Etonogestrel-Releasing Contraceptive Implant for Postpartum Adolescents: A Randomized Controlled Trial

Study Objective

To compare immediate postpartum insertion of the contraceptive implant to placement at the 6-week postpartum visit among adolescent and young women.

Home versus Hospital Breastfeeding Support for Newborns: A Randomized Controlled Trial

ABSTRACT: Background: The advantages of breastfeeding have been well established for both mothers and their infants. Existing research reports equivocal effects of early discharge and postpartum home care on breastfeeding success. The purpose of this study was to compare the effects of breastfeeding support offered in hospital and home settings on breastfeeding outcomes and maternal satisfaction for mothers of term and near‐term newborns who experienced standard or early discharge. Methods: In a randomized controlled trial with prognostic stratification for gestational age, 101 term and 37 near‐term (35–37 weeks’ gestational age) mother‐newborn pairs were randomized to either a standard care group (standard care and standard length of hospitalization) or an experimental group (standard hospital care with early discharge and home support from nurses who were certified lactation consultants). Data collection occurred before randomization, at discharge from hospital, and from 5 to12 days postpartum. Primary outcomes included breastfeeding rates and maternal satisfaction. Results: More mothers of term newborns in the experimental group were breastfeeding exclusively at follow‐up (p=0.02) compared with the control group. No significant breastfeeding differences occurred among mothers with near‐term newborns in the experimental and standard care groups. Conclusions: In‐home lactation support appears to facilitate positive breastfeeding outcomes for mothers of term newborns. This may also be a beneficial model of postpartum care for mothers of near‐term newborns; however, further research is required. The findings suggest implications for health caregivers and policy makers with respect to postpartum lactation and health care services. (BIRTH 29:4 December 2002)     

Initial Differences in Postpartum Attachment Behavior in Breastfeeding and Bottle-Feeding Mothers

Nurses frequently assume that breastfeeding mothers are more attached to their infants than bottle-feeding mothers. The researchers observed 15 breastfeeding and 15 bottle-feeding mothers using the Avant maternal-infant attachment tool. The scores of the two groups were compared and no significant differences were found. The study results and limitations of this study and recommendations for future research are discussed.     

Positioning for Breastfeeding

Abstract: Difficulties in breastfeeding frequently arise from the failure of mothers and caregivers alike to understand what is happening as babies breastfeed, and what that means about positioning the baby for breastfeeding. This paper summarizes and criticizes some concepts of how babies breastfeed that have been inadequately researched or influenced by literature about how babies bottle feed. Recent ultrasound studies confirm overlooked earlier work and offer the basis for a rational understanding of how to facilitate adequate contact between the baby's mouth and the mother's breast and how to recognize poor positioning. The importance of breast shape, tension, and protractility are discussed, and the role of engorgement in nipple trauma explained; the differences between breastfeeding and feeding from so-called orthodontic teats are outlined. Understanding these matters is important to preventing breast and nipple problems and premature weaning.     

Can Midwives Reduce Postpartum Psychological Morbidity? A Randomized Trial

Background: Women who are traumatized after childbirth find that listening, support, counseling, understanding, and explanation are the most useful treatments. However, little evidence is available from randomized trials of the relative efficacy of these treatments as a positive postnatal intervention. This study purpose was to examine if postnatal ‘‘debriefing’’ by midwives can reduce psychological morbidity after childbirth. Method: A randomized trial was conducted in a regional teaching hospital in northwest England. One hundred and twenty postnatal primigravidas were allocated by sealed envelopes to receive the debriefing intervention (n= 56) or not (n= 58). The main outcome measure was the Hospital Anxiety and Depression (HAD) scale administered by postal questionnaire 3 weeks after delivery. The proportion of women in each group with anxiety and depression scores of more than 10 points were compared, using odds ratios and 95% confidence intervals. Results: Women who received the intervention were less likely to have high anxiety and depression scores after delivery when compared with the control group. Conclusions: The support, counseling, understanding, and explanation given to women by midwives in the postnatal period provides benefits to psychological well-being. Maternity units have a responsibility to develop a service that offers all women the option of attending a session to discuss their labor. (BIRTH 25:4 December 1998)     

Breastfeeding Peer Support: Maternal and Volunteer Perceptions from a Randomized Controlled Trial

