Evaluation of an e-Learning Breastfeeding Program for Postpartum Mothers of Moderately High-Risk Newborn Infants Admitted to the Special Care Nursery.

Because of a lack of proper breastfeeding education to mothers and the visitation policy in the special care nursery, breastfeeding initiation and maintenance can be very challenging for both the mother and her infant who is admitted to the neonatal special care nursery after birth. Difficulties associated with forming initial bonds may contribute to some mothers changing their mind about their initially chosen feeding method. The aim of this quasi-experimental study was to evaluate the effectiveness of an e-learning breastfeeding program on maternal breastfeeding outcomes. Thirty-four mothers in the comparison group received routine care; 34 in the intervention group received an e-learning breastfeeding program and routine care. The program included 28 modules of different topics downloaded to a personal tablet computer. Each module elaborated on a breastfeeding issue and provided video clips to show practice steps. During the mothers' 3- to 5-day stay in the postpartum unit, they could repeatedly watch selected topics related to their situations at their own pace. After adjusting for each infant's birth weight, mothers in the intervention group had better attachment to their infants, greater perceived nurse support, and a higher exclusive breastfeeding rate than mothers in the comparison group. Using a tablet computer device to disseminate breastfeeding education is a feasible and supplemental method for postpartum mothers whose infants are in the special care nursery. Through the demonstrated situations, mothers are better prepared to understand their high-risk infants and the situations they may encounter during breastfeeding.

Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time series design.

BACKGROUND: For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent-infant interactions. A substantial lack of interactional knowledge can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers' mother-infant interaction quality and parenting sense of competence. METHODS: Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother-infant interactions. RESULTS: We observed an increase in the quality of mother-infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother-infant interaction. CONCLUSIONS: Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants' abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction.

[A gender perspective on medicalized childbirth].

Gender mainstreaming is a worldwide issue. The United Nations and the World Health Organization have emphasized the importance of incorporating gender perspectives and gender equity into government policy decisions. Different cultures have different attitudes toward the management of childbirth and these attitudes influence the feelings and needs of women and their partners. These needs must be better understood and satisfied. The widely held technocratic values of obstetricians influence the birthing experience of women significantly. This article uses a gender perspective to describe the medicalization of childbirth, the pharmacological pain-relief oppression of women, the prevalence of blaming women for decisions to conduct Caesarean sections, and the exclusion of men from involvement in the childbirth process. This article may be used as reference to enhance gender equality childbirth care for women.

[Constructing a baby-friendly community].

The Baby-Friendly Hospital Initiative (BFHI), developed by the World Health Organization and the United Nations Children's Fund to promote breastfeeding in maternity facilities worldwide, has had a global impact on breastfeeding outcomes. However, further interventions are necessary before and after hospital discharge to meet the initiative's recommended 6-month targets. The Baby-Friendly Community Initiative (BFCI), a multifaceted program for community based breastfeeding promotion designed to complement BFHI, addresses this challenge. The purpose of this paper is to introduce the origin of BFCI and its current implementation status in several countries as a reference for effective BFCI promotion in Taiwan.

[Pregnancy and the struggle to quit smoking].

The negative effects of smoking during pregnancy are well documented. Health care providers typically advise pregnant women who smoke usually to quit for their health as well as for the health of their fetus. Most women are familiar with the need to stop smoking while pregnant. Hospitals offer various smoking cessation services. However, the literatures reveals a low uptake of smoking cessation services among pregnant women. The purpose of this paper is to explore the smoking cessation experience and feelings amongst women during pregnancy and assess smoking cessation intervention in antenatal care. Findings may provide health care providers a better understanding of this issue and help women overcome related challenges.

Comparative analyses of linkage maps and segregation distortion of two F2 populations derived from japonica crossed with indica rice.

