Exclusive Breastfeeding, 24-Hour Rooming-In, and the Importance of Women's Informed Choices.

OBJECTIVE: To measure the relationship between exclusive breastfeeding and 24-hour rooming-in for low-risk primiparous women with uncomplicated vaginal births at term. DESIGN: Descriptive correlational design with a qualitative component. SETTING: The Labor & Delivery and Mother/Baby units of a community hospital with more than 2,300 births annually. PARTICIPANTS: A convenience sample of 89 women. INTERVENTION/MEASUREMENTS: Participants completed a demographic questionnaire, the Iowa Infant Feeding Attitude Scale, which measures attitudes toward breastfeeding, and a four-item questionnaire at 2, 6, and 12 weeks postpartum to assess breastfeeding status. RESULTS: Iowa Infant Feeding Attitude Scale scores suggest that most of the sample had positive attitudes toward breastfeeding. The average separation time for women and newborns was 3 hours 40 minutes. No statistically significant differences were found regarding maternal attitudes toward breastfeeding or mother-newborn separation during the postpartum period between newborns who were exclusively breastfeeding or formula-feeding at 12 weeks. CONCLUSION: Success with exclusive breastfeeding in the immediate postpartum period is not necessarily dependent on 24-hour rooming in, and it is important for women to have the ability to make informed choices regarding newborn separation in the hospital.

The Joys and Frustrations of Breastfeeding and Rooming-In Among Mothers With Opioid Use Disorder: A Qualitative Study.

OBJECTIVES: To investigate perspectives of mothers with opioid use disorder regarding breastfeeding and rooming-in during the birth hospitalization and identify facilitators and barriers. METHODS: We conducted in-depth qualitative interviews with 25 mothers with opioid use disorder 1-12 weeks after delivery. Grounded theory analysis was used until thematic saturation was reached. Findings were triangulated, with experts in the field and a subset of informants themselves, to ensure data reliability. RESULTS: Among 25 infant-mother dyads, 36% of infants required pharmacologic treatment, 72% of mothers initiated breastfeeding, and 40% continued until discharge. We identified the following themes: (1) information drives maternal feeding choice; (2) the hospital environment is both a source of support and tension for mothers exerting autonomy in the care of their infants; (3) opioid withdrawal symptoms negatively impact breastfeeding; (4) internal and external stigma negatively impact mothers' self-efficacy; (5) mothers' histories of abuse and trauma affect their feeding choice and bonding; (6) mothers' recovery makes caring for their infants emotionally and logistically challenging; and (7) having an infant is a source of resilience and provides a sense of purpose for mothers on their path of recovery. CONCLUSIONS: Future interventions aimed at increasing breastfeeding and rooming-in during the birth hospitalization should focus on education regarding the benefits of breastfeeding and rooming-in, supporting mothers' autonomy in caring for their infants, minimizing stigma, and maximizing resilience.

O enfermeiro educador no puerpério imediato em alojamento conjunto na perspectiva de Peplau / The educator nurse in the immediate puerperium in joint accommodation from the Peplau's perspective

Estudo com abordagem qualitativa objetivando compreender as orientações apreendidas de puérperas em alojamento conjunto e discutir as ações do enfermeiro educador na perspectiva da Teoria de Peplau. A amostra constou de 27 mulheres enquadradas nos seguintes critérios: idade igual ou maior que 18 anos; estar no puerpério; ter ficado com o bebê em alojamento conjunto durante sua estadia na maternidade. A coleta de dados decorreu de junho a julho de 2014. Após análise das entrevistas emergiram três categorias e suas subcategorias: orientações fornecidas pelo enfermeiro acerca dos cuidados com o recém-nascido; orientações relativas aos cuidados com as puérperas; memória das puérperas acerca das orientações recebidas. A evidência dos resultados demonstrou que a escuta foi instrumento identificado como ação terapêutica mais empregada pelas enfermeiras e os papéis desenvolvidos exercidos de acordo com as necessidades das puérperas, atendendo à dinâmica do relacionamento interpessoal tornando-as mais autônomas e satisfeitas nos seus cuidados.

