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

Determinants of exclusive direct breastfeeding using constructs from the breastfeeding relationship scale

OBJECTIVES

This study examined the relationship among constructs of the Breastfeeding Relationship Scale and exclusive direct breastfeeding (EDBF) while controlling for covariates in US breastfeeding dyads in the first 3 months.

BACKGROUND

The Breastfeeding Relationship Scale was developed to measure mother-infant mutual responsiveness during breastfeeding in response to perceived insufficient milk, but there is no clear understanding about the relationships between the Breastfeeding Relationship Scale's constructs and EDBF.

METHODS

A cross-sectional design was used. The convenience sample of 589 directly breastfeeding mothers in the US whose infants were between 1 and 12 weeks of age were included for analysis using a structural equation model. Covariates for EDBF included mother's age, education, marital status, parity, prior breastfeeding experience, infant's age, weight, and sex.

RESULTS

Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity were related (β = 0.33, p < .001), as were Breastfeeding Synchronicity and Perceived Adequate Milk Supply (β = 0.35, p < .001) and Mother-Infant Breastfeeding Interaction and Perceived Adequate Milk Supply (β = 0.08, p = .05). The relationship between Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity with EDBF was fully mediated by Perceived Adequate Milk Supply, where the odds of EDBF was higher for mothers with higher scores on Perceived Adequate Milk Supply (OR = 1.61, p < .001) and prior breastfeeding experience (OR = 2.31, p = .006).

CONCLUSIONS

Perceived Adequate Milk Supply and prior breastfeeding experience are major determinants of EDBF in the first 3 months. Breastfeeding Synchronicity can bolster Mother-Infant Breastfeeding Interaction and promote Perceived Adequate Milk. More attention should be paid to breastfeeding relationship to be the result of EDBF.

New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care

Background

In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days.

New perspectives

The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC.

Actionable recommendations

This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units.

Discussion

The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.

Skin-to-skin care (SSC) for term and preterm infants

Skin-to-skin care (SSC) is an important part of parent and infant care during the neonatal period and into infancy. SSC should be initiated immediately after birth and practiced as a standard of care in all settings, as well as in the home. There is strong evidence that SSC has a positive effect on breastfeeding and human milk feeding in both term and preterm infants, as well as on mortality, cardiopulmonary stability, and thermoregulation. SSC reduces pain and infant stress, enhances parent-infant bonding, has neurodevelopmental benefits, and has positive effects on parental mental health. The safety and feasibility of providing SSC has been established in term and preterm infants, and SSC is recommended as best practice for all infants. The benefits of SSC outweigh the risks in most situations, and despite challenges, care providers should implement procedures and accommodations to ensure that SSC occurs as a safe and positive experience for the parent, family, infant, and health care team. This statement includes all families as defined and determined by themselves, and recognizes that health communication, language, and terminology must be individualized to meet specific family needs by the health care team.

Les soins peau-à-peau chez les nourrissons à terme et prématurés

Les soins peau-à-peau (SPP) sont un aspect important des soins au parent et au nourrisson pendant la période néonatale et la première enfance. Ils doivent être entrepris immédiatement après la naissance et faire partie des soins standards dans tous les milieux, y compris à la maison. Selon de solides données probantes, les SPP ont un effet positif sur l'allaitement et l'alimentation par du lait humain, tant chez les nourrissons à terme que prématurés, de même que sur la mortalité, la stabilité cardiorespiratoire et la thermorégulation. Les SPP réduisent la douleur et le stress chez les nourrissons, accroissent l'attachement entre le parent et son nourrisson et ont des effets bénéfiques sur le neurodéveloppement de l'enfant ainsi que sur la santé mentale des parents. Le caractère sécuritaire et la faisabilité des SPP sont établis chez les nourrissons à terme et prématurés, et ces soins sont recommandés dans le cadre d'une pratique exemplaire auprès de tous les nourrissons. Les avantages des SPP sont supérieurs aux risques dans la plupart des situations, et malgré les défis qui y sont associés, les dispensateurs de soins devraient adopter des protocoles et prévoir des adaptations pour s'assurer que les SPP soient une expérience positive et sécuritaire pour le parent, la famille, le nourrisson et l'équipe soignante. Le présent document de principes s'adresse à toutes les familles, telles qu'elles se définissent et se déterminent elles-mêmes, et tiennent compte de l'importance de personnaliser la communication, le langage et la terminologie en matière de santé pour que l'équipe soignante réponde aux besoins particuliers de la famille.

A multilevel developmental psychopathology model of childbirth and the perinatal transition

Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.

Impact of Early Bonding During the Maternal Sensitive Period on Long-Term Effects: A Systematic Review

This research project examines the long-term effects of maternal-neonatal bonding during a mother's "sensitive period." The review explores how early contact between a mother and her newborn can affect their psychosocial and emotional well-being in the future. Within an hour after birth, oxytocin levels increase for mothers, while catecholamine surges enhance neonates' memory retention to encourage immediate skin-to-skin contact (SSC), which promotes breastfeeding with benefits, such as quicker placenta expulsion, less bleeding, and lower stress. As per sources to date, there is no systematic review on this subject; however, numerous studies exist regarding short-term outcomes, exclusive breastfeeding, and childhood problems. The exploration involves rigorous searches of academic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for transparency and reproducibility by using the Population, Intervention, Comparison, and Outcome (PICO) framework. Of the 516 initially identified articles, only five were relevant based on refined selection criteria, making it clear from the analysis that sensitive-period bonding produces long-term impacts in infants. Few studies are available, particularly in recent years; thus, more research is required in this area.

Is Birth Method Associated with Sensory Hyperreactivity in Children 3-4 Years in an Upper-Middle-Income Country?

Background

Research has shown that pressure in the vaginal birth process aids the infant's neurophysiological adaption to extrauterine life, including their ability to regulate their responses to diverse sensory stimuli. As pressure is absent in elective caesarean section births, we hypothesised that these children may be at higher risk for developing sensory hyperreactivity (SHR), a sensory modulation difficulty which negatively impacts on the child's engagement in their occupations. This paper reports on a study which investigated associations between birth method and SHR.

Method

In this cross-sectional study, 91 children aged three and four years from various language, cultural, and socioeconomic groups were recruited and categorised based on birth method (caesarean section or vaginal birth). Caregivers of each child completed the Short Sensory Profile-2 and a demographic questionnaire. The prevalence of SHR between the birth method groups was compared.

Results

The prevalence of SHR was greater in the vaginal birth group (29%) than the caesarean section group (9%). Mothers in the vaginal birth group were younger (p ≤ 0.001), of lower-income level (p = 0.003), and more likely to be single (p = 0.037). During data collection with the vaginal birth group, comprehensibility of certain items in the Short Sensory Profile-2 proved challenging for many caregivers.

Conclusion

The statistically significant higher prevalence of SHR in the vaginal birth group supported a null hypothesis. However, the results are questioned due to the challenges related to data collection. Given this, the study supports the need for further investigation of how sociocultural and socioeconomic factors influence the assessment of SHR in the South African context.

Mother-child separation after twin birth in a maternity unit with an appropriate level of neonatal care

OBJECTIVE

To evaluate the mother-child separation rate in twin pregnancies delivered in maternity units offering an appropriate level of neonatal care.

