The predictive factors in the final model were: the highest number of children and skin-to-skin contact at birth as flattering factors, while dystocic delivery reduced the likelihood of the onset of breastfeeding. The predictive ability (ROC AUC) in the derivation cohort was 0.89 (CI 95 %: 0.87-0.90), while in the validation cohort it was 0.89 (CI 95 %: 0.87-0.92).

CONCLUSIONS

This three-variable predictive model has excellent predictive ability in both the derivation cohort and the validation cohort. This model can identify women who are at high risk of non-initiating breastfeeding within the first hour after delivery.

Pro-lactation cesarean section: Immediate skin-to-skin contact and its influence on prolonged breastfeeding

Mexico has a high rate of cesarean sections and one of the lowest prevalences of exclusive breastfeeding in all of Latin America. There are known factors that can compensate for the disadvantages and drawbacks of cesarean delivery over breastfeeding. In terms of studying the variations of breastfeeding experiences, this work specifically concentrates on exploring different changes in the technique of cesarean section, related to immediate Skin-to-Skin Contact for women with high and low risk pregnancies, which may in turn influence Maternal Satisfaction and the choice of Prolonged Breastfeeding. A convenience sample of (n = 150) women who underwent cesarean section in a private hospital in Mexico between the years 2015-2020 participated in this study, the participants answered a structured interview protocol designed for the specific purposes of this study. The analysis was guided grounded theory. The majority of these participants (n = 121, 82.3%) were in labor before entering a cesarean section. The most common indications for cesarean section were those of active-phase arrest and regarding maternal complications, previous cesarean sections (n = 59) and hypertensive complications (n = 15) were the most frequent. For fetal complications, non-cephalic fetal positions (n = 12) were reported as the most common. Despite the different conditions of their cesarean sections, almost all the women experienced Skin-to-Skin Contact during the cesarean section. Almost all of them managed to breastfeed for more than 6 months and many of them breastfed their babies for up to 2 years. The main factors associated to prolonged breastfeeding and satisfaction were higher education degrees, immediate skin-to-skin contact during surgery and counseling on breastfeeding after the baby was born. Our findings highlight the importance of considering adjustments during and after a cesarean section, making it more focused on women and toward better probabilities of achieving prolonged breastfeeding in Mexican women. This being a first step for future studies of direct interventions in the breastfeeding process, such as the management of skin-to-skin contact and professional support after birth for guided breastfeeding.

Breastfeeding technique and associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia: observational method

BACKGROUND

The breastfeeding technique is explained positioning, attachment, and suckling during breastfeeding. Ineffective breast feeding technique is one of the factors leading to premature discontinuation of breastfeeding and malnutrition. There is a limited study on the assessments of BFT and associated factors among lactating mothers in the study area. Therefore, the study aimed to assess breastfeeding technique and the associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia.

METHODS

An institution-based cross-sectional study was conducted from February 20 to March 20, 2020. An observational checklist and structured interviewer-administered questionnaire were applied to collect the data. The data were entered into Epi-Data 4.6 version and transferred to analyzed using SPSS version 20. Bi-variable and multivariable logistic regressions were performed to identify the association. The strength of association was identified using odds ratio with a 95% confidence interval (), and a p-value of 0.05 was declare as statistically significant.

RESULTS

The proportion of effective BFT was 48% (95%, CI: 43.0-53.0%). The likelihood of applying proper BFT among age group of 18-20 years was 70% lower than (AOR = 0.3; 95% CI: 0.11-0.83) age group > 30 years. The odds of effective BFT in primipara mothers were 49% (AOR = 0.51; 95% CI: 0.32-0.82) lower compared to multiparous mothers. Likewise, the provability of effective BFT was 55% (AOR = 0.45; 95% CI: 0.29-0.70) times lower in women who had no counseling immediately after delivery compared to their counterparts. Moreover, effective breast feeding technique mothers who have breast problem was 78% lower than (AOR = 0.22; 95% CI: 0.07-0.68) mothers who have no breast problem. And mothers who had counselling of BFT during ANC follow up was 55% (AOR = 0.45; 95% CI: 0.29, 0.70) lower than mothers who had no counseling.

CONCLUSION

Just under half of the women in the study area applied proper breast feeding technique Younger and primipara mothers poorly performed to effective BFT. But women having counseling during antenatal care follow-up and immediately after delivery and not having breast problems applied BFT effectively. Hence, special emphasis have to give for younger and primipara mothers. Besides, educate the mother for preventing breast problems and working on enhancing counseling at postnatal clinic.

