Influence of cesarean section on mother-baby interaction

Fifty two mother-infant pairs were studied. Twenty six of these were delivered by the normal vaginal route (NVD group) and twenty six by Cesarean section (CS group). The NVD babies were roomed in with their mothers soon after birth whereas the CS babies had a mean separation of 2.8 +/- 1.0 days. The mother baby interaction was evaluated by (a) direct observation of the mother's behaviour during feeding, (b) observation of mother's behaviour during BNBAS (Brazelton Neonatal Behaviour Assessment Scale) on her baby, and (c) interview of the mother with attachment questions. Mothers in the NVD group showed significantly greater affectionate behaviour and encompassing compared to mothers in the CS group. They (NVD mothers) were more often involved in the care-taking activities of their babies and scored significantly higher for the interview implying a greater mother-baby attachment in this group.     

Effect of early suckling on term neonates' core body temperature.

The purpose of this study was to determine whether the practice of early suckling, through an effect on maternal behaviour, would improve neonatal temperature control. One hundred and sixty mothers having daytime spontaneous deliveries of healthy babies at term were randomized into two groups. The treatment group were encouraged to put the baby to the breast immediately after delivery. In the control group, the baby was placed in a cot immediately after birth and breastfeeding occurred some time later at a time of the mother's choice. Observations of the mother's behaviour towards her baby and the baby's core body temperature were recorded at 2 and 4 hours after birth and at 8 a.m. the next day. The early suckling group mothers were observed breastfeeding their babies more often than those of the control group. Significantly more of the control babies had temperatures below 36.5 degrees C at 8 a.m. the next day. Women of either group who were breastfeeding immediately prior to temperature recording were significantly less likely to have a baby with a low body temperature. It is concluded that a policy of early suckling, when compared with one of delayed contact, appears to reduce the incidence of low body temperature in the neonate.     

Follow-up study of psychological consequences of caesarean childbirth

This study was the follow-up part of a survey of psychosocial consequences of caesarean delivery (J. Psychosom. Obstet. Gynecol., 6 (1987) 197-209). Two groups of primiparous mothers were compared, one group of 103 mothers delivered by caesarean section and one control group of 103 mothers delivered by vaginal delivery. Semi-structured questionnaires were mailed at 2 months and 1 year after birth to explore the mothers' physiological and psychological condition and mother-infant adaptation. At 2 months, 92 mothers in the caesarean section group and 84 mothers in the control group returned a completed questionnaire. At one year there were, respectively, 79 and 71 in each group. The data indicated that the most obvious long-term psychological ill-effects of caesarean delivery appeared to be on mothers. They more often reported psychosomatic symptoms during first year than controls. At 2 months the concerns of caesarean mothers seemed more self-oriented than in the control group. They also felt less confident about their abilities to care for their babies. At 1 year these differences disappeared. Signs of disturbance in mother-infant interaction were not linked to the mode of delivery either at 2 months or at 1 year. The influence of the mode of anaesthesia for surgical delivery was also examined. The positive consequences of epidural analgesia which were observed are discussed taking into account the role of confounding variables.     

Community neonatal practices and its association with skilled birth attendance in rural Haryana,India

Aim: The study aimed to document home-based neonatal care practices and their association with type of birth attendance. Methods: This study was conducted in rural Haryana on mothers who had delivered a live baby one to 2 months prior to interview. The study instrument, administered through home visits, had questions related to cord care, breastfeeding, thermal care, baby handling and healthcare seeking. Logistic regression was performed to test for association [OR; 95% CI] of key newborn care practices with skilled birth attendance. Results: Of the 415 mothers interviewed, 26.7% applied nothing on umbilicus; 15% were kept in skin-to-skin contact with mother; 20.2% were exclusively breastfed in first month. Seeking care in private sector and cost incurred in the treatment for a neonatal illness was significantly higher for male babies. Delivery by skilled birth attendant (68.5%) was associated with applying nothing on the cord [1.8; 1.01–3.25], in skin-to-skin contact with mother for ≥6 h a day [2.21; 1.18–4.13], bathing the baby after third day [14.63; 6.85–31.21] and exclusive breastfeeding [8.84; 3.42–22.8]. Conclusion: The results of this study call for not only upscaling skilled birth attendance but also improving the quality of care currently provided.     

