#6: no separation of mother and baby with unlimited opportunity for breastfeeding

In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the value of keeping mothers and their babies together from the moment of birth is discussed and presented as an evidenced-based practice that helps promote, protect, and support normal birth. The paper is written for childbearing women and their families. Babies held skin-to-skin with their mothers cry less often, breathe easier, and stay warmer than babies who are separated from their mothers. They also instinctively attach to the breast and begin breastfeeding, usually within one hour of birth. The advantages of rooming-in for mother and baby are also discussed. The accompanying commentary-written by two leading professionals in the field of maternity care and pediatrics-provides further evidence to support the practice of keeping mothers and their babies together after birth. Lamaze International encourages women to give birth in settings that do not separate mothers and babies after birth.     

Healthy Birth Practice #6: Keep Mother and Baby Together— It’s Best for Mother,Baby, and Breastfeeding

Mothers and babies have a physiologic need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and babies together is a safe and healthy birth practice. Evidence supports immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. Unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding,” published in The Journal of Perinatal Education, 16(3), 2007.     

Research summaries for normal birth

In this column, the author summarizes four research studies that contribute to the body of literature on the benefits and physiology of normal childbirth. The topics of the studies include the effect of digital rotation of the baby in occipito-posterior position on position at birth and birth outcomes; temperature disturbances during skin-to-skin contact among babies exposed to epidural analgesia and exogenous oxytocin during labor; the prevalence of and motivations for "maternal request" cesarean surgery; and the benefits of delayed clamping of the umbilical cord after birth.     

Deconstruction Junction: How to Separate the Good Evidence From the Bad (From the Ugly)

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the need to look closely at research articles to avoid being misled. Examples include new research on the effectiveness of intrapartum antibiotics for preventing early onset Group B streptococcal disease in newborns, a recent study on the incidence of infection after cesarean surgery and vaginal birth, and a new study demonstrating long-term benefits of skin-to-skin contact between the mother and infant after birth.     

Research summaries for normal birth

In this column, the author summarizes four research studies relevant to normal birth. The topics of the studies include the clinical and behavioral benefits of skin-to-skin contact after birth; the effect of a group model of prenatal care on preterm birth risk and breastfeeding success; the harmful effects of a brief interval of electronic fetal monitoring at hospital admission; and barriers to access to midwifery care.     

Extended households and the life course of young mothers: understanding the associations using a sample of mothers with premature, low birth weight babies

This paper examined whether the greater average schooling and employment, and lower parenting competence, of young mothers who reside with adult relatives reflect preexisting differences versus potential causal mechanisms. The sample included 554 young mothers (ages 13 to 25; nearly two thirds African American) from the Infant Health and Development Program (IHDP) a random-assignment intervention study of premature, low birth weight babies followed 8 times from birth to age 3. Ordinary least squares, fixed-effects, and random-effects models indicated that young mothers of low birth weight babies sorted into extended households based on preexisting characteristics that were correlated with their lower parenting skills and knowledge. In contrast, coresidence predicted greater schooling or employment across models, with some variations for different subgroups.     

Safe and healthy birth: the importance of data

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses the mismatch between data commonly collected at the time of birth and the data needed to measure optimal care for physiologic birth. Selections include the importance of documenting duration of skin-to-skin contact after birth, the role of qualitative research in improving care in the second stage of labor, and pitfalls of meta-analyzing data on the safety of planned home birth.     

The social ecology and early parenting of Caucasian adolescent mothers

Social characteristics, maternal behaviors, and the home environments of Caucasian adolescent and nonadolescent mothers were investigated in a sample of 50 primiparous low- and middle-class women and their 4-month-old infants. The mothers were interviewed about their child-care network and about stressful life events that may have occurred since the infant's birth. The HOME inventory was completed and videotapes of 2 hours of home observations were coded to assess maternal proximity, verbalizations, activity, and physical contact with the infant. Interview data indicated that adolescent mothers relied more frequently on other teenagers and other network members for help in child care than nonadolescent mothers. In addition, they also received more frequent support from their mothers and less frequent help from their partner's and partner's mother and siblings than nonadolescent mothers. During the home visit, they were less verbal with their infants and scored significantly lower on the Responsiveness and Maternal Involvement subscales as well as on the total HOME inventory; these results were replicated on subgroups matched for socioeconomic status, emphasizing the unique social context and parenting practices of teenage mothers.     

