Does skin-to-skin contact and breast feeding at birth affect the rate of primary postpartum haemorrhage: results of a cohort study

Objective: to examine the effect of skin-to-skin contact and breast feeding within 30 minutes of birth, on the rate of primary postpartum haemorrhage (PPH) in a sample of women who were at mixed-risk of PPH. Design: retrospective cohort study. Setting: two obstetric units plus a freestanding birth centre in New South Wales (NSW) Australia. Participants: after excluding women (n=3671) who did not have opportunity for skin to skin and breast feeding, I analysed birth records (n=7548) for the calendar years 2009 and 2010. Records were accessed via the electronic data base ObstetriX. Intervention: skin to skin contact and breast feeding within 30 minutes of birth. Measures: outcome measure was PPH i.e. blood loss of 500 ml or more estimated at birth. Data was analysed using descriptive statistics and logistic regression (unadjusted and adjusted). Findings: after adjustment for covariates, women who did not have skin to skin and breast feeding were almost twice as likely to have a PPH compared to women who had both skin to skin contact and breast feeding (aOR 0.55, 95% CI 0.41–0.72, p\u3c0.001). This apparently protective effect of skin to skin and breast feeding on PPH held true in sub-analyses for both women at ‘lower’ (OR 0.22, 95% CI 0.17–0.30, p\u3c0.001) and ‘higher’ risk (OR 0.37 95% CI 0.24–0.57), p\u3c0.001. Key conclusions and implication for practice: this study suggests that skin to skin contact and breastfeeding immediately after birth may be effective in reducing PPH rates for women at any level of risk of PPH. The greatest effect was for women at lower risk of PPH. The explanation is that pronurturance promotes endogenous oxytocin release. Childbearing women should be educated and supported to have pronurturance during third and fourth stages of labour

The development of the logistics in the Rpublic of Kazakhstan in 2007 – 2012 according to the counry’s participation in NELTI

Раздел «Международная логистика»В данной статье анализируется развитие сферы логистических услуг в Республике Казахстан по методике Всемирного банка (LPI); критически рассматривается участие страны в международной программе НЕЛТИ – Новой Евроазиатской автотранспортной инициативе Международного союза автомобильного транспорта (IRU). Анализируются текущие трудности на пути развития транспортной и таможенной логистики в стране и даются рекомендации по их преодолению. = The article is devoted to the analysis of the logistics in the Republic of Kazakhstan according to the methodology of the World Bank (LPI). The country’s participation in NELTI (New Eurasian Land Transport Initiative IRU) is considered in a critical way. There is the analysis of current difficulties to the development of transport and customs logistics in the country and recommendations to eliminate them are made

Immediate, uninterrupted skin-to-skin contact and breastfeeding after birth: a cross-sectional electronic survey

Objective: To determine the incidence of immediate, uninterrupted SSC and breastfeeding after birth; and which factors are associated with it. Design: Cross-sectional e-survey was developed and piloted prior to distribution. Sampling was purposive and included snowball sampling. Associations between maternity care practices and the primary outcome measure were examined using logistic regression.Setting: Australia. Participants: Women who birthed a term baby within the previous three years, in any Australian setting (hospital, birth centre or at home), were eligible to participate. Measurements and findings: 1200 postpartum women met the eligibility criteria and completed the e-survey. The primary outcome, 'pronurturance', included: (1) immediate mother/baby holding; (2) SSC; (3) uninterrupted holding for at least 60\ua0min; 4) breastfeeding in the birth setting. Of 1200 participants, 22% (n = 258) experienced pronurturance. Pronurturance was less likely following caesarean section (adjusted Odds Ratio (aOR) 0.07, 95% Confidence Interval (CI) 0.03-0.17). Pronurturance was more likely with a known midwife during labour and birth (aOR 1.89, 95% CI 1.35-2.65). Contributing to the low rate of pronurturance were lack of antenatal skin-to-skin information; babies being wrapped; women wearing clothing; and non-urgent caregiver interruptions including weighing the baby or facilitating the mother to shower. Key conclusion: Health services must strategically address the institutional processes which delay and/or interrupt SSC and breastfeeding in birth suite and operating theatre settings. Implications for practice: Midwives and midwifery students providing continuity of carer are best placed to provide pronurturance to mothers and babies. Caregivers should educate women about pronurturance antenatally, and actively support immediate, uninterrupted mother/baby SSC and breastfeeding after birth

Navigating learning and teaching in expanding culturally diverse higher education settings

Developing a deeper understanding of factors that influence learning  and teaching in widening culturally diverse learning environments is  necessary in proactively planning supports and pedagogical approaches that encourage integration, intercultural understanding  and respect for cultural difference. This qualitative descriptive study  reports on the experiences and perceptions of teaching faculty and  students (domestic and international) of learning and teaching in  postgraduate culturally diverse environments. Three themes were  generated from the data: ‘early apprehension’, ‘cautious engagement’  and ‘shared acceptance’, highlighting the multifaceted responses to  cultural diversity in the learning environment. These findings illuminate how learning and teaching in widening culturally diverse education settings require careful, sensitive and proactive planning and  supports. The individuality of learning experiences, self-preservation  of identities, narrow perceptions of cultural difference and unconscious ‘othering’, influenced learning behaviours, integration and  cohesive learning. The findings also highlight the necessity of adopting culturally responsive pedagogies. </p