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Abstract

The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.

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... Furthermore, it increases parental sensitivity to the infant's behaviors [4,5]. Skinto-skin contact between mother and newborn supports bonding, reduces time to first breastfeed, maintains the temperature of the newborn, and reduces stress and formula supplementation in hospitals [6], promoting optimal development [7]. ...
... The results of this study are aligned with research findings from as early as the 1970s on the importance of nonseparation of mother and child during the first hour after birth [6,22,23]. Our results show a significant difference in time to first breastfeeding for newborns cared for skin-to-skin compared to infants dressed and in the mother's arms (p = 0.005). ...
... This means that healthy infants, after cesarean birth can stay warm when cared for by the mother or other primary caregiver skin-to-skin or dressed in the mother's arms. This is in line with previous studies showing no increased risk of hypothermia when the infant is cared for by the parents and the heart rate remains stable [6,25,26]. Skin-to-skin contact has been shown in previous studies to promote cardiorespiratory adaptation after birth [27,28]. For healthy newborn infants, initial care under a heater might not be necessary as their temperature remained stable while held [29]. ...
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Background The purpose of this study was to compare the effects of two caregiving models on full‐term healthy infants' wakefulness, rooting and sucking reflexes, initiation of breastfeeding, and physiological parameters when reunited with their mothers after a mother–infant separation of 130 min after elective cesarean birth. Methods Ninety‐five mother–infant pairs participated in a randomized controlled trial, in which full‐term healthy infants were allocated to be either dressed in their mothers' arms (n = 56) or skin‐to‐skin with their mother (n = 39) when reunited with the mother within 130 min after cesarean birth. Data were collected by the Neonatal Behavioral Assessment Scale (NBAS) to assess the infants' wakefulness and prebreastfeeding behaviors. Physiological parameters were assessed at 15 min intervals, from 130 to 205 min after birth. Time to first breastfeed was measured in minutes from the reunion with the mother. Results The primary finding was that physiologic parameters did not differ but time for initiation of breastfeeding after the reunion with the mother was significantly faster in the skin‐to‐skin group compared to the infants in the mothers' arms group (p = 0.005). Over the full study period, a more relaxed state and drowsy were found in the skin‐to‐skin group compared to the infants in the mothers' arms group. Conclusion Healthy full‐term infants born by elective cesarean, who were cared for by their mothers when reunited within 130 min of separation and cared for by their fathers during the mother–infant separation, initiated breastfeeding successfully and showed stable physiological patterns.
... For premature newborns, SSC improves cardiorespiratory regulation compared to those who do not receive SSC after birth [1,5,7,11]. SSC is closely related to breastfeeding, increasing the success of the infant's latching to the breast during the first hour of life, increasing the probability of exclusive breastfeeding during the first months of life and its prolongation over time [1,7,[11][12][13][14]. Furthermore, immediate SSC favors the colonization of the microbiome, especially for infants born by cesarean section who do not pass through the birth canal, consequently lacking the colonization they would have acquired were they to pass through it [5]. ...
... Furthermore, immediate SSC favors the colonization of the microbiome, especially for infants born by cesarean section who do not pass through the birth canal, consequently lacking the colonization they would have acquired were they to pass through it [5]. As for the mother, SSC increases oxytocin levels, promotes uterine contraction, reduces the risk of hemorrhage, shortens the delivery phase of labor, reduces maternal anxiety, and increases the confidence and psychological well-being of the mother [1,5,10,13,15,16]. Furthermore, early and immediate SSC between mother and child after birth has been shown to have a positive impact on the psychological aspects of the motherchild relationship, favoring the formation of a postnatal bond and attachment [1,5,7,9,10,17]. ...
... Few exceptions contraindicate SSC after birth; until relatively recently, among these exceptions was delivery by cesarean section [1,13]. It has been proven that SSC is safe for mothers who have given birth by cesarean section as long as the health status of the mother and/or newborn does not contraindicate it [1,5,11,20]. ...
Article
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The aim of this study was to develop and validate a predictive model for the establishment of skin-to-skin contact immediately after birth. A descriptive cross-sectional study was conducted during the last trimester of 2022 and the first trimester of 2023 with women who had given birth in Spain. A questionnaire containing sociodemographic, psychosocial, and health variables referring to the mother and the newborn, as well as the Bond and Attachment questionnaire (VAMF, for its name in Spanish) for the analysis of the mother-child bond and attachment, were administered. A multivariate analysis was performed, and areas under the ROC curve (AUC) with their 95% confidence intervals (CI) and the predictive characteristics of these models were estimated. In total, 1077 women participated. The prevalence of early skin-to-skin contact after delivery was 50.2% (468) in the derivation cohort and 49.8% (464) in the validation cohort. Multivariate analysis showed that prematurity, type of delivery, and birth experience were statistically significant, so they were included in the model (p ≤ 0.05). The predictive ability (AUC ROC) was good in both the derivation cohort, yielding 0.92 (95% CI: 0.89-0.95), and in the validation cohort, yielding 0.89 (95% CI: 0.85-0.93). This study developed a predictive model identifying factors facilitating early skin-to-skin contact between a mother and her newborn immediately after birth.
... Moore et al. and Boakye-Yiadom et al. state that early skin-to-skin contact increases the duration of breastfeeding after normal vaginal delivery [9,11] Hauck et al. found that women who gave birth by caesarean section were less likely to initiate breastfeeding, which was also supported by the research of Tahsina et al. [12,13]. Caesarean section reduces the initiation of breastfeeding, delays the time to first breastfeeding and reduces the chance to breastfeed exclusively, but also significantly delays the onset of lactation and increases the likelihood of complementary feeding [14]. Akylidiz et al. report that obstetric interventions adversely affect breastfeeding and that one out of two newborns do not have skin-to-skin contact with their mothers immediately after birth. ...
... Our results are in accordance with several previous studies [9,12,14,15]. In the case of infants born via caesarean section, there is a lower and delayed occurrence of skin-to-skin contact with the mother, a factor known to affect breastfeeding indicators. ...
... Mothers who delivered via caesarean section tended to initiate breastfeeding later [9,[12][13][14]. Our study confirmed this, showing that four-fifths of vaginally delivering mothers breastfed their child immediately, while this rate did not even reach 10% for planned caesarean section births or emergency caesarean section births. ...
Article
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Breast milk is the optimal and essential source of nutrients for babies. Many women, however, do not breastfeed or stop early after giving birth, often due to lack of support. For newborns delivered by caesarean section, there is often a delay, or no skin-to-skin contact after birth; thus, early breastfeeding is not achieved. Separation, complementary feeding or pacifier use also limits the mother’s ability to breastfeed. A quantitative, cross-sectional study was conducted. Sociodemographic data, the mode of delivery and postpartum circumstances, information on breastfeeding, and the method and duration of feeding were collected (n = 2008). Two-thirds of children born by caesarean section did not have skin-to-skin contact after birth (p < 0.001). Lack of rooming-in placement increased the incidence of more frequent complementary feeding (p < 0.001) and shortened the duration of exclusive breastfeeding (p < 0.001). The duration of breastfeeding may also be negatively affected by scheduled feeding (p = 0.007) and pacifier utilization (p < 0.001). The mode of delivery and postpartum circumstances directly affecting the mother and the newborn can affect the feasibility of breastfeeding and the duration of exclusive and partial breastfeeding. For positive breastfeeding outcomes, skin-to-skin contact immediately after birth, rooming-in and unrestricted, demand breastfeeding, as well as the avoidance of the use of pacifiers, are recommended.
... 9 In addition, multiple benefits have also been reported for the mother, such as less maternal pain perception and anxiety, 10,11 less oxidative stress, 11 less use of medication for pain relief, 10 and greater maternal satisfaction. [12][13][14] Immediate SSC is associated with improvement in mother-infant bonding, probably because of the rise in the mother's oxytocin levels during the first hour after birth. 15,16 This increase in maternal oxytocin levels provides multiple benefits such as antagonizing the fight/ flight effect and consequently reducing maternal anxiety, and increasing tranquility, and social receptivity. ...
... 21 Defenders of immediate SSC during cesarean birth argue that in addition to the known benefits for the baby and for the mother, the work environment in the OR improves thanks to the greater satisfaction experienced by the family. [12][13][14] Considering the multiple benefits that immediate SSC has for both, the mother and the baby 22 the aim of the present study was to investigate whether immediate SSC has an influence on operative time or blood loss in primary cesarean births for breech presentation. ...
... 23,24 The reduction in operative time observed in our study in the immediate SSC protocol group may be because of the better work environment created by the greater satisfaction of the family and the increase in maternal oxytocin levels. [12][13][14][15][16] However, reductions in operative time have also been linked to greater haste on the part of obstetricians in uncomfortable environments. 25 We do not believe that the reduction in time was because of the discomfort of working with a baby on the mother's chest during the cesarean birth. ...
Article
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Background Multiple benefits for both, mother and baby have been reported from immediate skin‐to‐skin care (SSC). The aim of this study was to analyze the influence of SSC on operative time and blood loss in primary cesarean births for breech presentation. Methods A SSC protocol for cesarean birth was implemented in our institution on February 25, 2019. In this single‐center retrospective cohort study, we compared the outcomes of planned primary cesarean births for breech presentation at term before and after its implementation. Results Data from 110 women who had a cesarean birth for breech presentation at term were analyzed, 55 in each group. Group 1 were women who had immediate SSC and Group 2 were women without immediate SSC. Maternal and surgical characteristics, and neonatal outcomes were similar in both groups. The mean operative time was 3.22 minutes shorter in the immediate SSC group compared with the not immediate SSC group (37.13 ± 12.27 vs 40.35 ± 12.23 minutes; P = 0.171). Conclusions In conclusion, immediate SSC following a low‐risk cesarean birth for breech presentation neither prolongs the operative time nor increases blood loss during the procedure. Although we were unable to demonstrate a significant reduction in the operative time with the immediate SSC protocol, a decrease of 3 minutes was noted.
... It has been observed that newborns birthed by cesarean section or instrumental delivery may have more problems with attachment and inadequate suction to the mother's breast (Lau et al., 2015;Hobbs et al., 2016). These are some of the reasons why a delay in the initiation of breastfeeding has been attributed to women who have had a cesarean section or an instrumental delivery (Chien, 2007;Stevens et al., 2014;Haghighi, 2015;Patel et al., 2015). ...
... Newborns who experience skin-to-skin contact with their mother develop behaviors such as crawling to the breast (Debes et al., 2013) and more effective suckling (Cantrill et al., 2014), in addition to the opportunity to express the necessary attention demands that trigger neuropsychobiological pathways that activate maternal behaviors and a more immediate response to the needs of the infant with increased lactogenesis (Conde-Agudelo, 2016). According to Stevens et al. (2014), the ideal time to initiate skin-to-skin contact is within the first 30 min of the newborn's life, even during cesarean sections, in order to leave a mark on the programming of the future physiology and behavior of the dyad, given this may impact the effectiveness of breastfeeding. ...
... /fsoc. . the surgical experience, increase the rate of early initiation of breastfeeding and exclusive breastfeeding at 6 months of age of the newborn as recommended by the World Health Organization (Stevens et al., 2014). The benefits of SSC during cesarean sections have even motivated the modernization of surgical birth protocols in different countries for its implementation, as is the case of the Spanish Association of Pediatrics [(Asociación Española de Pediatría (AEP), 2021)]. ...
Article
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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.
... Another possibility is that the staff is reluctant to changes and fears that something will go wrong after starting the immediate SSC in the operating room (Hung and Berg, 2011). However, there are multiple studies that highlight the advantages of immediate SSC after a C-section (Stevens et al., 2014). Taking into account the benefits of immediate SSC, health professionals should implement SSC as the first priority in the first 30 min for healthy newborns by C-section or instrumental delivery (Lau et al., 2018). ...
... Taking into account the benefits of immediate SSC, health professionals should implement SSC as the first priority in the first 30 min for healthy newborns by C-section or instrumental delivery (Lau et al., 2018). There is a need to provide more trained and motivated staff to implement immediate SCC (Stevens et al., 2014). ...
Article
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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.
... According to the studies, women who undergo a CS delivery and experience timely SSC postpartum have beneficial maternal and neonatal outcomes [19,21,25,26]. Firstly, this practice ensures comprehensive neonatal development, helps to form maternal-infant bonding, increases emotional well-being and confidence, and, most importantly, helps to establish a successful start to breastfeeding. ...
... Firstly, this practice ensures comprehensive neonatal development, helps to form maternal-infant bonding, increases emotional well-being and confidence, and, most importantly, helps to establish a successful start to breastfeeding. However, despite the obvious benefits of SSC, separating the mother and infant is still a usual routine in many countries [24,25]. ...
