Exclusive Breastfeeding, 24-Hour Rooming-In, and the Importance of Women's Informed Choices.

OBJECTIVE: To measure the relationship between exclusive breastfeeding and 24-hour rooming-in for low-risk primiparous women with uncomplicated vaginal births at term. DESIGN: Descriptive correlational design with a qualitative component. SETTING: The Labor & Delivery and Mother/Baby units of a community hospital with more than 2,300 births annually. PARTICIPANTS: A convenience sample of 89 women. INTERVENTION/MEASUREMENTS: Participants completed a demographic questionnaire, the Iowa Infant Feeding Attitude Scale, which measures attitudes toward breastfeeding, and a four-item questionnaire at 2, 6, and 12 weeks postpartum to assess breastfeeding status. RESULTS: Iowa Infant Feeding Attitude Scale scores suggest that most of the sample had positive attitudes toward breastfeeding. The average separation time for women and newborns was 3 hours 40 minutes. No statistically significant differences were found regarding maternal attitudes toward breastfeeding or mother-newborn separation during the postpartum period between newborns who were exclusively breastfeeding or formula-feeding at 12 weeks. CONCLUSION: Success with exclusive breastfeeding in the immediate postpartum period is not necessarily dependent on 24-hour rooming in, and it is important for women to have the ability to make informed choices regarding newborn separation in the hospital.

Percepções de puérperas acerca do cuidado de enfermagem recebido no pós-parto imediato / Perceptions of puerperas about nursing care received in the immediate post-breastfeeding / Percepciones de puerperas acerca del cuidado de enfermería recibido en lo post-parto inmediato

Objetivo: Conhecer as percepções de puérperas acerca do cuidado de enfermagem durante o pós-parto imediato. Métodos: Estudo descritivo, qualitativo, realizado no alojamento conjunto de um hospital público de Fortaleza-CE de junho a agosto de 2013. Participaram 25 puérperas por meio de entrevista semiestruturada. Da análise de conteúdo dos dados emergiram duas categorias. O estudo foi aprovado com o parecer n.314.363. Resultados: Os cuidados de enfermagem apresentaram conotações positivas e negativas, sendo as primeiras salientadas pelas puérperas e traduzidas pelo reforço à autonomia no cuidado de si e do bebê. Como ponto negativo, salientou-se a estrutura precária do alojamento conjunto. Conclusão: Apesar do cuidado de enfermagem ter sido considerado satisfatório, observa-se a necessidade de mudanças na assistência e estrutura/ organização do serviço, para que seja possível prestar um cuidado integral às puérperas e bebês

Objective: To understand the perceptions of mothers about the nursing care during immediate postpartum period. Methods: Descriptive and qualitative study developed in a rooming-in care of a public hospital in Fortaleza/CE from June to August 2013. 25 mothers participated through semi-structured interview. From the content analysis of the datarevealed two categories. The study was approved opinion n 314363. Results: Nursing care had positive and negative connotations, the first one highlighted by the women and translated by the autonomy reinforcement in self-care and baby care. The precarious structure of the rooming-in care was cited as a negative aspect.Conclusion: Despite the nursing care was considered satisfactory, changes in the care management and structure/organization of the service are necessary. So, it will be possible to provide an integral for mothers and babies

Objetivo: Conocerlas percepciones de madres sobre cuidados de enfermeríaen el postparto inmediato.Métodos:Estudio cualitativo,descriptivo, desarollado enel alojamiento conjuntode un hospital públicoenFortaleza/CE, de junio a agosto de 2013.Participó25madres através deentrevista semiestructurada.El análisis de contenido de los datosemergieron dos categorías. El estudio fue aprobado con la opinión Nº 314.363. Resultado: Cuidados de enfermeríateníaconnotaciones positivas y negativas, laprimerade relieve porlasmujeresy traducido porel fortalecimiento de laautonomía enel cuidado personaly el bebé. El lado negativodestacó laestructuraprecaria delalojamiento conjunto. Conclusión:Aunquelos cuidados de enfermeríase consideró satisfactoria, existe la necesidad de cambios enel cuidado y laestructura/organización del servicio. Así, se puede proporcionar unaatención integralpara las madresy los bebés

Rooming-in Reduces Salivary Cortisol Level of Newborn.

