| 1. |
- Brimdyr, Kajsa, et al.
(författare)
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Skin-to-skin contact after birth : Developing a research and practice guideline
- 2023
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 112:8, s. 1633-1643
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Forskningsöversikt (refereegranskat)abstract
- AimSkin-to-skin contact immediately after birth is recognised as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, the implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilised the World Health Organization guideline process to clarify best practice and improve the consistency of application. MethodsThe rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. ResultsThe developed guideline received a strong recommendation from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work were delineated. ConclusionThe World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.
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| 2. |
- Eikemo, Ragnhild, et al.
(författare)
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"Health challenges and midwifery support for new mothers after childbirth: A cross-sectional study in Sweden"
- 2024
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Ingår i: Midwifery. - : ELSEVIER SCI LTD. - 0266-6138 .- 1532-3099. ; 134
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed to investigate new mothers ' self -rated and perceived health problems and complications; their reasons for, and the frequency of, emergency department visits; how emergency department visits were associated with sociodemographic and obstetric factors; and new mothers ' experiences of received support from the midwifery clinic. Design: A cross-sectional survey. Setting and participants: The study was conducted at 35 of 64 midwifery clinics in Stockholm, Sweden. The study population consisted of 580 new mothers. Measurement and findings: Descriptive statistics and logistic regression were used. New mothers experience a range of different health problems and complications during the first four weeks after giving birth. Sixteen percent sought emergency care. The odds of seeking emergency care increased for women with higher age and poorer self -rated health. Sixty-three percent of the new mothers received support from a midwife in primary care within the first four weeks after childbirth. Mothers who did not receive the support they wanted, expressed a wish for earlier contact and better accessibility. Conclusion and implication for practice: It is notable that 16 % of new mothers seek emergency care in the first weeks after childbirth. This study has practical implications for midwifery practice and policy. There is a need for tailored postnatal support strategies so that midwives potentially are able to mitigate emergency department visits. Further studies should look at whether the high number of emergency visits among new mothers varies throughout Sweden, and whether this may be a result of reduced time of hospital stay after childbirth or other factors.
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| 3. |
- Eikemo, Ragnhild, et al.
(författare)
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"Health challenges and midwifery support for new mothers after childbirth: A cross-sectional study in Sweden"
- 2024
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Ingår i: MIDWIFERY. - : ELSEVIER SCI LTD. - 0266-6138 .- 1532-3099. ; 134
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed to investigate new mothers ' self -rated and perceived health problems and complications; their reasons for, and the frequency of, emergency department visits; how emergency department visits were associated with sociodemographic and obstetric factors; and new mothers ' experiences of received support from the midwifery clinic. Design: A cross-sectional survey. Setting and participants: The study was conducted at 35 of 64 midwifery clinics in Stockholm, Sweden. The study population consisted of 580 new mothers. Measurement and findings: Descriptive statistics and logistic regression were used. New mothers experience a range of different health problems and complications during the first four weeks after giving birth. Sixteen percent sought emergency care. The odds of seeking emergency care increased for women with higher age and poorer self -rated health. Sixty-three percent of the new mothers received support from a midwife in primary care within the first four weeks after childbirth. Mothers who did not receive the support they wanted, expressed a wish for earlier contact and better accessibility. Conclusion and implication for practice: It is notable that 16 % of new mothers seek emergency care in the first weeks after childbirth. This study has practical implications for midwifery practice and policy. There is a need for tailored postnatal support strategies so that midwives potentially are able to mitigate emergency department visits. Further studies should look at whether the high number of emergency visits among new mothers varies throughout Sweden, and whether this may be a result of reduced time of hospital stay after childbirth or other factors.
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| 4. |
- Elvin-Nowak, Ylva M. S., et al.
(författare)
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Intimate partner violence and negative health consequences: A cross-sectional study among women in a regional sample in Sweden
- 2023
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Ingår i: Scandinavian Journal of Public Health. - : SAGE PUBLICATIONS LTD. - 1403-4948 .- 1651-1905. ; 51:4, s. 636-643
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intimate partner violence (IPV) is a global health problem of enormous proportions. However, little is known about the prevalence or health consequences of IPV among women in Stockholm, Sweden, a city characterised by high levels of gender equality that hosts a large population of people born outside Europe. Aims: This study aimed to assess the prevalence of exposure to physical, psychological and sexual IPV and its associated background factors and health outcomes. Methods: This was a cross-sectional study employing a survey containing questions about the previous years exposure to IPV that was distributed to 35 midwifery clinics in Stockholm during the autumn of 2020. Any woman who visited any of these midwifery clinics during these two months was eligible to participate. Results: A total of 2239 women answered the questionnaire, of whom 25.1% reported having been subjected to IPV at some point during their life and 8.7% during the previous year. The most common ongoing exposure was psychological violence, which was reported by 6.6% of the women. Women living with IPV reported poorer self-rated general health and more recurring health symptoms and depression than unexposed women. Conclusions: Exposure to IPV is common and is associated with depression, lower general well-being and somatic health problems.
