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Gerhardsson, E., Oras, P., Mattsson, E., Thernström Blomqvist, Y. & Funkquist, E.-L. (2023). Health care professionals report positive experience with a breastfeeding training program based on the Baby-Friendly Hospital Initiative for Neonatal Intensive Care. Journal of Perinatal & Neonatal Nursing, 29(1), 75-80
Open this publication in new window or tab >>Health care professionals report positive experience with a breastfeeding training program based on the Baby-Friendly Hospital Initiative for Neonatal Intensive Care
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2023 (English)In: Journal of Perinatal & Neonatal Nursing, ISSN 0893-2190, E-ISSN 1550-5073, Vol. 29, no 1, p. 75-80Article in journal (Refereed) Published
Abstract [en]

Support from health care professionals (HCPs) with good knowledge and positive attitudes toward breastfeeding has been associated with better breastfeeding outcomes in the mothers of preterm infants. The aim of the study was to describe HCPs' experiences of a breastfeeding training program. A total of 48 specialist registered nurses, registered nurses, assistant nurses and physicians working at a neonatal intensive care unit attended a breastfeeding training program and answered a questionnaire including Likert scales and open-ended questions. The participants reported that their interest in breastfeeding had increased as a median (range) of 10 (8–10) on a 10-point scale and rated to what extent they had received new tools for breastfeeding support as a median of 10 (8–10) after training. There were no differences in the median between different professions' ratings. Qualitative content analysis of the open-ended questions resulted in two categories: Discussions of the case scenarios in the group and Knowledge regarding breastfeeding. The results showed that discussions based on breastfeeding scenarios were perceived as valuable; the health care professionals reported receiving new knowledge and useful practical skills. This program was shown to increase health care professionals’ interest in breastfeeding and is useful for different health care professions.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
attitudes, Baby-Friendly Hospital Initiative for Neonatal Intensive Care, breastfeeding support, healthcare staff, mother, preterm infant, training program
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-408018 (URN)10.1016/j.jnn.2022.02.008 (DOI)
Available from: 2020-04-02 Created: 2020-04-02 Last updated: 2024-06-14Bibliographically approved
Isacson, M., Thies-Lagergren, L., Oras, P., Hellström-Westas, L. & Anderssson, O. (2022). Umbilical cord clamping and management of the third stage of labor: A telephone-survey describing Swedish midwives’ clinical practice. European Journal of Midwifery, 6, 1-7, Article ID 6.
Open this publication in new window or tab >>Umbilical cord clamping and management of the third stage of labor: A telephone-survey describing Swedish midwives’ clinical practice
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2022 (English)In: European Journal of Midwifery, E-ISSN 2585-2906, Vol. 6, p. 1-7, article id 6Article in journal (Refereed) Published
Abstract [en]

Introduction:The timing of cord clamping impacts children’s short- and longterm well-being. When making clinical decisions, midwives incorporate their tacit and professional knowledge, experience and current evidence. There appears to be a lack of knowledge regarding Swedish midwives’ management of the third stage of labor and cord clamping practice. The aim of this study was to explore Swedish midwives’ clinical practice concerning umbilical cord clamping and the third stage of labor in spontaneous vaginal births.

Methods:The study was designed as a cross-sectional telephone survey including 13 questions. Midwives were randomly selected from 48 births units in Sweden. Two midwives from each unit were interviewed. The primary outcome was timing of umbilical cord clamping practice in full-term infants. Secondary outcomes were the management of the third stage of labor including prophylactic use of synthetic oxytocin, the timing of cord clamping in preterm infants, controlled cord traction, uterine massage, and cord milking.

Results:Altogether, 95 midwives were interviewed. In full-term infants, all midwives preferred late cord clamping. Considerable heterogeneity was seen regarding the practices of synthetic oxytocin administration postpartum, controlled cord traction, uterine massage or cord milking, and cord clamping in preterm infants.

Conclusions:Midwives in Sweden modify recommendations regarding delayed cord clamping in a way they might perceive as more natural and practical in their daily, clinical work. The study revealed a reluctance toward the administration of prophylactic oxytocin due to fear that the drug could pass to the infant. An overall large variation of the management of the third stage of labor was seen.

