Journey toward Baby-Friendly Hospital Initiative designation: Healthcare professional's view on successful implementation process and maintenance of accreditation.

PROBLEM: The Baby-Friendly Hospital Initiative has yet to achieve widespread global implementation. BACKGROUND: The implementation of the Baby-Friendly Hospital Initiative has been recognised as complex. The challenge has been to maintain accreditation. AIM: To explore and gain a deeper understanding of the healthcare professionals' perceptions of the implementation process and the maintenance of the Baby-Friendly Hospital Initiative. METHODS: A qualitative descriptive study with focus groups (n = 10) of the nurses, midwives and unit leaders (n = 43) perceptions of the implementation process were analysed using inductive thematic analysis. FINDINGS: Analysis of the data revealed five main themes: groundwork for the baby-focused breastfeeding context, management support throughout the process, promoting baby-friendly practices, effective communication ensuring the right track, and supporting the maintenance of BFHI designation. The main themes describe the implementation as a journey of climbing a hill and after reaching the top trying to maintain their position. DISCUSSION: The starting point for implementation was an optimal environment supporting baby-friendly breastfeeding practices. The support of the management of the organisation was an important way of moving the implementation forward. Commitment to the common goal strengthened the baby-friendly approach and with concrete and immediate feedback the right pathway on a journey was ensured. CONCLUSION: Practical ways to support the implementation journey include regular update education on breastfeeding and continuous monitoring, as well as providing statistics to health professionals. Global guidelines on how to sustain change are needed. This will ensure that the work done is not wasted.

Internet-based breastfeeding peer support for breastfeeding parents: An integrative review.

AIM: To explore what Internet-based breastfeeding peer support offers to breastfeeding parents. DESIGN: Integrative review. DATA SOURCES AND REVIEW METHODS: A systematic literature search was conducted in March 2024 using the following electronic databases: CINAHL, The Cochrane Library, PubMed/MEDLINE and PsycINFO. Database searches yielded 717 results. Two researchers removed the duplicates (n = 256) and screened the remaining titles (n = 461), abstracts (n = 197) and full texts (n = 60) independently. Eventually, 19 studies were included in the review. The chosen studies had qualitative (n = 11), quantitative (n = 6), or mixed methods designs (n = 2) and were published between 2015 and 2024. Qualitative content analysis was conducted. RESULTS: The main categories were supplying support that is responsive to the needs of parents and belonging to a breastfeeding community. The parents looked for and received breastfeeding support, advice, information, emotional support, reassurance and access to shared experiences from various online breastfeeding peer support groups. The support groups helped them in their breastfeeding decisions, thus making a difference in their breastfeeding experience. The support groups created breastfeeding communities for these parents and they were able to bond with others, feel like they belonged and share experiences. Additionally, these breastfeeding communities helped to normalize various breastfeeding practices. CONCLUSION: Breastfeeding peer support groups can offer parents the support and guidance they seek and a sense that they are part of a breastfeeding community. However, it is vital these groups are efficiently moderated to ensure the advice parents receive is evidence-based and the support is encouraging. IMPACT: These findings show that well-moderated online breastfeeding peer support can offer parents high-quality support. It is essential for health care professionals to be aware of the various options available in order to recommend high-quality support groups for breastfeeding parents. REPORTING METHOD: PRISMA. PATIENT OR PUBLIC CONTRIBUTION: This was an integrative review therefore no patient or public contribution was necessary.

'Breastfeeding exclusivity, difficulties, and support in the first days after hospital discharge: A correlational study'.

