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What is learnt from Mindfulness Based Childbirth and Parenting – participants experiences
In the search for effective interventions aiming to prevent perinatal stress, depression and anxiety, we are evaluating Mindfulness Based Childbirth and Parenting (MBCP). In this qualitative study we explore the participants experiences of the intervention and of practising mindfulness.
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Little is known about the developing breastfeeding behaviour of newborn infants. This study describes infants' pre-breastfeeding behaviour during the second day of life and explores possible associations with infant characteristics. We studied 13 mothers and healthy full-term infants after normal births. At 24-48 hours of life, the newborns were placed in skin-to-skin contact with their mothers for breastfeeding and were video filmed. The order, frequency and duration of pre-defined infant pre-feeding behaviours and suckling were coded and analysed using computer-based video software. Pre-feeding behaviours occurred in the following order: rooting, hand to mouth movements, licking of the nipple and hand to breast to mouth movements. The infants started to suckle at a median of one to two minutes. Rooting was the most common behaviour, observed in 12 infants. The duration of rooting movements during the last minute before breastfeeding was inversely related to neonatal age (p≤0.001) and positively related to neonatal weight loss (p=0.02) after birth. Infants exhibited a distinct sequence of pre-feeding behaviours during the second day of life and our findings suggest that rooting movements were governed by mechanisms involved in the regulation of food intake and weight gain. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors. a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records. data were recruited from antenatal health-care clinics in Halland, Sweden. a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42. five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States. results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy. this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth. Copyright © 2015 Elsevier Ltd. All rights reserved.
Background: Studies have suggested several risk factors for a negative birth experience among primiparas. Factors that are mentioned frequently include labour dystocia, operative intervention such as acute caesarean section or vacuum extraction, or the infant being transferred to neonatal care. Another important factor mentioned is lack of support from the midwife. Methods: A study was made of the deliveries of 446 healthy primiparas in a prospective cohort study performed at Soder Hospital, Stockholm, Sweden. Samples of amniotic fluid were collected at delivery and the levels of amniotic fluid lactate (AFL) were measured to give an indication of the metabolism of the uterine tissue. Obstetrical data were collected from birth records.Postpartum, all the women included in the study were asked to complete the Wijma Delivery Experience Questionnaire (W-DEQ B) that measures the experience of a woman's delivery. The main objective of the project was to study well-known as well as new factors associated with negative experience of childbirth among a group of healthy primiparas. Results: Risk factors for reporting a higher level of negative childbirth experience were shown to be a high level of AFL (AOR 3.1, 95%, CI; 1.1-8.9), a longer latent phase (AOR 1.8, 95%, CI; 1.03-3.1), and a low Apgar score (<7 at 1 min) (AOR 13.3, 95%, CI; 1.6-111.0). Those women who had a negative birth experience wanted the midwife to be present more of the time during labour (p = 0.003). Conclusions: A high AFL level, as a marker of uterine metabolic status, and a longer latent phase are strongly associated with a negative experience of childbirth. A low 1 minute Apgar score of the newborn seems to have the strongest negative influence on the woman's experience of childbirth, even when the infant recovers immediately.
Previous research has reported that women who are admitted to delivery wards in early labour process before an active stage of labour has started run an increased risk of instrumental deliveries. Therefore, it is essential to focus on factors such as self-efficacy that can enhance a woman's own ability to cope with the first stage of labour. However, there was no Swedish instrument measuring childbirth self-efficacy available. Thus, the aim of the study was to translate the Childbirth Self-efficacy Inventory and to psychometrically test the Swedish version on first- time mothers within the Swedish culture. The method included a forward-backward translation with face and content validity. The psychometric properties were evaluated using a Principal Component Analysis and by using Cronbach's alpha coefficient and inter-item correlations. Descriptive statistics and non-parametric tests were used to describe and compare the scales. All data were collected from January 2011 to June 2012, from 406 pregnant women during the gestational week 35-42. The Swedish version of the Childbirth Self-Efficacy Inventory indicated good reliability and the Principal Component Analysis showed a three-component structure. The Wilcoxon Signed-Ranks Test indicated that the women could differentiate between the concepts outcome expectancy and self-efficacy expectatancy and between the two labour stages, active stage and the second stage of labour. The Swedish version of Childbirth Self-efficacy Inventory is a reliable and valid instrument. The inventory can act as a tool to identify those women who need extra support and to evaluate the efforts of improving women's self-efficacy during pregnancy.
To explore the frequency of women seeking care during the latent phase of labour at two delivery wards. Also, to investigate interventions during labour and birth outcomes in relation to parity and remaining in hospital or not during the latent phase. A retrospective, population-based cohort study in two delivery wards in Sweden. The sample was based on electronic childbirth records of all births with spontaneous onset. Of 5797 women, 17.6% (n=1023) sought care during the latent phase. Of these, 57.8% (n=591) remained at the hospital, and 50.5% (n=517) had a prolonged latent phase. Nulliparae remaining in hospital had a lower rate of spontaneous vaginal births (p=0.007), more emergency Caesarean sections (CSs) (p<0.001) and more babies with Apgar <7 at 5min (p=0.045) compared with those returning home. Nulliparae having a prolonged latent phase and remaining in hospital had fewer spontaneous vaginal births (p=0.045), more emergency CSs (p=0.002) and more babies with Apgar <7 at 5min (p=0.023) compared with those returning home. For multiparous women with a previous vaginal birth, with or without prolonged latent phase, mode of delivery was not influenced by remaining in hospital or not. These findings indicate a need for different guidelines for nulliparous and multiparous women seeking hospital care during the latent phase, and for special attention to be given to nulliparous with a prolonged latent phase remaining in hospital during the latent phase.
This study investigated possible influences of medical interventions during labor on maternal blood pressure during a breastfeed 2 days postpartum. Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at -5, 10, 30, and 60 minutes during a morning breastfeed 2 days postpartum. Five treatment groups were formed based on the medical interventions received during labor: Non-medicated mothers (Control group, n=21); mothers receiving epidural analgesia (EDA) with oxytocin (OT) stimulation (EDA(OT) group, n=14); mothers receiving EDA without OT stimulation (EDA(non-OT) group, n=7); mothers receiving OT stimulation only (OT intravenously [iv] group, n=9); and mothers receiving 10 IU of OT intramuscularly (im) only (OT im group, n=15). Baseline diastolic, but not systolic, blood pressure differed between the groups as displayed by significantly lower diastolic blood pressure in the EDA(non-OT) group compared with the Control group, the OT iv group, and the EDA(OT) group (p=0.045, p=0.041, and p=0.024, respectively). Both systolic and diastolic blood pressure fell significantly during the breastfeeding session in the Control group (p=0.001 and p=0.004, respectively), the OT im group (p=0.006 and p=0.001, respectively), and the EDA(OT) group (p=0.028 and p=0.002, respectively), and the fall in diastolic blood pressure tended to be significant in the OT iv group (p=0.050). The duration of skin-to-skin contact before breastfeeding correlated positively with the decrease in systolic blood pressure in the OT im group (R(s)=0.540, p=0.046). Administration of EDA during labor lowers baseline diastolic blood pressure and abolishes the fall in blood pressure in response to a breastfeed 2 days after birth.
