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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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... A literatura descreve inúmeros benefícios do CPP, quando realizado imediatamente após o nascimento. Especificamente para o RN, destacam-se a promoção de melhor estabilidade fisiológica, início precoce e maior duração da amamentação, fortalecimento do vínculo materno, maiores níveis de glicose sanguínea, melhor controle de temperatura, estabilidade cardiorrespiratória, menor tempo de choro e concentração de cortisol mais baixa (nível de estresse) (3)(4)(5)(6)(7) . ...
... Estudos apontam que o tempo de permanência do RN em CPP, para que cada um desses benefícios seja atingido, é variável. Para melhor estabilidade fisiológica, por exemplo, o CPP deve durar cerca de 60 minutos (6) , o que se assemelha ao tempo necessário para o incentivo ao AM e para a promoção do vínculo materno-infantil (55 minutos de CPP) (6)(7)(8) . O período de 60 minutos também é considerado ideal para estabilizar os níveis de glicose sanguínea no RN (6) e para promover comportamentos neonatais mais estáveis (6)(7)(8) . ...
... Para melhor estabilidade fisiológica, por exemplo, o CPP deve durar cerca de 60 minutos (6) , o que se assemelha ao tempo necessário para o incentivo ao AM e para a promoção do vínculo materno-infantil (55 minutos de CPP) (6)(7)(8) . O período de 60 minutos também é considerado ideal para estabilizar os níveis de glicose sanguínea no RN (6) e para promover comportamentos neonatais mais estáveis (6)(7)(8) . Períodos de 15 minutos são considerados suficientes para promover o controle de temperatura e a estabilidade cardiorrespiratória (6) , e a permanência em CPP por 30 minutos favorece a redução do tempo de choro (6)(7) . ...
Article
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Objective: to analyze skin-to-skin contact practice in full-term newborns after birth. Method: a cross-sectional study carried out in São Paulo-SP with 78 mother-child binomials. Data were obtained from medical records and by non-participant observation. Maternal, neonatal and care conditions, length of skin-to-skin contact and breastfeeding attachment were analyzed. Results: skin-to-skin contact was performed in 94.9% of births, with a mean length of 29 minutes. Births with intact perineum took longer, neonates with Apgar 10, without upper airway aspiration, assisted by a nurse-midwife and with neonatal assistance by a resident in pediatrics. The variables that favor breastfeeding attachment were perineal integrity, newborn with good vitality, without upper airway aspiration and who received professional assistance for breastfeeding attachment. Conclusion: skin-to-skin contact was performed in almost all births, but with less time than recommended as best practice.
... [25] Immediately following birth, infants display highly specialized attachment and bonding behaviour towards their mothers, [26,27] and sensory connections with mothers form a strong basis for the regulation of their physiological systems. [28] For example, research on skin-to-skin contact (SSC) after birth has shown that early sensory connections improve many physical, psychological, and care outcomes, such as maintenance of newborn temperature, [30] stable respiratory and cardiac function, [31] organization of sleep cycles, [32] development of neurophysiological systems, [33,34] and reducing newborn stress. [30,35] In contrast, separation of mothers and infants hinders attachment, induces stress and behaviors that alter physiological processes resulting in an altered developmental trajectory. ...
... [28] For example, research on skin-to-skin contact (SSC) after birth has shown that early sensory connections improve many physical, psychological, and care outcomes, such as maintenance of newborn temperature, [30] stable respiratory and cardiac function, [31] organization of sleep cycles, [32] development of neurophysiological systems, [33,34] and reducing newborn stress. [30,35] In contrast, separation of mothers and infants hinders attachment, induces stress and behaviors that alter physiological processes resulting in an altered developmental trajectory. [28,29] This highlights newborns' needs to effectively bond with family, receive attentive care, and be kept warm and treated gently. ...
... 10.19.20213074 doi: medRxiv preprint post-birth, score higher on breastfeeding effectiveness, and breastfeed exclusively and for longer durations when compared to those without SSC. [30,43] This underscores the need to foster mother-infant interactions and minimize unnecessary interventions in maternity care. ...
Preprint
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Objectives Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors, or associated outcomes. This study aimed to examine these practices and associations with health care satisfaction, use, and breastfeeding. Design Prospective cohort study Setting Health facilities in Nairobi and Kiambu counties in Kenya Participants Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1,014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks postpartum. Primary and secondary outcome measures 1) Outcomes related to satisfaction with care and care utilization, 2) Continuation of post-discharge newborn care practices such as breastfeeding. Results 17.6% of women reported being separated from their newborns at the facility after delivery, of whom 71.9% were separated over 10 minutes. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 minutes) were 44% less likely to be exclusively breastfeeding at 2-4 weeks (aOR=0.56, 95%CI: 0.40, 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95%CI: 1.67, 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95%CI: 1.05, 4.41), and 33% greater likelihood of exclusive breastfeeding at 10 weeks (aOR=1.33, 95%CI: 1.10, 1.62). Conclusions Newborns, mothers, and families have a right to high quality, respectful care, including the ability to stay together, be informed and have proper consent for care. The implications of these practices on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care. Article Summary Strengths and Limitations of the Study This is one of the first studies to include survey questions surrounding details of separation of newborns from mothers and maternal consent for care, including risk factors and reasons for separation. This study used longitudinal data collected over 10 weeks following delivery to assess associations with outcomes, including postpartum visit attendance and breastfeeding. Differences in participants who responded to the 2-4week and 10 week follow-up interviews may have introduced bias due to differences in composition, thus comparisons of associations with outcomes between these two points should be interpreted conservatively. Findings may have limited generalizability to other contexts, as the study sample included women who gave birth at facilities in Nairobi and Kiambu counties.
... Early work conducted by Klaus and colleagues (1972) identified the benefits that extended close contact in the postpartum period has on infant-mother attachment [3]. Labour and birth is associated with hormonal and instinctive responses in the mother and infant that aid in the promotion of the initial bonding experience [4]. Immediate and uninterrupted skin-to-skin contact after birth is associated with enhanced bonding over the weeks and days following birth, decreases difficulties with breastfeeding and increases the likelihood of a secure attachment relationship at 12 months postpartum [4]. ...
... Labour and birth is associated with hormonal and instinctive responses in the mother and infant that aid in the promotion of the initial bonding experience [4]. Immediate and uninterrupted skin-to-skin contact after birth is associated with enhanced bonding over the weeks and days following birth, decreases difficulties with breastfeeding and increases the likelihood of a secure attachment relationship at 12 months postpartum [4]. Bystrova and colleagues (2009) identified the lasting impact that immediate postnatal mother-infant separation has on the mother-infant relationship even after one year postpartum [5]. ...
Article
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The postnatal period is crucial for infants in establishing a connection with and security in primary caregivers and can have enduring effects on attachment patterns. However, due to the need for symptom management, many infants diagnosed with neonatal abstinence syndrome (NAS) may be separated from primary caregivers and cared for in a neonatal intensive care unit (NICU) or special care nursery (SCN) soon after birth. Research has shown that substance-exposed infants are more likely to experience insecure attachment patterns with their primary caregivers and that mothers with a history of substance abuse are less sensitive to their infants’ cues. Therefore, the aim of this research was to explore nurses’ and midwives’ experiences in promoting the attachment relationship for infants admitted to an NICU/SCN with NAS. A qualitative research design was used to gather data on the experiences of nine nurses/midwives from various NICU and SCN settings in Australia. Individual, semi-structured interviews were conducted, and transcribed interviews were coded using thematic analysis. While nurses/midwives valued the attachment relationship for infants with NAS, facilitation of the attachment relationship was mainly promoted when the mother was present. However, parents were often reported to be absent from the nursery. Difficulties in promoting an attachment relationship were also identified when an infant had child protection involvement. This research identifies areas in need of innovative change regarding the approach taken to promote the attachment relationship for infants with NAS when they are admitted to an NICU/SCN.
... SSC is recommended to start immediately or within 10 minutes of birth after vaginal deliveries and as soon as the mother regains consciousness after cesarean Sect. (11). It is suggested to continue for an hour or longer if well tolerated by both the mother and the newborn (12). ...
... Our result showed that having a cesarean delivery reduced the likelihood of receiving SSC by 36% compared to the mothers having a vaginal birth. Findings from other studies also suggested a negative impact of cesarean section on SSC practices and early initiation of breastfeeding (11,(46)(47)(48)(49)(50). WHO recommends starting SSC immediately (if possible in the operation theater ) after cesarean delivery as soon as the mother regains consciousness in the absence of any precarious complications (12). ...
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Background: Skin-to-skin contact (SSC) is one of the eight proven Essential Newborn Care (ENC) practices that improve newborn survival. Despite having myriads of benefits, it is one of the least used ENC interventions especially in the low and middle-income countries (1% to 74%). In Bangladesh, the prevalence of SSC practices was 26% in 2014. To advance the use of this intervention, it is important to assess its prevalence within the population and to identify factors that facilitate or inhibit SSC practices in Bangladesh. Methods: We used baseline household survey data of USAID’s MaMoni MNCSP project conducted in 10 districts of Bangladesh in 2019. Our analysis included 13,695 recently delivered women (RDW) with a live birth outcome. Our primary outcome was the mother’s reported SSC practice. We examined various antepartum, intrapartum, newborn, and sociodemographic factors associated with SSC using a multivariable generalized linear model. Our findings were reported using adjusted Prevalence Risk Ratios (aPRRs) and 95% Confidence Intervals (CIs). Results: Overall, 28% of RDW reported practicing SSC across the 10 surveyed districts. Our multivariable analysis showed that public facility delivery (aPRR 2.01; 95%CI: 1.80, 2.26), private facility delivery (aPRR 1.23; 95%CI: 1.06, 1.42) and 4 antenatal care (ANC) visits at least one from a medically trained provider (MTP) (aPRR 1.17; 95%CI: 1.03, 1.26) had a significant positive association with SSC practices. Caesarean section (aPRR 0.64; 95%CI: 0.56, 0.73) had a significant negative association with SSC practices. We also found a significant positive association of SSC practices with mothers’ who perceived the birth size of their baby to be small, mothers with a higher education level (≥10 years), and mothers from households in the highest wealth quintile. Conclusions: The prevalence of SSC is very low in the surveyed districts of Bangladesh. Considering the factors associated with SSC, relevant stakeholders need to increase their efforts on improving ANC and facility delivery coverages as well as improving SSC practices in the facilities especially after caesarean deliveries. Countries with a high burden of home deliveries also need to emphasize community-based interventions and increasing coverage of skilled birth attendance for improving this life-saving intervention.