OBJECTIVE: Global breastfeeding rates are not optimal, and the early postpartum period represents a critical time for breastfeeding initiation. The Baby-Friendly Hospital Initiative endeavours to provide mothers with evidence-based breastfeeding support in birth hospitals. This study examined factors associated with breastfeeding exclusivity and breastfeeding difficulties in the first days after being discharged from Baby-Friendly designated hospital. The adequacy of breastfeeding support and maternal preferences for optimal support were also reported. STUDY DESIGN: A non-experimental correlational study was conducted between May 2021 and October 2022. A total of n = 80 breastfeeding mothers completed a semi-structured questionnaire within two weeks of discharge from Baby-Friendly hospital in Finland. The questionnaire included demographic and obstetric background information and six questions on breastfeeding exclusivity, breastfeeding difficulties, and breastfeeding support. Descriptive statistical analysis and multivariate binary logistic regression analysis were performed. RESULTS: The mean age of the mothers was 30.6 years (SD 5.4), and half of the mothers were primiparas (49 %). Most mothers gave birth vaginally (85 %) to a full-term infant (84 %). Most (85 %) had made some prenatal plans for breastfeeding, and the median planned duration of breastfeeding was 12 months. Half of the infants (53 %) received supplemental milk while in the hospital. Most mothers (81 %) were exclusively breastfeeding after hospital discharge. Mothers whose infants received supplemental milk in the hospital had an increased odds of non-exclusive breastfeeding (aOR 16.5 [CI 95 % 1.7-156.7], p 0.015). Approximately one-third of the mothers (39 %) experienced breastfeeding difficulties. Primiparous mothers had increased odds of experiencing breastfeeding difficulties (aOR 3.41 [CI 95 % 1.2-9.8], p 0.023). Mothers who received adequate postnatal breastfeeding support in birth hospital had decreased odds of experiencing breastfeeding difficulties (aOR 0.16 [CI 95 % 0.03-0.8], p 0.026). Mothers were mainly satisfied with breastfeeding support, although timelier access to support was preferred after hospital discharge. CONCLUSION: Adequate in-hospital postnatal breastfeeding support, including avoidance of non-medical supplementation, contributes to successful breastfeeding after hospital discharge in terms of more exclusive breastfeeding and fewer breastfeeding difficulties. Primiparous mothers need emphasized support to mitigate breastfeeding difficulties. Timelier access to breastfeeding support after discharge is needed.

Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study.

BACKGROUND: Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child. OBJECTIVE: The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection. METHODS: We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants' smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores≥12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction. RESULTS: The gradient boosting and decision tree models predicted maternal social loneliness with weighted F1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness. CONCLUSIONS: Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness.

Prospective longitudinal comparative study showed that breastfeeding outcomes were comparable in preterm twins and singleton infants.

AIM: We compared milk volumes, skin-to-skin contact and breastfeeding by the mothers of very preterm twins and singleton infants born at 28-32 weeks of gestation. METHODS: This Norwegian longitudinal prospective comparative study was carried out in two neonatal intensive care units: one with single family rooms and one open bay unit. It comprised 49 singleton infants, 28 twins and their mothers. The mothers' milk volume and direct breastfeeding were recorded from birth until 4 months' of corrected age. They also answered the breastfeeding self-efficacy scale and skin-to-skin contact was recorded. RESULTS: The mothers of preterm twins produced doubled the volume of expressed milk at day 14, compared to the mothers of singletons (mean 816 ± 430 mL vs. 482 ± 372 mL, p < 0.05) and this difference was still sustained at 34 + 0 weeks/days (p < 0.02). Mothers of twins had their first breastfeeding attempt later than mothers of singletons (median of 133 h compared to 56 (p < 0.002). Preterm twins received less daily skin-to-skin contact (mean 157 ± 66 min each vs. 244 ± 109) (p < 0.001). There were no differences in receiving mother's own milk, exclusively direct breastfeeding or perceived breastfeeding self-efficacy. CONCLUSION: Breastfeeding was initiated as successfully in preterm twins as singletons as the mothers' milk production doubled.

Comparing prenatal and postpartum stress among women with previous adverse pregnancy outcomes and normal obstetric histories: A longitudinal cohort study.

OBJECTIVE: The aim of this study was to compare subjectively and objectively measured stress during pregnancy and the three months postpartum in women with previous adverse pregnancy outcomes and women with normal obstetric histories. METHODS: We recruited two cohorts in southwestern Finland for this longitudinal study: (1) pregnant women (n = 32) with histories of preterm births or late miscarriages January-December 2019 and (2) pregnant women (n = 30) with histories of full-term births October 2019-March 2020. We continuously measured heart rate variability (HRV) using a smartwatch from 12 to 15 weeks of pregnancy until three months postpartum, and subjective stress was assessed with a smartphone application. RESULTS: We recruited the women in both cohorts at a median of 14.2 weeks of pregnancy. The women with previous adverse pregnancy outcomes delivered earlier and more often through Caesarean section compared with the women with normal obstetric histories. We found differences in subjective stress between the cohorts in pregnancy weeks 29 and 34. The cohort of women with previous adverse pregnancy outcomes had a higher root mean square of successive differences between normal heartbeats (RMSSD), a well-known HRV parameter, compared with the other cohort in pregnancy weeks 26 (64.9 vs 55.0, p = 0.04) and 32 (63.0 vs 52.3, p = 0.04). Subjective stress did not correlate with HRV parameters. CONCLUSIONS: Women with previous adverse pregnancy outcomes do not suffer from stress in subsequent pregnancies more than women with normal obstetric histories. Healthcare professionals need to be aware that interindividual variation in stress during pregnancy is considerable.

