Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial.

BACKGROUND: Infants with latch-on problems cause stress for parents and staff, often resulting in early termination of breastfeeding. Healthy newborns experiencing skin-to-skin contact at birth are pre-programmed to find the mother's breast. This study investigates if skin-to-skin contact between mothers with older infants having severe latching on problems would resolve the problem. METHODS: Mother-infant pairs with severe latch-on problems, that were not resolved during screening procedures at two maternity hospitals in Stockholm 1998-2004, were randomly assigned to skin-to-skin contact (experimental group) or not (control group) during breastfeeding. Breastfeeding counseling was given to both groups according to a standard model. Participants were unaware of their treatment group. Objectives were to compare treatment groups concerning the proportion of infants regularly latching on, the time from intervention to regular latching on and maternal emotions and pain before and during breastfeeding. RESULTS: On hundred and three mother-infant pairs with severe latch-on problems 1-16 weeks postpartum were randomly assigned and analyzed. There was no significant difference between the groups in the proportion of infants starting regular latching-on (75% experimental group, vs. 86% control group). Experimental group infants, who latched on, had a significantly shorter median time from start of intervention to regular latching on than control infants, 2.0 weeks (Q1 = 1.0, Q3 = 3.7) vs. 4.7 weeks (Q1 = 2.0, Q3 = 8.0), (p-value = 0.020). However, more infants in the experimental group (94%), with a history of "strong reaction" during "hands-on latch intervention", latched-on within 3 weeks compared to 33% in the control infants (Fisher Exact test p-value = 0.0001). Mothers in the experimental group (n = 53) had a more positive breastfeeding experience according to the Breastfeeding Emotional Scale during the intervention than mothers in the control group (n = 50) (p-value = 0.022). CONCLUSIONS: Skin-to-skin contact during breastfeeding seems to immediately enhance maternal positive feelings and shorten the time it takes to resolve severe latch-on problems in the infants who started to latch. An underlying mechanism may be that skin-to-skin contact with the mother during breastfeeding may calm infants with earlier strong reaction to "hands on latch intervention" and relieve the stress which may have blocked the infant's inborn biological program to find the breast and latch on. TRIAL REGISTRATION: Karolinska Clinical Trial Registration number CT20100055.

Influence of skin-to-skin contact and rooming-in on early mother-infant interaction: a randomized controlled trial.

The objective of this research was to study influence of birth routines on mother-infant interaction at Day 4. The present research is part of a longitudinal study where mother-infant pairs were randomized by infant location and apparel. We intended to assess mother-infant interaction from videos filmed at Day 4. A protocol for the assessment/coding of the affective quality of maternal behaviors indicative of early mother-infant interaction was developed and interculturally validated. Results were compared with birth randomization, as to explain impact of birth practices. Findings indicate that separation and swaddling at birth interfered with mother-infant interaction during a breastfeeding session at Day 4; these mothers significantly demonstrated more roughness in their behaviors with their infants at Day 4. Results also show evidences of a sensitive period for separation after birth. Implications are to encourage immediate and uninterrupted skin-to-skin contact at birth, and rooming-in during postpartum, as recommended in World Health Organization/UNICEF Ten Steps for Successful Breastfeeding.

Early contact versus separation: effects on mother-infant interaction one year later.

BACKGROUND: A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation. METHODS: A total of 176 mother-infant pairs were randomized into four experimental groups: Group I infants were placed skin-to-skin with their mothers after birth, and had rooming-in while in the maternity ward. Group II infants were dressed and placed in their mothers' arms after birth, and roomed-in with their mothers in the maternity ward. Group III infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group IV infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or dressed in baby clothes. Episodes of early suckling in the delivery ward were noted. The mother-infant interaction was videotaped according to the Parent-Child Early Relational Assessment (PCERA) 1 year after birth. RESULTS: The practice of skin-to-skin contact, early suckling, or both during the first 2 hours after birth when compared with separation between the mothers and their infants positively affected the PCERA variables maternal sensitivity, infant's self-regulation, and dyadic mutuality and reciprocity at 1 year after birth. The negative effect of a 2-hour separation after birth was not compensated for by the practice of rooming-in. These findings support the presence of a period after birth (the early "sensitive period") during which close contact between mother and infant may induce long-term positive effect on mother-infant interaction. In addition, swaddling of the infant was found to decrease the mother's responsiveness to the infant, her ability for positive affective involvement with the infant, and the mutuality and reciprocity in the dyad. CONCLUSIONS: Skin-to-skin contact, for 25 to 120 minutes after birth, early suckling, or both positively influenced mother-infant interaction 1 year later when compared with routines involving separation of mother and infant.