Article
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Background and aims: An excessive weight loss (EWL) of >10% after birth is associated with serious health outcomes. The aim of this study was to determine factors that can reduce weight loss in full-term, exclusively breastfed infants after birth. Methods: This is a retrospective, observational, single-center study. We included 642 healthy, full-term, exclusively breastfed neonates born in 2019 in a baby-friendly hospital, and their healthy mothers. The exclusion criteria were as follows: supplementation with formula, multiple pregnancies, and neonates or mothers with health issues. Results: The mean percentage of neonatal weight loss after 24 h of life was 5.13%, and that after 48 h was 6.34%. Neonates delivered via a caesarean section lost more weight after 24 and 48 h of life than those delivered via vaginal delivery (p < 0.01). There is a noticeable pattern that neonates tend to lose more weight if they do not get skin-to-skin contact (SSC) and breastfeeding within the first hour after birth (p > 0.05). Conclusions: Neonates born via a CS tend to lose more weight after 24 and 48 h of life. Immediate SSC and breastfeeding in the first hour after delivery may decrease the excessive weight loss.
... Doğumdan hemen sonra uygulanan TTT uygulaması yenidoğan ve anne için oldukça yararlıdır. TTT uygulaması yenidoğanın vücut sıcaklığının korunmasını sağlar (3,4), hipoglisemiyi önler (3,5) psiko-duygusal refahını ve fonksiyonel bebek beyin gelişimini destek-ler (6), anne bebek bağını güçlendirir ve emzirme başarısını artırır (4,7). UNICEF ve Dünya Sağlık Örgütü; dünya çapındaki sağlık kuruluşlarının emzirmeyi desteklemelerini teşvik etmek için 1991 yılında Bebek Dostu Hastane Girişimi'ni başlatmıştır. ...
... Çalışmamızda, yenidoğanların taburcu olana kadar SAS alamama durumlarının annenin ve bebeğin birçok tanımlayıcı özelliğinden etkilenmediği bulunmuştur. Çalışmalar yüksek eğitim düzeyinin SAS ile beslenme oranlarını artırdığını (21,22); sezaryen ile doğumun bebeği ilk anne sütüyle besleme ve SAS'ın sürdürülmesi konusunda olumsuz etkilediğini (7,19,23) ...
Article
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ÖZ Amaç: Bu çalışma, bebek dostu bir hastanede ilk ten tene temas zamanını ve taburcu olana kadar sadece anne sütü alımında fark oluşturan faktörler ile bunlar arasındaki ilişkinin incelenmesini amaçlamaktadır. Gereç ve Yöntem: Retrospektif ve tanımlayıcı olarak yapılan çalışmada, veriler Mart 2022-Mart 2023 tarihleri arasında bebek dostu bir hastanede doğum yapan 513 anne ve bebeklerine ait elektronik kayıtlardan ve hasta izlem kayıtlarından elde edilmiştir. Bulgular: Annelerin %90,1’inin doğum sonrası ilk bir saatte bebekleri ile ten tene temas kurabildikleri belirlenmiştir. İlk ten tene temas zamanı ortalaması 62,92±1,98 dakika olarak bulunmuştur. Yenidoğanların %97,1’inin taburcu olana kadar sadece anne sütü ile beslendiği, günde ortalama 10,67±0,04 kez anne sütü aldığı, %2,1’inin bir kez yapay besin ile beslendiği görülmüştür. Anne yaşının ve yenidoğanın doğum ağırlığının ten tene temas zamanını etkilediği; ilk bir saatte ten tene temasa başlayan yenidoğanların daha geç ten tene temasa başlayanlara göre, taburcu olana kadar sadece anne sütü ile beslenme oranının daha yüksek olduğu belirlenmiştir. Sonuç: Bebek dostu hastane unvanı alan bir kurumda ten tene temas zamanı ortalamasının bir saate yakın olduğu ve taburcu olana kadar sadece anne sütü alan bebek oranının yüksek olduğu bulunmuştur. Ülkemizde bebek dostu hastane unvanı alan hastanelerin sayılarının artması anne sütünün teşviki konusunda yararlı olabilir.
... Скорошни проучвания показват, че чревният микробиом вероятно играе роля при реакцията на стрес, възпалението, депресията и тревожността, като са необходими допълнителни изследвания, за да се установи категорично тази причинно-следствената връзка (41). Множество положителни ефекти са свързани с предоставянето на ранен, почти мигновен контакт кожа-до-кожа по време на ЦС, като по-продължително кърмене, по-нисък риск от жълтеница, улеснява се връзката между майката и новороденото, спомага за по-ниски нива на стрес, подобряват се нивата на кръвна захар и терморегулацията на новороденото (42). ...
... Recent studies suggest that the gut microbiome most likely plays a role in the stress response, inflammation, depression, and anxiety, and further research is needed to definitively establish this causal relationship (41). Multiple positive effects have been associated with providing early, near-instant skin-to-skin contact during CS, such as longer breastfeeding, lower risk of jaundice, easier mother-newborn bonding, lower levels of of stress, blood sugar levels and the thermoregulation of the newborn are improved (42). ...
Article
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Introduction: Demographic processes are an important determinant of the workforce pand the human resources in the economy, At the core of the statistical information on the workforce are the demographic indicators - age and gender. In connection with this, the category of the able-bodied population is considered, which is actually the population of working age - from 15 to 64 years. The upper age limit for working capacity is conditional and for the purposes of monitoring of the labor force its upper limit is set to 74 completed years. Objective: Analysis of the age structure of psychiatrists in Bulgaria and preparation of a forecast for the dropout of specialists from the labor market for the period 2022–2037. Materials and methods: The main indicators on which data are collected for psychiatrists in the country are age and region (area) of employment. Official information from the register of the Bulgarian Medical Union (BLS) and the National Statistical Institute (NSI) was used to conduct the research. To outline the problems related to the number of psychiatrists, their distribution in the country, statistical data were analyzed at the national and regional level. A number of statistical analyzes were performed through computer data processing, and in addition to that, dynamic series analysis and forecasting techniques were applied. The MS Excel, I IBM SPSS Statistics v. 26 program products were used for the calculations, tabular and graphical presentations. Data from the register of the Bulgarian Medical Union for gender, age and workplace of psychiatrists in Bulgaria were used. Based on a statistical method, the future of psychiatrists is predicted. Results: In the current study, the main reasons for psychiatrists dropping out of the labor market are reaching retirement age or death. The results of the analysis are presented in tabular and graphical form. In 2022, about 40% of psychiatrists in Bulgaria are of retirement age, and the forecast is that this share will progressively increase, reaching 60% as early as 2026. The average age of psychiatrists is 60 years, and in four regions of Bulgaria it is over 63 years. Discussion: The crisis in psychiatry in Bulgaria has been brewing since the 1960s. However, the necessary measures to promote the specialization of young doctors in this field have not been taken. Conclusion: The situation in psychiatry in Bulgaria is dramatic and it requires many changes to avoid a catastrophe in the coming years. Recommendations: Urgent measures are needed to overcome the huge deficit of psychiatrists (as well as other types of psychiatric staff) in Bulgaria. Two types of measures are proposed - in the short and medium term. Key words: psychiatrists, forecast, прогноза, labor market
... This study provides good evidence from the midwives, women, and support people that most women experience skin-to-skin contact immediately following birth. Skin-toskin promotes optimal immunological, physiological, and cognitive effects on the neonate, resulting in early initiation of breastfeeding with increased breastfeeding duration and maternal confidence and bonding [32][33][34] . ...
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INTRODUCTION Midwives in an Australian birth unit undertook a project to develop a resource for women and their support person. The aim of this study was to explore how the women, support persons and midwives viewed the introduction of this resource designed to guide and support women in their choice of support person. METHODS A quantitative survey study was used to explore how three participant groups viewed the introduction of a support person information resource. A hospital designed survey was developed for women, support people and midwives. Data were analyzed using SPSS, version 26 and Braun and Clarke’s guide for thematic analysis. RESULTS More than half (55%) of the midwives believed that the information resource presented influenced women’s choice of support people during labor. Almost three-quarters (72%) of the women did not change their choice of number of support people that they wanted during their labor. The majority (83%) of women would recommend the support person brochure to other women. The majority (83%) of support people stayed the entire duration of labor. Four themes were generated from open-ended questions: value of the information sheet, knowing how to be a support person, connecting midwives with being woman-centered, and choosing the support person. CONCLUSIONS The availability of an information resource was of benefit for women, support people and midwives, contributing to women feeling more informed in choosing their support person. Midwives felt they had evidence to support conversations with women, contributing to the feeling of being woman-centered. Support people had increased confidence.
... Ergebnisse systematischer Übersichtsarbeiten [59,187,198] [159]. Das erste Saugen an der Brust erfolgt möglichst innerhalb der ersten 1 bis 2 h nach der Geburt [40,159,163,201]. Die meisten Neugeborenen sind in den ersten 2 h nach der Geburt besonders aufmerksam und wach. ...
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During the first year after the birth of a child, nutrition and physical activity are particularly important for the short and long-term health of both mother and child. The recommendations for action on nutrition and physical activity in infants and breastfeeding women are now partially updated and are intended to provide health professionals with a reliable basis for advising families with infants. Based on recommendations from relevant specialist organizations and institutions as well as systematic reviews, meta-analyses, guidelines and other reliable study data, the scientific advisory board of the Healthy Start Network and other experts assessed the scientific evidence and formulated recommendations for action. A partial update took place in 2024. This concerns the recommendations for selecting infant formula when there is an increased risk of allergies, and for fluoride in the first year of life. All other recommendations reflect the status of 2016. Both processes were coordinated by the Healthy Start Network. The recommendations for action cover the topics of breastfeeding, infant formula, complementary food, beverages or supplementary fluid intake, learning to eat, diet of breastfeeding women, nutritional supplements for infants and breastfeeding women as well as alcohol, smoking and medication during the lactation period. It also contains general recommendations on allergy prevention in children as well as recommendations on physical activity in infancy and for breastfeeding women.
... Facilitating SSC in just minutes (immediate SSC) after CD or within the first hour of life (early SSC) can help reduce time to first breastfeeding, reduce formula supplementation in the hospital, improve mother-baby bonding and maternal satisfaction also does not imply disadvantages or other risks [73]. DOI: http://dx.doi.org ...
Chapter
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All the tissues of our body are formed by cells, but there are at least 1–10 times more microbes than cells in it, which coexist in balance and help us maintain our health. Most of them are found in the intestine; through their interaction with the food, they produce a great variety of functions related to nutrition and the functioning of the nervous, immune, and cardiovascular systems through their influence on gene programming, among others. It is now known that there are periods in life that are more sensitive and have greater long-term impacts that depend on the proper functioning of this large number of microbes in the human body. Pregnancy, birth, and the first 2 years of the life of a human are crucial stages that can predispose a person to health or disease, and in this chapter, we will be able to delve into the role played by cesarean section as a way of birth in this regard.
... A significant finding of our study was that only 12.1% of newborns had immediate skin-to-skin contact within the first 30 minutes, depriving newborns and their mothers of its multiple benefits, such as reducing infant mortality rates, facilitating a better transition to extrauterine life, promoting self-regulation and hemodynamic stability, optimal metabolic balance, neurological development, reducing postpartum depression, reducing neonatal crying, and improving the mother-child bonding and maternal oxytocin levels 25 . Unfortunately, recent publications continue to document skin-to-skin contact with low frequency when observed by external observers, as in the study by Gurung et al. in Nepal, and other authors [26][27][28][29][30][31] . ...
... Un hallazgo relevante en nuestro estudio fue que en solo el 12.1% se efectuó el contacto piel a piel en los primeros 30 minutos, negándole al recién nacido y la madre sus múltiples beneficios, tales como la disminución de los porcentajes de mortalidad infantil, facilitación a una mejor transición a la vida extrauterina, promoviendo la autorregulación y la estabilidad hemodinámica, un mejor balance metabólico y un óptimo desarrollo neurológico, disminuyendo la depresión posparto, reduciendo el llanto del neonato y mejorando la relación afectiva madre-hijo e incrementando los niveles de oxitocina materna 25 . Desafortunadamente en publicaciones recientes el contacto piel a piel sigue documentándose con una baja frecuencia cuando se ha realizado por observadores externos, como es el estudio de Gurung et al. en Nepal, y de otros autores [26][27][28][29][30][31] . ...
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Antecedentes: Múltiples estudios en Latinoamérica revelan que un gran número de pacientes ginecológicas sufren de violencia obstétrica en la atención institucional, la cual es definida como la apropiación del cuerpo de las mujeres por parte del personal de salud, aumentando las cifras de morbimortalidad. Objetivo: Determinar la frecuencia de acciones indirectas que representan violencia obstétrica, en un grupo de pacientes en el puerperio inmediato en hospitales rurales de la zona Nahua-Mixteca de los Estados de Puebla y Guerrero. Método: Estudio prospectivo y descriptivo realizado del 1 de enero al 30 de agosto del 2019 en el que se investigó la ocurrencia de violencia obstétrica en 296 pacientes atendidas durante el puerperio inmediato. Las variables sociodemográficas, procedimientos médicos durante el trabajo de parto, iniciativa de parto amigable y el alumbramiento fueron investigados en el expediente clínico. Resultados: La agresión verbal fue documentada en el 14.1% del grupo, siendo el médico el agresor más frecuente, seguido del personal de enfermería, sin embargo se documentó también la agresión por parte de otro tipo de personal. En un 13.5% no hubo evidencia de empatía con las emociones del trabajo de parto. Conclusiones: Se demostró una frecuencia elevada de violencia obstétrica, una mejora parcial en la iniciativa de parto amigable y un elevado porcentaje de procedimientos obstétricos que conllevan riesgos para la mujer y el recién nacido.