METHODS

JUMODA is a French, prospective, population-based cohort study of twin deliveries, including 7998 women who gave birth in maternity units with appropriate levels of neonatal care based on thresholds for weeks of gestational age (wGA) and birth weight according to French guidelines: level I (≥36 wGA), IIA (≥34 wGA), IIB (≥32 wGA and ≥ 1500 g), and IIII (<32 wGA or < 1500 g). The primary outcome was mother-child separation, defined as the transfer of at least one twin or the mother to another hospital.

RESULTS

Mother-child separation occurred in 2.1% of pregnancies. This rate was significantly higher in level I (4.8%, 95% confidence interval [CI] 1.5-12.5) and IIA (3.4%, 95% CI 2.4-4.7) compared with level IIB (1.6%, 95% CI 1.1-2.3) and level III maternity units (2.1%, 95% CI 1.9-2.8). In level IIA units, the rate of mother-child separation was higher for babies born between 34 and 36 wGA (8.3%) than for those born at 36 wGA or beyond (1.7%). In level IIb, the rate of mother-child separation for babies born between 32 and 34 wGA (7.5%) was higher than for those born between 34 and 36 wGA (2.1%) and at 36 wGA or beyond (0.9%).

CONCLUSION

Mother-child separation rates were low but differed by level of care. By using specific thresholds for twins to define levels of care, rather than data from singleton births, one-fifth of mother-child separations could have been avoided.

Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers-A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey

Early initiation of breastfeeding (EIBF) involves feeding a newborn with the mother's breast milk within the first hour of delivery. The prevalence of EIBF in Vietnam has recently shown a downward trend. The present study aimed to demonstrate the current prevalence of EIBF practices and identify factors associated with EIBF among Vietnamese mothers with children under 24 months of age. This study was a secondary analysis of data from the Viet Nam Sustainable Development Goal Indicators on Children and Women (SDGCW) survey 2020-2021. The study participants included 1495 mothers extracted from the SDGCW dataset. Descriptive statistics and logistic regression analyses were performed. The prevalence of EIBF practice was 25.5% among all mothers, 31.9% among vaginal-delivery mothers groups, and 9.0% among cesarean-section mothers groups. Factors negatively associated with EIBF were younger age (0.18 times), cesarean delivery (0.25 times), and absence of skin-to-skin contact with newborns immediately after birth (0.43 times). The prevalence of EIBF among Vietnamese mothers was found to be substantially low, especially among those who underwent cesarean delivery. EIBF should be promoted among younger mothers and those who underwent cesarean delivery.

Investigating short-stay admission to a neonatal intensive care unit as a risk factor for reduced breast feeding at discharge in infants ≥36 weeks' gestation: a retrospective cohort study

OBJECTIVE

This study aims to determine the effect of infant-mother separation following a short-stay (≤72 hours) admission to a Level 5 neonatal unit versus no admission on infant-feeding outcomes at hospital discharge.

DESIGN

Retrospective cohort study.

SETTING

An Australian Level 5 neonatal unit within a tertiary referral hospital.

PARTICIPANTS

Mothers and their infants born between 1 January 2018 and 31 December 2020 had a short-stay admission to the neonatal unit or no admission. All participants met admission criteria to the postnatal ward and were discharged home at ≤72 hours (n=12 540). Postnatal ward admission criteria included ≥36 weeks' gestation and birth weight ≥2.2 kg.

MAIN OUTCOME MEASURES

Infant feeding at discharge from hospital. Multivariate logistic regression analysis was conducted, adjusting for confounders associated with known breastfeeding issues. These included age, ethnicity, parity, obesity, socioeconomic score, hypertensive disorders of pregnancy, diabetes, infant gestation and birthweight centile, caesarean section birth, postpartum haemorrhage and skin-to-skin contact.

RESULTS

Of the 12 540 live births meeting inclusion criteria, 1000 (8%) infants were admitted to the neonatal unit. The primary reasons for admission were suspicion of sepsis (24%), maternal diabetes (19%) and jaundice (16%). We found a reduction in full breast feeding at hospital discharge in cases of a short admission to the neonatal unit compared with no admission (aOR 0.40; 95% CI 0.34 to 0.47; p<0.001). We identified that women of different ethnicities had differing levels of risk for formula supplementation at hospital discharge. The ethnic grouping least likely to be fully breast feeding at discharge was Southeast Asian women (aOR 0.47; 95% CI 0.39 to 0.57; p<0.001).

CONCLUSIONS

Identifying mother-infant dyads at risk of non-exclusive breast feeding at hospital discharge will help target resources for practice improvement.

Breastfeeding and infant care as 'sexed' care work: reconsideration of the three Rs to enable women's rights, economic empowerment, nutrition and health

Women's lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women's reproductive biology is closely linked to their social roles and situation, including regarding economic disadvantage and disproportionate unpaid work. Recognizing, as well as reducing and redistributing women's care and domestic work (known as the 'Three Rs'), is an established framework for addressing women's inequitable unpaid care work. However, the care work of breastfeeding presents a dilemma, and is even a divisive issue, for advocates of women's empowerment, because reducing breastfeeding and replacing it with commercial milk formula risks harming women's and children's health. It is therefore necessary for the interaction between women's reproductive biology and infant care role to be recognized in order to support women's human rights and enable governments to implement economic, employment and other policies to empower women. In this paper, we argue that breastfeeding-like childbirth-is reproductive work that should not be reduced and cannot sensibly be directly redistributed to fathers or others. Rather, we contend that the Three Rs agenda should be reconceptualized to isolate breastfeeding as 'sexed' care work that should be supported rather than reduced with action taken to avoid undermining breastfeeding. This means that initiatives toward gender equality should be assessed against their impact on women's ability to breastfeed. With this reconceptualization, adjustments are also needed to key global economic institutions and national statistical systems to appropriately recognize the value of this work. Additional structural supports such as maternity protection and childcare are needed to ensure that childbearing and breastfeeding do not disadvantage women amidst efforts to reduce gender pay gaps and gender economic inequality. Distinct policy interventions are also required to facilitate fathers' engagement in enabling and supporting breastfeeding through sharing the other unpaid care work associated with parents' time-consuming care responsibilities, for both infants and young children and related household work.

Effects of social and sensory deprivation in newborns: A lesson from the Covid-19 experience

BACKGROUND

Infancy is a complex period of human life, in which environmental experiences have a fundamental role for neurodevelopment. Although conditions of social and sensory deprivation are uncommon in high income countries, the Covid-19 pandemic abruptly modified this condition, by depriving people of their social stimuli of daily life.

AIM

To understand the impact of this deprivation on infants' behaviour, we investigated the short-term effects of isolation and use of individual protective systems by mothers during the first two weeks of life.

METHODS

The study included 11 mother-infant dyads with mothers tested positive to SARS-CoV-2 at the time of delivery (Covid group) and 11 dyads with a SARS-CoV-2 negative mother as controls. Neurobehavioral, visual, and sensory processing assessments were performed from birth to 3 months of age.

RESULTS

Findings showed the effect of deprivation on some neurobehavioral abilities of infants in the Covid group; in addition, differences in sensory maturation trends were observed, although they tended to gradually decrease until disappearance at 3 months of age.

CONCLUSION

These findings suggest the significant effects of early sensory and social deprivation during the first two weeks of life, but also provide several insights on the ability of the brain to restore its aptitudes by deleting or reducing the effects of early deprivation before the critical periods' closure.

Influence on operative time of immediate skin-to-skin care in low-risk primary cesarean births for breech presentation: Retrospective cohort study

BACKGROUND

Multiple benefits for both, mother and baby have been reported from immediate skin-to-skin care (SSC). The aim of this study was to analyze the influence of SSC on operative time and blood loss in primary cesarean births for breech presentation.