Maternal axillar and breast temperature after giving birth: effects of delivery ward practices and relation to infant temperature.

BACKGROUND: Little is known about the development and control of skin temperature in human mothers after birth. The purpose of this study was to explore the effects of delivery ward practices and early suckling on maternal axillar and breast temperatures during the first 2 hours postpartum and to relate them to the infant's foot and axillar temperatures. METHODS: Three groups of 176 mother-infant pairs were randomized as follows--group I: infants lying prone in skin-to-skin contact on their mother's chest, named the "skin-to-skin group" (n = 44), group II: infants who were dressed and lying prone on their mother's chest, named the "mother's arms group" (n = 44), and group III: infants who were dressed and kept in the nursery, named the "nursery group" (n = 88). Maternal axillar and breast temperatures and infants' axillar and foot temperatures were measured at 15-minute intervals from 30 to 120 minutes after birth. Episodes of early suckling were noted. RESULTS: The axillar and breast temperatures rose significantly in all mothers. The rise of temperature over time was significantly higher in multiparas than in primiparas but was influenced only slightly by group assignment. The variation in breast temperature was highest in mothers in the skin-to-skin group and lowest in mothers in the nursery group. In the mother's arms group, variation in breast temperature was larger in those mothers exposed to early suckling than in those not exposed. A positive relationship was found between the maternal axillar temperature and the infant foot and axillar temperature 90 minutes after the start of the experiment (120 min after birth) in the skin-to-skin and mother's arms groups. The rise in temperature in the infant's foot was nearly twice that in the axilla. No such relationship was established in the nursery group. In addition, foot temperature in infants from the skin-to-skin group was nearly 2 degrees C higher than that in infants from the mother's arms group. CONCLUSIONS: Maternal temperature rose after birth, and the rise was higher in multiparas than in primiparas. Skin-to-skin contact and early suckling increased temperature variation. Maternal temperature was related to infant foot and axillar temperatures.

Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg.

BACKGROUND: There are not many studies exploring parity differences in early lactation performance and the results obtained are fairly often contradictory. The present study investigated the effect of different maternity home practices in St. Petersburg, Russia, as well as of physiological breast engorgement and maternal mood, on milk production in primi- and multiparous women on day four. The amount of milk was studied in relation to the duration of "nearly exclusive" breastfeeding. METHODS: 176 mother-infant pairs were randomised into four groups according to an experimental two-factor design taking into account infant location and apparel. Data were recorded in the delivery ward at 25-120 minutes postpartum and later in the maternity ward. Group I infants (n = 37) were placed skin-to-skin in the delivery ward while Group II infants (n = 40) were dressed and placed in their mother's arms. Both groups later roomed-in in the maternity ward. These infants had the possibility of early suckling during two hours postpartum. Group III infants (n = 38) were kept in a cot in the delivery and maternity ward nurseries with no rooming-in. Group IV infants (n = 38) were kept in a cot in a delivery ward nursery and later roomed-in in the maternity ward. Equal numbers per group were either swaddled or clothed. Episodes of early suckling were noted. Number of breastfeeds, amount of milk ingested (recorded on day 4 postpartum) and duration of "nearly exclusive" breastfeeding were recorded. Intensity of breast engorgement was recorded and a Visual Analogue Scale measured daily maternal feelings of being "low/blue". RESULTS: On day four, multiparas had lower milk production than primiparas when they were separated from their infants and breastfeeding according to the prescriptive schedule (7 times a day; Group III). In contrast, there was no difference in milk production between multi- and primiparous mothers in the groups rooming-in and feeding on demand (Groups I, II and IV), although multiparas had higher numbers of feedings than primiparas. In addition during the first three days postpartum, multiparous mothers had higher perception of physiological breast engorgement and lower intensity of feeling "low/blue" than primiparous mothers. Early suckling was shown to positively affect milk production irrespective of parity. Thus Group I and II infants who suckled within the first two hours after birth ingested significantly more milk on day 4 than those who had not (284 and 184 ml respectively, SE = 14 and 27 ml, p = 0.0006).Regression analyses evaluated factors most important for milk production and found in Groups I and II for primiparous women that early suckling, intensity of breast engorgement and number of breastfeeds on day 3 were most important. Intensity of feeling "low/blue" was negatively related to amount of milk ingested. The significant factor for multiparous women was early suckling. Similar results were obtained in Groups III and IV; however, in primiparous mothers, engorgement was the most important factor and in multiparous women it was rooming-in. Amount of milk produced on day 4 was strongly correlated to a duration of "nearly exclusive" breastfeeding (p < 0.0001). CONCLUSION: The present data show that ward routines influence milk production. As our data suggest that milk production in primi- and multiparous women may be differently influenced or regulated by complex factors, further research is needed.

