Skin-to-skin contact after birth: Developing a research and practice guideline.

AIM: Skin-to-skin contact immediately after birth is recognised as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, the implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilised the World Health Organization guideline process to clarify best practice and improve the consistency of application. METHODS: The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. RESULTS: The developed guideline received a strong recommendation from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work were delineated. CONCLUSION: The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.

Powdered Baby Formula Sold in North America: Assessing the Environmental Impact.

Background: According to the Intergovernmental Panel on Climate Change, Greenhouse Gas emissions must decline by around 45% by 2030 and reach net zero in 2050. Biofuels, solar, and wind energy are obvious choices for reduction of the 75% of emissions from the energy sector (including transportation), but making reductions in the remaining 25%, the food sector, is more of a challenge. One way is to change our diets to increase low-carbon food alternatives. Objective: We chose to examine the impact of powdered baby formula products. The aim of this study is to compute a minimal estimate of green house gas (GHG) emissions for powdered baby formula products sold in North America comprising Canada, Mexico, and the United States. Results: We found that in 2016, the North America Greenhouse Gas emissions (in tons of CO2 eq.) attributable to sales of powdered formula for Canada was 70,256, for Mexico, 435,820, and for the United States, 655,956. The North American per capita emissions based on infants and toddlers from birth to 36 months of age in 2016 was, at a minimum, 59.06 kg of CO2 eq. Conclusion: The environmental and Greenhouse Gas impact of powdered baby formula, and related hazards arising from climate change, can be a relevant factor for health care providers in their advice to families on infant feeding. This study makes an innovative and potentially useful addition to the emerging evidence on this issue and should be considered when developing and funding infant and young child feeding policies and supportive programs.

The relationship between positioning, the breastfeeding dynamic, the latching process and pain in breastfeeding mothers with sore nipples.

In recognition of the irrefutable disadvantages of not breastfeeding to the mother, baby, society and the environment, increasing the duration of breastfeeding has become a focus of national and international health objectives. However, many mothers experience such painful sore nipples that they stop breastfeeding before they intended. The purpose of this study is to examine the relationship between various aspects of optimal breastfeeding (e.g. the positioning of the baby at the mother's breast, the positioning of the baby's head and mouth, the breastfeeding dynamic and the latching process) using a guided assessment and documentation tool and the breastfeeding mother's level of reported pain on a five-point verbal descriptor scale. Ninety-five healthy postpartum breastfeeding mothers who sequentially reported sore nipples within ten days of giving birth to healthy, term babies in a hospital in Latvia participated in the study. Each mother's midwife observed, assessed and documented a breastfeed using a guidance assessment form, the Lactation Assessment Tool (LAT). Each mother scored her own pain during breastfeeding. Four attribute categories were scored and examined as related to the pain levels of the mother: the baby's face position (chin and nose and head position, cheekline, lip flange and angle of mouth opening); the baby's body position (height at the breast, body rotation and body in relation to mother's body); the breastfeeding dynamic (change in breastfeeding pattern (suck vs swallow) and movement of mother's breast) and the latching process of the baby (root, gape, seal and suck). No significant difference was found between the mother's level of reported pain and the assessed head position, body position or breastfeeding dynamic attributes of the baby. However, more optimal latching process behaviour of the baby (rooting, gaping, sealing, and sucking behaviour) are slightly related to lower levels of reported pain (r(88) = -0.09, p > 0.05). This should serve to remind clinicians that no one aspect of positioning may be more critical than another. Assessment of breastfeeding should be comprehensive and should begin before the infant is at the breast. Early stages of the infant's breast seeking behaviours should be observed as well as the actual feeding.