Joy Noel-Weiss

An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss

BackgroundNewborn weight measurements are used as a key indicator of breastfeeding adequacy. The purpose of this study was to explore non-feeding factors that might be related to newborn weight loss. The relationship between the intravenous fluids women receive during parturition (the act of giving birth, including time in labour or prior to a caesarean section) and their newborns weight loss during the first 72 hours postpartum was the primary interest.MethodsIn this observational cohort study, we collected data about maternal oral and IV fluids during labour or before a caesarean section. Participants (n = 109) weighed their newborns every 12 hours for the first three days then daily to Day 14, and they weighed neonatal output (voids and stools) for three days.ResultsAt 60 hours (nadir), mean newborn weight loss was 6.57% (SD 2.51; n = 96, range 1.83-13.06%). When groups, based on maternal fluids, were compared (≤1200 mls [n = 21] versus > 1200 [n = 53]), newborns lost 5.51% versus 6.93% (p = 0.03), respectively. For the first 24 hours, bivariate analyses show positive relationships between a) neonatal output and percentage of newborn weight lost (r(96) = 0.493, p < 0.001); and b) maternal IV fluids (final 2 hours) and neonatal output (r(42) = 0.383, p = 0.012). At 72 hours, there was a positive correlation between grams of weight lost and all maternal fluids (r(75) = 0.309, p = 0.007).ConclusionsTiming and amounts of maternal IV fluids appear correlated to neonatal output and newborn weight loss. Neonates appear to experience diuresis and correct their fluid status in the first 24 hours. We recommend a measurement at 24 hours, instead of birth weight, for baseline when assessing weight change. Because practices can differ between maternity settings, we further suggest that clinicians should collect and analyze data from dyads in their care to determine an optimal baseline measurement.

Questioning current definitions for breastfeeding research.

BackgroundThe aim of this paper is to examine how breastfeeding is defined for research purposes.DiscussionCurrent breastfeeding definitions focus on the amount of breast milk an infant receives and do not encompass how a baby is fed. Our concerns are that key variables are not measured when mothers are pumping or expressing their milk and bottle feeding. It seems the breastfeeding relationship is not considered in the definition.ConclusionWhile we appreciate the implications of full versus partial breastfeeding in research studies, we also believe the method of infant feeding to be significant. Researchers should develop new definitions.

Ethics and Lactation Consultants: Developing Knowledge, Skills, and Tools

This article studies the role of ethics in the context of the work of International Board Certified Lactation Consultants. It provides an overview of some of the main ethical approaches with the goal of contributing to the knowledge, skills, and tools required by lactation consultants. Five main sections structure the article: background, current literature, ethical theory and principles, implications for lactation consultants, and decision-making frameworks. Background about the International Board of Lactation Consultant Examiners and International Board Certified Lactation Consultants and the significance of applied ethics in their work are described. Current literature regarding ethics and lactation consultants is reviewed. Because a computer-based literature search yielded a lack of articles, ethics in nursing literature is also presented. Three main ethical theories and 5 key ethical principles are explored with a view to their implications for lactation consultants. Finally, decision-making frameworks are considered as systematic tools for making ethical decisions.

Factors Influencing the Breastfeeding Practices of Young Mothers Living in a Maternity Shelter: A Qualitative Study:

Background: Young mothers have the lowest breastfeeding rates in Canada. Young mothers and their infants who access maternity shelters are especially at risk for poor outcomes, some of which breastfeeding may help to mitigate, yet little is known of the breastfeeding practices of this population. Research aim: The purpose of this study was to answer the research question, “What factors influence the breastfeeding practices of young mothers who live or have lived in a maternity shelter?” Methods: The study was conducted using interpretive description methodology and inductive content analysis. Data were collected by means of one-on-one interviews, with the participants recruited from a maternity shelter in Ontario, Canada. Results: Nine young mothers ages 17 to 24 years, who had initiated breastfeeding and resided at a maternity shelter, were interviewed. The five themes that emerged from the data were as follows: (a) choice, (b) special, (c) importance of early postpartum support, (d) being part of the “in crowd,” and (e) importance of ongoing supports. The participants in this study took ownership of their choice to breastfeed. Hospital postpartum nurses and lactation consultants had a critical role in the establishment of early breastfeeding, and ongoing, accessible, and nonjudgmental peer, family, and community support were important to breastfeeding duration. Conclusion: A combination of emotional and practical supports from multiple trusted sources, including professional and peer supports on an ongoing basis, enabled young mothers to reach their breastfeeding goals.

Lactation and Breastfeeding Research Studies: Who Should Provide Consent for the Neonate?

Research ethics guidelines do not provide sufficient direction for breastfeeding and human lactation studies. This article presents the principles of consent for research studies and discusses rationales for who should consent for infants in lactation and breastfeeding research studies.

Mothers' Experiences with Baby Scales in the First Two Weeks Post Birth: AQualitative Study

Introduction: Health care professionals are divided on the topic of routine weight measurements for healthy breastfed newborns. This study presents interviews with a subset of participants from a larger study. The interviews provided an opportunity to look at weighing babies from a different perspective, specifically, when mothers are routinely weighing their babies and when they have use and control of a baby scale. Objective: To describe womens experiences using baby scales and weighing their babies daily in their own homes during the first two weeks postpartum. Methods: Qualitative descriptive design comprised of telephone interviews in a mid-sized Canadian city. Eight participants were from a larger study about newborn weight loss. Results: The overall theme to emerge from the data was “the baby scale as a tool” and five subthemes emerged: builds confidence; fosters reassurance; offers convenience; provides information; and satisfies curiosity. Conclusions: This study produced new information about how breastfeeding mothers felt about using baby scales in their own homes. Contrary to what some might assume, weighing babies did not cause mothers distress and worry; it usually provided reassurance. Any discussion about regularly weighing healthy newborns assumed clinicians would weigh the babies. Giving women control of the baby scale might affect breastfeeding outcomes.