A study with a qualitative approach aimed to comprehend the learned orientations of puerperium women in joint accommodation and to discuss the actions of the educator nurse from the perspective of Peplau's Theory. Twenty- seven women composed the sample according to the following criteria: to be 18 years or older; to be in puerperium; to have stayed with the baby in a joint accommodation during her stay in the maternity. The data collection occurred from June to July 2014. After analyzing the interviews, three categories emerged and its subcategories: orientations provided by the nurse about newborn care; orientations related to puerperal women care; the memory of puerperal women about received orientations. Results evidence demonstrated listening being the instrument identified as the most used therapeutic action by nurses and the roles developed by the puerperal women needs, attending to the dynamic of the interpersonal relationship, making them more autonomous and satisfied in their care.

[Women and post-natal care: analysis of a rooming-in facility.] / La donna nel post-parto: uno studio sulla pratica del rooming-in.

INTRODUCTION: The practice of rooming-in (R-in) is widely but heterogeneously applied in Italian hospitals and consists in keeping babies in the same room with their mothers from the moment of birth through to the discharge. AIM: Explore the perception and use of R-in among Italian mothers who gave birth in a context where R-in is offered 24h. We aimed at comparing differences among women who consistently use the R-in practice to those who do not. METHOD: Sixty-five women in good health (average age=33.8 years old; sd=4.2) were assigned to two different groups: mothers who always kept their baby in the room (n=35) and mothers who referred their babies more than once to the nursery care (n=30). Women completed a questionnaire about their pregnancy, delivery, hospitalization, and R-in. Medical records were also collected. The two groups were compared with regard to medical/obstetrician/socio-demographic factors, as well as their perception of R-in. RESULTS: We observed no differences in terms of maternal age, education, and parity among the two groups. Women who had undergone Caesarean section were more likely to make use of the nursery care up to 72 hours after delivery (χ2=11,11, p<,001). A considerable proportion of the study population (42%) considered the level of information received about R-in unsatisfying; this percentage is higher (55%) among women who referred to the nursery. DISCUSSION: Women differ in the degree of R-in application use depending on the type of delivery and the subsequent maternal physical condition. It is important to support women by offering them a flexible service that accounts for their possible physical difficulties. Besides, it is crucial to provide an adequate level of information about R-in, so that mothers can feel in control of the situation, especially if they underwent Caesarean section.

Prolonged rooming-in in infancy is associated with generalized anxiety disorder in the adolescent period.

OBJECTIVE: This study aims to investigate whether anxiety disorders in adolescents have a link with the separation time of bed/bedroom sharing with parents. It also aims to raise awareness in society about the issue of minimizing anxiety disorders in childhood. METHODS: A case-control study was conducted in Sevket Yilmaz Training and Research Hospital between June 2013 and May 2014. The participants included 51 adolescents who were diagnosed as generalized anxiety disorder (GAD) with no-comorbidity and 71 healthy adolescents as the control group, who were chosen randomly. Diagnosis of GAD was based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed) by child and adolescent psychiatry doctors. The Turkish version of the State-Trait Anxiety Inventory (STAI) was used for the control group. A special survey about demographics and bed-sharing statements was constructed for the purpose of the study. The groups were analyzed in terms of duration of co-sleeping (bed-sharing) and rooming-in (keeping the mother and the baby in same room) with parents during infancy and the development of anxiety disorders in later period. RESULTS: Mean duration of rooming-in was significantly longer in the case group than in the control group (p=0.009). Similarly, mean duration of co-sleeping in the case group was longer than that of the control group. However, this difference was not statistically significant (p=0.529). CONCLUSION: Sleeping in the same room with children for a long time may result in anxiety disorders in later period due to possible difficulties in bonding and/or less self-confidence.

