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1.
Reprod Health ; 18(1): 29, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546720

RESUMO

BACKGROUND: Birth asphyxia is one of the leading causes of intrapartum stillbirth and neonatal mortality worldwide. We sought to explore the experiences of health care workers in managing foetal distress and birth asphyxia to gain an understanding of the challenges in a low-income setting. METHODS: We conducted in-depth interviews with 12 midwives and 4 doctors working in maternity units from different health facilities in Northern Uganda in 2018. We used a semi-structured interview guide which included questions related to; health care workers' experiences of maternity care, care for foetal distress and birth asphyxia, views on possible preventive actions and perspectives of the community. Audio recorded interviews were transcribed verbatim and analysed using inductive content analysis. RESULTS: Four categories emerged: (i) Understanding of and actions for foetal distress and birth asphyxia including knowledge, misconception and interventions; (ii) Challenges of managing foetal distress and birth asphyxia such as complexities of the referral system, refusal of referral, lack of equipment, and human resource problems, (iii) Expectations and blame from the community, and finally (iv) Health care worker' insights into prevention of foetal distress and birth asphyxia. CONCLUSION: Health care workers described management of foetal distress and birth asphyxia as complex and challenging. Thus, guidelines to manage foetal distress and birth asphyxia that are specifically tailored to the different levels of health facilities to ensure high quality of care and reduction of need for referral are called for. Innovative ways to operationalise transportation for referral and community dialogues could lead to improved birth experiences and outcomes.

2.
Sex Reprod Healthc ; 26: 100543, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32771942

RESUMO

Today, student midwives in Sweden spend half of their midwifery education at various internships. Practice reality demonstrates that there is an insufficient number of preceptors for the students, and the workload is demanding. Therefore, the present study aimed to explore the experiences of final term Swedish students during their midwifery internship and whether other paedagogical learning experiences beyond the apprenticeship model were included. A cross-sectional survey was distributed to 288 final year midwifery students at all universities offering the midwifery programme in Sweden. This paper focuses on open-ended questions, which were answered by 108 students, and analysed inductively via thematic analysis. Students described an intensive period with pressure during their internship. They expressed a desire for fewer parallel tasks and a better-structured internship. Students revealed that it was both a challenge and stressful to be under constant high performance while practising clinically. Furthermore, students described feelings of competition towards fellow peers in regard to attaining the final number of 50 assisted births. As to the paedagogical methods, the classical preceptorship model with a one-to-one student-preceptor relationship was predominately used. Preceptors were perceived as crucial role models. However, this learning experience was considered suboptimal for learning in the event where preceptors were not engaged or felt insecure regarding their knowledge, or if the preceptor was changed. For the students, the most optimal setting would be if preceptors were selected, trained, and supported in their role to supervise students, instead of being assigned any available preceptor, who was, at times, not a midwife.

3.
BMJ Open ; 10(7): e038938, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32636292

RESUMO

INTRODUCTION: In Scandinavia, 6% of infants are born preterm, before 37 gestational weeks. Instead of continuing in the in-utero environment, maturation needs to occur in a neonatal unit with support of vital functions, separated from the mother's warmth, nutrition and other benefits. Preterm infants face health and neurodevelopment challenges that may also affect the family and society at large. There is evidence of benefit from immediate and continued skin-to-skin contact (SSC) for term and moderately preterm infants and their parents but there is a knowledge gap on its effect on unstable very preterm infants when initiated immediately after birth. METHODS AND ANALYSIS: In this ongoing randomised controlled trial from Stavanger, Norway and Stockholm, Sweden, we are studying 150 infants born at 28+0 to 32+6 gestational weeks, randomised to receive care immediately after birth in SSC with a parent or conventionally in an incubator. The primary outcome is cardiorespiratory stability according to the stability of the cardiorespiratory system in the preterm score. Secondary outcomes are autonomic stability, thermal control, infection control, SSC time, breastfeeding and growth, epigenetic profile, microbiome profile, infant behaviour, stress resilience, sleep integrity, cortical maturation, neurodevelopment, mother-infant attachment and attunement, and parent experience and mental health. ETHICS AND DISSEMINATION: The study has ethical approval from the Swedish Ethical Review Authority (2017/1135-31/3, 2019-03361) and the Norwegian Regional Ethical Committee (2015/889). The study is conducted according to good clinical practice and the Helsinki declaration. The results of the study will increase the knowledge about the mechanisms behind the effects of SSC for very preterm infants by dissemination to the scientific community through articles and at conferences, and to the society through parenting classes and magazines. STUDY STATUS: Recruiting since April 2018. Expected trial termination June 2021. TRIAL REGISTRATION NUMBER: NCT03521310 (ClinicalTrials.gov).