... There are important limitations that may arise from changes over time in medical practices. At the time of data collection for this study (2000)(2001)(2002) in United Kingdom, skin-to-skin contact between mother and baby immediately after birth, known to promote breastfeeding initiation, 36 was not routinely practiced after C-section, 37 and has only recently been included in breastfeeding promotion guidelines. 28 Although breastfeeding support practices and related behaviors have expanded in United Kingdom since this study, and breastfeeding rates have increased in tandem, 38 these practices would not confound the relationship we examine based on the assertion that these practices do not predict the mode of birth. ...
Article
Introduction: Despite known benefits of breastfeeding, including prevention against infections for infants, in the presence of numerous barriers, less than half of infants in high-income countries breastfeed for 6 months. One potential barrier to breastfeeding is birth by cesarean section (C-Section), which can invoke long-term difficulties. However, our structured literature review found that existing empirical research does not fully elucidate this relationship due to differences in operationalization of C-section and breastfeeding, omission of important confounders, and failure to exclude those who did not initiate breastfeeding (or use time-to-event analyses). In this article, we attempt to overcome these limitations. Methods: We analyzed data from 14,414 mother-infant dyads enrolled in the United Kingdom-based prospective Millennium Cohort Study, beginning in 2001. Using multivariable logistic regression, we examined the association between mode of birth (vaginal, emergency C-section, and elective C-section) and likelihood of breastfeeding initiation. We then applied adjusted Accelerated Failure Time survival models to examine the associations between mode of birth and duration of any and exclusive breastfeeding. Results: Those with planned (but not emergency) C-section were less likely to initiate breastfeeding (odds ratio: 0.84, 95% confidence interval [CI]: 0.71-0.99) relative to vaginal births. However, those with either planned or unplanned C-section discontinued both any and exclusive breastfeeding sooner than vaginal births. This effect was more pronounced for those with planned C-section (time ratio [TR]: 0.75, 95% CI: 0.64-0.89) than unplanned C-section (TR: 0.85, 95% CI: 0.74, 0.97) compared with vaginal births. Conclusions: Through application of rigorous methods, this study provides compelling evidence that breast-feeding duration may be impeded by C-section birth. The findings suggest that additional support for mothers who intend to breastfeed and have a C-section birth may be warranted.
... In this study, patients who underwent vaginal delivery were more likely to receive SSC in the first hour of life than those who underwent cesarean delivery (122 [61%] vs. 79 [48.8%], p = 0.02). It has been previously published that SSC after a cesarean delivery can be challenging, particularly in cases of emergency cesarean delivery 16,19 . This practice requires the involvement of not just pediatricians but also anesthesiologists, obstetricians, and nurses. ...
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Background: Exclusive breastfeeding (BF) has the greatest potential impact on child mortality of any preventive intervention. Skin-to-skin contact (SSC) during the first hour of life is beneficial for initiating BF; however, routine separation of mother and infant is still common. This work aimed to demonstrate that SSC during the first hour of life is associated with a greater frequency and duration of exclusive BF. Methods: This is an observational case–control study. We reviewed the medical records of patients born between 2016 and 2022 classified as cases or controls based on the history of SSC in the first hour of life. Statistical analysis was performed using SPSS version 28. Results: We included 362 medical records, of which 200 (55.2%) had SSC and were considered cases; the 162 (44.8%) who did not have SSC were considered controls. Those who received SSC were more likely to receive exclusive BF at 3 (163 [81.5%] vs. 94 [58%], p < 0.001) and 6 months of age (147 [73.5%] vs. 83 [51.2%], p < 0.001). Conclusions: Patients who received SSC in the first hour of life were more likely to receive exclusive BF at 3 and 6 months of age. Promoting and respecting this practice is essential to increase the possibility of a newborn to be exclusively breastfed for the first 6 months of life.
... WHO defines SSC as "placing the baby naked on the mother's bare chest, in a prone position covered by a cloth/blanket." 9 It is recommended to start immediately or within 10 minutes of vaginal birth and as soon as the mother regains consciousness after cesarean section. 10 It is suggested to continue for an hour or longer if well tolerated by the mother and the newborn. 11 It represents a sensitive period of priming mothers and infants to evolve a synchronous, reciprocal interaction pattern. ...
Article
Introduction: WHO and UNICEF recommend initiating early skin-to-skin contact (SSC) of newborns as an important intervention to reduce neonatal mortality. In India, it has been reported that only 15% of babies receive early SSC, and at our institution, only 22% of stable babies delivered vaginally were receiving SSC at birth. Aim: To increase the early initiation of SSC practice in neonates born through vaginal delivery ≥36 weeks from the observed baseline of 22% to ≥85% over 3 months. Methods: The study was conducted in the labor room of a tertiary care hospital over 3 months (December 2022 to February 2023) and a sustenance phase from April 2023 to June 2023. A root cause analysis was done using the fishbone framework, focusing on barriers related to mothers, hospital staff, policy, place, and practices. Based on this, a comprehensive early initiation of SSC intervention was planned utilizing Plan-Do-Study-Act cycles. Results: At the end of the three months, we achieved 100% compliance in the early initiation of SSC from a baseline of 22%, and the same compliance was maintained during the sustenance phase. The line chart used for interpretation showed an increase in compliance and increased duration of SSC till early initiation of breastfeeding was established.
... The number of women who experienced operative delivery in our cohort is 247 (28.39%). However, all babies should have access to immediate skin-to-skin contact after vaginal birth, and after cesarean section as soon as the woman is awake and responsive (Stevens et al., 2014). Yet, other studies have also found that skin-to-skin contact is used much less frequently after operative deliveries than non-operative deliveries (Brubaker et al., 2019;Chalmers et al., 2010). ...
... In the years that followed, efforts to develop a "family-centered" or "gentle" caesarean birth technique mostly emphasized early skin-to-skin contact [2,7,25,26]. Only limited information about birth experiences has been gathered, particularly outside of scheduled caesarean delivery [27]. ...
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b>Background: The purpose of this systematic review and meta-analysis study was to compare various caesarean delivery methods. Methods: A search for available articles published since January 2023 was accomplished in PubMed, Medline, Embase, and Cochrane literature databases. The search method that encompassed all pertinent publications was developed using terms from the medical subject headings thesaurus and keywords from related literature. We also used the PICO method (where P is population, I is intervention, C is comparator/control, and O is outcome for our study) to establish research question. Whereas Cochrane handbook of “systematic reviews of interventions” was used for risk of bias assessment. Results: The results showed a significant difference in patient gratification between the gentle/natural/skin-to-skin contact caesarean and the traditional/conventional/standard caesarean. In assessing the satisfaction with delivery mode, the mean variance for these studies similarly revealed a significant difference between the natural caesarean and the conventional one. A skin-to-skin contact caesarean delivery takes less time to start nursing than a conventional delivery, according to the results of the study on the time of breastfeeding initiation after a natural caesarean. There was a low-risk bias among the selected studies. Conclusions: As a result of greater satisfaction with delivering experience the natural caesarean delivery was most preferred method. The enhanced skin-to-skin contact and breastfeeding suggested that natural caesarean is beneficial over the conventional method.
... 10 This is especially helpful if mothers want to but are not able to initiate skin-to-skin contact immediately, such as after a Cesarean section or while they are critically ill. 11 Mothers and partners have essentially identical neural circuits for parenting, although hormones may differ between them. 3 Male partners also experience a dopamine surge within 30 minutes of skin-to-skin contact with their infant and demonstrate stronger feelings and behavior toward their neonates when contact occurs within the first few hours of birth as compared to 2-3 days later. ...
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Through greater understanding of past social, cultural, economic, political, scientific and technological forces which shaped our current health systems to separate mothers and newborn infants, we can begin to devise effective approaches to reshape these systems to meet the needs of mothers and newborn infants today. Medical science and technology have evolved vastly in the last century; however, effects of historical factors persist in our current health care systems, reflected in separate maternal and neonatal care in different departments with distinct guidelines, providers, and treatment locations. This separation prevents maternal-infant skin-to-skin contact and bonding, which significantly affects infant development, well-being, and that of their caregivers. We explore historical precedents for the separation of maternal-newborn care, including the transition from midwifery home care to hospital obstetric care, reasons for the increase in hospital births and hospital nursery development, and the effects of world wars, federal acts, health insurance, rooming-in practices, and the development of medical advances such as antibiotics, on hospital infrastructure. This information is evaluated in the context of modern scientific advancements to show that the conditions which shaped health systems to separate mothers and newborns in the past no longer hold. The insights gained will help to identify strategic actions to reshape health care systems to enable more integrated maternal-newborn care and the practice of Kangaroo Mother Care, and to improve survival outcomes and well-being for mothers, families, and their newborn infants.
... However, perineal pain after an episiotomy is a complication that is common after this procedure, even with adequate local anesthesia. Currently, in addition to pharmacological methods for pain relief in perineal repairs, there is an increasing trend toward nonpharmacological methods, such as music therapy, prayer, application of cold packing, and skin-to-skin contact (SSC) with the neonate [5][6][7][8][9][10][11][12] . ...
Article
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Objective: To determine the effect of immediate skin-to-skin contact (SSC) between mothers and their newborns on episiotomy pain.Material and Methods: This randomized controlled trial enrolled 60 participants who underwent vaginal delivery. The participants were divided into two groups: an immediate SSC group and a no SSC group (n=30 for each group). SSC was initiated within 10 minutes after birth with a contact duration of at least 30 minutes. Episiotomy pain severity was evaluated using a visual analog scale (VAS) at one hour after birth in both groups. The pain scores were analyzed using the Mann-Whitney U test and the optimum contact time for reducing episiotomy wound pain was evaluated by a receiver operating characteristic (ROC) curve.Results: The median VAS of episiotomy pain at one hour after delivery in the SSC group was statistically significantly lower than the no SSC group (1.9 (0.8-3.1) vs. 3.4 (2-5.2) cm, p-value<0.001). The contact time for optimal pain reduction was at least 30 minutes of SSC.Conclusion: Immediate SSC contact between a mother and her neonate after delivery can effectively reduce episiotomy pain.
... Breastfeeding at an early age stimulates breast milk production, provides antibody protection for the newborn, and determines the success of breastfeeding establishment, duration, and neonatal mortality risk (Takahashi, Ganchimeg , Ota, Vogel, Souza & Laopaiboon,2017). This was related to immediate skin-to-skin contact may increase the success rate of breastfeeding initiation, decrease time to the first breastfeeding, prevent the use of formulas for neonatal feeding, enhance bonding and maternal well-being (Stevens, Schmied, Burns , & Dahlen, 2014). ...
... Las interrupciones del CPP pueden interferir en todos sus beneficios descritos y es necesario concienciar a los profesionales de ello. 11 Nuestros datos muestran que cuando se había realizado en paritorio este CPP, de forma ininterrumpida, y cuando se había realizado con breves interrupciones, las tasas de LME al alta hospitalaria eran similares. Aunque inicialmente parezca que las separaciones no tienen efecto en la LME, tras el parto inmediato o al alta del recién nacido de la maternidad, analizando las tasas lactancia artificial a los 6 meses del nacimiento, observamos que cuando no se había interrumpido este CPP las tasas de lactancia artificial a los 6 meses de vida eran menores que en los casos en los que se habían producido interrupciones. ...
