Janet Bryanton

Predictors of Women’s Perceptions of the Childbirth Experience

OBJECTIVE To determine the factors that predict womens perceptions of the childbirth experience and to examine whether these vary with the type of birth a woman experiences. DESIGN Prospective cohort study. SETTING The postpartum units of two eastern Canadian hospitals. PARTICIPANTS Six hundred fifty two women and their newborns. DATA COLLECTION Data were collected in hospital at 12 to 48 hours postpartum using self-report questionnaires and chart review. MAIN OUTCOME MEASURE Perception of the childbirth experience was measured for women having a vaginal and emergency cesarean birth using the Questionnaire Measuring Attitudes About Labor and Delivery and planned cesarean birth using the Modified Questionnaire Measuring Attitudes About Labor and Delivery. RESULTS Of the 20 predictors of womens childbirth perceptions, the strongest were type of birth; degree of awareness, relaxation, and control; helpfulness of partner support; and being together with the infant following birth. CONCLUSIONS Of the predictors of a quality birth experience, most were amenable to nursing interventions: enhancement of patient awareness, relaxation, and control; promotion of partner support; and provision of immediate opportunities for women to be with their babies.

Predictors of Early Parenting Self-efficacy Results of a Prospective Cohort Study

Background: Parenting self-efficacy has been identified as one determinant of positive parenting. The literature is inconsistent regarding the predictors of parenting self-efficacy, and there is limited evidence regarding these predictors in the early postpartum period. Objectives: To determine the factors predictive of parenting self-efficacy at 12 to 48 hr after childbirth and at 1 month postpartum. Method: Six-hundred fifty-two women were recruited consecutively from the postpartum units of two general hospitals on Prince Edward Island, Canada. Data were collected at 12 to 48 hr postpartum using self-report and chart review. On the basis of scoring positive or negative on their childbirth perceptions, 175 of these mothers were assigned to two cohorts. They were visited at home at 1 month postpartum, where data were collected using self-report. Results: Using multiple logistic regression, greater parenting self-efficacy at 12 to 48 hr after childbirth was predicted by multiparity and single marital status and correlated with positive perception of the birth experience, higher general self-efficacy, and excellent partner relationship. Greater parenting self-efficacy at 1 month was predicted by age ≤30 years and multiparity and correlated with excellent partner relationship and maternal perception of infant contentment. Discussion: Birth perception is a correlate of parenting self-efficacy that is modifiable; therefore, nurses have an opportunity to strive to create a positive birth experience for all women to enhance their early parenting self-efficacy. Nurses can also consider assessing women at risk for suboptimal parenting self-efficacy and intervene through teaching, support, and parenting self-efficacy boosting interventions.