4.
Glob Health Action ; 13(1): 1711618, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31955672

RESUMO

Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings.Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda.Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data.Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30-120) minutes in patients' records versus 139 (IQR 87-662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different.Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother's negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality.


Assuntos
Monitorização Fetal/normas , Mão de Obra em Saúde/estatística & dados numéricos , Frequência Cardíaca Fetal/fisiologia , Hospitais Públicos/estatística & dados numéricos , Trabalho de Parto/fisiologia , Feminino , Fidelidade a Diretrizes , Pessoal de Saúde , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Guias de Prática Clínica como Assunto , Gravidez , Uganda
5.
Horm Behav ; 121: 104679, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31927022

RESUMO

This selective review first describes the involvement of the maternal hypothalamic-pituitary-adrenal (HPA) axis during pregnancy and the postpartum period, and the relation between peripartum HPA axis function and maternal behavior, stress reactivity and emotional dysregulation in human mothers. To provide experimental background to this correlational work, where helpful, animal studies are also described. It then explores the association between HPA axis function in mothers and their infants, under ongoing non-stressful conditions and during stressful challenges, the moderating role of mothers' sensitivity and behavior in the mother-child co-regulation and the effects of more traumatic risk factors on these relations. The overarching theme being explored is that the HPA axis - albeit a system designed to function during periods of high stress and challenge - also functions to promote adaptation to more normative processes, shown in the new mother who experiences both high cortisol and enhanced attraction and attention to and recognition of, their infants and their cues. Hence the same HPA system shows positive relations with behavior at some time points and inverse ones at others. However, the literature is not uniform and results vary widely depending on the number, timing, place, and type of samplings and assessments, and, of course, the population being studied and, in the present context, the state, the stage, and the stress levels of mother and infant.

6.
Acta Paediatr ; 109(4): 697-704, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31618466

RESUMO

AIM: Current care of very preterm infants in an incubator implies separation of the mother-infant dyad. The aim of this study was to determine whether skin-to-skin contact (SSC) between parent and very preterm infant from birth and during the first postnatal hour is feasible. METHODS: Infants born in 2014-16 in Stockholm at gestational age 28 + 0-33 + 6 weeks were randomised to care provided in SSC with a parent or on a resuscitaire and later in an incubator or bed during the first postnatal hour. Infant body temperature was measured on admission to the neonatal unit and at one postnatal hour. Data on respiratory support and breastfeeding were prospectively collected. RESULTS: We studied 55 infants at 32 + 0 ± 1.4 weeks (range 28 + 2-33 + 6), with birthweight 1760 g ± 449 g (range 885-2822). 60% were boys. Mean body temperature in the SSC group was 0.3°C lower 1 hour after birth, 36.3°C ± 0.52 (range 34.4-37.2) vs 36.6°C ± 0.42 (range 36.0-37.4, P = .03). No differences between groups were seen in respiratory support or breastfeeding. CONCLUSION: Stabilisation of very preterm infants can be performed while in SSC with a parent, but caution needs to be paid to maintain normothermia.