Article
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Objetivo principal: Analizar la influencia del contacto piel con piel (CPP) en el éxito de la lactancia materna exclusiva (LME) hasta los 6 meses de vida. Metodología: Estudio analítico descriptivo y prospectivo, realizado mediante entrevista directa con 500 puérperas seleccionadas por muestreo de casos consecutivos. Resultados principales: Cuando se realizó el CPP de manera ininterrumpida la LME a los 6 meses de vida fue del 17,40% y la de lactancia artificial del 12,60%. En los casos en que no se realizó, eran mayores las tasas de lactancia artificial (10,80%) frente a las de LME (4,40%). Las variables con mayor influencia en el éxito de la lactancia materna exclusiva a los 6 meses de vida, el tipo de alimentación en hijos anteriores y el tipo de alimentación al alta hospitalaria. Conclusión principal: Se deben evitar rutinas hospitalarias que interrumpan el CPP así como procurar que al alta hospitalaria la LME esté correctamente establecida. Palabras clave: Lactancia materna. Lactancia materna exclusiva. Covid-19. Influence of skin-to-skin contact and other factors on the success of exclusive breastfeeding up to 6 months of age Abstract Objective: Analyze the influence of skin-to-skin contact for the success of exclusive breastfeeding up to 6 months after birth. Methods: An analytic , descriptive, prospective study, where a personal survey was conducted with 500 postpartum women selected by consecutive case test. Results: When skin-to-skin contact was uninterrupted, the percentage of exclusively breastfed babies by 6 months was 17.40%, and the artificially fed was 12.60%. In cases where skin-to-skin contact was interrupted, the rate of artificial feeding was higher (10.80%) compared to the rate of exclusive breastfeeding (4.40%). The variables that had the greatest influence on the success of exclusive breastfeeding at 6 months were the feeding option for previous children and the one chosen at hospital discharge. Conclusions: Hospital care routines that interrupt skin-to-skin contact should be avoided, and exclusive breastfeeding should be properly established at hospital discharge. Keywords: Breastfeeding. Exclusive Breastfeeding. Covid-19. Introducción El llamado método canguro se basa en el mantenimiento del contacto permanente piel con piel entre la madre y el re-cién nacido, de manera precoz, sin que se produzca separación entre ellos desde el momento en que este nace, evitando toda rutina de separación innecesaria si el recién nacido no la nece-sita en ese preciso momento. El contacto piel con piel (CPP) forma parte de los 10 pasos de la "Iniciativa para la Humani-zación de la Asistencia al Nacimiento y la Lactancia". 1 El método canguro surgió en 1979 por los pediatras Edgar Rey y Héctor Martínez, del hospital San Juan de Dios de Bo-gotá con un programa de cuidados para niños prematuros. Ante la falta de medios en su país crearon esta alternativa a las incubadoras, inspirándose en las crías de canguro. Se ha di-fundido por todo el mundo y es apoyada por UNICEF y la OMS. Comprobaron una mayor supervivencia en países en vías de desarrollo, una reducción del número de infecciones, más facilidades en la lactancia materna exclusiva (LME) y mayor autoconfianza de las madres. 1 Desde un punto de vista biológico el CPP representa el há-bitat normal para el ser humano tras el nacimiento y la lactan-cia es el comportamiento pre-programado para este hábitat. 2 Los resultados de diversos estudios demuestran que el CPP es más beneficioso que la incubadora, ya que permite una adecuada incorporación del recién nacido al medio externo, favoreciendo una mejor oxigenación y una mayor estabiliza-ción de la frecuencia cardíaca, frecuencia respiratoria y tempe
... Early SSC was defined as SSC performed within the first hour after delivery [19]. First, a midwife would check for the following initiation criteria: full consciousness of the mother, no abnormal breathing in the infant, and absence of hypothermia in the infant. ...
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Objective: This study aimed to clarify the effectiveness of early skin-to-skin contact (SSC) after a cesarean section (CS) program. Methods: An "early SSC after CS" program was implemented at a tertiary care hospital in Tanzania. A non-equivalent group design was used. A questionnaire was used to collect data on exclusive breastfeeding, breastfeeding intention, Birth Satisfaction Scale-Revised Indicator (BSS-RI) score, perioperative pain with a visual analogue scale, and infant hospitalization for infectious diseases and diarrhea at 2-3 days postpartum. Follow-up surveys were conducted until 4 months postpartum regarding exclusive breastfeeding, breastfeeding intention, and hospitalization of the infants. Results: This study involved 172 parturient women who underwent CS, with 86 in the intervention group and 86 in the control group. The exclusive breastfeeding rates at 4 months postpartum were 57 (76.0%) in the intervention group and 58 (76.3%) in the control group, with no significant difference. The BSS-RI score was higher in the intervention group (7.91, range 4-12, SD 2.42) than in the control group (7.18, range 3-12, SD 2.02) (p = 0.007) for women who underwent emergency CS. The survival probability for infants hospitalized owing to infectious diseases, and diarrhea was significantly higher in the intervention group (98.5%) than in the control group (88.3%) (χ2 = 5.231, p = 0.022) for multiparas. Conclusion: The early SSC after CS program showed a positive effect on the birth satisfaction of women undergoing emergency CS. It also reduced the incidence of infants hospitalized owing to infectious diseases and diarrhea for multiparas.
... The Baby-friendly Hospital Initiative (BFHI), a global effort developed by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), states that undisturbed skin-to-skin contact is also recommended right after a CS, as long as the mother is alert and able to hold the baby [35]. Although this practice has numerous positive health-related outcomes [36], it is rarely provided after a CS in standard hospital obstetric cares [37][38][39]. Still, as two hospitals in Dresden are certified as BFH, it is conceivable that the number of mothers holding their baby immediately or early after CS could be higher in the present study than the 61.9% found by Chalmers et al. [33]. ...
Article
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Background The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience. Methods This study is part of the prospective cohort study “Dresden Study on Parenting, Work, and Mental Health” (DREAM). Our sample comprised N = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables. Results Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents. Conclusions The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.
... We found that, in the ART group, cesarean section and thyroid dysfunction were negatively associated with 6-month exclusively breastfeeding. Indeed, it is known that women who give birth by caesarean section are less likely to initiate lactation timely and report more difficulties establishing and continuing breastfeeding 15,19 . Similarly, a clear negative association between hypothyroidism and breastfeeding has been reported due to the suppression of milk in mothers with this dysfunction 20 ; nevertheless, in the multivariate analysis, these associations were no longer significant after adjusting for all the covariates. ...
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Conceiving by assisted infertility treatments may influence breastfeeding duration. In one-year time, to evaluate the goal of 6 months breastfeeding, we recruited 55 consecutive mothers who conceived using assisted treatment compared to 45 mothers conceiving naturally, all giving birth to healthy, full-term, singleton infants, sharing the double-occupancy room. At birth, maternal/neonatal characteristics were obtained by medical records and interviews. Six months after, a telephonic interview was done about the exclusivity of breastfeeding, mood instability, and breastfeeding complications. All the women were supported by the same neonatal-pediatrician team, during the study period. The number of mothers who were exclusively breastfeeding at six months was not statistically different between the two groups, as well as, breastfeeding initiation, BMI, smoking habit, mood instability, co-morbidities. In the assisted group, the women were older, had fewer previous children, upper degree of education, higher rate of cesarean sections, their neonate’s birthweight was lower; they reported more breastfeeding complications, but the distribution was not different between groups. The control women had higher number of previously breastfed siblings. Our experience highlights that the mode of conception may not be the defining factor influencing the goal of 6 months lactation. The support of healthcare professional team has a crucial role in maintaining breastfeeding.
... Specific benefits of early SSC are well-established and include improved fetal-to-neonatal transition and cardiorespiratory stability with enhanced autonomic regulation [2,13,14]. Published studies support that early SSC in healthy term and preterm neonates following both vaginal and cesarean delivery is both safe and effective [15][16][17][18][19], and early SSC is recommended by the American Academy of Pediatrics and World Health Organizations [20]. Further, researchers have hypothesized that this immediate postnatal period represents a critical window for neuronal programming, somatosensory system development, parentinfant bonding, social development, and reward processing and learning, suggesting the potential for longer-term neurodevelopmental benefits of early SSC [5]. ...
Article
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Early skin-to-skin contact (SSC), beginning in the delivery room, provides myriad health benefits for mother and baby. Early SSC in the delivery room is the standard of care for healthy neonates following both vaginal and cesarean delivery. However, there is little published evidence on the safety of this practice in infants with congenital anomalies requiring immediate postnatal evaluation, including critical congenital heart disease (CCHD). Currently, the standard practice following delivery of infants with CCHD in many delivery centers has been immediate separation of mother and baby for neonatal stabilization and transfer to a different hospital unit or a different hospital altogether. However, most neonates with prenatally diagnosed congenital heart disease, even those with ductal-dependent lesions, are clinically stable in the immediate newborn period. Therefore, we sought to increase the percentage of newborns with prenatally diagnosed CCHD who are born in our regional level II–III delivery hospitals who receive mother-baby SSC in the delivery room. Using quality improvement methodology, through a series of Plan-Do-Study-Act cycles we successfully increased mother-baby skin-to-skin contact in the delivery room for eligible cardiac patients born across our city-wide delivery hospitals from a baseline 15% to greater than 50%.
... In congruence with previous literature (Leonard & Mayers, 2008;Athanasopoulou & Fox, 2014;Stevens et al., 2014;Cho et al., 2016), our study revealed important benefits of SSC, such as enhanced motherhood feelings and mother-baby emotional bond. The reason behind this might be the increased levels of oxytocin hormone in the mother. ...
Article
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Background: Skin-to-skin contact (SSC) has been known to improve the mother-infant attachment process with a variety of positive outcomes. Objectives: This qualitative study aimed at exploring the Jordanian mothers’ experiences in proving direct SSC to their preterm infants in one Jordanian neonatal intensive care unit (NICU) after the introduction of this care approach for the first time. Design and Methods: A descriptive phenomenological research was conducted using semi-structured interviews with a purposive sample of 10 Jordanian mothers who provided SSC to their pre-term infants in an NICU. Results: Three themes emerged from the data analysis. The first theme described how SSC has the power of physical closeness, in which SSC created a change from an anxiety state to a serenity state, as well as a positive ‘back to the womb’ feeling for mothers and their infants. The second theme described how SSC enhanced motherhood by promoting the mothers’ feelings as mothers, facilitating bonding and promoting breastfeeding. The third theme identified was the barriers to providing SSC in Jordanian NICUs. Nursing Implications: SSC was found to have positive outcomes for both mothers and their neonates. SSC can enhance positive psychological (serenity and relaxation) and physiological (enhancing the respiration of neonates and promoting breastfeeding) outcomes. Ongoing support and counseling from health-care providers are essential to maximizing the benefits of SSC practice. Keywords: Skin-to-skin contact, Experiences, Mothers, Neonates, Neonatal intensive care unit
... This gap in breastfeeding promotion changed healthcare attitudes and perception of how important it is for children to receive breast milk in the first hour after birth. C-section is a surgery procedure indicated in the circumstance of labor or high-risk pregnancy, but it should not be a barrier to promote early breastfeeding, and adequate support and trained personnel are essential to help women breastfeed after birth regardless of the type of delivery 32,33 . Most hospitals do not promote breastfeeding as part of health care. ...
Article
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Although studies in low- and middle-income countries (LMICs) have examined the effects of c-sections on early initiation of breastfeeding (EIBF), the role of the place of birth has not yet been investigated. Therefore, we tested the association between EIBF and the type of delivery by place of birth. Data from 73 nationally representative surveys carried out in LMICs between 2010 and 2019 comprised 408,013 women aged 15 to 49 years. Type of delivery by place of birth was coded in four categories: home vaginal delivery, institutional vaginal delivery, c-section in public, and c-section in private health facilities. We calculated the weighted mean prevalence of place of birth and EIBF by World Bank country income groups. Adjusted Poisson regression (PR) was fitted taking institutional vaginal delivery as a reference. The overall prevalence of EIBF was significantly lower among c-section deliveries in public (PR = 38%; 95% CI 0.618–0.628) and private facilities (PR = 45%; 95% CI 0.54–0.566) compared to institutional vaginal deliveries. EIBF in c-sections in public facilities was slightly higher in lower-middle (PR = 0.650, 95% CI 0.635–0.665) compared to low (PR = 0.544, 95% CI 0.521–0.567) and upper-middle income countries (PR = 0.612, 95% CI 0.599–0.626). EIBF was inversely associated with c-section deliveries compared to institutional vaginal deliveries, especially in private facilities compared to public ones.
... It is important to determine whether this is also true following a CS, as the rate of CSs has been gradually increasing throughout the world and in China [13]. In addition, CSs are known to limit breastfeeding and impose difficulties that lead to breastfeeding cessation [14][15][16]20]. Women who delivered by CS experienced a significant delay in breastfeeding initiation compared to women who give birth vaginally [21]. ...
Article
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We aimed to explore the association between skin-to-skin contact (SSC) duration after caesarean sections (CSs) and breastfeeding outcomes. A prospective study was conducted in four hospitals in China during January and August 2021. A total of 679 participants with singleton pregnancy who delivered by elective CS after 37 gestational weeks using epidural or spinal anesthesia were included. Logistic regression was applied to assess the association between SSC duration and early initiation of breastfeeding (EIBF), as well as the promoting factors for exclusive breastfeeding (EBF) at hospital discharge. Immediate SSC after CSs was strongly associated with higher rates of EIBF (p < 0.001) and EBF at hospital discharge (p = 0.002). The EIBF rates increased with longer duration of SSC, with the at least 90 min SSC group having the highest EIBF rate (74.5%). Skin-to-skin contact durations of at least 90 min, 60–89 min and 30–59 min were significantly associated with 8.53 times (OR = 8.53, 95%CI: 4.94–14.72, Padj < 0.001), 8.04 times (95%CI: 4.68–13.80, Padj < 0.001) and 6.28 times (95%CI: 3.75–10.51, Padj < 0.001), respectively, higher EIBF rates compared to those without immediate SSC. After multiple-testing correction, the rates of EBF at hospital discharge were found to be independent of the duration of SSC (Padj = 0.12). Early initiation of breastfeeding was not a significant predictor of EBF. Our results suggested that SSC is important for EIBF in Chinese baby-friendly hospitals. Skin-to-skin contact should be practiced after CS to promote breastfeeding and providing SSC with longer duration is encouraged to obtain the full benefit; if it is not feasible, a minimum of 30 min SSC could achieve improved EIBF and EBF at discharge.