BACKGROUND: Rooming-in practice improves breastfeeding and reduces newborn stress reactivity. When this modality is not available, partial rooming-in after birth can be considered. Salivary cortisol levels (SCLs) are considered reliable biomarkers to indicate stress. OBJECTIVE: To test the hypothesis that rooming-in duration impacts neonatal stress response in hospitalized newborns. DESIGN/METHODS: Forty term newborns, enrolled in the Neonatology and Obstetrics Nursing, C.G. Ruesch, Naples, Italy, were divided, according to the mother's choice, into the study (SG; n = 20) and control (CG; n = 20) groups if they received full (24 hs) or partial (14 hs) rooming-in care, respectively. Saliva samples were collected from all babies between 7:00 a.m. and 8:00 a.m. of the 3rd day of life by using oral swab. Salivary cortisol levels were measured using an enzyme immunoassay kit (Salimetrics LLC, PA, USA). RESULTS: A statistically significant difference in the SCLs between SG and CG was found (median: 258 ng/dl versus 488.5 ng/dl; p = 0.048). CONCLUSIONS: Data support the practice of full rooming-in care compared with partial rooming-in. The rooming-in duration clearly reduces SCLs and likely neonatal stress. These lower SCLs may have long-term positive effects reducing the risk of metabolic syndrome, high blood pressure, and cognitive and behavioural changes.

Nonopioid Management of Neonatal Abstinence Syndrome.

BACKGROUND: Current standard therapy for moderate to severe neonatal abstinence syndrome (NAS) includes opioid administration and often results in separation of mother and infant. Impaired maternal-infant bonding and extended neonatal opiate exposure may be associated with adverse developmental outcomes. Increased use of nonopioid adjunctive NAS therapies may decrease postnatal opioid exposure and length of stay (LOS), thereby promoting positive developmental outcomes for NAS-affected infants. PURPOSE: To review the efficacy of rooming-in care and acupuncture as nonpharmacologic adjunctive agents to reduce the magnitude of postnatal opioid exposure and LOS. METHODS: PubMed, Ovid Medline, Embase, and CINAHL databases were searched for primary studies on rooming-in care and acupuncture as adjunctive treatments for NAS; 8 are included in this review. FINDINGS: Rooming-in care may decrease postnatal opioid exposure and LOS in NAS-affected infants. Acupuncture is safe in NAS patients; however, its definitive effect on narcotic use and length of hospitalization are inconclusive. IMPLICATIONS FOR PRACTICE: Rooming-in care should be offered to NAS patients. Strong evidence does not exist to recommend acupuncture as a routine NAS treatment. IMPLICATIONS FOR RESEARCH: Additional randomized clinical trials are necessary to assess the efficacy of acupuncture and to confirm the effect of rooming-in care on NAS outcomes, and delineate optimal elements of a rooming-in care model.

Rooming-in for new mother and infant versus separate care for increasing the duration of breastfeeding.

