The nine stages of skin-to-skin: practical guidelines and insights from four countries.

Incorporating systematic evidence with clinical expertise is a key element in the quest to improve quality of care and patient outcomes. The evidence supporting skin-to-skin contact in the first hour after birth is robust and includes significantly improved outcomes for both mother and infant. This paper compares available iterative data about newborn behaviour in the first hour after birth to further describe the observable behaviour pattern and to provide clinical insight for further research.

Structural and solvent control over activation parameters for a pair of retro Diels-Alder reactions.

We report the temperature dependent NMR of two Diels-Alder adducts of furan: one formed with maleic anhydride and the other with N-methylmaleimide. These adducts are the products of so-called 'click' reactions, widely valued for providing simple, reliable, and robust reactivity. Under our experimental conditions, these adducts undergo a retro Diels-Alder reaction and we use our temperature dependent NMR to determine the rates of these reactions at multiple temperatures-ultimately providing estimates of the activation parameters for the reversion.

A plausible pathway of imprinted behaviors: Skin-to-skin actions of the newborn immediately after birth follow the order of fetal development and intrauterine training of movements.

We hypothesize that the competence of a newborn in the first hours after birth is the direct result of behavior training that begins during the first 12 weeks of fetal life. Correlation of Widström's 9 Instinctive Stages (behaviors of the full-term newborn during the first hours after birth) with the developmental movements during fetal life demonstrate that the fetus is invested in learning specific tasks, in a specific order, that are evolutionarily necessary for survival during the first hour and beyond.

The effect of labor medications on normal newborn behavior in the first hour after birth: A prospective cohort study.

Background: Skin-to-skin contact after birth between mother and baby has immediate and long-term advantages. Widström's 9 Stages of Newborn Behavior offer an opportunity to evaluate a baby in the natural, expected and optimal habitat. Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin (synOT), have been studied in relation to neonatal outcomes with conflicting results.

Skin-to-skin contact the first hour after birth, underlying implications and clinical practice.

Aim: This paper integrates clinical expertise to earlier research about the behaviours of the healthy, alert, full-term infant placed skin-to-skin with the mother during the first hour after birth following a noninstrumental vaginal birth.

Method: This state-of-the-art article forms a link within the knowledge-to-action cycle, integrating clinical observations and practice with evidence-based findings to guide clinicians in their work to implement safe uninterrupted skin-to-skin contact the first hours after birth.

Results: Strong scientific research exists about the importance of skin-to-skin in the first hour after birth.

The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth.

Background: Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin, have been previously studied in relation to neonatal outcomes, especially breastfeeding, with conflicting results. We examined the normal neonatal behavior of suckling within the first hour after a vaginal birth while in skin-to-skin contact with mother in relation to these commonly used drugs. Suckling in the first hour after birth has been shown in other studies to increase desirable breastfeeding outcomes.

A Realistic Evaluation of Two Training Programs on Implementing Skin-to-Skin as a Standard of Care.

The authors used realistic evaluation to examine the real-world effectiveness of two 5-day training techniques on sustained optimal skin-to-skin practices that support Step 4 of the revised Baby-Friendly Hospital Initiative (BFHI). The authors found that education alone was insufficient to effect sustainable practice change. Exposure to the 5-day immersion model (Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success, or PRECESS) alone or combined with education was an effective strategy to change and sustain the standard of care for skin-to-skin practice (p < 0.

Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial.

Background: Infants with latch-on problems cause stress for parents and staff, often resulting in early termination of breastfeeding. Healthy newborns experiencing skin-to-skin contact at birth are pre-programmed to find the mother's breast. This study investigates if skin-to-skin contact between mothers with older infants having severe latching on problems would resolve the problem.

Influence of skin-to-skin contact and rooming-in on early mother-infant interaction: a randomized controlled trial.

The objective of this research was to study influence of birth routines on mother-infant interaction at Day 4. The present research is part of a longitudinal study where mother-infant pairs were randomized by infant location and apparel. We intended to assess mother-infant interaction from videos filmed at Day 4.

Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates.

Purposes: Skin-to-skin care after birth often is absent, interrupted, or delayed for routine procedures. The purposes of this project were to improve skin-to-skin care and exclusive breastfeeding at hospital discharge.

Methods: For Part 1, we used a descriptive observational design, with video-ethnography and interaction analysis (PRECESS-Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success), during a 5-day quality improvement pilot study in a U.

Newborn behaviour to locate the breast when skin-to-skin: a possible method for enabling early self-regulation.

Aim: The aim of this study was to provide a more detailed analysis of the infant's behavioural sequence that begins immediately after birth and terminates with grasping the nipple, suckling and then falling asleep.

Method: Twenty-eight full-term infants were videotaped immediately after birth. A video protocol was developed to examine infant behaviours identified from five random videotapes.

Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care.

Unlabelled: The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin-to-skin vertically between the mother's breasts and below her clothes, 24 h/day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high-tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother-infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC.

State of the art and recommendations. Kangaroo mother care: application in a high-tech environment.

