Maternal Satisfaction with Administering Infant Interventions in the Neonatal Intensive Care Unit

ObjectiveTo examine mothers’ satisfaction with administering interventions for their preterm infants and with the helpfulness of the study nurse by comparing massage with auditory, tactile, visual, and vestibular stimulation (ATVV intervention), kangaroo care, and education about equipment needed at home and to explore whether mother and infant characteristics affected maternal satisfaction ratings.DesignThree‐group experimental design.SettingFour neonatal intensive care units (NICUs) (two in North Carolina, two in Illinois).ParticipantsTwo hundred and eight (208) preterm infants and their mothers.MethodsWhen the infant was no longer critically ill, mother/infant dyads were randomly assigned to ATVV, kangaroo care, or the education group all taught by study nurses. At discharge and 2 months corrected age, mothers completed questionnaires.ResultsAll groups were satisfied with the intervention and with nurse helpfulness, and the degree of satisfaction did not differ among them. Intervention satisfaction, but not nurse helpfulness, was related to recruitment site. Older, married, and minority mothers were less satisfied with the intervention but only at 2 months. Higher anxiety was related to lower intervention satisfaction at discharge and lower ratings of nurse helpfulness at discharge and 2 months. More depressive symptoms were related to lower nurse helpfulness ratings at 2 months.ConclusionsMothers were satisfied with interventions for their infants regardless of the intervention performed. Maternal satisfaction with the intervention was related to recruitment site, maternal demographic characteristics, and maternal psychological distress, especially at 2 months. Thus, nursing interventions that provide mothers with a role to play in the infant's care during hospitalization are particularly likely to be appreciated by mothers.     

Relationships Among Factors Related to Childbirth and Breastfeeding Outcomes in Primiparous Women

ObjectivesTo explore the relationships among potentially modifiable factors related to childbirth and effective breastfeeding initiation at approximately 36 hours after birth and duration and exclusivity at hospital discharge, 2 weeks, 2 months, and 6 months after birth in primiparous women and to explore whether modifiable and nonmodifiable secondary factors and covariates influenced the relationships among factors related to childbirth and these breastfeeding outcomes.DesignA prospective, longitudinal, cohort study.SettingThe postpartum units of two general hospitals in eastern Canada.ParticipantsNinety-seven mother–infant dyads.MethodsWe recorded demographic, childbirth, obstetric history, and breastfeeding data through chart review. A breastfeeding observation was completed at approximately 36 hours after birth by unit nurses. Participants maintained breastfeeding logs in hospital and for 6 months after birth and completed three self-report questionnaires before discharge. We analyzed outcomes using backward stepwise linear and logistic regression.ResultsOne childbirth factor, labor induced with oxytocin, was negatively associated with effective initiation of breastfeeding, and none was related to breastfeeding duration and exclusivity at any time point. Maternal weight; professional support; and newborn’s gestational age at birth, 5-minute Apgar score, weight loss, LATCH score, and active feeds (newborn actively suckled at the breast) were significantly associated with breastfeeding outcomes.ConclusionInduction of labor with oxytocin should be used judiciously; when used, nurses must be hypervigilant to assess the mother–infant dyad for breastfeeding issues and to intervene to prevent or remediate them.     

Maternal Holding of Preterm Infants During the Early Weeks After Birth and Dyad Interaction at Six Months

ObjectiveTo examine whether a supportive nursing intervention that promoted kangaroo holding of healthy preterm infants by their mothers during the early weeks of the infant's life facilitated coregulation between mother and infant at 6 months of age.DesignRandomized controlled trial.ParticipantsSixty-five mother/infant dyads with mean gestational age at birth of 33 weeks. Fifty percent of infants were male, and 50% were non-White.InterventionsAn 8-week home intervention encouraged daily 1-hour, uninterrupted holding with either blanket (baby wrapped in blanket and held in mother's arms) or the kangaroo (baby in skin-to-skin contact on mother's chest) method. In both conditions, weekly home visits by an experienced RN included encouragement to hold the infant, emotional support, and information about infant behavior and development. A control group received brief social visits, had no holding constraints, and participated in all assessments.Main Outcome MeasuresWhen infants were 6 months of age, the Still-Face Paradigm was used to assess mother/infant interaction. Outcome measures were coregulation of the dyad's responses during the play episodes of the Still-Face Paradigm and vitality in infant efforts to reengage the mother during the neutral face portion of the Still-Face Procedure.ResultsSignificant differences among groups were found in mother/infant coregulation. Post hoc analysis showed that dyads who were supported in kangaroo holding displayed more coregulation behavior during play than dyads in the blanket-holding group. No differences were found between groups in infant vitality during the neutral face portion of the Still-Face Procedure.ConclusionDyads supported in practicing kangaroo holding in the early weeks of life may develop more coregulated interactional strategies than other dyads.     