... 24 Despite the challenges faced by women after surgery, studies have shown that with proper support, initiation of breastfeeding within the first hour is possible for babies born by cesarean delivery. 2,29,32 Also consistent with the findings in other studies, including those that used older DHS surveys and studies with an experimental or quasi-experimental design, 10,12,13 skin-to-skin contact between the mother and her baby was associated with a shorter time to breastfeeding initiation in almost all countries. Immediate skin-to-skin contact is believed to be particularly important for newborns born by cesarean delivery for EIBF as well as exclusive breastfeeding. ...
... Immediate skin-to-skin contact is believed to be particularly important for newborns born by cesarean delivery for EIBF as well as exclusive breastfeeding. 32,33 Although EIBF and other breastfeeding practices could still be hampered by social and cultural beliefs or norms, the sizable increase in the coverage of facility delivery in low-and middle-income countries provides opportunities to promote optimal breastfeeding practices through interventions in health facilities. It is important to have current national guidelines that emphasize the importance of EIBF and essential training for health care staff. ...
Article
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Objective: Early breastfeeding has numerous benefits for both the mother and her baby. Previous research typically analyzes breastfeeding initiation in binary terms (within the first hour or day). Although delays are associated with cesarean delivery and skin-to-skin contact may facilitate early breastfeeding, a more nuanced understanding of these relationships is needed. Methods: With data from 31 countries that had a Demographic and Health Survey since 2015, we described breastfeeding initiation among babies most recently born in the last 2 years to women aged 15–49 years. In a subset of 21 countries, we conducted survival analysis with multivariable log-logistic accelerated failure time (AFT) regressions to examine factors associated with time to initiation of breastfeeding, specifically the mode of delivery and skin-to-skin contact, controlling for receipt of health care as well as socioeconomic and demographic characteristics of mothers and babies. Findings: Babies in most countries began breastfeeding within a few hours after birth. The mean time to initiation of breastfeeding ranged from 1.7 hours in Burundi to 32 hours in Pakistan and 40 hours in Chad. In most countries (24 of 31), the median time was 0.5 hours. Median time to initiation was greater for births by cesarean delivery compared with vaginal births at health facilities. After controlling for covariates, AFT models showed significant delays in breastfeeding among cesarean deliveries in most countries, with as much as a 9-fold delay in Senegal. Immediate skin-to-skin contact was significantly associated with a shorter time to initiation. Conclusion: Efforts to promote early breastfeeding should encourage skin-to-skin and target cesarean deliveries.
... The use of water for non-pharmacological pain relief in labour is associated with a reduction in the duration of labour and use of epidural anaesthesia, fewer interventions and transfer to obstetric units in labour, and no adverse outcomes [98,99]. Skin-to-skin contact, sometimes referred to as 'kangaroo care', can be defined as 'placing a naked infant onto the bare chest of the mother' [100] the benefits of which include improved adaptation to extrauterine life, stimulation of the digestive system and hormone release leading to improved feeding, protection against infection, reduced cortisol levels, and parent-infant bonding [100][101][102][103]. A recently published trial of a specialist continuity model of care for women at risk of preterm birth found those women randomised to the intervention were significantly more likely to have skin-to-skin contact after birth and to have it for a longer time [104]. ...
... The use of water for non-pharmacological pain relief in labour is associated with a reduction in the duration of labour and use of epidural anaesthesia, fewer interventions and transfer to obstetric units in labour, and no adverse outcomes [98,99]. Skin-to-skin contact, sometimes referred to as 'kangaroo care', can be defined as 'placing a naked infant onto the bare chest of the mother' [100] the benefits of which include improved adaptation to extrauterine life, stimulation of the digestive system and hormone release leading to improved feeding, protection against infection, reduced cortisol levels, and parent-infant bonding [100][101][102][103]. A recently published trial of a specialist continuity model of care for women at risk of preterm birth found those women randomised to the intervention were significantly more likely to have skin-to-skin contact after birth and to have it for a longer time [104]. ...
Article
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Background: Social factors associated with poor childbirth outcomes and experiences of maternity care include minority ethnicity, poverty, young motherhood, homelessness, difficulty speaking or understanding English, migrant or refugee status, domestic violence, mental illness and substance abuse. It is not known what specific aspects of maternity care work to improve the maternal and neonatal outcomes for these under-served, complex populations. Methods: This study aimed to compare maternal and neonatal clinical birth outcomes for women with social risk factors accessing different models of maternity care. Quantitative data on pregnancy and birth outcome measures for 1000 women accessing standard care, group practice and specialist models of care at two large, inner-city maternity services were prospectively collected and analysed using multinominal regression. The level of continuity of care and place of antenatal care were used as independent variables to explore these potentially influential aspects of care. Outcomes adjusted for women's social and medical risk factors and the service attended. Results: Women who received standard maternity care were significantly less likely to use water for pain relief in labour (RR 0.11, CI 0.02-0.62) and have skin to skin contact with their baby shortly after birth (RR 0.34, CI 0.14-0.80) compared to the specialist model of care. Antenatal care based in the hospital setting was associated with a significant increase in preterm birth (RR 2.38, CI 1.32-4.27) and low birth weight (RR 2.31, CI 1.24-4.32), and a decrease in induction of labour (RR 0.65, CI 0.45-0.95) compared to community-based antenatal care, this was despite women's medical risk factors. A subgroup analysis found that preterm birth was increased further for women with the highest level of social risk accessing hospital-based antenatal care (RR 3.11, CI1.49-6.50), demonstrating the protective nature of community-based antenatal care. Conclusions: This research highlights how community-based antenatal care, with a focus on continuity of carer reduced health inequalities and improved maternal and neonatal clinical outcomes for women with social risk factors. The findings support the current policy drive to increase continuity of midwife-led care, whilst adding that community-based care may further improve outcomes for women at increased risk of health inequalities. The relationship between community-based models of care and neonatal outcomes require further testing in future research. The identification of specific mechanisms such as help-seeking and reduced anxiety, to explain these findings are explored in a wider evaluation.
... Se asocia con el tipo de parto, en consonancia con otros estudios en que la satisfacción con la atención postparto es mayor en las mujeres cuyo parto es eutócico, sin anestesia epidural y que iniciaron la LM precoz (24) , y es menor en mujeres que finalizan su parto por cesárea. A su vez, la cesárea es un factor de riesgo en la interrupción de la LME (7,29) , especialmente cuando no se inicia el CPP temprano (30,31,32,33) . ...
... Para las mujeres que no tuvieron la opción de realizar CPP, se debió principalmente al parto por cesárea. El porcentaje de cesáreas en este estudio es más bajo que en otros realizados en países desarrollados (9,17,26) ; no obstante, existen estudios centrados en las mujeres que se someten a cesárea que muestran que el cumplimiento del CPP se logra en alrededor del 75% de los casos (31,33) . Es necesario seguir promoviendo dicha práctica en los partos por cesárea, recordando que los profesionales son los facilitadores o la principal barrera de este contacto. ...
Article
Objective: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO). Methods: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed. Results: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p<0.05). Conclusions: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high.
... The distress estimation of the experimental group was significantly lower than the control group (p = 0.000) (Table 3). Stevens, Schmied, Burns, and Dahlen (2014) reviewed articles reporting the research findings on skin-to-skin contact, published between January 2003 and October 2013 in English, and reported that KC was an appropriate method for newborns and reduced stress on the newborn. The World Health Organization and the United Nations International Children's Emergency Fund recommend that mothers and newborns make skin-to-skin contact immediately after vaginal delivery and when the mother is alert and sensitized after the caesarean section (Stevens et al., 2014). ...
... Stevens, Schmied, Burns, and Dahlen (2014) reviewed articles reporting the research findings on skin-to-skin contact, published between January 2003 and October 2013 in English, and reported that KC was an appropriate method for newborns and reduced stress on the newborn. The World Health Organization and the United Nations International Children's Emergency Fund recommend that mothers and newborns make skin-to-skin contact immediately after vaginal delivery and when the mother is alert and sensitized after the caesarean section (Stevens et al., 2014). In a systematic review of 736 newborns from 3 different studies, Taddio et al. (2015) reported that skin-to-skin contact reduced acute distress during the procedures. ...
Article
Kangaroo care (KC) or kangaroo mother care (KMC), sometimes called skin-to-skin contact, is a technique of newborn care where babies are kept chest-to-chest and skin-to-skin with a parent. The research was carried out experimentally to investigate the effect of the early kangaroo care by using Neonatal Comfort Behavior Scale in invasive interventions applied to the babies during early kangaroo care who born as healthy normal birth. Eighty babies who born at Adana Maternity and Child Health Hospital delivery room between 1 July and 31 October 2016 and their mothers constituted the research sampling. The babies were inserted into the experimental (n = 40) and control groups (n = 40) by the simple random sampling method. The invasive interventions were executed to the babies included in experimental group during early kangaroo care and COMFORTneo Behavior Scale was applied. The crying times of babies in both groups were measured with the aid of stopwatch. The level of comfort of the group receiving kangaroo care was found to be higher than those who did not. Significant connection was confirmed statistically positive, and highly between total score and duration of crying (r = 0.925; p = 0.000). It was determined that crying time increases and comfort decreases with increment in total score. As a result, it was found that the early kangaroo care applied during invasive interventions of newborns is an effective method in increasing baby's comfort who born at delivery room.
... WHO defines SSC as "placing the baby naked on the mother's bare chest, in a prone position covered by a cloth/blanket" [10]. SSC is recommended to start immediately or within 10 min of vaginal births and as soon as the mother regains consciousness after cesarean section [11]. It is suggested to continue for an hour or longer if well tolerated by both the mother and the newborn [12]. ...
