Influence of oxytocin or epidural analgesia on personality profile in breastfeeding women: a comparative study.

Women undergo physiological and psychological changes during pregnancy, labor and lactation. The psychological adaptations can be affective, cognitive and behavioral and can be measured by dimensional personality instruments. This study aims to compare (1) the personality profile in mothers after birth with a normative group of non-lactating women and to examine (2) whether the personality profile differs 2 days, 2 months and 6 months after birth between mothers who have been exposed to epidural anesthesia, oxytocin administration or neither. Sixty-nine primiparae were assigned to four groups: mothers having received oxytocin infusion during labor (OT iv group, n = 9), mothers having received epidural analgesia with/without oxytocin infusion (EDA group, n = 23), mothers having received 10 iU oxytocin intramuscularly after birth (OT im group, n = 15) and mothers having received none of these treatments (unmedicated group, n = 22). At 2 days and 2 and 6 months postpartum mothers completed the Karolinska Scales of Personality (KSP). The unmedicated, the OT iv- and OT im groups scored significantly lower on anxiety and aggression related scales and higher on the socialization subscale during the entire observation period when compared with a normative group. These differences were not observed in the EDA group 2 days postpartum. At 2 and 6 months postpartum, the scores of the EDA group had changed significantly and were almost similar to the KSP scores of the other groups. ANCOVA analysis revealed that OT infusion, over and above the effects of EDA, was associated with decreased levels of several anxiety and aggression subscales. We conclude that women who received exogenous oxytocin during labor show similar positive personality traits during breastfeeding such as reduction in anxiety and aggression and increasing socialization, including maternal behavior, that have previously been ascribed to endogenous oxytocin. More importantly, these effects were not seen at 2 days postpartum in women who received epidural anesthesia during labor.

Health providers' perceptions of adolescent sexual and reproductive health care in Swaziland.

AIM: To explore health providers' perceptions of adolescent sexual and reproductive healthcare services in Swaziland. METHODS: Fifty-six healthcare providers, working in 11 health clinics in Swaziland in 2005, were surveyed using a semi-structured questionnaire. The data were analysed by descriptive statistics and content analysis to identify key themes. FINDINGS: Most participants were women with a mean age of 36 years and a mean number of 6 years in the profession. Services provided included STIs/HIV/AIDS advice, pre- and post-test counselling and testing on HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts, negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against abortion, and the reality of the adolescents' situation. Forty-four wanted to be trained on post-abortion care while eight on how to perform abortions. Twenty-six wanted the government to support adolescent-friendly services and to train heathcare providers in adolescent sexual and reproductive health services. CONCLUSION: The curricula within nursing and midwifery preservice education need to be reviewed to incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for adolescents in Swaziland and appropriate youth-friendly services at all levels. There is need for nurse/midwifery participation, advocacy and leadership in policy development.

Newborn skin temperature two days postpartum during breastfeeding related to different labour ward practices.

AIM: To investigate (1) the skin temperature pattern in newborns two days after birth in connection to breastfeeding and to examine (2) if the administration of epidural analgesia (EDA) and oxytocin (OT) infusion during labour influences this parameter at this point of time. METHOD: Forty-seven mother-infant pairs were included in the study: nine mothers had received OT stimulation during labour (OT group), 20 mothers had received an EDA and OT during labour (EDA group), while 18 mothers had received neither EDA nor OT stimulation during labour (control group). A skin temperature electrode was attached between the newborn's shoulder blades. The newborn was placed skin-to-skin on the mother's chest and covered with a blanket. The temperature was recorded immediately after the newborn was put on the mother's chest and at 5, 10, 20 and 30 min. RESULTS: The temperature measured when the newborns were put skin-to-skin on their mothers' chest was significantly higher in the infants of the EDA group (35.07 degrees C) when compared to the control group (34.19 degrees C, p=0.025). Skin temperature increased significantly (p=0.001) during the entire experimental period in the infants belonging to the control group. The same response was observed in infants whose mothers received OT intravenously during labour (p=0.008). No such rise was observed in infants whose mothers were given an EDA during labour. CONCLUSION: The results show that the skin temperature in newborns rises when newborns are put skin-to-skin to breastfeed two days postpartum. This effect on temperature may be hampered by medical interventions during labour such as EDA.