Alojamento conjunto em um hospital universitário: depressão pós-parto na perspectiva do enfermeiro / Accommodation set in a university hospital: postpartum depression in nurses’ perspective / Alojamiento conjunto en un hospital universitario: depresión pós-parto en la perspectiva del enfermero

Objective: knowing the nurses' understanding from the accommodation-set about postpartum depression; and identify the perception of these nurses related to importance of guidelines for postpartum depression to puerperal women. Method: this is a descriptive, exploratory research, of qualitative approach, with five (5) nurses from the accommodation-set of a Hospital in Niterói/RJ, in the year 2011. The data were collected by semi-structured interviews and treated in accordance with the precepts of the content analysis, complying with the thematic analysis technique, after approval of the research project by the Research Ethics Committee of the Faculty of Medicine/HUAP/UFF, CAAE n. 0215.0.258.000-11, through favorable protocol no. 206/11. Results: the nurses find it difficult to provide a specific assistance and qualified to postpartum women because of lack of knowledge about this disorder. Conclusion: those nurses must have knowledge about postpartum depression to facilitate the approach and the care to postpartum women and family.

Objetivo: conhecer o entendimento dos enfermeiros do alojamento conjunto sobre depressão pós-parto; e identificar a percepção desses enfermeiros relativa à importância das orientações sobre depressão pós-parto às puérperas. Método: trata-se de uma pesquisa descritiva, exploratória, de natureza qualitativa, com cinco (5) enfermeiros do alojamento conjunto de um Hospital da cidade de Niterói/RJ, no ano de 2011. Os dados foram coletados por entrevistas semiestruturadas e tratados de acordo com os preceitos da análise de conteúdo, obedecendo à técnica de análise temática, após aprovação do projeto de pesquisa pelo Comitê de Ética em Pesquisa da Faculdade de Medicina/HUAP/UFF, CAAE n. 0215.0.258.000-11, mediante parecer favorável n° 206/11. Resultados: os enfermeiros encontram dificuldades em prestar uma assistência especifica e qualificada à puérpera por falta de conhecimentos sobre esse transtorno. Conclusão: o enfermeiro precisa ter o conhecimento sobre a depressão pós-parto para facilitar a abordagem e os cuidados à puérpera e a família.

Objetivo: conocer el entendimiento de los enfermeros del alojamiento conjunto en respecto a la depresión pos-parto; e identificar la percepción de estos enfermeros sobre la importancia de las orientaciones sobre depresión pos-parto a las puérperas. Método: se trata de una investigación descriptiva y exploratoria, de carácter cualitativo, con 5 enfermeros del Alojamiento Conjunto de un Hospital de la ciudad de Niterói/RJ, en el ano de 2011. Los datos fueron obtenidos a través de encuestas semi-estructuradas y fueron tratados de acuerdo con los preceptos de análisis de contenido, obedeciendo a la técnica de análisis temático, después de la aprobación del proyecto de investigación por el Comité de Ética en Investigación de la Facultad de Medicina/HUAP/UFF, CAAE n. 0215.0.258.000-11, por medio del parecer favorable nº 206/11. Resultados: los enfermeros encuentran dificultades en prestar una asistencia específica y calificada a la puérpera por falta de conocimientos sobre estos trastornos. Conclusión: el enfermero necesita tener el conocimiento sobre la depresión pos-parto para facilitar el abordaje y los cuidados a la puérpera y a la familia.

A comparison of parent satisfaction in an open-bay and single-family room neonatal intensive care unit.

OBJECTIVE: The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU). METHODS: This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities. RESULTS: Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility. CONCLUSIONS: Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.

Cultural differences in child delivery: comparisons between Jewish and Arab women in Israel.

OBJECTIVE: To compare Jewish and Arab women characteristics regarding pregnancy follow-up, compliance to a health regime and behavioural expressions during labour, delivery and the post-partum period. DESIGN: The participants answered a 45-item questionnaire designed for the current research. SETTING: The first three post-partum days in the delivery ward at one of the biggest hospitals in Israel. PARTICIPANTS: A total of 126 Jewish and Arab-Muslim parturients. RESULTS: Significant differences were found (P < 0.01) concerning pregnancy follow-up attendance and participation in a prenatal course, which were lower among Arab women. Several differences were found regarding delivery room attendance, type and number of companions, and behavioural expressions of pain, which were demonstrated more among Arab women. Epidural anaesthesia was highly prevalent among Jewish women, in comparison with the Arab women. While all Arab women decided to breastfeed their babies, only 71% of Jewish women expressed a wish to breastfeed. No significant differences were found between weight gains during pregnancy, reasons for delivery room attendance, number of pregnancy weeks prior to delivery and newborn weight. CONCLUSIONS: Cultural differences exist between Jewish and Arab women attending delivery rooms in Israel. Understanding these cultural differences may assist caregivers in providing culturally sensitive treatment that is suited to the parturients' needs.