Effect of Mother/Infant Skin‐to‐Skin Contact on Postpartum Depressive Symptoms and Maternal Physiological Stress

ObjectiveTo investigate the effect of mother/infant skin‐to‐skin contact (SSC) on mothers’ postpartum depressive symptoms during the first 3 postpartum months and their physiological stress during the first postpartum month.DesignLongitudinal quasi‐experiment.SettingData were collected during home visits.ParticipantsMothers in the SSC group (n = 30) provided approximately 5 hours per day of SSC with their infants in the infants’ first week and then more than 2 hours per day until the infants were age one month. Mothers in the control group (n = 60) provided little or no SSC. All mothers had full‐term infants.MethodsMothers completed self‐report depression scales when infants were 1 week, 1 month, 2 months, and 3 months of age.ResultsCompared to mothers in the control group, mothers in the SSC group had lower scores on the depression scales when the infants were one week and marginally lower scores when the infants were one month; when the infants were age 2 and 3 months, there were no differences between groups in the mothers’ depression scores. Over their infants’ first month, mothers in the SSC group had a greater reduction in their salivary cortisol than mothers in the control group.ConclusionMother/infant SSC benefits mothers by reducing their depressive symptoms and physiological stress in the postpartum period.     

Use of selective serotonin reuptake inhibitors during pregnancy and disorganised infant–mother attachment

Objective: To examine the quality of infant–mother attachment in a prospective case series of infants whose mothers took selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Background: SSRIs are prescribed to 2–6% of pregnant women. Recent articles on the use of SSRIs during pregnancy note the increased risk for problematic infant–mother relationships among mothers with untreated postpartum depression. However, little is known about the quality of infant–mother relationships among mothers who took SSRIs during pregnancy. Methods: Five mothers who took SSRIs during pregnancy were recruited from a community study of infant development. Mothers completed ratings of postpartum depression symptoms (Beck Depression Inventory) 4–6 times between 1 month and 1 year following the infant’s birth. At 1 year postpartum, quality of infant–mother attachment was assessed using the strange situation procedure. Results: Four of the five infant–mother dyads (80%) were classified as disorganised, a rate considerably higher than in postpartum depression samples. Conclusion: These results are used to raise questions about the clinical implications of research on in utero exposure to SSRIs, perinatal depression, and disorganised attachment. Specifically, this case series raises questions about using research on the link between postpartum depression and infant–mother attachment as a rationale for the use of SSRIs during pregnancy. Current research indicates use of SSRIs during pregnancy may: (1) increase risk for disorganised attachment, (2) decrease risk for disorganised attachment, or (3) have no effect on disorganised attachment.     

An Institutional Ethnography of Nurses’ Support of Breastfeeding on the Night Shift