Effect of Baby-Led Self-Attachment Breastfeeding Technique in the Postpartum Period on Breastfeeding Rates: A Randomized Study

Objective: To evaluate the effects of a baby-led self-attachment breastfeeding support intervention on the prevalence and duration of exclusive breastfeeding and nipple pain at 3 days, 6 weeks, 3 months, and 6 months postpartum among Chinese mothers. Materials and Methods: A randomized study was conducted with 504 mother-infant dyads allocated to the baby-led self-attachment breastfeeding support intervention (n = 251) and standard postpartum care (n = 253). Data on the prevalence and duration of exclusive breastfeeding and nipple pain were collected at 3 days, 6 weeks, 3 months and 6 months postpartum. Results: Mothers in the intervention group were significantly more likely exclusively breastfeeding at 3 days (mean difference = 12.1%, 95% confidence interval [CI]: 3.9-20.2%, p = 0.004) and 6 months postpartum (mean difference = 17.8%, 95% CI: 8.3-27.4%, p < 0.001). They were less likely to stop breastfeeding over the 6-month period, compared with the control group (Hazard ratio = 0.65; 95% CI: 0.49-0.87). They were also less likely to experience nipple pain at 3 days (mean difference = -8.1%, 95% CI: -15.9 to -0.4%, p = 0.04) and 3 months postpartum (mean difference = -4.9%, 95% CI: -8.7 to -1.2%, p = 0.01). Conclusions: The baby-led self-attachment breastfeeding support is clinically effective in increasing the prevalence and duration of exclusive breastfeeding and reducing nipple pain among Chinese mothers.

Mothers' perceptions and experiences of skin-to-skin contact after vaginal birth in Saudi Arabia: A cross-sectional study

PROBLEM

The World Health Organization recommends immediate skin-to-skin contact after birth, however, worldwide, separation of mothers and infant is common.

BACKGROUND

In Saudi Arabia, there is a lack of research exploring mothers' experiences of skin-to-skin contact after birth.

AIM

To estimate the rate of skin-to-skin contact and describe mothers' perceptions and experiences of immediate skin-to-skin contact after vaginal birth in two largest hospitals in Jeddah, Saudi Arabia.

METHODS

A cross-sectional study conducted in 2017. A total of 254 mothers completed the survey on the postnatal ward (92 % response rate). The survey consisted of 36 closed and open-ended items. Data were described using summary statistics and free text comments were analysed using content analysis.

RESULTS

The rate of direct skin-to-skin contact was 15%. A further 54% of mothers had the baby placed on their chest/abdomen but with a sheet/gown between them. Mothers reported favourable perceptions towards skin-to-skin contact and reported the practice as acceptable (67%). Most mothers did not express concerns about feeling exposed (85%) or that skin-to-skin contact was inconsistent with norms of modesty or culture (87%). The free text comments indicated that most mothers felt positive about their experience of skin-to-skin contact, while some mothers felt overwhelmed and unprepared.

DISCUSSION AND CONCLUSIONS

Skin-to-skin contact was not routinely implemented after birth and the rate was low. Mothers held positive perceptions and wanted to practice skin-to-skin contact. Policy makers and clinicians should acknowledge mothers' needs and feelings by facilitating skin-to-skin contact to achieve optimal outcomes for mothers and infants.

Dietary Knowledge and Myths Vary by Age and Years of Schooling in Pregnant Mexico City Residents

Pregnancy is a stage in a woman’s life when she is more open to receiving health advice, especially related to diet. However, women are often caught between receiving scientifically unfounded myths and concrete empirical knowledge. Culturally perpetuated myths may be acted upon more than knowledge, but research on these concepts, especially in the Americas, is scarce. This cross-sectional study aimed to describe the frequency of diet and nutrition myths and knowledge and describe the associated factors in pregnant mothers receiving care in Mexico City. A total of 695 pregnant adults and 322 pregnant adolescents participated in this study, in which they responded to a questionnaire on nutrition and diet myths, knowledge, and practice during pregnancy and breastfeeding. The myths were examined individually, but for the purposes of statistical analysis, a score was obtained. We compared means of variables that could be associated to myth and knowledge scores, then calculated linear and logistical regressions. Forty-six percent of participants had below the mean myth scores. Ninety-two percent of participants had a knowledge score below the mean. Age (β = 0.025, SE 0.007, 95% CI 0.011–0.040, p = 0.001) and years of education (β = 0.166, SE 0.024, 95% CI 0.119–0.213, p = 0.001) explained the myth’s score, while age explained the knowledge score (β = 0.011, SE 0.020, 95% CI −0.032–−0.008, p = 0.002). We found that although most women reported not believing in the myths, they acted on them. The probability of practicing such myths as “You must eat for two during pregnancy” was associated with being an adolescent (OR 1.76, p = 0.001) and being married (OR 1.47, p = 0.007), “Not satisfying cravings leave a mark on the infant’s body” with being adolescent (OR 1.59, p = 0.003) and low socioeconomic level (OR 1.41, p = 0.038), “A frightened or angry mother should not nurse her baby” with being adult (OR 2.61, p = 0.004), and “Drinking atole or beer enhances breast milk production” with being single (OR 2.07, p = 0.001). The probability of not acting on some knowledge was associated with being an adolescent (p ≤ 0.003) and having a high school education or below (p ≤ 0.046). Almost all of our participants held at least one myth about nutrition and diet during pregnancy and breastfeeding; younger participants showed a higher frequency of holding myths. Years of schooling and age were associated with acting on myths and not acting on correct knowledge.