Parent bed spaces in the PICU: effect on parental stress.

The purpose of this comparative descriptive study was to identify the impact of providing a parent bed space in the PICU, allowing for continual parental presence, on stress of the parents of critically ill children. Data were collected from parents (n = 86) at two children's hospitals 3 months prior to the opening of new PICUs with parent bed spaces. Following a transition period, data were collected from a sample of parents (n = 92) who had used the parent bed to stay overnight with their child. Parental stress was measured with the Parental Stressor Scale: Pediatric Intensive Care (PSS: PICU). Stress scores were significantly lower (p = .02) for parents who utilized the parent beds in the new PICUs. New PICU environments that facilitate continual parental presence may reduce parental stress related to a child's hospitalization.

Serum cholesterol concentration and distress in the initial days after childbirth.

The link between mood disorders and cholesterol is characterized by some contradictory data. In particular, it is not clear whether health factors are responsible for lowered cholesterol levels and mood swings. The present study tests the association between serum cholesterol level and psychological distress in women in two different post-delivery hospital settings: rooming-in (RI) and no rooming-in (no-RI). On day 3 after childbirth, 147 RI and 209 no-RI women completed the Kellner Symptom Questionnaire (SQ), which evaluates anxiety, depression, somatic symptoms and hostility. Plasma cholesterol concentration was measured on the same day. There was a significant negative correlation between cholesterol and depressive symptoms in no-RI women, but not in the RI group. However, this correlation is characterized by an extremely small effect size (-0.15). The findings of this study cast further doubt on the hypothesis of a possible association between cholesterol and depression in the general population and in mothers who have just given birth.

Reconceptualizing the nurse's role in the newborn period as an "attacher".

In the first few days and weeks after a child's birth, attachment is a major task for the mother and her newborn. Success in this long-term psychological process is associated with positive life-long outcomes for both the parenting mother and her child. This article proposes a relational approach to newborn nursing grounded in the principles of attachment theory. Understanding this "attacher" approach can benefit nurses by bringing a gratifying depth to their practice and can benefit families by helping mothers and newborns address the most compelling task before them.

[The lived experience of postpartum women receiving rooming-in care].

A phenomenological study was conducted to explore the lived experience of postpartum women receiving rooming-in care. Subjects (n = 21) were recruited from a medical center in Taichung. Data were collected by a demographic questionnaire, open-ended interview guide and a tape recorder. Content analysis by Giorgi's method was used, and identified four themes. Because of early contact women who receive rooming-in care in postpartum can perceive the happiness and suffering of nursing their baby, promote the success of breastfeeding, and increase family cohesion, but in this process women also have some needs and concerns. The results of this study can enable professional staff to understand the lived experience of postpartum woman receiving rooming-in care, so that nurses can provide care that meets their needs and enhance their willingness to participate. In this way, rooming-in care can be extended into family-centered maternity care and create baby-friendly hospitals.

El contacto precoz madre-hijo en el posparto: satisfacción materna y vínculo afectivo / Early mother-infant contact during the postpartum period: maternal satisfaction and bonding

Objetivo: conocer la satisfacción materna, el establecimiento del vínculo afectivo, las actitudes de adaptación de los recién nacidos (RN) y la prevalencia de la lactancia materna durante el primer mes del posparto en madres que han tenido un contacto precoz piel-piel con su hijo en la sala de partos. Material y métodos: estudio observacional, descriptivo y retrospectivo. Se entrevistó a 45 madres multíparas con partos normales y recién nacidos a término y sanos, que en este último parto tuvieron la oportunidad de experimentar en el posparto inmediato el contacto precoz con sus bebés, piel-piel, hasta un máximo de 2 horas. Resultados: más de la mitad de las madres (25, 56 por ciento) tuvieron contacto con su hijo piel-piel entre 1 y 2 horas. En este tiempo, un 77,8 por ciento manifestó experimentar de forma predominante sentimientos positivos, acompañados de conductas de interacción. En cuanto a los recién nacidos, un 88,9 por ciento presentó respuestas de "aproximación" y un 71,1 por ciento conductas de agarre y succión. AI término del primer mes, la lactancia materna exclusiva alcanzó el 77,8 por ciento. Conclusiones: recomendamos la implantación del contacto piel-piel posparto de forma precoz y prolongada. Se observó que un mayor tiempo de contacto aumenta la satisfacción de la madre, su sensación subjetiva de comunicación y vinculación con el recién nacido y la adaptación de éste al medio extrauterino. Del mismo modo, favorece el inicio de la succión del bebé, aunque no resulta determinante para el mantenimiento de la lactancia en este grupo de mujeres multíparas (AU)