Aim: to elucidate the effects of prior mental disorders on newly delivered women's mental health and to compare the outcome of different instruments to screen for maternal distress and depression after childbirth. The sample of 232 Stockholm women responded to a questionnaire on background data and three questionnaires, Beck Depression Inventory (BDI), Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Depression Symptoms Rating Scale (PPDS) at 4-6 weeks and 10-12 weeks after childbirth. Results: show that maternal distress was experienced by 20% of the women as assessed by the BDI and the EPDS at 4-6 weeks postpartum, and by 13-16% of the women at 10-12 weeks after childbirth. A regression analysis showed that a history of mental health problems influenced maternal self-assessment at both points-in-time. The following background data showed a small but significant impact on maternal self-assessment; younger age, lower educational level, and a short-term partner relationship. The most important emotional responses were sadness, guilt and self-blame across all three instruments at both points in time. Loss of pleasure, self-accusations, irritability, anger, worry and somatic symptoms such as muscular tension, headaches and stomach cramps also occurred. Conclusion: women with prior mental health problems are more vulnerable for maternal distress and midwives at the antenatal health clinics should encourage pregnant women to express emotional issues during their transition to motherhood in order to offer appropriate professional support and care.
Background: Cesarean birth may negatively affect mother-infant interactions, while professional support may positively affect these interactions. The aim of this study was to evaluate the effects of a process-oriented training program for antenatal midwives and postnatal nurses on first time mothers’ perceptions of professional support and on their relation to and feelings for their baby after a cesarean or a normal birth. Methods: An intervention through process-oriented training for health professionals regarding professional support in childbearing was conducted between 1999 and 2003. Ten municipalities were paired and within each pair, randomly assigned to intervention (five) or control (five) municipality. Mothers having caesarean (n=94) or normal birth (n=301) were included. Mothers received routine care (Control Group=CG) or care from health professionals having received training (Intervention Group=IG). The mothers answered questionnaires three days, three and nine months after birth. Factor analysis identified three factors: “Taking in baby,” “Confidence in relation to baby,” and “Feelings for baby.” Results: Mothers in the IG with cesarean birth reported more positive for the “Taking in baby” factor (p=0.002) three days after birth, more positive for the “Confidence in relation to baby” factor (p=0.004) and for the “Feelings for baby” factor (p=0.004) nine months after birth compared to Mothers in the CG. Mothers in the IG reported stronger professional support from health professionals compared to CG. Conclusion: Our result suggests that improved professional support during pregnancy may buffer negative effects of caesarean birth for first-time mothers in relation to and feelings for the baby.
The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session, introduction of breastmilk substitutes and solids, and the duration of breastfeeding. Ten municipalities in Sweden were randomized to either the intervention or control groups. The intervention included a process-oriented training program for midwives and postnatal nurses in the intervention municipalities. Primiparas (n=540) living in either an intervention or control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, 3 months, and 9 months postpartum. As a result of the process-oriented training program for midwives and postnatal nurses, the IG mothers had a significantly longer duration of exclusive breastfeeding, even if the initial breastfeeding session did not occur within 2 hours after birth, than the corresponding group of CGA mothers (p=0.01). Fewer infants in the IG received breastmilk substitutes (in the first week of life) without medical reasons compared with the control groups (p=0.01). The IG infants were significantly older (3.8 months) when breastmilk substitutes were introduced (after discharge from the hospital) compared with the infants in the control groups (CGA, 2.3 months, p=0.01; CGB, 2.5 months, p=0.03). A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital.
To investigate differences between the breast-seeking and crying behaviour of girls and boys in skin-to-skin contact (SSC) with their mother or their father after Caesarean section as well as the point-in-time for the first breastfeeding and to compare mothers' and fathers' interactive behaviour with their newborn girl or boy. Twenty girls and 17 boys were randomized to 25 min of SSC with one or the other parent immediately after birth. The interaction was videotaped. Girls started rooting movements earlier than boys in SSC with either parent (p = 0.027). Infants started to breastfeed significantly earlier if having been in SSC with mothers compared with SSC with fathers during the first 5-30 min (p = 0.018). Girls cried more than boys in SSC with either parent (p = 0.02). Mothers used more touching behaviour towards their newborn infant than fathers (p = 0.001). Mothers touched girls less than boys (p = 0.038). Fathers directed less speech towards girls compared with boys (p = 0.042). Early mother-infant SSC immediately after Caesarean section should be promoted until the occurrence of the first breastfeed. If the mother is unable to provide SSC immediately after birth, the father-infant SSC is a valuable alternative because it enhances paternal interaction.
Scand J Caring Sci; 2012; 26; 245–253 Depressive mood in women at childbirth predicts their mood and relationship with infant and partner during the first year postpartum Background: Although many studies have reported negative impact of maternal depressive symptoms on family relations, few studies have explored whether or not early depressive symptoms influence interfamily relationships. The aim was to describe first-time mothers’ feelings for their infant and partner during the first postpartum year in relation to maternal depressive symptoms. Research questions were addressed about: What is the prevalence of maternal depressive symptoms 10 days postpartum? How does maternal depressive symptoms on day 10 relate to her mood and feelings for the infant and partner at days 3 and 10, and at 6 and 12 months postpartum? Methods: A longitudinal study with first-time mothers, normal pregnancies, giving birth to healthy babies participated in the study; altogether, n = 419. Depressive symptoms were measured by Edinburgh Postnatal Depression Scale (EPDS) at 3 and 10 days. Additional questionnaires assessing the woman’s mood and relationship with her infant and partner were filled out at days 3 and 10, and at 6 and 12 months postpartum. Results: Twenty-two per cent of the women scored high on EPDS on day 10 postpartum. In addition, low mood seemed to remain prevalent over the baby’s first year, as confirmed by the mood scale at 6 and 12 months postpartum. Women with depressive symptoms showed less closeness, warmth and confidence as measured by the infant and partner relationship scales over the first year. Mothers with a high EPDS score on day 3 scored less optimal on the relationship scale to the infant at days 3 and 10, but not 6 or 12 months postpartum. Conclusions: To screen women for depressive symptoms, 10 days postpartum seems to be predictive of maternal assessment of maternal–infant relationship throughout the first year and enables early intervention.
to examine effectiveness and overall opiate consumption between high-sensory transcutaneous electrical nerve stimulation (Hi-TENS) combined with patient-controlled analgesia with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth. randomised, controlled study. a county hospital in south-west Sweden. 42 multiparous women. participants were randomly assigned and connected to patient-controlled analgesia with morphine alone or in combination with Hi-TENS apparatus. Levels of morphine consumed were calculated every third hour during the first 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption of morphine differed significantly between the groups: morphine with TENS was 16.2 ± 12.6 mg and morphine alone was 33.1 ± 20.9 mg (p = 0.007). Assessment of pain relief showed no significant difference. Sedation differed significantly between the groups (p = 0.045), especially between three and 12 hours post partum (p = 0.011). pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed benefit of this treatment combination is that the mother is more alert and better able to interact with her newborn during the first hours after birth without drowsiness due to large doses of opiates.
