Högskolan i Skövde

Aim: This study investigated if a process-oriented training for health professionals will influence women's use and reasons for using a nipple shield, the baby's weight, and the duration of breastfeeding.

Materials and Methods: An intervention was performed for health professionals that included a process-oriented training program on breastfeeding support. Primiparas living in either the intervention municipality or in a control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with those for the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, at 3 months, and at 9 months postpartum.

Results: The mothers' use of nipple shields related to the finding that if the women had a higher body mass index in the beginning of the pregnancy, the babies had difficulty in grasping over the nipple, and the mothers had pain or wound on the nipple. For the mothers in the IG group, there was no significant difference if they had used nipple shields or not in relation to breastfeeding duration. In contrast, the mothers in the control groups had a significant shorter breastfeeding duration if they had used nipple shields. In the IG, there were no significant difference between the use of nipple shields and the babies' weights at 3 or 9 months. The babies of women in the CGB who used nipple shields had a significantly lower weight at 3 months than the babies of those who did not use nipple shields (p=0.02).

Conclusions: A process-oriented training in breastfeeding counseling prolongs the duration of breastfeeding for women with breastfeeding problems, where the problems are remedied by the use of nipple shields.

Abstract Aim: The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session, introduction of breastmilk substitutes and solids, and the duration of breastfeeding. Materials and Methods: Ten municipalities in Sweden were randomized to either the intervention or control groups. The intervention included a process-oriented training program for midwives and postnatal nurses in the intervention municipalities. Primiparas (n=540) living in either an intervention or control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, 3 months, and 9 months postpartum. Results: As a result of the process-oriented training program for midwives and postnatal nurses, the IG mothers had a significantly longer duration of exclusive breastfeeding, even if the initial breastfeeding session did not occur within 2 hours after birth, than the corresponding group of CGA mothers (p=0.01). Fewer infants in the IG received breastmilk substitutes (in the first week of life) without medical reasons compared with the control groups (p=0.01). The IG infants were significantly older (3.8 months) when breastmilk substitutes were introduced (after discharge from the hospital) compared with the infants in the control groups (CGA, 2.3 months, p=0.01; CGB, 2.5 months, p=0.03). Conclusion: A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital.

Background and Aims: In this study we made a detailed analysis of the mothers' release pattern of adreno-corticotropic hormone (ACTH) and cortisol during a breastfeeding session during the second day postpartum and related these patterns to maternal oxytocin levels as well to the duration of sucking and the duration of skin-to-skin contact before sucking the breast. Furthermore, we investigated if epidural analgesia and oxytocin administration during and after labor influenced the release pattern of ACTH and cortisol.

Methods: Sixty-three primiparae were included in the study. Fourteen received oxytocin intramuscularly postpartum, nine received oxytocin infusion, 14 received epidural analgesia combined with oxytocin infusion, and six received epidural analgesia alone. Twenty mothers did not receive any of these medical interventions. Blood samples were analyzed for ACTH and cortisol by enzyme-linked immunoassay.

Results: Both ACTH and cortisol levels fell significantly during the breastfeeding session. A significant negative relationship was found between oxytocin and ACTH levels, but not between oxytocin and cortisol levels. A contact before onset of sucking was significantly and negatively associated with lower cortisol levels, but not with ACTH levels. Cortisol levels differed significantly between mothers having received epidural analgesia with and without oxytocin.

Conclusions: Breastfeeding is associated with a decrease of ACTH and cortisol levels. Skin-to-skin contact contributes to this effect. ACTH correlated negatively with the duration of sucking and median oxytocin levels, whereas cortisol levels correlated inversely with the duration of skin-to-skin contact preceding sucking, suggesting a partial dissociation between the mechanisms regulating ACTH and cortisol release. In addition, medical interventions in connection with birth influence the activity of the hypothalamic-pituitary-adrenal axis 2 days after birth.

Objective: This study investigated possible influences of medical interventions during labor on maternal blood pressure during a breastfeed 2 days postpartum.

Subjects and Methods: Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at –5, 10, 30, and 60 minutes during a morning breastfeed 2 days postpartum. Five treatment groups were formed based on the medical interventions received during labor: Non-medicated mothers (Control group, n=21); mothers receiving epidural analgesia (EDA) with oxytocin (OT) stimulation (EDA^OT group, n=14); mothers receiving EDA without OT stimulation (EDA^non-OT group, n=7); mothers receiving OT stimulation only (OT intravenously [iv] group, n=9); and mothers receiving 10 IU of OT intramuscularly (im) only (OT im group, n=15).