BACKGROUND: Mother-infant proximity and interactions after birth and during the early postpartum period are important for breast-milk production and breastfeeding success. Rooming-in and separate care are both traditional practices. Rooming-in involves keeping the mother and the baby together in the same room after birth for the duration of hospitalisation, whereas separate care is keeping the baby in the hospital nursery and the baby is either brought to the mother for breastfeeding or she walks to the nursery. OBJECTIVES: To assess the effect of mother-infant rooming-in versus separation on the duration of breastfeeding (exclusive and total duration of breastfeeding). SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2016) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs) investigating the effect of mother-infant rooming-in versus separate care after hospital birth or at home on the duration of breastfeeding, proportion of breastfeeding at six months and adverse neonatal and maternal outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion and assessed trial quality. Two review authors extracted data. Data were checked for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We included one trial (involving 176 women) in this review. This trial included four groups with a factorial design. The factorial design took into account two factors, i.e. infant location in relation to the mother and the type of infant apparel. We combined three of the groups as the intervention (rooming-in) group and the fourth group acted as the control (separate care) and we analysed the results as a single pair-wise comparison. Primary outcomesThe primary outcome, duration of any breastfeeding, was reported by authors as median values because the distribution was found to be skewed. They reported the overall median duration of any breastfeeding to be four months, with no difference found between groups. Duration of exclusive breastfeeding and the proportion of infants being exclusively breastfed at six months of age was not reported in the trial. There was no difference found between the two groups in the proportion of infants receiving any breastfeeding at six months of age (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.51 to 1.39; one trial; 137 women; low-quality evidence). Secondary outcomesThe mean frequency of breastfeeds per day on day four postpartum for the rooming-in group was 8.3 (standard deviation (SD) 2.2), slightly higher than the separate care group, i.e. seven times per day. However, between-group comparison of this outcome was not appropriate since every infant in the separate care group was breastfed at a fixed schedule of seven times per day (SD = 0) resulting in no estimable comparison. The rate of exclusive breastfeeding on day four postpartum before discharge from hospital was significantly higher in the rooming-in group 86% (99 of 115) compared with separate care group, 45% (17 of 38), (RR 1.92; 95% CI 1.34 to 2.76; one trial, 153 women; low-quality evidence). None of our other pre-specified secondary outcomes were reported. AUTHORS' CONCLUSIONS: We found little evidence to support or refute the practice of rooming-in versus mother-infant separation. Further well-designed RCTs to investigate full mother-infant rooming-in versus partial rooming-in or separate care including all important outcomes are needed.

Rooming-in for Infants at Risk of Neonatal Abstinence Syndrome.

OBJECTIVE: To examine the impact of a rooming-in program for infants at risk of neonatal abstinence syndrome (NAS) on the need for pharmacologic treatment and length of hospitalization. STUDY DESIGN: Our hospital implemented a rooming-in program for newborns at risk of NAS in June 2013. Previously, standard care was to admit these infants to the neonatal intensive care unit. Charts were reviewed to abstract data on at-risk infants born in the 13-month periods prior and subsequent to implementation of rooming-in (n = 24 and n = 20, respectively) and the groups were compared with the outcomes of interest. RESULT: Rooming-in was associated with a reduced need for pharmacologic treatment and shorter length of stay. CONCLUSION: These findings add to an emerging body of evidence on the health care resource utilization benefits associated with rooming-in for infants at risk of NAS. Future studies should evaluate a broader range of outcomes for this model of care.

Separate care for new mother and infant versus rooming-in for increasing the duration of breastfeeding.

BACKGROUND: Separate care for a new mother and infant may affect the duration of breastfeeding, breastfeeding behaviour and may have an adverse effect on neonatal and maternal outcomes. OBJECTIVES: To assess the effect of mother-infant separation versus rooming-in on the duration of breastfeeding (exclusive and total duration of breastfeeding). SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2012). SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs) investigating the effect of separate mother-infant care versus rooming-in after hospital birth or at home on the duration of breastfeeding, proportion of breastfeeding at six months and adverse neonatal and maternal outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion and assessed trial quality. Two review authors extracted data. Data were checked for accuracy. MAIN RESULTS: There were 23 reports from 19 potential trials identified. After assessment, one trial (involving 176 women) met our inclusion criteria.One trial reported an overall median duration of any breastfeeding of four months. Exclusive breastfeeding before discharge from hospital (at day four postpartum) was significantly lower in the separate care group compared with the rooming-in group (risk ratio (RR) 0.58; 95% CI 0.42 to 0.81; one trial, 141 women).  AUTHORS' CONCLUSIONS: We found little evidence to support or refute the practice of mother-infant separation versus rooming-in. Therefore, we see no reason to practise it. We recommend a well designed RCT to investigate full mother-infant rooming-in versus partial rooming-in or separate care on all of the primary and secondary outcomes suggested.

Postnatal unit bassinet types when rooming-in after cesarean birth: implications for breastfeeding and infant safety.