The aim of this study was to provide a more detailed analysis of the infant's behavioural sequence that begins immediately after birth and terminates with grasping the nipple, suckling and then falling asleep. Twenty-eight full-term infants were videotaped immediately after birth. A video protocol was developed to examine infant behaviours identified from five random videotapes. When birth crying had stopped, the babies showed a short period of relaxation and then successively became alert. They went through an 'awakening phase', an 'active phase' with movements of limbs, rooting activity and looking at the mother's face, a 'crawling phase' with soliciting sounds, a 'familiarization phase' with licking of the areola, and a 'suckling phase' and last a 'sleeping phase'. Five factors related to the time spent to locate the breast: more number of looks at the breast 10-20 min after birth (p < 0.0001); and exposure to meperidine (p = 0.0006) related to increased time. Early start of crawling (p = 0,0040); increased number of 'soliciting sounds' (p = 0.0022); and performing hand-breast-mouth movements (p = 0.0105) related to shorter time. Inborn breastfeeding reflexes were depressed at birth, possibly because of a depressed sensory system. It is hypothesized that when the infant is given the option to peacefully go through the nine behavioural phases birth cry, relaxation, awakening, activity, crawling, resting, familiarization, suckling and sleeping when skin-to-skin with its mother this results in early optimal self-regulation.
Becoming a parent is overwhelming for most men and women and alters the sexual relationship for many couples. To describe fathers' experience about sexual life after childbirth within the first 6 months after childbirth. A descriptive design, using content analysis with a qualitative approach, based on focus group discussions and one-to-one interviews. Eight first-time and two subsequent fathers participated. Three subthemes were identified: Struggling between stereotypes and personal perceptions of male sexuality during transition to fatherhood; new frames for negotiating sex; a need to feel safe and at ease in the new family situation. The overarching theme emerged as 'transition to fatherhood brings sexual life to a crossroads' and guided us to a deeper understanding of the difficulties men experience during the transition to fatherhood. To get sexual life working, a number of issues had to be resolved, such as getting involved in the care of the baby and the household and getting in tune with their partners in regard to sexual desire. The men needed to be reassured and prepared for this new situation by health care professionals. New fathers in our study put the baby in focus in early parenthood and were prepared to postpone sex until both parties were ready, although they needed reassurance to feel at ease with the new family situation. The fathers' perceptions of sexual life extended to include all kinds of closeness and touching, and it deviated from the stereotype of male sexuality. This is important information for health care providers and midwives to be aware of for their encounters with men (and women) during the transition to fatherhood, and parenthood and can contribute to caring science with a gender perspective on adjustment of sexual life after childbirth.
Cesarean section is associated with delayed mother-infant interaction because neither the mother nor the father routinely maintains skin-to-skin contact with the infant after birth. The aim of the study was to explore and compare parent-newborn vocal interaction when the infant is placed in skin-to-skin contact either with the mother or the father immediately after a planned cesarean section. A total of 37 healthy infants born to primiparas were randomized to 30 minutes of skin-to-skin contact either with fathers or mothers after an initial 5 minutes of skin-to-skin contact with the mothers after birth. The newborns' and parents' vocal interaction were recorded on a videotape and audiotape. The following variables were explored: newborns' and parents' soliciting, newborns' crying and whining, and parental speech directed to the other parent and to the newborn. Newborns' soliciting increased over time (p=0.032). Both fathers and mothers in skin-to-skin contact communicated more vocally with the newborn than did fathers (p=0.003) and mothers (p=0.009) without skin-to-skin contact. Fathers in skin-to-skin contact also communicated more with the mother (p=0.046) and performed more soliciting responses than the control fathers (p=0.010). Infants in skin-to-skin contact with their fathers cried significantly less than those in skin-to-skin contact with their mothers (p=0.002) and shifted to a relaxed state earlier than in skin-to-skin contact with mothers (p=0.029). Skin-to-skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin-to-skin contact and exposed to the parents' speech, the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin-to-skin contact after cesarean section, to support the early onset of the first vocal communication.
In this study we made a detailed analysis of the mothers' release pattern of adrenocorticotropic hormone (ACTH) and cortisol during a breastfeeding session during the second day postpartum and related these patterns to maternal oxytocin levels as well to the duration of sucking and the duration of skin-to-skin contact before sucking the breast. Furthermore, we investigated if epidural analgesia and oxytocin administration during and after labor influenced the release pattern of ACTH and cortisol. Sixty-three primiparae were included in the study. Fourteen received oxytocin intramuscularly postpartum, nine received oxytocin infusion, 14 received epidural analgesia combined with oxytocin infusion, and six received epidural analgesia alone. Twenty mothers did not receive any of these medical interventions. Blood samples were analyzed for ACTH and cortisol by enzyme-linked immunoassay. Both ACTH and cortisol levels fell significantly during the breastfeeding session. A significant negative relationship was found between oxytocin and ACTH levels, but not between oxytocin and cortisol levels. A positive and significant relationship was found between ACTH and cortisol levels. The duration of skin-to-skin contact before onset of sucking was significantly and negatively associated with lower cortisol levels, but not with ACTH levels. Cortisol levels differed significantly between mothers having received epidural analgesia with and without oxytocin. Breastfeeding is associated with a decrease of ACTH and cortisol levels. Skin-to-skin contact contributes to this effect. ACTH correlated negatively with the duration of sucking and with median oxytocin levels, whereas cortisol levels correlated inversely with the duration of skin-to-skin contact preceding sucking, suggesting a partial dissociation between the mechanisms regulating ACTH and cortisol release. In addition, medical interventions in connection with birth influence the activity of the hypothalamic-pituitary-adrenal axis 2 days after birth.
The present study investigates if mothers and fathers have similar ways of thinking and feeling about their babies during late pregnancy and how aspects of parental-fetal attachment are related to maternal depressive mood. Two hundred and ninety-eight Swedish-speaking women at 30-32 weeks of gestation and partners (n = 274) participated in the study. Socio-demographic background data were collected. Prenatal attachment was assessed with the maternal/paternal-fetal attachment scale (MFA/PFA), and depressive symptoms were assessed by the Edinburgh postnatal depression scale (EPDS). MFA and PFA scores mirrored each other. After factor analysis, five different factors loaded somewhat differently for men were revealed as significant. These factors were (I) concerns about the fetus and health behavior, (II) mental preparation to take care of the unborn child, (III) experiences of pregnancy, (IV) experiences of fetal movements, and (V) naming of the baby. Factors III and IV were related to depressive symptoms. Mothers with slight depressive symptoms were somewhat less positive about the pregnancy but showed more attention to the fetal movements. Midwives should conduct interviews on the women's psychosocial history and use validated instruments, which may help them to identify problems with the psychosocial health of the mother and her partner as they journey through pregnancy and transition to parenthood.
to describe midwives' reflections on counselling women at the postnatal check with special focus on sexual life after childbirth. qualitative descriptive study with focus group discussions as the method of data collection. antenatal clinics in Stockholm greater catchments' area. during 2006 and 2007, a voluntary sample of midwives from 10 different antenatal clinics were invited. content analysis was undertaken through identification of codes, categories and themes. Two themes emerged: balancing between personal perceptions of the woman's needs and the health system restrictions and strategies for counselling about sexual life after childbirth'. The midwives tried to create a picture for themselves of the woman coming for the postnatal check and her needs before the consultation. This picture guided the midwives, but lack of time and knowledge restricted them when counselling on sexual life after childbirth. Two different strategies in counselling were identified, one task-oriented and one subject-oriented. Demands and time restrictions led midwives to distance themselves from their clients. A task-oriented approach was more visible in midwives' encounters with foreign-born women, where linguistic difficulties, cultural diversity and narrow time frames restricted the midwives' effectiveness and/or sensitivity as caregivers. In contrast, the subject-oriented strategy meant 'getting in tune', i.e. listening to the woman when she expressed her feelings and emotions, encouraging the woman to be an active participant in decisions involving her care. This strategy is used for women who arouse midwives' empathy and when there is some form of recognition and understanding. The picture created of the woman and her needs guided the midwives, but lack of knowledge and time limitations restricted counselling on sexual life after childbirth. Two counselling strategies were identified, one task-oriented and one subject-oriented. Balancing these two counselling strategies improves both the ethical aspects and the quality of the counselling.
Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. The aim of the present study was to make a detailed analysis of maternal release of oxytocin and prolactin in response to breastfeeding during the second day postpartum in mothers who had received oxytocin either intravenously for stimulation of labor or intramuscularly for prevention of postpartum hemorrhage and/or epidural analgesia or those who had received no such treatment in connection with birth. In a descriptive comparative study plasma oxytocin and prolactin concentrations were measured in response to suckling during the second day postpartum in women who had received intravenous intrapartum oxytocin (n = 8), intramuscular postpartum oxytocin (n = 13), or epidural analgesia, either with (n = 14) or without (n = 6) intrapartum oxytocin infusion, and women who received none of these interventions (n = 20). Hormone levels were analyzed by enzyme immunoassay. All mothers showed a pulsatile oxytocin pattern during the first 10 minutes of breastfeeding. Women who had received epidural analgesia with oxytocin infusion had the lowest endogenous median oxytocin levels. The more oxytocin infusion the mothers had received during labor, the lower their endogenous oxytocin levels were during a breastfeeding during the second day postpartum. A significant rise of prolactin was observed after 20 minutes in all women, but after 10 minutes in mothers having received oxytocin infusion during labor. In all women, oxytocin variability and the rise of prolactin levels between 0 and 20 minutes correlated significantly with median oxytocin and prolactin levels. Oxytocin, released in a pulsatile way, and prolactin were released by breastfeeding during the second day postpartum. Oxytocin infusion decreased endogenous oxytocin levels dose-dependently. Furthermore, oxytocin infusion facilitated the release of prolactin. Epidural analgesia in combination with oxytocin infusion influenced endogenous oxytocin levels negatively.
Background: Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. The aim of the present study was to make a detailed analysis of maternal release of oxytocin and prolactin in response to breastfeeding during the second day postpartum in mothers who had received oxytocin either intravenously for stimulation of labor or intramuscularly for prevention of postpartum hemorrhage and/or epidural analge- sia or those who had received no such treatment in connection with birth. Methods: In a descriptive comparative study plasma oxytocin and prolactin concentrations were measured in response to suckling during the second day postpartum in women who had received intravenous intrapartum oxytocin ( n 8), intramuscular postpartum oxytocin ( n 13), or epidural analgesia, either with ( n 14) or without ( n 6) intrapartum oxytocin infusion, and women who received none of these interventions ( n 20). Hormone levels were analyzed by enzyme immunoassay. Results: All mothers showed a pulsatile oxytocin pattern during the first 10 minutes of breastfeeding. Women who had received epidural analgesia with oxytocin infusion had the lowest endogenous median oxytocin lev- els. The more oxytocin infusion the mothers had received during labor, the lower their endogenous oxytocin levels were during a breastfeeding during the second day postpartum. A significant rise of prolactin was ob- served after 20 minutes in all women, but after 10 minutes in mothers having received oxytocin infusion dur- ing labor. In all women, oxytocin variability and the rise of prolactin levels between 0 and 20 minutes corre- lated significantly with median oxytocin and prolactin levels. Conclusion: Oxytocin, released in a pulsatile way, and prolactin were released by breastfeeding during the sec- ond day postpartum. Oxytocin infusion decreased endogenous oxytocin levels dose-dependently. Furthermore, oxytocin infusion facilitated the release of prolactin. Epidural analgesia in combination with oxytocin infusion influenced endogenous oxytocin levels negatively.
Women undergo physiological and psychological changes during pregnancy, labor and lactation. The psychological adaptations can be affective, cognitive and behavioral and can be measured by dimensional personality instruments. This study aims to compare (1) the personality profile in mothers after birth with a normative group of non-lactating women and to examine (2) whether the personality profile differs 2 days, 2 months and 6 months after birth between mothers who have been exposed to epidural anesthesia, oxytocin administration or neither. Sixty-nine primiparae were assigned to four groups: mothers having received oxytocin infusion during labor (OT iv group, n = 9), mothers having received epidural analgesia with/without oxytocin infusion (EDA group, n = 23), mothers having received 10 iU oxytocin intramuscularly after birth (OT im group, n = 15) and mothers having received none of these treatments (unmedicated group, n = 22). At 2 days and 2 and 6 months postpartum mothers completed the Karolinska Scales of Personality (KSP). The unmedicated, the OT iv- and OT im groups scored significantly lower on anxiety and aggression related scales and higher on the socialization subscale during the entire observation period when compared with a normative group. These differences were not observed in the EDA group 2 days postpartum. At 2 and 6 months postpartum, the scores of the EDA group had changed significantly and were almost similar to the KSP scores of the other groups. ANCOVA analysis revealed that OT infusion, over and above the effects of EDA, was associated with decreased levels of several anxiety and aggression subscales. We conclude that women who received exogenous oxytocin during labor show similar positive personality traits during breastfeeding such as reduction in anxiety and aggression and increasing socialization, including maternal behavior, that have previously been ascribed to endogenous oxytocin. More importantly, these effects were not seen at 2 days postpartum in women who received epidural anesthesia during labor.
Among Swedish pregnant teenage girls it is unusual to continue pregnancy and to choose to have a baby. Swedish teenage mothers can therefore be expected to differ from adult mothers, at a group level. The aim of this study was to describe and compare teenage mothers who were giving birth in hospital with adult mothers as to sociodemographic background, perception of health and social support. A descriptive comparative study was conducted over one year, in a county in south-western Sweden, which comprised a group of all teenage mothers aged 15-19, who gave birth at hospital (study group n=97) and the same number of adult mothers aged 25-29, matched for parity and birth of a baby closest to the index mother (reference group). Both groups answered a questionnaire regarding sociodemographic variables, lifestyle, health, self-esteem, depressive symptoms, and support. Information on the mothers' pregnancy and delivery was obtained from their maternal health and delivery charts. Teenage mothers had more often been exposed to a difficult family situation, had more often experienced school failure than adult mothers, and showed health-risk behavior. Teenage mothers perceived less support, had lower self-esteem, and more depressive symptoms than adult mothers. Teenage mothers differed from adult mothers regarding family situation and health behavior as well as perception of support, self-esteem, and depressive symptoms, which may negatively influence their ability to cope with parenthood. Efforts should be made early in pregnancy to meet both health and support needs of teenage mothers.
