Skin‐to‐Skin Care with the Father after Cesarean Birth and Its Effect on Newborn Crying and Prefeeding Behavior

ABSTRACT: Background: Previous reports have shown that skin‐to‐skin care immediately after vaginal birth is the optimal form of care for full‐term, healthy infants. Even in cases when the mother is awake and using spinal analgesia, early skin‐to‐skin contact between her and her newborn directly after cesarean birth might be limited for practical and medical safety reasons. The aim of the present study was to compare the effects of skin‐to‐skin contact on crying and prefeeding behavior in healthy, full‐term infants born by elective cesarean birth and cared for skin‐to‐skin with their fathers versus conventional care in a cot during the first 2 hours after birth. Methods: Twenty‐nine father‐infant pairs participated in a randomized controlled trial, in which infants were randomized to be either skin‐to‐skin with their father or next to the father in a cot. Data were collected both by tape‐recording crying time for the infants and by naturalistic observations of the infants’ behavioral response, scored every 15 minutes based on the scoring criteria described in the Neonatal Behavioral Assessment Scale (NBAS). Results: The primary finding was the positive impact the fathers’ skin‐to‐skin contact had on the infants’ crying behavior. The analysis of the tape recordings of infant crying demonstrated that infants in the skin‐to‐skin group cried less than the infants in the cot group (p < 0.001). The crying of infants in the skin‐to‐skin group decreased within 15 minutes of being placed skin‐to‐skin with the father. Analysis of the NBAS‐based observation data showed that being cared for on the father’s chest skin‐to‐skin also had an impact on infant wakefulness. These infants became drowsy within 60 minutes after birth, whereas infants cared for in a cot reached the same stage after 110 minutes. Rooting activity was more frequent in the cot group than in the skin‐to‐skin group (p < 0.01), as were sucking activities (p ≤0.001) and overall duration of wakefulness (p < 0.01). Conclusions: The infants in the skin‐to‐skin group were comforted, that is, they stopped crying, became calmer, and reached a drowsy state earlier than the infants in the cot group. The father can facilitate the development of the infant’s prefeeding behavior in this important period of the newborn infant’s life and should thus be regarded as the primary caregiver for the infant during the separation of mother and baby. (BIRTH 34:2 June 2007)     

Onset of Vocal Interaction Between Parents and Newborns in Skin‐to‐Skin Contact Immediately After Elective Cesarean Section

Abstract: Background: Cesarean section is associated with delayed mother‐infant interaction because neither the mother nor the father routinely maintains skin‐to‐skin contact with the infant after birth. The aim of the study was to explore and compare parent‐newborn vocal interaction when the infant is placed in skin‐to‐skin contact either with the mother or the father immediately after a planned cesarean section. Methods: A total of 37 healthy infants born to primiparas were randomized to 30 minutes of skin‐to‐skin contact either with fathers or mothers after an initial 5 minutes of skin‐to‐skin contact with the mothers after birth. The newborns’ and parents’ vocal interaction were recorded on a videotape and audiotape. The following variables were explored: newborns’ and parents’ soliciting, newborns’ crying and whining, and parental speech directed to the other parent and to the newborn. Results: Newborns’ soliciting increased over time (p = 0.032). Both fathers and mothers in skin‐to‐skin contact communicated more vocally with the newborn than did fathers (p = 0.003) and mothers (p = 0.009) without skin‐to‐skin contact. Fathers in skin‐to‐skin contact also communicated more with the mother (p = 0.046) and performed more soliciting responses than the control fathers (p = 0.010). Infants in skin‐to‐skin contact with their fathers cried significantly less than those in skin‐to‐skin contact with their mothers (p = 0.002) and shifted to a relaxed state earlier than in skin‐to‐skin contact with mothers (p = 0.029). Conclusions: Skin‐to‐skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin‐to‐skin contact and exposed to the parents’ speech, the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin‐to‐skin contact after cesarean section, to support the early onset of the first vocal communication. (BIRTH 37:3 September 2010)     

Implementing Family‐Centered Cesarean Birth

Cesarean birth is recognized as a physical and psychological stressor for many women. Maternity practices during cesarean birth should meet women's needs, while maintaining safety, to optimize the experience. Family‐centered cesarean birth is a package of interventions that encourages a woman to participate in choosing interventions that would be helpful when undergoing a planned or unplanned cesarean birth. Included in family‐centered cesarean birth is implementation of skin‐to‐skin care in the operating room for neonates who appear term and healthy. The process of attempting to implement family‐centered cesarean birth at one academic center is presented, including steps for implementation, benefits, challenges, and areas for continued improvement and research. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.     