Place, publisher, year, edition, pages
European Publishing, 2022
Keywords
third stage of labor management, midwifery practice, prophylactic oxytocin, umbilical cord clamping, umbilical cord traction, vaginal delivery
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-487278 (URN)10.18332/ejm/145697 (DOI)000895919300002 ()35274089 (PubMedID)
Available from: 2022-10-27 Created: 2022-10-27 Last updated: 2023-01-25Bibliographically approved
Gerhardsson, E., Oras, P., Mattsson, E., Thernström Blomqvist, Y., Funkquist, E.-L. & Rosenblad, A. (2021). Developing the Preterm Breastfeeding Attitudes Instrument: a tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive car. Midwifery, 94, Article ID 102919.
Open this publication in new window or tab >>Developing the Preterm Breastfeeding Attitudes Instrument: a tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive car
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2021 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 94, article id 102919Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care.

Design: The study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme.

Setting and participants: A total of 70 specialist registered nurses, registered nurses, assistant nurses and physicians working at a Swedish neonatal intensive care unit answered 55 breastfeeding attitudes questions online before the training. The Preterm Breastfeeding Attitudes Instrument (PreBAI) consists of twelve of these 55 items/questions, selected using exploratory factor analysis.

Measurements and findings: Higher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the preand the post-test questionnaires, showing no significant difference. In the pre-test questionnaire, the majority of HCPs (84%) stated that they needed further breastfeeding training. They also stated that they perceived breastfeeding as very important, scoring a median of 10 (range 5-10) points on a 10-point scale. Three separate underlying dimensions were identified in the questionnaire, indicating different attitudes: Facilitating (five items), Regulating (four items), and Breastfeedingand skin-to-skin contact-friendly (three items). A positive correlation was found between how many years the HCPs had worked in neonatal care, and their PreBAI score (r(s) = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
attitudes, breastfeeding, healthcare professionals, instrument, preterm infant
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-408021 (URN)10.1016/j.midw.2020.102919 (DOI)000615888000001 ()33422884 (PubMedID)
Funder
Gillbergska stiftelsen
Available from: 2020-04-02 Created: 2020-04-02 Last updated: 2024-01-15Bibliographically approved
Oras, P., Ljungberg, T., Hellström-Westas, L. & Funkquist, E.-L. (2020). A breastfeeding support program changed breastfeeding patterns but did not affect the mothers' self-efficacy in breastfeeding at two months. Early Human Development, 151, Article ID 105242.
Open this publication in new window or tab >>A breastfeeding support program changed breastfeeding patterns but did not affect the mothers' self-efficacy in breastfeeding at two months
2020 (English)In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 151, article id 105242Article in journal (Refereed) Published
Abstract [en]

Background: Even though the biological norm in humans is frequent on demand breastfeeding,sparse feeding intervals have become the cultural norm in most Western countries due to a history of on schedule breastfeeding. This discrepancy between the biological basis and the culturally driven practice continues to interfere with women’s ability to breastfeed.

Aim: Our aim was to describe breastfeeding patterns in 2-month-old infants before and after the implementation of a breastfeeding support program. A secondary aim was to investigate the relationship between breastfeeding patterns and the mother’s self-efficacy in breastfeeding.

Methods: The study had a baseline/intervention design and was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding program. The larger project included breastfeeding training for health care professionals and provision of breastfeeding information to parents, including information about on demand breastfeeding. Data were gathered viabreastfeeding diaries (n=79 mothers from each group) and the Breastfeeding Self-efficacy Scale–Short Form (n=83 in the baseline group and n=79 in the intervention group).

Results: On demand breastfeeding patterns were more common in the intervention group (97.5%) than in the baseline group (74.7%) (p<0.001), and breastfeeding sessions were more frequent in the intervention group (a median of 14 times per 24 hours versus 11 times in the baseline group; p=0.026). Self-efficacy in breastfeeding did not differ between the groups, but was higher in mothers with exclusive breastfeeding.

Conclusions: Knowledge about infants’ breastfeeding behavior can strengthen on demand breastfeeding. Exclusive breastfeeding is associated with higher self-efficacy.

Keywords
human milk, infant feeding patterns, lactation management, mother-infant dyad
National Category
Pediatrics Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-421576 (URN)10.1016/j.earlhumdev.2020.105242 (DOI)000595858500002 ()33137580 (PubMedID)
Funder
Gillbergska stiftelsen
Available from: 2020-10-09 Created: 2020-10-09 Last updated: 2021-02-12Bibliographically approved
Oras, P. (2020). Care for the New-Born: Breastfeeding and Skin-to-Skin Contact. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Care for the New-Born: Breastfeeding and Skin-to-Skin Contact
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breastfeeding is associated with improved health in mothers and children and human milk is especially beneficial for preterm infants. The vast majority of pregnant women in Sweden intend to breastfeed, but breastfeeding rates are suboptimal, with even lower rates for preterm infants.