ABSTRACT: Background: Several studies have demonstrated the positive effects of peer support on various breastfeeding outcomes, but no study has assessed women's and peer volunteers’ views on, or the nature and intensity of, the supportive intervention. The objective of this study was to describe maternal and peer volunteer perceptions of their experience while participating in a breastfeeding peer support trial. Methods: A randomized controlled trial was conducted to evaluate the effect of telephone‐based peer (mother‐to‐mother) support on breastfeeding duration. Two hundred and fifty‐six primiparous breastfeeding women were randomly allocated to receive either conventional care or conventional care plus peer support. Three primary outcome measures were peer volunteer activity logs, maternal perceptions of peer support, and evaluations of the peer volunteer experience. Results: Questionnaires were completed by 98.5 percent (n=130) of the mothers in the peer support group. Mothers reported their peer volunteers were available when difficulties were experienced, increased their confidence, decreased their concerns, and assisted them in reaching their breastfeeding goals. These supportive interactions resulted in 81.5 percent of mothers (n=106) being satisfied with their peer support experience and suggesting that every new mother should be offered this intervention. Similarly, all the peer volunteers interviewed (n=30) viewed their experience positively. They suggested some intervention modifications as follows: ensure that mothers enrolled in the program want peer support; provide peer volunteers with ongoing educational sessions and opportunities to ‘‘socialize'’ with other volunteers; and disseminate the results of peer support efforts. Conclusions: Both mothers and peer volunteers perceived their intervention experiences positively. Whereas maternal satisfaction was related to the number and duration of peer volunteer contacts, peer volunteers enjoyed their training session and the opportunity to assist mothers for a variety of reasons. Specific intervention modifications should be implemented to enhance peer volunteer satisfaction and retention. (BIRTH 29:3 September 2002)     

Early Postpartum Discharge and Subsequent Breastfeeding

Background: Early postpartum discharge of babies was gradually introduced in Sweden in the 1980s on ideological grounds, based on the premise that maternity wards were unnatural settings for mothers and babies and hampered breastfeeding. From about 1990, early discharge was used as a means to reduce costs. The purpose of this study was to examine if mandated early discharge at Central Hospital of Karlstad, Sweden, influenced subsequent breastfeeding. Method: Breastfeeding outcomes of infants up to six months of age of all births in 1993 (n= 3231) were compared with the outcome of newborns in 1990 (n= 1462). Results: Breastfeeding at six months postpartum continued to increase during the early 1990s for both healthy and sick infants, irrespective of whether or not they were discharged early. In infants born in 1995 the breastfeeding rate at six months was 64 percent for healthy newborns and 53 percent for sick newborns. Conclusion: Factors other than the time of discharge, most likely a positive change of attitude in society and vigorous introduction of the Baby Friendly Hospital Initiative, seem to have been more important for successful breastfeeding. (BIRTH 25:4 December 1998)     

Perinatal Depression: A Randomized Controlled Trial of an Antenatal Education Intervention for Primiparas

Background: Depression can be an unexpected and distressing companion for a woman during the major life transition of becoming a mother for the first time. Researchers now demonstrate that approximately 50 percent of women will experience perinatal distress. Therefore, the etiology and management of perinatal depression is essential for a quality care of childbearing women. The objectives of this study were to develop an education intervention tailored to the information needs of primiparous women about perinatal depression, to deliver this intervention antenatally, and to conduct a randomized controlled trial to determine the effect of the antenatal education intervention in the reduction of postnatal depression. Method: A prospective, randomized controlled trial of the education intervention (n= 206) was conducted at three sites in Australia. The outcome of changes in mood state was measured by the Profile of Mood States questionnaire once antenatally (12–28 wk), and twice postnatally (8–12 and 16–24 wk); social support and demographic data were also collected. The education package was administered to the intervention group at the antenatal assessment of mood. Results: A significant and steady reduction in scores (overall and on the subscales) was observed over time for both groups that showed significant improvement in symptoms of depression. No difference was detected when comparing the intervention group with the control group. Additional multivariate regression analyses revealed no relevant influence of social support or demographic variables. Conclusions: Women in both the study and control groups were more depressed antenatally than postnatally. The finding that the education intervention made no difference challenges the two strongly held tenets of health education in childbearing women—that depression can be reduced through education and that antenatal education interventions can endure into the postnatal period.     

Two Mid‐pregnancy Interventions to Increase the Initiation and Duration of Breastfeeding: A Randomized Controlled Trial

Abstract: Background : Despite high levels of breastfeeding initiation in Australia, only 46 percent of women are still breastfeeding (exclusively or partially) 6 months later, with marked differences between social groups. This study aimed to determine the influence of mid‐pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge, and on the duration of breastfeeding. Methods : A randomized controlled trial to compare two strategies for increasing the initiation and duration of breastfeeding was conducted, in which 981 primiparas who attended a public, tertiary women's hospital in Melbourne, Australia, were randomized to one of two interventions or to standard care (327 in each group). The interventions were a 1.5‐hour class on practical aspects of breastfeeding using a previously tested tool (Practical Skills), and two 1‐hour classes exploring family and community attitudes toward, and experiences of, breastfeeding (Attitudes). Both interventions took place in interactive small groups when women were in mid‐pregnancy. Breastfeeding initiation was ascertained by interview 2 to 4 days after birth, and breastfeeding duration was assessed by telephone interview 6 months after birth. Results : Neither intervention increased breastfeeding initiation or duration compared with standard care. Rates at initiation were 97 percent (296/306) for the Practical Skills intervention, 95 percent (291/308) for the Attitudes intervention, and 96 percent (297/310) for standard care. Rates at 6 months were, respectively, 55 percent (162/297), 50 percent (146/293), and 54 percent (162/299). Conclusions : In settings where breastfeeding initiation is already high, neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration.     

