Mitzi Davis

It wasn't working. Women's experiences with short-term breastfeeding.

PURPOSE To investigate the lived experiences of women who initiate breastfeeding but stop within the first 2 weeks after birth. DESIGN Phenomenology. METHODS Interviews were recorded on audio tape, transcribed verbatim, and analyzed for themes by an interdisciplinary group of researchers. RESULTS Women described a clash or incongruity between highly idealized expectations and early breastfeeding problems. This led to incremental disillusionment and cessation of breastfeeding attempts. Women spoke poignantly about a sense of failure, guilt, or shame and had lingering self-doubts about not continuing with breastfeeding. CLINICAL IMPLICATIONS Women need more accurate information about the process of initiating breastfeeding. Nurses should avoid teaching breastfeeding practices that can confuse infants and sabotage mothers and should work toward providing sensitive care that respects personal boundaries of mothers. Additionally, provisions need to be made for continued support and consultation after the mothers discharge from the hospital or birthing center. Finally, nurses and other health professionals should understand that women who stop breastfeeding at an early date may feel guilty about doing so, and may need assistance in resolving feelings about having made that choice.

Postpartum Stress: Current Concepts and the Possible Protective Role of Breastfeeding

Objective: To review stress during the postpartum and the research supporting that a unique, protective biology exists in breastfeeding mothers that may reduce reactivity to stress. Data Sources: Publications from nursing and biomedical literature. Study Selection: Studies reviewed were those that have contributed to concurrent conceptualizations of postpartum stress. Additionally, studies with sufficient participants were analyzed for common findings. Animal literature was reviewed for studies on the stress response in lactating and nonlactating animal models. Data Extraction: Stress during the postpartum may be conceptualized as physical, intrapersonal, and interpersonal. Animal data and a few recent human studies suggest that the neuroendocrinology of the lactating mother may down-regulate the magnitude of the stress response. Data Synthesis: A diminished stress response may serve to protect the breastfeeding maternal-infant dyad from environmental stimuli and to direct the physiology of the mother toward milk production, energy conservation, and nurturance. Conclusion: Nurses understand the benefits of breastfeeding for optimal infant health, but new research suggests that maternal health may also be benefited in a biologic and as yet unexplored way.

Measures of salivary secretory immunoglobulin A and state anxiety after a nursing back rub

This study examined the effects of a 10-minute nursing back rub on salivary secretory immunoglobulin A (s-IgA) and state anxiety in well older adult subjects. A control group (n = 14) received no intervention, and an experimental group (n = 18) received a slow stroke effleurage back rub. All subjects initially completed the state portion of the Spielberger State/Trait Anxiety Inventory (STAI) and provided a timed, nonstimulated saliva sample. Control subjects lay positioned in bed for 10 minutes, and experimental subjects received the back rub. Both groups then provided a second saliva sample and completed the STAI again. Anxiety scores decreased for both groups, but not significantly, and s-IgA concentration increased in the experimental group. This study provides rationale for further research into the holistic benefits of the nursing back rub and should encourage nurses to continue to provide caring touch interventions to patients.

Neuroendocrine and immune relationships in postpartum fatigue.

Purpose:To explore relationships between fatigue, depression, stress, and infection in the postpartum. Study Design and Methods:This was a cross-sectional, correlational design with a sample of 119 new mothers at 4 to 6 weeks postpartum. Mothers completed fatigue, mood, and stress instruments as well as maternal and infant infection checklists. Morning blood and hindmilk (in breastfeeders) samples were collected. ELISA was used to measure prolactin, cortisol, melatonin, and secretory IgA (sIgA). Correlations between psychosocial, health, and biologic variables were explored. Results:Fatigue was correlated with symptoms of infection in both mothers and babies, with perceived stress and postpartum stress as well as with depression. Serum prolactin was inversely associated with depression. Milk sIgA was related to milk prolactin and inversely related to stress. Milk melatonin and prolactin were inversely related, and fatigue scores were correlated with melatonin and inversely with prolactin. Clinical Implications:The data suggest that fatigue, stress, depression, and infection are related in postpartum mothers and that these relationships extend to levels of serum hormones and milk factors. It is possible that a cycle is established that multiplies the effects of fatigue when mothers experience stress and that this cycle of stress and fatigue may lead to immune deficits and infectious illnesses.

Immunity, Inflammation and Infection in Post‐partum Breast and Formula Feeders

Little is known about immunological recovery in post‐partum women and if lactational status affects immunocompetence. Many physiological changes occur, such as uterine involution and recovery of non‐pregnant immune status. These changes may also affect susceptibility to disease.