The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling.

BACKGROUND: Few investigations have considered evaluating the effects of certain combinations of ward routines like swaddling of the baby and separation of mother and baby on infant variables such as neonatal weight loss. AIMS: To study the effect of different ward routines in respect to proximity to mother and type of infant apparel, on breastfeeding parameters (amount of ingested milk, volume of supplements, number of breastfeeds, total duration of breastfeeding time) day 4 after birth as well as recovery from neonatal weight loss and infant's weight on day 5. STUDY DESIGN AND SUBJECTS: In a randomized trial with factorial design four treatment groups including 176 mother-infant dyads were studied 25-120 min after birth. Randomized treatments focused on care routines administered to the infants after delivery and later in the maternity ward as well as to the type of clothing the infants received. Group 1 infants were placed skin-to-skin with their mothers after delivery, and had rooming-in while in the maternity ward. Group 2 infants were dressed and placed in their mothers' arms after delivery, and roomed-in with mothers in the maternity ward. Group 3 infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group 4 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 clothed in baby attire. Breastfeeding parameters were documented during day 4 after birth. Infant's weight was measured daily. RESULTS: Babies who were kept in the nursery received significantly more formula and significantly less breast-milk, than did babies who roomed-in with their mothers. Swaddling did not influence the breastfeeding parameters measured. However, swaddled babies who had experienced a 2-h separation period after birth and then were reunited with their mothers tended to have a delayed recovery of weight loss compared to those infants who were exposed to the same treatment but dressed in clothes. Furthermore, swaddled babies who were kept in the nursery and received breast-milk supplements had a significantly delayed recovery of weight loss after birth when compared to those infants ingesting only breast-milk. On day 5, regression analyses of predicted weight gain in the exclusively breastfed infants indicated a significant increase per 100 ml breast-milk (59 g), compared to the predicted weight gain on day 5 per 100 ml supplements in the swaddled babies (14 g) (P=0.001). CONCLUSION: Supplements given to the infants in the nursery had a negative influence on the amount of milk ingested. In addition, supplement feeding or a short separation after birth when combined with swaddling was shown to have a negative consequence to infant weight gain.

Maternal and infant health problems after normal childbirth: a randomised controlled study in Zambia.

STUDY OBJECTIVES: The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies, during a period of 42 days after delivery. Another aim was to compare the mothers', the midwife's, and the doctor's findings of prevalence of health problems at the end of the puerperium period. DESIGN: A randomised controlled trial was carried out. One group of mothers and their infants were randomly allocated to a home visiting group (Group A); the other group (Group B) was only visited at day 42. SETTING: The study was carried out at the University Teaching Hospital (UTH) in Lusaka, the capital city of Zambia. PARTICIPANTS: A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant, as assessed by the attending midwife, were randomised to two groups. Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3, 7, 28, and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42. MAIN RESULTS: At day 42 an equal proportion (30%) of mothers in both groups perceived that they had health problems. The prevalence of infant health problems in Group B was significantly higher (p < 0.01) as perceived by mothers. There were more mothers in Group B (p < 0.01) perceiving insufficient milk production and giving supplementary feeding. At day 42, mothers in Group A (56%) took more actions than mothers in Group B (41%) to solve infant health problems (p < 0.03). In both groups the mothers' perceived own health problems, were significantly higher (p < 0.01) than those observed by the obstetrician and those observed by the midwife. The midwife found more infant health problems in Group B (p < 0.01) than in Group A and more infants with health problems in both groups compared with the paediatrician's findings (p < 0.01). CONCLUSIONS: There was a significant difference between the mothers' reported health problems and the health problems identified by the midwife and the doctors. The study shows that a midwife home visit and individual health education to mothers, reduce the prevalence of infant health problems, and enables the mother to more often take action when an infant health problem is identified. There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care.

