A breast milk production model for achieving exclusive breastfeeding in low-risk primiparas who had vaginal births at 4 months postpartum: A prospective cohort study.

BACKGROUND: This study aimed to investigate the thresholds of milk production for predicting the achievement of exclusive breastfeeding (EBF) at 4 months postpartum. METHODS: The inclusion criteria were singleton, low-risk primiparas, non-cesarean section, and healthy mothers and infants. Temporary feeding of artificial milk in the past was included. Women who could be judged to have intentionally used artificial milk were excluded from the analysis. Measurements of the 24-h milk production by test weights were obtained at early postpartum (days 3-4) and at 1 month postpartum. To predict the achievement of EBF at 4 months postpartum, the area under the receiver operating characteristic (ROC) curve was calculated for early postpartum and 1 month milk production. RESULTS: There were 80 eligible participants analyzed. ROC analysis of milk production for achieving EBF at 4 months revealed an area under the curve (AUC) of 0.736 (95% CI: [0.625, 0.848]) for early postpartum and an AUC of 0.854 (95% CI: [0.772, 0.936]) for 1 month postpartum. The proposed thresholds are 102 g/day (higher sensitivity) and 161 g/day (higher specificity) at early postpartum, and 527 g/day (higher sensitivity) at 1 month postpartum. CONCLUSIONS: In low-risk primiparas, the milk production models at early postpartum and 1 month postpartum showed a high accuracy for predicting the achievement of EBF at 4 months postpartum. The present study indicates that even when formula milk is temporarily used, it is still possible to reach the goal of achieving EBF.

Development and evaluation of a decision-making aid for couples hesitant about transitioning from infertility treatment to advanced assisted reproductive technology: a usability and feasibility study.

OBJECTIVES: The aims of this study were (1) to develop a decision-making aid for couples hesitant about transitioning from infertility treatment to advanced assisted reproductive technology, (2) to examine the adequacy of this aid, and (3) to evaluate its usability. After the first version of the decision-making aid was created, the first version was supervised and finally a prototype of the decision-making aid was completed. We conducted a feasibility study from February to March 2022. We used a quantitative cross-sectional descriptive design involving 22 medical professionals and infertility survivors recruited. RESULTS: Twenty-two participants (3 reproductive medical specialists, 11 nurses who specialize in reproductive medicine, and 8 infertility survivors) were included in the final analysis (91.7% valid response rate). Of these participants, 81.8% answered Agree regarding "Easy-to-read degree of charts", 17 (77.3%) answered It is just the right amount regarding "Appropriateness of information volume", 81.8% answered Agree regarding "Ease of understanding content", and 90.9% answered Good regarding "Overall performance". From the opinions received, we extracted 4 categories: "Useful for decision making," "Suitable for providing information," "Useful in clinical practice," and "Needs improvement." Certain degrees of surface validity and content validity were confirmed for the trial version of the decision-making aid.

A longitudinal study of the association of epidural anesthesia and low-dose synthetic oxytocin regimens with breast milk supply and breastfeeding rates.

Breastfeeding is known to improve maternal and child health. However, epidural anesthesia (EDA) and synthetic oxytocin (synOT) are suggested to have negative effects on breastfeeding. In this study, we aimed to determine the effects of intrapartum synOT and EDA on breast milk supply, breastfeeding rates, and maternal salivary oxytocin levels. Women were recruited during pregnancy or after birth at a single hospital. Data were collected at 3 days postpartum (T1), 1 month postpartum (T2), and 4 months postpartum (T3) on 83 low-risk primiparous women who planned to breastfeed for at least 12 weeks postpartum to avoid dropouts from early discontinuance of breastfeeding. Women with cesarean section, twin pregnancy, premature neonates, and an Apgar score of < 7 at 5 min were excluded. Participants recorded their 24-h milk supply by test weights at 3 days and 1 month postpartum. Additionally, they filled out questionnaires assessing their breastfeeding level and lactogenesis stage II initiation. Salivary oxytocin levels were obtained at 3 days postpartum. Women who delivered using EDA had lower salivary oxytocin levels (P = .055, d = .442), breast milk supply in early postpartum (P = .025, d = .520) and at 1 month postpartum (P = .036, d = .483), and breastfeeding rates at 4 months postpartum (P = .037, V = .236) than women who did not deliver using EDA. There was no association between breastfeeding and the use of intrapartum synOT. In conclusion, this study showed that women who delivered using EDA had lower breast milk supply in the early postpartum period and breastfeeding rates at 4 months postpartum. It also revealed that using synOT at low doses during labor did not affect breastfeeding. Thus, women who deliver using EDA need support for increased breast milk supply in the early postpartum period.Trial registration: UMIN000037783 (Clinical Trials Registry of University Hospital Information Network).