ObjectiveTo describe nurses’ support of breastfeeding on the night shift and to identify the interpersonal interactions and institutional structures that affect this support.DesignInstitutional ethnography.SettingThe mother/baby unit of a tertiary care hospital with 4200 births per year.ParticipantsRegistered nurses (N = 16) who provided care on the night shift to mother/infant dyads in the immediate postpartum period.MethodsData were collected using focus groups, individual and group interviews, and mother/baby unit observations. The focus groups were held before the night shift and had five participants. The nine individual and group interviews were conducted between 0100 and 0230 on the mother/baby unit. Three unit observations were conducted. Interviews were recorded, professionally transcribed, and analyzed using a content analysis method.ResultsData analysis yielded three themes that described these nurses’ support of breastfeeding on the night shift: competing priorities, incongruent expectations, and influential institutional structures. The need of visitors to see their new family members competed with the needs of mothers to rest and breastfeed their newborns. Helping breastfeeding dyads who experienced difficulties competed with providing care to other patients. Parents’ expectations regarding newborn behavior were incongruent with the reality of newborn feeding and sleeping patterns. Institutional structures that affected the provision of breastfeeding support by nurses included hospital breastfeeding practices, staffing, and policies.ConclusionNurses’ support of breastfeeding on the night shift encompasses a complex interplay of interpersonal interactions with new families and visitors regarding priorities and expectations and negotiating institutional structures such as feeding policies and staffing.     

Scoping Review of Postpartum Discharge Education Provided by Nurses

ObjectiveTo determine what is known about postpartum education provided by nurses to women before discharge from the hospital after birth and whether current nursing practices are effective to prepare women to identify warning signs of complications, perform self-care (physical and emotional), prepare for parenting a newborn, and establish infant feeding.Data SourcesWe conducted a systematic search of CINAHL Plus and MEDLINE for relevant sources, including peer-reviewed articles, conference presentations, and guidelines from professional organizations, that were published in English from January 2010 through November 30, 2020.Study SelectionWe included sources if participants were women who had given birth to a healthy, liveborn, term infant and were receiving education in whole or in part by a nurse during the maternity hospitalization. We excluded sources with samples of high-risk women or those who gave birth to high-risk infants (preterm, congenital anomalies, neonatal abstinence syndrome). Forty-six of the sources met the inclusion criteria.Data ExtractionWe extracted citation, type of document, country of origin, context (prenatal/postpartum or both and inpatient/outpatient or both), aim, participants (mother/father or both, sample characteristics), content of education and who provided it, outcomes or key themes, and main results.Data SynthesisInfant topics included breastfeeding and safe sleep, and maternal topics included breastfeeding, postpartum mood, and self-care after birth. Nurses prioritized safety, including safe sleep; preventing infant falls; decreasing infection; screening for postpartum depression; and avoiding adverse outcomes after discharge. Women focused on self-care, pain management, infant care, and parenting. Women and nurses prioritized breastfeeding. Authors of the included sources measured effectiveness by patient satisfaction, chart audit, pre- and posttests of nurses’ knowledge, and breastfeeding duration. Women reported barriers to postpartum education such as limited nursing time or conflicting information.ConclusionPostpartum education is a priority, but its effectiveness is not well studied. Few maternal or infant health–centered outcomes have been measured beyond breastfeeding duration. Nursing care and nurse expertise are not easily quantified or measured. Research is needed to inform best practices for postpartum education.     

Breastfeeding Outcomes,Self-Efficacy,and Satisfaction Among Low-Income Women With Late-Preterm,Early-Term,and Full-Term Infants

ObjectiveTo assess breastfeeding exclusivity and rate of breastfeeding, breastfeeding self-efficacy, and satisfaction with breastfeeding after hospital discharge among low-income women with late-preterm and early-term infants compared with women with full-term infants.DesignProspective, comparative, with repeated measures.SettingFour Midwestern U.S. Special Supplemental Nutrition Program for Women, Infants, and Children offices.ParticipantsParticipants included 270 mother–infant dyads.MethodsWe assessed breastfeeding exclusivity, rate of breastfeeding, and breastfeeding self-efficacy at 2 weeks, 2 months, and 5 months and satisfaction with breastfeeding at 5 months after birth or when participants stopped breastfeeding.ResultsMore than 50% of women in each subgroup were non-Hispanic White. Late-preterm and early-term infants had lower breastfeeding exclusivity rates than full-term infants across the three time points (40%, 51%, and 65% at 2 weeks, p = .029; 22.5%, 34%, and 58% at 2 months, p < .001; and 7%, 15%, and 28.46% at 5 months, p < .001, respectively). The overall exclusive breastfeeding rate for all groups was 55.93% at 2 weeks, 44.07% at 2 months, and 20.37% at 5 months; 55.56% continued any breastfeeding at 5 months. Breastfeeding self-efficacy during the first 5 months after birth, satisfaction with breastfeeding, level of education, and attending breastfeeding classes were positively correlated with breastfeeding exclusivity. We found significantly less exclusive breastfeeding, lower breastfeeding self-efficacy, and lower satisfaction with breastfeeding among participants with late-preterm and early-term infants compared to those with full-term infants.ConclusionOngoing professional breastfeeding support for women is needed to improve and promote breastfeeding exclusivity and continuation among their late-preterm and early-term infants.     