Breastfeeding: Australian Breastfeeding Association volunteers are positive deviants in Australian society

PROBLEM

Australian breastfeeding rates are low, and strategies to increase them have been inadequate. New approaches for supporting breastfeeding are required.

BACKGROUND

Preliminary data suggested that Australian Breastfeeding Association members had higher exclusive breastfeeding rates than the general Australian population. The Engaging Mothers: Breastfeeding Experiences Recounted project provided an opportunity to determine which practices were influencing better breastfeeding outcomes.

AIMS

(1) To determine whether Australian Breastfeeding Association volunteer trainees were positive deviants regarding breastfeeding practices, (2) to explore characteristics or behaviours underpinning beneficial breastfeeding practices and (3) to identify modifiable characteristics to inform breastfeeding promotion.

METHODS

A cross-sectional, one-group survey design was used. Breastfeeding-related quantitative and qualitative data were obtained from lactation history questionnaires collected on application to train as volunteers with the Australian Breastfeeding Association (N=174), and analysed using descriptive statistics.

FINDINGS

Participants in this project had higher levels of exclusive breastfeeding to around 6 months (64%) and longer duration of breastfeeding (80% to one year) than the general Australian population, going beyond World Health Organization targets. Identified modifiable factors were knowledge and motivation to breastfeed, partner and peer support, birthing outcomes, immediate skin-to-skin contact, formula supplementation and positive attitudes to breastfeeding at work and breastfeeding in public.

DISCUSSION

Participants could be defined as positive deviants with positive attitudes towards breastfeeding. The personal behaviours and practices of this group may help inform future breastfeeding interventions.

CONCLUSIONS

Identifying positive deviants and supporting the broader community to adopt behaviours that explain improved breastfeeding outcomes could be powerful methods to produce change.

Skin-to-skin contact the first hour after birth, underlying implications and clinical practice

AIM

This paper integrates clinical expertise to earlier research about the behaviours of the healthy, alert, full-term infant placed skin-to-skin with the mother during the first hour after birth following a noninstrumental vaginal birth.

METHOD

This state-of-the-art article forms a link within the knowledge-to-action cycle, integrating clinical observations and practice with evidence-based findings to guide clinicians in their work to implement safe uninterrupted skin-to-skin contact the first hours after birth.

RESULTS

Strong scientific research exists about the importance of skin-to-skin in the first hour after birth. This unique time for both mother and infant, individually and in relation to each other, provides vital advantages to short- and long-term health, regulation and bonding. However, worldwide, clinical practice lags. A deeper understanding of the implications for clinical practice, through review of the scientific research, has been integrated with enhanced understanding of the infant's instinctive behaviour and maternal responses while in skin-to-skin contact.

CONCLUSION

The first hour after birth is a sensitive period for both the infant and the mother. Through an enhanced understanding of the newborn infant's instinctive behaviour, practical, evidence-informed suggestions strive to overcome barriers and facilitate enablers of knowledge translation. This time must be protected by evidence-based routines of staff.

Assessing the Breastfeeding Dyad: A Guide for Speech-Language Pathologists

Purpose

More than 80% of U.S. mothers initiate breastfeeding; for many of them, direct breastfeeding is an important goal. Speech-language pathologists (SLPs) who assess infants with feeding concerns, however, are generally much more familiar with assessing bottle-feeding. The purpose of this tutorial is to assist SLPs in building on their existing assessment skills in order to provide effective, evidence-based options for mothers who wish to breastfeed their infants.

Conclusion

SLPs can assist families in meeting their breastfeeding goals through effective assessment of breastfeeding dyads.