Changes in Salivary Oxytocin Level of Term Pregnant Women after Aromatherapy Footbath for Spontaneous Labor Onset: A Non-Randomized Experimental Study.

BACKGROUND: Aromatherapy is usually used to stimulate labor. However, its specific physiological effects have been scarcely examined. We evaluated whether an aromatherapy footbath increases oxytocin levels in term pregnant women. METHODS: In this quasi-experimental study, low-risk term pregnant women in Japan underwent aromatherapy using a footbath (1) infused with clary sage and lavender essential oils, (2) infused with jasmine oil, or (3) with no infused oils (control group). The primary outcome was the salivary oxytocin level. The secondary outcomes were uterine contractions and cortisol levels. RESULTS: In the clary sage and lavender group (n = 28), the oxytocin level increased significantly after the footbath (p = 0.035). The jasmine group (n = 27) and control group (n = 27) exhibited trends toward a respective increase and decrease in the oxytocin level; however, the changes in the oxytocin levels between the clary sage and lavender group and the control group showed no significance difference. There were no significant differences in the changes in the uterine contractions and cortisol levels between the experiment and control groups. CONCLUSIONS: The changes in the oxytocin levels in the clary sage and lavender group did not differ significantly with those in the control group, possibly because of the small sample size. Further studies are required to examine the effects of repeated aromatherapy footbaths to stimulate labor.

A comparison of team-based learning and lecture-based learning on clinical reasoning and classroom engagement: a cluster randomized controlled trial.

BACKGROUND: The lecture-based learning (LBL) implemented in most Indonesian nursing/midwifery schools underlies the students' lack of ability in clinical reasoning. Team-based learning (TBL) was proposed to improve the students' ability in clinical reasoning as it is applying a course concept of real complex scenarios. In this study, we aimed to assess and compare the effects of TBL and LBL of postpartum hemorrhage topics on the clinical reasoning and classroom engagement of midwifery students in Indonesia. METHODS: We conducted a cluster randomized controlled trial to compare the effects of TBL and LBL. The unit was schools and random allocation was conducted using a simple random sampling method (i.e., coin flipping). There was 1 cluster in the intervention group (n = 62 students) and 1 cluster in the control group (n = 53 students). The students in the intervention group participated in a TBL class (90 min) three times, whereas the students in the control group attended an LBL class on postpartum hemorrhage topics. The primary outcome was the clinical reasoning on postpartum hemorrhage score measured at pre-test, post-test, and 2 weeks post-test. The secondary outcome was Classroom Engagement Survey (CES) score measured after each class finished. We used an unpaired t-test to evaluate the differences between the two groups. The baseline characteristics of the participants were compared using standardized difference. RESULTS: We evaluated a total of 115 participants. Regarding the baseline characteristics, there was a small difference in the age, Grade Point Average and knowledge at pre-test between the intervention and control groups. The mean clinical reasoning on postpartum hemorrhage scores were significantly higher in the TBL students than in the LBL students at post-test (p < .001; Cohen's d = 1.41) and 2 weeks post-test (p < .001; Cohen's d = 1.50). The CES showed a significantly higher in the intervention group than in the control group. CONCLUSIONS: TBL is an effective learning method for enhancing the clinical reasoning ability of students. This learning method allows for more independent and active learning. Having a strong background knowledge, and discussing cases comprehensively with peers can sharpen the clinical reasoning ability of students.

Effectiveness of team-based learning on postpartum hemorrhage in midwifery students in Indonesia: A quasi-experimental study.

