Separation research

Anderson, G.C., (1989). Risk of mother-infant separation postbirth.  Image: Journal of Nursing Scholarship, 21(4), 196-199.  NOT A KC STUDY, but early identification of the need to prevent separation and highlights the negative outcomes of separation. THIS IS A CLASSIC separation REPORT, so it is included here. Non-separation is highlighted in the Nyqvist et al., 2010a and 2010b reports of the 2008 meeting of INK in Uppsala, Sweden.

 

Arivabene GC & Tyrell MA. (2010).  Kangaroo Mother Method:  Mothers’ experiences and contributions to nursing.  Revista Latino Americana Enfermagen 18(2), 262-268.  Descriptive study of focus group derived stories of KMC experiences of mothers in Brazil.  Themes were survival and recovery of the infant, mothers’ daily life modified by KMC, valuation of family affective bonds, increased maternal-infant bonding, decreased separation of infant from family, increased confidence in parental care before and after discharge, and improved maternal relationship to infant and to infant’s care team.  PT, Qualitative study, maternal feelings, confidence,  non-separation, daily life adaptations, 3rd world

 

Dumas, L, Lepage, M., Bystrova, K., Matthiesen, A-S, Welles-Nystrom, B., & widstrom, a-m/  (2013).  Influence of skin to skin contact and rooming in on early mother-infant inmteraction:  A randomized controlled Trial. Clinical Nursing Research,  Jan 3, 3013,  DOI 10.1177/1054773812468316.  This is another report of the RCT results of Bystrova’s study in Russia inw hich one group was given Birth KC  and the other was not.  151 Videos (25-45 mins) of mom-baby interaction at Day 4 before discharge were scored for AFFECTIVE quality of aternal behaviors and maternal tone ofvoice.  They developed their own maternal behavioral tool, yielding 7 items about QUALITY of mother’s behavior assessed on 1-5 point scale from roughest to most gentle behavior; two items are on a 3 point scale, and three items are yes or no questions to record occurrence or nonoccurrence of a behavior.   Baby’s state.  Separation and swaddling at birth interfered with mother-infant intereaction during a breastfeeding session on Day 4.  Separated and swaddled mothers demonstrated significantly more roughness in their behaviors. Great discussion on adverse effects of swaddling and putting infant in observation nursery. Also good discussion about putting swaddled infant in supine position.SEPARATION at birth prevents mothers from developing sense of confidence (refers to Barrett CR, Leiderman PH, Grobstein R & Kluas MH 1970. Neonatal separation:  The maternal side of interactional deprivation. Pediatris 45, 197-205. There is a sensitive period for separation after birth, so results encourage immediate and uninterrupted skin to skin contact at birth and rooming-in during postpartum. FT, Birth KC, interaction, separation, swaddling, rooming-in, supine positioning. NOT on charts 1-12-2013

 