Predictive validity of the Postpartum Depression Predictors Inventory-Revised (PDPI-R): A longitudinal study with Portuguese women

ObjectiveThis study examined the predictive validity of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in European Portuguese women, considering two gold standards to determine postpartum depression (PPD).DesignProspective longitudinal study conducted between November 2015 and September 2017.SettingOne public referral maternity hospital in the central region of Portugal.ParticipantsA total of 140 Portuguese women participated in the study.MeasurementsParticipants completed the PDPI-R during the second trimester of pregnancy (T1) and at 6 weeks postpartum (T2). At T2, participants also answered the Edinburgh Postnatal Depression Scale (EPDS). During the fourth month postpartum (T3), women were interviewed with the Structured Clinical Interview for DSM-IV Disorders, and between 6 and 9 months postpartum (T4), they completed the EPDS.FindingsRates of clinically significant depressive symptoms (EPDS ≥ 10) were 16.4% (23/140) at T2 and 23.2% (23/99) at T4. Six (4.3%) women met the criteria for a clinical diagnosis of PPD (major depressive episode) at T3. Overall, the postnatal version of the PDPI-R performed better than did the prenatal version (average area under the curve = 82% vs. 71%), but both versions accurately predicted women who developed a clinical diagnosis of PPD, at a cut-off score of 4.5 for the prenatal version (sensitivity = 83.3%; specificity = 85.8%) and 9.5 for the postnatal version (sensitivity = 83.3%; specificity = 94.8%).Key conclusions and implications for practiceDespite the low prevalence of PPD (albeit consistent with prior estimates of major depression at three months postpartum), this clinical condition has very serious consequences for the mother, the baby and the whole family when present. The PDPI-R is a valid screening tool to estimate the psychosocial risk for developing PPD among Portuguese women and can be used in research (e.g., for cross-cultural comparisons) and clinical practice. The recommended cut-off scores could assist health professionals (namely, midwives) in identifying the women who would benefit from appropriate referrals and/or closer monitoring to prevent them from developing PPD.     

Validation of the Postnatal Perceived Stress Inventory in a French Speaking Population of Primiparous Women

ObjectiveTo develop a Postnatal Perceived Stress Inventory (PNPSI) and assess its psychometric properties.DesignCross‐sectional quantitative study.SettingOne nurse‐managed labor and delivery unit in a university hospital in a major metropolitan area.ParticipantsOne hundred seventy‐nine (179) primiparous French speaking women who gave birth at term.MethodsThe PNPSI was validated at 6 weeks postpartum. Its predictive validity for depression and anxiety was assessed at the same time.ResultsThe exploratory analysis revealed a 19‐item structure divided into six factors. This inventory has good internal consistency (Cronbach's alpha = .815). The predictive validity shows that the PNPSI significantly predicts depression and anxiety at 6 weeks postpartum, and that certain factors are particularly prominent.ConclusionThe PNPSI's psychometric properties make it a useful tool for future research to evaluate interventions for perceived stress during the postnatal period. Its predictive power for depression indicates that it is also a promising tool for clinical settings.     