Factors Influencing the Reasons Why Mothers Stop Breastfeeding

Objectives: To explore the reasons why women stop breastfeeding completely before their infants are six months of age and to identify the factors associated with cessation and the timing of cessation.METHODS: For all singleton live newborns born between January 1, 2008 and December 31, 2009 in two district health authorities in Nova Scotia, Canada, mother’s self-reported breastfeeding status was collected at hospital discharge and at five follow-up visits until infants were six months of age. Mothers who stopped breastfeeding before six months were also questioned about the time of weaning and the reason they discontinued all breastfeeding. Eleven categories were created from the open-ended responses women provided. These data were linked with the Nova Scotia Atlee Perinatal Database in order to obtain information on maternal and neonatal characteristics. The relationship between maternal, obstetrical, and neonatal characteristics and each reason for stopping breastfeeding completely were examined.RESULTS: Of the 500 mothers who stopped breastfeeding completely before six months and provided a reason for discontinuing, the majority (73.6%) stopped within the first six weeks. The most common reasons cited were inconvenience or fatigue associated with breastfeeding (22.6%) and concerns about milk supply (21.6%). Return to work or school was associated with length of time that infants were breastfed: 20% of women who stopped after six weeks citing this as the reason. Most of the reasons, however, were not found to be associated with a specific duration of breastfeeding or with the examined maternal and infant characteristics.CONCLUSION: This study highlights factors associated with the reasons why women stop breastfeeding completely before six months and how these reasons varied with weaning age. The results will help inform future research aimed at identifying interventions to reduce early breastfeeding cessation.RésuméOBJECTIFS: Étudier les raisons pour lesquelles les femmes cessent complètement d’allaiter avant que leurs nourrissons atteignent l’âge de six mois et répertorier les facteurs associés à l’arrêt et au moment de l’arrêt de l’allaitement maternel.MÉTHODE: Pour tous les bébés uniques nés vivants entre le 1er janvier 2008 et le 31 décembre 2009 dans deux districts sanitaires de la Nouvelle-Écosse, au Canada, nous avons recueilli les informations sur l’allaitement maternel autodéclarées par les mères à leur sortie de l’hôpital et lors de cinq visites de suivi, jusqu’à ce que leurs nourrissons aient six mois. Les mères ayant cessé d’allaiter avant six mois ont aussi été interrogées sur le moment du sevrage et la raison pour laquelle elles avaient complètement cessé d’allaiter. Nous avons classé les réponses des femmes à nos questions ouvertes en 11 catégories. Nous avons ensuite lié ces données à celles de la base de données périnatales Atlee de la Nouvelle-Écosse afin d’obtenir de l’information sur les caractéristiques maternelles et néonatales. Les liens entre les caractéristiques maternelles, obstétriques et néonatales et chaque raison d’avoir complètement cessé l’allaitement maternel ont été examinés.RÉSULTATS: Sur les 500 mères ayant complètement cessé d’allaiter avant six mois et ayant partagé la raison de cet arrêt, la majorité (73,6 %) avaient cessé d’allaiter au cours des six premières semaines. Les raisons les plus communément citées étaient l’incommodité ou la fatigue associés à l’allaitement (22,6 %) et la crainte de ne pas avoir assez de lait (21,6 %). Le retour au travail ou aux études était associé à la durée de l’allaitement: 20 % des femmes ayant cessé d’allaiter après six semaines ont donné cette raison. La plupart des raisons invoquées, cependant, n’étaient pas associées à une durée d’allaitement particulière ni avec les caractéristiques disponibles sur les mères et les nourrissons.CONCLUSION: Cette étude fait ressortir les facteurs associés aux raisons pour lesquelles les femmes cessent complètement d’allaiter avant six mois et le fait que ces raisons varient selon l’âge du sevrage. Les résultats obtenus permettront d’éclairer les recherches futures qui visent à trouver des interventions pour réduire l’arrêt précoce de l’allaitement maternel.

Rates and determinants of exclusive breastfeeding in first 6 months among women in Nova Scotia: a population-based cohort study

BACKGROUND Despite compelling evidence that exclusive breastfeeding for the first 6 months of life provides important health benefits to both mothers and their infants, most mothers do not follow this practice. We conducted a study to identify predictors of early cessation of exclusive breastfeeding (before 6 months after delivery). METHODS For this population-based longitudinal cohort study, we linked data from a perinatal database and a public health database for infants born between 2006 and 2009 in 2 regions in the province of Nova Scotia, Canada. The cohort was followed from the mothers first prenatal visit until her infant was 6 months old. Hazard ratios (HRs) for early cessation of exclusive breastfeeding were determined through Cox proportional hazards regression modelling. RESULTS Overall, 64.1% (2907/4533) of the mothers in the cohort initiated breastfeeding. Only 10.4% (413/3957) exclusively breastfed for the recommended 6 months. The largest drop in exclusive breastfeeding occurred within the first 6 weeks after birth. Among the mothers who initiated breastfeeding, significant predictors of early cessation of exclusive breastfeeding identified by multivariable modelling included less than high school education (HR 1.66, 95% confidence interval [CI] 1.35-2.04), lowest neighbourhood income quintile (HR 1.35, 95% CI 1.13-1.60), single motherhood (HR 1.24, 95% CI 1.10-1.41), prepregnancy obesity (HR 1.43, 95% CI 1.23-1.65), smoking throughout pregnancy (HR 1.39, 95% CI 1.21-1.60), no early breast contact by the infant (< 1 hour after birth) (HR 1.44, 95% CI 1.29-1.62) and no intention to breastfeed (HR 1.78, 95% CI 1.44-2.16). INTERPRETATION We found that most predictors of early cessation of breastfeeding were intertwined with social determinants of health. However, we identified potentially modifiable risk factors. Providing opportunities for early breast contact by the infant and continued efforts in smoking cessation and obesity reduction may contribute to a longer duration of exclusive breastfeeding.