METHODS

A SSC protocol for cesarean birth was implemented in our institution on February 25, 2019. In this single-center retrospective cohort study, we compared the outcomes of planned primary cesarean births for breech presentation at term before and after its implementation.

RESULTS

Data from 110 women who had a cesarean birth for breech presentation at term were analyzed, 55 in each group. Group 1 were women who had immediate SSC and Group 2 were women without immediate SSC. Maternal and surgical characteristics, and neonatal outcomes were similar in both groups. The mean operative time was 3.22 minutes shorter in the immediate SSC group compared with the not immediate SSC group (37.13 ± 12.27 vs 40.35 ± 12.23 minutes; P = 0.171).

CONCLUSIONS

In conclusion, immediate SSC following a low-risk cesarean birth for breech presentation neither prolongs the operative time nor increases blood loss during the procedure. Although we were unable to demonstrate a significant reduction in the operative time with the immediate SSC protocol, a decrease of 3 minutes was noted.

Psychosocial factors associated with mother-infant bonding in Indonesian samples

BACKGROUND

Mother-infant bonding is an important factor that supports an infant's socio-emotional development. Therefore, every family member should acknowledge these processes, especially in an extended family set-up like in Indonesia. The general study objective was to predict several socio-demographic factors associated with mother-infant bonding in Indonesian samples.

METHOD

This is a cross-sectional study. The participants included 168 mothers who had infants aged 0 to 36 months and willingly joined the study by signing the informed consent form. The Indonesian version of mother-infant bonding scale and a socio-demographic questionnaire were administered to all mothers. Logistic regression was applied to identify the socio-demographic factors that had any association with the mother-infant bonding scale. The data were analyzed using the SPSS program version 21 for Mac.

RESULTS

The study showed that 13.1% of the participants were categorized as having a moderate-to-high level of impaired mother-infant bonding. Logistic regression analysis showed that vaginal or normal delivery mode was 4.07 (95% CI [1.27, 13.09]) times more likely to exhibit low levels of impaired mother-infant bonding compared to a cesarean section. The model explained 18.6% (Nagelkerke R²) of the variance in impaired mother-infant bonding and accurately classified 86.9% of cases.

CONCLUSION

The findings support prior studies that have been conducted in several countries. Psychoeducation on supporting mother-infant bonding may consist of several topics, such as the advantages of vaginal delivery mode and the importance of family support. It may be delivered in the early adulthood period and, hopefully, basic knowledge during those periods may help strengthen the understanding of mother-infant dyad issues among all family members.

Negative childbirth experience in relation to mode of birth and events during labour: A mixed methods study

OBJECTIVE

To explore descriptions of negative childbirth experience in relation to mode of birth and events during labour.

DESIGN

A descriptive study using a convergent mixed methods design. Written responses to open-ended online questions regarding negative childbirth experience were explored using qualitative content analysis. Generated sub-themes were quantified, and stratified on mode of birth and events during labour.

PARTICIPANTS AND SETTING

112 women with low ratings of overall childbirth experience, participating in a randomised controlled trial evaluating internet-based cognitive behavioural therapy in Sweden. Qualitative data were collected before randomisation, three months postpartum.

RESULTS

Four sub-themes emerged from the qualitative analysis: Experiencing fear-based emotions, Experiencing physical distress, Being affected by caregivers' and partner's behaviour and Being affected by bad facilities and poor organisation. Only small differences were found when stratifying sub-themes on mode of birth and events during labour. Regardless of mode of birth and events during labour, the childbirth experience was dominated by fear-based emotions.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Mixed-methods analyses demonstrate the challenges in understanding negative childbirth experience in relation to mode of birth and specific events during labour, with results clearly showing the multifaceted nature of this concept. The central role of fear in relation to negative childbirth experience should be considered when designing support during and after labour, to prevent adverse effects of the childbirth experience.

Congenital syphilis in a preterm newborn with gastrointestinal disorders and postnatal growth restriction

BACKGROUND

Congenital syphilis (CS) depends on the placental transmission of Treponema pallidum (TP) spirochetes from an infected mother to fetus during pregnancy. It shows a wide clinical variability with cutaneous and visceral manifestations, including stillbirths, neonatal death, and asymptomatic cases. Preterm infants with CS may have more severe features of disease than the term ones, due to the combined pathogenic effect of both CS and prematurity.

CASE PRESENTATION

We report on a female preterm (32⁺⁶ weeks of gestation) newborn showing most of the typical CS manifestations, in addition to gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorption leading to postnatal growth restriction. The mother resulted positive at the syphilis screening test of the first trimester of pregnancy, but she did not undergo any treatment. At birth, our newborn was VDRL positive (antibody titer four times higher compared to the mother), and she was treated with intravenous benzathine benzylpenicillin G for 10 days (50,000 IU/Kg three times per day). Poor tolerance to enteral nutrition (abdominal distension, increased biliary type gastric secretions) was observed. A barium enema X-Ray identified a colon stenosis within the descending tract. However, the poor general conditions due to a concurrent fungal sepsis did not allow to perform any surgical procedure, and a conservative approach with total parenteral nutrition was started. The following evolution was marked by difficulties in enteral feeding including refusal of food and vomiting, to which also contributed the neurological abnormalities related to a perinatal asphyxia, and the affective deprivation for the physical absence of the mother during hospitalization. At 5 months of age, after the introduction of an amino acid-based formula (Neocate LCP Nutricia ®), an improvement of enteral feeding was observed, with no further and significantly decreased episodes of abdominal distension and vomiting respectively, and regular stool emission. A psychological support offered to the family allowed a more stable bond between the mother and her baby, thus providing a significant additional benefit to food tolerance and growth. She was discharged at 5 months of age, and included in a multidisciplinary follow-up. She at present shows global growth delay, and normal development apart from mildly increased tone of lower limbs.

CONCLUSIONS

Our report highlights less common clinical CS manifestations like gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorption leading to postnatal growth delay. Moreover, it underlines how prematurity may worsen the clinical evolution of such congenital infection, due to the additional pathogenic effect of possible associated diseases and/or conditions like sepsis, hypoxic/ischemic injury, or use of drugs. CS may be observed also in high-income countries, with high rates of antenatal screening and availability of prenatal treatment. A multidisciplinary network must be guaranteed to the affected subjects, to ensure adequate care and improve the quality of life for patients and their families.

How to Improve the Care of Women after Childbirth in the Rooming-in Unit: A Prospective Observational Study

Rooming-in is the WHO-recommended care system for mothers in the puerperium and their babies. This system allows the newborn to stay with the mother in the same room, 24 h a day. We aimed to investigate the need to entrust a newborn (NEN) in the care of maternity rooming-in staff during the COVID-19 pandemic, and its relationship to pain, anxiety, and blood loss after delivery. A prospective study of 200 adult women in the maternity ward operating in the rooming-in system focussed on NEN in the care of maternity rooming-in staff on the first (T1) and the second day of puerperium (T2). Women who declared having NEN were compared with women without NEN for anxiety, pain, and a drop in haemoglobin in the blood after delivery. In T1, 34% and in T2, 27% of women felt NEN in the care of maternity rooming-in staff. The NEN of women after a cesarean section was higher on both days than the NEN of women after vaginal delivery. Women with NEN had higher levels of pain, state anxiety, and higher levels of postpartum anxiety than women without NEN. Further research should be warranted to investigate whether women who give birth in hospitals that satisfy the NEN in the care of maternity rooming-in staff in their rooming-in units experience less pain and anxiety in comparison to those who give birth in hospital units without such a possibility and whether this factor is an important element in reducing anxiety and pain during puerperium.

