Breastfeeding among parous women offered home-visit by a midwife after early discharge following planned cesarean section: Secondary analysis of a randomized controlled trial.

INTRODUCTION: Early discharge holds several advantages and seems safe after planned cesarean section among low-risk women. However, breastfeeding rates are lower after cesarean section. Thus, concern has been raised that early discharge among these women may affect breastfeeding even further. Therefore, we aimed to assess the effect of early discharge the day after planned cesarean section on breastfeeding, among parous women when a home-visit by a midwife was provided the day after discharge. METHODS: We conducted a secondary analysis of a randomized trial. Parous women (n=143) planned for cesarean section were allocated to either discharge within 28 hours after planned cesarean section followed by a home visit the day after (early discharge) or discharge at least 48 hours after planned cesarean section (standard care). The participants filled in questionnaires approximately 2 weeks before delivery and 1 week, 4 weeks, and 6 months postpartum. RESULTS: The proportions of women initiating breastfeeding were 84% versus 87% (early discharge vs standard care). After 6 months, 23% versus 21% were exclusively breastfeeding, while 29% versus 42% were partially breastfeeding. The mean duration of exclusive breastfeeding was 3.4 months (SD=2.3) in both groups. None of these differences was statistically significant. In both groups, the women's breastfeeding self-efficacy score before cesarean section correlated with the duration of breastfeeding. After 4 weeks, low-score rates were 28% versus 30%. CONCLUSIONS: Early discharge with follow-up home visits by a midwife after planned cesarean section in parous women is feasible without compromising breastfeeding.

What are the factors affecting parents' postnatal sense of security?

INTRODUCTION: The postpartum period is part of an important process for mothers and fathers. A sense of security is central as it might influence a parent's journey towards becoming a successful parent. The aim was to determine factors affecting parents' postnatal sense of security (PPSS) before postpartum discharge from a hospital in Konya, Turkey. METHODS: A descriptive study was conducted. From January 2019 to March 2019, a questionnaire was given to a convenience sample of 188 couples discharged from a regional hospital in Turkey. The sense of security was assessed using the PPSS instrument, with low scores defined as those less than the mean. RESULTS: Low and high sense of security was based on the mean in the population, for mothers 49.36 and for fathers 34.90. It was found that 43.6% of mothers and 69.7 % of fathers had a low score, which was linked to some specific factors in the postpartum period. These were the type of birth, being ready to take responsibility for baby care, being ready to be discharged, being healthy, having any concern about the baby's health, social support presence, having professional support, and presence of a sense of security. CONCLUSIONS: Many parents, particularly fathers, have a low postnatal sense of security. In the postpartum period, it is very important for midwives, who are always with the family, to identify the risks for a low sense of security during this period and provide effective care. More studies in different settings with larger samples are recommended.

Effect of early discharge after planned cesarean section on recovery and parental sense of security. A randomized clinical trial.

INTRODUCTION: In some European countries, discharge the day after planned cesarean section has become an accepted procedure. However, little is known about the patients' perception of early discharge. The aim of this study was to compare early discharge with standard care in relation to parental sense of security. Further, we evaluated postoperative pain, mobilization, and readmission. MATERIAL AND METHODS: We performed a randomized clinical trial including parous, singleton pregnant women with a planned cesarean section at term. The women were allocated to either discharge within 28 hours (intervention group) or after 48 hours (standard care group) following the cesarean section. Women discharged within 28 hours after cesarean section were offered a home visit by a midwife the following day. The primary outcome was the postnatal sense of security, which was reported by the woman and her partner in the "Parents' Postnatal Sense of Security" questionnaire 1 week postpartum. Secondary outcomes were pain score, use of analgesics, mobilization, readmission, and contacts with the healthcare system in the postoperative period. RESULTS: We included 143 women, of whom 72 were allocated to the intervention group and 71 were allocated to the standard care group. There were no differences in baseline characteristics. The two groups did not differ concerning the postnatal sense of security for the women (P = .98) or the postnatal sense of security for the partners (P = .38). We found no difference in pain scores, step count, use of analgesics, or number of contacts with the health-care system between the groups. CONCLUSIONS: Parental postnatal sense of security is not compromised by discharge within 28 hours followed by a home visit compared with discharge after 48 hours after planned cesarean section among parous women.

Midwives experiences of meeting pregnant women who are exposed to Intimate-Partner Violence at in-hospital prenatal ward: A qualitative study.

INTRODUCTION: Worldwide every third women is exposed to physical and/or sexual violence and pregnancy is no safe period for the women. The aim was to elucidate midwives experience of violence-exposed pregnant women who had been referred to a prenatal ward and were hospitalized. METHODS: An inductive qualitative method was used with four focus-group interviews performed with sixteen midwives working at in-hospital prenatal ward. The data were analyzed with content analysis. RESULTS: Three categories emerged. 'Professional area of responsibility', the midwives working at in-hospital prenatal ward considered it was the responsibility of the midwives working at antenatal care to ask routinely in order to detect violence-exposed women. Signs of help-seeking were based on the pregnant woman's behavior. Suspicion of intimate-partner violence was based on gut feeling. 'Conditions for support', the midwives strived to support pregnant women who were already identified as violence-exposed or if they had a suspicion that the pregnant woman was in a relationship where intimatepartner violence occurred. 'Barriers for giving support', both the work-place layout and routines constituted a barrier. The midwives own emotional state could affect her handling of the situation. CONCLUSIONS: The midwives working in-hospital considered it the responsibility of the midwives at antenatal healthcare to identify these women. The midwives had limited experience in dealing with violence-exposed pregnant women but recognized a number of signs and symptoms that could cause suspicion. They felt uncomfortable in the situation and expressed a need for both education and an action plan.

Fathers matter.

Becoming a father, especially for the first time, can present changes in men's identity and in the relationship with their partner. Affinity within the family and participation in the whole process of pregnancy, childbirth and the postnatal period are important for fathers' sense of postnatal security. The fathers want to be already prepared before birth for the early postnatal period. Willingness to participate and take responsibility from the first day of pregnancy is important for his own sake and also for the sake of the mother's and child's wellbeing. Affinity within the family can be strengthened by midwives' empowerment and the father's interaction with the midwife. Midwives should invite fathers to participate in maternity care rather than only 'permit' participation. To enable future development of postnatal care, a specific instrument called Parents'postnatal sense of security (PPSS) has been developed in Sweden. The PPSS can be used to evaluate antenatal and postnatal care and exists in one version for fathers and one for mothers.