Tiina Murto – Kansainvälisyyttä ja geenitutkimuksia

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Maternal perceptions of breastfeeding support in a birth hospital before and after designation to the Baby-Friendly Hospital Initiative : A quasi-experimental study

Objective: The purpose of this study was to examine maternal perceptions of postnatal breastfeeding support in the hospital before and after designation to the Baby-Friendly Hospital Initiative (BFHI). Further maternal and infant characteristics associated with the maternal perception of breastfeeding support were investigated. Our hypothesis was that mothers would perceive breastfeeding support more adherent to the standards of the BFHI after the hospital was designated to the BFHI compared with before.Design: The study had a quasi-experimental non-equivalent two-group design.Setting: The study was conducted in one postnatal ward and one neonatal intensive care unit in a public birth hospital in Finland. Participants: Postpartum mothers giving birth in the hospital before (pre-test group, n = 162) and after (post-test group, n = 163) designation to the BFHI participated. Intervention: The aim of the BFHI is to support and promote breastfeeding by implementing the Ten Steps to Successful Breastfeeding into routine care. Implementation in the study hospital required staff training and revision of current hospital practices, which took place during 2017-2018. The postnatal ward and neonatal intensive care unit were designated to the Baby-Friendly Hospital in February 2019. Measurements: Maternal perceptions of postnatal breastfeeding support were measured with a 20-item questionnaire developed for this study. Items were based on maternal self-report of the breastfeeding support in the hospital. A sum variable was created to measure the maternal perception of the support (scale 1-7), and higher scores indicated perception of breastfeeding support that is more adherent to the standards of the BFHI. Descriptive statics, nonparametric statistical tests, and multiple linear regression analysis were used to analyse data.Findings: Mothers in the post-test group (median 6.1, IQR 5.4-6.4) perceived breastfeeding support more adherent to the standards the BFHI compared with mothers in the pre-test group (median 5.0, IQR 4.25.8) (p 35 years) (median 4.4 vs 5.8, p = 7). After the BFHI designation, mothers who experienced preterm birth (GA < 37 weeks) perceived breastfeeding support less adherent to the BFHI standards compared with mothers who experienced a full-term birth. Key conclusions: Designation to the BFHI had a positive impact on breastfeeding support from the maternal perspective. Designation improved particularly multiparas' perceptions of receiving breastfeeding support that is in adherence with the standards of the BFHI. However, more emphasis should be placed, and further research should be conducted to ensure that mothers giving birth to a preterm infant receive breastfeeding support that is adherent to the BFHI standards. Implications for practice: Birth hospitals are recommended to implement the BFHI as it improves breastfeeding support in the hospital and provides mothers with a good basis and continuation for breastfeeding, even after hospital discharge. Maternal perceptions about the impact of BFHI designation are important to consider because mother - infant dyads are at the centre of that support, and their viewpoint may help to assess whether the designation to the BFHI in the unit is successful. Results of this study indicate that designation to BFHI improves breastfeeding support from the maternal perspective.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )Peer reviewe

The golden hour in Finnish birthing units - An ethnographic study

Objective: To explore midwives’ and parents’ perceptions and actions as well as the culture surrounding the first hour after the birth of a baby –the golden hour. Design: Short-term ethnographic study, which included observations, informal interviews and focus group interviews. Thematic network analysis was used to analyse the data. Setting: Two birthing hospitals in Finland. Participants: The first hour following 16 births was observed and informal interviews of attending mid- wives ( n = 10) and parents ( n = 3 couples and n = 6 mothers) were conducted to supplement the observations. The 16 cases included both primiparous ( n = 8) and multiparous ( n = 8) women, as well as vaginal ( n = 12) and elective caesarean births ( n = 4). Furthermore, two focus group interviews with midwives ( n = 9) were conducted to deepen the understanding. Findings: The over-arching theme Unchallenged hospital ‘rules’ comprised the two main themes of Safety-driven support by midwives and Silent voices of the parents. The hospital guidelines and practices guided the first hour, unchallenged by parents and midwives. Based on the guidelines, all the babies were given skin-to-skin contact early but not immediately. Midwives strictly followed the guidelines and performed many activities with the mothers during the first hour. Embedded power was present: midwives were in control but tended to listen to the parents. Although the mothers displayed a strong need to be close to their babies, their voices were silent in the units. The parents’ compliance with midwives and parents’ intense focus on the baby strengthened the midwives’ embedded power. Key conclusion: Care culture in birthing units was ‘rule-based’ and the guidelines and practices sometimes inhibited uninterrupted skin-to-skin contact without questioning. The golden hour was mainly controlled by the maternity care staff. Implications for practice: Re-evaluation of hospital guidelines should enable more woman- and family- centred care. The golden hour is unique to families, and unnecessary separation and interventions should be avoided.</div

Breastfeeding during the COVID-19 pandemic - a literature review for clinical practice

Background The COVID-19 pandemic is disrupting normal life globally, every area of life is touched. The pandemic demands quick action and as new information emerges, reliable synthesises and guidelines for care are urgently needed. Breastfeeding protects mother and child; its health benefits are undisputed and based on evidence. To plan and support breastfeeding within the current pandemic, two areas need to be understood: 1) the clinical characteristics of COVID-19 as it applies to breastfeeding and 2) the protective properties of breastfeeding, including the practice of skin-to-skin care. This review aims to summarise how to manage breastfeeding during COVID-19. The summary was used to create guidelines for healthcare professionals and mothers. Methods Current publications on breastfeeding during the COVID-19 pandemic were reviewed to inform guidelines for clinical practice. Results Current evidence states that the Coronavirus is not transmitted via breastmilk. Breastfeeding benefits outweigh possible risks during the COVID-19 pandemic and may even protect the infant and mother. General infection control measures should be in place and adhered to very strictly. Conclusions Breastfeeding should be encouraged, mothers and infant dyads should be cared for together, and skin-to-skin contact ensured throughout the COVID-19 pandemic. If mothers are too ill to breastfeed, they should still be supported to express their milk, and the infant should be fed by a healthy individual. Guidelines, based on this current evidence, were produced and can be distributed to health care facilities where accessible information is needed.</div