Breastfeeding attitudes among counselling health professionals.

AIM: The aim of the study was to develop an instrument that can be used for accurate assessment of nurses' and midwives' attitudes toward breastfeeding in a group of midwives, maternity-nursing staff and postnatal nurses experienced in breastfeeding counselling. METHOD: An instrument based on WHO standards was developed to measure breastfeeding attitudes. In all, 168 healthcare professionals filled in the instrument. A factor analysis using maximum likelihood and varimax rotation was performed. Spearman's correlation was used to correlate factorial dimensions and self-described interest in breastfeeding. RESULTS: By means of factor analysis four factors were identified: the "regulating" factor focused on regulating the mothers' breastfeeding management, the "facilitating" factor focused on making it easy for mothers to manage their breastfeeding, the "disempowering" factor focused on giving advice, disregarding the needs of the mother being counselled, and the "breastfeeding antipathy" factor focused on insufficient, basic, breastfeeding knowledge and aversive reactions to breastfeeding. Midwives rated higher on the facilitating factor and breastfeeding antipathy factor and lower on the regulating factor than postnatal nurses. Breastfeeding interest was positively correlated with the facilitating factor, and negatively with the disempowering factor and the breastfeeding antipathy factor. CONCLUSION: This instrument provides a picture of health professionals' attitudes towards breastfeeding. Four factors were identified in order of importance: regulating, facilitating, disempowering, and breastfeeding antipathy factors. Harmful attitudes were identified and suggested a need for educational programmes to help health professionals to reconcile damaging values, in order to improve breastfeeding counselling.

Night rooming-in: who decides? An example of staff influence on mother's attitude.

BACKGROUND: In 1989 the World Health Organization and UNICEF introduced the "Ten Steps" for successful breastfeeding. One step suggests that a mother and her newborn baby should remain together day and night during the hospital stay. The purpose of this study was to investigate, first, whether or not mothers in our hospital roomed-in with their babies at night, second, the attitudes of mothers toward night rooming-in and their feelings of closeness to their babies, and third, how mothers perceived hospital staff attitudes toward night rooming-in. METHODS: All mothers ( n = 132) of Nordic ancestry and with good knowledge of the Swedish language, who were admitted to the maternity wards during a 2-week period at Karolinska University Hospital, Stockholm, Sweden, answered a questionnaire on demographic background data and their current night rooming-in practices, including an attitude scale. RESULTS: Most study mothers were positive toward night rooming-in, regardless of whether they had roomed in with their babies at night (93% positive) or not (73% positive). Mothers who had not roomed-in with their babies were more likely to perceive that the staff believed their babies should stay in the nursery compared with those mothers who practiced night rooming-in (z = -2.733, p = 0.006). Mothers not rooming-in with their babies scored closeness to their babies as less important than those mothers who roomed-in with their babies (z = -3.780, p = 0.0002); they also were more worried about their own and their babies' sleep (z = -2.321, p = 0.02) and disturbing noises (z = -3.487, p = 0.0005). CONCLUSIONS: Mothers who left their babies in the nursery at night more often perceived that the staff believed their babies should stay in the nursery, rating closeness between mother and infant lower. Hence, negative staff attitudes toward night rooming-in may implicitly suggest to mothers that closeness between mothers and babies is not important.

Personality factors and emotional responses to pregnancy among IVF couples in early pregnancy: a comparative study.

BACKGROUND: Little is known as to whether negative experiences associated with infertility and IVF treatment persist after successful treatment. The aim of the study was to compare couples who have conceived after IVF and couples who have conceived naturally regarding personality factors and emotional responses to pregnancy. METHODS: Fifty-seven women pregnant after IVF and 55 male partners and 43 women who had conceived naturally and 39 male partners were recruited from university IVF clinics and antenatal clinics in Stockholm. The subjects were interviewed about their socio-demographic background. They completed scales of personality traits, anxiety, emotional responses to pregnancy, marital adjustment and reactions to recalled infertility while in pregnancy week 13 (range 11-17). RESULTS: The results showed that the IVF women had more muscular tension and were more anxious about loosing the pregnancy than the control women. The IVF women with high infertility distress were more anxious about loosing the pregnancy and less ambivalent than the women with lower distress. The IVF men had more somatic anxiety, indirect aggression, guilt, and were more detached and more anxious about loosing the pregnancy and less ambivalent than the control men. The IVF men with high infertility distress were more anxious about the baby not being normal than the men with lower infertility distress. CONCLUSIONS: The women and men who had conceived after IVF differed on a number of personality dimensions and emotional responses to the pregnancy from that of the women and the men who had conceived naturally. The results suggest that IVF couples may need additional emotional support in early pregnancy.