Innovation in Practice: Preparing Doulas to Support Cesarean Births

Despite growing initiatives to support patient-centered labor and birth care, implementation of this care in the operating room is still limited. Doulas can be utilized in the operating room to facilitate evidence-based practices such as skin-to-skin contact for patients and newborns during cesarean birth. This article evaluates a curriculum and training method that was developed to educate doulas to provide safe and effective care during the cesarean birth experience. This intervention was found to be effective at improving doulas'' self-perceived confidence in skills essential to support cesarean births and may serve as a model for other institutions to address barriers to the implementation of patient-centered evidence-based care in the operating room.     

Continuing Education Module: Persuasion: The Key to Changing Women's Ideas About Birth

Although standard maternity care is not evidence-based and, in many cases, increases risks for mothers and babies, few women make birth decisions that reflect this knowledge. This column discusses persuasion as a way to change women''s ideas about safe, healthy birth. The relationship between persuasion and choice is discussed, and the differences between presenting information and persuading women that natural birth is the safest and healthiest way to give birth are explored.     

Some factors affecting mother-child relationships following low birthweight delivery in a Nigerian sociocultural environment

Twenty mothers with low birthweight babies, cared for in a neonatal unit and kept in incubators (as index group) and 20 mothers with full-term babies (as control group) were studied to determine the extent of maternal separation and deprivation following delivery and the effects of these on mother-child relationships. The population was prospectively sampled and an interview method using a structured questionnaire, was adopted to obtain the information for the study. The result showed a delayed post-partum contact, negative reactions and some delays in maternal attachment in mothers of premature infants. Nevertheless, some degree of adjustment in the mother-child relationship, as shown by some positive perceptions of the infants, took place 6 months after leaving hospital. Other social and cultural factors that may contribute to the negative reactions of the mothers to premature delivery are highlighted.     

Risk,Safety, and Choice in Childbirth

In this column, the author explores current understandings of risk and safety in pregnancy and childbirth. An emphasis on risk management places the provider and hospital in control of women’s decisions related to pregnancy and birth and may make pregnancy and birth less safe for mothers and babies. Accepting that no life is risk free, women can let go of fear and make choices that take into account real, not imagined, or exaggerated risk and, in doing so, increase safety for themselves and their babies. The focus of maternity care becomes enhancing safety through evidence-based practice rather than managing risk.     

Attachment for Infants in Foster Care: The Role of Caregiver State of Mind

The concordance between foster mothers' attachment state of mind and foster infants' attachment quality was examined for 50 foster mother-infant dyads. Babies had been placed into the care of their foster mothers between birth and 20 months of age. Attachment quality was assessed between 12 and 24 months of age, at least 3 months after the infants' placement into foster care. The two-way correspondence between maternal state of mind and infant attachment quality was 72%, kappa = .43, similar to the level seen among biologically intact mother-infant dyads. Contrary to expectations, age at placement was not related to attachment quality. Rather, concordance between maternal state of mind and infant attachment was seen for relatively late-placed babies, as well as early placed babies. These findings have two major implications. First, following a disruption in care during the first year and a half of life, babies appear capable of organizing their behavior around the availability of new caregivers. Second, these data argue for a nongenetic mechanism for the intergenerational transmission of attachment.     

New Resources for Childbirth Educators and Parents

In this column, reviewers offer perspectives and comments on a variety of new media resources for childbirth educators and for expectant and new parents. The books, CD, and DVDs reviewed in this issue''s column address the following topics: natural, safe, and healthy birth practices; doula care; breastfeeding; empowering women to make healthy lifestyle choices during pregnancy; encouraging mothers to bond with their babies before birth; and fathers'' and partners'' supportive role during labor and birth.     

Literacy 8–12 months: what are babies learning?

