Margaret J. Dick

PREDICTING EARLY BREASTFEEDING ATTRITION

The Breastfeeding Attrition Prediction Tool (BAPT) is based on the theory of planned behavior, which explains behavior as a function of attitudes, subjective norm, and perceived control. The BAPT subscales are positive and negative attitudes toward breastfeeding, family and professional expectations, and perceived ability to be successful. The purpose of this studywas to test the reliability and validity of the BAPT among269 women who planned to breastfeed for at least 8 weeks. Subjects completed the BAPT in the hospital and duringa telephone interview at 8 weeks. Based on factor analysis, several items were deleted. Usingdiscriminant function analysis, the modified BAPT was an effective predictor of 78% of women who stopped breastfeedingbefore 8 weeks and 68% of those who were still breastfeeding. There is potential for the modified BAPT to be an adjunct for the clinician in identifyingw omen at risk for early cessation of breastfeeding.

Sleep during the week before labor: relationships to labor outcomes.

This correlational study was conducted to examine the relationship between maternal sleep during the nights prior to the onset of labor and labor outcomes of length, type of delivery, and maternal perceptions of labor. Subjects (N = 99) were drawn from childbirth education classes at a womens hospital in the southeastern United States. Subjects completed the Visual Analog Sleep Scale each morning, beginning two weeks prior to their due dates. Following delivery, subjects completed the Perception of Labor and Delivery Scale, and researchers gathered data about their labors. These women reported poor sleep effectiveness coupled with high sleep disturbance; however, there were no significant correlations between sleep quality and length of labor or maternal perceptions of labor for either the night, or the week, prior to the onset of labor. This finding leads us to question the view that disturbed prenatal sleep will interfere with the progress of labor and lead to more cesarean sections.

Preterm Infants in Pain: Nurses' and Physicians' Perceptions

Within the past few years, the assumption that preterm infants experience little or no pain has been challenged in nursing and medical literature. It is not clear to what extent changes have taken place in the practice area. The purpose of this qualitative study was to explore the beliefs of NICU nurses and physicians about the existence and treatment of pain in preterm infants. Respondents to the open-ended interviews were 5 neonatologists and i0 nurses at two regional referral neonatal intensive care units in North Carolina. Interviews took from 20 to 40 minutes and were analyzed using the Ethnograph program AU respondents agreed that preterm. infants experience pain. Both groups identified behavioral and physiological cues to pain recognition. There were differences in initial approaches to treatment. However, both groups indicated that the nurse has the pivotal role in recognition and initiation of treatment to reduce or eliminate pain.

Postpartum Sleep in the Hospital Relationship to Taking-in and Taking-Hold

This descriptive, correlational study examined the relationship of sleep in the hospital to the new mothers progression through Rubins phases of taking-in and taking-hold in 120 women who had delivered vaginally. The Martell and Mitchell Postpartum Questionnaire, which measured taking-in and taking-hold, was completed the evening of delivery and the following two mornings. The Verran and Snyder-Halpern Visual Analog Sleep Scale was completed each morning. Both taking-in and taking-hold were present on the evening of delivery. There were small decreases in taking-in and small increases in taking-hold between the evening of delivery and the first morning. Sleep disturbance was high, and sleep effectiveness was low, on the first evening. Neither sleep measure was a predictor of change in taking-in or taking-hold. Findings indicate that taking-in and taking-hold are both present on the day of delivery and that increases in taking-hold take place despite high levels of sleep disturbance.

Commentary by Dick

This study represents major contributions to our understanding of breastfeeding and mothers of preterm infants. The major focus of the article was to identify how behavioral manifestations of stress might influence milk volume in lactating mothers. The authors are to be commended for this large, multifaceted study. The outcome measure selected was the total volume of breast milk in the 6th week. To measure each of the behavioral symptoms of stress, composite scores were created that represented overall perceived stress, sleep difficulty, and fatigue across the 6 weeks. These composite scores did not add to the prediction of milk volume in the 6th week. This approach seems to assume that the effect of stress is cumulative and may mask the effect of higher levels of stress occurring in close proximity to the measurement of milk volume. I question this assumption and suggest that it would be more conceptually appropriate to regress the composite scores that represent stress during the 6 weeks on the total milk volume over all 6 weeks. Another way to approach this question would be to regress composite psychological scores for the 6th week on the total volume for the 6th week. Either of these two suggested approaches would clarify the possible role of perceived stress in the volume of milk produced in these two groups of women. The other aspect of the study that is even more striking deals with the manifestations of stress in new mothers in the first 6 weeks following delivery. As the authors indicated, these aspects have been well defined in mothers of term infants, leaving our understanding of perceived stress, sleep difficulties, and fatigue in mothers of preterm infants rather weak. Mothers of full-term infants recorded decreasing levels of stress, sleep disturbance, and fatigue by 6 weeks postpartum, whereas the data present a dramatically different trajectory for mothers of preterm infants. The findings that mothers of preterm infants consistently experience greater stress than mothers of fullterm infants is consistent with expectations from earlier research and from clinical experience with these mothers. What is most striking among the mothers of preterm infants is the rise in perceived stress at 6 weeks postpartum to almost the same level as at the time of the birth of the infant. In an even more dramatic manner for mothers of preterm infants, maternal sleep