The first sexual intercourse after childbirth may be challenging for women, especially if the birth resulted in injuries in the genital area. The purpose of this study was to investigate whether or not tears in the vagina, perineum, sphincter ani, or rectum hindered sexual intercourse during the year after childbirth. We obtained information from 2,490 women in a population-based cohort identified at antenatal care. Information about first sexual intercourse was collected by means of a questionnaire sent 1 year after birth to the women and about women's tears reported in the population-based Swedish Medical Birth Register. Adjusted relative risks with 95 percent confidence intervals for not having had sexual intercourse within 3 and 6 months, respectively, after childbirth were 1.5 (95% CI 1.2-1.8) and 1.6 (95% CI 1.2-2.3) for tears in the vagina, 1.4 (95% CI 1.1-1.6) and 1.5 (95% CI 1.1-2.1) for tears in the perineum, and 2.1 (95% CI 1.4-3.1) and 2.2 (95% CI 1.1-4.6) for tears in the sphincter ani and rectum. No statistically significant differences were found at 1-year follow-up. No associations between episiotomy and delay in resuming intercourse were found after adjusting the relative risks. Tears in the vagina, perineum, sphincter ani, or rectum are associated with a delay in women's resumption of sexual intercourse 6 months after childbirth in Sweden.
The benefits of breastfeeding for infants are well known. Recently data have started to emerge showing that breastfeeding may also induce positive effects in the mother. This study aimed to investigate the pattern of maternal blood pressure before, during, and after a breastfeed 2 days postpartum. Additionally, blood pressure during the following 25-week breastfeeding period was investigated. Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at -5, 10, 30, and 60 minutes in connection with a morning breastfeed. Thirty-three women continued to measure blood pressure before and after breastfeeding for 25 weeks. Blood pressure fell significantly in response to breastfeeding 2 days after birth. The fall in systolic and diastolic blood pressure amounted to 8.8 (SD = 11.00) and 7.7 (SD = 9.3) mm Hg, respectively. During the 25-week follow-up period a significant fall of basal blood pressure (systolic, df = 3, F = 7.843, p < 0.001; diastolic, df = 3, F = 5.453, p = 0.002) was observed. The total fall in systolic and diastolic blood pressure amounted to a mean of 15 (SD = 10.4) mm Hg and 10 (SD = 9.7) mm Hg, respectively. In addition, blood pressure fell significantly in response to individual breastfeeding sessions during the entire observation period. In conclusion, both systolic and diastolic blood pressures fall during a breastfeeding session, and pre-breastfeeding blood pressure decreases during at least the first 6 months of a breastfeeding period in a homelike environment. This study lends further support to the health-promoting effects of breastfeeding.
to explore and describe the student midwife's experiences in offering continuous labour support. a qualitative research design was chosen. Each student midwife offered continuous labour support to five women/couples and wrote narratives about each of these occasions. Written narratives from 11 student midwives were analysed using qualitative content analysis. when student midwives offer continuous labour support to women/couples, they try to establish rapport. When this works, their presence, their sense of confidence and their ability to offer reassurance increase. If establishing rapport does not work, students experience a sense of powerlessness, a need for reassurance and a lack of confidence. offering continuous labour support to women and/or their partners made the students aware of the importance of establishing rapport, and it made them realise the impact that their mere presence in the room could have. The students had a need for reassurance which could hamper their efforts to establish rapport. Experiencing a lack of confidence made students focus more strongly on their clinical skills and on their perceived role as a student midwife. this study can initiate discussions about how student midwives learn to be supportive, as well as about the role models that students encounter during their clinical training in Sweden.
to describe Swedish midwives' reflections on their experiences of caring for teenage girls during pregnancy and childbirth. a hermeneutical approach was used, with focus-group discussions as the method of data collection. three focus-group discussions were conducted in a county comprising urban, suburban and rural districts in south-western Sweden. a voluntary sample of 24 midwives, aged 32-61 years, who were caring for women in different birth settings, participated in 2004. two main themes, with three sub-themes each, were generated by the midwives: (1) the teenage mother, as 'teenagers who are proud of becoming mothers', 'teenagers who are unprepared for becoming mothers' and 'teenagers with an immigrant background', and (2) 'the midwives' wish to care for the teenage mother', as 'taking the teenage mother seriously', 'being an important person for the teenage mother', and 'being a help for the teenage mother'. the findings provide some understanding of the unique characteristics of caring for teenage mothers. For the midwives, the most important aspects of caring for the teenage mother included taking the teenage mother seriously, allowing the midwife herself to become an important person for the teenage mother, and being a help to the mother. This help requires the midwife to balance the different needs of each teenage mother.
The present study aimed to explore secondary school students' needs in relation to sexual and reproductive health in order to inform efforts to improve the quality of health services available to young people. The study involved data collection from 716 11-22-year-old students in four secondary schools in an urban area in Zambia. Students completed a questionnaire and were invited to write down any inquiries they had regarding sexuality and reproduction. Findings revealed that boys and girls lack adequate information about human reproduction and STIs, including HIV. To avoid misconceptions and myths, they also need clear information on contraceptives and masturbation. Responses indicate that young people would welcome guidance and support related to contraception, pregnancy, abortion and STIs/HIV, but also on love and relationships. Culture, religion and gender are important factors influencing sexuality and sexual abuse. These issues need to be taken into consideration when developing youth-friendly programmes for young people.
To investigate (1) the skin temperature pattern in newborns two days after birth in connection to breastfeeding and to examine (2) if the administration of epidural analgesia (EDA) and oxytocin (OT) infusion during labour influences this parameter at this point of time. Forty-seven mother-infant pairs were included in the study: nine mothers had received OT stimulation during labour (OT group), 20 mothers had received an EDA and OT during labour (EDA group), while 18 mothers had received neither EDA nor OT stimulation during labour (control group). A skin temperature electrode was attached between the newborn's shoulder blades. The newborn was placed skin-to-skin on the mother's chest and covered with a blanket. The temperature was recorded immediately after the newborn was put on the mother's chest and at 5, 10, 20 and 30 min. The temperature measured when the newborns were put skin-to-skin on their mothers' chest was significantly higher in the infants of the EDA group (35.07 degrees C) when compared to the control group (34.19 degrees C, p=0.025). Skin temperature increased significantly (p=0.001) during the entire experimental period in the infants belonging to the control group. The same response was observed in infants whose mothers received OT intravenously during labour (p=0.008). No such rise was observed in infants whose mothers were given an EDA during labour. The results show that the skin temperature in newborns rises when newborns are put skin-to-skin to breastfeed two days postpartum. This effect on temperature may be hampered by medical interventions during labour such as EDA.
Continuous support during the childbirth process ultimately may strengthen the mother's self-esteem and her capacity to interact with and nurture her infant and also may improve paternal involvement in general. In the present study, we investigated whether mothers, who were attended by midwives and nurses who had had a process-oriented training program in breastfeeding counseling, perceived stronger maternal feelings for their infant than mothers who had received only routine care. In a previous study, an intervention that included a process-oriented program on breastfeeding counseling for health professionals and continuity in family classes through childbirth was conducted. The 10 largest municipalities were classified in pairs that were similar in size and had similar figures of breastfeeding duration. The municipalities were randomized pairwise to either an intervention or a control group. The present study is a follow-up study on women's feelings for their infants in relation to the kind of care that they had had and was undertaken between April 2000 and January 2003. The sampling frame was based on women who were cared for at either the intervention clinic or control clinics. The mothers at the control clinics had received standard routine care and had attended family classes through the point of birth. Data collection for control group A started before effects of the intervention could be studied. Data for control group B were collected simultaneously with data collection for the intervention group (n = 540). The mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. Background data of the mothers were collected. The perception of support that was provided by the health professionals and the perception of mother-infant relationship and feelings for the infant were rated on Likert scales. At 3 days postpartum, both the intervention group and control group B versus the control group A thought that their understanding of the infant was better, they perceived more strongly that the infant as their own, and they enjoyed more breastfeeding and resting with the infant. Although there was no significant difference between the intervention group and control group B at 3 days and 3 months observation, mothers in the intervention group talked more to their infant, perceived their infant to be more beautiful than other infants, and perceived more strongly that the infant was their own than did the mothers in control group B at 9 months observation. In addition, the mothers in the intervention group felt significantly more confident with the infant and felt the infant to be closer than did the mothers in control group B. A process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention that guaranteed continuity of care strengthened the maternal relationship with the infant and the feelings for the infant.
Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care. Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales. Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both control groups. After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care, the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care.
Adolescent sexuality is a highly charged moral issue in Kenya and Zambia. Nurse-midwives are the core health care providers of adolescent sexual and reproductive health services but public health facilities are under-utilised by adolescents. The aim of this study was to investigate attitudes among Kenyan and Zambian nurse-midwives (n=820) toward adolescent sexual and reproductive health problems, in order to improve services for adolescents. Data were collected through a questionnaire. Findings revealed that nurse-midwives disapproved of adolescent sexual activity, including masturbation, contraceptive use and abortion, but also had a pragmatic attitude to handling these issues. Those with more education and those who had received continuing education on adolescent sexuality and reproduction showed a tendency towards more youth-friendly attitudes. We suggest that critical thinking around the cultural and moral dimensions of adolescent sexuality should be emphasised in undergraduate training and continuing education, to help nurse-midwives to deal more empathetically with the reality of adolescent sexuality. Those in nursing and other leadership positions could also play an important role in encouraging wider social discussion of these matters. This would create an environment that is more tolerant of adolescent sexuality and that recognises the beneficial public health effect for adolescents of greater access to youth-friendly sexual and reproductive health services.
To give birth and become a parent is a source of many emotions and expectations. Several studies show that women experience different problems after giving birth. It can bring many physical, emotional and social changes that may alter the woman's sexual needs and impact on her relationship. The aim of this study was to elucidate how some women experienced their sexual life with their partner after giving birth. Twenty-seven women participated in six focus group discussions (FGDs). These discussions took place 3-24 months postdelivery. The midwives at their antenatal clinics selected them. A discussion guide with broad questions related to the subject was used and an observer took notes during the FGD. Four themes were identified: body image after childbirth, how sexual patterns are altered following new stresses of family life, discordance of sexual desire with the partner and the necessity for reassurance. The women did not feel comfortable with the physical changes that had taken place and their body image. Childbirth meant less sleep and less free time; consequently, instead of having sex, women wanted to sleep or have time for themselves and that led to a changed sex pattern. Discordance of sexual desire with the partner was a problem but most of the women expressed confidence that their sexual desire would return shortly. Reassurance and confirmation that they were physically alright and back to normal was essential. New mothers are concerned with their body image and the ability to adapt to parenting. They need sensitive, professional counselling and reassurance about their body, as well as about sexual life after childbirth. This level of professional counselling is presently not widely available to new mothers, while midwives and gynaecologists should be the key persons to provide this service.
The purpose of the study was to measure the attitudes of antenatal midwives and postnatal nurses to breastfeeding before and after common, process-oriented breastfeeding training. Antenatal centres and child-health centres in 10 municipalities were randomized to either an intervention or a control group. The antenatal midwives and postnatal nurses in the intervention group were together given process-oriented breastfeeding training and were, in addition, asked to develop a common breastfeeding policy. A previously developed instrument was used to measure the effects of a training programme on breastfeeding attitudes among midwives and postnatal nurses. It consisted of four scales measuring a person's attitudes toward breastfeeding in four dimensions: regulating, facilitating, disempowering, and breastfeeding-antipathy attitudes. A mean score was calculated for each individual on these four dimensional scales. The higher the score, the stronger the attitude. After one year, the intervention group reduced their scores on the regulating scale when compared with the control group (p<0.001). The intervention group decreased their scores on the regulating scale and increased their scores on the facilitating scale over the first year after training. The control group also significantly increased their scores on the facilitating scale. When the results were analysed profession-wise, the postnatal nurses in the intervention group decreased their scores on the regulating and disempowering scales and increased their scores on the facilitating scale. In contrast, the midwives in the intervention group decreased their scores only on the breastfeeding antipathy scale. The control group midwives decreased their scores on the disempowering scale. No differences were found among the postnatal nurses in the control group. Process-oriented breastfeeding training made both antenatal midwives and postnatal nurses better disposed to breastfeeding; postnatal nurses in particular improved their attitudes. Attitudes to breastfeeding tended to be stable over time, but process-oriented training lowered the scores a little on the regulating scale, suggesting that after this kind of training counsellors would find it less necessary to schedule and control the mothers' breastfeeding behaviour.
Our aim in this study was to describe the perspectives, experiences, and reasoning about becoming and being a teenage mother by Swedish teenage girls. Twenty pregnant and parenting teenage girls, aged 15 to 19 years, were interviewed. The teenagers described a pattern of early childbirth in their families, lack of opportunity in life, and ambivalence in contraceptive use as reasons for becoming a teenage mother. They experienced being pregnant and a teenage mother as both a positive transition into adulthood but also as a physiological and psychological hardship. Furthermore, the teenagers emphasized the importance of supportive relationships with families, friends, and society as a prerequisite for successful parenting. The results of our study may be viewed as generating a working hypothesis that can be transferred to other settings on the basis of the information gathered.
The aim of the study was to develop an instrument that can be used for accurate assessment of nurses' and midwives' attitudes toward breastfeeding in a group of midwives, maternity-nursing staff and postnatal nurses experienced in breastfeeding counselling. An instrument based on WHO standards was developed to measure breastfeeding attitudes. In all, 168 healthcare professionals filled in the instrument. A factor analysis using maximum likelihood and varimax rotation was performed. Spearman's correlation was used to correlate factorial dimensions and self-described interest in breastfeeding. By means of factor analysis four factors were identified: the "regulating" factor focused on regulating the mothers' breastfeeding management, the "facilitating" factor focused on making it easy for mothers to manage their breastfeeding, the "disempowering" factor focused on giving advice, disregarding the needs of the mother being counselled, and the "breastfeeding antipathy" factor focused on insufficient, basic, breastfeeding knowledge and aversive reactions to breastfeeding. Midwives rated higher on the facilitating factor and breastfeeding antipathy factor and lower on the regulating factor than postnatal nurses. Breastfeeding interest was positively correlated with the facilitating factor, and negatively with the disempowering factor and the breastfeeding antipathy factor. This instrument provides a picture of health professionals' attitudes towards breastfeeding. Four factors were identified in order of importance: regulating, facilitating, disempowering, and breastfeeding antipathy factors. Harmful attitudes were identified and suggested a need for educational programmes to help health professionals to reconcile damaging values, in order to improve breastfeeding counselling.
