Nurse Home Visits Improve Maternal/Infant Interaction and Decrease Severity of Postpartum Depression

ObjectiveTo test the efficacy of the relationship‐focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum.DesignRandomized clinical trial (RCT) with three phases.MethodsIn this three‐phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants.SettingPhase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse‐led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants’ homes.ParticipantsPostpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty‐five mother/infant dyads were fully retained in the 9‐month protocol.ResultsTreatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self‐reflection during data collection, directions for video‐recorded interaction, and assistance with referrals likely contributed to improvements for both groups.ConclusionsEfficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse‐led home visits had a positive effect on outcomes for all participants.     

分娩过程中使用缩宫素对产后出血的影响

目前,产后出血仍是孕产妇死亡的主要原因之一,研究证实分娩过程中使用缩宫素增加了产后出血的发生风险,尤其是在缩宫素使用时间过长、浓度过高或未积极管理第三产程时。缩宫素受体的脱敏反应是其主要病理生理学机制,临床上表现为后续缩宫素诱导的子宫收缩反应性降低,进而引起宫缩乏力和产后出血。综述使用缩宫素与产后出血的相关性研究进展,帮助临床医生建立合理的缩宫素管理方案,减少宫缩乏力性产后出血的发生。     

Effects of a Specialized Prenatal Adolescent Program on Maternal and Infant Outcomes

The effects of a specialized prenatal educational program on perinatal outcomes in an urban adolescent maternity term population were examined. Fifty pregnant adolescents attended the program and 50 nonattenders served as controls. All subjects delivered at the same large metropolitan hospital. The data supported the hypotheses predicting that those adolescents exposed to the educational program and their infants would demonstrate fewer perinatal complications than those not exposed to the program. When analyzed by age, attenders and their infants in both groups (13 to 15 and 16 to 18 years of age) had fewer complications than nonattenders. Attenders also demonstrated lower frequencies of several obstetric and postnatal complications than did nonattenders. This study underscores the positive effects a specialized education program can have on adolescent perinatal outcomes.     

Maternal Country of Origin and Infant Birthplace: Implications for Birth-weight

Summary: This study investigated the effect of mother's country of origin and baby's birthplace on infant birth-weight. The mean birth-weights of full-term babies born of well immigrant women from 5 countries were compared with diose of women of Anglo-Australian origin confined at die same hospital. Data were collected from medical records at Canterbury hospital for 1,274 women confined between 1989 and 1992 and 2,524 of their babies. Multiple regression analysis showed that infants born in Australia to women from Vietnam and Korea were significantly heavier man infants born to these women in their country of origin. Babies born to women from Vietnam were significantly lighter than babies born to Anglo-Australian controls.     

Breastfeeding Patterns: Comparing the Effects on Infant Behavior and Maternal Satisfaction of Using One or Two Breasts

In the Western world advice given by breastfeeding consultants about the use of one or two breasts at each feed has resulted in apparently arbitrary changes over time. This study compared 1-month-old breastfed infants' reactions to single- and two-breast feeds in terms of restlessness, crying, sleeping, and frequency of feeds, wet diapers, and loose stools. Eighty mothers were randomly assigned at the maternity ward, 44 to the single-breast group and 36 to the two-breast group. At one-month follow-up no differences between the groups were seen regarding any infant behavior variables, or in terms of maternal satisfaction, confidence, and mood throughout the full 24-hour observation period or during a 4-hour period in the evening. Compliance with the assigned feeding method was better in the two-breast than in the one-breast group. This may partly be due to tradition, since the two-breast practice has been recommended by child health nurses in Sweden for over 50 years. It seems reasonable that a baby should be allowed to finish the first breast and, if still hungry, be offered the second breast. The baby's appetite is the deciding factor.     