... Our results showed that having a cesarean delivery reduced the likelihood of receiving SSC by 36% compared to the mothers having a vaginal birth. Findings from other studies also suggested a negative impact of cesarean section on SSC practice and early initiation of breastfeeding [11,[45][46][47][48][49]. WHO recommends starting SSC immediately (if possible in the operation theater) after cesarean delivery as soon as the mother regains consciousness in the absence of any precarious complications [12]. ...
Article
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Background Skin-to-skin contact (SSC) practice improves newborn survival and child development through preventing hypothermia in newborns, improving early initiation of breastfeeding practice, and strengthening mother-child bonding. Despite having numerous benefits, it is one of the least practiced interventions in low and middle-income countries (1 to 74%). In Bangladesh, the prevalence of SSC was 26% in 2014. In this study, we aimed to estimate the prevalence of SSC in the study districts and identify factors that facilitate or inhibit SSC practice so that context-specific recommendations can be made to advance the use of this intervention. Methods We used baseline household survey data of USAID’s MaMoni MNCSP project conducted in 10 districts of Bangladesh in 2019. Our analysis included 13,695 recently delivered women (RDW) with a live birth outcome. Our primary outcome was the mother’s reported practice of SSC. We examined various antepartum, intrapartum, newborn, and sociodemographic factors associated with SSC using a multivariable generalized linear model. Our findings were reported using adjusted Prevalence Risk Ratios (aPRRs) and 95% Confidence Intervals (CIs). Results Overall, 28% of RDW reported practicing SSC across the 10 surveyed districts. Our multivariable analysis showed that public facility delivery (aPRR 2.01; 95%CI: 1.80, 2.26), private facility delivery (aPRR 1.23; 95%CI: 1.06, 1.42) and ≥ 4 antenatal care (ANC) visits at least one from a medically trained provider (MTP) (aPRR 1.17; 95%CI: 1.03, 1.26) had a significant positive association with SSC practice. Caesarean section (aPRR 0.64; 95%CI: 0.56, 0.73) had a significant negative association with SSC practice compared to vaginal births. We also found a significant positive association of SSC practice with mothers’ who perceived the birth size of their baby to be small, mothers with a higher education level (≥10 years), and mothers from households in the highest wealth quintile. Conclusions The prevalence of SSC is very low in the surveyed districts of Bangladesh. Considering the factors associated with SSC, relevant stakeholders need to increase their efforts on improving ANC and facility delivery coverages as well as improving SSC practice in the facilities especially after caesarean deliveries. Countries with a high burden of home deliveries, also need to emphasize community-based interventions and increasing coverage of skilled birth attendance for improving this life-saving intervention.
... As only mothers who delivered vaginally were included, potential effects of SSC on pain were possibly not visible in assessments starting 14 days post-delivery. Moreover, a review provided the first indications that SSC immediately after caesarean birth may be related to lower reported pain 52 . Given that very few mothers with cesareans were included in the study overall, we decided to exclude these dyads from the analyses. ...
Article
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This randomized controlled trial examined the effects of a daily hour of mother-infant skin-to-skin contact (SSC) during the first five postnatal weeks, compared to care-as-usual, on maternal depressive (primary outcome), anxiety, stress, fatigue, pain, and delivery-related post-traumatic stress symptoms (PTSS). Prenatal symptom severity and touch discomfort were examined as moderators. Mothers and full-term infants were randomly allocated to SSC or care-as-usual conditions and followed during the first postnatal year. For the total group (intention-to-treat analyses), care-as-usual mothers showed an increase of anxiety symptoms from week 2 to 12, while SSC mothers displayed a stability of anxiety symptoms. Also, care-as-usual mothers showed an initial decrease in fatigue followed by an increase, while SSC mothers showed a decrease from week 2 to 12. In per-protocol analyses, including only the SSC dyads who adhered to SSC guidelines, findings on anxiety, but not fatigue, were replicated. No SSC effects were found for depressive, stress, and pain symptoms. No moderator, dose–response, or 52-week follow-up effects were found. PTSS were low with little variation; consequently, analyses were discontinued. Daily SSC in healthy mother-infant dyads may reduce anxiety and fatigue symptoms, but not depressive, stress, and pain symptoms, during the early postpartum period. Replication studies are recommended.
... They described SSC as an approach that calmed and stabilized them and their infant, both physically and emotionally. Our findings are in accordance with other studies describing the benefits of SSC (Campbell-Yeo et al., 2015;Jones & Santamaria, 2018;Stevens et al., 2014). How urgent is the initiation of SSC? ...
Article
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Traditional care immediately after very preterm birth separates the mother and child by the transfer of the infant to the neonatal intensive care unit. A nonseparation approach is currently being considered, allowing early skin-to-skin contact in the delivery room/postoperative care unit. This study aimed to explore mothers’ experiences of early skin-to-skin contact and traditional care. A qualitative study using individual semi-structured interviews with five mothers from each of the two groups was conducted. Content analysis revealed that both groups’ experiences were characterized by (i) mothers’ need to be affirmed of their infants’ vitality, (ii) bonding challenges, and (iii) benefits of skin-to-skin contact. We suggest that early skin-to-skin contact after very preterm births is crucial for the bonding process and mothers’ feelings of safety and well-being. When early skin-to-skin contact is infeasible, our findings reveal the significance of photos, information, and the father’s presence at the time of postpartum separation.
... Although the WHO guidelines [25] state that keeping the mother and baby together for at least the first hour after birth leads to an improved initiation and duration of breastfeeding, however it is not always as easy to apply for women having a CS and especially an emergency CS [63]. Nevertheless, skin-to-skin contact is recommended by the relevant health authorities such as the National Institute for Health and Care Excellence (NICE) [50] and the Pan American Health Organization [64]. It has been reported that early initiation and a long duration of skin-to-skin contact when compared to a short time duration, has a dose-response effect on breastfeeding [65]. ...
Chapter
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The cesarean section rates in the developed countries are well above the 5% to 15% rate of all births as suggested by the World Health Organization (WHO) in 2009 and currently range widely between 25% and 50%. Moreover, the WHO guidance promotes early breastfeeding initiation during the first hour postpartum, exclusive breastfeeding up until the 6th month and maintaining breastfeeding at least up to the second year of the infant’s life. In this review, we discuss the current evidence on whether a cesarean section interferes with the initiation and the long-term duration of breastfeeding practice among new mothers. The literature shows that a cesarean birth does have a detrimental effect on breastfeeding outcomes, however it is not per se a negative factor. It rather seems that infants who have feeding difficulties in the immediate postpartum period may experience long term problems. Therefore, interventions are discussed to promote breastfeeding after cesarean section for health professionals. Emphasis is given on promoting early skin-to-skin contact and on counseling new mothers about the advantages of breastfeeding as well as providing practical support and guidance throughout the early postpartum period.
... If the woman received general anaesthesia during caesarean section, she could only initiate breastfeeding when she was awake and able to respond [24]. If the woman received regional anaesthesia during caesarean section, she could initiate breastfeeding even before the effects of the anaesthesia had worn off [25,26]. This approach would ensure that the first feeding occurred within the recommended time when she was alert and not in severe pain. ...
Article
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Background Irrespective of the place and mode of delivery, ‘delayed’ initiation of breastfeeding beyond the first hour of birth can negatively influence maternal and newborn health outcomes. In Bangladesh, 49% of newborns initiate breastfeeding after the first hour. The rate is higher among deliveries at a health facility (62%). This study investigates the maternal, health service, infant, and household characteristics associated with delayed initiation of breastfeeding among health facility deliveries in Bangladesh. Methods We used data from the 2014 Bangladesh Demographic and Health Survey. We included 1277 last-born children born at a health facility in the 2 years preceding the survey. ‘Delayed’ breastfeeding was defined using WHO recommendations as initiating after 1 h of birth. We performed univariate and multivariable logistic regression to determine factors associated with delayed initiation. Results About three-fifth ( n = 785, 62%) of the children born at a health facility delayed initiation of breastfeeding beyond 1 h. After adjusting for potential confounders, we found delayed initiation to be common among women, who delivered by caesarean section (adjusted Odds Ratio (aOR): 2.93; 95% CI 2.17, 3.98), and who were exposed to media less than once a week (aOR: 1.53; 95% CI 1.07, 2.19). Women with a higher body mass index had an increased likelihood of delaying initiation (aOR: 1.05; 95% CI 1.01, 1.11). Multiparous women were less likely to delay (aOR: 0.71; 95% CI 0.53, 0.96). Conclusions Delayed initiation of breastfeeding following caesarean deliveries continues to be a challenge, but several other health facility and maternal factors also contributed to delayed initiation. Interventions to promote early breastfeeding should include strengthening the capacity of healthcare providers to encourage early initiation, especially for caesarean deliveries.
... Early skin-to-skin care has many benefits, including increased initiation and continuation of breastfeeding. 20, 21 Sharma, for example, found that breastfeeding was established on average after around 50 minutes of skin-to skin time. 22 Our findings also highlight the crucial importance of immediate skin-to-skin care between mother and infant in increasing the chance of successful initiation of breastfeeding. ...
Article
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Objective: To investigate the association, in the United Kingdom, between having an episiotomy during childbirth and giving human milk by any modality as an infant's first feed. We also identified maternal demographic factors and perinatal experiences associated with increased chance of the infant's first feed being human milk. Study Design: Retrospective observational cohort study at two large maternity units within district general hospitals in the United Kingdom. Population: Mothers giving birth vaginally to singleton babies at ≥34 weeks and ≥1,800 g. Methods and Main Outcome Measures: Deidentified data from hospital records were analyzed. The odds ratio (OR) of a mother giving human milk for an infant's first feed after episiotomy versus no episiotomy was calculated using a chi-squared test. Logistic regression was used to investigate and then control for confounders known to affect breastfeeding. Results: A total of 13,906 women met the inclusion criteria (2,113 had had an episiotomy and 11,793 had not). Human milk was given as a first feed to 70% of infants in the study population. Women whose infants received their first feed as human milk were on average older, had lower body mass index, lived in an area of less socioeconomic deprivation, and had fewer previous births than those women who gave formula milk as the first feed to their infant. The occurrence of an episiotomy during delivery was not associated with a change in the odds of the infant receiving human milk for the first feed (OR: 1.12 [confidence interval, CI: 0.96-1.38]). Where a woman had skin-to-skin care with her infant straight after birth, the infant was more likely to receive human milk as a first feed (OR: 4.23 [CI: 3.59-4.98]). Conclusion: There is no link between episiotomy during delivery and the odds of a woman giving human milk as the first feed to her infant.