Parents and newborn "togetherness" after birth

Purpose

Zero separation is a family-centred approach where newborns should be accompanied by their parents, regardless of the type of birth or health status. To our knowledge, few studies have described the way this approach is realized in clinical practice. This study describes situations of separation between mother/partner and newborn after birth on the labour ward, maternity ward and at the neonatal unit.

Method

An observation study was conducted during four months at a Swedish hospital. All caregivers at the three units were given the task of collecting the data. A semantic thematic analysis was performed with an inductive approach.

Results

Six themes emerged from the analysis. Two themes were common to all three units, one theme was common to two units and three themes emerged at only one unit. The themes describe various causes of separation, such as organizational and economic barriers, clinical routines, parents’ own decisions, shortage of collaboration within and between units, as well as a shortage of interprofessional communication.

Conclusion

Our study shows that there is still a gap between the latest evidence-based knowledge of the importance of zero separation and current practice in newborn care. There is a need for continuous collaboration between all units responsible for the care of mother and newborn.

Navigating through motherhood in pregnancy and postpartum periods during the COVID-19 pandemic: A systematic review and qualitative meta-synthesis

AIM

The aim of this work is to critically appraise and synthesize the qualitative studies on the experiences, perspectives, and consequences of pregnant women experiencing motherhood during the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic has posed a threat to the health of pregnant women. Such a pandemic disrupted their routine care, as well as normal daily life. However, little is known about their coping strategies to the changes brought by COVID-19.

EVALUATION

A qualitative systematic review was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist. A meta-aggregative approach rooted in pragmatism and Husserlian transcendental phenomenology was used to synthesize the findings. Dependability and credibility of both study findings and synthesized findings were appraised by Joanna Briggs Institute (JBI) ConQual process.

KEY ISSUES

Key issues include (a) pregnant women experienced changes in routine care, (b) pregnant women used a range of strategies to cope with the consequence of the pandemic, (c) pregnant women struggled to embrace motherhood, and (d) pregnant women received different levels of social support.

CONCLUSION

Facing challenges caused by the pandemic, pregnant women used a variety of strategies to cope with and adapt to the changes, but sometimes the adaption is limited. Emotional, instrumental, and informational support should be provided to them in an accessible way.

IMPLICATIONS FOR NURSING MANAGEMENT

As an essential part of policymakers, nursing managers should consider the balance between restriction and the accessibility of maternity care. It is also crucial for them to consider how to provide necessary support in an accessible way.

Peripartum effects of synthetic oxytocin: The good, the bad, and the unknown

The first clinical applications of oxytocin (OT) were in obstetrics as a hormone to start and speed up labor and to control postpartum hemorrhage. Discoveries in the 1960s and 1970s revealed that the effects of OT are not limited to its peripheral actions around birth and milk ejection. Indeed, OT also acts as a neuromodulator in the brain affecting fear memory, social attachment, and other forms of social behaviors. The peripheral and central effects of OT have been separately subject to extensive scrutiny. However, the effects of peripheral OT-particularly in the form of administration of synthetic OT (synOT) around birth-on the central nervous system are surprisingly understudied. Here, we provide a narrative review of the current evidence, suggest putative mechanisms of synOT action, and provide new directions and hypotheses for future studies to bridge the gaps between neuroscience, obstetrics, and psychiatry.

Effects of different doses of synthetic oxytocin on neonatal instinctive behaviors and breastfeeding

Synthetic oxytocin is the current domestic first-line agent of induced labor and labor augmentation, and its potential effects on neonatal neurobehavioral development is currently attracting increased attention. To explore the effect of different doses of synthetic oxytocin on neonatal instinctive breastfeeding behavior and breastfeeding by observing neonatal behaviors during skin-to-skin contact with mothers after delivery. Observations and comparisons of neonatal instinctive behaviors were conducted by using Widström's 9 Stages method. According to the total dosage of oxytocin administered during labor, participants were divided into a low dose group (≤ 2.5 U) of 39 pairs, a medium dose group (> 2.5 U) of 38 pairs, a high dose group (> 7.5 U) of 38 pairs and a control group (no synthetic oxytocin use) of 39 pairs. The occurrence time of newborns' instinctive movements and the duration of each behavior stage for the four groups were also analyzed. The number of exclusive breastfeeding sessions within 3 days after birth and the rate of exclusive breastfeeding at 3 months were collected and compared. There were significant differences among the four groups in the occurrence time of raising head or turning head (p = 0.004), eating hands (p = 0.011), moving body (p = 0.001), locating areola (p < 0.001), licking nipples (p = 0.002), containing nipple (p = 0.001), sucking (p < 0.001). There were significant differences among the four groups in the duration of activity (p = 0.004), clawing (p = 0.001), familiarization (p = 0.001), and sucking (p < 0.001). There was also a significant difference in the number of exclusive breastfeeding sessions of 24 h (p = 0.011), 48 h (p < 0.001), 72 h (p = 0.001) after birth among the four groups, but there was no statistical difference in the rate of exclusive breastfeeding at 3 months after birth. The intrapartum administration of synthetic oxytocin was associated with the expression of neonatal instinctive breastfeeding. With increases in drug dose, the effect of breast seeking activity and breast attachment was more significant, and the association of synthetic oxytocin on sucking and breastfeeding was dose-dependent.

Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months

OBJECTIVE

To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States.

DESIGN

A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019.

PARTICIPANTS

We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion.

MEASUREMENTS

The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences.

RESULTS

Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]).

CONCLUSION

Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.

Birth, love, and fear: Physiological networks from pregnancy to parenthood

Pregnancy and childbirth are among the most dramatic physiological and emotional transformations of a lifetime. Despite their central importance to human survival, many gaps remain in our understanding of the temporal progression of and mechanisms underlying the transition to new parenthood. The goal of this paper is to outline the physiological and emotional development of the maternal-infant dyad from late pregnancy to the postpartum period, and to provide a framework to investigate this development using non-invasive timeseries. We focus on the interaction among neuroendocrine, emotional, and autonomic outputs in the context of late pregnancy, parturition, and post-partum. We then propose that coupled dynamics in these outputs can be leveraged to map both physiologic and pathologic pregnancy, parturition, and parenthood. This approach could address gaps in our knowledge and enable early detection or prediction of problems, with both personalized depth and broad population scale.

A Systematic Review of the Effects of Skin-to-Skin Contact on Biomarkers of Stress in Preterm Infants and Parents

BACKGROUND

Premature infants and their parents experience significant stress related to separation and lifesaving procedures. While evidence suggests that skin-to-skin contact (SSC) is a stress-reducing intervention for both neonates and parents, the mechanisms that underlie its efficacy are not well understood.

OBJECTIVE

Purpose of this systematic review is to summarize the current state of knowledge on changes in biomarkers (ie, oxytocin [OT], cortisol, hypoxanthine, xanthine, uric acid, and allantoin), associated with SSC in premature infants and parents, that may reflect physiologic responses to stress.

METHODS

A comprehensive literature search was conducted from 1990 to 2020. Studies were selected using prespecified inclusion and exclusion criteria.

RESULTS

Of the 175 studies identified, only 19 are included in this review. Ten studies evaluated only infants, 2 evaluated only parents, and 7 evaluated for changes in biomarkers in both infants and parents. Cortisol was the most common biomarker evaluated. While changes in infants' cortisol levels were highly variable, in 55% of the parent studies, parent cortisol levels decreased following SSC. In both parents and infants, OT levels decreased following SSC. Only 1 study found that allantoin levels were significantly lower in infants who received SSC.