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| 5. |
- Flacking, Renée, 1964-, et al.
(författare)
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Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants : a meta-ethnographic review
- 2021
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Ingår i: International Breastfeeding Journal. - : BioMed Central (BMC). - 1746-4358. ; 16:1
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Forskningsöversikt (refereegranskat)abstract
- BackgroundMost qualitative research on breastfeeding the preterm or low-birthweight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants.MethodsA systematic review using meta-ethnographic methods was conducted. Search strategies involved a comprehensive search strategy on six bibliographic databases, citation tracking and reference checking. The analysis involved a reciprocal level of translation and a line of argument synthesis.ResultsSearches identified 1774 hits and 17 articles from 14 studies were included, representing the views of 697 mothers. A positive breastfeeding experience was identified as being 'attuned'. Three themes and eight sub-themes were developed to describe what characterizes attuned breastfeeding. 'Trusting the body and what it can do', concerned how attuned breastfeeding was facilitated through understanding the bodily responses and capacity and feeling comfortable with holding the infant and to breastfeed. 'Being emotionally present - in the here and now' described the importance of feeling relaxed and reassured. 'Experiencing mutual positive responses', illuminated how attunement was related to feelings of mutuality - when the mother recognises the infant's cues, responds to these signals and receives a positive response from the infant. The key factors to facilitate attuned breastfeeding were opportunities for prolonged close physical contact with the infant, positive relationships with and support from staff and peers, and being facilitated to breastfeed when the infant showed feeding cues.ConclusionsThis study provides new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units' design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother's physical and emotional states and the infant's behavioural responses and physiological signals should guide the process towards positive breastfeeding practices.
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| 6. |
- Handlin, Linda, et al.
(författare)
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Effects of Sucking and Skin-to-Skin Contact on Maternal ACTH and Cortisol Levels During the Second Day Postpartum - Influence of Epidural Analgesia and Oxytocin in the Perinatal Period
- 2009
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Ingår i: Breastfeeding Medicine. - : Mary Ann Liebert. - 1556-8253 .- 1556-8342. ; 4:4, s. 207-220
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: In this study we made a detailed analysis of the mothers' release pattern of adreno-corticotropic hormone (ACTH) and cortisol during a breastfeeding session during the second day postpartum and related these patterns to maternal oxytocin levels as well to the duration of sucking and the duration of skin-to-skin contact before sucking the breast. Furthermore, we investigated if epidural analgesia and oxytocin administration during and after labor influenced the release pattern of ACTH and cortisol.Methods: Sixty-three primiparae were included in the study. Fourteen received oxytocin intramuscularly postpartum, nine received oxytocin infusion, 14 received epidural analgesia combined with oxytocin infusion, and six received epidural analgesia alone. Twenty mothers did not receive any of these medical interventions. Blood samples were analyzed for ACTH and cortisol by enzyme-linked immunoassay.Results: Both ACTH and cortisol levels fell significantly during the breastfeeding session. A significant negative relationship was found between oxytocin and ACTH levels, but not between oxytocin and cortisol levels. A contact before onset of sucking was significantly and negatively associated with lower cortisol levels, but not with ACTH levels. Cortisol levels differed significantly between mothers having received epidural analgesia with and without oxytocin.Conclusions: Breastfeeding is associated with a decrease of ACTH and cortisol levels. Skin-to-skin contact contributes to this effect. ACTH correlated negatively with the duration of sucking and median oxytocin levels, whereas cortisol levels correlated inversely with the duration of skin-to-skin contact preceding sucking, suggesting a partial dissociation between the mechanisms regulating ACTH and cortisol release. In addition, medical interventions in connection with birth influence the activity of the hypothalamic-pituitary-adrenal axis 2 days after birth.
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| 7. |
- Handlin, Linda, et al.
