Evaluation of an e-Learning Breastfeeding Program for Postpartum Mothers of Moderately High-Risk Newborn Infants Admitted to the Special Care Nursery.

Because of a lack of proper breastfeeding education to mothers and the visitation policy in the special care nursery, breastfeeding initiation and maintenance can be very challenging for both the mother and her infant who is admitted to the neonatal special care nursery after birth. Difficulties associated with forming initial bonds may contribute to some mothers changing their mind about their initially chosen feeding method. The aim of this quasi-experimental study was to evaluate the effectiveness of an e-learning breastfeeding program on maternal breastfeeding outcomes. Thirty-four mothers in the comparison group received routine care; 34 in the intervention group received an e-learning breastfeeding program and routine care. The program included 28 modules of different topics downloaded to a personal tablet computer. Each module elaborated on a breastfeeding issue and provided video clips to show practice steps. During the mothers' 3- to 5-day stay in the postpartum unit, they could repeatedly watch selected topics related to their situations at their own pace. After adjusting for each infant's birth weight, mothers in the intervention group had better attachment to their infants, greater perceived nurse support, and a higher exclusive breastfeeding rate than mothers in the comparison group. Using a tablet computer device to disseminate breastfeeding education is a feasible and supplemental method for postpartum mothers whose infants are in the special care nursery. Through the demonstrated situations, mothers are better prepared to understand their high-risk infants and the situations they may encounter during breastfeeding.

Health literacy and depression in women with type 2 diabetes mellitus.

OBJECTIVES: The prevalence of diabetes mellitus has recently increased in Taiwan, and depression is common among these patients. Moreover, a lack of health literacy may lead to depression. In this study, we explored the correlation between health literacy and depression in diabetic women. METHODS: In this cross-sectional study, 152 women with type 2 diabetes mellitus were recruited from the outpatient clinic of a regional teaching hospital in Taiwan. The data were collected through medical records and a self-reported structured questionnaire, which included items on basic attributes, self-rated health status, the Center for Epidemiologic Studies Depression Scale (CES-D), and Chinese Health Literacy Scale for Diabetes (CHLSD). The results were analyzed using descriptive statistical analyses, bivariate correlation tests, and linear regression analyses. RESULTS: One hundred thirty-five valid questionnaires were obtained. Approximately 20% of the participants had a higher tendency toward depression as per their CES-D score, and the CHLSD results showed that 13.33% had poor health literacy. There was a negative correlation between health literacy and depressive tendencies after adjusting for self-rated health status, economic satisfaction status, employment status, and education level using multivariate linear regression analyses. For each 1-point rise in the CHLSD score, the CES-D score decreased by 0.17 points (z=-2.05, p=0.042). CONCLUSIONS: A negative correlation was identified between health literacy and depression. Self-rated health status, economic satisfaction, employment status, and higher education level are factors that also affect depressive tendency among diabetic women.

Health literacy and depression in women with type 2 diabetes mellitus

OBJECTIVES: The prevalence of diabetes mellitus has recently increased in Taiwan, and depression is common among these patients. Moreover, a lack of health literacy may lead to depression. In this study, we explored the correlation between health literacy and depression in diabetic women. METHODS: In this cross-sectional study, 152 women with type 2 diabetes mellitus were recruited from the outpatient clinic of a regional teaching hospital in Taiwan. The data were collected through medical records and a self-reported structured questionnaire, which included items on basic attributes, self-rated health status, the Center for Epidemiologic Studies Depression Scale (CES-D), and Chinese Health Literacy Scale for Diabetes (CHLSD). The results were analyzed using descriptive statistical analyses, bivariate correlation tests, and linear regression analyses. RESULTS: One hundred thirty-five valid questionnaires were obtained. Approximately 20% of the participants had a higher tendency toward depression as per their CES-D score, and the CHLSD results showed that 13.33% had poor health literacy. There was a negative correlation between health literacy and depressive tendencies after adjusting for self-rated health status, economic satisfaction status, employment status, and education level using multivariate linear regression analyses. For each 1-point rise in the CHLSD score, the CES-D score decreased by 0.17 points (z=−2.05, p=0.042). CONCLUSIONS: A negative correlation was identified between health literacy and depression. Self-rated health status, economic satisfaction, employment status, and higher education level are factors that also affect depressive tendency among diabetic women.

Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time series design.

BACKGROUND: For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent-infant interactions. A substantial lack of interactional knowledge can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers' mother-infant interaction quality and parenting sense of competence. METHODS: Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother-infant interactions. RESULTS: We observed an increase in the quality of mother-infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother-infant interaction. CONCLUSIONS: Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants' abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction.

Factors associated with women's perception of and satisfaction with quality of intrapartum care practices in Swaziland.

OBJECTIVE: giving birth is a lifetime event, where the quality of care a woman receives has the potential to affect her or her baby both physically and emotionally either on a short-term or long-term basis. This study aimed at identifying factors associated with women's perception of and satisfaction with the quality of intrapartum care as well as their future loyalty intentions in two regional hospitals in Swaziland. METHODS: this is a correlational study where data were collected from 383 women conveniently selected from two regional hospitals where they gave birth. The QPP-I, SHPC, AND WOM questionnaires were used for data collection which was done from July to September 2016. FINDINGS: the results reflected that women's satisfaction with quality of intrapartum care total mean score was (M±SD = 74.17±10.1), a perceived reality of intrapartum care practices total mean score of (M±SD = 96.94±16.0), a high subjective importance total mean score (M±SD = 117.78±10.5), and above average future loyalty intension total mean score (M±SD 1.67±0.69). Factors that significantly predicted women's satisfaction with quality of intrapartum care include, perceived quality (F = 54.13, p<0.001 with 28% R2 variance), demographic variables (educational level, employment status and gestational weeks) (F = 10.66, p =<0.001, with 8% R2 variance), future loyalty intensions (F = 48.57, p<0.001with 7% R2 variance), and subjective importance (F = 44.74, p<0.001 with 1% R2 variance). CONCLUSION: the study revealed that women's perceived reality of and satisfaction with the quality of intrapartum care practices was suboptimal. Improvement should be focused on evidence-based intrapartum care that is women-centered, involving the clients in decision-making and also a comprehensive childbirth education for the pregnant mothers.

A proposed mother-friendly childbirth model for Taiwanese women and obstetricians' attitudes toward it.

OBJECTIVE: Pleasant and humane childbirth is every mother's wish. The objective of this study was to propose a practicable mother-friendly childbirth model tailored to Taiwanese women in order to improve the quality of perinatal care and maternal satisfaction. MATERIAL AND METHODS: In this study, the guidelines of several countries were systematically reviewed, and a standard set of clinical guidelines were established by a focus group. In addition, a total of 172 Taiwanese obstetricians were visited, and a cross-sectional study of these obstetricians' attitudes toward the practicality and effectiveness of the model was performed using questionnaires. RESULTS: A total of 10 suggestions were developed for this woman-friendly childbirth model, including: (1) intermittent fetal monitoring for low-risk pregnancy, (2) no routine enema, (3) no routine perineal shaving, (4) no routine restricted oral intake, (5) no routine parenteral fluid support, (6) no routine elective amniotomy, (7) nonpharmacological pain management, (8) upright position during childbirth, (9) delayed pushing, and (10) restrictive episiotomy. Taiwanese obstetricians approved of no routine oral intake restriction and providing nonmedical pain relief. The majority of obstetricians disagreed that perineal shaving and routine elective amniotomy were necessary, and agreed to modify their practice according to the suggestions. Suggestions were still being debated, such as no routine parenteral fluid support, using an upright position for childbirth, and delayed pushing. Intermittent fetal monitoring for low-risk pregnancy, no routine enema, and restrictive episiotomy were questioned by many Taiwanese obstetricians. CONCLUSION: Several suggestions were made in this model. However, there was still no consensus of Taiwanese obstetricians. More evidence for the advantages and disadvantages of the various suggestions was needed to convince Taiwanese obstetrician to modify their routine practice.

A proposed mother-friendly childbirth model for Taiwanese women, the implementation and satisfaction survey.