Supporting lifestyle change in obese pregnant mothers through the wearable internet-of-things (SLIM) -intervention for overweight pregnant women: Study protocol for a quasi-experimental trial.

OBJECTIVES: To assess, in terms of self-efficacy in weight management, the effectiveness of the SLIM lifestyle intervention among overweight or obese women during pregnancy and after delivery, and further to exploit machine learning and event mining approaches to build personalized models. Additionally, the aim is to evaluate the implementation of the SLIM intervention. METHODS: This prospective trial, which is a non-randomized, quasi-experimental, pre-post intervention, includes an embedded mixed-method process evaluation. The SLIM Intervention is delivered by public health nurses (n = 9) working in maternity clinics. The public health nurses recruited overweight women (n = 54) at their first antenatal visit using convenience sampling. The core components of the intervention i.e. health technology, motivational interviewing, feedback, and goal setting, are utilized in antenatal visits in maternity clinics starting from gestational week 15 or less and continuing to 12 weeks after delivery. Mixed effect models are used to evaluate change over time in self-efficacy, weight management and weight change. Simple mediation models are used to assess calories consumed and moderate to vigorous physical activity (MVPA) as mediators between self-efficacy and weight change. Signal processing and machine learning techniques are exploited to extract events from the data collected via the Oura ring and smartphone-based questionnaires. DISCUSSION: The SLIM intervention was developed in collaboration with overweight women and public health nurses working in maternity clinics. This study evaluates the effectiveness of the intervention among overweight women in increasing self-efficacy and achieving a healthy weight; thus, impacting the healthy lifestyle and long-term health of the whole family. The long-term objective is to contribute to women's health by supporting weight-management through behavior change via interventions conducted in maternity clinics. TRIAL REGISTRATION: The trial was registered at the Clinicaltrials.gov register platform (ID NCT04826861) on 17 March 2021.

Exclusive breastfeeding, breastfeeding problems, and maternal breastfeeding attitudes before and after the baby-friendly hospital initiative: A quasi-experimental study.

BACKGROUND: Breastfeeding practices remain globally suboptimal despite many known maternal and neonatal health benefits and the Baby-Friendly Hospital Initiative as a global effort to support breastfeeding. OBJECTIVE: We aimed to evaluate the effects of the implementation of the Baby-Friendly Hospital Initiative for a proportion of mothers who exclusively breastfed during a 6-month period, including breastfeeding problems, and maternal breastfeeding attitudes. METHODS: Using a quasi-experimental non-equivalent two-group design, we recruited two independent samples of postpartum mothers in a maternity hospital to compare the situation before (N = 162) and after (N = 163) the implementation. We measured breastfeeding status and possible breastfeeding problems via text-message questions at 2 weeks, 1, 4 and 6 months after birth. We measured Mothers' attitudes toward breastfeeding at the maternity hospital and 4 months after birth using the Iowa Infant Feeding Attitude Scale. RESULTS: The implementation of the Baby-Friendly Hospital Initiative had no effect on the proportion of mothers who exclusively breastfed, and we found no significant differences in exclusive breastfeeding at 6 months (41.3 % vs 52.9 %, p =.435). The intervention did not influence the reported number of breastfeeding problems (p =.260) or maternal breastfeeding attitudes (p =.354). More favourable breastfeeding attitudes (p <.001) and less problematic breastfeeding (p <.001) were associated positively with exclusive breastfeeding. CONCLUSION: Exclusive breastfeeding rates did not increase after the intervention; however, the rates at baseline were already high. Ensuring the Baby-Friendly Hospital Initiative practices through pre- and postnatal periods and preparing mothers to manage common breastfeeding problems might improve breastfeeding rates. This trial was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.

A comprehensive accuracy assessment of Samsung smartwatch heart rate and heart rate variability.