... If maternity hospitals do not provide immediate SSC after caesarean sections, many women and their newborns may miss out on the potential benefits conferred by SSC (Stevens et al., 2014). Techniques such as the caesarean section should not preclude performing SSC from the operating room since, as we have seen while conducting this study, it can be done with no difficulty. ...
Article
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Aim: We analysed whether immediate skin-to-skin contact between the healthy newborn and the mother after a caesarean section has a modulatory role on postpartum haemorrhage and uterine contraction. Design: Unblinded, randomized clinical trial, simple random sampling, conducted in women undergoing caesarean sections. Methods: Of the population identified, the caesarean section total (N = 359), 23.2% (N = 83) met the inclusion criteria: scheduled caesarean section, accepting skin-to-skin contact, good level of consciousness. They were randomly allocated to the intervention group, skin-to-skin contact (N = 40), and to the control group, usual procedure (N = 40). There were three losses. Clinical variables: plasma haemoglobin, uterine contraction, breastfeeding, postoperative pain, were measured, and subjective variables: maternal satisfaction, comfort, comparison with previous caesarean section and newborn crying. Results: Women with skin-to-skin contact had greater uterine contraction after caesarean section. The maternal plasma haemoglobin levels at discharge were significantly higher. It was associated with higher breastfeeding rate, satisfaction, comfort levels and with less maternal pain and less crying in the newborn.
... The Baby-friendly Hospital Initiative (BFHI), a global effort developed by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), states that undisturbed skin-to-skin contact is also recommended right after a CS, as long as the mother is alert and able to hold the baby [35]. Although this practice has numerous positive health-related outcomes [36], it is rarely provided after a CS in standard hospital obstetric cares [37][38][39]. Still, as two hospitals in Dresden are certi ed as BFH, it is conceivable that the number of mothers holding their baby immediately or early after CS could be higher in the present study than the 61.9% found by Chalmers et al. [33]. ...
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Background The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience. Methods This study is part of the prospective cohort study “Dresden Study on Parenting, Work, and Mental Health” (DREAM). Our sample comprised N = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables. Results Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents. Conclusions The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.
... ). Problematisch ist es, dass Eltern offenbar unterschiedliche Anweisungen erhalten(Flahermann et al. 2016;Swift & Scholten 2009).Auch die Vorgehensweise professioneller GeburtshelferInnen sub partu ist schon von großer Bedeutung für die Laktation. Früher Hautkontakt zwischen Mutter und Kind unterstützt das Ingangkommen der Milchbildung und verringert die Wahrscheinlichkeit, dass Formulanahrung gefüttert werden muss(Stevens et al. 2014). Zudem ist die Bedeutung der frühen Förderung der Milchbildung belegt(Becker et al. 2011). ...
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Auch Frühgeborene und kranke Neugeborene, die direkt nach der Geburt von ihrer Mutter getrennt werden müssen, sollten Muttermilch bekommen. Dann können elektrische Milchpumpen dazu beitragen, die Laktation zu fördern und aufrecht zu erhalten. In einer Studie wurden Mütter nach ihren Erfahrungen mit dem Abpumpen in den ersten 14 Tagen befragt.
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Aim Skin‐to‐skin contact (SSC) immediately after birth may improve breastfeeding outcomes. This study explored the effect of the duration of SSC in the delivery room on breastfeeding quality and duration. Methods In this prospective observational cohort study, mother–infant pairs practising SSC were categorised into two groups based on SSC duration (≤45 or >45 min). Outcomes included breastfeeding quality in the delivery room and at 24 h of age assessed by the Infant‐Breastfeeding Assessment Tool (IBFAT) score, and long‐term breastfeeding duration up to 6 months while accounting for potential confounding variables. Results The study included 72 mother–infant pairs. SSC for more than 45 min was significantly correlated with longer immediate breastfeeding (65 vs. 19 min, p < 0.001) and higher breastfeeding quality scores immediately after birth (IBFAT score of 10 vs. 7, p < 0.001). Regarding the long‐term effect, infants in the extended SSC group were breastfed longer (5.2 vs. 3.7 months, p = 0.005) and had exclusive breastfeeding (4.7 vs. 2.7 months, p > 0.001). No significant confounding variables were identified. Conclusion Extended SSC (>45 min) correlated with prolonged, higher‐quality breastfeeding after birth and longer successful breastfeeding.
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Person-centered models of care built on newborn and family needs and rights, such as nonseparation immediately after birth and during the care process, can address the complex needs of the newborn, family, and health system. This is particularly important in low- and middle-income countries, where cost-effective modalities are highly needed to accelerate the survival of newborn babies. We conducted a systematic review to explore country experiences on implementation and challenges to implement and scale-up family-centered newborn care models of care. MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched to identify studies on patient-centered care and newborns between 1990 and 2023. Studies meeting our predefined inclusion criteria were quality assessed and relevant data extracted. We utilized the World Health Organization framework on integrated people-centered health services to summarize and analyze findings while highlighting patterns. Forty-one studies were included for review (including approximately 60% from low- and middle-income countries). Different research conducted over time highlighted how immediate and uninterrupted skin-to-skin care facilitates a series of critical processes for newborns, parents, and health system, including breastfeeding initiation and exclusivity rates, reduced incidence of post-partum depression, and prevention of infection and hospitalization. Thanks to the close contact of the kangaroo position or skin-to-skin contact, parents recount becoming more and more attached to and familiar with their baby, easily establishing a relationship. Overall, countries could transform the newborn care service in terms of family center care by adopting three simple rules: (i) minimizing mother–child separation; (ii) involving fathers; (iii) empowering parents from the time of birth. A paradigm shift is required to change the conventional model of provider-centric care to one of person-centered neonatal health care. Such an approach is feasible in diverse country settings and should be facilitated through political commitment and policies enabling early focus on the maternal–infant relationship. This could, in turn, help achieve improved dignity of care and help create a more efficient and responsive health system and society.
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Background The rate of cesarean section is increasing from 15% to 40% in recent years. The type of delivery influences the hormonal, emotional and mental health of the mother, which correlates positively or negatively with the health benefits of the newborn. There have been many published studies on kangaroo mother care for mothers undergoing elective cesarean section, but there is still a lack of understanding about emergency cesarean section. Objective This study aimed to evaluate the benefits of KMC practice for mothers undergoing emergency cesarean section in terms of hormone levels such as oxytocin, cortisol, prolactin, interleukin-6 and interleukin-10. Methods This retrospective analysis used remnant serum (KMC group = 16; control group = 9), and clinical data such as KMC practice (15–30 minutes three or four times daily until discharge), breastfeeding initiation time, feeding time, crying time and hospital stay were extracted from the electronic database. All hormone and cytokine expressions were quantitatively determined by ELISA. Comparisons within and between groups were performed using appropriate statistical tests. Results In the KMC group, increased levels of the hormone oxytocin significantly reduced cortisol and IL-6 and negatively influenced prolactin and IL-10 levels. The elevated prolactin facilitates overall lactation behaviour, of which 64% reported breastfeeding directly at the breast. The cytokine analysis revealed a reduction in pro-inflammatory cytokines and thereby an improved wound healing was seen in the KMC group. Conclusion These quantitative results strongly encourage the use of KMC for mothers undergoing emergency cesarean section. These simple yet effective breastfeeding strategies promote maternal and infant health, which can reduce medication use.
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Introduction. Studying the gut microbiota of C-section newborns and its correction is a topical problem at present. Aim. To study the process of gut microbiota formation in healthy C-section infants, and the option for its correction using a Lactobacillus reuteri strain DSM 17938 probiotic. Materials and methods. A total of 80 healthy newborns were included in the study. Of these, 59 completed the study: the treatment group consisted of 36 elective caesarean (EC)-section infants and the control group was made up of 23 vaginally delivered infants. Newborns of the treatment study group were randomized into subgroups, one of which received the L. reuteri strain DSM 17938 (L subgroup) probiotic, and the second one did not receive it (0 subgroup). During the entire period of the study, infants were exclusively breastfed. The gut microbiota was analysed with the 16S rRNA sequencing method, and the metabolic activity of the gut microbiota was additionally assessed using gas-liquid chromatography. Results and discussion. The metagenomic analysis showed that the taxonomic richness and biological diversity of the gut microbiota in L subgroup infants increased in time interval 3, which indicated the active effect of the strain on the infant microbiota by Exposure Day 30. The gas-liquid chromatography analysis showed more pronounced changes in short-chain fatty acids in infants of the L subgroup: they were more similar to the findings in the control group (vaginal delivery). Also, bowel problems and allergies occurred less frequently in infants of this subgroup and they less frequently suffered from respiratory diseases during the year. The study showed the association between the mode of delivery and changes in anthropometric measurements. Conclusion. The use of L. reuteri strain DSM 17938 p robiotic had a significant effect on the formation of the microbiota by the 30th day of age. A daily long-term addition of a L. reuteri strain DSM 17938 probiotic can prevent early microbiota dysbiosis and have a protective effect in later age period.
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Background: Benefits of early skin-to-skin contact (SSC) between mother and newborn are widely documented, including improved breastfeeding outcomes. While promoting immediate SSC is standard practice for vaginal birth, it happens less often after cesarean birth. It is not known how changes in hospital practices and staffing shortages during the COVID-19 pandemic have influenced the practice of SSC in the operating room (OR). This study aims to identify the relationship between SSC after cesarean birth and breastfeeding and compare SSC before and during the COVID-19 pandemic at a single institution. Materials and Methods: This was a retrospective cohort study of 244 subjects who had scheduled cesarean births during 2019 and 2020. The primary outcome was newborn feeding at hospital discharge. Secondary outcomes were time to initiate breastfeeding, newborn feeding at 4-8-weeks postpartum, and location of SSC initiation in 2019 versus 2020. Results: SSC within 3 days of birth was significantly associated with feeding type on discharge and/or 4-8 weeks postpartum. More subjects intending to exclusively breastfeed met this intention at discharge with SSC in the OR. Newborns who had SSC in the OR had significantly earlier initiation of breastfeeding. There was an increase in SSC in the OR between 2019 (27%) and 2020 (39%). Conclusion: SSC in the OR was associated with improved short-term breastfeeding outcomes in our study. If immediate SSC is not possible, SSC within 3 days of birth may have breastfeeding benefits. The increase in SSC in the OR during the COVID-19 pandemic indicates that SSC practices can be implemented, despite challenging circumstances.
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Background: Evidence on the association between severe maternal morbidity (SMM) and mother-infant bonding and self-harm ideation is limited. We aimed to examine these associations and the mediating effect of Neonatal Intensive Care Unit (NICU) admission at one-month postpartum. Methods: This multicenter, prospective cohort study was conducted in Japan (n = 5398). SMM included preeclampsia, eclampsia, severe postpartum hemorrhage, placental abruption, and a ruptured uterus. Lack of affection (LA) and Anger and Rejection (AR) were assessed using the Mother-Infant Bonding Scale (MIBS), and self-harm ideation was assessed using the 10th item of the Edinburgh Postnatal Depression Scale (EPDS). Linear and logistic regression models were used to examine the association between SMM and MIBS score and self-harm ideation. A structural equation model (SEM) was employed to examine the mediating effect of NICU admission on the association between SMM and mother-infant bonding and postpartum depressive symptoms. Results: Women with SMM had a 0.21 (95 % confidence interval [CI]:0.03-0.40) point higher MIBS score and a decreasing trend in the risk of self-harm ideation (odds ratio 0.28, 95 % CI: 0.07-1.14) compared to those without SMM. SEM analysis revealed that SMM was associated with MIBS partially through NICU admission. Limitations: EPDS scores during pregnancy could be an unmeasured confounder. Conclusions: Women with SMM had higher MIBS scores, particularly on the LA subscale, which was partially mediated by NICU admission. Psychotherapy to support parent-infant relationships is necessary for women with SMM.
