Breastfeeding among low-income women with and without peer support.

This research examined the effect of peer support on breastfeeding duration and exclusivity (breastfeeding without supplements) in a population of low-income women during the first 3 months postpartum. Participants in the peer counselor group (n = 18) exhibited higher rates of exclusive breastfeeding across time than those without a counselor (n = 18), and more exclusive breastfeeding was associated with long duration overall. Mother's career plans had the greatest effect on duration of breastfeeding. Women who intended to return to work, attend school, or both breastfed 6 to 9 weeks less than participants who intended to stay home. Attendance at a breastfeeding class and knowing someone who had breastfed was significantly correlated with a longer duration of breastfeeding. Nutritionists from the Women, Infants and Children (WIC) Program were the primary source of breastfeeding information. Two main factors discouraged women from breastfeeding: returning to work, school, or both and the perception of a diminished milk supply. Greater emphasis should be placed on prenatal breastfeeding education for low-income women, and their mothers and grandmothers should be included. Peer support is one important component of social support in the area of breastfeeding that community health nurses (CHNs) can utilize. CHNs are in a unique position to assist working mothers, provide support, and develop educational programs to enhance breastfeeding success in this population.

Home care concerns for the normal newborn.

Four of the most common problems encountered with newborns in the home include feeding difficulties, jaundice, gastrointestinal problems, and inconsolable crying. This article suggests assessment measures and intervention strategies to deal with these problems and evaluate the home environment for safety. This article also includes suggestions to promote safe infant feeding, bathing, sleeping arrangements, car safety seats, firearm and poison storage, fall prevention, concerns about pets, pest control, heating and cooling, and a nonsmoking environment.

Women's satisfaction with couplet care nursing compared to traditional postpartum care with rooming-in.

The purpose of this study was to compare patient satisfaction with two types of nursing care postpartum: traditional nursing care with rooming-in versus mother-baby (couplet) nursing care. A descriptive comparative research design was used. Questionnaire responses were obtained from 71 women who received traditional postpartum care with rooming in and 64 women who received couplet care on the same unit 6 months later. Women in both groups were satisfied with nursing care given to themselves and infants, with no difference in satisfaction between groups. The traditional model of having a nurse for the baby and different nurse for the mother can be as satisfying to women as having one nurse for the mother-baby couplet when rooming-in is encouraged and implemented.

The effects of birth chair delivery on maternal perceptions.

A prospective quasi-experimental study was conducted to determine women's perceptions of their childbirth experiences using a birth chair. The sample consisted of 55 primiparas, from 37 to 41 gestational weeks, with normal pregnancy and labor; 22 women delivered on a traditional delivery table (DT), and 33 women used a birth chair (BC). A questionnaire consisting of 21 items on a five-point scale (the higher the score, the more positive the perception) was self-administered by subjects during postpartum hospitalization. No significant differences were found between groups on overall score. However, women using the birth chair had a significantly higher score on the comfort subscale, as did women who had attended prepared childbirth classes.

A comparison of fetal outcome in birth chair and delivery table births.

This study was conducted to determine the effect of the birth chair on fetal outcome in primigravid subjects with a normal pregnancy and labor. A quasi-experimental design was used to compare 33 birth-chair deliveries with 22 delivery-table deliveries. No difference between groups was found in the mean pH and pO2 of arterial and venous cord blood samples. The mean arterial pCO2 was lower in the chair group (49.25 and 44.50, p = 0.023), but there was no difference in venous pCO2. In the chair group, the mean vein pO2 was higher when the angle of the chair was more than 45 degrees upright (22.3 and 28.4, p = 0.007). Means for chair and table groups were similar for maternal hemoglobin, breathholding while pushing, duration of second stage, time of first cry, time of cord clamping, and Apgar scores. Incidence of cord around the neck was identical. The mean one-minute Apgar scores were significantly higher when chair or table was more than 30 degrees upright (8.0 and 8.59, p = 0.037). Results suggest that the birth chair is a safe alternative to the delivery table in terms of fetal outcome. The findings of lower arterial pCO2 with unchanged pO2 and pH in the chair group, support earlier findings of less transient cord compression in upright positions.

Effect of the birth chair on duration of second stage labor and maternal outcome.