An implementation algorithm to improve skin-to-skin practice in the first hour after birth

Evidence supporting the practice of skin‐to‐skin contact and breastfeeding soon after birth points to physiologic, social, and psychological benefits for both mother and baby. The 2009 revision of Step 4 of the WHO/UNICEF “Ten Steps to Successful Breastfeeding” elaborated on the practice of skin‐to‐skin contact between the mother and her newly born baby indicating that the practice should be “immediate” and “without separation” unless documented medically justifiable reasons for delayed contact or interruption exist. While in immediate, continuous, uninterrupted skin‐to‐skin contact with mother in the first hour after birth, babies progress through 9 instinctive, complex, distinct, and observable stages including self‐attachment and suckling. However, the most recent Cochrane review of early skin‐to‐skin contact cites inconsistencies in the practice; the authors found “inadequate evidence with respect to details … such as timing of initiation and dose.” This paper introduces a novel algorithm to analyse the practice of skin to skin in the first hour using two data sets and suggests opportunities for practice improvement. The algorithm considers the mother's Robson criteria, skin‐to‐skin experience, and Widström's 9 Stages. Using data from vaginal births in Japan and caesarean births in Australia, the algorithm utilizes data in a new way to highlight challenges to best practice. The use of a tool to analyse the implementation of skin‐to‐skin care in the first hour after birth illuminates the successes, barriers, and opportunities for improvement to achieving the standard of care for babies. Future application should involve more diverse facilities and Robson's classifications.

An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.

Gestalt Breastfeeding: Helping Mothers and Infants Optimize Positional Stability and Intraoral Breast Tissue Volume for Effective, Pain-Free Milk Transfer

In the past decade, biological nurturing and activation of maternal and infant instincts after birth have constituted a major advance in clinical breastfeeding support. Yet, physiologic breastfeeding initiation is not enough to ensure ongoing pain-free and effective breastfeeding for many pairs. Current interventions, including "hands-off" mammalian approaches, do not improve breastfeeding outcomes, including in randomized controlled trials. Back-arching, difficulty latching or staying on the breast, and fussing at the breast are common signs of infant positional instability during breastfeeding. These cues are, however, often misdiagnosed as signs of medical conditions or oral connective tissue abnormalities, and underlying positional instability is not addressed. New clinical approaches are urgently required. This article offers a clinical approach to fit and hold (or latch and positioning)- gestalt breastfeeding, which aims to optimize positional stability and intraoral breast tissue volumes for pain-free effective breastfeeding. The word gestalt (pronounced "ger-shtolt") means a whole that is more than the sum of its parts. Gestalt breastfeeding builds on the theoretical foundations of complexity science, physiologic breastfeeding initiation, and new understandings of the biomechanics of infant suck elucidated in ultrasound studies. It also integrates simple psychological strategies from applied functional contextualism, popularly known as Acceptance and Commitment Therapy, empowering women to attend mindfully to breast sensations and their infant's cues. Gestalt breastfeeding can be reproduced for research purposes, including in comparison studies with oral surgery, and has the potential to improve breastfeeding outcomes.

Newborns' temperature submitted to radiant heat and to the Top Maternal device at birth

OBJECTIVE

to compare the axillar temperatures of newborns that are put immediately after birth in skin-to-skin contact under the Top Maternal device, as compared to those in a radiant heat crib.

METHODS

comparatives observational study of the case-control type about temperature of 60 babies born at the Obstetric Center and Normal Delivery Center of a public hospital of the municipality of Sao Paulo, being them: 29 receiving assistance in heated crib and 31 in skin-to skin contact, shielded by a cotton tissue placed on mother's thorax, called Top Maternal.

RESULTS

the temperature of the babies of the skin-to-skin contact group presented higher values in a larger share of the time measures verified, as compared to those that were placed in radiant heat crib, independently from the place of birth. Differences between the two groups were not statistically significant.

CONCLUSION

the study contributes to generate new knowledge, supporting the idea of keeping babies with their mothers immediately after birth protected with the Maternal Top, without harming their wellbeing, as it keeps the axillar temperature in recommendable levels.

Midwives’ Experiences, Education, and Support Needs Regarding Basic Newborn Resuscitation in Jordan

Newborns who are compromised at birth require rapid attention to stabilize their respiration attempts. Lack of knowledge regarding basic newborn resuscitation is a contributing factor to poor newborn health outcomes and increased mortality. The purpose of this study was to explore Jordanian midwives’ experiences, education, and support needs to competently perform basic newborn resuscitation. Qualitative descriptive methodology was used to analyze a convenience sample of 20 midwives. A thematic approach was used to analyze the data. Participants discussed their experiences of basic newborn resuscitation including knowledge, skills, and barriers and suggested solutions to improve practice. Four themes were revealed: lack of knowledge and skills in newborn resuscitation, organizational constraints, inadequate teamwork, and educational needs. The midwives perceived that their ability to perform newborn resuscitation was hindered by lack of knowledge and skills in newborn resuscitation, organizational constraints (such as lack of equipment), and poor co-ordination and communication among team members.