To facilitate genetic research, we constructed two linkage maps by employing two F2 populations derived from rice inter-subspecific crosses, japonica Tainung 67 (TNG67)/indica Taichung Sen 10 (TCS10) and japonica TNG67/indica Taichung Sen 17 (TCS17). We established linkage map lengths of 1481.6 cM and 1267.4 cM with average intervals of 13.8 cM and 14.4 cM by using 107 and 88 PCR markers for coverage of 88% of the rice genome in TNG67/TCS10 and TNG67/TCS17, respectively. The discrepancy in genetic maps in the two populations could be due to different cross combinations, crossing-over events, progeny numbers and/or markers. The most plausible explanation was segregation distortion; 18 markers (16.8%) distributed at nine regions of seven chromosomes and 10 markers (11.4%) at four regions of four chromosomes displayed severe segregation distortion (p < 0.01)in TNG67/TCS10 and TNG67/TCS17, respectively. All segregation-distorted markers in these two populations corresponded to reported reproductive barriers, either gametophytic or zygotic genes but not to hybrid breakdown genes. The observed recombination frequency, which was higher or lower than the intrinsic frequency, revealed the association of segregation distortion skewed to the same or different genotypes at the consecutive markers. The segregation distortion, possibly caused by reproductive barriers, affects the evaluation recombination frequencies and consequently the linkage analysis of QTLs and positional cloning.

Health literacy and depression in women with type 2 diabetes mellitus.

OBJECTIVES: The prevalence of diabetes mellitus has recently increased in Taiwan, and depression is common among these patients. Moreover, a lack of health literacy may lead to depression. In this study, we explored the correlation between health literacy and depression in diabetic women. METHODS: In this cross-sectional study, 152 women with type 2 diabetes mellitus were recruited from the outpatient clinic of a regional teaching hospital in Taiwan. The data were collected through medical records and a self-reported structured questionnaire, which included items on basic attributes, self-rated health status, the Center for Epidemiologic Studies Depression Scale (CES-D), and Chinese Health Literacy Scale for Diabetes (CHLSD). The results were analyzed using descriptive statistical analyses, bivariate correlation tests, and linear regression analyses. RESULTS: One hundred thirty-five valid questionnaires were obtained. Approximately 20% of the participants had a higher tendency toward depression as per their CES-D score, and the CHLSD results showed that 13.33% had poor health literacy. There was a negative correlation between health literacy and depressive tendencies after adjusting for self-rated health status, economic satisfaction status, employment status, and education level using multivariate linear regression analyses. For each 1-point rise in the CHLSD score, the CES-D score decreased by 0.17 points (z=-2.05, p=0.042). CONCLUSIONS: A negative correlation was identified between health literacy and depression. Self-rated health status, economic satisfaction, employment status, and higher education level are factors that also affect depressive tendency among diabetic women.

A birth education program for expectant fathers in Taiwan: effects on their anxiety.

BACKGROUND: A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety. The objective of this study was to evaluate how an education program for expectant fathers who attended their partners' labor and birth affected their anxiety. METHODS: In a randomized controlled trial, 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block randomization to an experimental (n = 45) and a control (n = 42) group. The men completed their basic personal information, a childbirth expectations questionnaire, and a Trait Anxiety Inventory when they were recruited. Two hours after birth of their child, all the expectant fathers completed a State of Anxiety Inventory. RESULTS: Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations. After analysis of covariance (ANCOVA) was applied to correct for education level, sources of childbirth information, attendance at Lamaze childbirth classes, and childbirth expectations at baseline, the effect of the childbirth program was significant for the postnatal level of anxiety (F = 3.38, p = 0.001). CONCLUSIONS: The study findings justify the clinical implementation of a birth education program based on the self-efficacy theory as an effective means of reducing anxiety among expectant fathers.

The experiences of mothers in breastfeeding their very low birth weight infants.

