Ruth Merle Cantrill

Effective suckling in relation to naked maternal-infant body contact in the first hour of life: an observation study

BackgroundBest practice guidelines to promote breastfeeding suggest that (i) mothers hold their babies in naked body contact immediately after birth, (ii) babies remain undisturbed for at least one hour and (iii) breastfeeding assistance be offered during this period. Few studies have closely observed the implementation of these guidelines in practice. We sought to evaluate these practices on suckling achievement within the first hour after birth.MethodsObservations of seventy-eight mother-baby dyads recorded newborn feeding behaviours, the help received by mothers and birthing room practices each minute, for sixty minutes.ResultsDuration of naked body contact between mothers and their newborn babies varied widely from 1 to 60 minutes, as did commencement of suckling (range = 10 to 60 minutes). Naked maternal-infant body contact immediately after birth, uninterrupted for at least thirty minutes did not predict effective suckling within the first hour of birth. Newborns were four times more likely to sustain deep rhythmical suckling when their chin made contact with their mother’s breast as they approached the nipple (OR 3.8; CI 1.03 - 14) and if their mothers had given birth previously (OR 6.7; CI 1.35 - 33). Infants who had any naso-oropharyngeal suctioning administered at birth were six times less likely to suckle effectively (OR .176; CI .04 - .9).ConclusionEffective suckling within the first hour of life was associated with a collection of practices including infants positioned so their chin can instinctively nudge the underside of their mother’s breast as they approach to grasp the nipple and attach to suckle. The best type of assistance provided in the birthing room that enables newborns to sustain an effective latch was paying attention to newborn feeding behaviours and not administering naso-oropharyngeal suction routinely.

Pre-operative self-efficacy education vs. usual care for patients undergoing joint replacement surgery: a pilot randomised controlled trial.

BACKGROUND Hip and knee replacement is a major surgical procedure performed worldwide. Despite 20 or so years of clinical research and care guidelines, the management of acute postoperative pain continues to be a concern. A growing number of self-efficacy strategies are being included in education programs for patients to enable then to have a central role in managing their illness and symptoms. AIMS AND OBJECTIVES The purpose of this pilot study was to evaluate the feasibility of testing an education intervention to improve self-efficacy in patients undergoing hip or knee replacement. METHODS A single-blinded, parallel, pilot randomised control trial design was used. Ninety-one patients undergoing hip or knee replacement surgery were randomly assigned to an intervention or control group. Intervention group participants were given a DVD demonstrating self-efficacy activities to undertake four times before admission. Feasibility criteria related to recruitment, protocol adherence and missing data were assessed. Participants were assessed for pain, anxiety, self-efficacy and healthcare utilisation. RESULTS In relation to recruitment, 55% of screened patients were eligible and of these 81% enrolled (n = 91). Exclusion following randomisation was 10% with missing data ranging from 0 to 20.7%. Nineteen per cent of participants were lost to follow up in the control group and 20% lost to follow up in DVD group. Protocol adherence to components of the intervention varied. Both groups were generally satisfied with pain management during hospitalisation, and there were no differences in groups on clinical outcome measures. CONCLUSIONS Preliminary evidence for the benefits of self-efficacy-based education for patients undergoing hip or knee replacement was identified. Additional findings included a need to strengthen the intervention and reducing the number of data collection points to improve the protocol, missing data and numbers lost to follow up before a larger trial is undertaken.