Unlabelled: Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up.

Early contact versus separation: effects on mother-infant interaction one year later.

Background: A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation.

Methods: A total of 176 mother-infant pairs were randomized into four experimental groups: Group I infants were placed skin-to-skin with their mothers after birth, and had rooming-in while in the maternity ward.

Maternal axillar and breast temperature after giving birth: effects of delivery ward practices and relation to infant temperature.

Background: Little is known about the development and control of skin temperature in human mothers after birth. The purpose of this study was to explore the effects of delivery ward practices and early suckling on maternal axillar and breast temperatures during the first 2 hours postpartum and to relate them to the infant's foot and axillar temperatures.

Methods: Three groups of 176 mother-infant pairs were randomized as follows--group I: infants lying prone in skin-to-skin contact on their mother's chest, named the "skin-to-skin group" (n = 44), group II: infants who were dressed and lying prone on their mother's chest, named the "mother's arms group" (n = 44), and group III: infants who were dressed and kept in the nursery, named the "nursery group" (n = 88).

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

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.

Psychological correlates of prenatal attachment in women who conceived after in vitro fertilization and women who conceived naturally.

Background: Investigators have pointed out that long-awaited pregnancies, such as those after in vitro fertilization (IVF), are emotionally vulnerable. In addition, higher pregnancy-related distress has been found among women pregnant after in vitro fertilization compared with women with "naturally" achieved pregnancy. The aim of this study was to compare prenatal attachment among IVF mothers and control mothers (women who conceived naturally), and to study relationships between prenatal attachment and psychosocial variables.

Mothers' perception of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as compared to conventional care.

Background: Family-centred care according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to positively influence family function. The aim was to examine if NIDCAP affects the views of prematurely born infants' mothers regarding maternal role, perception of the infant and the neonatal care.

Method: Preterm infants with gestational age <32 weeks were randomly assigned to receive either care based on NIDCAP (n=12) or conventional neonatal care (n=13), forming two comparable groups with respect to gestational age, birth weight, female/male ratio, and initial illness severity.

Does continuity of care by well-trained breastfeeding counselors improve a mother's perception of support?

Background: Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care.

Method: Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities.

The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling.

Background: Few investigations have considered evaluating the effects of certain combinations of ward routines like swaddling of the baby and separation of mother and baby on infant variables such as neonatal weight loss.

Aims: To study the effect of different ward routines in respect to proximity to mother and type of infant apparel, on breastfeeding parameters (amount of ingested milk, volume of supplements, number of breastfeeds, total duration of breastfeeding time) day 4 after birth as well as recovery from neonatal weight loss and infant's weight on day 5.

Study Design And Subjects: In a randomized trial with factorial design four treatment groups including 176 mother-infant dyads were studied 25-120 min after birth.

Process-oriented training in breastfeeding alters attitudes to breastfeeding in health professionals.

Aim: The purpose of the study was to measure the attitudes of antenatal midwives and postnatal nurses to breastfeeding before and after common, process-oriented breastfeeding training.

Method: Antenatal centres and child-health centres in 10 municipalities were randomized to either an intervention or a control group. The antenatal midwives and postnatal nurses in the intervention group were together given process-oriented breastfeeding training and were, in addition, asked to develop a common breastfeeding policy.

Breastfeeding attitudes among counselling health professionals.

Aim: The aim of the study was to develop an instrument that can be used for accurate assessment of nurses' and midwives' attitudes toward breastfeeding in a group of midwives, maternity-nursing staff and postnatal nurses experienced in breastfeeding counselling.

Method: An instrument based on WHO standards was developed to measure breastfeeding attitudes. In all, 168 healthcare professionals filled in the instrument.

Some early indicators for depressive symptoms and bonding 2 months postpartum--a study of new mothers and fathers.

The aim was to investigate associations between blues, bonding, perception of the child's temperament and depressive symptoms two months postpartum in both parents. Questionnaires to be filled out during the first week were; Blues Questionnaires day 1-5, Postpartum Bonding Questionnaire (PBQ) and Edinburgh Postpartum Depressive Scale (EPDS) and at two months; questions about breastfeeding, EPDS, PBQ and the Infant Characteristic Questionnaire (ICQ). In all, 106 couples returned all questionnaires on both occasions.

"Struggling with life": narratives from women with signs of postpartum depression.

Aim: The aim of this study was to explore and describe how Swedish women with signs of postpartum depression two months postpartum experience the first months with their child.

Method: A grounded theory approach was chosen. Twenty-two women who showed signs of depression, i.

Night rooming-in: who decides? An example of staff influence on mother's attitude.

Background: In 1989 the World Health Organization and UNICEF introduced the "Ten Steps" for successful breastfeeding. One step suggests that a mother and her newborn baby should remain together day and night during the hospital stay. The purpose of this study was to investigate, first, whether or not mothers in our hospital roomed-in with their babies at night, second, the attitudes of mothers toward night rooming-in and their feelings of closeness to their babies, and third, how mothers perceived hospital staff attitudes toward night rooming-in.