BACKGROUND: Postnatal unit rooming-in promotes breastfeeding. Previous research indicates that side-cars (3-sided bassinets that lock onto the maternal bed frame) facilitate breastfeeding after vaginal birth more than stand-alone bassinets (standard rooming-in). No study has previously investigated side-car bassinet use after cesarean, despite the constraints on maternal-infant interactions that are inherent in recovery from this birth mode. OBJECTIVE: To test the effect of the side-car bassinet on postnatal unit breastfeeding frequency and other maternal-infant behaviors compared to a stand-alone bassinet following cesarean birth. METHODS: Participants were recruited and prenatally randomized to receive the side-car or stand-alone bassinet for their postnatal unit stay between January 2007 and March 2009 in northeastern England. Mother-infant interactions were filmed over the second postpartum night. Participants completed face-to-face interviews before and after filming. The main outcome measures were infant location, bassinet acceptability, and breastfeeding frequency. Other outcomes assessed were breastfeeding effort, maternal-infant contact, sleep states, midwife presence, and infant risk. RESULTS: Differences in breastfeeding frequency, maternal-infant sleep overlap, and midwife presence were not statistically significant. The 20 dyads allocated to side-car bassinets breastfed a median of 0.6 bouts/ hour compared to 0.4 bouts/hour for the 15 stand-alone bassinet dyads. Participants expressed overwhelming preference for the side-car bassinets. Bed sharing was equivalent between the groups, although the motivation for this practice may have differed. Infant handling was compromised with stand-alone bassinet use, including infants positioned on pillows while bed sharing with their sleeping mothers. CONCLUSIONS: Women preferred the side-car, but differences in breastfeeding frequency were not statistically significant. More infant risks were observed with stand-alone bassinet use.

[Influence of hospital location on short-term fate of premature infants born at 34 weeks of gestation]. / Influence du lieu d'hospitalisation sur le devenir à court terme des prématurés nés à 34 semaines d'aménorrhée.

In France, new care units have emerged in maternity wards for the treatment of moderate prematurity, called mother-child units (MCU). We compared the length of hospitalization between the MCUs and the neonatal units (NNUs) for premature infants born at 34 weeks of amenorrhea at Grenoble university hospital. This was a retrospective, single-center study, including 99 premature infants born from 34 of amenorrhea to 34 weeks+6 days between 2004 and 2009. Were included all premature 34-week infants hospitalized in the NNU or the MCU excluding those with respiratory distress, birth defects, and including infants whose birth weight was less than 1500g admitted to the neonatal intensive care unit or transferred secondarily to the MCU. The characteristics of both groups were similar apart from a lower birth weight in the NNU group (1892 vs. 2182g) and gestational age less than in the NNU group (34.1 vs. 34.3 SA). Our primary outcome, length of hospital stay, was significantly shorter in the MCU (15.4 vs. 20.7 days in the NNU, P<0.01) as well as the duration of nasogastric tube feeding (2.8 vs. 9.1 days, P<0.01). This difference remained after adjustment for birth weight and gestational age. Our retrospective study shows that the length of hospitalization of premature infants born at 34 weeks gestation and hospitalized in our center is significantly shorter when they are admitted to the MCU rather than neonatology. For this reason, this mode of hospitalization in maternity MCUs can be recommended.

Evidence-based delivery room care of the very low birth weight infant.

The first hour of a newborn's life is fraught with difficulty. Recommendations regarding the fundamental issues of resuscitation of these infants are developed and disseminated by the International Liaison Committee on Resuscitation and other organizations. However, these recommendations frequently do not address the needs of the very low birth weight infant and do not address some of the nuances that might lead to improved outcome. Improved organization and teamwork as well as improved monitoring and respiratory support can potentially improve the outcome of these infants.

Randomised trial of sidecar crib use on breastfeeding duration (NECOT).

OBJECTIVE: To determine whether the use of sidecar cribs on the postnatal ward affects breastfeeding duration. DESIGN: A randomised non-blinded parallel trial comparing sidecar cribs with standalone cots. SETTING: Postnatal wards of the Royal Victoria Infirmary, Newcastle upon Tyne. PARTICIPANTS: 1204 pregnant women intending to breastfeed were recruited at 20 weeks' gestation and randomised at 34 weeks to use either a sidecar crib attached to their bed (n=601) or a standalone cot adjacent to their bed (n=603). MAIN OUTCOME MEASURES: Duration of any, and exclusive, breastfeeding up to 26 weeks obtained by telephone follow-up. RESULTS: 334 mothers were withdrawn or lost to follow-up from the trial; infant feeding data were therefore obtained for 870 mothers (433 intervention; 437 controls). Using an intention-to-treat Cox regression analysis, no significant difference was found between the two groups for duration of any breastfeeding (sidecar crib vs cot, hazard ratio (HR) 0.96, 95% CI 0.79 to 1.18), or exclusive breastfeeding (HR 0.99, 95% CI 0.85 to 1.16) adjusting for maternal age, education, previous breastfeeding and delivery type. Bed sharing was not significantly more common in mothers randomised to sidecar cribs (67% vs 64%, adjusted difference 2.8%, 95% CI -3.5% to 9.0%). There were no adverse events. CONCLUSION: The use of sidecar cribs for mothers and infants did not improve the duration of any or exclusive breastfeeding, or frequency of bed sharing at home.