Rooming-in for babies born by caesarean section in Dr. Cipto Mangunkusumo General Hospital Jakarta

Rooming-in was begun in this hospital in 1981 to serve those families whose newborns were born vaginally. Following positive results with this, the hospital began rooming-in for babies delivered by cesarean section in 1984 if they met certain criteria. However, the facilities for rooming-in for cesarean-delivered babies were still limited so that not every baby who fulfilled the criteria could room with their mother. In 1986, 4112 babies were born and among theses, 848 were delivered by cesarean section. Of these, 435 babies fulfilled the criteria but only 269 babies could room with their mothers; 166 had to be nursed separately. The authors compared the data of the rooming-in babies to those nursed separately. The study showed that among the rooming-in group, more mothers were fully breastfeeding on discharge and the incidence of sepsis, enteritis, and hyperbilirubinemia were significantly lower, while mortality and the incidence of pneumonia, omfalitits, conjunctivitis, and pyodermia did not differ significantly.     

Psychosocial consequences of caesarean childbirth: a four-year follow-up study

This paper describes the last part of a study on the long-term psychosocial consequences of caesarean delivery. One group of 103 primiparous caesarean delivered women and one control group of 103 women delivered vaginally were followed from delivery to the children's fourth birthday. Previous assessments were made at birth, two months and one year later (Garel, M., Lelong, N. and Kaminski, M. (1987) J. Psychosom. Obstet. Gynecol., 6, 197-209 and (1988) Early Hum. Dev., 16, 271-282). Four years after delivery, 58 mothers of the caesarean group and 50 mothers of the control group returned a completed questionnaire. The questionnaire included questions about subsequent pregnancies and mother's and child's general state of health. The comparisons between respondents and non-respondents showed no significant difference with regard to social and medical factors. As far as possible, factors which might have interfered with the mothers' and children's conditions were controlled in the analysis. There was no association between the method of delivery and the mother's overall state of health. However, after a caesarean section, mothers tended to have fewer children and more difficulty in conceiving. Four years after delivery, mothers in the caesarean group reported fatigue more frequently than control mothers. Five mothers (9%) consulted a psychiatrist, none in the control group (P less than 0.09). Between one and four years, caesarean born children had more hospital admissions but their overall behaviour and development, as reported by the mothers, was not different from those of children in the control group.     

Lactational failure—Study of risk factors in Turkish mothers

Risk factors for lactational failure in puerperium were investigated. Sixty mothers with inadequate daily milk supply for their babies were the lactational failure group, and 60 mothers with similar age having babies with similar age and weight were chosen as the control group. Low prolactin levels, low serum iron and low serum ferritin levels and low aldosterone values and birth in community hospitals were associated with significantly increased risk of deficient lactation. High income of the family, increase osmolality of breastmilk, high systolic blood pressure of the mother, birth by cesarean section were some of the variables that increased the risk that could not reach the level of significance. Prematurity of the baby was not among the risk factors if the gestational ages were more than 30 weeks. It is concluded that physicians awareness of the factors that may adversely effect the initiation and continuation of lactation is vital. Correcting iron deficiency even if it is not overt, sparing more time for the mothers discussing the benefits of breastmilk to their babies, and avoiding cesarean section if possible may help increase the incidence of breastmilk feeding.     

KMC facilitates mother baby attachment in low birth weight infants

Objective  To determine whether Kangaroo mother care (KMC) facilitates mother baby attachment in low birth weight infants. Methods  Over 16 month period 110 neonates were randomized into kangaroo mother care group and control group using a random number table. The kangaroo group was subjected to Kangaroo mother care for at least 6 hours per day. The babies also received kangaroo care after shifting out from NICU and at home. The control group received standard care (incubator or open care system). After 3 months followup, structured maternal interview was conducted to assess attachment between mothers and their babies. Results  Mean birth weight was 1.69 ± 0.11 Kg in KMC group compared to 1.690 ± 0.12 Kg in control group (p>0.05). Mean gestational age was 35.48 ± 1.20 week in KMC group and 35.04±1.09 week in the control group (p>0.05). KMC was initiated at a mean age of 1.72±0.45 days. The duration of KMC in first month was 10.21±1.50 hour, in the 2^nd month was 10.03±1.57 hour and in the 3^rd month was 8.97±1.37 hours. The duration of hospital stay was significantly shorter in the KMC group (3.56±0.57 days) compared to control group (6.80±1.30 days). The total attachment score (24.46±1.64) in the KMC group was significantly higher than that obtained in control group (18.22±1.79, p<0.001). In KMC group, mother was more often the main caretaker of the baby. Mothers were significantly more involved in care taking activities like bathing, diapering, sleeping with their babies and spent more time beyond usual care taking. They went out without their babies less often and only for unavoidable reasons. They derived greater pleasure from their babies. Conclusion  KMC facilitates mother baby attachment in low birth weight infants.     