... Undersøgelser viser, at de fleste mødre finder det er naturligt og vil gerne ligge hud mod hud med deres nyfødte barn efter fødslen [32] [44]. ...
Research
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National Clinical Guideline on establishing breastfeeding following birth
... SSC has been shown to have a myriad of benefits, including neonate thermoregulation, blood glucose regulation, and a decreased risk of jaundice, in addition to enhanced bonding for the dyad (Stevens et al., 2014). SSC is associated with the development of natural feeding cues and longer duration of exclusive breastfeeding, which contribute to a decrease in neonatal mortality and prevention of obesity later in life (WHO & United Nations Children's Fund, 2018). ...
Article
Objective To measure the increase in rates of skin-to-skin contact (SSC) for at least 15 minutes within the first hour of life in the operating room (OR) after cesarean birth after implementation of an SSC initiative. Our goal was to improve the rate of SSC from 20.3% to 50% for eligible newborns. Design Quality improvement initiative with a pre–/post–practice implementation design using surveys. Setting /Local Problem: A tertiary academic hospital in the U.S. Midwest with more than 12,500 births annually. Participants Nursing staff on a labor and delivery unit (N = 40). Interventions/Measurements We implemented nurse education, included SSC as part of the interdisciplinary team time-out (TTO) before procedures, and developed a new practice guideline to initiate SSC for at least 15 minutes within the first hour of life in the OR after cesarean birth. We measured nurses’ knowledge and self-reported SSC practices with preimplementation and postimplementation surveys. We measured nurses’ inclusion of SSC in the TTO and actual SSC practices in the OR with an audit tool. Results We analyzed a total of 394 audit tool forms from the initiative. Nurses reported more use of SSC after implementation of the SSC initiative. Skin-to-skin contact was verbalized in 75.3% (70/93) of the TTOs after implementation, and SSC for 15 minutes in the OR was completed in 20.3% (16/79) of preimplementation and 24.7% (23/93) of postimplementation phases. Total SSC for any length of time within the first hour in the OR increased from 30.4% (24/79) to 61.3% (57/93) in eligible women and newborns after implementation of the initiative. Conclusion SSC in the OR increased after a 4-month initiative to increase SSC through nurse education, inclusion of SSC in the TTO, and a new guideline to initiate SSC in the OR at least 15 minutes within the first hour of life.
... In a literature review by the authors, this was the only study [14] comparing pain control effectiveness of SSC by mother and father. SSC has been proven to confer several benefits in addition to pain control in preterm neonates [18][19][20][21][22][23][24][25], including several benefits to the mother [20][21][22], and improves parent-infant bonding [25]. Also, SSC has been established as an effective preterm neonatal pain control intervention [8,17,[26][27][28][29], and so it is advocated as the most preferred preterm neonatal pain control intervention. ...
Article
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Objective: To compare skin-to-skin care (SSC) given by mother and father for preterm neonatal pain control by premature infant pain profile (PIPP) score. Methods: 64 stable preterm (28-36 weeks gestational age) neonates born at a level-3 neonatal intensive care unit were included in the trial. Random allocation with the help of a computer-generated sequence was done. In group A, SSC was given by the mother 15 minutes before the first heel-stick, and subsequently, SSC was given by the father before the second heel-stick. In group B, the sequence of SSC provider was reversed. Blinded PIPP score assessment at 0, 1, and 5 minutes of heel-stick were done by two independent assessors using video recording. Results: The mean (SD) birth weight was 1665.18 (339.35) grams, and mean (SD) gestational age was 34.28 (2.24) weeks. The PIPP score at 0, 1, and 5 minutes had no statistical or clinically significant differences between both groups (PIPP score mean (SD) at 0 minute = 3.20 (1.11) vs. 3.01 (1.29), p value = 0.38; 1 minute = 8.59 (4.27) vs. 8.26 (4.08), p value = 0.66; 5 minutes = 3.79 (1.40) vs. 3.93 (1.99), p value = 0.65 in SSC by mother and father group, respectively). Furthermore, there was no statistical difference between the groups for any components of the PIPP score (all p values > 0.05). The PIPP score at 5 minutes almost attained the 0-minute level in both the groups. Conclusion: Father is as effective as the mother for providing skin-to-skin care for preterm neonatal pain control. This trial is registered with CTRI/2018/01/016783.
... Skin-to-skin was also found to positively affect mother-infant bonding ( Charpak et al., 2007 ;Mörelius et al., 2015 ;Stevens et al., 2014 ). This bonding takes place after birth through oxytocin release, which is reinforced by skin-to-skin contact immediately after birth Levine et al., 2007 ;Uvnäs-Moberg et al., 2019 ). ...
Article
Objective: Previous research has shown that skin-to-skin contact in the delivery room is associated with an increase satisfaction with childbirth. The purpose of the present study was to examine whether this association differs as a function of mode of birth, such that the positive effect of skin-to-skin contact would be especially pronounced for women who had operative births. Design: Survey design using self-administered questionnaires during pregnancy (Time 1) and at two months postpartum (Time 2). Setting: At Time 1, women were recruited at community and hospital medical centres in two large metropolitan areas in the centre of Israel and through home midwives and internet forums. At Time 2, women completed a second questionnaire in which they reported whether they had skin-to-skin contact with their infant immediately after birth and their birth satisfaction. Participants: Pregnant women, gestation week ≥24, with singleton pregnancy, who took part in both T1 and T2 (N = 1371, 75% of the 1833 women recruited at T1). Measurements: Analysis of covariance (ANCOVA) was used to examine whether the association between skin-to-skin contact after birth and birth satisfaction two months post-partum, differs as a function of mode of birth. Maternal or infant complications during birth, parity, and whether the pregnancy was planned, served as covariates. Birth satisfaction was measured using the Childbirth Satisfaction Scale. All measures were self-reported. Findings: The frequency of skin-to-skin was high (83%) for women who had vaginal birth, but lower for women who had an instrumental birth (66%) or a caesarean section (31%). At two months postpartum, women who had operative births reported less satisfaction with their birth than women who gave birth via vaginal birth. A significant interaction between skin-to-skin and mode of birth showed that although skin-to-skin was associated with higher birth satisfaction among women across all three modes of birth, i.e., vaginal (Cohen's d = .41), instrumental (Cohen's d = .64) and caesarean (Cohen's d = .87), the effect for the difference in birth satisfaction between women with and without skin-to-skin was especially large for operative births, particularly for caesarean sections. Key Conclusions: Operative birth is related to lower satisfaction with childbirth and lower rates of skin-to-skin contact immediately after birth. Yet, the association between skin-to-skin and birth satisfaction is especially strong for women who had operative births and specifically a caesarean section, suggesting that the possible contribution of skin-to-skin to birth satisfaction should be emphasised particularly after operative births. Implications for Practice: It is recommended that maternity care providers, managers, policy makers and medical teams facilitate skin-to-skin contact between the woman and her infant immediately, or as soon as possible, after childbirth, in both operative and non-operative births.
... [24] If the woman received 312 regional anaesthesia during caesarean section, she could initiate breastfeeding even before the 313 effects of the anaesthesia had worn off. [25,26] This approach would ensure that the first 314 feeding occurred within the recommended time when she was alert and not in severe pain. ...
Preprint
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Background: Irrespective of the place and mode of delivery, 'delayed' initiation of breastfeeding beyond the first hour of birth can negatively influence maternal and newborn health outcomes. In Bangladesh, 49% of newborns initiate breastfeeding after the first hour. The rate is higher among deliveries at a health facility (62%). Objective: This study investigates the maternal, health service, infant, and household characteristics associated with delayed initiation of breastfeeding among health facility deliveries in Bangladesh. Methods and Study Design: We used data from the 2014 Bangladesh Demographic and Health Survey. We included 1277 last-born children born at a health facility in the two years preceding the survey. 'Delayed' breastfeeding was defined using WHO recommendations as initiating after one hour of birth. We performed univariate and multivariable logistic regression to determine factors associated with delayed initiation. Results: About three-fifth (n=785,62%) of the children born at a health facility delayed initiation of breastfeeding beyond one hour. After adjusting for potential confounders, we found delayed initiation to be common among women, who delivered by caesarean section (aOR:2.93; 95%CI:2.17-3.98), and who were exposed to media less than once a week (aOR:1.53; 95%C:1.07-2.19). Women with a higher body mass index had an increased likelihood of delaying initiation (aOR:1.05; 95%CI:1.01-1.11). Multiparous women were less likely to delay (aOR:0.71; 95%CI:0.53-0.96). Conclusions: Delayed initiation following caesarean deliveries continues to be a challenge. Several other health facility and maternal factors also contribute to the delayed. Interventions to promote early breastfeeding should include strengthening the capacity of healthcare providers to encourage early initiation, especially for caesarean deliveries.
... Except for serious medical reasons, preventing mother-child separation is a basic, safe and sound, evidence-based practice that improves short-term and long-term health outcomes for mothers and children (Mazúchová et al., 2016). The importance of early mother-child contact for maternal satisfaction during childbirth has also been reported in other studies (Conesa Ferrer et al., 2016;Stevens et al., 2014). Midwives play an important role in respecting women's dignity and shaping their experience of childbirth (MirzaeeRabor et al., 2016). ...
... As other authors have suggested, the first hours after birth are crucial to breastfeeding, and skin-to-skin contact has positive effects on breastfeeding, bonding, and maternal satisfaction. 47 Thus, strategies to better facilitate breastfeeding should be encouraged. ...
