Randomized Controlled Trial of a Prenatal Breastfeeding Self-Efficacy Intervention in Primiparous Women in Iran.

OBJECTIVE: To determine the effects of a prenatal breastfeeding self-efficacy intervention on breastfeeding self-efficacy and breastfeeding outcomes. DESIGN: Randomized controlled trial. SETTING: Four health centers in Ahvaz, Iran. PARTICIPANTS: A total of 120 low-risk, nulliparous women between 35 and 37 weeks gestation who intended to breastfeed their singleton infants. METHODS: Women were randomly assigned to receive the breastfeeding self-efficacy intervention (n = 60) or standard care (n = 60). The intervention was multifaceted and included two prenatal group sessions, an information package with breastfeeding images, and text messages until 8 weeks postpartum to promote exclusive breastfeeding. The primary outcome was breastfeeding self-efficacy measured with the Breastfeeding Self-Efficacy Scale-Short Form, translated into Persian, at 8 weeks postpartum. Additional outcomes included rates of breastfeeding exclusivity, duration, practices, satisfaction, and problems. RESULTS: At 8 weeks postpartum, participants in the intervention group had significantly higher mean Breastfeeding Self-Efficacy Scale-Short Form scores and rates of exclusive breastfeeding than those in the control group. No significant group differences were found with regard to breastfeeding duration. CONCLUSION: Emerging evidence supports the use of breastfeeding self-efficacy interventions to improve breastfeeding self-efficacy and rates of exclusive breastfeeding. Further evaluation of this prenatal intervention is warranted.

Preceptorship in a Nurse Practitioner Program: The Student Perspective.

Preceptorship has been identified as an effective strategy for facilitating clinical learning among diverse health care professionals. The benefits of preceptored experiences are well documented; however, the preceptorship model is also vulnerable to challenges. There has been limited evaluation of preceptorship with nurse practitioner (NP) students. This article describes an evaluation of the preceptorship experience from the perspective of NP students. In particular, the facilitators and barriers to clinical learning are described.

Maternal Substance Use and Neonatal Abstinence Syndrome: A Descriptive Study.

Neonatal Abstinence Syndrome (NAS) is one of the primary negative effects of substance use during pregnancy. The exact statistics regarding NAS and substance use during pregnancy are difficult to determine due to underreporting, especially in the context of pregnancy. Similarly, little is known regarding whether the severity of NAS differs based on substance exposure. The purpose of this study was to evaluate the prevalence of NAS and types of substance use during pregnancy, and determine whether the presentation of NAS symptoms differ based on the type of substance. A retrospective chart review was conducted over a one year period at a tertiary care hospital. One hundred thirty-one mother-infant pairs met the inclusion criteria of documented NAS scores using the Modified Finnegan Scoring Tool and substance use during pregnancy. The results identified a high prevalence of NAS (8.7 %) primarily as a result of exposure to illicit opioids and/or to methadone as the treatment for opioid addiction. In addition, more than half the women on methadone maintenance treatment continued to use additional substances primarily opiates. Infants who were exposed to methadone experienced more severe NAS compared to infants not exposed to methadone including higher peak scores, prolonged NAS treatment, and length of stay. Given the severity of symptoms of the methadone exposed infants and the high rate of opioid use with methadone treatment, evidence-based interventions are required to decrease the negative effects of NAS.

Breastfeeding and Aboriginal women: validation of the Breastfeeding Self-Efficacy Scale-Short Form.

The purpose of this methodological investigation, part of a prospective cohort study, was to test the reliability and validity of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among Aboriginal women.The sample comprised 130 breastfeeding Aboriginal women from the postpartum ward of an urban tertiary care hospital or a rural community hospital.The women provided baseline information while in hospital and were telephoned at 4 and 8 weeks postpartum for assessment of their method of infant feeding. The BSES-SF was found to be a valid and reliable tool for assessing breastfeeding self-efficacy among Aboriginal women. Significant differences were found in BSES-SF in-hospital scores among women who at 4 weeks postpartum were exclusively breastfeeding, combination feeding, or solely feeding formula (F(2) = 7.31, p = 0.001).The authors conclude that Aboriginal women with low breastfeeding self-efficacy in the early postpartum period may be at risk for early cessation and could benefit from additional breastfeeding support.

The impact of infant feeding method on neonatal abstinence scores of methadone-exposed infants.

PURPOSE: To determine whether neonatal abstinence scores of infants exposed to methadone in utero differed by infant feeding method. DESIGN: A retrospective chart review. SUBJECTS: Twenty-eight term infants that were exposed to methadone in utero and exhibited symptoms of neonatal abstinence syndrome (NAS) prior to hospital discharge were included into the study. The sample was further divided by self-selected infant feeding method including (1) predominately breastfed (n = 8), combination fed (n = 11) or predominately formula fed (n = 9). METHODS: Data were extracted by two independent researchers from both the mother's and infant's chart. This included variables such as NAS scores, NAS treatment, infant feeding method and baseline demographic information. MAIN OUTCOME MEASURES: NAS scores were assessed by Registered Nurses according to hospital protocol using a Modified Finnegan Scoring Tool. PRINCIPAL RESULTS: A non-parametric Kruskal-Wallis one way analysis of variance based on ranks revealed statistically significant differences in the number of NAS scores recorded (P = 0.001), magnitude (P < 0.0001) and area score (P = 0.04) by infant feeding method. In particular, infants who were predominantly breastfed had significantly fewer NAS scores done and lower mean scores suggesting decreased severity and duration of NAS symptoms when compared to infants who were combination fed or predominately formula fed. CONCLUSION: Breastfeeding may offer enhanced benefits for infants who have been exposed to methadone in utero. As such, in the absence of contraindications, mothers in methadone maintenance programs should be encouraged and supported to breastfeed their infants.

A pilot randomized controlled trial of a breastfeeding self-efficacy intervention with primiparous mothers.

OBJECTIVES: To pilot test a newly developed breastfeeding self-efficacy intervention. DESIGN: Pilot randomized controlled trial (RCT). SETTING: An acute care hospital located in Northwestern Ontario that is the sole provider of maternity care for the city and referral center for the region. PARTICIPANTS: One-hundred-and-fifty primiparous women intending to breastfeed their healthy, term, singleton infant. INTERVENTION: A standardized, individualized nursing intervention protocol was designed and administered to increase mothers' breastfeeding self-efficacy. Participants were randomly allocated to the intervention group or control group using sealed, opaque envelopes. Participants in the intervention group received three individualized, self-efficacy enhancing sessions with the researcher: two in-hospital and one by telephone. Participants in the control group received standard in-hospital and community care. MAIN OUTCOME MEASURES: Feasibility, compliance, and the acceptability of the breastfeeding self-efficacy intervention. Other outcomes assessed were breastfeeding self-efficacy, duration, and exclusivity. RESULTS: Findings suggest that the intervention was feasible; there was a high degree of protocol compliance, and the majority of mothers reported that the intervention was beneficial. Mothers in the intervention group had higher rates of breastfeeding self-efficacy, duration, and exclusivity at 4 and 8 weeks postpartum. However, the differences between groups were not statistically significant. CONCLUSION: The pilot RCT provided valuable information in examining the feasibility of the trial design and intervention.