Associations between Human Milk SIgA and Maternal Immune, Infectious, Endocrine, and Stress Variables

Fifty breastfeeding mothers were studied at 4, 5, or 6 weeks postpartum. Morning hind milk, serum samples, and stress and infection data were collected to examine whether milk secretory immunoglobulin A (SIgA) is related to demographic, stress, immune, and infection factors. The authors investigated relationships between milk SIgA and maternal stress, mood, symptoms of infection, serum proinflammatory and proimmune cytokines, and cortisol. Older women had lower SIgA, and smokers and lower-income women had higher SIgA. There was a relationship between postpartum infection symptoms and SIgA concentration. The Profile of Mood States-anger score was correlated with higher SIgA and perceived stress with lower SIgA. Positive life events were correlated with higher SIgA. In regression analysis, age, postpartum infections, and serum interferon (IFN)-γ were significant predictors of milk SIgA. The data suggest that milk SIgA is primarily affected by maternal immune/infection status, but several other stress and mood variables may potentially influence the concentration of milk SIgA.

I felt violated: Women's experience of childbirth-associated anger

Purpose To investigate the lived experience of childbirth-associated anger. Design Descriptive phenomenology. Methods Open-ended interviews were conducted with 10 women who had experienced the phenomenon of interest and volunteered to participate. All of the women had experienced vaginal delivery of term or near-term infants without anomalies or birth sequelae of note. Interviews were recorded on audio tape, transcribed verbatim, and analyzed for themes by an interdisciplinary group of researchers. Results Women’s narratives described violation of the implicit relational contract with their healthcare providers. Themes focused on the anger experienced when their expectations about trust, power, control, and being kept informed were not met. Clinical Implications Nursing implications include the need to educate women prenatally about the process of labor and delivery, establish relationships that convey care and concern, keep women informed about events and progress, and treat women as full participants in the decision-making process.

Anger and cancer: an analysis of the linkages.

The purposes of this article are to review literature on anger’s link to cancer, to analyze the state of the science in this area, and to propose some directions for future research. Extremely low anger scores have been noted in numerous studies of patients with cancer. Such low scores suggest suppression, repression, or restraint of anger. There is evidence to show that suppressed anger can be a precursor to the development of cancer, and also a factor in its progression after diagnosis. Some studies indicate that it may be beneficial for patients to mobilize anger to battle their cancer. However, there is a paucity of research on the outcomes of various anger interventions. Longitudinal studies that repeatedly measure anger and other moods over the disease trajectory are needed.

52 Relationships between serum proinflammatory and proimmune cytokines and stress in breastfeeding and formula feeding mothers

dictor of CRP (b = .16, p < .05). Next, the role of pain and perceptions of general health were examined. As expected, hostility was associated with both pain and overall health (bs = .30 and .29, respectively, p < s < .01), both of which were also associated with CRP (bs = .26 and .16, p < s p < s <.001). Nevertheless, hostility remained a significant independent predictor of CRP (b = .17, p < /I > < .05). Finally, health behaviors ñ including cigarette use, caffeine use, alcohol use, and exercise ñ were included in the model; although none were directly associated with hostility, the unique effect of hostility on CRP decreased to marginal significance in this final model (b = .15, p < = .06). Pain and perceived health remained independent predictors. In the final model, IL-6 was predicted directly by body mass, age, and CRP (overall R = .12). CRP was directly predicted by body mass, gender, cigarette use, exercise, general health, pain, and IL-6 (overall R = .30). This research suggests that hostility plays an important, probably indirect role in a cycle of inflammation among older adults and that pain and perceived health may contribute directly. In addition, the current research illuminates the interrelations among other variables that have been previously associated with CRP and IL-6, the mediation of which will be the focus of future research.

Review: In ReviewPostpartum Stress: Current Concepts and the Possible Protective Role of Breastfeeding

Objective: To review stress during the postpartum and the research supporting that a unique, protective biology exists in breastfeeding mothers that may reduce reactivity to stress. Data Sources: Publications from nursing and biomedical literature. Study Selection: Studies reviewed were those that have contributed to concurrent conceptualizations of postpartum stress. Additionally, studies with sufficient participants were analyzed for common findings. Animal literature was reviewed for studies on the stress response in lactating and nonlactating animal models. Data Extraction: Stress during the postpartum may be conceptualized as physical, intrapersonal, and interpersonal. Animal data and a few recent human studies suggest that the neuroendocrinology of the lactating mother may down-regulate the magnitude of the stress response. Data Synthesis: A diminished stress response may serve to protect the breastfeeding maternal-infant dyad from environmental stimuli and to direct the physiology of the mother toward milk production, energy conservation, and nurturance. Conclusion: Nurses understand the benefits of breastfeeding for optimal infant health, but new research suggests that maternal health may also be benefited in a biologic and as yet unexplored way.