OBJECTIVES: Pleasant and humane childbirth is every mother's wish. We established one practicable and tailored Taiwanese mother-friendly childbirth model, and the objective of this study was to investigate the implementation, pregnancy outcomes, and women's satisfaction. MATERIALS AND METHODS: We used the Taiwanese mother-friendly childbirth model. Women from eight hospitals were divided into an experimental group and control group. The experimental group received prenatal care modified by the Taiwanese mother-friendly childbirth model and the control group received routine prenatal care according to their hospital. We performed a quasi-experimental study of women's satisfaction toward this mother-friendly childbirth model by questionnaires and surveyed the practicality and effectiveness of this model. RESULTS: Seven hundred and fifty-one women from eight hospitals, including three medical centers and five regional hospitals were included. There was significantly different practices between the two groups, such as: (1) intermittent fetal monitoring for low-risk pregnancy; (2) no routine enema; (3) no perineal shaving; (4) less routine parenteral fluid support; (5) using an upright position; and (6) restrictive episiotomy. The mean maternal height, body weight gain, gestational age, birth weight, and episiotomy wound infection rate were indifferent. The epidural anesthesia rate and induction medication use were significantly lower in the experimental group. The self-reported pain score was higher in the experimental group and the self-reported satisfactory score was also higher in the experimental group, without statistical significance. CONCLUSION: Women receiving standardized prenatal care modified by the woman-friendly childbirth model of prenatal care had less epidural anesthesia, less induction medication, higher self-reported satisfaction score, and indifferent pregnancy outcomes such as gestational age, birth weight, and wound infection rate.

[A gender perspective on medicalized childbirth].

Gender mainstreaming is a worldwide issue. The United Nations and the World Health Organization have emphasized the importance of incorporating gender perspectives and gender equity into government policy decisions. Different cultures have different attitudes toward the management of childbirth and these attitudes influence the feelings and needs of women and their partners. These needs must be better understood and satisfied. The widely held technocratic values of obstetricians influence the birthing experience of women significantly. This article uses a gender perspective to describe the medicalization of childbirth, the pharmacological pain-relief oppression of women, the prevalence of blaming women for decisions to conduct Caesarean sections, and the exclusion of men from involvement in the childbirth process. This article may be used as reference to enhance gender equality childbirth care for women.

The experiences of women who quit smoking during pregnancy and how they dealt with their spouses' continued smoking.

OBJECTIVE: to explore how pregnant women in Taiwan dealt with their spouses who continued to smoke and with passive smoking during their own process of quitting and abstaining. DESIGN: a qualitative study using an oral history approach. Data were collected via tape-recorded open-ended interviews. All interviews were transcribed verbatim. Data were analysed using narrative analysis. SETTING: the homes of the participant women living in the district of a regional hospital of eastern Taiwan. PARTICIPANTS: a purposive sample of 10 Taiwanese women who had quit smoking while pregnant was recruited at 1-3 months following the birth of their infants. FINDINGS: five major themes emerged: (1) the women coping with tobacco addiction on their own, (2) creating a non-smoking section or environment at home, (3) dealing with passive smoking, (4) conflict over the wife's sensitivity to her spouse's residual tobacco smell, and (5) allowing the husband to continue smoking to avoid conflicts. KEY CONCLUSIONS: the pregnant women were expected by their spouses to quit smoking, yet the husbands continued to smoke. Women had to struggle to quit smoking on their own. The findings from this study support the need to listen to pregnant women's stories, as this is paramount to understanding their experiences of tobacco-use reduction and cessation, and for developing gender appropriate interventions to support their efforts. IMPLICATIONS FOR PRACTICE: health care providers should encourage and help pregnant women who are willing to quit smoking. This help could be more family-centred instead of focusing on the pregnant women alone, and therefore involve educating the spouse to support his wife.

[Constructing a baby-friendly community].

The Baby-Friendly Hospital Initiative (BFHI), developed by the World Health Organization and the United Nations Children's Fund to promote breastfeeding in maternity facilities worldwide, has had a global impact on breastfeeding outcomes. However, further interventions are necessary before and after hospital discharge to meet the initiative's recommended 6-month targets. The Baby-Friendly Community Initiative (BFCI), a multifaceted program for community based breastfeeding promotion designed to complement BFHI, addresses this challenge. The purpose of this paper is to introduce the origin of BFCI and its current implementation status in several countries as a reference for effective BFCI promotion in Taiwan.

[Pregnancy and the struggle to quit smoking].