Does perception of the childbirth experience predict women's early parenting behaviors?

Evidence regarding the predictors of positive parenting behaviors in the early transition to parenting is inconsistent and limited. In this prospective, cohort study, we examined whether womens perceptions of their childbirth experience, as well as selected demographic, obstetrical, and psychosocial variables, predicted positive parenting behaviors at 1 month postpartum in 175 Canadian mothers. Womens birth experience did not predict early parenting behaviors, however being better educated and having a vaginal birth did. Excellent partner support and maternal mental health were also significantly associated with positive parenting at 1 month. Nurses have a responsibility to assess women for possible risks for sub-optimal parenting, based on the predictors found, and intervene to enhance parenting behaviors.

Incidence of prenatal alcohol exposure in Prince Edward Island: a population-based descriptive study

BACKGROUND Fetal alcohol spectrum disorder (FASD) is a leading preventable cause of neurodevelopmental disability in North America. The stigma associated with alcohol use and abuse during pregnancy makes it difficult to obtain information on prenatal alcohol use through self-reporting. We assessed the incidence of prenatal alcohol exposure in Prince Edward Island to facilitate future public health initiatives addressing FASD. METHODS Prenatal alcohol exposure was examined via population-based collection of meconium and analysis of fatty acid ethyl esters (FAEEs). Fatty acid ethyl esters are nonoxidative metabolites of ethanol that are produced in the fetus. Meconium FAEE concentrations of 2.0 nmol/g or greater are indicative of frequent prenatal alcohol exposure during the last 2 trimesters of pregnancy. Samples were collected from 1307 neonates between Nov. 8, 2010, and Nov. 8, 2011, in hospitals in PEI, or from those born to mothers who resided in PEI but gave birth in Halifax, Nova Scotia. Samples were frozen and shipped for analysis. Fatty acid ethyl esters were analyzed by gas chromatography-mass spectrometry and quantified by means of deuterated internal standards. RESULTS Of the 1307 samples collected, 1271 samples were successfully analyzed. Positive results for FAEEs were obtained in 3.1% (n = 39) of samples collected within the first 24 hours after birth. INTERPRETATION Not all neonates exposed to heavy prenatal alcohol in utero will exhibit FASD; based on current estimates of predictive value for disease by exposure, our findings suggest that 1.3% of neonates born in PEI during this 1-year period will have FASD. In its application to an entire provincial birth cohort, this study successfully implemented a public health-centred approach for evaluating population-based risk of FASD, with implications for practice across Canada.

Exploration of attenuated total reflectance mid-infrared spectroscopy and multivariate calibration to measure immunoglobulin G in human sera

Immunoglobulin G (IgG) is crucial for the protection of the host from invasive pathogens. Due to its importance for human health, tools that enable the monitoring of IgG levels are highly desired. Consequently there is a need for methods to determine the IgG concentration that are simple, rapid, and inexpensive. This work explored the potential of attenuated total reflectance (ATR) infrared spectroscopy as a method to determine IgG concentrations in human serum samples. Venous blood samples were collected from adults and children, and from the umbilical cord of newborns. The serum was harvested and tested using ATR infrared spectroscopy. Partial least squares (PLS) regression provided the basis to develop the new analytical methods. Three PLS calibrations were determined: one for the combined set of the venous and umbilical cord serum samples, the second for only the umbilical cord samples, and the third for only the venous samples. The number of PLS factors was chosen by critical evaluation of Monte Carlo-based cross validation results. The predictive performance for each PLS calibration was evaluated using the Pearson correlation coefficient, scatter plot and Bland-Altman plot, and percent deviations for independent prediction sets. The repeatability was evaluated by standard deviation and relative standard deviation. The results showed that ATR infrared spectroscopy is potentially a simple, quick, and inexpensive method to measure IgG concentrations in human serum samples. The results also showed that it is possible to build a united calibration curve for the umbilical cord and the venous samples.