AIM: This paper is a report of a study of the breastfeeding experience of mothers of very low birth weight babies. BACKGROUND: Very low birth weight babies, being born preterm, are at risk for feeding difficulties. Medical complications may prolong their hospital stays and further delay their progression towards oral feeding. Many studies have focused on the benefits of breastfeeding to very low birth weight babies, but very few have explored the breastfeeding experiences of their mothers. METHOD: Data were collected between 2005 and 2007. In-depth interviews were conducted during home visits with 31 mothers who breastfed their very low birth weight babies. Following her baby's discharge from hospital, each mother was interviewed twice about her breastfeeding experience. The data were analysed using qualitative content analysis. FINDINGS: Five themes were identified from the mothers' reports: wanting to compensate, maintaining motivation and connectedness, needing 'extra helping hands', controlling emotions and matching baby's individual pace. Mothers' self-blaming provoked them to breastfeed their very low birth weight babies to compensate babies for the harm caused by them. These mothers learned how to express breast milk and this served as an important vehicle that gradually connected them to their babies. CONCLUSION: Breastfeeding a very low birth weight baby is a challenging and exhausting experience for the mother. A better teaching protocol for breastfeeding and an improved breastfeeding ethos need to be implemented in the neonatal intensive care unit and special care nursery to support families of very low birth weight infants.

Evaluating the effects of an Internet education programme on newborn care in Taiwan.

AIM: The objectives of this study were to evaluate an Internet education programme provided to primigravida in the third trimester of pregnancy with the aim of enhancing mothers' knowledge about newborn care and increasing their maternal confidence. BACKGROUND: Shorter hospital stays have had an impact on the traditional role of mother-baby nurses in providing education about parenting to their parturient women. Internet education is an efficient way to provide nursing instruction. DESIGN: A randomised controlled trial was used. A total of 118 women receiving prenatal care in a hospital clinic who met study criteria and who consented were assigned randomly to intervention and control groups. The study was conducted at a hospital in Taiwan. METHODS: The target population was women at 32-34 weeks gestation, using the Internet on a regular basis. The primigravida were randomly assigned to either the control group (n = 57) or the experimental group (n = 61). Two primary outcome measures were newborn-care knowledge and maternal confidence. RESULTS: The changes in newborn-care knowledge were 7.21 for the experimental group, compared with 1.95 for the control group; the difference between the least-squares means computed by ancova was 5.73 and statistically significant (p < 0.001). The changes in maternal confidence were 8.46 for the experimental group and 3.05 for the control group; the difference between the least-squares means computed by ancova was 5.94 and statistically significant (p < 0.001). CONCLUSION: Results suggest that Internet education about newborn care may contribute to greater care knowledge and maternal confidence. Relevance to clinical practice. Internet newborn-care education programmes can achieve success in promoting newborn care and provide health professionals with evidence-based intervention.

[Changes in nurse-midwifery practices in Taiwan].

Nurse-midwifery professionals play an important role for pregnant women in the healthcare system, providing assistance to both expectant women and their newborn children. In Taiwan, midwifery professionals have contributed significantly to women and infant health. Before 1960s, nurse-midwives were the main nursing caregivers for women and babies. However, this changed for a variety of reasons. In the past, the education of much of the population was limited to vocational high schools and five-year junior colleges. In 1999, midwifery education was extended to the college and graduate school levels. Nurse-midwives hold that pregnancy, childbirth, and breastfeeding represent natural processes. Traditionally speaking, women have been in control of pregnancy and childbirth. Healthcare offered includes the following items: proper medical consultation, collaboration with obstetricians on case management, referral of cases to other institutions, participation in women's health promotion and illness prevention. In Taiwan, in an attempt to realize the great potential of the nurse-midwifery profession, we hope to emphasize the three stages of teaching, examination, and employment. In the future, we hope that nurse-midwifery policies will be directed to promote the image of nurse-midwives and confirm their status as healthcare professionals.

Low birth weight, prematurity, and paternal social status: impact on the basic competence test in Taiwanese adolescents.