[Perspectives of puerperal women regarding rooming-in: from abandonment to acceptance]. / Representações de puérperas sobre o sistema alojamento conjunto: do abandono ao acolhimento.

UNLABELLED: The Objective of this study was understand the mothers' social representation concerning the rooming-in. POPULATION: 23 mothers assisted in the University Hospital of São Paulo University. Data analysis was obtained by individual and group interviews, based on the Social Representation. RESULTS: showed the feeling of fear, submission to the institutional rules and health team's routines, a mix of accommodation and resistance to the impersonal way these women were been treated. It also indicates, as the availability of some professionals to interact with these women effectively, acts as an element of re-significance of the women's representations of the abandonment and indifference related to the care given to them.

Representações de puérperas sobre o sistema alojamento conjunto: do abandono ao acolhimento / Representación de las puérperas acerca del alojamiento conjunto: del abandono al acogimiento / Mothers' representation concerning the rooming-in: from the abandonment to the acceptance

O objetivo desse estudo foi compreender a representação social das puérperas acerca do Alojamento Conjunto (AC). Participaram 23 puérperas internadas no AC do HU-USP. A análise dos dados, obtidos por entrevistas individuais e grupos focais, baseou-se nas Representação Sociais. Uma das representações sobre sua internação mostra sentimento de medo, submissão às rotinas institucionais e equipe de saúde, um misto de acomodação e resistência a maneira impessoal como são tratadas. A Hospitalização: do abandono ao acolhimento, indica como a disponibilidade de interagir dos profissionais atua como elemento de re-significação das representações de abandono e indiferença sobre o atendimento à mulher.

The Objective of this study was understand the mothers' social representation concerning the rooming-in. Population: 23 mothers assisted in the University Hospital of São Paulo University. Data analysis was obtained by individual and group interviews, based on the Social Representation. Results: showed the feeling of fear, submission to the institutional rules and health team's routines, a mix of accommodation and resistance to the impersonal way these women were been treated. It also indicates, as the availability of some professionals to interact with these women effectively, acts as an element of re-significance of the women's representations of the abandonment and indifference related to the care given to them.

El objetivo de este estudio fue el de comprender la representación social de las puérperas acerca del Alojamiento Conjunto (AC). Participaron 23 puérperas internadas en el AC del Hospital Universitario de la USP. El análisis de los datos, obtenidos por entrevistas individuales y grupos focales, fue realizada en base a los presupuestos de las Representaciones Sociales. Una de las representaciones de las mujeres sobre su internación hospitalar muestra el sentimiento de miedo, sumisión a las rutinas institucionales y al equipo de salud, una combinación entre acomodo y resistencia de manera muchas veces impersonal de la como son tratadas. La Hospitalización: del abandono al acogimiento, indica también, como la disponibilidad de algunos profesionales, en interactuar efectivamente con esas mujeres, actúa como elemento de re-significación de las representaciones de abandono e indiferencia que éstas cargam consigo, sobre la atención a la mujer.

[Evaluation of the rooming-in system at the D. Francisca Cintra Silva Maternity Department, Santa Casa Hospital at the Sao Carlos municipality]. / Avaliação do sistema de alojamento conjunto na maternidade D. Francisca Cintra Silva da Santa Casa de São Carlos-SP.

The rooming-in was implemented at a maternity at the municipality of São Carlos in 1997. This study analyzes the acceptance of the system by mothers and how nursing participates in this work. Results showed that mothers are satisfied. However, the nursing team does not agree with this evaluation, confirming the need of increasing the number of workers as well as qualifying them.