Routine care of women experiencing normal deliveries in Zambian maternity wards: a pilot study.

OBJECTIVE: To describe the routine care of women during normal labour and delivery, and the immediate care of newborn babies in Zambia at different levels of health care. DESIGN: A descriptive survey carried out between July 1994 and January 1995. SETTING: Eleven maternity facilities, one University teaching hospital, two urban health centres and eight rural hospitals in one province in Zambia. PARTICIPANTS: Eighty-four women in normal childbirth and their babies studied from admission to the labour ward until time of discharge from the labour ward. MEASUREMENTS AND FINDINGS: Observations related to the care of the women during normal labour and delivery, and the immediate care of the baby. The findings show that women were confined to bed during the whole labour and delivery period, food and drinks were withheld, and no gowns were provided. None of the women were allowed to have a companion present during labour. Fetal monitoring was inconsistent and the partograph was either not used or partly lacking. All women were delivered in a lithotomy position and primiparae were fixed in stirrups during the second and third stages of labour. There was general lack of support for early mother/baby contact, prevention of hypothermia in the babies and early initiation of breast feeding. IMPLICATIONS FOR PRACTICE: Based on our findings we suggest that many present maternity ward routines, both physiological and psychological, should be carefully studied. It is also suggested that the midwives reorient their caring practices to more culturally and evidenced-based maternity care. Refresher courses for midwives who have been working for many years are recommended.

PIP: A descriptive survey conducted at 11 maternity facilities in Lusaka, Zambia, and Zambia's rural Southern Province from July 1994 to January 1995 sought to characterize the routine care of women during uncomplicated labor and delivery and the immediate care of newborns by type of health facility. A total of 84 women from 8 rural hospitals, 2 urban health centers, and 1 teaching hospital were enrolled. All facilities had a qualified midwife assigned to women in labor. Women were confined to their beds throughout labor and delivery and were not permitted to have a partner or companion present. Fetal monitor and partograph use was inconsistent. Primiparous women were put in stirrups during the second and third stages of labor, and all women were delivered in the lithotomy position. None of the newborns was fully dried to prevent hypothermia. Notable was a lack of staff support for early mother-infant contact or initiation of breast feeding. Midwives were unaware of the guidelines of the Baby Friendly Hospital Initiative. These findings indicate a need for a reassessment of present maternity ward routines, both psychological and physiological, and a review of the midwifery educational curriculum. First, however, a larger, more representative study should be conducted of maternity facilities throughout Zambia.

Views on involving a social support person during labor in Zambian maternities.

Because social support persons are excluded from modern obstetric care in Zambia, the aim of this study was to explore the views of 84 mothers and 40 health staff about allowing women to be attended by a supportive companion during labor in Zambian urban and rural maternities. Most of the mothers wanted a companion present to provide emotional and practical support. Those who were opposed to the idea had nobody to ask to be with them, or they had relatives who would interfere with the care provided. All health staff cited hospital policy as the principal reason for prohibiting social support persons from staying with laboring women. They also said that the health staff's role is to care for laboring women, and they worried that social support persons could interfere with their work by giving the laboring women traditional medicine. However, most health staff also said that a social support person could help the laboring women and give her a sense of security. The study concludes that Zambian maternity staff should be exposed to new research findings about the benefits of social support during childbirth and that this practice should be encouraged in Zambia. Ultimately, it should be the laboring woman who decides whether she wants to bring a social support person to the labor ward.

Family planning practices before and after childbirth in Lusaka, Zambia.

A total of 408 randomly selected normally delivered women who had given birth to healthy infants were recruited from a postnatal ward at the University Teaching Hospital (UTH) in Lusaka, Zambia. Family planning practices before and after pregnancy and delivery were investigated among 376 of these women. The interviews were conducted in their homes or at the postpartum clinic at the UTH at the end of puerperium. The remaining 32 women, mainly primiparae, were lost to follow-up. Thirty four percent of the women had used a family planning method before the present childbirth. Most of those (90%) had used modern methods. Women with eight and more years of education used modern contraceptive methods more often than those with less education. One year after delivery, 64% of the women were using modern or traditional family planning methods. Of those who used traditional methods, 15% relied on lactational amenorrhoea. Of those who did not use any method, 39% indicated that their husbands did not allow them. Fifty-six per cent of the teenagers stated that they had no knowledge of family planning, whereas 84% of the single teenagers had not used contraceptives before. In view of this, teenagers and single mothers need a special focus in the development of family planning programmes. We also recommend that more research should focus on views of both men and women on contraceptive use.