The overall aim of this thesis was to describe breastfeeding patterns of preterm and term infants and to evaluate an intervention based on the Ten steps to successful breastfeeding on breastfeeding outcomes.

In Paper I, mothers of preterm infants reported large variations in breastfeeding frequencies and patterns. The median breastfeeding frequencies from birth to six months ranged from 10–14 times per 24 hours with the majority practicing on demand breastfeeding.

In Paper II the median daily duration of skin-to-skin contact in preterm infants during the hospital stay was associated with earlier breastfeeding attainment. Infants commenced full breastfeeding at a median postmenstrual age of 35+0 weeks (range 32+1 to 37+5). Breastfeeding duration was shorter than national statistics.

Paper III describes the development and implementation of a breastfeeding support program for term and preterm infants using Intervention Mapping. The method was time-consuming, but allowed for a solid theoretical base, high involvement of stakeholders and was sufficiently comprehensive.

Paper IV included term infants at age two months and their mothers and consisted of a baseline group and intervention group. Mothers reported large variations in breastfeeding frequencies and patterns. Mothers in the intervention group breastfed more frequently, in median 14 times compared to 11 times in the baseline group, and they also practiced on demand breastfeeding to a larger extent. Mothers with exclusive breastfeeding reported higher self -efficacy.

This thesis provides a better understanding of breastfeeding patterns in preterm and term infants and it demonstrates that breastfeeding frequencies and on demand breastfeeding can be influenced with improved breastfeeding support. For preterm infants, breastfeeding attainment is facilitated by skin-to-skin-contact and they have the capability to breastfeed at a low postmenstrual age. This thesis also demonstrates a possible link between breastfeeding patterns and mothers’ ability to interpret infant cues. Intervention Mapping is a useful tool in the development of breastfeeding support programs.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1692
Keywords
Breastfeeding, Lactation, Human Milk, Newborn, Infant, Preterm Infant, Kangaroo Mother Care, Mother-infant interaction, Parent-Child Relations, Object Attachment, Self Efficacy, Implementation Science, Quality of healthcare, Quality improvement
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-421577 (URN)978-91-513-1039-8 (ISBN)
Public defence
2020-12-03, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2020-11-12 Created: 2020-10-14 Last updated: 2021-01-22
Oras, P., Thernström Blomqvist, Y., Hedberg Nyqvist, K., Gradin, M., Rubertsson, C., Hellström-Westas, L. & Funkquist, E.-L. (2016). Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants. Acta Paediatrica, 105(7), 783-789
Open this publication in new window or tab >>Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants
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2016 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 7, p. 783-789Article in journal (Refereed) Published
Abstract [en]

AIM:

This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored.

METHODS:

A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28+0 to 33+6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records and follow-up questionnaires were filled in by parents.

RESULTS:

The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35+0 (32+1 to 37+5) weeks of postmenstrual age and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p<0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding.

CONCLUSION:

A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.

Keywords
Breastfeeding duration; family-centred care; human milk; infant growth; Kangaroo mother care
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-289173 (URN)10.1111/apa.13431 (DOI)000378565100018 ()27100380 (PubMedID)
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2020-10-14
Oras, P., Thernström Blomqvist, Y., Hedberg Nyqvist, K., Gradin, M., Rubertsson, C., Hellström-Westas, L. & Funkquist, E.-L. (2015). Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks. Journal of Human Lactation, 31(3), 377-385
Open this publication in new window or tab >>Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks
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2015 (English)In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 31, no 3, p. 377-385Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support.

OBJECTIVE:

This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age.

METHODS:

As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions.

RESULTS:

In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8).

CONCLUSION:

Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.

National Category
Clinical Medicine Pediatrics
Identifiers
urn:nbn:se:uu:diva-254708 (URN)10.1177/0890334415586406 (DOI)000358070300010 ()25956792 (PubMedID)
Note

This study was supported by grants from the Regional Research Council in the Uppsala-Orebro region, Uppsala County Council, and Uppsala University Funds.

Available from: 2015-06-10 Created: 2015-06-10 Last updated: 2020-10-14
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1306-2281

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