IMPLICATIONS FOR PRACTICE AND RESEARCH

While evidence suggests the numerous benefits of SSC, additional research is needed to identify the optimal biomarker to determine the mechanisms that underlie these effects. The use of novel biomarkers (eg, gene expression changes microbiome) may provide new insights into the mechanisms that underlie the efficacy of SSC.Video Abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48.

Initiation and duration of skin-to-skin contact for extremely and very preterm infants: A register study

AIM

This study sought to describe how skin-to-skin contact between extremely and very preterm infants and their parents is practised in Swedish neonatal units.

METHODS

Data from the Swedish Neonatal Quality Register from 2020 to 2021 were extracted to analyse initiation time and daily duration of skin-to-skin contact in different gestational ages and regions.

RESULTS

Of the 1475 infants in the cohort, mean (range) gestational age was 28 weeks (22-31), and mean (range) birthweight was 1205 g (360-2810). For extremely preterm infants (<28 weeks), median (interquartile range) skin-to-skin contact initiation time was at 88 postnatal hours (48-156) and 5% had skin-to-skin contact on the first day. For very preterm infants (<32 weeks), the corresponding numbers were 14 h (4-36) and 34%. Median (interquartile range) daily skin-to-skin contact duration for the entire cohort during the first day, first three and seven days and the remaining hospital stay was 0 (0-0), 0.7 (0-2.7), 1.6 (0.4-3.6) and 4.4 (3.0-6.1) h, respectively.

CONCLUSION

A minority of extremely and very preterm infants were exposed to skin-to-skin contact on the first postnatal day. Daily duration during the first week of life amounted to less than two hours. Initiation time and daily duration varied among gestational ages.

Canada's Colonial Genocide of Indigenous Peoples: A Review of the Psychosocial and Neurobiological Processes Linking Trauma and Intergenerational Outcomes

The policies and actions that were enacted to colonize Indigenous Peoples in Canada have been described as constituting cultural genocide. When one considers the long-term consequences from the perspective of the social and environmental determinants of health framework, the impacts of such policies on the physical and mental health of Indigenous Peoples go well beyond cultural loss. This paper addresses the impacts of key historical and current Canadian federal policies in relation to the health and well-being of Indigenous Peoples. Far from constituting a mere lesson in history, the connections between colonialist policies and actions on present-day outcomes are evaluated in terms of transgenerational and intergenerational transmission processes, including psychosocial, developmental, environmental, and neurobiological mechanisms and trauma responses. In addition, while colonialist policies have created adverse living conditions for Indigenous Peoples, resilience and the perseverance of many aspects of culture may be maintained through intergenerational processes.

Influence of the COVID-19 pandemic on breastfeeding support for healthy mothers and the association between compliance with WHO recommendations for breastfeeding support and exclusive breastfeeding in Japan

Background

Professional breastfeeding support contributes to maternal and child health. However, the influence of the current coronavirus disease 2019 (COVID-19) pandemic on breastfeeding support has not been carefully examined. Therefore, we assessed maternal breastfeeding intention and professional breastfeeding support before and during the pandemic. We further examined the association of compliance with World Health Organization (WHO) recommendations for professional breastfeeding support with exclusive breastfeeding during the pandemic.

Methods

This cross-sectional, internet-based, questionnaire study analyzed data from 484 healthy women with live singleton births between 15 October 2019 and 25 October 2020 in Japan. A delivery before 5 March 2020 was classified as a before-pandemic delivery (n = 135), and a delivery after 6 March 2020 was a during-pandemic delivery (n = 349). Among the ten breastfeeding support steps recommended by the WHO, we assessed the five steps that are measurable by maternal self-report and would likely exhibit variability. Receipt of a free formula sample or invitation to a free sample campaign by the time of survey was also asked. Infant feeding status at the time of the survey was measured among women with infants younger than 5 months, which was a subgroup of mothers who delivered during the pandemic. Mothers were asked what was given to infants during the 24 h before the survey and when nothing other than breast milk was given, the status was classified as exclusive breastfeeding.

Results

While 82.2% of women with a delivery before the pandemic intended to breastfeed, the rate was 75.6% during the pandemic (p = 0.120). The average number of breastfeeding support steps received was 3.24 before the pandemic but it was 3.01 during the pandemic (p = 0.069). In particular, rooming-in was less frequent (39.3% before vs. 27.8% during the pandemic, p = 0.014). Among mothers with infants younger than 5 months who had a delivery during the pandemic (n = 189), only 37.0% (n = 70) reported exclusively breastfeeding during the 24 h before completing the survey. Multiple logistic regression analysis indicated that receiving support for all five steps was positively associated with exclusive breastfeeding during the 24 h before the survey (adjusted odds ratio 4.51; 95% CI [1.50-13.61]). Receipt of a free formula sample or invitation to a free sample campaign was negatively associated with exclusive breastfeeding (adjusted odds ratio 0.43; 95% CI [0.19-0.98]). Other factors related to non-exclusive breastfeeding were older maternal age, lower education level, primiparity, and no breastfeeding intention.

Conclusions

The pandemic weakened breastfeeding support for healthy women in Japan; however, support practice that adhered to WHO recommendations appeared to be effective during the pandemic.

COVID-19 Pandemic-Related Restrictions: Factors That May Affect Perinatal Maternal Mental Health and Implications for Infant Development

This review aims to discuss the factors that may affect maternal mental health and infant development in COVID-19 pandemic condition. Toward this direction, the two objectives of this review are the following: (a) to discuss possible factors that may have affected negatively perinatal mental health through the pandemic-related restrictions; and (b) to present the implications of adversely affected maternal emotional wellbeing on infant development. We conclude that the pandemic may has affected maternal mental health with possible detrimental effects for the infants of the COVID-19 generation. We highlight the need for evidence-based interventions to be integrated within the health system for prenatal and postpartum care in an effort to promote maternal mental health and infant development.

It's more than just lubrication of the skin: parents' experiences of caring for a child with ichthyosis

Background: The ichthyoses are a group of genetic skin disorders, characterized by excessive amounts of dry, thickened skin, which may be fragile, inelastic and prone to fissures and infection. Skin care is time consuming and demanding, and, usually performed by the parents.

Methods: We aimed to explore parental experience of caring for a child with ichthyosis, and collected data using semistructured interview, and thematic analysis.

Results: Our analysis revealed four main themes: Parents' and others' reactions to the child's difference, Experiences with healthcare services, It's all skin care, and Impact on relationships.

Conclusion: After birth of a child with severe ichthyosis, the parents experienced emotional distress and stigmatization due to the different appearance of the skin and healthcare professionals' lack of knowledge. Skin care caused pain in the child, was time consuming, and caused financial burdens. This study can guide healthcare professionals on where to focus future efforts in meeting the clinical and psychological needs of parents caring for a child with ichthyosis.

Father newborn skin-to-skin wheelchair transfer from delivery room to neonatal care unit: Possible change in practices

OBJECTIVE

To evaluate the transfer of newborns from the delivery room to the neonatal care unit with their fathers on wheelchairs in terms of the safety of the procedure and paternal anxiety.

METHODS

A prospective observational single-center before-and-after pilot study was conducted from February to May 2018 at the University Maternity Hospital of Nantes. Safe transfer was judged on the basis of episodes of hypothermia or hypoglycemia. Paternal anxiety was assessed with the State-Trait Anxiety Inventory (STAI) scale after newborn transfer.

