Skin-to-skin contact and suckling in early postpartum : Effects on temperature, breastfeeding and mother-infant interaction

The overall aim of this thesis was to explore the role of closeness versus separation on infant and maternal temperature adaptation, breastfeeding outcome and mother-infant interaction. In addition, we aimed to study a potential influence of swaddling on all outcomes measured. Material and design. A randomized factorial design and a longitudinal approach were used. One hundred and seventy six (176) mother-infant pairs from Maternity Home 13 in St. Petersburg were randomized into four groups. Group I infants were placed skin-to-skin with their mothers after birth, and had rooming-in two hours later. Group II infants were dressed and placed in their mothers arms after birth, and had rooming-in two hours later. Group III infants were kept in the nursery both after birth and during the rest of maternity stay. Group IV infants were kept in the nursery after birth, but roomed-in with their mothers two hours later. Equal numbers of infants were either swaddled or dressed in baby clothes. Methods included assessment of infant axillar, thigh, back and foot temperature and maternal axillar and breast temperature, at 15-minute intervals from 30 to 120 minutes after birth. A diary was filled in daily by mothers with their estimation of feeling low/blue (Visual Analogue Scale), perception of physiological breast engorgement, and number of breastfeeds. In addition, on day 4 time of breastfeeds, milk amount ingested and extra food given to the infants were registered. Recovery of the neonatal weight loss was calculated. The duration of nearly exclusive breastfeeding was noted. At the age of one year infants were video-filmed with their mothers and interaction scored according to the Parent-Child Early Relational Assessment (PCERA) method. Results. Maternal axillar and breast temperature exhibited a small but significant rise after delivery in all groups. In contrast, the variation in maternal breast temperature increased by close contact and suckling. Infant skin temperature, except for foot temperature in the Nursery group, rose in all groups and was the highest in infants with skin-to-skin contact. The rise of foot temperature was most pronounced in the Skin-toskin group, and it remained high during the maternity stay. Furthermore, in unseparated mother-infant dyads maternal axillar temperature was positively related to the infant foot temperature at 120 minutes postpartum. Infant foot temperature rose about 2 units per unit of change in the maternal axillar temperature. Breastfeeding. Infants who stayed in the nursery and had standardized breastfeeding frequency (7 times per 24 hours) ingested less breast-milk, suckled for a shorter time and received more supplements day 4, than rooming-in infants. Supplementation was one of the main factors reducing milk production/ingestion. Swaddling did not affect these breastfeeding parameters. In contrast, swaddled infants separated in the nursery, who were in addition supplemented by formula, had significantly less weight gain. Milk production/ingestion on day 4 postpartum in primiparas was positively correlated with early suckling, with the level of perception of breast engorgement and with the suckling frequency of the previous day. It was negatively correlated with high levels of feeling low/blue. Milk production/ingestion in multiparas was related to early suckling and rooming-in. The duration of nearly exclusive breastfeeding was related to amount of breast-milk produced/ingested on day 4 after birth. Maternal-infant interaction. Skin-to-skin contact between the mother and infant during the first two hours after birth significantly influenced the level of maternal sensitivity, infant ability to regulate behavior (selfregulation), and mutuality and reciprocity in the dyad when the infant was one year old. In the absence of skin-to-skin contact, early suckling induced these effects. Swaddling of the infant decreased the mother s ability for positive affective involvement in the infant and also mutuality and reciprocity in the dyad. These results were revealed using the PCERA. Conclusions. The data suggest that regulation of skin temperature and of milk production seems to be mediated by different and independent physiological mechanisms. In addition, the data show that early skinto- skin contact influences the development of maternal-infant interaction recorded at the age of one year, suggesting the existence of an early sensitive period

Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg

Abstract Background There are not many studies exploring parity differences in early lactation performance and the results obtained are fairly often contradictory. The present study investigated the effect of different maternity home practices in St. Petersburg, Russia, as well as of physiological breast engorgement and maternal mood, on milk production in primi- and multiparous women on day four. The amount of milk was studied in relation to the duration of "nearly exclusive" breastfeeding. Methods 176 mother-infant pairs were randomised into four groups according to an experimental two-factor design taking into account infant location and apparel. Data were recorded in the delivery ward at 25–120 minutes postpartum and later in the maternity ward. Group I infants (n = 37) were placed skin-to-skin in the delivery ward while Group II infants (n = 40) were dressed and placed in their mother's arms. Both groups later roomed-in in the maternity ward. These infants had the possibility of early suckling during two hours postpartum. Group III infants (n = 38) were kept in a cot in the delivery and maternity ward nurseries with no rooming-in. Group IV infants (n = 38) were kept in a cot in a delivery ward nursery and later roomed-in in the maternity ward. Equal numbers per group were either swaddled or clothed. Episodes of early suckling were noted. Number of breastfeeds, amount of milk ingested (recorded on day 4 postpartum) and duration of "nearly exclusive" breastfeeding were recorded. Intensity of breast engorgement was recorded and a Visual Analogue Scale measured daily maternal feelings of being "low/blue". Results On day four, multiparas had lower milk production than primiparas when they were separated from their infants and breastfeeding according to the prescriptive schedule (7 times a day; Group III). In contrast, there was no difference in milk production between multi- and primiparous mothers in the groups rooming-in and feeding on demand (Groups I, II and IV), although multiparas had higher numbers of feedings than primiparas. In addition during the first three days postpartum, multiparous mothers had higher perception of physiological breast engorgement and lower intensity of feeling "low/blue" than primiparous mothers. Early suckling was shown to positively affect milk production irrespective of parity. Thus Group I and II infants who suckled within the first two hours after birth ingested significantly more milk on day 4 than those who had not (284 and 184 ml respectively, SE = 14 and 27 ml, p = 0.0006). Regression analyses evaluated factors most important for milk production and found in Groups I and II for primiparous women that early suckling, intensity of breast engorgement and number of breastfeeds on day 3 were most important. Intensity of feeling "low/blue" was negatively related to amount of milk ingested. The significant factor for multiparous women was early suckling. Similar results were obtained in Groups III and IV; however, in primiparous mothers, engorgement was the most important factor and in multiparous women it was rooming-in. Amount of milk produced on day 4 was strongly correlated to a duration of "nearly exclusive" breastfeeding (p Conclusion The present data show that ward routines influence milk production. As our data suggest that milk production in primi- and multiparous women may be differently influenced or regulated by complex factors, further research is needed.</p