Kristin P. Tully

Postnatal Unit Bassinet Types When Rooming-In after Cesarean Birth: Implications for Breastfeeding and Infant Safety

Background: Postnatal unit rooming-in promotes breastfeeding. Previous research indicates that side-cars (3-sided bassinets that lock onto the maternal bed frame) facilitate breastfeeding after vaginal birth more than stand-alone bassinets (standard rooming-in). No study has previously investigated side-car bassinet use after cesarean, despite the constraints on maternal-infant interactions that are inherent in recovery from this birth mode. Objective: To test the effect of the side-car bassinet on postnatal unit breastfeeding frequency and other maternal-infant behaviors compared to a stand-alone bassinet following cesarean birth. Methods: Participants were recruited and prenatally randomized to receive the side-car or stand-alone bassinet for their postnatal unit stay between January 2007 and March 2009 in northeastern England. Mother-infant interactions were filmed over the second postpartum night. Participants completed face-to-face interviews before and after filming. The main outcome measures were infant location, bassinet acceptability, and breastfeeding frequency. Other outcomes assessed were breastfeeding effort, maternal-infant contact, sleep states, midwife presence, and infant risk. Results: Differences in breastfeeding frequency, maternal-infant sleep overlap, and midwife presence were not statistically significant. The 20 dyads allocated to side-car bassinets breastfed a median of 0.6 bouts/ hour compared to 0.4 bouts/hour for the 15 stand-alone bassinet dyads. Participants expressed overwhelming preference for the side-car bassinets. Bed sharing was equivalent between the groups, although the motivation for this practice may have differed. Infant handling was compromised with stand-alone bassinet use, including infants positioned on pillows while bed sharing with their sleeping mothers. Conclusions: Women preferred the side-car, but differences in breastfeeding frequency were not statistically significant. More infant risks were observed with stand-alone bassinet use.

Trade-offs underlying maternal breastfeeding decisions: a conceptual model.

This paper presents a new conceptual model that generates predictions about breastfeeding decisions and identifies interactions that affect outcomes. We offer a contextual approach to infant feeding that models multi-directional influences by expanding on the evolutionary parent-offspring conflict and situation-specific breastfeeding theories. The main hypothesis generated from our framework suggests that simultaneously addressing breastfeeding costs and benefits, in relation to how they are interpreted by mothers, will be most effective. Our approach focuses on contributors to the attitudes and commitment underlying breastfeeding outcomes, beginning in the prenatal period. We conclude that some maternal-offspring conflict is inherent with the dynamic infant feeding relationship. Guidance that anticipates and addresses family trade-offs over time can be incorporated into breastfeeding support for families.

Systematic Review of Evidence for Baby-Friendly Hospital Initiative Step 3: Prenatal Breastfeeding Education

Background: The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative. Research aim: This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity. Methods: The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies. Results: Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women’s partners or family are involved. However, varying study quality and lack of standardized assessment of participants’ breastfeeding intentions limited the ability to recommend any single intervention as most effective. Conclusion: Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions.

The fourth trimester: a critical transition period with unmet maternal health needs

After childbirth, most American women are not scheduled for follow-up care for 6 weeks, and this visit is poorly attended. Many new mothers feel unprepared for the common health issues they encounter and are uncertain of whom to contact. To improve care, the 4th Trimester Project is bringing together mothers, health care providers, and other stakeholders to explore what families need most from birth to 12 weeks postpartum. Eighty-seven individuals convened in March 2016 in Chapel Hill, NC. Four major topic areas emerged: (1) the intense focus on womens health prenatally is unbalanced by infrequent and late postpartum care; (2) medical practice guidelines often do not align with womens experiences and constraints; (3) validation of women as experts of their infants and elevating their strengths as mothers is necessary to achieve health goals; and (4) mothers need comprehensive care, which is difficult to provide because of numerous system constraints. Considerations for improving postpartum services include enabling more convenient care for families that is holistic, culturally appropriate, conversation based, and equitable. Maternal health issues in the fourth trimester intersect and can compound one another. Enhanced collaboration among health care providers may improve the focus of clinical interactions to address the interrelated health issues most important to women.

The Relationship Between Infant Feeding Outcomes and Maternal Emotional Well-being Among Mothers of Late Preterm and Term Infants: A Secondary, Exploratory Analysis.

Background: Late preterm birth is associated with lower rates of breastfeeding and earlier breastfeeding cessation than term birth. Purpose: The objectives of this secondary analysis were to compare the incidence of exclusive breastfeeding after late preterm and term childbirth and to examine the association between infant feeding outcomes and maternal emotional well-being. Methods: Participants were 105 mother–infant dyads (54 late preterm and 51 term) at a southeastern US medical center. Face-to-face data collection and telephone follow-up occurred during 2009-2012. Results: Late preterm mothers were less likely to exclusively provide their milk than were term mothers during hospitalization. Feeding at 1 month did not differ between late preterm and term infants. Among late preterm mothers, (1) formula supplementation during hospitalization was associated with greater severity of anxiety than among those exclusively providing formula and (2) exclusive provision of human milk at 1 month was associated with less severe depressive symptoms than among those supplementing or exclusively formula feeding. Among term mothers, feeding outcome was not related to emotional well-being measures at either time point. Implications for Practice: Mothers of late preterm infants may particularly benefit from anticipatory guidance and early mental health screening, with integrated, multidisciplinary lactation teams to support these interrelated healthcare needs. Implications for Research: Prospective research is critical to document womens intentions for infant feeding and how experiences with childbirth and the early postpartum period impact achievement of their breastfeeding goals.