Effect of stay in a postpartum care institution on postpartum depression in women

IntroductionPregnancy and childbirth can cause substantial psychological and social changes and may lead to mental disorders. Women who are discharged directly from the maternity hospital after delivery without social support may have postpartum psychological health issues. Rarely have studies focused on the effect of postpartum care institutions on postpartum depression in women.MethodsWe conducted a longitudinal study in Taiwan from January 2017 to July 2018. The data were collected via questionnaires administered at four time points: the first trimester of pregnancy (n = 309), the second trimester of pregnancy (n = 269), the third trimester of pregnancy (n = 257) and six weeks postpartum (n = 252). Among the participants, 130 women stayed in e postpartum care institutions, while 122 did not stay in an institution. Analysis included student t test, chi-square test, and difference in differences analysis. Linear regression analysis was used to determine the independence of the related factors for postpartum depression.ResultsThe women who stayed at postpartum care institutions (n = 130) had a higher education status, higher income, higher percentage of assisted reproductive technology (ART) treatment, higher cesarean section rate, and lower postpartum Edinburgh Perinatal Depression Scale (EPDS) scores (14.6% vs. 27.8%) compared with those who did not stay at postpartum care institutions. Among the women who stayed in postpartum care institutions, the average EPDS scores were 8.74 ± 0.46 and 8.15 ± 0.49 in the ART and natural pregnancy groups at baseline (3rd month), respectively, and there was no significant difference (p = 0.59). The EPDS scores in the ART group significantly declined at the 6th month (difference = −0.67, p<0.05), 9th month (difference = −2.00, p<0.01) and postpartum (difference = −4.01, p<0.01). Multivariate linear regression analysis indicated that postpartum care institutions was the main factor (r = 1.38, p = 0.014) correlating to postpartum depression in women.ConclusionProviding maternal and infant care in postpartum care institutions allows the mother to rest; and the professional guidance from the medical staff can provide the necessary support and help mothers to learn. Postpartum care institutions can decrease the incidence and severity of postpartum depression.     

A community-based continuum of care model for the prevention of postpartum hemorrhage in rural Ghana

ObjectiveTo report on Phase 1 of an operations research study designed to reduce postpartum hemorrhage (PPH)-related morbidity and mortality in rural Ghana.MethodsPhase 1 of the study—which included a needs assessment, community sensitization, implementation of blood collection drapes, training of service providers, and baseline data collection—comprised preliminary work to prepare for misoprostol distribution in Phase 2. Seventy-four primary healthcare providers were trained on safe-motherhood practices, use of blood collection drapes, and data collection. Baseline data were collected from 275 women regarding home deliveries, who attended the deliveries, incidence of PPH, and use of blood collection drapes.ResultsBlood collection drapes were used at 67.6% of deliveries, increasing to 88.5% over the final 6 months of Phase 1. Community health extension workers (CHEWs) were present at 57.1% of all deliveries but attendance increased to 86.9% during the last 6 months of Phase 1. Overall, 96.0% of deliveries resulted in healthy outcomes for the mother; 4.0% of births had complications.ConclusionThe preliminary work conducted in Phase 1 of the study was crucial in guiding misoprostol distribution in Phase 2. However, challenges existed, including inadequate community sensitization, low home-birth attendance by CHEWs, and data collection problems.     

Social proximity in Swedish mother-daughter and mother-son interactions in infancy

This study investigated free play interactions between 20 Swedish mothers and their infants (11 boys and nine girls) at 9 and 14 months of age. Higher degrees of social proximity within mother-daughters dyads were found, as compared to mother-son dyads. Mothers with daughters also displayed more physical contact at 9 months and scored higher on maternal sensitivity at 14 months, as compared to mothers of boys. Higher degrees of social promixity (combined infant and mother scores) were found at 14 months of age, as compared to 9 months. These findings suggest that despite the high level of gender equality promoted in Swedish society, Swedish mothers treat girls differently from boys.     