Shared book reading in families is strongly linked with successful school literacy and thus with identity, belonging and participation in literate societies. From an ‘emergent’ perspective, literacy is recognised as beginning from birth. However, despite exceptions such as research into the UK program, ‘Bookstart’, most research into shared book reading does not focus on babies. In this paper, I report on interactions during shared book reading between 10 babies aged 8–12 months, and their mothers. A detailed examination of linguistic and paralinguistic features of the interactions in the ten mother–baby dyads showed varying individual patterns of language use, discourse structure and paralinguistic interaction. There were also differences in children's dispositions to engage in the activity. The findings from this study have important implications for parent support, prevention/intervention programs, and early childhood settings that include infants and toddlers.     

攀枝花市出生缺陷的现况调查

目的：掌握攀枝花市出生缺陷发生率,了解出生缺陷分布特征、影响因素、发生原因等,制定预防出生缺陷实施方案,提高出生人口素质。方法：按照“攀枝花市出生缺陷监测方案”的要求,在攀枝花市所有出生缺陷监测单位对2008年10月1日至2011年9月30日出生的围产儿进行监测。结果：共监测30111例围产儿,胎龄28周以上出生缺陷381例,出生缺陷发生率为126．5／万;男性出生缺陷发生率高于女性,差异具有统计学意义（x2=11．49,P〈0．01）;出生缺陷儿母亲各年龄组间差异无统计学意义。攀枝花市出生缺陷主要为总唇裂、多指（趾）、外耳畸形等。结论：攀枝花市三年来出生缺陷发生率呈下降趋势;全面实施出生缺陷干预措施,认真落实“三级预防”措施、强化孕期保健是减少出生缺陷发生的关键。     

Fathers' birth attendance, early contact, and extended contact with their newborns: a critical review

Research concerning fathers' birth attendance, early contact, and extended contact with newborn infants is reviewed in this paper. Relationships between fathers' early history with infants and subsequent patterns of involvement are discussed. The methodological challenges of studying the effects of fathers' birth attendance and early contact with infants are considered. In contrast to popular belief, no conclusive statements can be made at this time concerning the effects of paternal birth attendance, early contact, and extended contact on father involvement in infancy. Implications for future research and policy-making are discussed.     

Factors associated with exclusive breastfeeding 2 to 4 weeks following discharge from a large, urban, academic medical center striving for baby-friendly designation

Substantial evidence documents the superiority of breastfeeding for mothers and breastmilk for babies. Although the American Academy of Pediatrics and the U.S. Healthy People 2010 initiative promote breastfeeding, current breastfeeding rates often fall short of recommendations. This study determined factors associated with exclusive breastfeeding 2 to 4 weeks following discharge from a large, urban, academic medical center striving for Baby-Friendly designation. Results indicated that mothers who breastfed within the first hour of birth (61%) were significantly more likely to be exclusively breastfeeding 2 to 4 weeks after discharge. Incorporating care practices that include a number of the "Ten Steps to Successful Breastfeeding," as recommended by the Baby-Friendly Hospital Initiative, may increase the duration of exclusive breastfeeding after discharge.     

Effects of a prenatal care intervention for adolescent mothers on birth weight, repeat pregnancy, and educational outcomes at one year postpartum

About one-third of adolescent mothers receive inadequate prenatal care, and babies born to young mothers are more likely to be of low birth weight. The objective of this study is to evaluate a peer-centered prenatal care program for adolescent mothers. Pregnant adolescents were randomly assigned to an experimental or control group in a mastery modeling peer-support intervention designed to improve long- and short-term perinatal outcomes. A sample of 282 urban pregnant adolescents (94% African American, 4% Caucasian, 2% other) participated in the study. Participants were recruited from five clinics located mainly in Detroit, Michigan. Participants in the experimental group received care in a small group setting and learned to perform critical measurements with a peer partner during prenatal visits. Participants in the control group received individual prenatal care in the same clinics. Outcome measures included birth weight, years of schooling completed at one year postpartum, planned and unplanned pregnancy at one year postpartum, and employment and school attendance at one year postpartum. Mothers in the experimental group had a lower rate of low birth weight (6.6% vs. 12.5%, p=0.08). The rate of unplanned pregnancy was also lower for adolescents in the experimental group (13.4% vs. 15.9%), although this difference was not statistically significant. Adolescents who participated in the intervention were more likely to have continued their education during the pregnancy and the postpartum year. The mastery modeling, peer-centered, prenatal care program produced some positive pregnancy outcomes for adolescent mothers.