7.
J Affect Disord ; 262: 133-142, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31733457

RESUMO

OBJECTIVES: The aim of this study was to test the efficacy of a Mindfulness-Based Childbirth and Parenting Program (MBCP) in reducing pregnant women's perceived stress and preventing perinatal depression compared to an active control condition. METHOD: First time pregnant women (n = 197) at risk of perinatal depression were randomized to MBCP or an active control treatment, which consisted of a Lamaze childbirth class. At baseline and post-intervention, participants filled out questionnaires on perceived stress, depressive symptoms, positive states of mind, and five facets of mindfulness. RESULTS: Compared to the active control treatment, MBCP significantly reduced perceived stress (p = 0.038, d = 0.30) and depressive symptoms (p = 0.004, d = 0.42), and increased positive states of mind (p = 0.005, d = 0.41) and self-reported mindfulness (p = 0.039, d = 0.30). Moreover, change in mindfulness possibly mediated the treatment effects of MBCP on stress, depression symptoms, and positive states of mind. The subscales "non-reactivity to inner experience" and "non-judging of experience" seemed to have the strongest mediating effects. LIMITATIONS: The outcomes were self-report questionnaires, the participants were not blinded to treatment condition and the condition was confounded by number of sessions. CONCLUSIONS: Our results suggest that MBCP is more effective in decreasing perceived stress and risk of perinatal depression compared to a Lamaze childbirth class. The results also contribute to our understanding of the underlying psychological mechanisms through which the reduction of stress and depression symptoms may operate. Thus, this study increases our knowledge about efficient intervention strategies to prevent perinatal depression and promote mental wellbeing among pregnant women.

8.
Hum Nat ; 30(4): 448-476, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31749065

RESUMO

Animal and human studies suggest that parenting style is transmitted from one generation to the next. The hypotheses of this study were that (1) a mother's rearing experiences (G1) would predict her own parenting resources (G2) and (2) current maternal mood, motivation to care for her offspring, and relationship with her parents would underlie this association. In a subsample of 201 first-time mothers participating in the longitudinal Maternal Adversity, Vulnerability and Neurodevelopment project, we assessed a mother's own childhood maltreatment and rearing experiences (G1) using the Childhood Trauma Questionnaire and the Parental Bonding Instrument. At 6 months postpartum, mothers completed questionnaires on parenting stress (G2), symptoms of depression, maternal motivation, and current relationship with their own parents. The sample consisted of mostly high socioeconomic status mothers recruited from Montréal (n = 135) or Hamilton (n = 66), Canada, with an age range from 18 to 43 years (M = 29.41, SD = 4.85 years). More severe maltreatment and less supportive rearing by the mother's parents (G1) predicted increased parenting stress at 6 months (G2). These associations were mediated through distinct psychosocial pathways: maltreatment (G1) on parenting stress (G2) through symptoms of depression (Z = 2.297; p = .022); maternal rearing (G1) on parenting stress (G2) through maternal motivation (Z = -2.155; p = .031) and symptoms of depression (Z = -1.842; p = .065); and paternal rearing (G1) on parenting stress (G2) through current relationship with the father (Z = -2.617; p = .009). Maternal rearing experiences predict a mother's own parenting resources though distinct psychosocial pathways, including depressed mood, maternal motivation, and social support.


Assuntos
Experiências Adversas da Infância , Educação Infantil/psicologia , Depressão/psicologia , Comportamento Materno/psicologia , Mães/psicologia , Motivação , Apego ao Objeto , Relações Pais-Filho , Poder Familiar/psicologia , Apoio Social , Estresse Psicológico/psicologia , Adolescente , Adulto , Canadá , Feminino , Humanos , Lactente , Estudos Longitudinais , Paridade , Adulto Jovem
9.
J Fam Psychol ; 32(8): 1025-1035, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30407037

RESUMO

This study examined potential pathways in the associations between breastfeeding and mothers' relationship satisfaction, including her satisfaction with father involvement (FI) and parity, among mothers not working outside the home at 6 months. Mothers (n = 222) completed questionnaires at 4 time-points, 3 to 24 months postpartum as part of a longitudinal cohort study. In this study, we were interested in two main outcome variables: mothers' relationship satisfaction with their partner (RS) and continuation of breastfeeding after 3 months. Our first analysis revealed that breastfeeding at 3 months postpartum predicted decreased RS at 6 months postpartum, which was mediated by mothers' dissatisfaction with FI in infant caretaking at 6 months postpartum. These associations depended on mothers' parity: Multiparous breastfeeding mothers were the most dissatisfied with FI. Second, mothers' satisfaction with FI at 6 months also predicted increased RS at 24 months through increased RS at 12 months, but not through FI at 18 months. Third, we found that high dissatisfaction with FI at 6 months was the only significant predictor for the discontinuation of breastfeeding from 3 to 6 months postpartum. Our results suggest that multiparous breastfeeding mothers might be more dissatisfied with FI in caregiving than nonbreastfeeding mothers and primiparous breastfeeding mothers. Furthermore, mothers' satisfaction with FI seems a potent predictor of overall RS up to 24 months postpartum and the continuation of breastfeeding from 3 to 6 months postpartum, regardless of parity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Aleitamento Materno/psicologia , Relações Pai-Filho , Julgamento , Casamento/psicologia , Mães/psicologia , Poder Familiar/psicologia , Satisfação Pessoal , Adulto , Pré-Escolar , Feminino , Comportamento de Ajuda , Humanos , Estudos Longitudinais , Masculino , Apego ao Objeto , Jogos e Brinquedos , Inquéritos e Questionários
10.
Acta Paediatr ; 107(7): 1205-1217, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29405436

