Randomised trial of infant sleep location on the postnatal ward

Objective: To determine whether postnatal mother–infant sleep proximity affects breastfeeding initiation and infant safety. Design: Randomised non-blinded trial analysed by intention to treat. Setting: Postnatal wards of the Royal Victoria Hospital (RVI), Newcastle upon Tyne, UK. Participants: 64 newly delivered mother–infant dyads with a prenatal intention to breastfeed (vaginal deliveries, no intramuscular or intravenous opiate analgesics taken in the preceding 24 h). Intervention: Infants were randomly allocated to one of three sleep conditions: baby in mother’s bed with cot-side; baby in side-car crib attached to mother’s bed; and baby in stand-alone cot adjacent to mother’s bed. Main outcome measures: Breastfeeding frequency and infant safety observed via night-time video recordings. Results: During standardised 4-h observation periods, bed and side-car crib infants breastfed more frequently than stand-alone cot infants (mean difference (95% confidence interval (CI)): bed v stand-alone cot = 2.56 (0.72 to 4.41); side-car crib v stand-alone cot = 2.52 (0.87 to 4.17); bed v side-car crib = 0.04 (–2.10 to 2.18)). No infant experienced adverse events; however, bed infants were more frequently considered to be in potentially adverse situations (mean difference (95% CI): bed v stand-alone cot = 0.13 (0.03 to 0.23); side-car crib v stand-alone cot = 0.04 (–0.03 to 0.12); bed v side-car crib = 0.09 (–0.03–0.21)). No differences were observed in duration of maternal or infant sleep, frequency or duration of assistance provided by staff, or maternal rating of postnatal satisfaction. Conclusion: Suckling frequency in the early postpartum period is a well-known predictor of successful breastfeeding initiation. Newborn babies sleeping in close proximity to their mothers (bedding-in) facilitates frequent feeding in comparison with rooming-in. None of the three sleep conditions was associated with adverse events, although infrequent, potential risks may have occurred in the bed group. Side-car cribs are effective in enhancing breastfeeding initiation and preserving infant safety in the postnatal ward

Bedding-in and rooming-in on the post-natal ward : breastfeeding initiation.

Hospitals making a commitment to the UNICEF UK Baby Friendly Initiative adopt a number of practices to help increase breastfeeding initiation rates. Allowing mothers and their infants uninterrupted skin to skin contact for at least the first 30 minutes following delivery and keeping mothers and babies close are two of the practices that have been shown to encourage breastfeeding initiation. Bedding-in (bed-sharing on the postnatal ward) is an obvious extension to skin-to-skin contact and a way of ensuring that mothers and their infants stay close. Bedding-in also has a number of other benefits in that it can facilitate bonding and assists in post partum rest for mothers. This randomised control trial investigated the effects of bedding-in compared to rooming-in on breastfeeding initiation, mother-infant contact, maternal responsiveness, midwifery assistance and infant safety required on the first post-natal night. In addition, a relatively new infant sleep condition (clip on crib) was assessed to determine whether infants and their mothers allocated to this condition behaved more like the bedding-in group or the rooming-in group. This presentation will concentrate on breastfeeding initiation in the three groups only. Mothers were recruited via breast-feeding workshops held within the Royal Victoria Infirmary, Newcastle-Upon-Tyne, England, when they were approximately 37 weeks gestation. Following vaginal delivery (without the use of intramuscular opiate analgesics) the behaviors and interaction of the mothers and their babies were recorded on the post-natal ward using infra-red video equipment. Tapes were coded using The Observer® (Noldus Information Technology bv, The Netherlands) according to a taxonomy used by the Parent-Infant Sleep Lab team at the University of Durham. We found that mothers who bed-in were more responsive to their infants’ feeding cues, breastfed more frequently and breastfed for longer durations when initiating breastfeeding on the first postnatal night