The effect of delivering in a birth chair on duration of second stage labor, perineal swelling, incidence of episiotomies, lacerations, hemorrhoids, and maternal blood loss was examined in a prospective quasi-experimental study. The sample consisted of 55 primiparous women, 37 to 41 weeks gestation, with normal pregnancy and labor; 22 delivered on a traditional delivery table (DT) and 33 in a birth chair (BC). Comparisons were made between groups for mean duration of second stage labor, mean time bearing down in the delivery room, mean maternal blood loss, frequency of instrument-assisted deliveries, frequency of episiotomies and lacerations, and frequency of perineal swelling and hemorrhoids. The two groups were statistically similar for weight of infant. No significant difference was found between groups for mean duration of second stage labor (BC M = 55 minutes, DT M = 43 minutes) or mean time bearing down (BC M = 60 minutes, DT M = 53 minutes). No difference was found in the amount of blood loss between the two groups as measured by the mean difference in the pre- and postdelivery hemoglobin (BC M change = 1.4 Gms, DT M change = 1.8 Gms). The lack of significant differences in blood loss may be due to the fact that the angle of the birth chair was lowered during or after delivery in 88% of the cases. The incidence of instrument-assisted deliveries (BC = 7, DT = 6), episiotomies (BC = 27, DT = 20), lacerations (BC = 17, DT = 5), and hemorrhoids (BC = 14, DT = 4) was similar between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

A clinical evaluation tool for nursing students based on the nursing process.

An integrated curriculum was implemented in an upper division baccalaureate nursing program which required letter grades for clinical courses. The second semester clinical course involved student evaluation in four different settings. The original evaluation tool lacked both the discrimination needed for letter grades and the competencies common to all the settings. A computerized evaluation tool was developed to identify behaviors which could be evaluated and assigned a letter grade in all four clinical settings, and to provide formative and summative evaluation of performance for students throughout the semester. The tool focuses on the four areas of the nursing process, each of which is weighted according to the conceptual framework of the curriculum and the ability of a student at this level. In each of these four areas, entry level behaviors were identified and then built upon by progression from fundamental skills to more complex and independent behaviors. Students are rated on a criterion-referenced rating scale. A statistician verified that the tool was mathematically sound. Once developed, the tool was placed on computer where both students and faculty evaluate student clinical performance every two to four weeks. Because the tool was placed on computer, students receive immediate feedback, which facilitates formative evaluations. Trends in student performance can be identified easily, and faculty paperwork is decreased. The tool also promotes objectivity in evaluation and student awareness of expected behaviors. Finally, faculty and students have become more familiar and more comfortable with computers.

Effect of the birth chair on duration of second stage labor, fetal outcome, and maternal blood loss.

The effect of delivering in a birth chair on duration of second stage labor, fetal outcome, and maternal blood loss was examined in a retrospective study. The sample consisted of 60 primiparous women, 37 to 41 weeks gestation with a normal pregnancy and labor, 30 delivering on a traditional delivery table and 30 delivering in a birth chair. Comparisons were made between groups for mean duration of second stage labor, mean Apgar scores at one and five minutes, and mean maternal hemoglobin and hematocrit values during the pre- and post-partum periods. No significant difference was found between delivery table and birth chair groups for mean duration of second stage labor (birth chair, X = 60 minutes versus delivery table, X = 43 minutes, t = 1.66, p = .10). Mean Apgar scores at one and five minutes were nearly identical. Statistically significant differences existed between groups in mean maternal hemoglobin and hematocrit values. Both the mean hemoglobin and the mean hematocrit upon admission were significantly higher in the birth chair group (p less than .027). However, postpartally the birth chair group had significantly lower mean hemoglobin and hematocrit values (p less than .025). These findings suggest that the birth chair, as an alternate delivery method, is safe in terms of fetal outcome but presents no advantage to the mother in terms of shorter second stage labor. Further investigation of maternal blood loss is recommended to rule out possible untoward effects.

Rectal or axillary temperature measurement: effect on plasma bilirubin and intestinal transit of meconium.

Physiologic jaundice (5-6 mg/100 ml plasma bilirubin) is common and considered normal in newborn infants during the first week postbirth, but is considered abnormal in older infants. Early meconium passage correlates with lower plasma bilirubin concentrations. Rectal stimulation during rectal temperature measurement may aid passage of meconium containing potentially toxic, absorbable bilirubin. In this study, 100 clinically normal infants were assigned randomly to groups for rectal or axillary temperature measurement. The time of first meconium passage, time of first all-yellow stool, and total plasma bilirubin were compared between groups. Bilirubin was measured during metabolic screening at 48-80 h postbirth (mean 69 h in both groups). By this time 30 infants in the rectal group, but only 17 in the axillary group, had passed yellow stools (p = 0.011). The rectal group had lower mean (+/- 1 SD) bilirubin (5.5 mg/100 ml +/- 2.7 vs. 6.5 +/- 3.0, p = 0.042), and a trend toward earlier first meconium (5.9 h +/- 5.0 vs. 7.3 +/- 5.9, p = 0.096). For clinically normal infants in the first 48-80 h postbirth, these data suggest that rectal stimulation accompanying rectal temperature measurement enhances intestinal bilirubin excretion because of more rapid meconium passage.