Article
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Abstract Background Public patient involvement (PPI) generates knowledge about the health‐illness process through the incorporation of people's experiences and priorities. The Babies Born Better (BBB) survey is a pan‐European online questionnaire that can be used as a PPI tool for preliminary and consultative forms of citizens' involvement. The purpose of this research was to identify which practices support positive birth experiences and which ones women want changed. Methods The BBB survey was distributed in virtual communities of practice and through social networks. The version launched in Spain was used to collect data in 2014 and 2015 from women who had given birth in the previous 5 years. A descriptive, quantitative analysis was applied to the sociodemographic data. Two open‐ended questions were analyzed by qualitative content analysis using a deductive and inductive codification process. Results A total of 2841 women participated. 41.1% of the responses concerned the category “Care received and experienced,” followed by “Specific interventions and procedures” (26.6%), “Involved members of care team” (14.2%), and “Environmental conditions” (9%). Best practices were related to how care is provided and received, and the main areas for improvement referred to specific interventions and procedures. Conclusions This survey proved a useful tool to map the best and poorest practices reported. The results suggest a need for improvement in some areas of childbirth care. Women's reports on negative experiences included a wide range of routine clinical interventions, avoidable procedures, and the influence exerted by professionals on their decision‐making.
... No entanto, sabe-se que, após a cesárea, o CPP imediato pode ser realizado normalmente, no caso do bloqueio espinhal ou epidural, tendo em vista que mãe e RN permanecem alertas e responsivos (34) . Além disso, foram verificados, a partir de revisão sistemática, os benéficos do CPP imediato após cesárea, como estabilidade fisiológica da mãe e RN, bem-estar emocional, aprimoramento das capacidades de comunicação, potencial da redução da dor materna e promoção do início precoce do AM (35) . Em um estudo qualitativo, realizado em uma maternidade pública no sul do Brasil com profissionais de saúde da obstetrícia, nas falas é referido que, no CPP na implantação pós-cesárea, observou-se dificuldades das puérperas, como náusea após a anestesia; para o RN, maior risco de queda; da instituição e profissionais da saúde, o RN durante o CPP atrapalharia o cuidado da puérpera e precisaria de um espaço maior para os cuidados pós-cesárea e circulação dos profissionais e a temperatura do ar-condicionado divergente para aos profissionais e a puérpera. ...
Article
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Objective: to analyze the association of skin-to-skin contact and social determinants of health. Methods: this is a cross-sectional study with 187 medical records of newborns from a reference rooming in in northeastern Brazil. An instrument with maternal and neonatal data was used. Analysis was descriptive and inferential statistics. For the associations, a chi-square test was used to measure strength, an Odds Ratio was calculated, with a 95% confidence interval. Results: 62% of newborns who made skin-to-skin contact at birth were eutrophic, full-term, Apgar > 7, mothers with prenatal care and without abortion. The determinants associated with non-skin-to-skin contact were preterm (CR=3.2;95%CI: 2.72-18.98); 1st minute Apgar < 7 (CR:2.9;95%CI: 2.38-3.06), cesarean section (CR:8.4;95%CI: 4.29-16.57), and unhealthy NB (CR 12.7;95%CI: 4.9-32.67). We used STROBE guidelines. Conclusion: skin-to-skin contact was influenced by gestational age, Apgar, delivery, and newborn health.
... [30][31][32] Global evidence suggests that, with adequate support, cesarean section mothers can start breastfeeding within 1 h after birth. [33,34] Counseling during ANC can help to improve optimal breastfeeding practices, but the association of ANC with BF practices was not significant in this study. ...
... Even though WHO recommended that exclusive breastfeeding should be initiated within one hour of birth for all infants, more than half of infants in developing countries did not initiate breastfeeding in a timely manner. There is some evidence that Cesarean section is the most common constraining factor [9,[39][40][41][42]. Our country, Ethiopia is one of these developing countries striving to reduce unacceptably high neonatal morbidity and mortality, in which delayed initiation of breastfeeding was the main contributor. ...
Article
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Background Timely initiation of breastfeeding is feeding of breast milk within one hour of birth, however, three in five babies were not breastfed in the first hour of birth globally. There is evidence that cesarean section is the major constraint for this low prevalence, but the impact of cesarean section on timely initiation of breastfeeding in Ethiopia is limited. Therefore, this meta-analysis aimed to provide evidence for policy makers, health professionals and program implementers. Methods This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Electronic bibliographic databases such as PubMed/Medline, EMBASE, PsycINFO, CINHAL, Scopus, Google Scholar, Science Direct and Cochrane Library were used to search relevant studies and was conducted up to February 2021. Random effects model meta-analysis was applied to estimate the pooled impact of cesarean section on timely initiation of breastfeeding with 95% confidence intervals (CI). I² statistical test and, funnel plot and Egger’s test were used to check heterogeneity and publication bias across included studies respectively. Results According to meta-analysis of 17 studies, the pooled estimate of timely initiation of breastfeeding among women who had cesarean section in Ethiopia was 40.1% (95% CI 33.29, 46.92). The meta-analysis of 29,919 study participants showed that cesarean section was associated with a 79% lower odds of timely initiation of breastfeeding compared with vaginal birth (OR 0.21; 95% CI 0.16, 0.28). Conclusions In Ethiopia, almost only one-third of mothers who gave birth by cesarean section initiate breastfeeding within one hour of birth, much lower than the pooled prevalence among general population. Special health promotion, intervention and healthcare provider support during immediate or early skin to skin contact, and having focused breastfeeding guidelines for post-operative patient and trained health professionals should be considered for mothers who give birth through cesarean section.
... Consequently, skin-to-skin contact (SSC), which can establish maternal-infant bonding (Moore et al., 2016), has been promoted clinically in order to relieve psychological distress. SSC refers to the exposure of newborn babies on the mother's bare chest for contact, while kangaroo care (KC) is often used to describe SSC in the Neonatal Intensive Care Units (NICU) (Stevens et al., 2014). Now, robust evidence supports that SSC shows benefit for both mothers and newborns in many ways. ...
Article
Full-text available
Premature mothers present more anxiety and stress after delivery, which may be caused by mother–infant separation while hospitalised. Skin-to-skin contact (SSC), a mitigating factor for mother–infant separation, can benefit infants and mothers in many ways, but few studies focused on its efficacy on maternal anxiety and stress states. Therefore, this review aims to evaluate the effect of SSC on anxiety and stress. Comprehensive research was conducted in nine databases. Meta-analysis was conducted to investigate the effect of SSC, and subgroup analyses were performed to explain the sources of heterogeneity. Eight randomised controlled trials with 728 participants were included, and SSC significantly reduced the level of anxiety ([standardised mean difference, SMD] −0.72; 95% CI −1.08 to −0.35) and stress state ([SMD] −0.84; 95% CI −1.59 to −0.09). One subgroup analysis revealed that SSC can relieve anxiety if performing SSC no less than 1 h per day ([SMD] −0.94; 95% CI −1.34 to −0.53). Another subgroup analysis suggested that applying SSC repeatedly and lasting less than 1 week ([SMD] −1.49; 95% CI −2.31 to −0.66) or for 1 week to 2 weeks ([SMD] −1.04; 95% CI −1.29 to −0.79) can significantly reduce maternal anxiety level but no significance if lasting over 2 weeks ([SMD] −0.33; 95% CI −0.67 to 0.01). SSC can effectively improve anxiety and stress states among premature mothers after delivery, and not definitive finding presents that only SSC that was performed no less than 60 min could improve postpartum anxiety states, while SSC alone was not as effective when carried out over 2 weeks.
... In mothers, SSC also supports more rapid physiological stabilisation, and reduced pain, shivering, physiological stress and depressive symptoms in the postpartum period. [34][35][36][37][38] The potential benefits of early and exclusive breast feeding to babies, mothers and their families are numerous, including reduced morbidity, mortality and non-communicable diseases. 39 The reduction in NICU admissions from 16.7% to 11.8% of all caesarean section births represented a decline in 438 annual admissions. ...
Article
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Background: To improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction. Methods: Maternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013-October 2014) and post-EENC (November 2014-October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics. Findings: A total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59). Conclusion: The EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.
... The few studies that investigated the reasons for the low uptake of skin-to-skin contact for newborns reported barriers such as a lack of nurses, a heavy workload, a lack of knowledge, time constraints, difficulty determining eligibility for skin-to-skin care, a lack of social support, a lack of guidelines, policies and cultural norms. [19][20][21] A recent population-based cross-sectional study from The Gambia found that the place of delivery, place of residence and timing of antenatal care (ANC) booking were all determinants of skin-to-skin contact. 13 There is, however, a scarcity of literature on the predictors of skin-to-skin contacts in SSA. ...
Article
Full-text available
Introduction: Skin-to-skin contact is an evidence-based intervention that signifies a situation whereby a newborn is positioned directly on the mother's abdomen or chest in order for them to have direct ventral-to-ventral skin contact. The act of skin-to-skin contact begins immediately after delivery to about 23 hours afterwards. Evidence shows that skin-to-skin contact is important in improving child health outcomes. Nevertheless, evidence on its prevalence and predictors in sub-Saharan Africa (SSA) remains sparse. The study, therefore, estimated the prevalence of skin-to-skin contact between mothers and their newborns, as well as its predictors. Methods: Using data from the recent Demographic and Health Survey conducted between 2015 and 2020 from 17 countries in SSA, we included 131 094 women who gave birth in the last 5 years preceding the survey in the final analysis. We used percentages to summarise the prevalence of skin-to-skin contact. Multilevel logistic regression analysis was used to determine the predictors of skin-to-skin contact. Adjusted odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were used to present the results of the regression analysis. Results: Approximately 42% (41.7 to 42.2) of mothers practiced newborn skin-skin contact. The highest prevalence was found in Benin (75.1% (74.1 to 76.0)) and the lowest prevalence in Nigeria (11.7% (11.2 to 12.1)). The likelihood of skin-to-skin contact was higher among women covered by health insurance, those who delivered in health facilities, those in the richest wealth index, women who attended 1-3 antenatal care (ANC) visits and four or more ANC visits, and those with secondary or higher education. The odds of skin-to-skin contact was low among women who delivered by caesarean section (adjusted OR=0.15; 95% CI 0.13 to 0.16). Conclusion: Considering that less than half of the surveyed women practiced skin-to-skin contact, it is expedient for intensification of advocacy and strict supervision of the practice within the included countries. Informal educational programmes can also be rolled out through various media platforms to sensitise the public and healthcare providers on the need for skin-to-skin contact. These will help maximise the full benefits of skin-to-skin contact and expedite prospects of achieving the Sustainable Development Goal targets 3.1 and 3.2.