PIP: This article presents an analysis of contraceptive usage before and after childbirth among 376 women (out of a total of 408 randomly selected women) delivering at the University Teaching Hospital in Lusaka, Zambia, during 1989-90. 90% of the original 408 women were married and living with their husbands. 75% lived in the high-density districts of Lusaka. 60% were housewives, and 22% had regular wage employment. 80% of husbands had regular paid employment. 66% reported knowledge of at least one contraceptive method; 34% had no contraceptive knowledge. 97% of those with some knowledge knew about modern methods. 56% of adolescents were unaware of any contraceptive method. 67% did not use any contraceptives. Of the 33% who used a method, 90% used a modern one. 84.4% of unmarried teenagers had not used contraceptives before the study. 58.4% stopped contraceptive use in order to conceive. After 1 year, 64% of 309 women were using contraceptives, of which 55% used a modern method. The most commonly used method was the pill. 17% of the 89 women who used traditional methods relied on lactational amenorrhea. 92% were still breast feeding (2-11 feeds in a 24-hour period) at the end of a year. 47% were menstruating. 68% had resumed sexual relations. 39% of the women at the end of the year who did not use contraception reported that husbands did not allow this practice. 22 women reported that their infant died within the year. Women with 8 or more years of education were more likely to use modern contraception. Contraceptive knowledge and use was influenced by parity, education, marital status, and age. Women mainly asked about what contraceptive methods were available, when to start use, and where to obtain contraception.

Maternity care routines in a teaching hospital in Zambia.

At the University Teaching Hospital, Lusaka, Zambia, 59 uncomplicated, vaginally delivered mothers, were studied with regard to maternity care during the antenatal period and delivery. Information was collected from antenatal cards, labour records, observations during delivery and interviews with mothers. The average of more than five antenatal visits indicates that there was a sufficient demand for health care. The results suggest low application of the recommended maternity care routines, positive correlation between application of the maternity care and the mother's educational level and low staff encouragement of self-care among mothers. These findings suggest a need for systematic critical review and, if necessary, modification of current maternal care technologies and improved general and health education of women.

Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin, in response to suckling during the second day postpartum.

BACKGROUND: Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. The aim of the present study was to make a detailed analysis of maternal release of oxytocin and prolactin in response to breastfeeding during the second day postpartum in mothers who had received oxytocin either intravenously for stimulation of labor or intramuscularly for prevention of postpartum hemorrhage and/or epidural analgesia or those who had received no such treatment in connection with birth. METHODS: In a descriptive comparative study plasma oxytocin and prolactin concentrations were measured in response to suckling during the second day postpartum in women who had received intravenous intrapartum oxytocin (n = 8), intramuscular postpartum oxytocin (n = 13), or epidural analgesia, either with (n = 14) or without (n = 6) intrapartum oxytocin infusion, and women who received none of these interventions (n = 20). Hormone levels were analyzed by enzyme immunoassay. RESULTS: All mothers showed a pulsatile oxytocin pattern during the first 10 minutes of breastfeeding. Women who had received epidural analgesia with oxytocin infusion had the lowest endogenous median oxytocin levels. The more oxytocin infusion the mothers had received during labor, the lower their endogenous oxytocin levels were during a breastfeeding during the second day postpartum. A significant rise of prolactin was observed after 20 minutes in all women, but after 10 minutes in mothers having received oxytocin infusion during labor. In all women, oxytocin variability and the rise of prolactin levels between 0 and 20 minutes correlated significantly with median oxytocin and prolactin levels. CONCLUSION: Oxytocin, released in a pulsatile way, and prolactin were released by breastfeeding during the second day postpartum. Oxytocin infusion decreased endogenous oxytocin levels dose-dependently. Furthermore, oxytocin infusion facilitated the release of prolactin. Epidural analgesia in combination with oxytocin infusion influenced endogenous oxytocin levels negatively.