Bedding-in and Rooming-in on the post-natal ward: breastfeeding initiation

Hospitals making a commitment to the UNICEF UK Baby Friendly Initiative adopt a number of practices to help increase breastfeeding initiation rates. Allowing mothers and their infants uninterrupted skin to skin contact for at least the first 30 minutes following delivery and keeping mothers and babies close are two of the practices that have been shown to encourage breastfeeding initiation. Bedding-in (bed-sharing on the postnatal ward) is an obvious extension to skin-to-skin contact and a way of ensuring that mothers and their infants stay close. Bedding-in also has a number of other benefits in that it can facilitate bonding and assists in post partum rest for mothers. This randomised control trial investigated the effects of bedding-in compared to rooming-in on breastfeeding initiation, mother-infant contact, maternal responsiveness, midwifery assistance and infant safety required on the first post-natal night. In addition, a relatively new infant sleep condition (clip on crib) was assessed to determine whether infants and their mothers allocated to this condition behaved more like the bedding-in group or the rooming-in group. This presentation will concentrate on breastfeeding initiation in the three groups only. Mothers were recruited via breast-feeding workshops held within the Royal Victoria Infirmary, Newcastle-Upon-Tyne, England, when they were approximately 37 weeks gestation. Following vaginal delivery (without the use of intramuscular opiate analgesics) the behaviors and interaction of the mothers and their babies were recorded on the post-natal ward using infra-red video equipment. Tapes were coded using The Observer® (Noldus Information Technology bv, The Netherlands) according to a taxonomy used by the Parent-Infant Sleep Lab team at the University of Durham. We found that mothers who bed-in were more responsive to their infants’ feeding cues, breastfed more frequently and breastfed for longer durations when initiating breastfeeding on the first postnatal night

Observing mother-infant sleep behaviour

Research teams from the Parent-Infant Sleep Lab at Durham University, UK, and the Mother-Baby Sleep Lab at Notre Dame University, USA both study mother-infant sleep behavior and night-time care-giving and utilise The Observer® Video Pro 5.0 (Noldus Information Technology bv, The Netherlands) for data capture and analysis. The research questions we address are similar, deriving from anthropological perspectives on infant care practices within an evolutionary paradigm. The Durham team have recently completed a study of mother-newborn sleep behavior on the 1st two post-natal nights in a hospital setting, while the Notre Dame researchers have examined night-time parenting behavior of adolescent and adult first-time mothers with their 4 and 8 months old infants in the setting of the sleep lab. In both studies mother-infant sleep and care-giving behavior is captured to videotape using low-light intensity cameras illuminated via infra-red light. Observation periods last for the entire night and video coding is therefore complex and prolonged. Individual behaviors and dyadic interactions (sometimes triadic in the hospital study) are coded as events or states according to similar multi-level behavioral taxonomies in both studies. We operate 11 behavioral classes with up to 14 elements per behavioral class, and 8 modifier classes with up to 20 elements per modi.er class. Behavioral recordings are of 8 to 15 hours duration resulting in data files that contain an average of 1600 observations. Simple analyses involve generating output of event frequencies and state durations per dyad (e.g. frequency of crying, duration of sleep bouts). More complex analyses of behavior sequences and time-lag analyses are also required (e.g. intensity of signalling required for baby to wake mother; time lag between baby’s first signal and maternal response). In some cases the limitations of the observation environment causes difficulty. In other cases aspects of software design thwart some of our analytical desires. This short presentation will describe our common experiences of coding and analysing nocturnal mother-infant interactions using The Observer Video-Pro

Observing mother-infant sleep behaviour.

Research teams from the Parent-Infant Sleep Lab at Durham University, UK, and the Mother-Baby Sleep Lab at Notre Dame University, USA both study mother-infant sleep behavior and night-time care-giving and utilise The Observer® Video Pro 5.0 (Noldus Information Technology bv, The Netherlands) for data capture and analysis. The research questions we address are similar, deriving from anthropological perspectives on infant care practices within an evolutionary paradigm. The Durham team have recently completed a study of mother-newborn sleep behavior on the 1st two post-natal nights in a hospital setting, while the Notre Dame researchers have examined night-time parenting behavior of adolescent and adult first-time mothers with their 4 and 8 months old infants in the setting of the sleep lab. In both studies mother-infant sleep and care-giving behavior is captured to videotape using low-light intensity cameras illuminated via infra-red light. Observation periods last for the entire night and video coding is therefore complex and prolonged. Individual behaviors and dyadic interactions (sometimes triadic in the hospital study) are coded as events or states according to similar multi-level behavioral taxonomies in both studies. We operate 11 behavioral classes with up to 14 elements per behavioral class, and 8 modifier classes with up to 20 elements per modi.er class. Behavioral recordings are of 8 to 15 hours duration resulting in data files that contain an average of 1600 observations. Simple analyses involve generating output of event frequencies and state durations per dyad (e.g. frequency of crying, duration of sleep bouts). More complex analyses of behavior sequences and time-lag analyses are also required (e.g. intensity of signalling required for baby to wake mother; time lag between baby’s first signal and maternal response). In some cases the limitations of the observation environment causes difficulty. In other cases aspects of software design thwart some of our analytical desires. This short presentation will describe our common experiences of coding and analysing nocturnal mother-infant interactions using The Observer Video-Pro