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Objective: This study aimed to investigate the frequency of delayed onset of lactation and accompanying perinatal factors in mothers who gave birth after a normal gestational course without any health problems. Methods: The study sample consisted of infants and their mothers who had given birth at Şanlıurfa Şan Med Hospital and then applied to the Pediatrics Health and Diseases Polyclinic for health check-ups within 3-15 days postpartum between June 2017 and September 2017. The data were analyzed with IBM SPSS Statistics 22.0. Results: Delayed lactation was reported by 30.6% of mothers, being more common among primiparous mothers and those who delivered by cesarean section (p
Chapter
A significant aspect of Person Centered Medicine involves the empowerment of individuals and communities, recognizing them as actors and protagonists in the construction of their own health. Thus, the empowering of community members may be helpfully framed by the proper understanding of person-centered care. Core notions or principles of this approach posit whole contextualised persons as the centre of health and as the goal and protagonists of health actions. But what is the relevant context? In recent years, it has become clear that the persons’ health is intimately linked to their social situation and to the broader environment in which they live.Substantial attention is directed in this manuscript to the understanding and procedures related to self-care praxis, including the Seven Pillars of Self-Care, the Self-Care Continuum and the Self-Care Matrix. Some attention is given to the emerging concept of inter-care or mutual care, and its potential conceptual and policy implications.This chapter focuses on three contextual levels—firstly, whole contextualised individuals and the range of their activities and behaviours relevant to their health. Secondly considered is the social situation (family and community) and, thirdly, the broader environment (the health system and the green and built environment) and how these can affect the health of persons as individuals and communities. Everyone lives in some sort of community and environment, which may either empower and enrich or hinder their health. A person-centred approach should consider these broader contexts while focusing on the persons involved.The chapter concludes with a discussion on the social and economic impact of self-care and inter-care by the empowered individuals and community, and how such forms of care can be considered as fundamental acts of person-centeredness.KeywordsEmpowermentIndividualsCommunitySelf-careInter-care person-centerednessSocial contextEnvironment
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Prevention reduces lifestyle causes of poor health and targets those with the highest risk of ill health, which requires a nationally led drive that makes the priority to be people instead of the system. The fundamental difference between prevention and promotion is that prevention stops the illness from happening or deteriorating, while promotion encourages, enhances and even creates health. However, as prevention and promotion act synergistically in fulfilling each one’s scope, they are often used in tandem. In fact, some consider them as two separate but collaborating sectors in medicine and public health. The authors adopted the latter approach in this chapter, shaping the outline around the person- and people-centred perspective. Person-centred prevention can help with the current range of health sector pressures, which makes clear that a paradigm shift in effort and investment is needed from the curative biomedical approach to a more preventive or risk-avoiding approach to care. History has shown that preventive methods can be significant changers of population health outcomes. Many of the current pathologies burdening our health systems now have their origins in our lifestyle, behaviour, and environment.KeywordsPerson-centred preventionHealth factorsPublic health policyPatient-centred preventionPublic health stakeholdersHealth systemsCOVID-19
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Neonatal conditions cause 2.5 million neonatal deaths every year and represent an important cause of childhood morbidity and long-term disability. Despite increased coverage of skilled care at birth, quality of essential newborn care is often suboptimal and a considerable proportion of the 30 million newborns requiring inpatient care every year receive no care at all or poor quality of care.Person-centered models of care such as non-separation immediately after birth and during the care process (e.g. NICU family-integrated care and Kangaroo Mother Care for preterm babies), are very promising and can address the complex needs of the newborn, family and health system. The concept of person and people-centered care is critical when applied to the neonatal period, given the long-life impact of the environment and care on the health and development of the infant and on family experience and attachment to the child.Family-centered model of newborn care necessitates policies ensuring no separation of newborn from mother/father from birth onwards, skin-to-skin and Kangaroo Mother Care as early as possible, and participation of the parents in care and decision-making during hospitalization of their newborns. This requires reorganization of services and infrastructure, addressing capacity building of health care providers and parents, and overcoming the cultural, gender and financial barriers. These models of care align well with the WHO quality of care framework, will help achieve universal health coverage, equity and dignity of care with an efficient and responsive health system, and will contribute to better neonatal survival, health and development.KeywordsNewborn-centered careInfant-centered careFamily-centered careFamily-integrated careKangaroo Mother CareNewbornRooming-inPostnatal depressionPostpartum depressionMental health problems
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Background: Breast milk plays a role in cognitive, sensory, and motor development and protects against infections and chronic diseases. The process of breastfeeding will protect the baby from illness, and increase cognitive intelligence and social-emotional development between mother and baby. Duration of breastfeeding was associated with acute illnesses, diarrhea, constipation, and a lower likelihood of being overweight/obese. Thus, this study aimed to the investigated correlation between pregnancy status and delivery type with successful breastfeeding in postpartum mothers at Roemani Muhammadiyah Hospital Semarang Methods: This type of research was analytical descriptive, conducted in December 2021 with purposive sampling and a sample size of 120 respondents. The inclusion criteria of postpartum mothers who breastfeed their babies, mothers who are in good health, and baby who has no congenital abnormalities. Respondents who refused and who have babies with congenital abnormalities are excluded from the study. The data was extracted from the questionnaire and also coded into the SPSS 25 ver. Data were analyzed descriptively and analytically by using chi-square analysis. Results: The participant with a planned pregnancy was 107 mothers (89.2%), unplanned 13 mothers (10,8%), section Caesarea type of delivery was 70 mothers (52%) and vaginal type of delivery was 50 mothers (48%). Based on LATCH score analysis planned pregnancy showed good category 38 mothers (31,7%), medium category 69 mothers (57,5%), and planned pregnancy showed good category 4 mothers (3,4%), medium category 8 mothers (6,7%), bad category 1 mother (0,8%). Based on the type of delivery, the vaginal type score was good for 25 mothers (50%), medium for 25 mothers (25%), and the section Caesarea type score was good for 17 mothers (24%), medium for 52 mothers (75%) and bad 1 mothers (1%). Either pregnancy status and type of delivery have P value scores of 0,016 and 0,012, respectively. Conclusion: A mother that delivers a vaginal has a better level of breastfeeding than SC, and pregnancy status such as planned pregnancy also shows a better level than they are not.
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The manner in which a new baby is welcomed into the world during the first hours after birth may have short- and long-term consequences. There is good evidence that normal, term newborns who are placed skin to skin with their mothers immediately after birth make the transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying indicating decreased stress. Mothers who hold their newborns skin to skin after birth have increased maternal behaviors, show more confidence in caring for their babies and breastfeed for longer durations. Being skin to skin with mother protects the newborn from the well-documented negative effects of separation, supports optimal brain development and facilitates attachment, which promotes the infant’s self-regulation over time. Normal babies are born with the instinctive skill and motivation to breastfeed and are able to find the breast and self-attach without assistance when skin-to-skin. When the newborn is placed skin to skin with the mother, nine observable behaviors can be seen that lead to the first breastfeeding, usually within the first hour after birth. Hospital protocols can be modified to support uninterrupted skin-to-skin contact immediately after birth for both vaginal and cesarean births. The first hour of life outside the womb is a special time when a baby meets his or her parents for the first time and a family is formed. This is a once-in-a-lifetime experience and should not be interrupted unless the baby or mother is unstable and requires medical resuscitation. It is a “sacred” time that should be honored, cherished and protected whenever possible.
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Aim To determine the occurrence and risk factors of sudden unexpected postnatal collapse (SUPC) in presumably healthy newborn infants. Methods All live-born infants during a 30-month period, in five major delivery wards in Stockholm, were screened, and possible cases of SUPC thoroughly investigated. Infants were ≥35 weeks of gestation, had an Apgar score >8 at 10 min and collapsed within 24 h after birth. Maternal, infant, event characteristics and outcome data were collected. Results Twenty-six cases of SUPC were found among 68 364 live-born infants, an incidence of 38/100 000 live births. Sixteen of these cases of SUPC required resuscitation with ventilation >1 min, and 14 of these remained unexplained (21/100 000). Fifteen of the 26 children were found in a prone position, during skin-to-skin contact, 18 were primipara, and 13 occurred during unsupervised breastfeeding at <2 h of age. Three cases occurred during smart cellular phone use by the mother. Five developed hypoxic–ischaemic encephalopathy (HIE) grade 2, and 4 underwent hypothermia treatment. Twenty-five infants had a favourable neurological outcome. Conclusion SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin-to-skin contact should be implemented.
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Objective: Postpartum anxiety screening does not typically occur, despite changes in life roles and responsibility after childbirth. We sought to determine the prevalence of postpartum anxiety during the maternity hospitalization and its associations with maternal and child outcomes. We further aimed to compare correlates of anxiety with correlates of depression. Methods: For a randomized controlled trial of mothers with "well" newborns ≥34 weeks' gestation comparing 2 post-hospital discharge care models, mothers completed baseline in-person interviews during the postpartum stay and telephone surveys at 2 weeks, 2 months, and 6 months to assess health care use, breastfeeding duration, anxiety, and depression. All participants intended to breastfeed. State anxiety scores ≥40 on the State Trait Anxiety Inventory (STAI) and depression scores ≥12 on the Edinburgh Postnatal Depression Survey (EPDS) were considered positive. Results: A total of 192 (17%) of 1123 participating mothers had a positive baseline STAI; 62 (6%) had a positive EPDS. Primiparity was associated with a positive STAI (20% vs 15%, P = .02), but not a positive EPDS (4% vs 7%, P = .05). Positive STAI scores were associated with cesarean delivery (22% vs 15%, P = .001), reduced duration of breastfeeding (P = .003), and increased maternal, but not infant total unplanned health care utilization within 2 weeks of delivery (P = .001). Positive STAI scores occurred more frequently than positive EPDS scores at each assessment through 6 months postpartum. Conclusions: Postpartum state anxiety is a common, acute phenomenon during the maternity hospitalization that is associated with increased maternal health care utilization after discharge and reduced breastfeeding duration. State anxiety screening during the postpartum stay could improve these outcomes.
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Background The aim of this study was to describe and compare breastfeeding practices in rural and urban areas of Vietnam and to study associations with possibly influencing person and household factors. This type of study has not been conducted in Vietnam before. Methods Totally 2,690 children, born from 1st March 2008 to 30th June 2010 in one rural and one urban Health and Demographic Surveillance Site, were followed from birth to the age of 12 months. Information about demography, economy and education for persons and households was obtained from household surveys. Standard statistical methods including survival and regression analyses were used. Results Initiation of breastfeeding during the first hour of life was more frequent in the urban area compared to the rural (boys 40% vs. 35%, girls 49% vs. 40%). High birth weight and living in households with large number of assets significantly increased the probability for early initiation of breastfeeding. Exclusive breastfeeding at three months of age was more commonly reported in the rural than in the urban area (boys 58% vs. 46%, girls 65% vs. 53%). The duration of exclusive breastfeeding as well as of any breastfeeding was longer in the rural area than in the urban area (medians for boys 97 days vs. 81 days, for girls 102 days vs. 91 days). The percentages of children with exclusive breastfeeding lasting at least 6 months, as recommended by WHO, were low in both areas. The duration of exclusive breastfeeding was significantly shorter for mothers with three or more antenatal care visits or Caesarean section in both areas. High education level of mothers was associated with longer duration of exclusive breastfeeding in the rural area. No significant associations were found between duration of exclusive breastfeeding and mother’s age, household economy indicators or household size. Conclusion Intervention programs with the aim to promote breastfeeding are needed. Mothers should particularly be informed about the importance of starting breastfeeding early and to prolong exclusive breastfeeding. In order to reach the WHO recommendation of six months exclusive breastfeeding, we propose an extended maternity leave legislation to at least six months.
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Objective: Exclusive breast-feeding is estimated to reduce infant mortality in low-income countries by up to 13 %. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan. Design: A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006-2007. Setting: A nationally representative sample of households. Subjects: Last-born alive children aged 0-23 months (total weighted sample size 3103). Results: The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0-23 months, exclusive breast-feeding and predominant breast-feeding in infants aged 0-5 months were 27·3 %, 32·1 %, 37·1 % and 18·7 %, respectively. Multivariate analysis indicated that working mothers (OR = 1·48, 95 % CI 1·16, 1·87; P = 0·001) and mothers who delivered by Caesarean section (OR = 1·95, 95 % CI 1·30, 2·90; P = 0·001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR = 0·37, 95 % CI 0·23, 0·59; P < 0·001) not to breast-feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR = 1·96, 95 % CI 1·18, 3·24; P = 0·009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR = 1·93, 95 % CI 1·46, 2·55; P < 0·001) and belonged to the richest wealth quintile (OR = 2·41, 95 % CI 1·62, 3·58; P < 0·001). Conclusions: The majority of Pakistani mothers have suboptimal breast-feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.
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Keeping mothers and newborns together during the time immediately following delivery has several benefits, including the promotion of maternal-infant bonding and breastfeeding, which are essential components of care. A new care delivery model was instituted at a large women's health hospital so that women who delivered by cesarean were able to recover with their infants. The change was the result of a multi-department collaborative effort, and the outcome has been very positive, with increased satisfaction reported by nurses, physicians and patients, as well as the observation of the promotion of breastfeeding and maternal-infant bonding.