Domains of Postpartum Doula Care and Maternal Responsiveness and Competence

Objective: To describe the domains of postpartum doula care and illustrate how doulas facilitate development of maternal responsiveness and competence.
Design: Qualitative study using ethnographic method of participant observation.
Setting: Homes of mothers who received postpartum doula care.
Participants: Thirteen women and their infants; 4 postpartum doulas.
Results: Eleven domains emerged: emotional support, physical comfort, self-care, infant care, information, advocacy, referral, partner/father support, support mother/father with infant, support mother/father with sibling care, and household organization. Emotional support was used consistently and in combination with the other domains. Activities in all of the domains were used to facilitate the development of maternal responsiveness and maternal competence with 3 issues: resolution of infant feeding, integrating the infant into the family, and supporting developmental care and attachment.
Conclusions: Data suggest that by using 11 domains of care, postpartum doulas facilitate maternal responsiveness and competence. Development of a long-term relationship, mother-centered care, and education and support related to infant feeding, integrating the infant into family, and developmental care and attachment may contribute to these outcomes.     

Maternal Axillar and Breast Temperature After Giving Birth: Effects of Delivery Ward Practices and Relation to Infant Temperature

ABSTRACT: Background: Little is known about the development and control of skin temperature in human mothers after birth. The purpose of this study was to explore the effects of delivery ward practices and early suckling on maternal axillar and breast temperatures during the first 2 hours postpartum and to relate them to the infant’s foot and axillar temperatures. Methods: Three groups of 176 mother‐infant pairs were randomized as follows—group I: infants lying prone in skin‐to‐skin contact on their mother’s chest, named the “skin‐to‐skin group” (n = 44), group II: infants who were dressed and lying prone on their mother’s chest, named the “mother’s arms group” (n = 44), and group III: infants who were dressed and kept in the nursery, named the “nursery group” (n = 88). Maternal axillar and breast temperatures and infants’ axillar and foot temperatures were measured at 15‐minute intervals from 30 to 120 minutes after birth. Episodes of early suckling were noted. Results: The axillar and breast temperatures rose significantly in all mothers. The rise of temperature over time was significantly higher in multiparas than in primiparas but was influenced only slightly by group assignment. The variation in breast temperature was highest in mothers in the skin‐to‐skin group and lowest in mothers in the nursery group. In the mother’s arms group, variation in breast temperature was larger in those mothers exposed to early suckling than in those not exposed. A positive relationship was found between the maternal axillar temperature and the infant foot and axillar temperature 90 minutes after the start of the experiment (120 min after birth) in the skin‐to‐skin and mother’s arms groups. The rise in temperature in the infant’s foot was nearly twice that in the axilla. No such relationship was established in the nursery group. In addition, foot temperature in infants from the skin‐to‐skin group was nearly 2°C higher than that in infants from the mother’s arms group. Conclusions: Maternal temperature rose after birth, and the rise was higher in multiparas than in primiparas. Skin‐to‐skin contact and early suckling increased temperature variation. Maternal temperature was related to infant foot and axillar temperatures. (BIRTH 34:4 December 2007)     

III Studies of Maternal Nutrition and Infant Outcome: Statistical Versus Biological Significance

ABSTRACT: Nearly all of the nutritional supplementation programs for malnourished pregnant women have resulted in statistically significant increases in birthweight. To tell whether these gains are biologically or socially significant we must factor in the effects of infections, other nutrient deficits, secular changes in health care, and stress. We must reexamine assumptions about 2,500 grams dividing low from normal birthweight, and the increase in protein in the U.S. Recommended Daily Allowance (RDA) for pregnant women. Most studies have raised questions about the mechanism of nutritional adaptation to pregnancy and methods of evaluating the nutritional status of pregnant women.     

Baby massage classes and the work of the International Association of Infant Massage

This article describes the role of the International Association of Infant Massage (IAIM) in promoting the importance of touch for the developing relationship between the parents and infants. Infants are unique personalities and it is important that the parent learns how to respond appropriately to the infant's needs. Infant massage classes can demonstrate and promote interaction with infants using eye-to-eye contact, recognizing infant cues, talking and singing, and responding in a loving and sensitive manner. The photographs are of an infant massage class held recently in Leicestershire.     