RESUMO

AIM: To explore the role of breastfeeding as a possible link between maternal and infant cortisol attunement across the first postpartum year. METHODS: Mothers (n = 93) provided salivary samples for cortisol levels over a two-day period during mid-pregnancy and at three, six and 12 months and infants at six and 12 months postpartum. Breastfeeding status was established at these same time points. RESULTS: Among breastfeeding mothers, positive correlations were found between maternal cortisol levels during pregnancy and at three months postpartum and infant cortisol at six or 12 months postpartum. Among nonbreastfeeding mothers, these same maternal and infant cortisol relations were inverse and less pronounced. Further, in breastfeeding mothers, the relationship between maternal prenatal cortisol and infant cortisol at 12 months was mediated through maternal cortisol at three months postpartum. CONCLUSION: These results suggest that maternal cortisol levels are positively associated with cortisol levels of the infant, among mothers who breastfeed. This relationship persists over a one-year period.


Assuntos
Aleitamento Materno , Hidrocortisona/metabolismo , Adulto , Feminino , Humanos , Lactente , Masculino , Mães , Gravidez , Saliva/metabolismo , Fatores Socioeconômicos
11.
Horm Behav ; 77: 167-81, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26232032

RESUMO

This article is part of a Special Issue "Parental Care".Producing milk to support the growth of their young is a central element of maternal care in mammals. In spite of the facts that ecological constraints influence nursing frequency, length of time until weaning and the composition of milk, there is considerable similarity in the anatomy and physiology of milk production and delivery across mammalian species. Here we provide an overview of cross species variation in nursing patterns and milk composition as well as the mechanisms underlying mammary gland development, milk production and letdown. Not all women breastfeed their infants, thus in later sections we review studies of factors that facilitate or impede the initiation and duration of breastfeeding. The results of these investigations suggest that the decisions to initiate and maintain breastfeeding are influenced by an array of personal, social and biological factors. Finally, studies comparing the development of breastfed and formula fed infants as well as those investigating associations between breastfeeding, maternal health and mother/infant interaction are reviewed. Leading health agencies including the World Health Organization and CDC advocate breastfeeding for at least the first 6months postpartum. To achieve these rates will require not only institutional support but also a focus on individual mother/infant dyads and their experience.


Assuntos
Aleitamento Materno , Lactação/fisiologia , Comportamento Materno/fisiologia , Relações Mãe-Filho , Período Pós-Parto/fisiologia , Animais , Feminino , Humanos , Lactente , Leite , Mães
12.
Acta Paediatr ; 104(10): 1018-23, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26073678

RESUMO

AIM: Little is known about the developing breastfeeding behaviour of newborn infants. This study describes infants' prebreastfeeding behaviour during the second day of life and explores possible associations with infant characteristics. METHODS: We studied 13 mothers and healthy full-term infants after normal births. At 24-48 hours of life, the newborns were placed in skin-to-skin contact with their mothers for breastfeeding and were video-filmed. The order, frequency and duration of predefined infant prefeeding behaviours and suckling were coded and analysed using computer-based video software. RESULTS: Prefeeding behaviours occurred in the following order: rooting, hand to mouth movements, licking of the nipple and hand to breast to mouth movements. The infants started to suckle at a median of one to two minutes. Rooting was the most common behaviour, observed in 12 infants. The duration of rooting movements during the last minute before breastfeeding was inversely related to neonatal age (p ≤ 0.001) and positively related to neonatal weight loss (p = 0.02) after birth. CONCLUSION: Infants exhibited a distinct sequence of prefeeding behaviours during the second day of life, and our findings suggest that rooting movements were governed by mechanisms involved in the regulation of food intake and weight gain.