A Test of Kangaroo Care on Preterm Infant Breastfeeding

OBJECTIVE To test the effects of kangaroo care (KC) on breastfeeding outcomes in preterm infants compared with two control groups and to explore whether maternal-infant characteristics and the mothers choice to use KC were related to breastfeeding measures. DESIGN Secondary analysis of a multisite, stratified, randomized three-arm trial. The treatment groups used KC, auditory-tactile-visual-vestibular (ATVV) intervention, or received preterm infant care information. SETTING Neonatal intensive care units from 4 hospitals in the United States from 2006 to 2011. PARTICIPANTS Racially diverse mothers (N = 231) and their preterm infants born weighing less than 1,750 g. METHODS Mothers and their infants were enrolled once the infants were no longer critically ill, weighed at least 1,000 g, and could be safely held outside the incubator by parents. Participants were instructed by study nurses; those allocated to the KC or ATVV groups were asked to engage in these interactions with their infants for a minimum of 3 times a week in the hospital and at home until their infants reached age 2 months adjusted for prematurity. RESULTS Feeding at the breast during hospitalization, the duration of postdischarge breastfeeding, and breastfeeding exclusivity after hospital discharge did not differ statistically among the treatment groups. Regardless of group assignment, married, older, and more educated women were more likely to feed at the breast during hospitalization. Mothers who practiced KC, regardless of randomly allocated group, were more likely to provide their milk than those who did not practice KC. Breastfeeding duration was greatest among more educated women. CONCLUSION As implemented in this study, assignment to the KC group did not appear to influence the measured breastfeeding outcomes.

Assessment of infant sleep: how well do multiple methods compare?

The current study compares sleep variables obtained from videosomnography, actigraphy, and sleep diaries, three of the most common sleep assessment methods used in infant sleep studies. Using a sample of 90 African American 3-month olds, we compare correlations and discrepancies for seven sleep variables across each of the three pairs of assessment methods for one night of a week-long sleep study. These seven variables are indicative of sleep schedule (e.g. sleep onset time, rise time), duration (e.g. sleep period, sleep time, wake time), and fragmentation (e.g. night wakings, longest sleep period). We find that across all sleep assessment methods, correlations are highest for variables indicative of sleep schedule, and lowest for variables indicative of sleep fragmentation. Comparing the magnitude and significance of the discrepancies, we find that actigraphy and sleep diaries significantly overestimate sleep period duration and underestimate the number of night waking episodes, compared with videosomnography. Actigraphy and sleep diaries were more concordant with one another than with videosomnography. Epoch-by-epoch analyses indicated that actigraphy had low sensitivity to detect wakefulness, compared with videosomnography. Contrary to our hypothesis, the discrepancies between sleep assessment methods did not vary widely based on infant sleep location (own room vs. parents room) or sleep surface (own bed vs. parents bed). Limitations and implications of these findings for future research are discussed.

Preventing Newborn Falls and Improving Care for Postpartum Women and Their Newborns

In their article, “Newborn Falls in a Large Tertiary Academic Center Over 13 Years,” Loyal et al1 report a retrospective review of newborn falls at a hospital birthing facility over a period of >10 years. This study is important because it reveals a problem that has recently garnered attention from The Joint Commission as being one that is not sufficiently understood.2 Birth is the most common reason for hospitalization in the United States, and although newborn falls are uncommon, it is a serious adverse event for patients, parents, and hospital staff when they do occur. Falls among hospitalized adults are ∼10- to 20-fold more common than falls among newborns, with the former having an occurrence rate of 3.56 falls per 1000 patient days, according to the authors of a recent study.3 In the study reported in this issue, the authors found a fall rate of 4.6 falls per 10 000 live births, or ∼2 falls per 10 000 patient days. Although the rate of infant falls during postpartum hospitalization is comparatively small, anyone who has experienced a newborn fall is well aware of the distress and potential harm that are caused when this does occur. We as clinicians and hospital administrators want to implement every step …

Night-time on a postnatal ward: experiences of mothers, infants, and staff

This chapter illustrates an alternative approach to video ethnography, in which video case studies are described alongside semi-structured interview responses to detail night-time challenges of mothers, newborns, and hospital staff on a postnatal ward. Data from three original, inter-related research projects were combined. We uncovered five themes: maternal need for support, response to infant cues, negative experiences, bedsharing as a way of coping, and insufficient staffing. In detailing these issues, we draw attention to previously unknown or unacknowledged obstacles for new mothers and their infants, as well as the constraints on the staff involved in their care.