... 25 Immediately following birth, infants display highly specialised attachment and bonding behaviour towards their mothers, 26 27 and sensory connections with mothers form a strong basis for the regulation of their physiological systems. 28 For example, research on skin-to-skin contact (SSC) after birth has shown that early sensory connections improve many physical, psychological and care outcomes, such as maintenance of newborn temperature, 29 stable respiratory and cardiac function, 30 organisation of sleep cycles, 31 development of neurophysiological systems 32 33 and reducing newborn stress. 29 34 In contrast, separation of mothers and infants hinders attachment, and induces stress and behaviours that alter physiological processes resulting in an altered developmental trajectory. ...
Article
Full-text available
Objectives Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use and breast feeding. Design Prospective cohort study. Setting 3 public hospitals, 2 private hospitals, and 1 health centre/dispensary in Nairobi and Kiambu counties in Kenya. Participants Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1014 women surveyed at baseline and at least one follow-up at 2–4 or 10 weeks post partum. Primary and secondary outcome measures (1) Outcomes related to satisfaction with care and care utilisation; (2) continuation of post-discharge newborn care practices such as breast feeding. Results 17.6% of women reported newborn separation at the facility, of whom 71.9% were separated over 10 min. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 min) were 44% less likely to be exclusively breast feeding at 2–4 weeks (adjusted OR (aOR)=0.56, 95% CI: 0.40 to 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95% CI: 1.67 to 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95% CI: 1.05 to 1.55), and 33% greater likelihood of exclusive breast feeding at 10 weeks (aOR=1.33, 95% CI: 1.10 to 1.62). Conclusions Newborns, mothers and families have a right to high-quality, respectful care, including the ability to stay together, be informed and properly consent for care. The implications of these experiences on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.
... In the current study, neonates who were not breastfed for the first feed after birth were less likely to be exclusively breastfed on discharge. While the reasons for low breastfeeding rates in this group are unknown, it may be associated with medical complications and interventions disrupting immediate skin-toskin contact and first-feed following birth [27,28]. Indeed, greater medical intervention at birth [29,30] and poor management of postoperative pain [31] precluded women from early breastfeeding in other studies. ...
Article
Background The World Health Organization recommend that infants be exclusively breastfed until six months of age. The Baby Friendly Health Initiative (BFHI) was developed for protecting, promoting, and supporting breastfeeding. The BFHI global criteria guides hospital practice for supporting infant feeding and reducing disparities in breastfeeding outcomes. Aim The aim of this study was to analyse 2019 data to identify factors that predict exclusive breastfeeding vs non-exclusive breastfeeding on discharge to determine areas for intervention in relation to BFHI guidelines. Material and Methods A retrospective chart review of 5836 neonates born at an Australian tertiary hospital in 2019 was conducted. Descriptive statistics were used to report exclusive breastfeeding rates. Univariate and logistic regression analyses were conducted to determine factors associated with exclusive breastfeeding and non-exclusive breastfeeding on discharge. Results A total of 69% of neonates were exclusively breastfed on discharge in 2019. When excluding admissions to Newborn Services, 75% of neonates were exclusively breastfed on discharge, achieving the BFHI benchmark. Predictors which significantly reduced the odds of exclusive breastfeeding on discharge were maternal country of birth (Vietnam, p<0.001, Sudan p<0.001, Samoa p<0.01, Philippines p<0.05), main language (Other, p<0.05), birth type (caesarean or assisted vaginal birth p<0.001), first-feed type (mixed feeding or formula p<0.001), and Newborn Services admission (p<0.001). Conclusions Examining breastfeeding outcomes is an important quality assurance process for health services. Understanding groups of mothers who commence breastfeeding but do not exclusively breastfeed upon discharge enables identification of areas for intervention to achieve BFHI targets and reduce breastfeeding disparities.
... Results of the current study indicated that, statistically significant differences were found between both groups regarding to successful breastfeeding. This may be 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 et al., 2014). ...
... Thus, the early postpartum period is a critical and sensitive period for the close relationship between the mother and her infant, [20] which may be affected by their separation at birth [21] and type of delivery. [22] According to Lai et al., [23] women with induced caesarian delivery had higher postpartum fatigue scores compared to those with natural delivery. The higher postpartum fatigue score was associated with more problems in infant care. ...
Background: The Robson criteria allows for standardized comparisons of data and possible driving changes in Cesarean Section (C/S) rates and complications. The aimed to compare maternal-infant attachment in C/S based on Robson Classification. Materials and methods: This cross-sectional prospective study was conducted on 369 women who had undergone C/S in Hazrate Zeinab Peace Be Upon Him (PBUH), Hafez, and Shooshtari hospitals affiliated to Shiraz University of Medical Sciences, Iran from April 2018 to March 2019. The study data were collected using a demographic form, an obstetric form, and Avant Checklist (AC) at postpartum and pre-discharge stages. Each participant was placed in Robson classification and the attachment score was calculated in each Robson Classification, and a comparison was made among the 10 groups. The data were analyzed into the SPSS 16 software and using descriptive statistics and paired t test. Results: The total mean (SD) score of attachment was 38.73 (18.65) at 1-7 h postpartum and 90.52 (23.79) at pre-discharge. The highest total mean (SD) score of attachment was observed in group 6 (86.78 (8.70) at postpartum and 118.67 (4.47) at pre-discharge). The lowest total mean (SD) score of attachment was observed in group 10 (12.79 (2.37) at 1-7 h postpartum and 45.44 (7.99) at pre-discharge). Conclusions: Obstetric characteristics in Robson Classification, parity, previous C/S, gestational age, onset of labor, fetal presentation, and number of fetuses were effective in clarifying information. The use of this system is necessary to determine the causes of increased C/S cases in low-income and middle-income countries.
... Как известно, реализация неблагоприятной роли кесарева сечения на лактогенез осуществляется посредством различных механизмов, в т.ч. через нейроэндокринную сферу матери [23,24], ее мотивационные установки [25], а также через обстоятельства медико-организационного характера, связанные с затруднениями раннего контакта «кожа-к-коже» и раннего стартового прикладывания младенца к груди [26]. Так, в отдельных публикациях указывается на важную роль запаздывания первого прикладывания к груди матери и/или запаздывания первого сцеживания с последующей дотацией материнского молока младенцу в развитии отсроченных нарушений лактации у женщин после кесарева сечения [24] и, соответственно, в уменьшении доступности грудного молока для детей. ...
Article
Background . Breast milk is the optimal nutrition for late preterm babies, but mothers of these babies frequently experience difficulties with breastfeeding associated with lactation onset and establishment. Objective . The aim of the study is to examine factors associated with successful breastfeeding of late preterm infants in neonatal hospital. Methods . The retrospective study included medical records of late preterm infants (gestational age of 34–36 weeks) admitted to neonatology department within one calendar year. Maternal and infant factors on exclusive breastfeeding were considered at hospital discharge. Exclusive breastfeeding was defined as absence of any other food or drink, even water, except breast milk (expressed or donor), whereas enteral fluid for rehydration, as well as drops and syrups (vitamins, minerals, medicines) were allowed. Determination of independent predictors was performed via multifactorial binary logistic regression. Results. 84 (41%) of children received exclusive breastfeeding at hospital discharge, others were on formula or mixed feeding. Multifactorial analysis has shown that gestational age of 36 weeks (compared to 34 weeks, odds ratio (OR) 2.16; 95% confidence interval (CI) 1.18–3.98) and breastfeeding onset in 6 first hours of life (OR 2.38; 95% CI 1.19–4.75) were associated with relatively high probability of exclusive breastfeeding at hospital discharge, and twins (OR 0.31; 95% DI 0.15–0.65) — with low probability. Conclusion. Breastfeeding of late preterm babies with maternal milk (expressed milk included) in the first hours of life positively affects the lactation establishment and the provision of exclusively breast milk to these patients in neonatal hospital. The risk group for early cessation of breastfeeding may include late premature infants with gestational age less than 36 weeks and twins.
... By unraveling the psychological mechanism underlying the relation between CS and PTSS-FC, our results add to previous research on the positive effects of skin-to-skin contact for women's well-being following birth (e.g., [37,56]). It also provides further empirical support for the recommendation of the Baby Friendly Health Initiative [1] to allow all babies access to immediate skin-to-skin contact following vaginal birth, and as soon as the mother is alert and responsive after a CS. ...
Article
Objectives Despite the well-documented negative effects of posttraumatic stress symptoms following childbirth (PTSS-FC), research on protective factors for PTSS-FC is still missing. Aiming to fill this gap, we proposed and examined a process model through which maternal-infant skin-to-skin contact after birth reduces PTSS-FC by decreasing negative emotions, especially for women who had operative births. Method In this longitudinal study, pregnant women (N = 1833) were recruited at community and hospital medical centres in the center of Israel and through internet forums. At Time 1, during pregnancy, they rated their prenatal depressive symptoms which served as an indicator for prenatal vulnerabilities. At Time 2, two-months postpartum (N = 1371, 75% of the sample), they reported their mode of birth, whether they had skin-to-skin contact with their newborn after birth, their emotions during birth, and rated their current PTSS-FC. A moderated mediation analysis was used to examine the proposed model. Results Guilt and fear during birth mediated the association between mode of birth (instrumental or cesarean versus vaginal) and PTSS-FC. Skin-to-skin contact was related to reduced feelings of guilt and fear during birth, especially for women who had a cesarean section. Conclusions Our results recognize the specific emotions that contribute to the development of PTSS-FC following operative births and show how skin-to-skin contact can possibly reduce them. As such they emphasize the importance of the implementation of skin-to-skin contact following childbirth, and especially following a cesarean section as recommended by the Baby Friendly Health Initiative (World Health Organization & UNICEF, [1]).