Support from the mother's network of relatives, friends, and professional caregivers during childbirth is likely to be important for breastfeeding success. Few studies have been conducted to examine mothers' perceptions of breastfeeding support. The objective of this study was to describe breastfeeding support and feelings of confidence of primiparas and multiparas in relation to duration of breastfeeding. Mothers who delivered vaginally were eligible for inclusion. After receiving a questionnaire when their children were 9 to 12 months of age, 194 primiparas and 294 multiparas responded to questions on breastfeeding history and on perceived and overall breastfeeding support and feelings of confidence. Feelings of overall breastfeeding support were correlated with duration of exclusive breastfeeding in both primiparas (p < 0.001) and multiparas (p < 0.001). Multiparas who knew how long they were breastfed as a child showed a longer duration of exclusive (p = 0.006) and total (p = 0.007) breastfeeding than multiparas who did not know. The time during which the partner was present after labor was correlated with the duration of exclusive (p < 0.001) and total breastfeeding (p = 0.002) in primiparas. Feelings of confidence when the baby was 6 to 12 months old, as retrospectively rated on a visual analog scale, was correlated with feelings of confidence in the partner during childbirth in both primiparas (p < 0.001) and multiparas (p < 0.001) and the experience of overall breastfeeding support (primiparas, p = 0.002; multiparas, p < 0.001). Both groups were more content with breastfeeding information they received from midwives in the maternity wards, compared with that from antenatal midwives and postnatal nurses (p < 0.001). A helpful support strategy for mothers with respect to breastfeeding outcome is for health professionals to discuss the grandmother's perception of breastfeeding with the mother. It is important for perinatal caregivers to provide an environment that enables the family to stay together after delivery. A helpful support strategy for health professionals might be to mobilize grandmothers with positive breastfeeding perception to provide support for their daughters' breastfeeding.
The aim of this study was to describe the effects of sociodemographic factors and maternity ward practices on the duration of breastfeeding in Swedish primiparas (n = 194) and multiparas (n = 294), consecutively selected from hospital birth files for 3 months, who responded to a questionnaire 9 to 12 months after childbirth. The impact of sociodemographic data and maternity ward practices on exclusive and any breastfeeding were examined. Smoking and supplementation without medical reasons influenced the duration of both exclusive and any breastfeeding negatively, whereas early first breastfeeding influenced the duration of both exclusive and any breastfeeding positively, and parity had no significant influence. Late hospital discharge influenced the duration of exclusive breastfeeding positively, and higher maternal age influenced the duration of any breastfeeding positively. These variables altogether explained 11.4% (P < .001) of the variance in the duration of exclusive breastfeeding and 8.2% (P < .001) of the duration of any breastfeeding.
Newborns not exposed to analgesia, when placed on the mother's chest, exhibit an inborn prefeeding behavior. This study was performed to assess the effects of different types of analgesia during labor on the development of spontaneous breastfeeding movements, crying behavior, and skin temperature during the first hours of life in healthy term newborns. Video recordings were made of 28 newborns who had been dried and placed in skin-to-skin contact between their mother's breasts immediately after delivery. The video recordings were analyzed blindly with respect to infant exposure to analgesia. Defined infant behaviors were assessed every 30 seconds. Group 1 mothers (n = 10) had received no analgesia during labor, group 2 mothers (n = 6) had received mepivacaine via pudendal block, and group 3 mothers (n = 12) had received pethidine or bupivacaine or more than one type of analgesia during labor. All infants made finger and hand movements, but the infant's massagelike hand movements were less frequent in infants whose mothers had received labor analgesia. A significantly lower proportion of group 3 infants made hand-to-mouth movements (p < 0.001), and a significantly lower proportion of the infants in groups 2 and 3 touched the nipple with their hands before suckling (p < 0.01), made licking movements (p < 0.01), and sucked the breast (p < 0.01). Nearly one-half of the infants, all in groups 2 or 3, did not breastfeed within the first 2.5 hour of life. The infants whose mothers had received analgesia during labor had higher temperatures (p = 0.03) and they cried more (p = 0.05) than infants whose mothers had not received any analgesia. The present data indicate that several types of analgesia given to the mother during labor may interfere with the newborn's spontaneous breast-seeking and breastfeeding behaviors and increase the newborn's temperature and crying.
Newborns placed skin-to-skin with their mothers show an inborn sequence of behavior similar to that seen in other mammals. The purpose of this study was to make a detailed exploration of hand movements and sucking behavior in healthy term newborns who were placed skin-to-skin on their mothers' chests, and to study maternal oxytocin release in relation to these behaviors. Ten vaginally delivered infants whose mothers had not been exposed to maternal analgesia were video-recorded from birth until the first breastfeeding. Video protocols were developed based on observations of the videotapes. Each infant's hand, finger, mouth, and tongue movements, positions of the hand and body, and sucking behavior were assessed every 30 seconds. Maternal blood samples were collected every 15 minutes, and oxytocin levels were analyzed by radioimmunoassay. A statistical test for establishing the relationship between maternal oxytocin levels and infants' hand movements or sucking behavior was developed. Infants used their hands to explore and stimulate their mother's breast in preparation for the first breastfeeding. A coordinated pattern of infant hand and sucking movements was also identified. When the infants were sucking, the massagelike hand movements stopped and started again when the infants made a sucking pause. Periods of increased massagelike hand movements or sucking of the mother's breast were followed by an increase in maternal oxytocin levels (p < 0.005). The findings indicate that the newborns use their hands as well as their mouths to stimulate maternal oxytocin release after birth, which may have significance for uterine contraction, milk ejection, and mother-infant interaction.
Midwives tend to leave minor perineal lacerations to heal spontaneously, and clinical experience and studies show that women can suffer from their stitched lacerations. The study purpose was to determine any differences in the healing process and experience of minor perineal lacerations when they were sutured or not sutured. Eighty term pregnant primiparas with minor perineal lacerations of grades I-II were randomized after childbirth. The experimental group was nonsutured and the control group was sutured. A follow-up examination was performed at 2 to 3 days, 8 weeks, and 6 months after the delivery. Participants were asked about the type of discomfort, and the effect of the laceration on breastfeeding and sexual intercourse. No significant differences were found in the healing process. The type of pain differed between the groups, but the amount of discomfort was the same. The sutured group had to visit the midwife more often because of discomfort from the stitches. Sixteen percent of the women in the sutured group, but none in the nonsutured group (p = 0.0385), considered that the laceration had had a negative influence on breastfeeding. Minor perineal lacerations can be left to heal spontaneously. The benefits for the woman include the possibility of having a choice, avoiding the discomfort of anesthesia and suturing, providing positive affects on breastfeeding.
The aim of the present study was to investigate if personality profiles reflecting anxiety and social interaction of mothers who delivered by Cesarean section (CS) or by the vaginal route (VD) differed in early postpartum and to investigate whether these personality traits were correlated with hormonal data. Seventeen women delivered by emergency CS and 20 by the vaginal route were selected for this study. The amount of milk transferred to the baby was measured. Blood samples were collected during the second breast-feeding on the second day after delivery. The samples were analysed for oxytocin and prolactin. After breastfeeding, the mothers were asked to fill in the personality inventory, Karolinska Scales of Personality (KSP). The scores were compared between the two groups and with a normative group of women. Each scale on the personality inventory was correlated with hormonal parameters. The KSP showed significant differences between the delivered mothers and the normative group in variables related to anxiety and socialization. The VD mothers deviated more than the CS mothers from the normative group. Correlations with hormonal data indicated that anxiety was inversely related with basal levels of oxytocin and prolactin in the CS mothers, whereas the pulsatility of oxytocin was related to social desirability in both groups. Social desirability and oxytocin pulsativity were also correlated with the amount of milk transferred from the mother to the baby. The correlations indicate that central oxytocin, as reflected by basal plasma levels and patterns, may be involved in behavioral adaptations to the maternal role.