BACKGROUND: Poor quality of care by midwives in Indonesia has become a barrier to improving maternal health. To eliminate this barrier, reforming the educational system (i.e., teaching and learning processes) is an urgent concern. Herein, we propose the use of team-based learning (TBL) as an active learning strategy to enhance knowledge of postpartum hemorrhage (PPH) and learning satisfaction of midwifery students in Indonesia. OBJECTIVES: To assess and compare knowledge of PPH, long-term retention of knowledge, and learning satisfaction of midwifery students attending a TBL class versus a didactic lecture on PPH topics. METHODS: A quasi-experimental design was used. The participants were second-year diploma level midwifery students who have (a) no TBL experience, (b) completed the previous semester, and (c) graduated from senior high school (without nursing background). We recruited 118 participants. The midwifery students in the intervention group participated 3 times in the TBL class (90 min), whereas those in the control group participated in the didactic lecture on PPH topics. An unpaired t-test was used to evaluate differences between groups. ANOVA was used to evaluate differences within groups. RESULTS: A total of 115 participants (intervention = 62, control = 53) were finally evaluated. The demographic data and pre-test scores were not significantly different between the 2 groups. The mean knowledge of PPH scores were significantly higher in the TBL students than in the control students at post-test, 2 weeks post-test, 6 weeks post-test, and 12 weeks post-test (all p < .001). The nursing student satisfaction scale score was significantly higher in the intervention group than in the control group. CONCLUSION: The findings showed that TBL is an effective active learning strategy to improve knowledge of PPH of Indonesian midwifery students before clinical practice exposure. Further long-term evaluation (e.g., 1 semester) of the effectiveness of TBL is warranted.

Changes in the cortisol and oxytocin levels of first-time pregnant women during interaction with an infant: a randomized controlled trial.

BACKGROUND: During pregnancy, physiological, psychological, and social changes affect pregnant women's childcare anxiety and childrearing behavior. However, there are scarce reports on hormonal evaluation related to such anxiety and behavior. Herein, we evaluated changes in salivary cortisol (primary outcome) and oxytocin (secondary outcome) levels of first-time pregnant women when interacting with an infant and discussed the relation of these changes to the women's stress level. METHODS: This was a two-arm randomized controlled trial. Participants were randomly assigned using a web-based randomization system. The experimental group involved interaction with an infant for 30 min. The control group involved watching a DVD movie of an infant for 30 min. Saliva samples were collected at preintervention and postintervention. Saliva samples were assayed, and all data were compared between and within the groups using independent t-test and paired t-test with a two-sided 5% significance level. This study was approved by the Research Ethics Committee of St. Luke's International University. RESULTS: A total of 102 women were randomly assigned to the experimental (n = 51) and control (n = 51) groups. Finally, 38 women in the experimental group and 42 women in the control group were analyzed. The salivary cortisol level significantly decreased after the interventions in both groups (t = 4.57, p = 0.00; t = 5.01, p = 0.00). However, there were no significant differences in the salivary cortisol (t = 0.349, p = 0.73) and oxytocin (t = - 1.945, p = 0.58) levels between the two groups. CONCLUSIONS: The salivary cortisol level of first-time pregnant women significantly decreased in the experimental and control groups postintervention, although no significant difference was found between the two groups. Such decrease indicates stress reduction and release among these women. The absence of a significant increase in salivary oxytocin level in both groups may be related to the limitations of an insufficient number of samples that could be analyzed owing to the small saliva volume in some samples and the lack of adequate tactile stimulation of the intervention protocol. These results and procedural limitations provide useful insights into approaching subsequent studies aiming at continuously optimizing detection procedures. TRIAL REGISTRATION: UMIN000028471 (Clinical Trials Registry of University Hospital Information Network. July 31, 2017- Retrospectively registered.

Effects of team-based learning about postpartum haemorrhage on learning outcomes and experience of midwifery students in Indonesia: A pilot study.

Aim: This pilot study aimed to evaluate the effects of team-based learning about postpartum haemorrhage on the learning outcomes and experience of midwifery students in Indonesia. Design: One-group pre-test-post-test study. Methods: This study enrolled 64 midwifery students as participants from an Indonesian health polytechnic school. This group attended two team-based learning class sessions (90 min weekly for 2 weeks) on postpartum haemorrhage. Student learning outcomes and experience were assessed quantitatively. Results: The mean knowledge score (0-100) was significantly higher at post-test (mean = 85.9, SD 9.8) than at pre-test (mean = 61.4, SD 12.9) (p < .001). There was a significant difference in the mean clinical reasoning score (12-60) between post-test (mean = 35.4, SD 5.8) and pre-test (mean = 21.3, SD 7.9) (p < .001). Most students (98.4%) engaged in classroom activities.