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Aim Separating infants and their parents after a Caesarean section is still the routine care worldwide. This study investigated three caregiving models on the wakefulness and physiological parameters of full‐term infants after an elective Caesarean section. Methods Newborn infants born in a Chilean public hospital in 2009‐12 were randomised to three groups: cot, fathers' arms or skin‐to‐skin contact with their father. They were assessed at 15‐minute intervals, from 45 to 120 minutes after the Caesarean section. Their physiological parameters were measured, and their wakefulness was assessed using the Neonatal Behavioural Assessment Scale. Results We studied 95 infant (53% girls) born at a mean gestational age of 38.9 ± 0.9 weeks. Heart rates were significantly higher in the skin‐to‐skin than cot or fathers' arms groups and showed greater stability over time. Wakefulness was initially higher in the skin‐to‐skin group, but there were no significant differences by the end of the observation. There were no differences between the groups in peripheral oxygen saturation. Skin‐to‐skin contact had no negative impact on the infants. Conclusion The skin‐to‐skin group showed some advantages over the cot and fathers' arms groups when it came to establishing stable physiological parameters and wakefulness. This approach should be supported during mother‐infant separation.
Article
Background Early skin to skin contact after vaginal delivery increases milk production and may increase oxytocin release, leading to reduction in postpartum hemorrhage (PPH) rate. Objective To examine the impact of “natural” cesarean deliveries (NCD) on perioperative maternal blood loss. Study Design This is a randomized controlled trial conducted at a single university affiliated medical center, between August 2016 and February 2018. Term singleton gestations scheduled for a planned CD under spinal anesthesia were included. Women were randomized at a ratio of 1:1 to NCD (study group) or traditional CD (control group) during the routine preoperative assessment. Women in the study group watched fetal extraction, had early skin to skin contact, and breastfed until the end of surgery. Neonates in the control group were presented to the mother for few minutes. Blood samples were drawn from all women, during fascia closure, to determine oxytocin levels using an ELISA kit. The Laboratory component was performed after recruitment completion and was accomplished in February 2019. The primary outcome was postpartum hemoglobin (Hb) levels. To detect a difference of 0.5 g/dL between the groups with α = .05 and β = 80%, 214 women were needed. Results Of 214 women that were randomized, 23 were excluded. There were no significant differences in demographic and obstetric variables between the groups. Postpartum Hb levels were 10.1±1.1 and 10.3±1.3 g/dL in the study and control groups, respectively (P = .19). There were no significant differences in rates of PPH and blood transfusion. Maternal pain scores, satisfaction, and exclusive breastfeeding, were comparable. Maternal oxytocin blood levels were 389.5±183.7 and 408.5±233.6 pg/mL in the study and control groups, respectively (P = .96). Incidence of neonatal hypothermia was comparable between the groups (P=.13). Conclusions NCD does not affect perioperative Hb level or maternal oxytocin blood concentration. Clinical Trial Registration clinicaltrials.gov Identifier: NCT02768142.
Article
Objectives: Exclusive breastfeeding is the ideal source of nutrition for the first 6 months of life. Although skin-to-skin contact (SSC) has been shown to be associated with greater rates of exclusive breastfeeding, the results are heterogeneous. SSC involves placing a naked infant on its mother's bare chest immediately after birth. We examined the association between SSC immediately after birth and exclusive breastfeeding at 4 months. Methods: A retrospective cohort of healthy, term, singleton infants who were liveborn from 2008 to 2019 was constructed from the Nova Scotia Atlee Perinatal Database. Our main outcome was exclusive breastfeeding at 4 months, available for a subset of the cohort through linkage to a primary care database (n=256). Our secondary outcome was exclusive breastfeeding at hospital discharge, available for the broader cohort (n=56,459). Odds ratios (OR) for the association between SSC and exclusive breastfeeding at 4 months were estimated from logistic regression models. Results: The odds of breastfeeding exclusively at 4 months were 4.14 (95% confidence interval (CI) 1.89-9.25) times greater among those who had SSC than among those who did not. The odds of breastfeeding exclusively at hospital discharge were 3.81 (95% CI 3.64-3.99) times greater among those who had SSC than among those who did not. The association between SSC and exclusive breastfeeding at hospital discharge was heterogeneous by birth year (OR 4.35, CI 4.07-4.65 in 2008-2011; OR 2.81, CI 2.57-3.07 in 2012-2015; OR 1.89, CI 1.63-2.10 in 2016-2019). Conclusion: Skin-to-skin contact appears to be associated with greater odds of exclusive breastfeeding at discharge and 4 months postpartum. Early SSC should continue to be supported for breastfeeding promotion.
Article
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates. The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid.Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed.All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published.Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.
Article
Problem Women having an elective caesarean birth are often separated from their babies at birth with newborns transferred to a postnatal ward with the significant other. Background Two midwives were employed in 2019 to provide skin-to-skin contact for women who planned for elective caesarean births in a public hospital in metropolitan New South Wales with 4000 births per year and a 39% CB rate (57.8% of these births being elective). Aim To compare the outcomes for women and their newborns on the effects of skin-to-skin contact at elective caesarean births within the first five minutes of birth to those who did not have skin-to-skin contact and to explore the lived experiences of women having skin-to-skin contact during their elective caesarean births. Methods A quasi-experimental design study with a qualitative component of in-depth interviews. Quantitative analyses included independent t-tests, chi square and logistic regression. Thematic analysis was used for the qualitative data. Findings In the quantitative results, there was a reduction in the time to the first feed (t(100) = −11.32, p < 0.001) (M = 38.9, SE = 20.7) (M = 124.9, SE = 50.1) and the first breastfeed (t(100) = −5.2, p < 0.001) (M = 53.2, SE = 82.5) (M = 277, SE = 295.8) with increased breastfeeding on discharge for women that had skin-to-skin contact at caesarean birth in comparison to those who did not receive skin-to-skin contact χ2(1) = 10.22, p < 0.05. In the qualitative results, women who had skin-to-skin contact during their caesarean birth had a positive experience with improved bonding and reported less anxiety and depression than their previous caesarean birth. Conclusion This study provides evidence of the benefits of skin-to-skin contact during a caesarean birth.
Article
Aim: To evaluate whether early skin-to-skin contact at the end of the second stage of labor could relieve perineal wound suture pain. Methods: From March 2020 to November 2020, a total of 241 parturients with full-term single fetuses delivered through the vagina and who underwent episiotomy suture (n = 120) or perineal laceration repair (n = 121) in our hospital were included in the study. Parturients were categorized according to whether they received episiotomy suture or perineal laceration repair. They were randomized into an early skin contact group and a traditional neonatal care group. The primary outcome was pain, which was quantified by the Numerical Rating Scale, Visual Analog Scale, Verbal Rating Scale, Faces Pain Scale-Revised. The secondary outcomes were healing of the perineal wound, the maternal cooperation rate and operation time. The confounding factors of severe pain were analyzed. Results: Early skin-to-skin contact alleviated the pain of perineal laceration repair and episiotomy suture, shortened the operation time of episiotomy suture and improved the cooperation rate of parturients receiving suture. It had no effect on perineal wound healing, operation time, or the cooperation rate of perineal laceration repair. In addition to the operation and early skin contact, the occurrence of high-grade pain was also associated with prepregnancy body mass index, group B streptococcus (GBS) positive, and academic degree. Conclusion: Early skin-to-skin contact at the end of the second stage of labor can alleviate pain and improve the delivery experience of vaginal delivery.
Article
Purpose : To study breastfeeding initiation and continuation rates and identify clinical predictors of breastfeeding initiation related to maternal epilepsy and the newborn's condition among women with epilepsy (WWE). Methods : Data on a cohort of 1195 pregnant WWE from an epilepsy centre in Poland from 2000-2019 were prospectively collected. Mann-Whitney U and ch2 tests -based comparisons between lactating and non-lactating WWE according to age, week of delivery, Apgar score, birth weight, type of epilepsy, seizure control, major congenital malformation (MCM), mode of delivery, type and dose of antiseizure medication (ASM) were performed. A logistic regression model was constructed to identify predictors of breastfeeding initiation. Results : Among 921 WWE, who gave birth to a living child, 709 (77%) initiated breastfeeding. The annual rate did not significantly change over the study period. Higher breastfeeding initiation rates were associated with vaginal birth (OR = 0.66) and lack of MCM (OR = 0.23). Breastfeeding initiation was less frequent with old-generation ASM monotherapy (OR = 0.36) or polytherapy (OR = 0.33) compared to no ASM treatment. The rate of breastfeeding initiation was positively associated with gestational week and the newborn's condition. At 6 months, about 1/3 of WWE maintained lactation. Conclusion : Approximately ¾ of the WWE cohort initiated breastfeeding. Breastfeeding initiation was associated with delivery mode, treatment type, and the newborn's condition but was not associated with seizures during pregnancy or the individual ASM dose. Further studies are needed to identify additional factors that may negatively affect breastfeeding.
Article
Despite growing initiatives to support patient-centered labor and birth care, implementation of this care in the operating room is still limited. Doulas can be utilized in the operating room to facilitate evidence-based practices such as skin-to-skin contact for patients and newborns during cesarean birth. This article evaluates a curriculum and training method that was developed to educate doulas to provide safe and effective care during the cesarean birth experience. This intervention was found to be effective at improving doulas' self-perceived confidence in skills essential to support cesarean births and may serve as a model for other institutions to address barriers to the implementation of patient-centered evidence-based care in the operating room.
Article
Professor Dulitha Nandanie Fernando (1944-2021) is much recognized for her contribution to high-quality research that generated evidence for public health policy and practice in Sri Lanka. The present article is one such example of her contribution to the translation of evidence into practice in maternal and child health. The article aims to demonstrate how the knowledge generated through a study conducted on essential newborn care in Sri Lanka during 2003-04 period enriched the global evidence base and impacted the newborn care programme and services in Sri Lanka.
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Objectives. Survey current experience with Skin to Skin care (SSC) in Pennsylvania Maternity Centers. Study Design. The nursing director of each Maternity Center in PA (n = 95) was sent an on-line confidential survey querying SSC practices. Responses were compared by delivery size, location, and nature of affiliation. Statistics analyzed by chi-square and student t-test. Results. Of these 64/95 MCs (67%) responded. All allowed SSC after vaginal deliveries, 55% after C-section, 73% mother’s room. Monitoring included delivery room nurse (94%) with support from other providers (61%), family members (37%), and electronic monitoring (5%). If SSC occurred in mother’s room all reported family education on safe practices. 40% were aware of adverse SSC events, including falls and suffocation. About 80% educated staff about infant safety during SSC. Conclusions. Gaps in education and supervision during SSC were identified. Additional education and standardization of best practices are needed to reduce risks from falls and suffocation during SSC.