The negative effects of smoking during pregnancy are well documented. Health care providers typically advise pregnant women who smoke usually to quit for their health as well as for the health of their fetus. Most women are familiar with the need to stop smoking while pregnant. Hospitals offer various smoking cessation services. However, the literatures reveals a low uptake of smoking cessation services among pregnant women. The purpose of this paper is to explore the smoking cessation experience and feelings amongst women during pregnancy and assess smoking cessation intervention in antenatal care. Findings may provide health care providers a better understanding of this issue and help women overcome related challenges.

Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour.

OBJECTIVES: To evaluate maternal labour pain, fatigue, duration of the second stage of labour, the women's bearing-down experiences and the newborn infant Apgar scores when spontaneous pushing is used in an upright position. DESIGN: Quasi-experimental study. SETTING: Medical centre in Taichung, Taiwan. PARTICIPANTS: 66 Women giving birth at the hospital, with 33 primigravidas assigned to each group. INTERVENTIONS: During the second stage of labour, the women in the experimental group pushed from an upright position and were given support to push spontaneously; the women in the control group pushed from a supine position and were supported via Valsalva pushing. OUTCOME MEASURES: Pain scores were recorded at two evaluation time points: at 10 cm of cervical dilation and one hour after the first pain score evaluation. One to four hours after childbirth, the trained nurses collected the fatigue and pushing experience scores. FINDINGS: The women in the experimental group had a lower pain index (5.67 versus 7.15, p = 0.01), lower feelings of fatigue post birth (53.91 versus 69.39, p < 0.001), a shorter duration of the second stage of labour (91.0 versus 145.97, p = 0.02) and more positive labour experiences (39.88 versus 29.64, p < 0.001) compared with the control group. There was no significant difference in the Apgar score for newborn infants during either the first minute (7.70 versus 7.73, p = 0.72) or the fifth minute (8.91 versus 8.94, p = 0.64). KEY CONCLUSIONS: The pushing intervention during the second stage of labour lessened pain and fatigue, shortened the pushing time and enhanced the pushing experience. IMPLICATIONS FOR PRACTICE: Pushing interventions can yield increased satisfaction levels for women giving birth.

Comparative analyses of linkage maps and segregation distortion of two F2 populations derived from japonica crossed with indica rice.

To facilitate genetic research, we constructed two linkage maps by employing two F2 populations derived from rice inter-subspecific crosses, japonica Tainung 67 (TNG67)/indica Taichung Sen 10 (TCS10) and japonica TNG67/indica Taichung Sen 17 (TCS17). We established linkage map lengths of 1481.6 cM and 1267.4 cM with average intervals of 13.8 cM and 14.4 cM by using 107 and 88 PCR markers for coverage of 88% of the rice genome in TNG67/TCS10 and TNG67/TCS17, respectively. The discrepancy in genetic maps in the two populations could be due to different cross combinations, crossing-over events, progeny numbers and/or markers. The most plausible explanation was segregation distortion; 18 markers (16.8%) distributed at nine regions of seven chromosomes and 10 markers (11.4%) at four regions of four chromosomes displayed severe segregation distortion (p < 0.01)in TNG67/TCS10 and TNG67/TCS17, respectively. All segregation-distorted markers in these two populations corresponded to reported reproductive barriers, either gametophytic or zygotic genes but not to hybrid breakdown genes. The observed recombination frequency, which was higher or lower than the intrinsic frequency, revealed the association of segregation distortion skewed to the same or different genotypes at the consecutive markers. The segregation distortion, possibly caused by reproductive barriers, affects the evaluation recombination frequencies and consequently the linkage analysis of QTLs and positional cloning.

Effects of Gua-Sha therapy on breast engorgement: a randomized controlled trial.