RESULTS

Overall, 70 preterm newborns were enrolled, 44 were carried in wheelchairs in the father's arms (target group) and 26 were transferred in an incubator (control group). After adjusting for gestational age and birthweight, there were no statistically significantly differences between the target and the control group in the rates of hypothermia (43.9% vs 30.8%, p = 0,59) and hypoglycemia (9.52% vs 19.23%, p = 0,19). The STAI scale score was not significantly different between groups after incubator transfer or wheelchair transfer, at 35 ± 8.2 and 38 ± 10.2, respectively (p = 0.07).

CONCLUSION

Transferring a newborn to the neonatal care unit via wheelchair with the father is a safe alternative to incubator transfer.

Social Connection as a Public Health Issue: The Evidence and a Systemic Framework for Prioritizing the "Social" in Social Determinants of Health

There is growing interest in and renewed support for prioritizing social factors in public health both in the USA and globally. While there are multiple widely recognized social determinants of health, indicators of social connectedness (e.g., social capital, social support, social isolation, loneliness) are often noticeably absent from the discourse. This article provides an organizing framework for conceptualizing social connection and summarizes the cumulative evidence supporting its relevance for health, including epidemiological associations, pathways, and biological mechanisms. This evidence points to several implications for prioritizing social connection within solutions across sectors, where public health work, initiatives, and research play a key role in addressing gaps. Therefore, this review proposes a systemic framework for cross-sector action to identify missed opportunities and guide future investigation, intervention, practice, and policy on promoting social connection and health for all. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The concept, importance and values of support during childbearing and breastfeeding - A discourse paper

BACKGROUND

Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing.

AIM

The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites.

DESIGN

Discourse paper.

METHODS

This discourse paper is based on our own experiences and is supported by literature and theory.

RESULTS

Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.

[Optimization of neonatal hospital care for very preterm babies while supporting early parent-child relationships]

Research shows that not only medical but also psychological factors such as parents' emotional state, their parenting skills, quality of very early relationships with the infant influence child's physical and mental health and development. The support of good infant-mother relationships is an essential part of early family-centered help to premature babies. The article reviews existing evidence-based programs of neonatal care and support of early mother-child relationships for preterm babies at the hospital. It covers three main directions: discussing with parents prognosis of a child's health and development; supporting natural conditions of child development, and including parents into child early care and observation. Data presented in the article shows that if using each of the mentioned above directions that are important for quality early care and interaction, positive dynamics is seen both on parents' and preterm infant's side. Designated programs can be widely implemented in neonatal intensive care units for children born before term, including those with extremely low body weight when they achieve clinical stabilization. The material presented in the article may be used as the scientific base for implementing in Russian Federation early care system both at the hospital level and, later, in the family environment. It also constitutes new directions for research of preterm babies and their parents.

Parents' Experiences of Immediate Skin-to-Skin Contact After the Birth of Their Very Preterm Neonates

OBJECTIVE

To explore parents' experiences of immediate skin-to-skin contact after the birth of their very preterm neonates and their perceptions regarding care and support from staff.

DESIGN

A descriptive qualitative study.

SETTING

Birth and neonatal units within a university hospital in Sweden.

PARTICIPANTS

Six parent couples who co-cared for their very preterm neonates with skin-to-skin contact throughout the first 6 hours after birth.

METHODS

We analyzed individual interviews using reflexive thematic analysis as described by Braun and Clarke.

RESULTS

The parents' experiences of immediate skin-to-skin contact with their very preterm neonates were represented by the following three themes: A Pathway to Connectedness, Just Being in a Vulnerable State, and Creating a Safe Haven in an Unknown Terrain. Skin-to-skin contact helped the parents attain their roles as essential caregivers and provided a calming physical sensation that promoted parents' feelings of connectedness with their newborns. When parents provide skin-to-skin contact at birth, staff members need to recognize and address their vulnerability. A good relationship with nursing staff, which was mediated through staff behaviors and availability, facilitated skin-to-skin contact.

CONCLUSION

Skin-to-skin contact initiated at birth with very preterm neonates was a valuable and empowering experience for parents and enhanced early bonding between parents and their newborns. Staff members should recognize that skin-to-skin contact between parents and neonates is an interactive process that has challenges. Future research is warranted to understand the needs of nursing staff who provide initial care in the postpartum period. Furthermore, we recommend the implementation of maternal-neonatal couplet care.

Influence of Shared Decision Making on Decisional Conflict and Regret in Postpartum Mother-Infant Care: A Randomized Controlled Trial

OBJECTIVES

Although postpartum rooming-in is encouraged by the World Health Organization, independent separated nursery care is still widely adopted in Eastern countries. Our aim is to evaluate the effect of shared decision making (SDM) assisted by patient decision aids on subjective decisional conflict and regret among women who are required to make choices regarding postpartum infant care.

METHODS

A total of 196 pregnant women who came for routine checkups 1 month before delivery were randomly assigned to the SDM group or the classic group. Before the mothers were discharged after delivery, their decision-making difficulties were evaluated. The primary outcome was the decisional conflict, which was assessed using the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) scale. The secondary outcome was the decisional regret, which was measured using the Decision Regret scale.

RESULTS

Compared with the classic group, SDM group had surer feelings about the choice (P＜.001), felt more confident about knowing the benefits and risks of each option (P＜.001), had a clearer understanding of the benefits and risks (P＜.001), and felt sufficiently supported with enough advice to make a suitable choice (P＜.001). No significant difference was noted in the Decision Regret scores between groups. The choice of 24-hour rooming-in, 12-hour rooming-in, and separated nursery care was not significantly different between groups.

CONCLUSIONS

SDM reduced the decisional conflict and uncertainty of the mothers. Available choices of postpartum mother-infant care should be provided to mothers through SDM that includes individual values, health goals, and clear knowledge and transparency.

Maternal Bonding in Early Infancy Predicts Childrens' Social Competences in Preschool Age

Background: There are many studies on mother-child-bonding with little theoretical doubt that better bonding may have a positive effect on further social development. However, there is hardly any empirical evidence. In particular, there is a lack prospective longitudinal studies. Methods: As part of a longitudinal study, bonding was assessed in a community sample of 97 healthy mothers using the Postpartum Bonding Questionnaire (PBQ) 6 weeks after birth of their child. Social competencies in the offspring were assessed using the Self- and Other-oriented Social Competencies (SOCOMP) at 5.5 years of age. A potential correlation between bonding and social competencies was tested using Spearman Rank Correlation. Results: Retention rate over 5.5 years was 77.23%. Lower Maternal Bonding Impairment Scores 6 weeks postnatally were positively related to childrens' social competences at 5.5 years of age. Conclusion: The present data confirm a positive and long-term influence of bonding on social skills and provide further evidence of the importance of parent child bonding for child development in general. This result should give reason to further investigate this relationship in depth, causally and at later points in time.

Systematic review confirmed the benefits of early skin-to-skin contact but highlighted lack of studies on very and extremely preterm infants

AIM

We systematically reviewed the literature to identify the benefits of early skin-to-skin contact (SSC) for all gestational ages.

METHODS

The MEDLINE, Embase and CINAHL databases were searched for papers published in English from 1 January 1975 to 31 March 2020. Early SSC was defined as when the infant was placed directly onto the mother's chest within 180 min of birth. Two authors independently searched the databases, appraised study quality and extracted the study design and outcome data. The primary outcomes were the infants' physiological stability after birth: thermoregulation and stabilisation. The secondary outcomes were exclusive breastfeeding and mother-infant interaction.