(författare)
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Influence of Common Birth Interventions on Maternal Blood Pressure Patterns During Breastfeeding 2 Days After Birth
- 2012
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Ingår i: Breastfeeding Medicine. - : Mary Ann Liebert. - 1556-8253 .- 1556-8342. ; 7:2, s. 93-99
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study investigated possible influences of medical interventions during labor on maternal blood pressure during a breastfeed 2 days postpartum.Subjects and Methods: Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at –5, 10, 30, and 60 minutes during a morning breastfeed 2 days postpartum. Five treatment groups were formed based on the medical interventions received during labor: Non-medicated mothers (Control group, n=21); mothers receiving epidural analgesia (EDA) with oxytocin (OT) stimulation (EDAOT group, n=14); mothers receiving EDA without OT stimulation (EDAnon-OT group, n=7); mothers receiving OT stimulation only (OT intravenously [iv] group, n=9); and mothers receiving 10 IU of OT intramuscularly (im) only (OT im group, n=15).Results: Baseline diastolic, but not systolic, blood pressure differed between the groups as displayed by significantly lower diastolic blood pressure in the EDAnon-OT group compared with the Control group, the OT iv group, and the EDAOT group (p=0.045, p=0.041, and p=0.024, respectively). Both systolic and diastolic blood pressure fell significantly during the breastfeeding session in the Control group (p=0.001 and p=0.004, respectively), the OT im group (p=0.006 and p=0.001, respectively), and the EDAOT group (p=0.028 and p=0.002, respectively), and the fall in diastolic blood pressure tended to be significant in the OT iv group (p=0.050). The duration of skin-to-skin contact before breastfeeding correlated positively with the decrease in systolic blood pressure in the OT im group (Rs=0.540, p=0.046).Conclusion: Administration of EDA during labor lowers baseline diastolic blood pressure and abolishes the fall in blood pressure in response to a breastfeed 2 days after birth.
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| 8. |
- Jonas, Wibke, et al.
(författare)
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Influence of oxytocin or epidural analgesia on personality profile in breastfeeding women : a comparative study
- 2008
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Ingår i: Archives of Women's Mental Health. - : Springer. - 1434-1816 .- 1435-1102. ; 11:5-6, s. 335-345
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Tidskriftsartikel (refereegranskat)abstract
- Women undergo physiological and psychological changes during pregnancy, labor and lactation. The psychological adaptations can be affective, cognitive and behavioral and can be measured by dimensional personality instruments. This study aims to compare (1) the personality profile in mothers after birth with a normative group of non-lactating women and to examine (2) whether the personality profile differs 2 days, 2 months and 6 months after birth between mothers who have been exposed to epidural anesthesia, oxytocin administration or neither. Sixty-nine primiparae were assigned to four groups: mothers having received oxytocin infusion during labor (OT iv group, n=9), mothers having received epidural analgesia with/without oxytocin infusion (EDA group, n=23), mothers having received 10 iU oxytocin intramuscularly after birth (OT im group, n=15) and mothers having received none of these treatments (unmedicated group, n=22). At 2 days and 2 and 6 months postpartum mothers completed the Karolinska Scales of Personality (KSP). The unmedicated, the OT iv- and OT im groups scored significantly lower on anxiety and aggression related scales and higher on the socialization subscale during the entire observation period when compared with a normative group. These differences were not observed in the EDA group 2 days postpartum. At´2 and 6 months postpartum, the scores of the EDA group had changed significantly and were almost similar to the KSP scores of the other groups. ANCOVA analysis revealed that OT infusion, over and above the effects of EDA, was associated with decreased levels of several anxiety and aggression subscales. We conclude that women who received exogenous oxytocin during labor show similar positive personality traits during breastfeeding such as reduction in anxiety and aggression and increasing socialization, including maternal behavior, that have previously been ascribed to endogenous oxytocin. More importantly, these effects were not seen at 2 days postpartum in women who received epidural anesthesia during labor.