Oxytocin levels in low-risk primiparas following breast stimulation for spontaneous onset of labor: a quasi-experimental study.

BACKGROUND: Breast stimulation is performed to self-induce labor. However, there are apparently no reports on hormonal evaluation during stimulation for consecutive days in relation to induction effect. We evaluated the salivary oxytocin level following 3 consecutive days of own breast stimulation for 1 h each day compared with no breast stimulation. METHODS: We used a quasi-experimental design. The participants were low-risk primiparas between 38 and 39 gestational weeks. Eight saliva samples per participant were collected at preintervention and 30, 60, and 75 min postintervention on the first and third days. The primary outcome was change in the salivary oxytocin level on the third day after 3 consecutive days of breast stimulation for 1 h each day compared with no breast stimulation. The secondary outcomes were the rate of spontaneous labor onset and negative events including uterine hyperstimulation and abnormal fetal heart rate. RESULTS: Between February and September 2016, 42 women were enrolled into the intervention group (n = 22) or control group (n = 20). As there were differences in the basal oxytocin levels between the 2 groups, to estimate the change in the oxytocin level from baseline, we used a linear mixed model with a first-order autoregressive (AR1) covariance structure. The dependent variable was change in the oxytocin level from baseline. The independent variables were gestational weeks on the first day of intervention, age, education, rs53576 and rs2254298, group, time point, and interaction of group and time. After Bonferroni correction, the estimated change in the mean oxytocin level at 30 min on the third day was significantly higher in the intervention group (M = 20.2 pg/mL, SE = 26.2) than in the control group (M = - 44.4 pg/mL, SE = 27.3; p = 0.018). There was no significant difference in the rate of spontaneous labor onset. Although there were no adverse events during delivery, uterine tachysystole occurred in 1 case during the intervention. CONCLUSIONS: The estimated change in the mean oxytocin level was significantly higher 30 min after breast stimulation on the third day. Thus, consecutive breast stimulation increased the salivary oxytocin level. Repeated stimulations likely increase the oxytocin level. TRIAL REGISTRATION: UMIN000020797 (University Hospital Medical Information Network; Prospective trial registered: January 29, 2016).

Changes in salivary oxytocin levels and bonding disorder in women from late pregnancy to early postpartum: A pilot study.

OBJECTIVES: This pilot study aimed to 1) follow the longitudinal changes in the salivary oxytocin level of pregnant women from late pregnancy to early postpartum, 2) examine the factors related to these changes, and 3) clarify the association of these changes with mother-infant bonding. METHODS: This study used a longitudinal observational design and questionnaires to obtain objective and subjective data. For oxytocin evaluation, saliva samples were collected and their oxytocin levels were measured at 4-time points [i.e., 1) 36-37 gestation weeks, 2) 38-39 gestation weeks, 3) 1-2 days postpartum, 4) 4-5 days postpartum]. The oxytocin level was assayed in duplicates by enzyme-linked immunosorbent assay. Baseline data were evaluated using the Parental Bonding Instrument (25 items), State Trait Anxiety Inventory (20 items), and Center for Epidemiologic Studies Depression Scale. Postpartum data were evaluated using the Mother to Infant Bonding Scale Japanese Version (10 items), Maternity Blues Scale (13 items), and 'Fatigue after Childbirth' using the Visual Analogue Scale (VAS: 0-100 mm). RESULTS: The participants were 13 primiparas with a mean age of 33 years. They had no depression or anxiety at the baseline. Their mean salivary oxytocin levels significantly increased from late pregnancy (36-39 gestation weeks) up to 1 day postpartum and then decreased until 5 days postpartum. There was a negligible correlation between the bonding disorder and the salivary oxytocin level on the 5th day after childbirth. A moderate correlation was observed between the maternity blues score and the salivary oxytocin level. There was a significant negative correlation between the postpartum fatigue and the salivary oxytocin level 1 day and 5 days after childbirth. CONCLUSION: The mean salivary oxytocin levels significantly increased from the baseline up to 1 day postpartum and then decreased until 5 days postpartum. The salivary oxytocin level was moderately associated with maternity blues and significantly with postpartum fatigue.