Echocardiographic changes of cardiac structures and LV function in newborns

Cardiac chamber size and function indices were studied repeatedly over the first months of life in two groups of babies, born either spontaneously or by caesarian section under peridural anaesthesia.For cardiac chamber size, no significant differences were found between the two groups: cardiac structures increased in size as a linear function of age and weight in all babies. Right ventricular systolic time interval ratios, however, were higher at birth in babies born by caesarian section, and dropped more rapidly during the first 24 h. The decrease of RV systolic time interval ratios followed a parabolic function for both groups, thus reflecting the physiological decrease of pulmonary vascular resistance after birth. The possible causes of more rapid decrease in pulmonary vascular resistance in babies born by caesarian section is discussed.This work is dedicated to Professor A. Prader on the occasion of this 60th birthday     

Cesarean section and delayed contact: effect on baby's behaviour

Fifty two babies were assessed by the Brazelton Neonatal Behaviour Assessment Scale (BNBAS) first at 24-48 hours after birth and next at 28 days of age. Of these 26 belonged to the normal vaginal delivery (NVD) group where the babies were roomed in with their mothers immediately after birth. The other 26 were delivered by Cesarean Section (CS) and had a mean separation of 2.8 +/- 1.0 day from their mothers. Babies in the NVD group performed better for the interactive processes at both the initial and follow-up assessment. They were more active initially and on follow up. Although no differences were obtained at the initial assessment for organisational processes (physiological response to stress and state control) the follow up revealed that the NVD babies smiled more, cried less and were less irritable.     

Severe pre-eclampsia and infants of very low birth weight.

The effect of severe pre-eclampsia on the outcome of infants of very low birth weight was studied in a prospective case control study of 35 pairs of infants of comparable gestation. Significantly more infants were delivered before the onset of labour and by caesarean section in the group with pre-eclampsia. These babies tended to be smaller and had a higher incidence of hyaline membrane disease, patent ductus arteriosus, pulmonary air leak, and hypotension. They also required more intensive treatment with oxygen and mechanical ventilation. The significant difference in birth weight was still apparent at 2 years of age. Although the mean psychomotor developmental index and the incidence of specific neurodevelopmental impairments were not significantly different between the two groups, survivors in the group born to pre-eclamptic mothers had a significantly lower mean mental developmental index, and significantly more of these children had one or more impairments compared with the control group at 2 years of age.     

Neonatal hyperparathyroidism secondary to unknown maternal hypoparathyroidism]

Vitamin D or its analogue (calcitriol) is an effective treatment for hypoparathyroidism during pregnancy. Normal babies are delivered and very few cases of associated neonatal hyperparathyroidism are reported. CASE REPORT: We report the case of a baby born to a mother suffering unknown hypoparathyroidism. He was delivered prematurely by cesarean section for birth asphyxia. His mother had had recurrent bouts of impetigo herpetiformis for several months. Severe demineralization associated with decreased plasma calcium level were observed at birth. The PTH level was very high (955 ng/mL) in the baby and very low in the mother, leading to the diagnosis. The baby was given intravenous calcium gluconate, oral 1 alpha-hydroxyvitamin D and mechanical ventilation. Normal plasma calcium level was reached on day 2. PTH level improved by one month of age. Because of impaired respiratory mechanics and bronchopulmonary dysplasia, the baby was kept on ventilation for 58 days. By 20 months of age, he was in good health despite a small height for his age. CONCLUSION: In such cases 1 alpha-hydroxyvitamin D seems to be very effective but plasma and urinary calcium levels need careful monitoring.     

The effect of early contact on maternal perception of infant behavior

The effect of extra maternal-infant contact during the first postpartum hour on maternal perception of infant behavior one month after delivery was measured by the Broussard Neonatal Perception Inventories and the attachment questions of Klaus and colleagues. All mothers were indigent primiparas who vaginally delivered normal, term infants. 60 mother-infant dyads were randomly assigned to either an extra contact or routine contact group. 49 mothers were available 1 month later for home visits. Scores on the Neonatal Perception Inventories were not significantly affected by either degree of contact or the sex of the child. There was also no difference between contact groups in the maternal response to the attachment questions. Infant behaviors recorded by 24 mothers during the 4 days following home visits were similar in the 2 contact groups. Mothers reported significantly more negative behaviors for female than for male infants. Any effects of extra contact during the first hour after birth on maternal-infant interaction are unlikely to result from changes in maternal perception of infant behavior.     