Midwives,Physicians, and the Timing of Maternal Postpartum Discharge

Hospitalization for childbirth has traditionally provided the opportunity to assure that infants and mothers have adjusted to the birth and that ongoing care has been arranged, but economic and social pressures have resulted in a dramatic decrease in the duration of hospitalization. Using a sample of mothers who delivered well infants from the 1988 nationally representative National Maternal and Infant Health Survey, this study examines how midwives and physicians used an extra day of hospitalization in response to demographic, economic, behavioral, health status, and health care risk factors. Although midwives were much more likely to discharge mothers early (OR = 2.29) there were marked differences between risk factors and discharge timing for midwives and physicians. For the patients of midwives, the only factor associated with early discharge timing was attendance at childbirth classes. For the patients of physicians, less than a high school education, inadequate prenatal care, receipt of Medicaid or lack of insurance, and no childbirth classes were associated with early discharge. In spite of the intense pressures to discharge patients early, midwives appear to have been more attentive to potential risk factors in making discharge decisions in 1988. Because brief hospitalization is now prevalent, attention to maternal and newborn adjustment after birth, as apparently practiced by midwives, is crucial.     

Release of Oxytocin and Cortisol Is Associated With Neurobehavioral Patterns in Premature Infants

ObjectiveTo examine relationships among salivary oxytocin and cortisol levels in parents and preterm infants and neurobehavioral functioning in preterm infants after skin-to-skin contact.DesignA secondary analysis of a randomized crossover study.SettingNICU.ParticipantsTwenty-eight stable premature infants and their mothers and fathers.MethodsParticipating infants contributed 108 saliva samples that we collected 45 minutes after skin-to-skin contact and tested for oxytocin and cortisol. We randomized data collection by whether the infant was held first by the mother or by the father. We conducted linear regression to test if summary scores on the NICU Network Neurobehavioral Scale were associated with salivary oxytocin and cortisol levels.ResultsWe found a significant negative relationship between infant oxytocin levels and the Stress scores (b = –0.07, p < .01) and the Excitability scores (b = –1.12, p = .04) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant oxytocin levels and the Self-Regulatory scores (b = 0.38, p = .05) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant cortisol level and the Stress scores (b = 0.05, p = .04), Excitability scores (b = 1.06, p = 0.05), and Asymmetrical Reflexes scores (b = 1.21, p = .03) among infants held skin-to-skin with their mothers. We only found a negative significant relationship between infant cortisol levels and the Stress scores (b = –0.03, p = .04) among infants held skin-to-skin with their fathers.ConclusionWe found that oxytocin is an important biomarker that may improve infant neurobehavioral functioning. The data showed a difference in oxytocin responses after skin-to-skin contact with mothers compared to fathers.     

The Relationship of Maternal Personality Characteristics to Birth Outcomes and Infant Development

Background: Previous studies reported an association between maternal psychological factors and adverse pregnancy outcomes. The objective of this study was to evaluate the relationships between maternal personality characteristics, as determined by the Minnesota Multiphasic Personality Inventory (MMPI), and infant birth outcomes and development. Method: The inventory was administered during pregnancy to 638 pregnant women enrolled in a staff model health maintenance organization. MMPI validity as well as clinical and research scales were evaluated in relationship to infant birth outcomes (low birthweight, preterm birth) and 15‐month‐old infant development as assessed by the Bayley Scales of Infant Development. Results: Mothers of low birthweight infants scored significantly lower on the hypochondriasis scale, a relationship which was no longer significant after controlling for ethnicity. No other relationships were observed between infant birth outcomes and maternal MMPI scale scores. A higher infant Mental Developmental Index (MDI) was related to higher maternal masculinity‐femininity and ego‐strength scale scores and lower lie and hypochondriasis scale scores. Only the relationship between infant MDI and maternal masculinity‐femininity scale score remained significant after controlling for ethnicity and socioeconomic index (β= 0.104, p =0.036). Conclusions: Maternal personality characteristics, as determined by the MMPI, did not appear to be significantly related to the occurrence of preterm birth or low birthweight in this healthy, general population. Maternal personality characteristics reflected in the MMPI masculinity‐femininity scale appeared to be related to infant mental development, above and beyond the effects of socioeconomic status and ethnicity.