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To evaluate if early skin-to-skin contact (SSC) improves breast-feeding (BF) behavior and exclusive BF (EBF) rates in term infants at 48 h of age. Term infants born by normal delivery were randomized at birth to either early SSC (n = 20) or conventional care (controls; n = 21). SSC was continued for at least 2 h after birth. Subsequently, one BF session of the infants was video recorded at about 48 h of life. The primary outcome, infants' BF behavior at 48 h of life, was assessed using the modified infant Breast-Feeding Assessment Tool (BAT; a score consisting of infant's readiness to feed, sucking, rooting and latching, each item scored from 0 to 3) by three independent masked observers. The secondary outcomes were EBF rates at 48 h and 6 weeks of age and salivary cortisol level of infants at 6 h of age. Baseline characteristics including birth weight and gestation were comparable between the two groups. There was no significant difference in the BAT scores between the groups [median: 8, interquartile range (IQR) 5-10 vs. median 9, IQR 5-10; p = 0.6]. EBF rates at 48 h and at 6 weeks were, however, significantly higher in the early-SSC group than in the control group [95.0 vs. 38.1%; relative risk (RR): 2.5, 95% confidence interval (95% CI): 1.4-4.3 and 90 vs. 28.6%; RR: 3.2, 95% CI: 1.6-6.3]. Early SSC did not improve BF behavior at discharge but significantly improved the EBF rates of term neonates.
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To investigate the effect of mother/infant skin-to-skin contact (SSC) on mothers' postpartum depressive symptoms during the first 3 postpartum months and their physiological stress during the first postpartum month. Longitudinal quasi-experiment. Data were collected during home visits. Mothers in the SSC group (n = 30) provided approximately 5 hours per day of SSC with their infants in the infants' first week and then more than 2 hours per day until the infants were age one month. Mothers in the control group (n = 60) provided little or no SSC. All mothers had full-term infants. Mothers completed self-report depression scales when infants were 1 week, 1 month, 2 months, and 3 months of age. Compared to mothers in the control group, mothers in the SSC group had lower scores on the depression scales when the infants were one week and marginally lower scores when the infants were one month; when the infants were age 2 and 3 months, there were no differences between groups in the mothers' depression scores. Over their infants' first month, mothers in the SSC group had a greater reduction in their salivary cortisol than mothers in the control group. Mother/infant SSC benefits mothers by reducing their depressive symptoms and physiological stress in the postpartum period.
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The rate of exclusive breastfeeding remains low in many countries. Furthermore, cesarean delivery (CD) is increasing and may affect breastfeeding success. The objective was to conduct a systematic review and meta-analysis of observational studies to determine whether CD (prelabor or in-labor) is associated with a lower rate of breastfeeding compared with vaginal delivery (VD). Studies published before January 2011 that reported breastfeeding up to 6 mo postpartum and compared outcomes after CD or VD, including foreign language publications, were identified through PubMed and bibliographic review. Prespecified data were extracted independently by multiple observers. The types of CD [prelabor (elective/scheduled) or in-labor (emergency)] were compared by subgroup analyses. Potential sources of study-level bias were analyzed by using meta-regression and sensitivity analyses. The systematic review included 53 studies (554,568 subjects, 33 countries); 25 authors contributed additional data (245,455 subjects), and 48 studies (553,306 subjects, 31 countries) were included in the meta-analysis. Rates of early breastfeeding (any initiation or at hospital discharge) were lower after CD compared with after VD (pooled OR: 0.57; 95% CI: 0.50, 0.64; P < 0.00001) and lower after prelabor but not after in-labor CD (prelabor OR: 0.83; 95% CI: 0.80, 0.86; P < 0.00001; in-labor OR: 1.00; 95% CI: 0.97, 1.04; P = 0.86). In mothers who initiated breastfeeding, CD had no significant effect on any breastfeeding at 6 mo (OR: 0.95; 95% CI: 0.89, 1.01; P = 0.08). There was a negative association between prelabor CD and early breastfeeding. If breastfeeding is initiated, mode of delivery has no apparent effect on the number of mothers still breastfeeding at 6 mo. Women and health care workers should be aware of the negative associations between CD and early breastfeeding and consequent implications for infants' well-being.
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Skin-to-skin care after birth often is absent, interrupted, or delayed for routine procedures. The purposes of this project were to improve skin-to-skin care and exclusive breastfeeding at hospital discharge. For Part 1, we used a descriptive observational design, with video-ethnography and interaction analysis (PRECESS-Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success), during a 5-day quality improvement pilot study in a U.S. hospital (August 13-17, 2010). For Part 2, we used electronic health record review to test for differences in monthly rates of skin-to-skin care and exclusive breastmilk feeding (baseline, July 2010; post-intervention, August-December 2010). In Part 1, 11 mothers and babies participated: 10 (91%) received immediate skin-to-skin care, eight (73%) received uninterrupted skin-to-skin care, nine (82%) planned to breastfeed, six (67%) of these babies were exclusively breastfeeding at hospital discharge, and five (83%) of the six babies who completed all nine instinctive stages during skin-to-skin care were exclusively breastfeeding at hospital discharge. In our subsequent review (Part 2), we found a significant improvement (25% above baseline) in the overall rate of skin-to-skin care across post-intervention months (Pearson χ(2)=23.798, df=5, p<0.000), predominantly from improvements in the cesarean section population. The rates of exclusive breastfeeding showed no significant change. The PRECESS immersion method may help to rapidly improve skin-to-skin care. Babies who undergo all nine stages during skin-to-skin care may be more likely to exclusively breastfeed. Mothers need support during skin-to-skin care to recognize their baby's readiness to breastfeed. Skin-to-skin care during cesarean surgery may reduce maternal stress and improve satisfaction with the surgical experience.
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Objective: Lactation performance depends on stress surrounding labor and delivery, and it is likely to be different in women who underwent elective cesarean delivery (ECD) or vaginal (VD). The aim of this study was to assess the relationship between cortisol and human prolactin (hPRL), following ECD and lactation performance, from the delivery room to the 6th month of life. Methods: A total of 106 mothers were consecutively enrolled: 38 after ECD, 28 after emergency cesarean delivery (EmCD), and 40 after VD. Results: Basal stress-, lactogenic-hormones, cortisol, and hPRL were comparable on day 3 postpartum in all the women. Multivariate analysis indicated that ECD has a negative impact (OR; 95% CI) on breastfeeding prevalence on the seventh day (0.14; 0.0–0.44, p = 0.008) and at third month post partum (0.19; 0.05–0.71, p = 0.05) in comparison to VD. In addition, hPRL levels proved to have a statistically significant role in early breastfeeding (1.01; 1–1.01, p = 0.002). Conclusions: ECD is a risk factor for successful lactation performance. This information should be provided to mothers and caregivers for extra breastfeeding guidance.
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To characterise the first infants receiving continuous Kangaroo Mother Care from birth to discharge in a Swedish neonatal intensive care unit and to investigate their mothers' experiences of this model of care. Admission of a newborn infant to a neonatal intensive care unit commonly implies separation of the new mother from her infant. Kangaroo Mother Care is a model of neonatal care which supports the parental role as primary care-giver and contributes to minimising the separation between the infant and parents. A retrospective survey design. A purposive sample consisting of 23 mother-infant pairs. Relevant infant data were obtained from their medical records. A questionnaire with questions about the infant's care and regarding Kangaroo Mother Care was designed for this study. The infants were born at a gestational age of 31-41 weeks, birth weight ranging from 1715-3700 g. The mothers of these moderately preterm and ill newborn infants showed good acceptance of the idea of providing their infants with continuous Kangaroo Mother Care during their stay at the neonatal intensive care unit. The mothers' evaluations of this method were predominantly positive. Negative comments concerned lack of information about practical application of the method, and some mothers perceived their infants' care during the night as exhausting. No mother would have preferred not to perform continuous Kangaroo Mother Care or to terminate Kangaroo Mother Care earlier than they did. These mothers accepted this model of care very well, provided that they received the help and support they required. Mothers whose infants are admitted to an neonatal intensive care units in settings similar to the study setting should be offered opportunities to be present and provide Kangaroo Mother Care for their infants, to the extent that they are able and willing to do so and as permitted by the infant's medical condition and care.
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Cesarean delivery has negative effects on breastfeeding. The objective of this study was to evaluate breastfeeding rates, defined in accordance with World Health Organization guidelines, from delivery to 6 months postpartum in infants born by elective and emergency cesarean section and in infants born vaginally. Delivery modalities were assessed in relation to breastfeeding patterns in 2,137 term infants delivered at a tertiary center, the Padua University School of Medicine in northeastern Italy, from January to December 2007. The study population included 677 (31.1%) newborns delivered by cesarean section, 398 (18.3%) by elective cesarean, 279 (12.8%) by emergency cesarean section, and 1,496 (68.8%) delivered vaginally. Breastfeeding prevalence in the delivery room was significantly higher after vaginal delivery compared with that after cesarean delivery (71.5% vs 3.5%, p < 0.001), and a longer interval occurred between birth and first breastfeeding in the newborns delivered by cesarean section (mean ± SD, hours, 3.1 ± 5 vs 10.4 ± 9, p < 0.05). No difference was found in breastfeeding rates between the elective and emergency cesarean groups. Compared with elective cesarean delivery, vaginal delivery was associated with a higher breastfeeding rate at discharge and at the subsequent follow-up steps (7 days, 3 mo, and 6 mo of life). Conclusions:  Emergency and elective cesarean deliveries are similarly associated with a decreased rate of exclusive breastfeeding compared with vaginal delivery. The inability of women who have undergone a cesarean section to breastfeed comfortably in the delivery room and in the immediate postpartum period seems to be the most likely explanation for this association.
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Poor feeding practices in early childhood contribute to the burden of childhood malnutrition and morbidity. To estimate the key indicators of breastfeeding and complementary feeding and the determinants of selected feeding practices in Sri Lanka. The sample consisted of 1127 children aged 0 to 23 months from the Sri Lanka Demographic and Health Survey 2000. The key infant feeding indicators were estimated and selected indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Breastfeeding was initiated within the first hour after birth in 56.3% of infants, 99.7% had ever been breastfed, 85.0% were currently being breastfed, and 27.2% were being bottle-fed. Of infants under 6 months of age, 60.6% were fully breastfed, and of those aged 6 to 9 months, 93.4% received complementary foods. The likelihood of not initiating breastfeeding within the first hour after birth was higher for mothers who underwent cesarean delivery (OR = 3.23) and those who were not visited by a Public Health Midwife at home during pregnancy (OR = 1.81). The rate of full breastfeeding was significantly lower among mothers who did not receive postnatal home visits by a Public Health Midwife. Bottlefeeding rates were higher among infants whose mothers had ever been employed (OR = 1.86), lived in a metropolitan area (OR = 3.99), or lived in the South-Central Hill country (OR = 3.11) and were lower among infants of mothers with secondary education (OR = 0.27). Infants from the urban (OR = 8.06) and tea estate (OR = 12.63) sectors were less likely to receive timely complementary feeding than rural infants. Antenatal and postnatal contacts with Public Health Midwives were associated with improved breastfeeding practices. Breastfeeding promotion strategies should specifically focus on the estate and urban or metropolitan communities.
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In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. To estimate infant and young child feeding indicators and determinants of selected feeding practices in India. The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005-06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for 2 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for 2 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR = 1.29), higher maternal education level (OR = 1.32), urban residence (OR = 1.46), and absence of postnatal examination (OR = 1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR = 0.57), and for those who watched television (OR = 0.75). Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households.
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Background: Childhood undernutrition and mortality are high in Nepal, and therefore interventions on infant and young child feeding practices deserve high priority. Objective: To estimate infant and young child feeding indicators and the determinants of selected feeding practices. Methods: The sample consisted of 1906 children aged O to 23 months from the Demographic and Health Survey 2006. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results: Breastfeeding was initiated within the first hour after birth in 35.4% of children, 99.5% were ever breastfed, 98.1% were currently breastfed, and 3.5% were bottle-fed. The rate of exclusive breastfeeding among infants under 6 months of age was 53.1%, and the rate of timely complementary feeding among those 6 to 9 months of age was 74.7%. Mothers who made antenatal clinic visits were at a higher risk for no exclusive breastfeeding than those who made no visits. Mothers who lived in the mountains were more likely to initiate breastfeeding within 1 hour after birth and to introduce complementary feeding at 6 to 9 months of age, but less likely to exclusively breastfeed. Cesarean deliveries were associated with delay in timely initiation of breastfeeding. Higher rates of complementary feeding at 6 to 9 months were also associated with mothers with better education and those above 35 years of age. Risk factors for bottle-feeding included living in urban areas and births attended by trained health personnel. Conclusions: Most breastfeeding indicators in Nepal are below the expected levels to achieve a substantial reduction in child mortality. Breastfeeding promotion strategies should specifically target mothers who have more contact with the health care delivery system, while programs targeting the entire community should be continued.
