ABSTRACT
Background: The acceptance for PPIUCD in our country, especially in rural areas is very low despite all the efforts. Counselling during the antenatal visits may play a vital role in improving the acceptance of PPIUCD. Objective of this study was to assess the factors associated with the acceptability of immediate PPIUCD insertion in women; counselled during antenatal and postpartum period; according to their sociodemographic and obstetric characteristics, and future pregnancy desires.Methods: One-year prospective study carried out in the department of obstetrics and gynecology, S. S. Medical College Rewa, Madhya Pradesh, India. a total of 4850 women were counselled for PPIUCD insertion; 2540 during their antenatal visits, and 2310 during postpartum period who visited in study centre for first time and their follow up was done. Chi square tests were applied to compare proportions.Results: After antenatal counselling in 2540 women, (with multiple counselling sessions) about half of the women gave verbal acceptance for PPIUCD. However, during postpartum counselling in 2310 women, (where only single short session of counselling could be done) majority of the women declined (80.9%) for PPIUCD insertion with only about a fifth (19.1%) of the women giving verbal acceptance. Women who had antenatal counselling one third of them had PPIUCD insertion. In the postpartum counselling group, a meagre 15.1% women had PPIUCD insertion.Conclusions: Counselling during antenatal and postpartum period is the key to improve the awareness and acceptance of PPIUCD in our community. Multiple counselling sessions during antenatal visits make it easier for the women to slowly understand the process and accept PPIUCD as compared to the short counseling during postpartum period.
ABSTRACT
Background: Breastfeeding has been a universal practice. A number of factors influence the breastfeeding practices of the mothers. This study was conducted to assess the breast-feeding practices and its association with mother’s education and antenatal counselling.Methods: A community based cross sectional study was conducted among 167 mothers with infants who were residing in field practice area of a medical college. A pretested semi-structured validated questionnaire was administered to assess the breast-feeding practices followed. Towards the end of each interview the investigator observed the mothers as they breast fed their children to assess the appropriateness of positioning and attachment. Chi-square test and Fischer’s exact probability test were used to test the associations.Results: 19.8% of the mothers were illiterate. 64.1% had received antenatal counselling on breast feeding. 62.3% initiated breast feeding within one hour. Colostrum was discarded by 6% of the mothers and 28.7% gave pre-lacteal feeds. 72.3%, 86.1% and 77.3% of them practiced appropriate position of feeding, held their children in the appropriate position and had good attachment to the breast, respectively. Mother’s education had a statistically significant association with pre-lacteal feeds administration, exclusive breastfeeding and breast-feeding position. Antenatal breast-feeding counselling had a statistically significant association with appropriate positioning of the child, attachment and practicing burping.Conclusions: Breast feeding practices in the current study was far from satisfactory. Mother’s education and antenatal breast-feeding counselling had a major role in the feeding practices.
ABSTRACT
Background: Exclusive Breastfeeding (EBF) for 6 months is the optimal way of feeding infants. NFHS4 data shows 45.5% of children were exclusively breastfed at 6 months in Puducherry. The Global Nutrition Targets 2025 aims at increasing EBF rates in first 6 months up to at least 50%. The main objective is to find areas of needed intervention using LATCH scoring and to find factors responsible for fall in rates of EBF.Methods: A prospective study was conducted between November 2017 and April 2019 (1'years). Mothers were educated about breastfeeding. LATCH score assessed at 8 and 48 hours of life. At 48hours, score >8 indicates there is a high chance for EBF for next 6 months and score <8 indicates, mother is having difficulty in feeding and are intervened at this point. Data about EBF and reason for early weaning at 6 weeks and 6 months collected.Results: LATCH score at 8 hours was >8 in infants delivered via NVD: 50% as against 9.6% in babies delivered via LSCS. At 48 hours LATCH score improved in both groups: 60.8% in babies delivered via NVD, 38.3% in babies delivered via LSCS.' Compared to Primi-mothers, infants born to multigravida mothers had higher scores at 48 hours: 62.2% as against 31.1%. 84% were EBF at 6 weeks. 51% were EBF at 6 months. When mothers with LATCH score <8 at 48 hours were intervened, EBF rate at 6 weeks improved. Most common reason for early weaning at 6 weeks was maternal problems: 6.6% and at 6 months- due to influence of relatives: 27%.Conclusions: LATCH score helps in predicting breastfeeding duration as early as 48 hours of life. Low scores indicate, it requires intervention and identifies the areas of needed intervention. Counselling regarding EBF must include not only mothers but also relatives.
ABSTRACT
Objective: To improve the usage of expressed breast milk invery low birth weight infants admitted in the neonatal intensivecare unit of a tertiary centre in India.Methods: Between April 2015 and August 2016, various Plan-do-act-study cycles were conducted to test change ideas likeantenatal counselling including help of brochure and video, post-natal telephonic reminders within 4-6 hours of birth,standardization of Kangaroo mother care, and non-nutritivesucking protocol. Data was analyzed using statistical processcontrol charts.Results: 156 very low birth weight infants were deliveredduring the study period, of which 31 were excluded due tovarious reasons. Within 6 months of implementation, theproportion of very low birth weight infants who receivedexpressed breast milk within 48 hours improved to 100% from38.7% and this was sustained at 100% for next 8 months. Themean time of availability and volume of expressed breast milkwithin 48 hours, improved gradually from 73.3 h to 20.9 h and 4.7mL to 15.8 mL, respectively. The mean proportion of expressedbreast milk once infant reached a feed volume of 100 mL/kg/dayalso improved from 61.3% to 82.3%.Conclusion: Quality improvement interventions showedpromising results of increased expressed breast milk usage invery low birth weight infants.
ABSTRACT
Antenatal parental counselling by healthcare providers is recommended to inform parents and assist with decision-making before the birth of a child with anticipated poor prognosis. In the setting of a low-income country, like Mongolia, attitudes of healthcare providers towards resuscitation of high-risk newborns are unknown. The purpose of this study was to examine the attitudes of healthcare providers regarding ethical decisions pertaining to non-initiation and withdrawal of neonatal resuscitation in Mongolia. A questionnaire on attitudes towards decision-making for non-initiation and withdrawal of neonatal resuscitation was administered to 113 healthcare providers attending neonatal resuscitation training courses in 2009 in Ulaanbaatar, the capital and the largest city of Mongolia where ~40% of deliveries in the country occur. The questionnaire was developed in English and translated into Mongolian and included multiple choices and free-text responses. Participation was voluntary, and anonymity of the participants was strictly maintained. In total, 113 sets of questionnaire were completed by Mongolian healthcare providers, including neonatologists, paediatricians, neonatal and obstetrical nurses, and midwives, with 100% response rate. Ninety-six percent of respondents were women, with 73% of participants from Ulaanbaatar and 27% (all midwives) from the countryside. The majority (96%) of healthcare providers stated they attempt pre-delivery counselling to discuss potential poor outcomes when mothers present with preterm labour. However, most (90%) healthcare providers stated they feel uncomfortable discussing not initiating or withdrawing neonatal resuscitation for a baby born alive with little chance of survival. Religious beliefs and concerns about long-term pain for the baby were the most common reasons for not initiating neonatal resuscitation or withdrawing care for a baby born too premature or with congenital birth-defects. Most Mongolian healthcare providers provide antenatal counselling to parents regarding neonatal resuscitation. Additional research is needed to determine if the above-said difficulty with counselling stems from deficiencies in communication training and whether these same counselling-related issues exist in other countries. Future educational efforts in teaching neonatal resuscitation in Mongolia should incorporate culturally-sensitive training on antenatal counselling.