A standard dose of 100 mg of pethidine was given im to 13 healthy primiparae during labour. The aim of the study was to investigate whether developing breastfeeding behaviour in the newborn infant was associated with the dose-delivery time interval (DDI) or with the plasma concentration of pethidine and norpethidine in mixed cord blood at birth. The DDI was found to be unevenly distributed with no pethidine exposures in the time interval 5.4-8 h. The material was therefore divided into a "short DDI" group (1.1-5.3 h) and a "long DDI" group (8.1-9.9 h). The infants in the "short DDI" group had a depressed sucking behaviour in 15-45 min of observation and a delayed initiation of lip and mouth movements when compared with the infants in the "long DDI" group. Six of the thirteen infants did not suck their mothers' breasts during the observation period. These infants had higher median plasma concentrations of pethidine at birth than the seven infants who did start sucking. No differences wer found between the plasma levels of norpethidine and the behaviour. It was concluded that 100 mg of pethidine im as an analgesic given under routine conditions may have unfavourable effects on infants' developing breastfeeding behaviour if the DDI is short.
The aim of this study was to find out whether the hormonal patterns of oxytocin, prolactin and cortisol differed between women delivered by emergency section or by the vaginal route and if these patterns show any relation to the duration of breastfeeding. Seventeen mothers with emergency section (C.S.) and 20 mothers with normal vaginal deliver (V.D.) were blood sampled in connection with breastfeeding on day 2 post partum for oxytocin, prolactin and cortisol. The number of oxytocin pulses as calculated with the PULSAR program occurring during the first 10 min of the breastfeeding session varied between 0 and 5. The V.D. mothers had significantly more pulses than the C.S. ones. Furthermore the C.S. women lacked a significant rise in prolactin levels at 20-30 min after the onset of breastfeeding. Logistic regression analysis revealed mode of delivery and infant's age at first breastfeed to be the most important, independent variables showing a relation to the release pattern of oxytocin on day 2. Correlations between oxytocin pulsatility on day 2 and the duration of the exclusive breastfeeding period in the V.D. group suggest that development of an early pulsatile oxytocin pattern is of importance for breastfeeding.
The aim of this study was to determine plasma levels of oxytocin in women immediately after delivery. Oxytocin was measured in 18 healthy women at 15 minute intervals after normal vaginal deliveries with healthy infants. The mothers had their infants put skin-to-skin on their chests immediately after birth. The infants stayed there up to two hours post partum. There were significant elevations of oxytocin 15, 30 and 45 minutes after delivery (p = 0.007, 0.02 and 0.02 respectively) when compared with average pre partum levels sampled approximately 7-15 minutes before partus. This elevation of oxytocin coincided with the expulsion of placenta. In most women this first elevation was followed by repeated elevations of oxytocin. Oxytocin levels returned to pre partum levels at 60 minutes post partum. Oxytocin is known to play a role in maternal bonding in animals. Earlier studies indicate that there is a sensitive period for bonding the first hour after giving birth even in women. Our study demonstrates a coincidence of this putative 'sensitive period' and high levels of oxytocin.
The aim of this quasi-experimental study was to examine the effects of maternal pethidine during labour on the developing breast feeding behaviour in infants in the first 2 h after birth compared with infants not exposed to pethidine. Forty-four healthy infants were observed immediately after birth. They were placed skin-to-skin on their mothers' chests. The development of mouth and sucking movements as well as rooting behaviour and state of sleep/wakefulness were noted. The observer was blind as to the pain relief the mother had received during labour. Of the 44 mothers 18 had received pethidine. The main findings were that infants exposed to pethidine had delayed and depressed sucking and rooting behaviour. In addition, a smaller proportion of infants exposed to pethidine started to suckle the breast. Rooting movements which are expected to be vigorous at 30 min after birth were affected both by administration of pethidine and a longer second stage of labour. It is suggested that the differences found in sucking behaviour may be a central effect of pethidine. Depression of rooting movements in the pethidine group may be caused by exhaustion due to a longer second stage of labour and administration of pethidine. It is recommended that pethidine-exposed mother-infant couples stay together after birth long enough to enable the infant to make the choice to attach or not to attach to the nipple without the forceful helping hand of the health staff.
The aim of this quasi-experimental study was to examine the effects of maternal pethidine during labour on the developing breast feeding behaviour in infants in the first 2 h after birth compared with infants not exposed to pethidine. Forty-four healthy infants were observed immediately after birth. They were placed skin-to-skin on their mothers' chests. The development of mouth and sucking movements as well as rooting behaviour and state of sleep/wakefulness were noted. The observer was blind as to the pain relief the mother had received during labour. Of the 44 mothers 18 had received pethidine. The main findings were that infants exposed to pethidine had delayed and depressed sucking and rooting behaviour. In addition, a smaller proportion of infants exposed to pethidine started to suckle the breast. Rooting movements which are expected to be vigorous at 30 min after birth were affected both by administration of pethidine and a longer second stage of labour. It is suggested that the differences found in sucking behaviour may be a central effect of pethidine. Depression of rooting movements in the pethidine group may be caused by exhaustion due to a longer second stage of labour and administration of pethidine. It is recommended that pethidine-exposed mother-infant couples stay together after birth long enough to enable the infant to make the choice to attach or not to attach to the nipple without the forceful helping hand of the health staff.
The aim of the present investigation was to explore whether the personality characteristics of women who have recently given birth differ from those of a control group of similar aged women and if so, whether such deviations are related to the pregnancy- and lactation-associated hormones oxytocin and prolactin which in animal experiments have been shown to play a role in maternal behavior. Thereforethe Karolinska Scales of Personality (KSP) were used in 50 women 4 days postpartum and in addition 18 blood samples were drawn in connection with breastfeeding. Oxytocin and prolactin levels were measured by radioimmunoassay. The women investigated scored lower in Muscular Tension (p < 0.05), in Monotony Avoidance (p < 0.001) and Psychasthenia (p < 0.01) and higher in Social Desirability (p < 0.001) than a reference material. Plasma levels of oxytocin and prolactin rose as expected in response to breastfeeding. When the average prolactin and oxytocin levels obtained at the 18 different timepoints of each woman were correlated with the scores obtained in the various KSP items, some significant relationships were found. Significant positive correlations were found between prolactin and the KSP dimensions Social Desirability and Inhibited Aggression and negative correlations with Psychasthenia. Significant inverse relationships between oxytocin and several Anxiety and Aggression variables, Guilt in particular, were also found. Correlations with oxytocin and prolactin levels were as a rule particularly clear in samples collected during breastfeeding. The data obtained are discussed from a biological point of view in relation to the specific 'maternal behavior' described in other mammals. It is suggested that subtle psychological and behavioral changes occur in women during motherhood and that these changes may in part be related to prolactin and oxytocin.
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