OBJECTIVE: To investigate whether birth weight and paternal education may have independent and interactive effects on the learning achievement of adolescents. STUDY DESIGN: We linked birth weights, gestational ages (term or preterm) and paternal education of a 4-year birth cohort to the Basic Competence Test (BCT) scores in Mandarin, mathematics and science for junior high school students age 15 to 16 years. The study groups comprised infants with term low birth weight (TLBW; n = 33 507), preterm normal birth weight (PNBW; n =19 905), and preterm low birth weight (PLBW; n = 25 840), as well as randomly selected term infants with normal birth weight (TNBW; n = 83 756). Paternal education levels were categorized. RESULTS: Compared with the TNBW adolescents, the TLBW adolescents consistently showed larger deficits in mean scores for Mandarin (beta = -2.36), mathematics (beta = -2.89), and science (beta = -2.11). The corresponding significant deficit scores for the PLBW adolescents were -1.93, -2.80, and -1.92. The deficit scores were very small for the PNBW adolescents. Paternal education was inversely associated with scores of all 3 groups. Lower paternal education level tended to worsen the negative impact of low birth weight on BCT scores. CONCLUSIONS: Both lower birth weight and lower paternal education exert an independent and interactive effect on adolescent learning achievement.

Evaluating effects of a prenatal breastfeeding education programme on women with caesarean delivery in Taiwan.

AIMS: The aims of this study were: (1) to evaluate the effectiveness of a prenatal breastfeeding education programme for primigravida women who have elected caesarean section as a model of delivery and (2) to evaluate its effectiveness for encouraging a positive attitude to breastfeeding and rooming-in and to increase exclusive breastfeeding rates within hospital and at one month postpartum. BACKGROUND: Prenatal preparation for pregnant women about breastfeeding enhances their practical knowledge and skills about breastfeeding techniques, which prepares them when encountering possible difficulties. DESIGN: A quasi-experimental design was used. METHODS: The targeted population was primigravidas at 36-39 weeks and who had chosen to deliver by caesarean section. The study consisted of approximately 100 individuals; the control group consisted of 46 subjects and the following 54 made up the experimental group. The study was conducted at a hospital in Taiwan. RESULTS: The results of the study show that the subjects of the experimental group exhibited a more positive breastfeeding attitude (88.9 vs. 79.8, t = 7.40, p < 0.001), a higher 24 hours rooming-in rate (87% vs. 63%, chi(2) = 16.06, p < 0.001) and a higher exclusive breastfeeding rate (79.6% vs. 52.2%, chi(2) = 8.38, p = 0.004) during hospital stays and a higher exclusive breastfeeding rate (75.9% vs. 34.7%, chi(2) = 16.98, p < 0.001) for the one month postpartum period. CONCLUSION: Results suggest that providing education booklets, videos and telephone interview on breastfeeding prior to a caesarean delivery may contribute to breastfeeding attitude and improved rooming-in and exclusive breastfeeding rates. RELEVANCE TO CLINICAL PRACTICE: This breastfeeding education programme has proven to be successful in aiding women breastfeeding after a caesarean delivery and provides health care professionals with an evidence-based intervention.

Community-based epidemiological study on breastfeeding and associated factors with respect to postpartum periods in Taiwan.