Randomized Controlled Trial of Motivational Interviewing to Support Breastfeeding Among Appalachian Women

ObjectiveTo determine the effectiveness of a single session of prenatal motivational interviewing (MI) to enhance breastfeeding outcomes.DesignA randomized controlled trial with two groups (MI and psychoeducation) with repeated measures: preintervention, postintervention, and at 1 month postpartum.SettingThe intervention was conducted at a university-associated clinic, community locations, and participants’ homes. Postpartum follow-up was conducted by telephone.ParticipantsA total of 81 women with low-risk pregnancies enrolled at 28 to 39 weeks gestation who lived in Appalachia.MethodsParticipants were randomly assigned to MI or psychoeducation on infant development. Pre- and postintervention outcome measures included intention to breastfeed, confidence in and importance of breastfeeding plan, and breastfeeding attitudes. At 1 month postpartum, participants completed a telephone interview to assess actual breastfeeding initiation, exclusivity, and plans to continue breastfeeding.ResultsAt 1 month postpartum, women in the MI group were more likely to report any current breastfeeding than women in the psychoeducation group, regardless of parity, χ²(1, N = 79) = 4.30, p = .040, Φ = .233. At the postintervention time point, the MI intervention had a significant effect on improving attitudes about breastfeeding among primiparous women only (p < .05).ConclusionOne session of MI was effective to promote breastfeeding at 1 month postpartum and to enhance positive attitudes toward breastfeeding among primiparous women in Appalachia.     

The Effect of Patient Positioning on Ureteral Efflux During Intraoperative Cystoscopy: A Randomized Controlled Trial

Study ObjectiveTo identify the relationship between patient position during surgery and time to confirmation of ureteral patency on cystoscopy.DesignRandomized controlled trial.SettingAcademic tertiary care medical center.Patients or ParticipantsA total of 91 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy between February 2021 and February 2022 were randomized to intervention (n = 45) or control (n = 46). Exclusion criteria included known kidney disease or urinary tract anomaly, current ureteral stent, pregnancy, malignancy, and recognized intraoperative urinary tract injury.InterventionsSubjects in the control group were placed in a 0° supine position during cystoscopy. Subjects in the intervention group were placed in a 20° angle in reverse Trendelenburg (RT) position during cystoscopy.Measurements and Main ResultsThe primary outcome, time to confirmation of bilateral ureteral patency, was measured at the time the second ureteral jet was viewed during intraoperative cystoscopy. There was no significant difference in mean time to confirmation (66.5 seconds in supine vs 67 seconds in RT, p = .2) nor in total cystoscopy time (111 seconds in supine vs 104.5 seconds in RT, p = .39). There were no significant differences in need for alternative modalities to aid in ureteral efflux visualization, delayed diagnosis of ureteric injury, and operative time. RT position seemed to have reduced the time to confirmation for the small group of patients with longer confirmation time (>120 seconds).ConclusionRT position does not change time to confirmation of bilateral ureteral patency compared with supine position. However, there may be a benefit in position change if time to confirmation is >120 seconds.     

Management of Severe Hypertension in the Postpartum Period with Intravenous Hydralazine or Labetalol: A Randomized Clinical Trial

Objective: To compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in the puerperium. Design: Randomized clinical trial. Setting: Critical care unit of gynecology and obstetrics department in the Complejo hospitalario “Dr. AAM” de la Caja de Seguro Social in Panama. Population: Eighty-two women with severe hypertension during the postpartum period. Methods: Patients were randomized to receive hydralazine (5 mg as a slow bolus dose given intravenously, and repeated every 20 minutes to a maximum of five doses) or labetalol (20 mg in an intravenous bolus dose followed by 40 mg if not effective within 20 minutes, followed by 80 mg every 20 minutes to a maximum dose of 300 mg). The primary endpoint was the successful lowering of blood pressure. Secondary endpoints were maternal complications and side-effects. Results: Forty-two women were enrolled in the hydralazine group and 40 in the labetalol group. Women were similar with respect to characteristics at randomization. No significant differences were observed for persistent severe hypertension or maternal side-effects. There was only one case of persistent severe hypertension in the labetalol group. There were no maternal deaths in any of the women studied. Conclusions: This randomized clinical trial shows that intravenous hydralazine and intravenous labetalol are effective and safe in the management of severe hypertension in the postpartum period.     