Results: Baseline diastolic, but not systolic, blood pressure differed between the groups as displayed by significantly lower diastolic blood pressure in the EDA^non-OT group compared with the Control group, the OT iv group, and the EDA^OT group (p=0.045, p=0.041, and p=0.024, respectively). Both systolic and diastolic blood pressure fell significantly during the breastfeeding session in the Control group (p=0.001 and p=0.004, respectively), the OT im group (p=0.006 and p=0.001, respectively), and the EDA^OT group (p=0.028 and p=0.002, respectively), and the fall in diastolic blood pressure tended to be significant in the OT iv group (p=0.050). The duration of skin-to-skin contact before breastfeeding correlated positively with the decrease in systolic blood pressure in the OT im group (R_s=0.540, p=0.046).

Conclusion: Administration of EDA during labor lowers baseline diastolic blood pressure and abolishes the fall in blood pressure in response to a breastfeed 2 days after birth.

Background: Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. The aim of the present study was to make a detailed analysis of maternal release of oxytocin and prolactin in response to breastfeeding during the second day postpartum in mothers who had received oxytocin either intravenously for stimulation of labor or intramuscularly for prevention of postpartum hemorrhage and/or epidural analgesia or those who had received no such treatment in connection with birth.

Methods: In a descriptive comparative study plasma oxytocin and prolactin concentrations were measured in response to suckling during the second day postpartum in women who had received intravenous intrapartum oxytocin (n = 8), intramuscular postpartum oxytocin (n = 13), or epidural analgesia, either with (n = 14) or without (n = 6) intrapartum oxytocin infusion, and women who received none of these interventions (n = 20). Hormone levels were analyzed by enzyme immunoassay.

Results: All mothers showed a pulsatile oxytocin pattern during the first 10 minutes of breastfeeding. Women who had received epidural analgesia with oxytocin infusion had the lowest endogenous median oxytocin levels. The more oxytocin infusion the mothers had received during labor, the lower their endogenous oxytocin levels were during a breastfeeding during the second day postpartum. A significant rise of prolactin was observed after 20 minutes in all women, but after 10 minutes in mothers having received oxytocin infusion during labor. In all women, oxytocin variability and the rise of prolactin levels between 0 and 20 minutes correlated significantly with median oxytocin and prolactin levels.

Conclusion: Oxytocin, released in a pulsatile way, and prolactin were released by breastfeeding during the second day postpartum. Oxytocin infusion decreased endogenous oxytocin levels dose-dependently. Furthermore, oxytocin infusion facilitated the release of prolactin. Epidural analgesia in combination with oxytocin infusion influenced endogenous oxytocin levels negatively.

Background and aims: The benefits of breastfeeding for infants are well known. Recently data have started to emerge showing that breastfeeding may also induce positive effects in the mother. This study aimed to investigate the pattern of maternal blood pressure before, during, and after a breastfeed 2 days postpartum. Additionally,blood pressure during the following 25-week breastfeeding period was investigated.Methods: Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at –5, 10, 30, and 60 minutes in connection with a morning breastfeed. Thirty-three women continued to measure blood pressure before and after breastfeeding for 25 weeks.Results: Blood pressure fell significantly in response to breastfeeding 2 days after birth. The fall in systolic and diastolic blood pressure amounted to 8.8 (SD=11.00) and 7.7 (SD=9.3) mm Hg, respectively. During the 25-week follow-up period a significant fall of basal blood pressure (systolic, df=3, F=7.843, p<0.001; diastolic, df=3, F=5.453, p=0.002) was observed. The total fall in systolic and diastolic blood pressure amounted to a mean of 15 (SD=10.4) mm Hg and 10 (SD=9.7) mm Hg, respectively. In addition, blood pressure fell significantly in response to individual breastfeeding sessions during the entire observation period.Conclusions: In conclusion, both systolic and diastolic blood pressures fall during a breastfeeding session, and pre-breastfeeding blood pressure decreased during at least the first 6 months of a breastfeeding period in a homelike environment. This study lends further support to the health-promoting effects of breastfeeding.