Assuntos
Aleitamento Materno/psicologia , Comportamento do Lactente , Recém-Nascido/psicologia , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Perda de Peso
13.
Acta Paediatr ; 104(7): 678-86, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25727570

RESUMO

AIM: Research findings are inconclusive when it comes to whether breastfeeding is associated with the mother-infant relationship or infant temperament. We examined the association between breastfeeding at three months postpartum and infant temperament at 18 months postpartum and whether this link was affected by the mothers' anxiety and mediated by her sensitivity. METHODS: We assessed 170 mothers for breastfeeding and anxiety using the Spielberger State-Trait Anxiety Inventory (STAI) at three months postpartum, maternal sensitivity using the Ainsworth Sensitivity Scale at six months postpartum and infant temperament using the Early Childhood Behaviour Questionnaire at 18 months postpartum. RESULTS: Mothers who breastfed at three months postpartum were more sensitive in their interactions with their infants at six months postpartum, and elevated sensitivity, in turn, predicted reduced levels of negative affectivity in infant temperament at 18 months postpartum. This indirect mediation persisted after controlling for confounders (effect ab = -0.0312 [0.0208], 95% CI = -0.0884 to -0.0031). A subsequent analysis showed that the mediation through sensitivity only occurred in women experiencing higher anxiety, with a STAI score ≥33.56 at three months (ab = -0.0250 [0.0179], 95% CI = -0.0759 to -0.0013). CONCLUSION: Our results suggest that breastfeeding and maternal sensitivity may have a positive impact on the early development of infant temperament.


Assuntos
Ansiedade/psicologia , Aleitamento Materno/psicologia , Desenvolvimento Infantil/fisiologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Temperamento , Adulto , Afeto , Feminino , Humanos , Lactente , Comportamento Materno/psicologia , Período Pós-Parto , Inquéritos e Questionários
14.
Arch Womens Ment Health ; 18(5): 693-705, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25627018

RESUMO

The aims of this study were to examine the anxiety trajectories of women from pregnancy to 2 years postpartum and to assess the influence of their early life experiences and the temperament of the child on these trajectories. We evaluated state anxiety (State-Trait Anxiety Inventory) at pregnancy and 3, 6, 12, 18, and 24 months postpartum and determined its course as a function of self-reported early adverse experiences (Childhood Trauma Questionnaire) and the temperament of the child at 18 months (Early Child Behavior Questionnaire). Based on growth curve modeling, we found that anxiety followed a general U-shape pattern from gestation to 2 years postpartum, which was modified by early life experience of women. Greater early adversity was associated with higher gestational anxiety, followed by a marked decrease once the baby was born, and subsequent increase during the later postpartum period. The temperament of the child also modulated anxiety trajectories. Thus, mothers of children high in negative affectivity and who also experienced greater early adversity had elevated and flat anxiety trajectories, while child extraversion was associated with increasing anxiety courses approaching 2 years postpartum. These results show that maternal anxiety dynamically changes through the postpartum period with a course that is affected by previous and current experiences.


Assuntos
Ansiedade/complicações , Comportamento Materno/psicologia , Relações Mãe-Filho , Complicações na Gravidez/psicologia , Temperamento , Adulto , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Feminino , Humanos , Mães/psicologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Inquéritos e Questionários , Fatores de Tempo
16.
Breastfeed Med ; 7(2): 93-9, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22313391