BACKGROUND: Breast engorgement is a common problem that affects the initiation and duration of breastfeeding. Limited solutions are available to relieve the discomfort associated with breast engorgement. Thus, further investigation of methods to achieve effective relief of symptoms is critical to promote breastfeeding success. PURPOSE: : The purpose of this study was to determine the effects of two breast care methods, that is, scraping (Gua-Sha) therapy (administered to the experimental group) and traditional breast care (i.e., massage and heating; administered to the control group). METHODS: A randomized controlled trial was conducted on 54 postpartum women at a Level III medical teaching hospital. Participant inclusion criteria included postpartum breastfeeding women (a) who had an uncomplicated delivery and (b) who were experiencing breast engorgement problems. The Gua-Sha protocol selected appropriate acupoint positions, which included ST16, ST18, SP17, and CV17. Each position was lightly scraped seven times in two cycles. For the control group, we used hot packs and massage for 20 min in accordance with recommendations given in an obstetrical technique textbook. RESULTS: Results showed no statistical differences between the two groups at baseline. Body temperature, breast temperature, breast engorgement, pain levels, and discomforting levels were statistically different between the two groups at 5 and 30 min after intervention (p < .001). The results of generalized estimating equation analysis indicated that, with the exception of body temperature, all variables remained more significant (p < .0001) to improving engorgement symptoms in the experimental group than those in the control group, after taking related variables into account. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings provided empirical evidence supporting that Gua-Sha therapy may be used as an effective technique in the management of breast engorgement. By using Gua-Sha therapy, nurses can handle breast engorgement problems more effectively in primary care and hence help patients both physically and psychologically.

Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: a randomised controlled trial.

BACKGROUND: In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans. OBJECTIVE: The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences. DESIGN: A randomised, single-blind controlled trial study design was used. SETTINGS: This study involved seven hospitals and 10 obstetricians in Taiwan. PARTICIPANTS: Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n=155) or control (n=141) groups. METHODS: The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations. RESULTS: The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t=2.48, p=0.01). The experimental group also showed a higher degree of childbirth control (t=9.60, p<0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t=2.63, p=0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t=3.74, p<0.001) in the experimental group than in the control group. CONCLUSIONS: The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.

Effects of a prenatal yoga programme on the discomforts of pregnancy and maternal childbirth self-efficacy in Taiwan.

OBJECTIVE: to evaluate a yoga programme provided to primigravidas in the third trimester of pregnancy with the aim of decreasing the discomforts associated with pregnancy and increasing childbirth self-efficacy. DESIGN: non-randomised controlled experimental study. SETTING: a hospital in northern Taiwan. PARTICIPANTS: the target population was primigravidas at 26-28 weeks of gestation (no high-risk pregnancies) who had not engaged in regular exercise or yoga for at least one year. The study included 88 individuals; 43 in the control group and 45 in the experimental group who took part in the prenatal yoga programme. INTERVENTION: the duration of the prenatal yoga programme was 12-14 weeks, with at least three sessions per week. Each workout lasted for 30 minutes. MEASUREMENTS AND FINDINGS: women who took part in the prenatal yoga programme reported significantly fewer pregnancy discomforts than the control group (38.28 vs 43.26, z=-2.58, p=0.01) at 38-40 weeks of gestation. The subjects who participated in the yoga programme exhibited higher outcome and self-efficacy expectancies during the active stage of labour (104.13 vs 83.53, t=3.24, p=0.002; 99.26 vs 77.70, t=3.99, p ≤ 0.001) and the second stage of labour (113.33 vs 88.42, t=3.33, p=0.002; 102.19 vs 79.40, t=3.71, p ≤ 0.001) compared with the control group. KEY CONCLUSIONS: the provision of booklets and videos on yoga during pregnancy may contribute to a reduction in pregnancy discomforts and improved childbirth self-efficacy. IMPLICATIONS FOR PRACTICE: this yoga programme provides health-care professionals with an evidence-based intervention.

Taiwanese women's experiences of hospital midwifery care: a phenomenological study.

OBJECTIVE: to explore women's experiences in interaction with their midwives during their antenatal checks and during labour. DESIGN: a qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. All interviews were transcribed verbatim. Data were analysed using Colaizzi's method for data analysis. SETTING: the homes of the study participants in the district of a Taipei (Taiwan) teaching hospital. PARTICIPANTS: a purposive sample of 11 Taiwanese women, one primipara, and 10 multiparae, who were one to three months post-childbirth at the time of interview. FINDINGS: five major themes revealed the essence of women's experiences of their interaction with a midwife during pregnancy and childbirth: (1) being respected, (2) being accompanied, (3) trust, (4) being satisfied, and (5) professional competence. KEY CONCLUSIONS: the women recognised the service model of the midwife; they treasured their mutual relationships and the benefits that women derived from midwifery care during childbirth. In Taiwan, the government is mandated to offer midwifery models of care in hospitals, and to allow women to choose different types of care provider. IMPLICATIONS FOR PRACTICE: an awareness of women's experiences will help identify the caring behaviours as recognised by the women and may help health-care professionals provide better support and care for women during the pregnancy and childbirth periods. These findings can serve as references for future midwifery practice models and improvements in quality of care.