Henderson, A.  (2011).  Understanding the breast crawl: Implications for nursing practice.  Nursing for  Women’s Health ,15(4),  296-307.  This is a clinical review article that states that Klaus in 1998 called the process of initiation of BF at birth THE BREAST CRAWL and that UNICEF recommends the breast crawl as the “preferred method for initiating breastfeeding.”  The breast crawl is a process that is more than just a way of providing breast milk, it is a behavioral process that brings mothers and babies together. The breast crawl is defined as”the  newborn, undisturbed and skin to skin on mother’s chest for the purpose of locating and self-attaching for the first feeding” (p.297). The breast crawl is a five part process: 1.infant rests on mom’s abdomen and intermittently looks at her, 2. Infant salivates and mouth her fingers, 3. Leg and arm movements propel her towardthe breast. 4. Upon reaching sternum, her head bounces up and down and side to side. 5.She approaches nipple, mouth open, and after several attempts self-latchs and suckles.(Others call this inborn INNATE process prefeeding and feeding behaviors with  1) the birth cry, 2) relaxation, 3) awakening, 4) crawling, 5) breast preparation, 6) at breast, 7) sucking (This is Nyqvist et al, 2010 Towards Universal KC..) . KC facilitates the breast crawl. Maternal body is the habitat for newborn stabilization and supports innate behaviors. She says that skin to skincontact immediately after birth is recommended by AAP, and that the Kangaroo position (chest to chest) facilitates the breast crawl. The Kangaroo position should be frog like, head to one side, wear hat and diaper and blanket..  KC is now the standard of care for all newborns, healthy and vulnerable.  GOAL of KMC is to “empower parents as they practice the skills and responsibilities of caregiving while meeting all of their newborn’s physical and emotional needs (quote from Nyqvist et al, 2010 Towards Universal KC).  Neonatal reflexes also facilitate BF. The Reflexes are Sucking, Swallowing, Rooting, hand-to-mouth, arm and leg movements, fingere flexing/extending, mouth gape, tongue dart/licking, head turning to right/left,head bobbing/nodding, placing, palmar gasp, plantar gasp, and Babinski toe fan (pg. 298).  When on the semi-reclined mother (her body is foundation of support and arms contain infant), gravity holds baby on the chest, pressure on top of feet elicit placing, brushing foot sole against body elicits stepping, instinctive stroking from mother elicits babinski which in turn directly stimulate lip and tongue reflexes.  Hand to mouth movements stimulate the mouth gape reflex, gravity assists head and arm movments to stimulate the breast and position at the nipple. Newborn has all senses and olfactory is acute and infant responds to chemical cues secreted from Montgomery Tubercles on areola and surrounding glands as well as to milk scent. These cues stimulate search, mouthing, grasping and rooting (pg. 298 and citation of Brown 2008 and Schaal et al., 2009).  Olfaction is part of social learning and behavior and the olfactory bulb is part of the olfactory cortex within the limbic lobe ( site of emotional memory, emotions and visceral responses to emotions in brain). Oxytocin release is stimulated by uterine pressure (from infant in kangaroo position), nipple stimulation., food intake, warmth, light massage/stroking, stimulation of anterior chest, abdomen and urogenital organs. Increased  levels of oxytocin stimulate increased  trust, sociability, decreased fear and axiety, vasodilation (vasodilation of maternal chest skin causes it to heat up and the chest and breast are then a warm and safe environment [Kimura  C& Matsuoka M, 2007.Changes in breast skin temperature during the course of feeding. J Hum Lact, 23(1):60-69], lower  HR, lower BP, enhanced healing, improved nutrient storage, increased social memory and curiosity, social bonding,relaxation, and elevated endorphin levels, by directly countering the effects of cortisol.   Oxytocin also stimulates the amygdala so that the mother is imprinted with details of her newborn and begins bonding. (pg. 300).  The breast crawl promotes physical stabilization, temp regulation, HR, RR, and blood glucose are improved and quickly stabilized, and the multisensory stim of KC lower circulating levels of cortisol.  Mother and baby are relaxed and  have sense of well-being and then infants go into deep quiet sleep.   Nurses can facilitate the breast crawl by providing patient educaton prenatally as well as intrapartally, opportunities for the breast crawl and don’t rush him to do feeding within one hour, navigate barriers,  Cesarean  is one barrier and baby should be given to father and then to mother when fully alert. She says there are two risks:  bed sharing and falls.  Observation should be vigilant at all times, and bed sharing which is encouraged because it increases duration of breastfeeding and UNICEF/BABY FRIENDLY says when baby is in bed with mother and mother is sleeping, “it’s only necessary to provide intermittent observation to monitor for any immediate environmental dangers and promote a safe sleep environment (UNICEF UK BFHI 2004).  Do not permit sleeping on couch or recliner, only on firm mattress with light blankets, well-fitting sheet and no bulky objects around baby. No smoking, no ETOH use, no substance use (alters response or sensitivity to newborn).  She gives guidance for prevention of falls, i.e. low bed,, head of bed <45 degrees, tucking in linens, no sleeping between parents, mother sleeping on side to enclose baby and let baby roll onto back after feeding. (pg. 305).  Hospitals can promote the breast crawl by educating nurses, get help gaining experience, adequate staffing, encouragement from  management.   Full term, birth KC, cesarean,  KC goal,  Newborn reflexes, prefeeding behaviors, oxytocin,  bed sharing,  barriers, educate nurses, blood glucose, BF difficulties, c/s, paternal KC, guidelines from USBC and AAP, safety, falls,  implementation, sudden infant collapse/life threatening events. THIS IS A BEST ARTICLE

 

Anderson, G.C., Chang, H-P., Behnke, M., Conlon, M. & Eyler, F.P. (1995).  Self-regulatory mothering (SR) post-birth. Effect on and correlation between infant crying and salivary cortisol.  Pediatric Research, 34(4), part 2, (Abstract 57), 12A. . Not a KC study per se.   In a randomized controlled trial (N=224), full term infants who were separated from their mothers at 60 minutes post-birth cried twice as much between 60 minutes and 300 minutes (1 and 5 hours), compared to infants who remained with their mothers.  The separated infants also had salivary cortisol levels that were twice as high at 5 hours .  FT, RCT, crying, separation,   Not on charts because not KC.

Labor and Delivery

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