Fetal Movement Counting—Effects on Maternal‐Fetal Attachment: A Multicenter Randomized Controlled Trial

Abstract: Background: Women presenting with decreased fetal movement have an increased risk of adverse pregnancy outcomes. Fetal movement counting may be associated with improvement in maternal‐fetal attachment, which in turn, improves pregnancy outcome and postnatal mother–infant attachment. The study aim was to test whether maternal‐fetal attachment differed between groups of mothers who systematically performed fetal movement counting and mothers who followed standard antenatal care where routine fetal movement counting was discouraged. Methods: In a multicenter, randomized trial, 1,123 women were assigned to either systematic fetal movement counting from pregnancy week 28 or to standard antenatal care. This study sample included primarily white, cohabiting, nonsmoking, and relatively well‐educated women. The outcome measure was maternal‐fetal attachment, measured by using the Prenatal Attachment Inventory. Analysis was by intention‐to‐treat. Results: No difference was found between the groups in the scores on prenatal attachment; the means and standard deviations were 59.54 (9.39) and 59.43 (9.35) for the intervention and the control groups, respectively (p = 0.747). The mean difference between the groups was 0.20 (95% CI: 1.02–1.42). Conclusions: Fetal movement counting in the third trimester does not stimulate antenatal maternal‐fetal attachment. This result differs from a previous study where fetal movement counting improved maternal‐fetal attachment. Further research with a focus on possible mediating factors such as levels of stress, concern, and other psychological factors is required. (BIRTH 38:4 December 2011)     

Early Postpartum Breastfeeding and Acculturation among Hispanic Women

ABSTRACT: Background: Exclusive breastfeeding in the hospital is predictive of postpartum breastfeeding patterns. Although breastfeeding rates are similar for Hispanic and white women in the United States, evidence shows that more acculturated Hispanic mothers have lower rates of breastfeeding than those less acculturated. To date, no studies have examined whether this pattern exists in the immediate postpartum period. Methods: We used medical record data from 1,635 participants in the San Diego Birth Center Study, a cohort study of low‐income, low‐risk pregnant women. We applied a proxy measure of acculturation to categorize participants into a low acculturation (Hispanic, Spanish speaking [n = 951]); high acculturation (Hispanic, English speaking [n = 408]); or white, English speaking (n = 276) group. Logistic regression was used to examine the relationship between acculturation and exclusive breastfeeding at the time of hospital discharge while controlling for potential confounders. Results: Exclusive breastfeeding rates were significantly different across acculturation groups (p < 0.01). After adjusting for available confounding variables, women in the low acculturation group were more likely to breastfeed exclusively at discharge than those in the high acculturation group (OR = 1.36, 95% CI = 1.01–1.84). Women in the white, English‐speaking group also had greater odds of exclusive breastfeeding when compared with those in the high acculturation group (OR = 1.49, 95% CI = 1.02–2.19). Conclusions: This cross‐sectional study provides evidence of a correlation between acculturation and immediate postpartum breastfeeding, where higher acculturation is associated with lower odds of exclusive breastfeeding. Additional research is needed to understand how the process of acculturation may affect short‐ and long‐term breastfeeding behavior. (BIRTH 34:4 December 2007)     

A Randomized Trial of the Effects of Monitrice Support During Labor: Mothers' Views Two to Four Weeks Postpartum

Abstract: One hundred three women who were randomized to receive either routine nursing care (controls) or routine care plus one-to-one support by an experienced monitrice (experimental) were compared as to obstetric outcomes and their memories of types of support they had from nurse, monitrice, and mate. Women assigned a monitrice arrived at the hospital significantly further along in labor, and nearly twice as many had no medication during labor and delivery. Significantly fewer of these women used stirrups during delivery, and more had intact perineums. There was no difference between groups in use of forceps or cesarean sections. Length of labor was confounded by use of medications. Mothers in the experimental group remembered receiving more physical comfort measures, emotional support, and advocacy from monitrices compared to control mothers who received intrapartum care from nurses.     

Abbreviated Antibiotic Therapy for Clinical Chorioamnionitis: A Randomized Trial

Simple observation may he adequate therapy for patients with clinical chorioamnionitis after vaginal delivery. This study involves 41 subjects who delivered vaginally and had chorioamnionitis. Subjects were prospectively assigned in a randomized, double-blind fashion to either a continued antibiotic or placebo group. Postpartum observation without antibiotics in select patients with chorioamnionitis was supported by equivalent results in the two groups.