RESUMO

OBJECTIVE: This study investigated possible influences of medical interventions during labor on maternal blood pressure during a breastfeed 2 days postpartum. SUBJECTS AND METHODS: Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at -5, 10, 30, and 60 minutes during a morning breastfeed 2 days postpartum. Five treatment groups were formed based on the medical interventions received during labor: Non-medicated mothers (Control group, n=21); mothers receiving epidural analgesia (EDA) with oxytocin (OT) stimulation (EDA(OT) group, n=14); mothers receiving EDA without OT stimulation (EDA(non-OT) group, n=7); mothers receiving OT stimulation only (OT intravenously [iv] group, n=9); and mothers receiving 10 IU of OT intramuscularly (im) only (OT im group, n=15). RESULTS: Baseline diastolic, but not systolic, blood pressure differed between the groups as displayed by significantly lower diastolic blood pressure in the EDA(non-OT) group compared with the Control group, the OT iv group, and the EDA(OT) group (p=0.045, p=0.041, and p=0.024, respectively). Both systolic and diastolic blood pressure fell significantly during the breastfeeding session in the Control group (p=0.001 and p=0.004, respectively), the OT im group (p=0.006 and p=0.001, respectively), and the EDA(OT) group (p=0.028 and p=0.002, respectively), and the fall in diastolic blood pressure tended to be significant in the OT iv group (p=0.050). The duration of skin-to-skin contact before breastfeeding correlated positively with the decrease in systolic blood pressure in the OT im group (R(s)=0.540, p=0.046). CONCLUSION: Administration of EDA during labor lowers baseline diastolic blood pressure and abolishes the fall in blood pressure in response to a breastfeed 2 days after birth.


Assuntos
Pressão Sanguínea/fisiologia , Aleitamento Materno , Lactação/fisiologia , Período Pós-Parto , Adulto , Analgesia Epidural , Estudos de Coortes , Diástole , Feminino , Humanos , Recém-Nascido , Infusões Intravenosas , Injeções Intramusculares , Massagem , Relações Mãe-Filho , Ocitocina/administração & dosagem , Suécia , Sístole , Tato
17.
Breastfeed Med ; 4(4): 207-20, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19731998

RESUMO

BACKGROUND AND AIMS: In this study we made a detailed analysis of the mothers' release pattern of adrenocorticotropic hormone (ACTH) and cortisol during a breastfeeding session during the second day postpartum and related these patterns to maternal oxytocin levels as well to the duration of sucking and the duration of skin-to-skin contact before sucking the breast. Furthermore, we investigated if epidural analgesia and oxytocin administration during and after labor influenced the release pattern of ACTH and cortisol. METHODS: Sixty-three primiparae were included in the study. Fourteen received oxytocin intramuscularly postpartum, nine received oxytocin infusion, 14 received epidural analgesia combined with oxytocin infusion, and six received epidural analgesia alone. Twenty mothers did not receive any of these medical interventions. Blood samples were analyzed for ACTH and cortisol by enzyme-linked immunoassay. RESULTS: Both ACTH and cortisol levels fell significantly during the breastfeeding session. A significant negative relationship was found between oxytocin and ACTH levels, but not between oxytocin and cortisol levels. A positive and significant relationship was found between ACTH and cortisol levels. The duration of skin-to-skin contact before onset of sucking was significantly and negatively associated with lower cortisol levels, but not with ACTH levels. Cortisol levels differed significantly between mothers having received epidural analgesia with and without oxytocin. CONCLUSIONS: Breastfeeding is associated with a decrease of ACTH and cortisol levels. Skin-to-skin contact contributes to this effect. ACTH correlated negatively with the duration of sucking and with median oxytocin levels, whereas cortisol levels correlated inversely with the duration of skin-to-skin contact preceding sucking, suggesting a partial dissociation between the mechanisms regulating ACTH and cortisol release. In addition, medical interventions in connection with birth influence the activity of the hypothalamic-pituitary-adrenal axis 2 days after birth.


Assuntos
Hormônio Adrenocorticotrópico/sangue , Analgésicos/farmacologia , Hidrocortisona/sangue , Ocitócicos/farmacologia , Comportamento de Sucção/fisiologia , Hormônio Adrenocorticotrópico/efeitos dos fármacos , Adulto , Analgesia Epidural , Analgésicos/administração & dosagem , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/fisiologia , Recém-Nascido , Infusões Intravenosas , Injeções Intramusculares , Lactação/sangue , Lactação/efeitos dos fármacos , Lactação/fisiologia , Ocitócicos/sangue , Sistema Hipófise-Suprarrenal/fisiologia , Período Pós-Parto/fisiologia , Gravidez , Fenômenos Fisiológicos da Pele
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