Short- and long-term decrease of blood pressure in women during breastfeeding.

BACKGROUND AND AIMS: The benefits of breastfeeding for infants are well known. Recently data have started to emerge showing that breastfeeding may also induce positive effects in the mother. This study aimed to investigate the pattern of maternal blood pressure before, during, and after a breastfeed 2 days postpartum. Additionally, blood pressure during the following 25-week breastfeeding period was investigated. METHODS: Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at -5, 10, 30, and 60 minutes in connection with a morning breastfeed. Thirty-three women continued to measure blood pressure before and after breastfeeding for 25 weeks. RESULTS: Blood pressure fell significantly in response to breastfeeding 2 days after birth. The fall in systolic and diastolic blood pressure amounted to 8.8 (SD = 11.00) and 7.7 (SD = 9.3) mm Hg, respectively. During the 25-week follow-up period a significant fall of basal blood pressure (systolic, df = 3, F = 7.843, p < 0.001; diastolic, df = 3, F = 5.453, p = 0.002) was observed. The total fall in systolic and diastolic blood pressure amounted to a mean of 15 (SD = 10.4) mm Hg and 10 (SD = 9.7) mm Hg, respectively. In addition, blood pressure fell significantly in response to individual breastfeeding sessions during the entire observation period. CONCLUSIONS: In conclusion, both systolic and diastolic blood pressures fall during a breastfeeding session, and pre-breastfeeding blood pressure decreases during at least the first 6 months of a breastfeeding period in a homelike environment. This study lends further support to the health-promoting effects of breastfeeding.

Immediate maternal thermal response to skin-to-skin care of newborn.

AIM: To elucidate the immediate maternal thermal skin response when placing the neonate on the mothers' chest, skin-to-skin (STS). METHODS: Ugandan mothers with non-asphyxiated newborns after vaginal delivery (n = 39) were studied. Maternal skin and axillary temperatures were measured immediately before STS contact, then every 2 min for 20 min and finally 10 min after removing the neonate. Neonatal axillary/forehead temperatures were measured immediately before STS contact, and twice after initiating STS, followed by a measurement 10 min after the newborn had been removed. RESULTS: A rapid thermal response was demonstrated in maternal breast skin immediately after STS contact. It rose by 0.5 degrees C (p < 0.0001) on average the first 2 min after STS contact and fell by 0.5 degrees C 10 min after we had removed the neonate (p < 0.0001). Maternal axillary temperature also rose 2 min after initiation of STS (p < 0.0001) but stayed constant 10 min after removal of the newborn from the STS position. CONCLUSION: The findings indicate that there is a rapid maternal, thermal response to the positioning of the newborn STS. The tactile contact may elicit a maternal adaptation enhancing the warming of the newborn. Possible mechanisms include maternal autonomic nerve-mediated skin vasodilatation.

Trunk muscle strength and low back pain.

The strength of the trunk muscles was measured in a group of young males with low back insufficiency (n=7) and in an age matched (19-21 yrs) healthy control group (n=8). A recently designed new application of the isokinetic technique was used to record maximal torque produced by the trunk muscles during flexion, extension and lateral flexion. Trunk muscle strength was measured during isometric contractions in different trunk positions and during slow isokinetic contractions in the whole range of motion. No significant differences between the groups were observed for trunk extension, lateral flexion or flexion with the centre of rotation at L2-L3 level. However, in the initial part of isokinetic trunk flexion with the pivot point at the hip joint the strength values for the back patients were significantly lower than for the controls. The present results demonstrate the importance of a comprehensive approach to the assessment of trunk muscle strength, including different movement velocities, body positions and pivot points. Further studies are needed to evaluate the significance of the specific weakness observed in dynamic trunk flexion strength in the back patients.