BACKGROUND: Photoplethysmography (PPG) is a low-cost and easy-to-implement method to measure vital signs, including heart rate (HR) and pulse rate variability (PRV) which widely used as a substitute of heart rate variability (HRV). The method is used in various wearable devices. For example, Samsung smartwatches are PPG-based open-source wristbands used in remote well-being monitoring and fitness applications. However, PPG is highly susceptible to motion artifacts and environmental noise. A validation study is required to investigate the accuracy of PPG-based wearable devices in free-living conditions. OBJECTIVE: We evaluate the accuracy of PPG signals-collected by the Samsung Gear Sport smartwatch in free-living conditions-in terms of HR and time-domain and frequency-domain HRV parameters against a medical-grade chest electrocardiogram (ECG) monitor. METHODS: We conducted 24-hours monitoring using a Samsung Gear Sport smartwatch and a Shimmer3 ECG device. The monitoring included 28 participants (14 male and 14 female), where they engaged in their daily routines. We evaluated HR and HRV parameters during the sleep and awake time. The parameters extracted from the smartwatch were compared against the ECG reference. For the comparison, we employed the Pearson correlation coefficient, Bland-Altman plot, and linear regression methods. RESULTS: We found a significantly high positive correlation between the smartwatch's and Shimmer ECG's HR, time-domain HRV, LF, and HF and a significant moderate positive correlation between the smartwatch's and shimmer ECG's LF/HF during sleep time. The mean biases of HR, time-domain HRV, and LF/HF were low, while the biases of LF and HF were moderate during sleep. The regression analysis showed low error variances of HR, AVNN, and pNN50, moderate error variances of SDNN, RMSSD, LF, and HF, and high error variances of LF/HF during sleep. During the awake time, there was a significantly high positive correlation of AVNN and a moderate positive correlation of HR, while the other parameters indicated significantly low positive correlations. RMSSD and SDNN showed low mean biases, and the other parameters had moderate mean biases. In addition, AVNN had moderate error variance while the other parameters indicated high error variances. CONCLUSION: The Samsung smartwatch provides acceptable HR, time-domain HRV, LF, and HF parameters during sleep time. In contrast, during the awake time, AVNN and HR show satisfactory accuracy, and the other HRV parameters have high errors.

Impact of the COVID-19 Pandemic on Breastfeeding Support Services and Women's Experiences of Breastfeeding: A Review.

Objective: The aim of this systematic review was to explore the impact of the COVID-19 pandemic on breastfeeding support services and continuation rates. Methods: Electronic searches were undertaken in seven databases: Academic Search Complete, Springer Nature Journals, CINAHL Medline, Health Source: Nursing/Academic Edition, Masterfile premier, and SocINDEX. Publications following the COVID-19 pandemic between January 2020 and March 2022 were searched for using the following keywords: impact or effect or influence and breastfeeding support and breastfeeding continuation and COVID-19 or coronavirus. Fifteen studies were included for investigation and extracted to identify seven themes related to breastfeeding support during COVID-19. Results: Factors which impacted breastfeeding support during the COVID-19 pandemic included separation, lack of skin-to-skin contact, insufficient support, online breastfeeding support, the impact of the pandemic on breastfeeding rates and experiences, fears of the pandemic, and the need for additional support. The pandemic mostly influenced breastfeeding support negatively, with a small exception occurring where some mothers experienced lockdown as positive since it protected the mother-infant dyad from unwanted visitors. Virtual breastfeeding support was introduced in many contexts; however, practitioners and mothers reported that this could not replace the need for face-to-face support. Conclusion: Breastfeeding is a lifesaving intervention, especially in the face of a disruption such as a pandemic. This work highlights the need for clear, consistent, and evidence-based information about risks, and for key practices to be maintained including not separating mothers and infants, promoting skin-to-skin contact, and ensuring availability of high-quality breastfeeding support.

Trends in Heart Rate and Heart Rate Variability During Pregnancy and the 3-Month Postpartum Period: Continuous Monitoring in a Free-living Context.