Can modifications to the bedroom environment improve the sleep of new parents? Two randomized controlled trials.

Postpartum sleep disruption is common among new parents. In this randomized controlled trial we evaluated a modified sleep hygiene intervention for new parents (infant proximity, noise masking, and dim lighting) in anticipation of night-time infant care. Two samples of new mothers (n = 118 and 122) were randomized to the experimental intervention or attention control, and sleep was assessed in late pregnancy and first 3 months postpartum using actigraphy and the General Sleep Disturbance Scale. The sleep hygiene strategies evaluated did not benefit the more socioeconomically advantaged women or their partners in Sample 1, but did improve postpartum sleep among the less advantaged women of Sample 2. Simple changes to the bedroom environment can improve sleep for new mothers with few resources.

Diabetic mothers and their newborn infants - rooming-in and neonatal morbidity.

AIM: As a result of increased neonatal morbidity, the infants of diabetic mothers have routinely been admitted to a neonatal special care unit (NSCU). We therefore investigated whether the offer of rooming-in diabetic mothers and their newborn infants has an effect on neonatal morbidity. METHODS: The records of an old cohort of 103 infants routinely admitted to the NSCU, and a new cohort (N = 102), offered rooming-in were assessed for neonatal morbidity. RESULTS: Eighty-four (82%) of the new cohort infants followed their mothers to the maternity ward; whereas 19 (18%) were transferred to the NSCU chiefly because of prematurity. Ten infants were later transferred to the NSCU for minor problems. Neonatal morbidity and neonatal hypoglycaemia were significantly less common in the new cohort than in the old cohort [27 (26%) vs. 55 (54%), p < 0.001 and 42 (41%) vs. 64 (63%), p = 0.0027 respectively]. Maternal HbA1c in late pregnancy was significantly lower in the new cohort, but the only independent predictors of neonatal morbidity were belonging to the old cohort and preterm delivery. CONCLUSION: Neonatal care with rooming-in mothers with type 1 diabetes and their newborn infants seems safe and is associated with reduced neonatal morbidity, when compared with routine separation of infants from their mothers.

Epidemiology of co-sleeping and nighttime waking at 12 months in a birth cohort.

OBJECTIVE: To investigate the prevalence and factors associated with co-sleeping and nighttime waking among the children of the Pelotas 2004 cohort at 12 months of age. METHODS: All children born in the city of Pelotas, RS, Brazil during 2004 were enrolled on a longitudinal study. Mothers were interviewed at delivery and once more at 12 months of age to obtain information on their sociodemographic and reproductive characteristics and on their children's sleep and the environment in which their children sleep. Co-sleeping was defined as habitually sharing the bed with another person. Multivariate analysis was performed using Poisson regression. RESULTS: The prevalence of co-sleeping at 12 months was 45.8% (95%CI 44.2-47.3). Co-sleeping was more common among mothers with low socioeconomic status, less education, younger mothers, mothers with more previous births and among children who wake at night. The prevalence of nighttime waking was 46.1% (95%CI 44.6-47.7). Nighttime waking was more common among boys and among the offspring of mothers who had had a greater number of previous pregnancies and of mothers who had been employed while pregnant. CONCLUSION: Co-sleeping and nighttime waking are common among this study population, indicating a need to continue follow-up in order to observe how long these habits persist through childhood and to investigate their consequences for child development and behavior.