Centrifugal ultrafiltration of human serum for improving immunoglobulin A quantification using attenuated total reflectance infrared spectroscopy

Attenuated total reflectance infrared (ATR-IR) spectroscopy is a simple, rapid and cost-effective method for the analysis of serum. However, the complex nature of serum remains a limiting factor to the reliability of this method. We investigated the benefits of coupling the centrifugal ultrafiltration with ATR-IR spectroscopy for quantification of human serum IgA concentration. Human serum samples (n = 196) were analyzed for IgA using an immunoturbidimetric assay. ATR-IR spectra were acquired for whole serum samples and for the retentate (residue) reconstituted with saline following 300 kDa centrifugal ultrafiltration. IR-based analytical methods were developed for each of the two spectroscopic datasets, and the accuracy of each of the two methods compared. Analytical methods were based upon partial least squares regression (PLSR) calibration models - one with 5-PLS factors (for whole serum) and the second with 9-PLS factors (for the reconstituted retentate). Comparison of the two sets of IR-based analytical results to reference IgA values revealed improvements in the Pearson correlation coefficient (from 0.66 to 0.76), and the root mean squared error of prediction in IR-based IgA concentrations (from 102 to 79 mg/dL) for the ultrafiltration retentate-based method as compared to the method built upon whole serum spectra. Depleting human serum low molecular weight proteins using a 300 kDa centrifugal filter thus enhances the accuracy IgA quantification by ATR-IR spectroscopy. Further evaluation and optimization of this general approach may ultimately lead to routine analysis of a range of high molecular-weight analytical targets that are otherwise unsuitable for IR-based analysis.

Transmission infrared spectroscopy for rapid quantification of fat, protein, and lactose concentrations in human milk

ObjectiveTo develop partial least squares regression (PLSR) calibration models in combination with transmission infrared (TIR) spectroscopy for rapid and optimal quantification of human milk macronutrient concentrations.Study designHuman milk samples (n = 306) were characterized simultaneously by reference chemical analytical methods and TIR spectroscopy. Reference macronutrient concentrations were linked to pre-processed spectra and divided into two (training and test) sets. PLSR was used to develop trial calibration models using training set, and the test set was used to assess the accuracy of the trial analytical methods.ResultsFor the methods selected as optimal, the concordance correlation coefficients between reference and TIR-based methods were 0.93 for fat, 0.96 for protein, and 0.52 for lactose. The Bland-Altman plots showed no evidence of systematic bias between TIR and reference methods.ConclusionsTIR spectroscopy provides the basis for accurate and rapid quantification of human milk fat and protein concentrations but is less accurate for measuring lactose concentration.

CLINICAL RESEARCHTub Bathing Versus Traditional Sponge Bathing for the Newborn

Objective: To compare selected effects of tub bathing versus traditional sponge bathing in healthy, term newborns and their mothers’ ratings of pleasure and confidence with the bath. Design: Randomized controlled study. Setting: The maternity unit of an eastern Canadian hospital. Participants: One hundred two mother-baby pairs were randomly assigned to an experimental tub bath or a sponge bath control group. Interventions: Fifty-one newborns were tub bathed and 51 sponge bathed according to the study protocols for their initial and one additional bath. Main Outcome Measures: (a) Newborn temperature stability was assessed by recording axillary temperatures pre- and postbath, (b) umbilical cord healing was identified by daily observations and infection control surveillance, (c) infant contentment was quantified by applying the Brazelton Neonatal Behavioral Assessment Scale, and (d) maternal pleasure with the bath and confidence with bathing at discharge were self-rated on a 5-point scale. Results: Tub-bathed babies experienced significantly less temperature loss (t = 4.79, p = .00) and were significantly more content (t =−6.48, p = .00) than were those who were sponge bathed. No differences in cord healing scores were found. Mothers of tub bathed babies rated their pleasure with the bath significantly higher than did mothers of sponge bathed babies (t = 4.15, p = .00). No differences in maternal confidence were noted. Conclusions: Tub bathing is a safe and pleasurable alternative to sponge bathing in healthy, term newborns.