Asphyxia neonatorum: A clinical evaluation of 60 affected infants

Summary The study of 60 asphyxiated babies revealed the following conclusions: Maternal medication for obstetric analgesia should be used sparingly and the dose of pethidine should not be increased beyond 50 mg. Excess dose is an important cause of asphyxia neonatorum (5 cases). Neonates delivered by caesarian section had a high incidence of asphyxia and morbidity in the form of neurological manifestations. Abnormal foetal presentation raised the risk of asphyxia in neonates. The clinical evaluation by Apgar scoring at one and five minutes after birth may give some indication of possible neurological damage and may guide management. The prompt recognition and management of asphyxiated babies would prevent brain damage.     

Crying and behavior pattern in breast- and formula-fed infants

Breast- and formula-fed infants were compared with regard to behavior patterns, especially crying behavior. A diary concerning seven behaviors was completed by 188 mothers of breast- and formula-fed infants at the well baby clinic. Breast-fed infants were fed more frequently with longer feeding duration. They slept more, but their long bouts were shorter than those of formula-fed infants. The crying pattern of formula-fed infants was different from that of breast-fed infants in that they displayed an evening cluster and a 7-week peak of crying. Since the educational level of the formula group mothers was higher and there are more later born babies in that group, it is speculated that these mothers have a Westernized tendency in their caretaking style and, as a result, the crying pattern of formula-fed infants are similar to that of Western babies. In multivariate analysis, contact, play, sleep durations and mothers' education contributed significantly to cry duration. These results imply that contact with the mother and other caretaking practices are closely associated with infants' crying.     

Maternal perceptions of neonatal care

In a large-scale study of neonatal care in England, hospital and questionnaire data were collected on the experiences of an unselected group of 420 mothers whose babies had recently been admitted for neonatal care to one of 23 widely distributed hospitals. Perceptions of their infant while in the neonatal unit differed in relation to gestational age, whether or not the baby required assisted ventilated, the mother's own health and if she had previously had a baby cared for in this way. This investigation of how mothers see and adjust to their small, sick baby in the neonatal unit confirmed the crisis nature of the birth and admission, and provides insights for staff and other health professionals about the salient issues for parents at this time.     

Maternal age-specific incidence of Down's syndrome in Malaysian neonates

Over an 18 month period, 34,495 livebirths were delivered in the Kuala Lumpur Maternity Hospital. 36 neonates (1.044 per 1000 livebirths) had Down's syndrome. The observed rates of Down's syndrome per 1000 livebirths by single year intervals of maternal age were calculated. By using the discontinuous slope model, our study showed that the incidence of Down's syndrome among the Malaysian liveborns increased markedly when the maternal age exceeded 35 years. This study also suggested that the Malay mothers had increased risk of producing babies with Down's syndrome at a later age than the Chinese and the Indians. However, a larger number of babies in each racial group needs to be studied to confirm this.     

Risk factors for early termination of breast feeding in Brazil

A prospective study was undertaken to identify possible factors related to the duration of breast feeding. Two hundred and thirty-eight mothers who had delivered normal single babies with birth weights greater than 2.5 kg and had initiated breast feeding were randomly selected at the maternity hospital, Hospital de Clinicas de Porto Alegre, Brazil, and followed by mail questionnaires until termination of breast feeding, or until the end of the first year. If no reply was received, telephone contact or home visits were made. The group of mothers who stopped breast feeding prior to the end of the third month was compared with those who extended breast feeding beyond three months with respect to socioeconomic, biological, environmental, medical and psychological factors. The variables with a significant coefficient of association with early termination of breast feeding were maternal education, past experience with breast feeding, help of a maid, help with housework provided by a relative, breast feeding orientation during prenatal care and encouragement from the husband. These factors act simultaneously, with interactions among them.     

Skin to skin contact for very low birthweight infants and their mothers.

Separation between mothers and very low birthweight infants is often prolonged with subsequent psychological distress, behaviour problems, and lactation failure. Babies as small as 700 g, who no longer require oxygen, can be safely and enjoyably held naked, except for a nappy, between the mother''s breasts for up to four hours a day. We have carried out a randomised trial among babies less than 1500 g. Seventy one infants were randomised. In 35, the mother was helped to hold her baby in skin to skin contact and encouraged to do so whenever she visited the baby. In 36, the mother was encouraged to handle her baby but without skin to skin contact. Mothers using skin to skin contact lactated for four weeks longer on average than the control group. At 6 months of age the infants who had skin to skin contact cried significantly less than the control group. Skin to skin contact can safely and enjoyably be offered to very low birthweight infants especially in developing countries where the mother''s lactation is vital.     

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

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