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Z Doğumdan sonraki ilk saatler, anne ve yenidoğan etkileşimini geliştiren tensel temas ve emzirmenin sağlanması açısından hassas bir süreçtir. Postpartum erken tensel temasın sağlanması annelik dav-ranışının gelişmesini, emzirme başarısını ve yenidoğanın yaşama uyumunu kolaylaştırmaktadır. Tensel temas ve emzirme yenidoğan açısından güven duygusunun gelişmesini sağlarken anneye doyum ve mutluluk vermektedir. Ancak sezaryen sonrası yenidoğanın bakımı, annenin kendine gelmesi, rahatlı-ğının sağlanması gibi nedenlerle anne ve bebeği ayırmak yaygın olarak yapılan bir uygulamadır. Diğer taraftan sezaryen sonrası yaşanan sorunlar annenin emzirme konusunda daha stresli hissetmesine ve emzirme başarısının düşmesine yol açabilmektedir. Bu nedenle sezaryen sonrası anne ve yenidoğa-nın tensel temasının sağlanması, emzirmenin desteklenmesi, anne ve yenidoğanın bir arada tutulması ameliyat sonrası hemşirelik bakımının önemli bir parçasını oluşturmaktadır. Bu derlemede, sezaryen sonrası tensel temas ve emzirmenin desteklenmesinin önemi konusunda bilgi verilmektedir. Anahtar Kelimeler: Emzirme; hemşirelik bakımı; sezaryen. ABSTRACT The first hours after birth are a sensitive process in terms of providing sensual contact and breastfeed-ing, which improves the interaction of mother and newborn infant. Providing early postpartum skin-to-skin contact facilitates the development of maternal behavior, breastfeeding success and the newborn infant's adaptation to life. While skin-to-skin contact and breastfeeding provide the development of a sense of trust for the newborn, it gives satisfaction and happiness to the mother. However, it is a common practice to separate the mother and the baby for reasons such as the care of the newborn after cesarean section, the recovery of the mother and the comfort. On the other hand, problems experienced after cesarean section may cause the mother to feel more stressed about breastfeeding and yo decrease breastfeeding success. For this reason, after cesarean section, providing skin-to-skin contact of infant and mother, supporting breastfeeding, keeping mother and newborn infant together constitute an important part of postoperative nursing care. In this review, the information is given about the supporting and importance of breastfeeding and skin-to-skin contact after cesarean section.
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Background: Skin-to-skin contact between mother and infant immediately after birth is recommended regardless of delivery method; however, it is less common after cesarean delivery. We aimed to describe and compare women's experiences of cesarean birth with and without skin-to-skin contact at an urban tertiary care hospital. Methods: In this hermeneutic phenomenologic study, we used semistructured telephone interviews from 2015 to 2018 to interview a convenience sample of women who delivered at term by scheduled skin-to-skin cesarean birth at an urban tertiary care hospital in Toronto, Ontario. Women were invited to participate if they had had a previous planned or unplanned cesarean birth and a scheduled skin-to-skin cesarean birth between 2013 and 2017. Participants were excluded if they had antenatally diagnosed conditions, they delivered before 37 weeks, they had general anesthesia, their condition was unstable at the time of surgery, a skin-to-skin cesarean birth was not possible or they declined skin-to-skin cesarean birth. Interviews were recorded, transcribed and analyzed by means of thematic analysis. Results: Ten women were interviewed 1-19 months postpartum. Four central themes emerged: support for skin-to-skin cesarean birth (women feeling supported by their families and health care providers); control (participants experiencing greater control during their skin-to-skin cesarean birth); connection with the infant, which enabled women to be active participants in their delivery, enhanced bonding and intimacy, facilitated breastfeeding and bolstered confidence during early parenthood; and logistic considerations, with participants recognizing that skin-to-skin cesarean birth required additional resources. Interpretation: These findings refine what is known about skin-to-skin cesarean birth and provide a critical perspective, that of mothers. They support the transformation of traditional operating room dynamics to a more patient-centred environment.
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Majority of neonatal deaths that occur in the first day of life could be prevented by the presence of a skilled attendant at birth. This is however lacking in many instances. In this prospective, cross-sectional study, health care providers attending Caesarian deliveries were covertly evaluated by using scheduled proforma designed based on standard practice guidelines. Six enumerators were assigned from 1 st May-31 st May,2017 to observe the practice of the providers from setting up of trolley to the tenth minute post-delivery. Actions and omissions of vital procedures were entered onto the proforma. Forty-one (41) providers were observed in successive Caesarean deliveries during the study period. In 68% of deliveries the baby cried immediately after birth. About 80% of providers didn't scrub before receiving the baby. Resuscitation equipment was pretested in 97.6% of cases and all babies were dried immediately. Immediate skin to skin with mother was done in 7.3% and delayed cord clamping in 21.9% of deliveries. In assessing the APGAR score, 44% didn't check the heart rate and 82.9% didn't check reflex irritability. This study revealed gaps in the care of newborns immediately after Caesarean delivery. Measures should be put in place to rectify them to improve quality of care.
Article
Background: Breast milk is recognized as the best source of nutrition for babies. The World Health Organization (WHO) recommends exclusive breastfeeding in the first six months after birth and continued breastfeeding for up to two years. According to the reported literature, breastfeeding and exclusive breastfeeding rates worldwide are relatively low, especially after a cesarean section (C-section). Therefore, this review aims to summarize existing data on C-section and breastfeeding performance worldwide to interpret their relationship further. Methods: Research articles related to C-section and breastfeeding were retrieved from electronic databases, including CINAHL Complete, Health Source: Nursing/Academic Edition, Academic Search Complete, MEDLINE, PubMed, and Google Scholar. Only full-text English articles reported from 2015 to 2020 are summarized in this review. Results: Among a total of 389 articles identified, 18 papers met our inclusion criteria, which reported that the C-section was associated with the initiation of breastfeeding and the duration of exclusive breastfeeding. Furthermore, these studies also discussed factors and experiences related to breastfeeding difficulties in mothers who have a C-section. Besides, several studies investigated effective initiatives that support breastfeeding in mothers who have a C-section. Conclusion: C-section is thought to be related to the initiation and duration of breastfeeding. In comparison with natural childbirth, C-section can delay the start of breastfeeding and shorten the duration of exclusive breastfeeding. Moreover, the planned C-section is considered the most critical factor affecting breastfeeding. Also, breastfeeding initiatives are highly recommended to support mothers who have a C-section. According to the literature, different regions and populations may have distinct experiences of breastfeeding. Therefore, future research is required to identify breastfeeding support for diverse populations with higher quality.
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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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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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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.
Article
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.
Article
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.
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.
Article
IntroductionPostpartum depression (PPD) is a disorder that affects not only mothers, but also can lead to family, social, economic and vocational breakdown. The objective of this study was to determine the prevalence and factors associated with postpartum depression among mothers in an urban hospital setting in Malaysia.Methods In this cross-sectional study, mothers attending routine visits at six to eight weeks postpartum at a postnatal clinic were assessed on socio-demographic data, obstetric history, social support, breastfeeding status and psychiatric history. Mini International Neuropsychiatric Interview (M.I.N.I.) was administered to establish a diagnosis of postpartum depression.ResultsA total of 411 subjects participated in the study. The prevalence rate of postpartum depression was 6.8%. Univariate analysis found that being a housewife, having a cesarian section, low social support, family history of depression, previous history of depression and non-exclusive breastfeeding were significantly associated with postpartum depression. Predictors for postpartum depression were non-exclusive breastfeeding (P < 0.01, OR = 23.7, 95% CI 3.1–179.7) and previous history of depression (P < 0.05, OR = 82.3, 95% CI 1.2–5897.6).DiscussionThe prevalence rate of postpartum depression in urban Malaysian mothers was comparable to the rates in other countries. Mothers who did no exclusively breast feeding their babies appeared to have more risk for postpartum depression. Therefore, screening for depression should become a routine during postpartum period and mothers must be encouraged to exclusively breastfeed their babies.
Article
Background: Although exclusive breastfeeding is recommended for the first 6 months, the use of breast milk substitutes is widespread around the world. Objectives: To describe the patterns of infant formula supplementation among healthy breastfeeding newborns, to identify factors contributing to in-hospital formula supplementation, and to assess the dose-response relationship between the amount of in-hospital formula supplementation and the duration of any breastfeeding. Methods: A sample of 1246 breastfeeding mother-infant pairs was recruited from 4 public hospitals in Hong Kong and followed prospectively for 12 months or until weaned. Multiple logistic regression analysis was used to examine factors associated with in-hospital supplementation. Cox regression analysis was used to explore the impact of in-hospital supplementation on breastfeeding duration. Results: Of the total, 82.5% of newborns were supplemented in the hospital; one-half received formula within 5 hours of birth. Assisted vaginal delivery (odds ratio [OR] = 2.06, 95% confidence interval [CI] 1.03, 4.15), cesarean section (OR = 3.45, 95% CI 1.75, 6.80), and higher birth weight (OR = 1.56, 95% CI 1.12, 2.18) were positively associated with in-hospital formula supplementation, whereas initiating breastfeeding in the delivery room (OR = 0.55, 95% CI 0.33, 0.89) was associated with decreased likelihood of in-hospital supplementation. Any infant formula in the first 48 hours was associated with a shorter duration of breastfeeding (hazard ratio [HR] = 1.51, 95% CI 1.27, 1.80), but there was no dose-response effect. Conclusion: In-hospital formula supplementation is common in Hong Kong hospitals and appears to be detrimental to breastfeeding duration. Continued efforts should be made to avoid the provision of infant formula to breastfeeding babies while in the hospital unless medically indicated.
Article
Early sudden unexpected death in infancy (ESUDI) is a rare cause of death occurring in newborns during the first hours of life. Our aim was to find additional data for the identification of risk factors and establishment of prevention strategies. We describe three cases of ESUDI and give an overview of the literature. ESUDI was observed in term babies with normal birth weight after good postnatal adaptation within the first four hours of life. Maternal age was between 29 and 36 years, mothers were primiparous and of normal weight. All three events occurred during unobserved early skin-to-skin contact. Autopsy and post-mortem metabolic screening re