Epidemiologia do co-leito e do despertar noturno aos 12 meses de idade em uma coorte de nascimentos / Epidemiology of co-sleeping and nighttime waking at 12 months in a birth cohort

OBJETIVO: Investigar a prevalência e os fatores associados ao co-leito e ao despertar noturno entre as crianças da coorte de Pelotas de 2004, aos 12 meses de idade. MÉTODOS: Todas as crianças nascidas em 2004 em Pelotas (RS) foram incluídas em um estudo longitudinal. Ao nascer e aos 12 meses de idade, as mães foram entrevistadas sobre características sociodemográficas e reprodutivas e sobre o sono e o ambiente em que a criança dorme. Co-leito foi definido como o compartilhamento habitual da cama com outra pessoa. As análises multivariáveis foram realizadas por regressão de Poisson. RESULTADOS: A prevalência de co-leito aos 12 meses foi de 45,8 por cento (IC95 por cento 44,2-47,3). O co-leito foi maior entre as mães de baixo nível socioeconômico, menos escolarizadas, mais jovens, com maior paridade e entre crianças que acordam à noite. A prevalência de despertar noturno foi de 46,1 por cento (IC95 por cento 44,6-47,7). O despertar noturno foi mais freqüente entre os meninos e entre filhos de mães com maior paridade, e menos freqüente entre mães que trabalharam fora durante a gravidez. CONCLUSÃO: O co-leito e o despertar noturno são freqüentes na população estudada, indicando a necessidade de acompanhamento para observar a persistência destes hábitos ao longo da infância e investigar suas conseqüências sobre o comportamento e o desenvolvimento infantis.

OBJECTIVE: To investigate the prevalence and factors associated with co-sleeping and nighttime waking among the children of the Pelotas 2004 cohort at 12 months of age. METHODS: All children born in the city of Pelotas, RS, Brazil during 2004 were enrolled on a longitudinal study. Mothers were interviewed at delivery and once more at 12 months of age to obtain information on their sociodemographic and reproductive characteristics and on their children's sleep and the environment in which their children sleep. Co-sleeping was defined as habitually sharing the bed with another person. Multivariate analysis was performed using Poisson regression. RESULTS: The prevalence of co-sleeping at 12 months was 45.8 percent (95 percentCI 44.2-47.3). Co-sleeping was more common among mothers with low socioeconomic status, less education, younger mothers, mothers with more previous births and among children who wake at night. The prevalence of nighttime waking was 46.1 percent (95 percentCI 44.6-47.7). Nighttime waking was more common among boys and among the offspring of mothers who had had a greater number of previous pregnancies and of mothers who had been employed while pregnant. CONCLUSION: Co-sleeping and nighttime waking are common among this study population, indicating a need to continue follow-up in order to observe how long these habits persist through childhood and to investigate their consequences for child development and behavior.

Information support concerning care of a baby provided for lying-in women during their stay in maternity ward in rooming-in system.

UNLABELLED: The aim of the study was to estimate the need for information support concerned with care of a baby and evaluation of lying-in women expectations referred to sources of support, methods and devices used during presentation. The research included 200 lying-in women hospitalized in Clinic of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin; there were separated the study group which consisted of primiparas (n=100) and reference group - multiparas (n=100). The applied method was medical history of a patient, and a research tool was author's questionnaire. The results show that primiparas noticeably more often than multiparas need information support related to care of umbilical stump (p < 0.001), bathing (p < 0.001), care of skin and mucous membranes (p < 0.001), management of regurgitation, management of colic (p < 0.001), signs of neonatal transient states, and checking for concern-raising signs (p < 0.001). Lying-in women much more often indicate a nurse/midwife and a doctor working in maternity ward as a source of information support, and considerably more often expect information to be provided in the form of training and chatty lecture with the use of brochures. CONCLUSIONS: (1) Primiparas require greater involvement of health professionals in providing information support and especially giving information on baby care. (2) A nurse/midwife and a doctor are these people in maternity ward who are particularly expected to provide information support for both primiparas and multiparas. (3) Different methods (training, chatty lecture) may be applied when information support is provided and the choice should correspond with patients' needs, goals and organizational possibilities. (4) Lying-in women expect various devices used for providing information support, but in most cases they are brochures with information on particular topics.