Gamma‐aminobutyric acidA receptor agonist,muscimol, increases KiSS‐1 gene expression in hypothalamic cell models

Purpose

Accumulating evidence indicates that hypothalamic kisspeptin plays a pivotal role in the regulation of the hypothalamic–pituitary–gonadal (HPG) axis. In this study, the direct action of the gamma‐aminobutyric acid (GABA)_A receptor agonist on kisspeptin‐expressing neuronal cells was examined.

Methods

A hypothalamic cell model of rat hypothalamic cell line R8 (rHypoE8) cells and primary cultures of neuronal cells from fetal rat brains were stimulated with a potent and selective GABA_A receptor agonist, muscimol, to determine the expression of the KiSS‐1 gene.

Results

Stimulation of the rHypoE8 cells with muscimol significantly increased the level of KiSS‐1 messenger (m)RNA expression. The ability of muscimol to increase the level of KiSS‐1 mRNA also was observed in the primary cultures of the neuronal cells from the fetal rat brains. The muscimol‐induced increase in KiSS‐1 mRNA expression was completely inhibited in the presence of the GABA_A receptor antagonist. Although muscimol increased the expression of KiSS‐1, the natural compound, GABA, failed to induce the expression of KiSS‐1 in the rHypoE8 cells. Muscimol did not modulate gonadotropin‐releasing hormone expression in either the rHypoE8 cells or the primary cultures of the fetal rat brains.

Conclusions

This study's observations suggest that the activation of the GABA_A receptor modulates the HPG axis by increasing kisspeptin expression in the hypothalamic neurons.     

Behavior Change Following Implementation of Home‐Based Life‐Saving Skills in Liberia,West Africa

Introduction: Home‐Based Life‐Saving Skills (HBLSS) has been fully integrated into Liberia's long‐term plan to decrease maternal and newborn mortality and morbidity, coordinated through the Ministry of Health and Social Welfare. The objective of this article is to disseminate evaluation data from project monitoring and documentation on translation of knowledge and skills obtained through HBLSS into behavior change at the community level. Methods: One year after completion of HBLSS training, complication audits were conducted with 434 postpartum women in 1 rural county in Liberia. Results: Sixty‐two percent (n = 269) of the women were attended during birth by an HBLSS‐trained traditional midwife or family member, while 38% (n = 165) were attended by a traditional midwife or family member who did not receive HBLSS training. Home‐Based Life‐Saving Skills–trained birth attendants performed significantly more first actions (life‐saving actions taught to be performed after every birth) than the attendants not HBLSS trained. Fourteen percent of our sample (n = 62) reported too much bleeding following the birth. Of these women, approximately half (n = 29) were attended by an HBLSS‐trained traditional midwife or family member. There was a significant difference in secondary actions (those actions taught to be performed when a woman experiences too much bleeding following childbirth) that were reported to have been performed by HBLSS‐trained attendants (mean 5.26, standard deviation [SD] 1.88) and untrained attendants (mean 2.73, SD 1.97; P < .0001). Discussion: Our findings suggest that HBLSS knowledge is being transferred into behavior change and used at the community level by traditional midwives and family members.     

Evidence‐Based Practice for Intrapartum Care: The Pearls of Midwifery

Care for women in labor in the United States is in a period of significant transition. Many intrapartum care practices that are standard policies in hospitals today were instituted in the 20th century without strong evidence for their effect on the laboring woman, labor progress, or newborn outcomes. Contemporary research has shown that many common practices, such as routine intravenous fluids, electronic fetal monitoring, and routine episiotomies, do more harm than good. In 2010, the American College of Nurse‐Midwives released a PowerPoint presentation titled Evidence‐Based Practice: Pearls of Midwifery. This presentation reviews 13 intrapartum‐care strategies that promote normal physiologic vaginal birth and are associated with a lower cesarean rate. They are also practices long associated with midwifery care. This article reviews the history of intrapartum practices that are now changing, the evidence that supports these changes, and the practical applications for the 13 Pearls of Midwifery.     

