Ann-Marie Widström

Different patterns of oxytocin, prolactin but not cortisol release during breastfeeding in women delivered by Caesarean section or by the vaginal route

The aim of this study was to find out whether the hormonal patterns of oxytocin, prolactin and cortisol differed between women delivered by emergency section or by the vaginal route and if these patterns show any relation to the duration of breastfeeding. Seventeen mothers with emergency section (C.S.) and 20 mothers with normal vaginal deliver (V.D.) were blood sampled in connection with breastfeeding on day 2 post partum for oxytocin, prolactin and cortisol. The number of oxytocin pulses as calculated with the PULSAR program occurring during the first 10 min of the breastfeeding session varied between 0 and 5. The V.D. mothers had significantly more pulses than the C.S. ones. Furthermore the C.S. women lacked a significant rise in prolactin levels at 20-30 min after the onset of breastfeeding. Logistic regression analysis revealed mode of delivery and infants age at first breastfeed to be the most important, independent variables showing a relation to the release pattern of oxytocin on day 2. Correlations between oxytocin pulsatility on day 2 and the duration of the exclusive breastfeeding period in the V.D. group suggest that development of an early pulsatile oxytocin pattern is of importance for breastfeeding.

Newborn behaviour to locate the breast when skin-to-skin: a possible method for enabling early self-regulation

Aim:  The aim of this study was to provide a more detailed analysis of the infant’s behavioural sequence that begins immediately after birth and terminates with grasping the nipple, suckling and then falling asleep.

Duration of Breastfeeding in Swedish Primiparous and Multiparous Women

The aim of this study was to describe the effects of sociodemographic factors and maternity ward practices on the duration of breastfeeding in Swedish primiparas (n = 194) and multiparas (n = 294), consecutively selected from hospital birth files for 3 months, who responded to a questionnaire 9 to 12 months after childbirth. The impact of sociodemographic data and maternity ward practices on exclusive and any breastfeeding were examined. Smoking and supplementation without medical reasons influenced the duration of both exclusive and any breastfeeding negatively, whereas early first breastfeeding influenced the duration of both exclusive and any breastfeeding positively, and parity had no significant influence. Late hospital discharge influenced the duration of exclusive breastfeeding positively, and higher maternal age influenced the duration of any breastfeeding positively. These variables altogether explained 11.4% (P <.001) of the variance in the duration of exclusive breastfeeding and 8.2% (P <.001) of the duration of any breastfeeding. J Hum Lact. 19(2):172-178.

Personality factors and emotional responses to pregnancy among IVF couples in early pregnancy: a comparative study.

Background. Little is known as to whether negative experiences associated with infertility and IVF treatment persist after successful treatment. The aim of the study was to compare couples who have conceived after IVF and couples who have conceived naturally regarding personality factors and emotional responses to pregnancy.

Oxytocin and prolactin levels in breast-feeding women. Correlation with milk yield and duration of breast-feeding.

The aim of the present study was to examine suckling‐related plasma levels of oxytocin and prolactin in early and established lactation and to correlate hormone profiles to success of lactation performance. Fifty‐five primiparous women participated in the study. From each, 18 blood samples were drawn in connection with breast‐feeding on day 4 post partum and after 3‐4 months. Oxytocin and prolactin levels were determined with radio‐immunoassay. Basal levels of both hormones were significantly higher 4 days post partum than 3‐4 months later and after weaning. Basal prolactin levels fell significantly within 24 h of weaning. Oxytocin and prolactin levels rose in response to breast‐feeding—an effect which persisted during the lactation period. the suckling‐induced release of prolactin—but not that of oxytocin—was related to basal hormone levels. Basal as well as stimulated oxytocin levels obtained 4 days and 3‐4 months post partum correlated significantly, indicating that each woman has an individual, characteristic level of this hormone. Milk yield did not correlate with oxytocin or prolactin levels, but prolactin levels recorded 3‐4 months post partum did correlate with the remaining period of breast‐feeding. In addition, mothers who breast‐fed exclusively 3‐4 months post partum had significantly higher oxytocin and prolactin levels than those who gave supplementary feed. there was a significant correlation between oxytocin levels at 4 days and birth weight of the infant.

Patterns of emotional responses to pregnancy, experience of pregnancy and attitudes to parenthood among IVF couples: a longitudinal study

The aim of this longitudinal study was to compare couples who had conceived by in-vitro fertilization (IVF) with couples who had conceived naturally, regarding patterns of emotional response to different stages of pregnancy and to compare their expectations of and attitudes to pregnancy, parenthood and children. Fifty-seven IVF women and 55 of their male partners, and a control group of 43 pregnant women and 39 of their male partners participated. They completed scales measuring emotional responses to pregnancy, attitudes to pregnancy, parenthood and children. The IVF couples were interviewed about their experience of pregnancy. The overall anxiety about losing the pregnancy was higher among the IVF couples from early to late pregnancy. The IVF women experienced the pregnancy in a more positive way and they were less concerned about the childs gender and loss of freedom in their future lives as parents compared to controls. The IVF men were more anxious about the baby being injured during birth. The interviews with the IVF couples confirmed the self-ratings. In conclusion, the results suggest that it is important for healthcare providers to pay attention to an elevated anxiety among IVF couples and to give them extra time to discuss emotions during pregnancy and their future life as parents.

Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial

BackgroundInfants with latch-on problems cause stress for parents and staff, often resulting in early termination of breastfeeding. Healthy newborns experiencing skin-to-skin contact at birth are pre-programmed to find the mother’s breast. This study investigates if skin-to-skin contact between mothers with older infants having severe latching on problems would resolve the problem.MethodsMother-infant pairs with severe latch-on problems, that were not resolved during screening procedures at two maternity hospitals in Stockholm 1998–2004, were randomly assigned to skin-to-skin contact (experimental group) or not (control group) during breastfeeding. Breastfeeding counseling was given to both groups according to a standard model. Participants were unaware of their treatment group. Objectives were to compare treatment groups concerning the proportion of infants regularly latching on, the time from intervention to regular latching on and maternal emotions and pain before and during breastfeeding.ResultsOn hundred and three mother-infant pairs with severe latch-on problems 1–16 weeks postpartum were randomly assigned and analyzed. There was no significant difference between the groups in the proportion of infants starting regular latching-on (75% experimental group, vs. 86% control group). Experimental group infants, who latched on, had a significantly shorter median time from start of intervention to regular latching on than control infants, 2.0 weeks (Q1 = 1.0, Q3 = 3.7) vs. 4.7 weeks (Q1 = 2.0, Q3 = 8.0), (p-value = 0.020). However, more infants in the experimental group (94%), with a history of “strong reaction” during “hands-on latch intervention”, latched-on within 3 weeks compared to 33% in the control infants (Fisher Exact test p-value = 0.0001). Mothers in the experimental group (n = 53) had a more positive breastfeeding experience according to the Breastfeeding Emotional Scale during the intervention than mothers in the control group (n = 50) (p-value = 0.022).ConclusionsSkin-to-skin contact during breastfeeding seems to immediately enhance maternal positive feelings and shorten the time it takes to resolve severe latch-on problems in the infants who started to latch. An underlying mechanism may be that skin-to-skin contact with the mother during breastfeeding may calm infants with earlier strong reaction to “hands on latch intervention” and relieve the stress which may have blocked the infant’s inborn biological program to find the breast and latch on.Trial registrationKarolinska Clinical Trial Registration numberCT20100055

Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates.

PURPOSES Skin-to-skin care after birth often is absent, interrupted, or delayed for routine procedures. The purposes of this project were to improve skin-to-skin care and exclusive breastfeeding at hospital discharge. METHODS For Part 1, we used a descriptive observational design, with video-ethnography and interaction analysis (PRECESS-Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success), during a 5-day quality improvement pilot study in a U.S. hospital (August 13-17, 2010). For Part 2, we used electronic health record review to test for differences in monthly rates of skin-to-skin care and exclusive breastmilk feeding (baseline, July 2010; post-intervention, August-December 2010). RESULTS In Part 1, 11 mothers and babies participated: 10 (91%) received immediate skin-to-skin care, eight (73%) received uninterrupted skin-to-skin care, nine (82%) planned to breastfeed, six (67%) of these babies were exclusively breastfeeding at hospital discharge, and five (83%) of the six babies who completed all nine instinctive stages during skin-to-skin care were exclusively breastfeeding at hospital discharge. In our subsequent review (Part 2), we found a significant improvement (25% above baseline) in the overall rate of skin-to-skin care across post-intervention months (Pearson χ(2)=23.798, df=5, p<0.000), predominantly from improvements in the cesarean section population. The rates of exclusive breastfeeding showed no significant change. CONCLUSIONS The PRECESS immersion method may help to rapidly improve skin-to-skin care. Babies who undergo all nine stages during skin-to-skin care may be more likely to exclusively breastfeed. Mothers need support during skin-to-skin care to recognize their babys readiness to breastfeed. Skin-to-skin care during cesarean surgery may reduce maternal stress and improve satisfaction with the surgical experience.

Influence of Skin-to-Skin Contact and Rooming-In on Early Mother–Infant Interaction A Randomized Controlled Trial

The objective of this research was to study influence of birth routines on mother–infant interaction at Day 4. The present research is part of a longitudinal study where mother–infant pairs were randomized by infant location and apparel. We intended to assess mother–infant interaction from videos filmed at Day 4. A protocol for the assessment/coding of the affective quality of maternal behaviors indicative of early mother–infant interaction was developed and interculturally validated. Results were compared with birth randomization, as to explain impact of birth practices. Findings indicate that separation and swaddling at birth interfered with mother–infant interaction during a breastfeeding session at Day 4; these mothers significantly demonstrated more roughness in their behaviors with their infants at Day 4. Results also show evidences of a sensitive period for separation after birth. Implications are to encourage immediate and uninterrupted skin-to-skin contact at birth, and rooming-in during postpartum, as recommended in World Health Organization/UNICEF Ten Steps for Successful Breastfeeding.

Centres for Clinical Education (CCE): Developing the Health Care Education of Tomorrow A Preliminary Report

A new interdisciplinary concept of medical and health care education has been introduced at Karolinska Institute in collaboration with the County Council in Stockholm under the motto Learning together to be able to work together. Centres of Clinical Education are built up in four major hospitals to promote meeting places during clinical education for students from different categories. During a three-year project more than 5000 students from four educational programmes have been involved--medicine, nursing, occupational therapy and physiotherapy. The project started in 1998 and will turn into regular activities in 2002. The Centres consist of three parts. First is the Clinical Training Ward, a ward without patients where manual skills as well as skills in communication are taught, practised and videotaped. Second is the Clinical Education Ward, a student-driven ward where students during two-week periods experience their own professional roles in day-to-day work and learn how to work together. Third is the Multidisciplinary Team, where teachers from the four programmes plan and provide opportunities for students to learn together. Opportunities to meet and learn together have promoted a wider understanding of each professional in health care teams among students and staff. The Centres of Clinical Education provide excellent opportunities to bridge professional borders and to coordinate undergraduate studies and clinical reality.