BACKGROUND: Heart rate variability (HRV) is a noninvasive method that reflects the regulation of the autonomic nervous system. Altered HRV is associated with adverse mental or physical health complications. The autonomic nervous system also has a central role in physiological adaption during pregnancy, causing normal changes in HRV. OBJECTIVE: The aim of this study was to assess trends in heart rate (HR) and HRV parameters as a noninvasive method for remote maternal health monitoring during pregnancy and 3-month postpartum period. METHODS: A total of 58 pregnant women were monitored using an Internet of Things-based remote monitoring system during pregnancy and 3-month postpartum period. Pregnant women were asked to continuously wear Gear Sport smartwatch to monitor their HR and HRV extracted from photoplethysmogram (PPG) signals. In addition, a cross-platform mobile app was used to collect background and delivery-related information. We analyzed PPG signals collected during the night and discarded unreliable signals by applying a PPG quality assessment method to the collected signals. HR, HRV, and normalized HRV parameters were extracted from reliable signals. The normalization removed the effect of HR changes on HRV trends. Finally, we used hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters. RESULTS: HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P=.006). Time-domain HRV parameters, average normal interbeat intervals (IBIs; average normal IBIs [AVNN]), SD of normal IBIs (SDNN), root mean square of the successive difference of normal IBIs (RMSSD), normalized SDNN, and normalized RMSSD decreased significantly during the second trimester (P<.001). Then, AVNN, SDNN, RMSSD, and normalized SDNN increased significantly during the third trimester (with P=.002, P<.001, P<.001, and P<.001, respectively). Some of the frequency-domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF, decreased significantly during the second trimester (with P<.001, P<.001, and P=.003, respectively), and HF increased significantly during the third trimester (P=.007). In the postpartum period, normalized RMSSD decreased (P=.01), and the LF to HF ratio (LF/HF) increased significantly (P=.004). CONCLUSIONS: Our study indicates the physiological changes during pregnancy and the postpartum period. We showed that HR increased and HRV parameters decreased as pregnancy proceeded, and the values returned to normal after delivery. Moreover, our results show that HR started to decrease, whereas time-domain HRV parameters and HF started to increase during the third trimester. The results also indicated that age was significantly associated with HRV parameters during pregnancy and postpartum period, whereas education level was associated with HRV parameters during the third trimester. In addition, our results demonstrate the possibility of continuous HRV monitoring in everyday life settings.

Maternal perceptions of breastfeeding support in a birth hospital before and after designation to the Baby-Friendly Hospital Initiative: A quasi-experimental study.

OBJECTIVE: The purpose of this study was to examine maternal perceptions of postnatal breastfeeding support in the hospital before and after designation to the Baby-Friendly Hospital Initiative (BFHI). Further maternal and infant characteristics associated with the maternal perception of breastfeeding support were investigated. Our hypothesis was that mothers would perceive breastfeeding support more adherent to the standards of the BFHI after the hospital was designated to the BFHI compared with before. DESIGN: The study had a quasi-experimental non-equivalent two-group design. SETTING: The study was conducted in one postnatal ward and one neonatal intensive care unit in a public birth hospital in Finland. PARTICIPANTS: Postpartum mothers giving birth in the hospital before (pre-test group, n = 162) and after (post-test group, n = 163) designation to the BFHI participated. INTERVENTION: The aim of the BFHI is to support and promote breastfeeding by implementing the Ten Steps to Successful Breastfeeding into routine care. Implementation in the study hospital required staff training and revision of current hospital practices, which took place during 2017-2018. The postnatal ward and neonatal intensive care unit were designated to the Baby-Friendly Hospital in February 2019. MEASUREMENTS: Maternal perceptions of postnatal breastfeeding support were measured with a 20-item questionnaire developed for this study. Items were based on maternal self-report of the breastfeeding support in the hospital. A sum variable was created to measure the maternal perception of the support (scale 1-7), and higher scores indicated perception of breastfeeding support that is more adherent to the standards of the BFHI. Descriptive statics, nonparametric statistical tests, and multiple linear regression analysis were used to analyse data. FINDINGS: Mothers in the post-test group (median 6.1, IQR 5.4-6.4) perceived breastfeeding support more adherent to the standards the BFHI compared with mothers in the pre-test group (median 5.0, IQR 4.2-5.8) (p < 0.001). Fifteen of 20 of the measured breastfeeding support practices improved after the hospital's designation to the BFHI. The largest difference between groups was observed for multipara mothers (median 4.6 vs 6.0, p < 0.001), older mothers (> 35 years) (median 4.4 vs 5.8, p < 0.001), and mothers with a longer history of breastfeeding (6-12 months) (median 4.4 vs 6.2, p < 0.001). Before the BFHI designation, multipara mothers and mothers who gave birth to an infant with low Apgar scores (< 7) perceived breastfeeding support less adherent to the BFHI standards than did primiparas or mothers of an infant with high Apgar scores (≥ 7). After the BFHI designation, mothers who experienced preterm birth (GA < 37 weeks) perceived breastfeeding support less adherent to the BFHI standards compared with mothers who experienced a full-term birth. KEY CONCLUSIONS: Designation to the BFHI had a positive impact on breastfeeding support from the maternal perspective. Designation improved particularly multiparas' perceptions of receiving breastfeeding support that is in adherence with the standards of the BFHI. However, more emphasis should be placed, and further research should be conducted to ensure that mothers giving birth to a preterm infant receive breastfeeding support that is adherent to the BFHI standards. IMPLICATIONS FOR PRACTICE: Birth hospitals are recommended to implement the BFHI as it improves breastfeeding support in the hospital and provides mothers with a good basis and continuation for breastfeeding, even after hospital discharge. Maternal perceptions about the impact of BFHI designation are important to consider because mother - infant dyads are at the centre of that support, and their viewpoint may help to assess whether the designation to the BFHI in the unit is successful. Results of this study indicate that designation to BFHI improves breastfeeding support from the maternal perspective.