Self‐Rated “No‐” and “Low‐” Risk Pregnancy: A Comparison of Outcomes for Women in Obstetric‐Led and Midwife‐Led Units in England

ABSTRACT: Background: Debate in the United Kingdom about place of birth often concerns obstetric‐led units and midwife‐led units and relates to notions of risk and safety. Outcomes for these two types of unit are often not comparable because of the restricted selection criteria for midwife‐led units. The purpose of this study was to compare outcomes for women intending to give birth in these different types of unit and whose self‐rated pregnancy risk level was “none” or “low.” Methods: Self‐completion questionnaires were distributed to mothers 8 days after the birth in 9 units (6 midwife led 3 obstetric led) over a 6‐month period. Results: Completed questionnaires were received from 432 women (midwife led = 294, obstetric led = 138). Mothers in midwife‐led units spent shorter times in labor in the unit (p < 0.01), received less analgesia (p < 0.01) and had fewer interventions (p < 0.01), and were more likely to have a normal delivery (p < 0.01) than women in obstetric‐led units. Similar differences were found for both primiparous and multiparous women. In terms of the number of midwives attending each woman, analysis of covariance suggested different models of care depending on type of unit (p < 0.05) and parity (p < 0.01). Conclusions: Since these mothers’ self‐rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric‐led units compared with midwife‐led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes. (BIRTH 34:4 December 2007)     

Group B Streptococcal Bacteriuria in Pregnancy: An Evidence‐Based,Patient‐Centered Approach to Care

Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS‐related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline‐based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence‐based, patient‐centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.     

Women's Attitudes Toward Their Partners’ Involvement in Antenatal Care and Prevention of Mother‐to‐Child Transmission of HIV in Cameroon,Africa

Introduction : Although the HIV epidemic has stabilized worldwide, it remains a public health challenge in sub‐Saharan Africa. The key strategy to prevention and control of HIV remains voluntary counseling and testing. In sub‐Saharan Africa, 76% of pregnant women have at least one antenatal visit. Therefore, antenatal care is a venue through which women can access HIV testing, and, if infected, obtain care for prevention of mother‐to‐child transmission (PMTCT). Public health organizations have promoted increasing HIV testing of men by incorporating partner testing into antenatal care. Recent studies have shown that African women may not be receptive to their partner's involvement in obstetric care secondary to cultural attitudes and traditional beliefs. Methods : A quality improvement project surveyed women to identify their attitudes and beliefs concerning antenatal care, PMTCT, and partner's participation in antenatal care and testing. Results : Women viewed antenatal care as important to having a positive pregnancy outcome and the primary venue through which they accessed HIV testing. Most women (83.8%) were receptive to their partners’ involvement in antenatal care and identified increased partner participation over the past 5 years. Women (98.2%) said men's primary role was payment for obstetric care. Cultural and gender‐based attitudes and beliefs were identified as barriers to HIV testing of men. Discussion : Women viewed antenatal care as important to a positive pregnancy outcome with access dependent on their families’ finances and their partners’ ability and willingness to pay for their care. Although pregnancy has traditionally been viewed as a women's affair, the majority of women wanted their partners to participate in their care, including receiving HIV counseling and testing. Women identified men's involvement as an individual belief, saying that many in their community were not supportive of male participation in antenatal care. Multiple options, including couples testing in antenatal clinics, should be available to increase HIV testing in men.     

Role of pituitary adenylate cyclase‐activating polypeptide in modulating hypothalamic‐pituitary system

Background

Pituitary adenylate cyclase‐activating polypeptide (PACAP) is a multifunctional peptide that is isolated and identified from the ovine hypothalamus, whose effects and mechanisms have been elucidated in numerous studies. The PACAP and its receptor are widely expressed, not only in the hypothalamus but also in peripheral organs.

Methods

The studies on the role of PACAP in the hypothalamic‐pituitary system, including those by the authors, were summarized.

Results

In the pituitary gonadotrophs, PACAP increases the gonadotrophin α‐, luteinizing hormoneβ‐, and follicle‐stimulating hormone β‐subunit expression and the expression of gonadotropin‐releasing hormone (GnRH) receptor and its own receptor, PAC1R. Moreover, a low‐frequency GnRH pulse increases the expression of PACAP and PAC1R more than a high‐frequency GnRH pulse in the gonadotrophs. The PACAP stimulates prolactin synthesis and secretion and increases PAC1R in the lactotrophs. In the hypothalamus, PACAP increases the expression of the GnRH receptors, although it is unable to increase the expression of GnRH in the GnRH‐producing neurons.

Conclusion

The PACAP not only acts directly in each hormone‐producing cell, it possibly might regulate hormone synthesis via the expression of its own receptors or those of other hormones.