A Descriptive Study of Transient Neonatal Feeding Intolerance in a Tertiary Care Center in Turkey

ObjectiveTo investigate the characteristic features of transient neonatal feeding intolerance (TNFI) during the hospitalization for birth in the maternity ward.DesignA prospective follow‐up study.SettingMaternity ward and neonatal intensive care unit (NICU) in an academic medical center.ParticipantsTerm (≥ 37‐weeks gestation) infants admitted to the neonatal intensive care unit with recurrent vomiting and refusal to feed between January and December 2011. These infants were prospectively followed‐up at 1, 2, 4, 6 months of age in the outpatient clinic.ResultsDuring the study period 1280 infants were evaluated in the maternity ward. Forty‐eight (3.75%) neonates with repeated vomiting and refusal to feed were hospitalized from the maternity unit to the NICU Level I on the first postnatal day for further investigation. All infants started vomiting in the first day (median 5.75 hours; interquartile range: 1–24) and recovered by the 48^th postnatal hour (median 27.5 hours; interquartile range: 14–48 hours). Laboratory and imaging studies showed no abnormalities. After discharge, 6‐month follow‐up of these infants showed no vomiting or feeding intolerance during well‐child visits.ConclusionsInfants with TNFI can be managed with close observation and supportive measures if they have no other indications of underlying disease. We believe that expectant management and supportive measures under skilled nursing care will prevent unnecessary diagnostic evaluation, mother/infant separation, and prolonged hospital stay.     

Positive Effect of Kangaroo Mother Care on Long‐Term Breastfeeding in Very Preterm Infants

ObjectiveTo investigate the use of Kangaroo Mother Care (KMC) and its association with breastfeeding at 1 to 6 months of corrected age in mothers of very preterm (VPT) and preterm (PT) infants.DesignProspective longitudinal study.SettingNeonatal Intensive Care Units in four counties in Sweden.ParticipantsThe study included 103 VPT (<32 gestational weeks) and 197 PT (32‐36 gestational weeks) singleton infants and their mothers.MethodsData on KMC, measured in duration of skin‐to‐skin contact/day during all days admitted to a neonatal unit, were collected using self‐reports from the parents. Data on breastfeeding were obtained by telephone interviews.ResultsVPT dyads that breastfed at 1, 2, 5, and 6 months had spent more time in KMC per day than those not breastfeeding at these times. A trend toward significance was noted at 3 and 4 months. In the PT dyads no statistically significant differences were found in the amount of KMC per day between those dyads that breastfed and those that did not.ConclusionsThis study shows the importance of KMC during hospital stay for breastfeeding duration in VPT dyads. Hence, KMC has empowering effects on the process of breastfeeding, especially in those dyads with the smallest and most vulnerable infants.     

Prevalence and Factors Affecting Breastfeeding Among Aboriginal Women in Northwestern Ontario

ObjectiveTo evaluate breastfeeding outcomes among Aboriginal women and to determine variables affecting breastfeeding in the early postpartum period.DesignProspective cohort study.SettingTwo sites in Northwestern Ontario, Canada: a tertiary care center and a rural hospital.ParticipantsOne hundred thirty breastfeeding Aboriginal women agreed to participate in the study.MethodsAll women completed a baseline survey in hospital that included questions regarding demographic, prenatal, breastfeeding, obstetric, postpartum, and neonatal characteristics. Women were then telephoned at 4 and 8 weeks postpartum to complete additional questionnaires regarding infant feeding.ResultsLow rates of breastfeeding initiation (69%) and exclusive breastfeeding were identified at 4 (37.5%) and 8 (35.3%) weeks postpartum. Among those who initiated breastfeeding, duration rates at 4 (86%) and 8 weeks (78%) postpartum are comparable to other studies. Variables associated with any and exclusive breastfeeding at 8 weeks included the following: (a) household income, (b) intended breastfeeding duration, (c) plan to exclusively breastfeed, (d) perception of meeting their planned duration goal, and (e) higher breastfeeding self‐efficacy. Partner support was associated with any breastfeeding at 8 weeks but not exclusivity. Women who were breastfeeding exclusively in hospital (prevalence ratio [PR] = .48, 95% confidence interval [CI] [0.27, 0.86]), did not smoke (PR = 2.5, 95% CI [1.4, 4.3]) and/or use substances during pregnancy (PR = 4.5, 95% CI [1.5, 14]) were more likely to be breastfeeding exclusively at 8 weeks.ConclusionMany of the variables may be considered modifiable and amenable to intervention. Targeted interventions should be directed toward improving breastfeeding outcomes among Aboriginal women.