Comparison of Oura Smart Ring Against ActiGraph Accelerometer for Measurement of Physical Activity and Sedentary Time in a Free-Living Context.

Smart rings, such as the Oura ring, might have potential in health monitoring. To be able to identify optimal devices for healthcare settings, validity studies are needed. The aim of this study was to compare the Oura smart ring estimates of steps and sedentary time with data from the ActiGraph accelerometer in a free-living context. A cross-sectional observational study design was used. A convenience sample of healthy adults (n = 42) participated in the study and wore an Oura smart ring and an ActiGraph accelerometer on the non-dominant hand continuously for 1 week. The participants completed a background questionnaire and filled out a daily log about their sleeping times and times when they did not wear the devices. The median age of the participants (n = 42) was 32 years (range, 18-46 years). In total, 191 (61% of the potential) days were compared. The Oura ring overestimated the step counts compared with the ActiGraph. The mean difference was 1416 steps (95% confidence interval, 739-2093 steps). Daily sedentary time was also overestimated by the ring; the mean difference was 17 minutes (95% confidence interval, -2 to 37 minutes). The use of the ring in nursing interventions needs to be considered.

Accuracy Assessment of Oura Ring Nocturnal Heart Rate and Heart Rate Variability in Comparison With Electrocardiography in Time and Frequency Domains: Comprehensive Analysis.

BACKGROUND: Photoplethysmography is a noninvasive and low-cost method to remotely and continuously track vital signs. The Oura Ring is a compact photoplethysmography-based smart ring, which has recently drawn attention to remote health monitoring and wellness applications. The ring is used to acquire nocturnal heart rate (HR) and HR variability (HRV) parameters ubiquitously. However, these parameters are highly susceptible to motion artifacts and environmental noise. Therefore, a validity assessment of the parameters is required in everyday settings. OBJECTIVE: This study aims to evaluate the accuracy of HR and time domain and frequency domain HRV parameters collected by the Oura Ring against a medical grade chest electrocardiogram monitor. METHODS: We conducted overnight home-based monitoring using an Oura Ring and a Shimmer3 electrocardiogram device. The nocturnal HR and HRV parameters of 35 healthy individuals were collected and assessed. We evaluated the parameters within 2 tests, that is, values collected from 5-minute recordings (ie, short-term HRV analysis) and the average values per night sleep. A linear regression method, the Pearson correlation coefficient, and the Bland-Altman plot were used to compare the measurements of the 2 devices. RESULTS: Our findings showed low mean biases of the HR and HRV parameters collected by the Oura Ring in both the 5-minute and average-per-night tests. In the 5-minute test, the error variances of the parameters were different. The parameters provided by the Oura Ring dashboard (ie, HR and root mean square of successive differences [RMSSD]) showed relatively low error variance compared with the HRV parameters extracted from the normal interbeat interval signals. The Pearson correlation coefficient tests (P<.001) indicated that HR, RMSSD, average of normal heart beat intervals (AVNN), and percentage of successive normal beat-to-beat intervals that differ by more than 50 ms (pNN50) had high positive correlations with the baseline values; SD of normal beat-to-beat intervals (SDNN) and high frequency (HF) had moderate positive correlations, and low frequency (LF) and LF:HF ratio had low positive correlations. The HR, RMSSD, AVNN, and pNN50 had narrow 95% CIs; however, SDNN, LF, HF, and LF:HF ratio had relatively wider 95% CIs. In contrast, the average-per-night test showed that the HR, RMSSD, SDNN, AVNN, pNN50, LF, and HF had high positive relationships (P<.001), and the LF:HF ratio had a moderate positive relationship (P<.001). The average-per-night test also indicated considerably lower error variances than the 5-minute test for the parameters. CONCLUSIONS: The Oura Ring could accurately measure nocturnal HR and RMSSD in both the 5-minute and average-per-night tests. It provided acceptable nocturnal AVNN, pNN50, HF, and SDNN accuracy in the average-per-night test but not in the 5-minute test. In contrast, the LF and LF:HF ratio of the ring had high error rates in both tests.