RESULTS

We reviewed 30 studies that assessed the benefits of early SSC: 22 comprised term-born healthy infants and eight focused on preterm or ill infants. These included various gestational ages, birth methods and cultural backgrounds. The studies demonstrated that early SSC stabilised neonatal physiological parameters, promoted exclusive breastfeeding and supported bonding. Most of the data were from term and late preterm births.

CONCLUSION

This systematic review showed that early SSC could be beneficial. Further studies that focus on providing very and extremely preterm infants with SSC, and parental experiences, are needed to enable SSC to be adopted as routine practice.

Increasing Early Skin-to-Skin in Extremely Low Birth Weight Infants

BACKGROUND

Early skin-to-skin care (SSC) has been shown to improve outcomes after preterm birth, including improved clinical stability and establishment of breastfeeding. Recent evidence suggests the most unstable infants get the most benefit, yet these infants are not consistently offered opportunities for SSC because of safety concerns and discomfort of the care team.

PURPOSE

To identify barriers and implement a multidimensional approach to increase SSC within the first 72 hours of life among infants born less than 28 weeks' gestation and less than 1,000 g in a Level IV university-based regional intensive care nursery.

METHODS

Using Institute of Healthcare Improvement quality improvement methodology, a multidisciplinary team identified barriers to SSC and developed targeted interventions, including a unit-specific protocol; widespread parent, staff, and provider education; and an infant readiness checklist. The primary outcome was the rate of SSC within 72 hours. The balancing measure was the rate of severe intraventricular hemorrhage (IVH). Data were collected from monthly chart review and analyzed with statistical process control charts. The aim was to increase SSC within 72 hours of birth from 7 percent to greater than 80 percent within 12 months for infants born less than 28 weeks' gestation or less than 1,000 g.

RESULTS

Between June 2017 and December 2019, there were 52 extremely preterm infants included in the project (15 preintervention and 37 postintervention). The rate of SSC within the first 72 hours increased from 7 to 84 percent. There has been no increase in any or severe IVH during the project period despite the increased rate of SSC.

IMPLICATIONS FOR PRACTICE

Implementation of multidimensional, multidisciplinary interventions for reducing barriers to early SSC in extremely preterm infants resulted in rapid adoption of SSC in the first 72 hours of life without increasing severe IVH in this high-risk population.

Oxytocin Modulation of Maternal Behavior and Its Association With Immunological Activity in Rats With Cesarean Delivery

Oxytocin (OT), a neuropeptide produced in the supraoptic (SON) and paraventricular (PVN) nuclei, is not only essential for lactation and maternal behavior but also for normal immunological activity. However, mechanisms underlying OT regulation of maternal behavior and its association with immunity around parturition, particularly under mental and physical stress, remain unclear. Here, we observed effects of OT on maternal behavior in association with immunological activity in rats after cesarean delivery (CD), a model of reproductive stress. CD significantly reduced maternal interests to the pups throughout postpartum day 1-8. On postpartum day 5, CD decreased plasma OT levels and thymic index but increased vasopressin, interleukin (IL)-1β, IL-6 and IL-10 levels. CD had no significant effect on plasma adrenocorticotropic hormone and corticosterone levels. In the hypothalamus, CD decreased corticotropin-releasing hormone contents in the PVN but increased OT contents in the PVN and SON and OT release from hypothalamic implants. CD also increased c-Fos expression, particularly in the cytoplasm of OT neurons. Lastly, CD depolarized resting membrane potential and increased spike width while increasing the variability of the firing rate of OT neurons in brain slices. Thus, CD can increase hypothalamic OT contents and release but reduce pituitary release of OT into the blood, which is associated with depressive-like maternal behavior, increased inflammatory cytokine release and decreased relative weight of the thymus.

Epidural Analgesia With or Without Oxytocin, but Not Oxytocin Alone, Administered During Birth Disturbs Infant Pre-feeding and Sucking Behaviors and Maternal Oxytocin Levels in Connection With a Breastfeed Two Days Later

Aims This work aimed to study consequences of medical interventions in connection with birth on infant pre-feeding and feeding behaviors and on maternal oxytocin levels in connection with a breastfeed 2 days later.

Materials and Methods Mothers and their full-term newborns (n = 41) were videotaped during a breastfeed 2 days after birth. Duration and quality of rooting [Infant Breastfeeding Assessment Tool (IBFAT)] were assessed. Maternal blood samples were collected, oxytocin levels were analyzed, and mean oxytocin level and variance were calculated. Data on medical interventions during birth, number of breastfeedings, and infant weight loss since birth were recorded. Data were analyzed using logistic regression models.

Results The duration of infant rooting was significantly shorter when the mother had received epidural analgesia. The shorter the duration of infant rooting, the more often infants had breastfed and the greater was the infant weight loss since birth. Mothers with epidural analgesia with oxytocin had the lowest oxytocin mean levels in connection with a breastfeed. Oxytocin variance correlated positively with quality of rooting and correlated negatively with infant weight loss. In the control group alone, we found similar patterns of associations with oxytocin levels.

Conclusion Epidural analgesia and epidural analgesia with oxytocin infusion in connection with birth negatively influenced infant rooting behavior and maternal mean oxytocin levels, respectively. Oxytocin infusion alone was without effect. The data also suggest that infants who suck well stimulate oxytocin release more efficiently, as expressed by a high oxytocin variance, leading to a better stimulation of milk production and consequently to a reduced infant weight loss 2 days after birth.

What are women's experiences of immediate skin-to-skin contact at caesarean section birth? An integrative literature review

BACKGROUND

Skin-to-skin is a well-established practice at vaginal births promoting the health of women and babies. Facilitation of skin-to-skin at caesarean section birth is growing despite environmental and historical challenges. This is led by the expectancy of women and of health professionals increasingly understanding its importance.

OBJECTIVE

To synthesise original research that explores the experience of women having immediate and uninterrupted skin-to-skin contact at caesarean section when woman and baby are well.

DESIGN

Integrative literature review.

DATA SOURCES

The databases of SCOPUS, PubMed, CINAHL plus, Wiley Online, Cochrane Library, Web of Science and MIDIRS were used to identify studies from 2010-2020. Hand searching of library journals, reference and citation lists were also used.

METHODS

The framework of Whittemore and Knafl (2005) was used to guide the literature search, thematic analysis, and synthesis of original research. Initial screening against inclusion criteria was utilised for English-published papers of full-term, well, woman and baby dyads who experienced skin-to-skin at caesarean section birth. Papers were not limited by methodology. The validated Mixed Methods Appraisal Tool (MMAT) was used for critical quality appraisal (Bartlett et al., 2018).

FINDINGS

In total, 750 results were returned in the initial search and a final 13 papers were included in this review including quantitative (6), qualitative (5) and mixed method (2) designs. Immediate and uninterrupted skin-to-skin at caesarean section birth, when mother and baby are well, is safe, appropriate and desired by women, improving birth experience and satisfaction. Three main themes were identified with sub-themes - Positive birth experience (satisfaction; breastfeeding goals); Sense of control (empowered; birth, not a procedure); Natural (wanting to hold their baby; becoming a mother).