Effects of breast stimulation for spontaneous onset of labor on salivary oxytocin levels in low-risk pregnant women: A feasibility study.

OBJECTIVES: This preliminary study aimed to 1) determine changes in the salivary oxytocin (OT) level during breast stimulation for promoting the spontaneous onset of labor in low-risk term pregnancies, and 2) clarify the feasibility of the breast stimulation intervention protocol in terms of practicality and acceptability. METHODS: We used a single arm trial design. Sixteen low-risk pregnant women between 38 and 40 weeks of gestation with cephalic presentation participated. They performed breast stimulation for 3 days with an attendant midwife in a single maternity hospital. Each breast was stimulated for 15 minutes for a total of 1 hour per day. Saliva was collected 10 minutes before the intervention and 15, 30, 60, 75, and 90 minutes after the intervention, yielding 18 samples per woman. RESULTS: Among a total of 282 saliva samples from the 16 participants, OT level was measured in 142 samples (missing rate: 49.6%). The median OT level showed the highest values on day 3 of the breast stimulation, with a marked increase 30 min after the intervention. In the mixed models after multiple imputation for missing data, the OT level on the first day of intervention was significantly lower than that on the third day of intervention. Fatigue from breast stimulation decreased on subsequent days, and most of the women (75%) felt no discomfort with the protocol. Uterine hyperstimulation was not observed. CONCLUSION: Following a 3-day breast stimulation protocol for spontaneous onset of labor, the mean OT level showed the highest values on day 3. The breast stimulation intervention protocol showed good feasibility in terms of practicality and acceptability among the pregnant women. Additional large-scale studies are warranted to confirm the protocol's effectiveness.

Changes in salivary oxytocin after inhalation of clary sage essential oil scent in term-pregnant women: a feasibility pilot study.

OBJECTIVES: This pilot study using a quasi-experimental design was conducted to evaluate the feasibility (i.e., limited efficacy, practicality, and acceptability) of our intervention protocol involving inhalation of the scent of clary sage essential oil by pregnant women and measurement of their preinhalation and postinhalation oxytocin levels. RESULTS: Participants were women of singleton pregnancies between 38 and 40 gestation weeks (N = 11). The experiment group (n = 5) inhaled the scent of clary sage essential oil diluted 50-fold with 10 mL of odorless propylene glycol for 20 min. Regarding limited efficacy, the oxytocin level 15 min postinhalation increased in 3 women and was unmeasurable in 2. The control group (n = 6) inhaled similarly without the 50-fold dilution of clary sage essential oil. Their oxytocin level increased in 2 women, decreased in 2, and was unmeasurable in 2. Uterine contraction was not observed in both groups. Regarding practicality, 3 of the 11 women could not collect sufficient saliva. The cortisol level decreased in both groups postinhalation. The protocol had no negative effects. Regarding acceptability, burden of the protocol was not observed. Trial registration The Clinical Trials Registry of University Hospital Medical Information Network in Japan-UMIN000017830. Registered:  June 8, 2015.

Changes in Streptococcus pneumoniae serotypes in the nasopharynx of Japanese children after inoculation with a heptavalent pneumococcal conjugate vaccine.

In this study, we prospectively investigated changes in Streptococcus pneumoniae serotypes among Japanese children after heptavalent pneumococcal conjugate vaccine (PCV7) inoculation. We acquired nasopharyngeal swabs from the children at each routine PCV7 inoculation and again at least 2 months after the last PCV7 inoculation. We defined 2 periods with regard to each culture: the inoculation period as "the period of pre- or incomplete vaccination" and post-inoculation as "the period of post- or completed vaccination." The prevalence of vaccine-type (VT) pneumococci was significantly reduced from 9.5% in the inoculation-period cultures to 2.9% in the post-inoculation cultures (P < 0.01). There was no statistical difference in the prevalence of non-vaccine-type pneumococci between the inoculation-period and post-inoculation cultures (24.1% versus 23.4%). The protection of PCV7 against nasopharyngeal colonization was inferred from the decrease in VT carriage post-inoculation. The decrease in VT carriage may be conducive to reducing VT transmission within the study area.