AIMS: To explore the prevalence of breastfeeding in different geographical areas and identify the factors influencing breastfeeding practices during in-hospital stay and at one, four and six months postpartum in Taiwan. BACKGROUND: The national data on prevalence for breastfeeding patterns are still unknown. DESIGN: Community-based epidemiological survey design. METHODS: A total of 12,201 women were sampled from the birth registration and surveyed between June-October 2004. Data were collected through a computer-assisted telephone interview at four different postpartum periods. Logistic regression modelling was applied to determine factors influencing breastfeeding patterns and postpartum time-specific odds ratios. RESULTS: Rates of breastfeeding practices were 29.4, 33.2, 16.9 and 13.1% for in-hospital stay, the first-, fourth- and sixth-month postpartum respectively. Mother's intention to breastfeed was the most important factor to lengthen breastfeeding practices over time. The effect of an advocate programme in the hospital was significantly associated with breastfeeding only at the time of in-hospital stay. Age, family support and singleton were found to be significantly related to the continuation of breastfeeding at the fourth month postpartum. Employment status was significantly associated with the termination of breastfeeding, particularly at the later postpartum period. Geographical variation in breastfeeding practices within the first month postpartum was identified. In contrast, ethnic variation was more apparent at the later postpartum period. CONCLUSIONS: This large-scale study revealed a significantly decreasing trend after one month postpartum of breastfeeding rate in each geographical area of Taiwan. Factors associated with women's decision and continuation on breastfeeding patterns tended to be dependent on the time-specific postpartum period and varied between geographical areas. RELEVANCE TO CLINICAL PRACTICE: If breastfeeding rates are to increase, more attention should be paid to establish early breastfeeding and counter the negative influences of factors within the social environment.

Breastfeeding experiences of Taiwan nurses on rotational shifts.

The aim of this study was to describe the experiences of ten three-shift nurses, with particular focus on how they make arrangements regarding breastfeeding in relation to their workplaces and work breaks. Using a qualitative approach, data were obtained through semi-structured interviews with ten three-shift nurses who had breastfed for more than six months and who returned to work after childbirth. Snowball sampling was used to recruit participants, each of whom was interviewed for 1.5-2 hours. Content analysis was used to synthesize interview transcripts. The following three predominant themes and nine sub-themes were identified: (1) managing to express milk--finding appropriate times to express milk during day shifts, learning the timing to express milk during night shifts, and expressing all milk from the breasts during early morning 'graveyard' shifts; (2) dealing with the conflict between work and expressing milk--learning to both take care of patients and express milk, coming back to work on time after expressing milk, and finding "good" places to express milk; and (3) viewing breastfeeding as part of life--being with the baby at home more than being out, turning cars into mobile breastfeeding and milk-expressing "rooms", and breastfeeding as an accomplishment. These findings can help nurses and other healthcare professionals provide anticipatory guidance to women who plan to continue to breastfeed after returning to work. Study results can provide a reference for shift workers who continue to breastfeed after they return to work.

Factors associated with women's perception of and satisfaction with quality of intrapartum care practices in Swaziland.

OBJECTIVE: giving birth is a lifetime event, where the quality of care a woman receives has the potential to affect her or her baby both physically and emotionally either on a short-term or long-term basis. This study aimed at identifying factors associated with women's perception of and satisfaction with the quality of intrapartum care as well as their future loyalty intentions in two regional hospitals in Swaziland. METHODS: this is a correlational study where data were collected from 383 women conveniently selected from two regional hospitals where they gave birth. The QPP-I, SHPC, AND WOM questionnaires were used for data collection which was done from July to September 2016. FINDINGS: the results reflected that women's satisfaction with quality of intrapartum care total mean score was (M±SD = 74.17±10.1), a perceived reality of intrapartum care practices total mean score of (M±SD = 96.94±16.0), a high subjective importance total mean score (M±SD = 117.78±10.5), and above average future loyalty intension total mean score (M±SD 1.67±0.69). Factors that significantly predicted women's satisfaction with quality of intrapartum care include, perceived quality (F = 54.13, p<0.001 with 28% R2 variance), demographic variables (educational level, employment status and gestational weeks) (F = 10.66, p =<0.001, with 8% R2 variance), future loyalty intensions (F = 48.57, p<0.001with 7% R2 variance), and subjective importance (F = 44.74, p<0.001 with 1% R2 variance). CONCLUSION: the study revealed that women's perceived reality of and satisfaction with the quality of intrapartum care practices was suboptimal. Improvement should be focused on evidence-based intrapartum care that is women-centered, involving the clients in decision-making and also a comprehensive childbirth education for the pregnant mothers.