CONCLUSIONS

The findings of this review show that skin-to-skin improves the experience for women, and particularly empowers women having a caesarean section giving them a sense of a more natural birth. Women see skin-to-skin as an opportunity to maintain control and not be separated from their baby. Many studies have focused on the benefits of skin-to-skin but less so on the wants and choices of women. Women want to see, hold and feed their babies but are unable to achieve this of their own volition during a surgical birth. Understanding how women value this close physical contact can seek to inform further research on the impact of separation. This can inform policy and practice development in maternity care services to ensure best outcomes for both women and infants.

IMPLICATIONS FOR PRACTICE

The practice of skin-to-skin and keeping mother and baby together is valued by women and justified by research as best-practice for health and well-being. The findings of this paper highlight the importance of maternity settings facilitating both skin-to-skin and non-separation for all women and their newborns, even more so at caesarean section births.

Intertwined disparities: Applying the maternal-infant dyad lens to advance perinatal health equity

Differences in the quality of delivery hospital care contribute to persistent, intertwined racial and ethnic disparities in both maternal and infant health. Despite the shared causal pathways and overlapping burden of maternal and infant health disparities, little research on perinatal quality of care has addressed obstetric and neonatal care jointly to improve outcomes and reduce health inequities for the maternal-infant dyad. In this paper, we review the role of hospital quality in shaping perinatal health outcomes, and investigate how a framework that considers the mother-infant dyad can enhance our understanding of the full burden of obstetric and neonatal disparities on health and society. We conclude with a discussion of how integrating a maternal-infant dyad lens into research and clinical intervention to improve quality of care can move the needle on disparity reduction for both women and infants around the time of birth and throughout the life course.

Relationship between prenatal and maternal attachment: a longitudinal study from Turkey

The healthy development of the attachment which starts in the prenatal period and continues after the birth strengthens, positively supports the newborn care and contributes to raising healthy individuals in the future. This study was carried out to determine the effect of mother-fetus attachment that develops during pregnancy on mother-infant attachment in the postpartum period. This descriptive, correlational and longitudinal study was conducted with 150 volunteer mothers who could be reached again within 1-4 months after birth. Data were collected by the Questionnaire Form, the Prenatal Attachment Inventory (PAI) and the Maternal Attachment Scale (MAS). When the relationship between participants' PAI (41.20 ± 11.35) and MAS (26.05 ± 5.13) point averages was examined, it was observed that there was a weak, positive and statistically significant relationship between the two scales (r = 0.304, p=.000). It was observed that there was a relationship between the attachment between pregnant woman and developing fetus and the maternal attachment in the postnatal period.Impact statementWhat is already known on this subject? Attachment is a process which is formed by an interaction between the mother and the infant that is satisfying and enjoyed by both sides. It provides a basis for the establishment of relationships of the infant with the outside world and for the psychological development of the infant.What the results of this study add? This study has shown that a strong and healthy establishment of attachment in the prenatal period will positively contribute to the mother-infant attachment process in the postnatal period. A strong and healthy establishment of attachment in the prenatal period will positively contribute to the mother-infant attachment process in the postnatal period.What the implications are of these findings for clinical practice and/or further research? Mother-infant attachment can be strengthened just before the baby is born by determining the prenatal attachment and providing the appropriate approach to those who identify the problems in this regard, and thus, the risk of neglect and exploitation of the baby can be reduced and also the problems such as breastfeeding of the baby after birth, receiving proper care, and postnatal depression in the mother can even be reduced.

Maternal Intensive Care Unit Admission as an Indicator of Severe Acute Maternal Morbidity: A Population-Based Study

BACKGROUND

Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the profile of women admitted to an ICU and of their ICU stay, according to the association with other SAMM criterion.

METHODS

We performed a secondary analysis of the 2540 women with SAMM included in the epidemiology of severe acute maternal morbidity (EPIMOMS) multiregional prospective population-based study (2012-2013, n = 182,309 deliveries). The EPIMOMS definition of SAMM, based on national experts' consensus, is a combination of diagnosis, organ dysfunctions, and intervention criteria, including ICU admission. Among women with SAMM, we identified characteristics associated with maternal ICU admission with or with no other SAMM criterion compared with ICU admission, by using multivariable multinomial logistic regression models.

RESULTS

Overall, 511 women were admitted to an ICU during or up to 42 days after pregnancy, for a population-based rate of 2.8 of 1000 deliveries (511/182,309; 95% confidence interval [CI], 2.6-3.1); 15.5% of them (79/511; 95% CI, 12.4-18.9) had no other SAMM criterion compared with ICU admission. Among women with SAMM, the odds of ICU admission with no other morbidity criterion were increased in women with preexisting medical conditions (adjusted odds ratio (aOR), 2.13; 95% CI, 1.17-3.86) and cesarean before labor (aOR, 3.12; 95% CI, 1.47-6.64). Women admitted to ICU with no other SAMM criterion had more often decompensation of a preexisting condition, no interventions for organ support, and a shorter length of stay than women admitted with other SAMM criteria.

CONCLUSIONS

Among women with SAMM, 1 in 5 is admitted to an ICU; 15.5% of those admitted in ICU have no other SAMM criterion and a less acute condition. These results challenge the use of ICU admission as a criterion of SAMM.

Delivering Clinically on Our Knowledge of Oxytocin and Sensory Stimulation: The Potential of Infant Carrying in Primary Prevention

Oxytocin (OT) is one of the most intensively researched neuropeptides during the three past decades. In benign social contexts, OT exerts a range of desirable socioemotional, stress-reducing, and immunoregulatory effects in mammals and humans and influences mammalian parenting. Consequentially, research in potential pharmacological applications of OT toward human social deficits/disorders and physical illness has increased substantially. Regrettably, the results from the administration of exogenous OT are still relatively inconclusive. Research in rodent maternal developmental programming has demonstrated the susceptibility of offspring endogenous OT systems to maternal somatosensory stimulation, with consequences for behavioral, epigenetic, cognitive, and neurological outcomes. A translation of this animal research into practically feasible human parenting recommendations has yet to happen, despite the significant prevention potential implied by the maternal developmental programming research. Extended physical contact with full-term healthy infants in the months following birth (infant carrying) might constitute the human equivalent of those specific rodent maternal behaviors, found to positively influence emerging OT systems. Findings from both OT and maternal programming research parallel those found for infants exposed to such extended parental physical contact, whether through skin-to-skin contact or infant carrying. Clinical support of parents to engage in extended physical contact represents a feasible intervention to create optimum conditions for the development of infant OT systems, with potential beneficial long-term health effects.

In Touch with the Heartbeat: Newborns' Cardiac Sensitivity to Affective and Non-Affective Touch

The sense of touch is the first manner of contact with the external world, providing a foundation for the development of sensorimotor skills and socio-affective behaviors. In particular, affective touch is at the core of early interpersonal interactions and the developing bodily self, promoting the balance between internal physiological state and responsiveness to external environment. The aim of the present study is to investigate whether newborns are able to discriminate between affective touch and non-affective somatosensory stimulations and whether affective touch promotes a positive physiological state. We recorded full-term newborns' (N = 30) heart rate variability (HRV)-which reflects oscillations of heart rate associated with autonomic cardio-respiratory regulation-while newborns were presented with two minutes of affective (stroking) and non-affective (tapping) touch alternated with two minutes of resting in a within-subject design. The results revealed that non-affective touch elicits a decrease in HRV, whereas affective touch does not result in a change of HRV possibly indicating maintenance of calm physiological state. Thus, newborns showed cardiac sensitivity to different types of touch, suggesting that early somatosensory stimulation represents scaffolding for development of autonomic self-regulation with important implications on infant's ability to adaptively respond to the surrounding social and physical environment.