A birth education program for expectant fathers in Taiwan: effects on their anxiety.

BACKGROUND: A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety. The objective of this study was to evaluate how an education program for expectant fathers who attended their partners' labor and birth affected their anxiety. METHODS: In a randomized controlled trial, 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block randomization to an experimental (n = 45) and a control (n = 42) group. The men completed their basic personal information, a childbirth expectations questionnaire, and a Trait Anxiety Inventory when they were recruited. Two hours after birth of their child, all the expectant fathers completed a State of Anxiety Inventory. RESULTS: Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations. After analysis of covariance (ANCOVA) was applied to correct for education level, sources of childbirth information, attendance at Lamaze childbirth classes, and childbirth expectations at baseline, the effect of the childbirth program was significant for the postnatal level of anxiety (F = 3.38, p = 0.001). CONCLUSIONS: The study findings justify the clinical implementation of a birth education program based on the self-efficacy theory as an effective means of reducing anxiety among expectant fathers.

The experiences of mothers in breastfeeding their very low birth weight infants.

AIM: This paper is a report of a study of the breastfeeding experience of mothers of very low birth weight babies. BACKGROUND: Very low birth weight babies, being born preterm, are at risk for feeding difficulties. Medical complications may prolong their hospital stays and further delay their progression towards oral feeding. Many studies have focused on the benefits of breastfeeding to very low birth weight babies, but very few have explored the breastfeeding experiences of their mothers. METHOD: Data were collected between 2005 and 2007. In-depth interviews were conducted during home visits with 31 mothers who breastfed their very low birth weight babies. Following her baby's discharge from hospital, each mother was interviewed twice about her breastfeeding experience. The data were analysed using qualitative content analysis. FINDINGS: Five themes were identified from the mothers' reports: wanting to compensate, maintaining motivation and connectedness, needing 'extra helping hands', controlling emotions and matching baby's individual pace. Mothers' self-blaming provoked them to breastfeed their very low birth weight babies to compensate babies for the harm caused by them. These mothers learned how to express breast milk and this served as an important vehicle that gradually connected them to their babies. CONCLUSION: Breastfeeding a very low birth weight baby is a challenging and exhausting experience for the mother. A better teaching protocol for breastfeeding and an improved breastfeeding ethos need to be implemented in the neonatal intensive care unit and special care nursery to support families of very low birth weight infants.

Evaluating the effects of an Internet education programme on newborn care in Taiwan.

AIM: The objectives of this study were to evaluate an Internet education programme provided to primigravida in the third trimester of pregnancy with the aim of enhancing mothers' knowledge about newborn care and increasing their maternal confidence. BACKGROUND: Shorter hospital stays have had an impact on the traditional role of mother-baby nurses in providing education about parenting to their parturient women. Internet education is an efficient way to provide nursing instruction. DESIGN: A randomised controlled trial was used. A total of 118 women receiving prenatal care in a hospital clinic who met study criteria and who consented were assigned randomly to intervention and control groups. The study was conducted at a hospital in Taiwan. METHODS: The target population was women at 32-34 weeks gestation, using the Internet on a regular basis. The primigravida were randomly assigned to either the control group (n = 57) or the experimental group (n = 61). Two primary outcome measures were newborn-care knowledge and maternal confidence. RESULTS: The changes in newborn-care knowledge were 7.21 for the experimental group, compared with 1.95 for the control group; the difference between the least-squares means computed by ancova was 5.73 and statistically significant (p < 0.001). The changes in maternal confidence were 8.46 for the experimental group and 3.05 for the control group; the difference between the least-squares means computed by ancova was 5.94 and statistically significant (p < 0.001). CONCLUSION: Results suggest that Internet education about newborn care may contribute to greater care knowledge and maternal confidence. Relevance to clinical practice. Internet newborn-care education programmes can achieve success in promoting newborn care and provide health professionals with evidence-based intervention.