Interrelationship between insulin resistance and menopause on the metabolic syndrome and its individual component among nondiabetic women in the kinmen study.

BACKGROUND: The literature to date is not clear as to whether any interactive effect exists between insulin resistance and menopause on the metabolic syndrome and its individual components. We explored this issue in 4107 homogeneous, nondiabetic Chinese women in the Kinmen Study. METHODS: Overnight fasting blood samples were drawn for glucose, insulin, lipid, and other biochemical measurements. Demographic and clinical variables including body mass index, waist circumference, and blood pressure were measured and documented during face-to-face interviews with structured questionnaires. Menstrual history was used to define menopause as the absence of menses for 12 consecutive months. RESULTS: Approximately 16% of premenopausal women (390/2423) were insulin-resistant. After adjustment for age, body mass index, lifestyle, and diet, both menopause and insulin resistance were independently and significantly correlated with metabolic syndrome. For each component of the metabolic syndrome, besides the main effect, the interaction (insulin resistance x menopause) had significant correlation with systolic blood pressure, diastolic blood pressure, and waist circumference. CONCLUSIONS: Both insulin resistance and menopause have significant effects on metabolic syndrome independent of age and obesity. In premenopausal and nondiabetic women, various degrees of insulin resistance exist. The synergistic contribution of insulin resistance and menopause to components of the metabolic syndrome were observed with systolic blood pressure, diastolic blood pressure, and waist circumference. This requires further study.

[Assisting mother with preterm infant breastfeeding].

It is necessary to gain nutrition for infants, especially premature. The digestive systems of premature infants are immature, so they find it hard to absorb nutrients. Mother's milk is easy for preterm infants to digest and absorb, so it is the best food for them. In reality, however, mothers always face many problems when breastfeeding preterm infants. They need support systems to establish their confidence in breastfeeding in order to improve their success rates and thus facilitate their continuation of the practice. Nurses can teach mothers how to breastfeed preterm infants. The purpose of this paper, therefore, is to describe the characteristics of the gastrointestinal systems of premature babies, the benefits of breastfeeding for premature babies, the factors influencing premature breastfeeding, the transition from gavage to oral feeding and how to assist the mothers of premature babies with breastfeeding. It also provides information on premature breastfeeding to enable nurses to provide early assistance to mothers in nursing their premature infants and in maintaining the practice of breastfeeding.

[Humanized childbirth].

Childbirth is a major event in a family. The expectant parent's perception of the childbirth experience influences his or her development as a parent. Making childbirth a positive and satisfying experience for women is the responsibility of health care providers. Women want to have physical and emotional privacy during labor and delivery, and to experience both in a friendly, comfortable environment. For women expected to undergo normal deliveries, humanized childbirth is one accessible approach. This article explores the definition and evolution of humanized childbirth and the care practice that it involves. It also explores birth plans and birth experiences, and the improvements necessary to routine labor practices to enable women to participate in decision making about their childbirth experiences. The author emphasizes that when health-care providers recognize the value of humanized childbirth and make changes accordingly, the dignity of women's childbirth experiences will be enhanced.

[Constructing a breastfeeding-friendly workplace: demonstration from hospital].

To breastfeed is a right of women and infants. However, breastfeeding is viewed as a " Private domain" rather than as a "public domain" issue. Many people therefore think that it is unnecessary to use public policy to solve problems associated with breastfeeding. Nurses, due to heavy work loads and responsibilities, and shift rotation, have to face many difficulties when they combine breastfeeding and work. Since the question of whether nurses may successfully breastfeed their offspring in the workplace is one of particular significance, this article considers the importance of breastfeeding in the workplace and nurses experiences thereof, and the international criteria for a friendly breastfeeding workplace for women, in order to discuss ways in which Taiwan's health care institutions should create breastfeeding-friendly environment.