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Exclusive breastfeeding is recommended as the optimal way to feed infants for the first six months of life. While overall breastfeeding rates are high, exclusive breastfeeding is relatively uncommon among Middle Eastern women. The objective of this study was to identify the incidence of breastfeeding amongst women in the six governorates of Kuwait and the factors associated with the initiation of breastfeeding. A sample of 373 women (aged 17-47 years), recruited shortly after delivery from four hospitals in Kuwait, completed a structured, interviewer-administered questionnaire. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding. In total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed since birth, the remainder of the breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. Of the mothers who attempted to breastfeed, the majority of women (55.4%) delayed their first attempt to breastfeed until 24 hours or more after delivery. Breastfeeding at discharge from hospital was positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery. The reasons for the high use of prelacteal and supplementary formula feeding warrant investigation. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding by mothers in Kuwait.
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The purpose of this study was to investigate maternal, gestational, and neonatal features associated with the early initiation of breastfeeding. A descriptive study was done between July-October 2006 in the maternity ward of Dr. Zekai Tahir Burak Maternity and Research Hospital, a certificated Baby-Friendly Hospital. Babies with postpartum health problems and those hospitalized in the newborn intensive care unit were not included into the study. A total of 577 mothers participated within 4 to 36 hours' postpartum on a voluntary basis. The mothers completed a questionnaire about the gestational, maternal, neonatal, and first suckling characteristics. Of the 577 cases, 35.2% initiated breastfeeding within the first hour while 72.8% of them initiated breastfeeding within the first two hours of birth. In the multivariate logistic analysis, it was found that the factors affecting early breastfeeding status (within the first 2 hours of birth) were maternal illness during pregnancy, cesarean section and preterm birth. We concluded that the prevention of premature birth, limitation of cesarean section indication, management of maternal anemia, regular and effective pregnancy follow-up visits are important for the early initiation of breastfeeding.
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To estimate the influence of skin-to-skin care on the thermal regulation of the infant and the rate of breastfeeding at different points of time. We also aim to establish whether skin-to-skin contact reduces maternal pain during episiotomy repair and decreases the time to expel the placenta. A randomized control study was performed with 137 patients in each branch of the study. Differences between the study groups were analysed with the unpaired t-test, Fisher test or chi-square test as appropriate. Greater thermal stability in the skin-to-skin care group was found where an average temperature rise of 0.07°C was observed. Mothers in the skin-to-skin care group exclusively breastfed more frequently at discharge. Mean time to expel the placenta was lesser in the skin-to-skin care group. This study shows that skin-to-skin care implies better thermal regulation and a better proportion of exclusive breastfeeding at hospital discharge.
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Objectives: The primary objective of this review was to determine the best available evidence for maintenance of euglycaemia in healthy term neonates, and the management of asymptomatic hypoglycaemia in otherwise healthy term neonates. Inclusion criteria: The review included any relevant published or unpublished studies undertaken between 1995 and 2004. Studies that focus on the diagnostic accuracy of point-of-care devices for blood glucose screening and/or monitoring in the neonate were initially included as a subgroup of this review. However, the technical nature and complexity of the statistical information published in diagnostic studies retrieved during the literature search stage, as well as the considerable volume of published research in this area, suggested that it would be more feasible to analyse diagnostic studies in a separate systematic review.The review focused on studies that included healthy term (37- to 42-week gestation) appropriate size for gestational age neonates in the first 72 h after birth.All interventions that fell within the scope of practice of a midwife/nurse were included:Interventions that required initiation by a medical practitioner were excluded from the review.Outcomes that were of interest included:The review initially focused on randomised controlled trials reported from 1995 to 2004. Insufficient randomised controlled trials were identified and the review was expanded to include additional cohort and cross-sectional studies for possible inclusion in a narrative summary. Search strategy: The major electronic databases, including MEDLINE/PubMed, CINAHL, EMBASE, LILACS, Cochrane Library, etc., were searched using accepted search techniques to identify relevant published and unpublished studies undertaken between 1995 and 2004. Efforts were made to locate any relevant unpublished materials, such as conference papers, research reports and dissertations. Printed journals were hand-searched and reference lists checked for potentially useful research. The year 1995 was selected as the starting point in order to identify any research that had not been included in the World Health Organisation review, which covered literature published up to 1996. The search was not limited to English language studies. Assessment of quality: Three primary reviewers conducted the review assisted by a review panel. The review panel was comprised of nine nurses with expertise in neonatal care drawn from senior staff in several metropolitan neonatal units and education programs. Authorship of journal articles was not concealed from the reviewers. Methodological quality of each study that met the inclusion criteria was assessed by two reviewers, using a quality assessment checklist developed for the review. Disagreements between reviewers were resolved through discussion or with the assistance of a third reviewer. Data extraction and analysis: Two reviewers used a data extraction form to independently extract data relating to the study design, setting and participants; study focus and intervention(s); and measurements and outcomes.As only one relevant randomised controlled trial was found, a meta-analysis could not be conducted nor tables constructed to illustrate comparisons between studies. Instead, the findings were summarised by a narrative identifying any relevant findings that emerged from the data. Results: Seven studies met the inclusion criteria for the objective of this systematic review. The review provided information on the effectiveness of three categories of intervention - type of feeds, timing of feeds and thermoregulation on two of the outcome measures identified in the review protocol - prevention of hypoglycaemia, and re-establishment and maintenance of blood or plasma glucose levels above the set threshold (as determined by the particular study). There was no evidence available on which to base conclusions for effectiveness of monitoring or developmental outcomes, and insufficient evidence for breast-feeding success.Given that only a narrative review was possible, the findings of this review should be interpreted with caution. The findings suggest that the incidence of hypoglycaemia in healthy, breast-fed term infants of appropriate size for gestational age is uncommon and routine screening of these infants is not indicated. The method and timing of early feeding has little or no influence on the neonatal blood glucose measurement at 1 h in normal term babies. In healthy, breast-fed term infants the initiation and timing of feeds in the first 6 h of life has no significant influence on plasma glucose levels. The colostrum of primiparous mothers provides sufficient nutrition for the infant in the first 24 h after birth, and supplemental feeds or extra water is unnecessary.Skin-to-skin contact appears to provide an optimal environment for fetal to neonatal adaptation after birth and can help to maintain body temperature and adequate blood glucose levels in healthy term newborn infants, as well as providing an ideal opportunity to establish early bonding behaviours. Implications for practice: The seven studies analysed in this review confirm the World Health Organisation's first three recommendations for prevention and management of asymptomatic hypoglycaemia, namely:1 Early and exclusive breast-feeding is safe to meet the nutritional needs of healthy term newborns worldwide.2 Healthy term newborns that are breast-fed on demand need not have their blood glucose routinely checked and need no supplementary foods or fluids.3 Healthy term newborns do not develop 'symptomatic' hypoglycaemia as a result of simple underfeeding. If an infant develops signs suggesting hypoglycaemia, look for an underlying condition. Detection and treatment of the cause are as important as correction of the blood glucose level.If there are any concerns that the newborn infant might be hypoglycaemic it should be given another feed. Given the importance of thermoregulation, skin-to-skin contact should be promoted and 'kangaroo care' encouraged in the first 24 h after birth. While it is important to main the infant's body temperature care should be taken to ensure that the child does not become overheated.
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Objectives The objectives of this review are to determine from the available evidence: • the maintenance of euglycaemia in healthy full term neonates, and • the management of asymptomatic hypoglycaemia in otherwise healthy full term neonates. Questions The specific questions being asked are: Does the available evidence support the types and timing of various midwifery/nursing interventions that are commonly used to: • prevent hypoglycaemia in healthy full term neonates? • manage asymptomatic hypoglycaemia in otherwise healthy full term neonates? Criteria for considering studies for this review Types of participants Studies that include healthy full term (37-42 weeks gestation) neonates in the first 72 hours following birth. Exclusions: • Preterm or SGA newborns • Full term neonates with a diagnosed medical or surgical condition, congenital or otherwise. • Babies of diabetic mothers. • Neonates with symptomatic hypoglycaemia. • LGA neonates (as significant proportion are of diabetic mothers) Types of interventions All interventions that fall within the scope of practice of a midwife/nurse will be included. The interventions of primary interest are those related to: • Type (breast or breast milk substitutes), amount and/or timing e.g. initiation of feeding, and frequency • Maintenance of body temperature • Monitoring (including screening) of both 'not-at-risk' and 'at risk' neonates, including blood or plasma glucose levels (bgl/pgl) and other forms of monitoring Types of outcome measures Outcomes that are of interest include, but are not confined to: • Successful breastfeeding • Occurrence of hypoglycaemia • Re-establishment and maintenance of bgl/pgl at or above set threshold (as defined in a particular study) • Developmental outcomes.
Article
Poster Presentation Purpose for the Program Skin‐to‐skin cesarean delivery is an innovative way to facilitate the involvement of the family during a cesarean delivery. Just by changing the routine to incorporate immediate skin‐to‐skin contact there is a potential enhancement of the bonding process for the family and the facilitation of breastfeeding. Proposed Change To establish a team involved in care during cesarean deliveries for the purpose of the development of a protocol, which includes family input, to institute skin‐to‐skin care immediately after cesarean deliveries. Implementation, Outcomes, and Evaluation The inclusion criteria for skin‐to‐skin contact candidates were foundational to the protocol development. The families included experienced nonemergent, elective, repeat cesarean deliveries, or cesarean deliveries performed because of a failure to progress/dilate or breech presentation. The infants were greater than 38 weeks of gestation and in no acute distress. Role responsibilities were developed for the neonatal registered nurse, certified registered nurse anesthetist/anesthesiologist, circulating registered nurse, delivering physician, scrub technician, the mother, and the mother's support person. The protocol included a surgical unit that was setup to allow the mother to select music, provided the use of dim lighting, provided extra sterile plastic cord clamp on field, and positioned warmed blankets and an infant cap near the head of the mother's bed. The protocol of family education was to discuss with the mother and her support person one of the following three options: (a) observe the delivery from the moment of uterine incision up to the birth (not for breech deliveries); (b) immediate skin‐to‐skin contact if the infant is vigorous and stable; and (c) delayed skin‐to‐skin contact for infants with any situation that would lead to a delay transition. Key elements of skin‐to‐skin contact after cesarean delivery were open communication with the operating room team and the family throughout the procedure; placing of the infant on the mother's chest if infant is deemed stable; monitoring infant's axillary temperature every 10 minutes; and perform measurements, medications, and footprints when the mother requests them to be done. Implications for Nursing Practice Assuring the provision of family‐centered care during a cesarean delivery that includes skin‐to‐skin contact may improve breastfeeding, bonding, and family satisfaction with the birth experience. Continued evaluation is ongoing on these outcome indicators.
Article
Newborn Care Paper Presentation Objective To assess the effects of early skin‐to‐skin contact (SSC) on breastfeeding, physiological adaptation, and behavior in healthy mother–newborn dyads. Design Systematic review and meta‐analysis. Setting N/A. Sample Thirty‐four randomized controlled trials involving 2,177 participants (mother–infant dyads). The search strategy included the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2011), the Cochrane Neonatal Group's Trials Register (June 2011), and Medline (1976‐2011). Selection criteria included randomized controlled trials comparing early SSC with usual hospital care. Methods We independently assessed trial quality and extracted data. Study authors were contacted for additional information. Results Data from more than two trials were available for only 10 outcome measures. We found statistically significant and positive effects of early SSC on breastfeeding at 1 to 4 months post birth (13 trials, 702 participants) (risk ratio 1.27, 95% confidence interval [CI] 1.06 to 1.53, and a trend toward significance (p = .06) in breastfeeding duration (seven trials, 324 participants) (mean difference [MD] 42.55 days, 95% CI –1.69 to 86.79). SSC infants were more likely to have a successful first breastfeeding (two trials, 54 participants) (MD in IBFAT scores 1.79, 95% CI 0.24‐3.35). Late preterm infants had better cardio‐respiratory stability with early SSC (one trial, 31 participants) (MD 2.88, 95% CI 0.53‐5.23). SSC infants cried for a shorter length of time (one trial, 44 participants) (MD –8.01, 95% CI –8.98 to –7.04). The overall methodological quality of trials was mixed, and there was high heterogeneity for some outcomes. Limitations included methodological quality, variations in intervention implementation, and outcomes. Conclusion/Implications for Nursing Practice Mother–infant separation post birth is common in Western culture. Early SSC begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. This time may represent a psychophysiologically sensitive period for programing future physiology and behavior. The intervention appears to benefit breastfeeding outcomes, cardio‐respiratory stability, and infant crying, and has no apparent short‐ or long‐term negative effects. Further investigation is recommended. To facilitate meta‐analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC with time of initiation and duration and include means, standard deviations, and exact probability values.