Healthcare Professionals' Breastfeeding Attitudes and Hospital Practices During Delivery and in Neonatal Intensive Care Units: Pre and Post Implementing the Baby-Friendly Hospital Initiative.

BACKGROUND: The Baby-Friendly Hospital Initiative represents a global effort to support breastfeeding. Commitment to this program has been associated with the longer duration and exclusivity of breastfeeding and improvements in hospital practices. Further, healthcare professionals' breastfeeding attitudes have been associated with the ability to provide professional support for breastfeeding. RESEARCH AIMS: To determine healthcare professionals' breastfeeding attitudes and hospital practices before and after the implementation of the Baby-Friendly Hospital Initiative. METHODS: Using a quasi-experimental pretest-posttest study design, healthcare professionals (N = 131) from the single hospital labor and delivery, maternity care, and neonatal intensive care were recruited before and after the Baby-Friendly Hospital Initiative intervention during 2017 and 2019. Breastfeeding attitudes with the validated Breastfeeding Attitude Questionnaire, breastfeeding-related hospital practices, and background characteristics were collected. RESULTS: The healthcare professionals' breastfeeding attitude scores increased significantly after the implementation of the Baby-Friendly Hospital Initiative, difference = 0.16, (95% CI [0.13, 0.19]) and became breastfeeding favorable among all professional groups in each study unit. Positive changes in breastfeeding-supportive hospital practices were achieved. The infants had significantly more frequent immediate and uninterrupted skin-to-skin contact with their mothers. The rate of early breastfeeding, as well as the number of exclusively breastfed infants, increased. CONCLUSIONS: After the Baby-Friendly Hospital Initiative and Baby-Friendly Hospital Initiative for neonatal wards (Neo-BFHI) interventions were concluded, we found significant improvements in the breastfeeding attitudes of healthcare professionals and in breastfeeding-related care practices.This RCT was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.

Maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals: An integrative review.

Background: The Baby-Friendly Hospital Initiative aims to improve breastfeeding by implementing the Ten Steps to Successful Breastfeeding (Ten Steps) into routine breastfeeding support in birth hospitals. Maternal perspective to breastfeeding support is important to consider as mothers and their infants are in the center of that support. Objectives: To review and synthesize the existing literature on maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals. A sub-aim was to describe differences in breastfeeding support between Baby-Friendly hospitals and non-Baby-Friendly hospitals from maternal perspective. Data sources and review methods: An integrative literature review. A systematic literature search was conducted in October 2021 in five databases: PubMed, CINAHL, Cochrane, Scopus, Web of Science. Original peer-reviewed studies published in English exploring maternal viewpoints on breastfeeding support in Baby-Friendly hospitals were included. Two reviewers independently screened the titles (n=914), abstracts (n=226), and full texts (n=47). The review comprised of seventeen studies and includes both quantitative studies (n=14) and qualitative studies (n=3). Inductive content analysis and descriptive synthesis were conducted. Results: Most studies (n=14) measured hospitals' compliance with the Ten Steps practices from maternal perspective. Mothers were provided with breastfeeding information and encouragement, however, a qualitative finding indicated that information focused on positive aspects of breastfeeding. Early skin-to-skin contact between the mother and infant was well facilitated although often not lasting more than 30 min. Breastfeeding was facilitated by practical support but according to findings of two qualitative studies, support was not always adequate to address mothers' problems with breastfeeding. Most mothers were exclusively breastfeeding during the hospital stay and no supplemental milk was offered to infant. Mothers were roomed-in together with their infant and were mostly encouraged to breastfeed on demand. Differences between Baby-Friendly hospitals and non-Baby-Friendly hospitals were observed particularly for steps 6 and 9: supplementary feeding and pacifier use were less common in Baby-Friendly hospitals. Conclusions: From the maternal perspective, breastfeeding support in the Baby-Friendly hospitals was mainly but not completely in adherence with the Ten Steps practices. Low compliance with some of the Ten Steps indicates a need for a more frequent assessment of the breastfeeding support practices and consideration of strategies facilitating a more sustainable implementation of the initiative. Regardless of some shortcomings with the breastfeeding support, mothers were mainly satisfied with the support in the hospital. Mothers in the Baby-Friendly hospitals perceived that breastfeeding support was more adherent to the Ten Steps compared to mothers in non-Baby-Friendly hospitals.

Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review.

BACKGROUND: Most qualitative research on breastfeeding the preterm or low-birthweight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants. METHODS: A systematic review using meta-ethnographic methods was conducted. Search strategies involved a comprehensive search strategy on six bibliographic databases, citation tracking and reference checking. The analysis involved a reciprocal level of translation and a line of argument synthesis. RESULTS: Searches identified 1774 hits and 17 articles from 14 studies were included, representing the views of 697 mothers. A positive breastfeeding experience was identified as being 'attuned'. Three themes and eight sub-themes were developed to describe what characterizes attuned breastfeeding. 'Trusting the body and what it can do', concerned how attuned breastfeeding was facilitated through understanding the bodily responses and capacity and feeling comfortable with holding the infant and to breastfeed. 'Being emotionally present - in the here and now' described the importance of feeling relaxed and reassured. 'Experiencing mutual positive responses', illuminated how attunement was related to feelings of mutuality - when the mother recognises the infant's cues, responds to these signals and receives a positive response from the infant. The key factors to facilitate attuned breastfeeding were opportunities for prolonged close physical contact with the infant, positive relationships with and support from staff and peers, and being facilitated to breastfeed when the infant showed feeding cues. CONCLUSIONS: This study provides new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units' design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother's physical and emotional states and the infant's behavioural responses and physiological signals should guide the process towards positive breastfeeding practices.

Long-Term IoT-Based Maternal Monitoring: System Design and Evaluation.

Pregnancy is a unique time when many mothers gain awareness of their lifestyle and its impacts on the fetus. High-quality care during pregnancy is needed to identify possible complications early and ensure the mother's and her unborn baby's health and well-being. Different studies have thus far proposed maternal health monitoring systems. However, they are designed for a specific health problem or are limited to questionnaires and short-term data collection methods. Moreover, the requirements and challenges have not been evaluated in long-term studies. Maternal health necessitates a comprehensive framework enabling continuous monitoring of pregnant women. In this paper, we present an Internet-of-Things (IoT)-based system to provide ubiquitous maternal health monitoring during pregnancy and postpartum. The system consists of various data collectors to track the mother's condition, including stress, sleep, and physical activity. We carried out the full system implementation and conducted a real human subject study on pregnant women in Southwestern Finland. We then evaluated the system's feasibility, energy efficiency, and data reliability. Our results show that the implemented system is feasible in terms of system usage during nine months. We also indicate the smartwatch, used in our study, has acceptable energy efficiency in long-term monitoring and is able to collect reliable photoplethysmography data. Finally, we discuss the integration of the presented system with the current healthcare system.

Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel.

BACKGROUND: Maternal overweight is increasing, and it is associated with several risk factors for both the mother and child. Healthy lifestyle behaviors adopted during pregnancy are likely to impact women's health positively after pregnancy. The study's aim was to identify and describe weight management behaviors in terms of the Capability, Opportunity and Motivation Behaviour (COM-B) -model to target weight management interventions from both the perspectives of women who are overweight and maternity care professionals. METHODS: This qualitative, descriptive study was conducted between 2019 and 2020. Individual interviews with pregnant and postpartum women who were overweight (n = 11) and focus group interviews with public health nurses (n = 5) were undertaken in two public maternity clinics in Southwest Finland. The data were analyzed using deductive content analysis consistent with the COM-B model. RESULTS: In the capability category, the women and the public health nurses thought that there was a need to find consistent ways to approach overweight, as it had often become a feature of the women's identities. The use of health technology was considered to be an element of antenatal care that could be used to approach the subject of weight and weight management. Smart wearables could also support an evaluation of the women's lifestyles. The opportunity category highlighted the lack of resources for support during perinatal care, especially after birth. Both groups felt that support from the family was the most important facilitating factor besides motivation. The women also expressed a conflict between pregnancy as an excuse to engage in unhealthy habits and pregnancy as a motivational period for a change of lifestyle. Furthermore, the women wanted to be offered a more robust stance on weight management and discreet counseling. CONCLUSIONS: Our findings offer a theoretical basis on which future research can define intervention and implementation strategies. Such interventions may offer clear advice and non-judgmental support during pregnancy and after delivery by targeting women's capabilities, opportunities, and motivation. Health technology could be a valuable component of intervention, as well as an implementation strategy, as they provide ways during maternity care to approach this topic and support women.