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| 9. |
- Jonas, Wibke
(författare)
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Mother and newborn adaptations after birth : influence of administration of oxytocin and epidural analgesia during labour
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: This thesis explores postpartum physiological and psychological adaptations in mothers and newborns in the short-and long-term perspective. The thesis further explores the influence of labour ward interventions, such as epidural analgesia (EDA) and exogenous administration of oxytocin on these adaptations. Material and methods: An explorative longitudinal design was used. 72 healthy, non-smoking Swedish-speaking primiparae with a normal singleton pregnancy and birth and their healthy full term newborns were consecutively enrolled in the study. Mothers and newborns stayed together at the labour-and maternity wards and the newborns had been exclusively breastfed on demand. The mother-newborn dyads had been exposed to different labour ward routines: 1) mothers who had received intravenous oxytocin during labour (OT iv group, n=10), 2) mothers who had received oxytocin intramuscularly after birth to prevent postpartum haemorrhage but no other treatment (OT im group, n=15) and 3) mothers who had received EDA during labour (EDA group, n=24). 4) Mothers who had not received any form of oxytocin or EDA during labour (control group, n=23). The EDA group was divided into two separate groups: EDA with (EDAOT group, n=17) or without oxytocin infusion (EDAnon-OT group, n=7). Data were collected two days postpartum in connection with a morning breastfeed. Maternal blood samples were drawn with an interval of 30 seconds during the first 7.5 minutes and at 10, 20, 30, and 60 minutes after start of suckling. These samples were analysed for oxytocin and prolactin using ELISA (I). Blood pressure was recorded by a wrist blood pressure monitor before and at 10, 30, and 60 minutes after start of breastfeeding. 33 mothers continued to measure their blood pressure once per week in connection with a breastfeed during a 6-month follow up (II). The women s personality profile was assessed at two days, two and six months postpartum by the Karolinska Scales of Personality (KSP) (III). The newborn interscapular skin temperature was recorded with an electronic thermometer before and at 5, 10, 20, and 30 minutes after start of the breastfeed (IV). Results: Breastfeeding two days postpartum. Breastfeeding induced an immediate pulsatile release of oxytocin and prolactin levels rose significantly after 20 minutes. There was a positive correlation between oxytocin and prolactin levels (I). Maternal systolic and diastolic blood pressure fell during the breastfeed by 9 and 8 mmHg, respectively (II). At two days postpartum, according to the KSP, the maternal personality profile was changed towards reduced anxiety and aggression and increased socialisation when compared to a normative sample of women (III). The interscapular skin temperature of the newborns rose during the breastfeed (IV). Follow up study. Blood pressure fell in response to breastfeeding episodes and basal systolic and diastolic blood pressure fell by 15 and 10 mmHg, respectively, during the 6-month follow up period (II). KSP ratings showed that the breastfeeding women exhibited lower scores on anxiety and aggression and higher scores on socialisation at two and six months postpartum, when compared to the normative sample of women (III). Medical interventions during labour. Median oxytocin levels were lower in the group of women having received EDA with oxytocin infusion (EDAOT group) than in the EDAnon-OT, OT iv and OT im groups. In addition, median oxytocin levels were decreased in a dose-dependent manner in women having received oxytocin infusion in connection with labour (OT iv and EDAOT groups). Prolactin levels did not rise in women belonging to the EDAnon-OT group, but rose more and at an earlier time point in mothers having received oxytocin infusion (OT iv and EDAOT groups) than in controls (I). The administration of EDA attenuated changes in the KSP towards less anxiety and more socialisation at two days post partum as seen in the control, OT iv, and OT im groups. At two and six months postpartum, however, the KSP scores of the EDA group had approached the KSP scores of the other groups. Exogenous oxytocin infusion (OT iv and EDAOT groups) dose-dependently reinforced the KSP changes in some anxiety and aggression subscales (III). Newborns to mothers who had received EDA during labour did not show a rise in interscapular skin temperature in response to breastfeeding, but the response was reinforced in newborns to mothers belonging to the OT iv group, when compared to controls (IV). Conclusion: This study confirms the existence of physiological and psychological adaptations in breastfeeding mothers and their newborns in the short-and long-term perspective. Administration of exogenous oxytocin and EDA during labour influenced these adaptations.
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| 10. |
- Klemming, Stina, et al.
(författare)
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Mother-newborn couplet care : Nordic country experiences of organization, models and practice
- 2023
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Ingår i: Journal of Perinatology. - : Springer Nature. - 0743-8346 .- 1476-5543. ; 43:SUPPL 1, s. 17-25
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Tidskriftsartikel (refereegranskat)abstract
- Mother-Newborn Couplet Care is a concept and is defined as the provision of care for a sick or preterm newborn in close proximity to and coupled with the care for the mother from the birth of the infant and for as long as the mother needs hospital care. This concept of care requires system change in both obstetrics and pediatrics in terms of the planning and organization of care, equipment and design of units. Accordingly, strong leadership setting clear goals and emphasizing a culture of cohesive care, supported by targeted education and training is crucial to ensure high-quality care of all mother-newborn dyads without separation. We describe various organizational models of Mother-Newborn Couplet Care used in Sweden and Finland and implementation processes. We envision a future where newborns and mothers are always together, irrespective of medical needs, and form an inseparable center around which healthcare services and providers are organized.
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