References:
Abstract 1:
Premise: Providing postpartum rooming-in increases the amount of maternal-child contact. The extended interaction leads to intimate touching and helps to foster the maternal-child affection.
Research Hypothesis: Mothers who delivered in a hospital that provided early and extended infant contact in a rooming-in setting would have more positive mother-infant interactions than mothers who delivered at a facility that offered early, but minimal, contact.
Subjects: A total of 31 unmarried first-time mothers who were between the ages of 16-22 years. Predominantly African American with low socioeconomic status, who experienced uncomplicated pregnancy and delivered healthy full-term infants.
Study Design: Fifteen mothers roomed in with their infant while 16 only had minimal contact. The two groups were equal in regards to substance use and in factors such as prenatal and postpartum plan of care. Both groups bottle-fed their infants. Mothers entered the study during hospitalization. The mothers were told that they were being observed interacting with their infants. Mothers were observed for 15 minutes after a morning feeding, approximately 18 hours after delivery. The observer monitored 13 items such as holding, talking, touching, and attentiveness and completed a Maternal Touching Checklist.
Findings: Rooming-in mothers looked at and talked more to their infants. They talked less with others, watched less television, and spent less time on the phone. Rooming-in mothers also demonstrated more intimate touching behavior such as palming, as opposed to the minimal contact group that lightly touched their infant. Rooming-in mothers touched more intimate areas of the infant such as the face and head when compared to the minimal contact group. Results indicate that more intimate touching by the rooming-in mothers suggests that they have developed a more familiar and comfortable relationship with their infant than the mothers with limited contact. No differences in holding, cradling, and rocking behavior were observed between the two groups.
Research reviewed by Suzanne Winder, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 2:
Premise: To determine whether or not early contact between infants and mothers in the first few hours postpartum affects attachment by studying the behavior of infants by using the Brazelton Neonatal Behavior Assessment Scale (BNBAS) between two similar groups of women.
Research Question: Does early contact have an additional effect on mother’s affectionate behavior and on infant’s performance on the BNBAS.
Background: The focus of this study was on effect of early contact between the mother and infant. Half of the group followed the usual hospital routine of separation for clinical observation and tasks; half of the group was provided early contact following birth. Both groups had permanent rooming-in beginning at 6 hours postpartum.
Subjects: A total of 60 primiparous women with selection criteria of: intention to breastfeed, white, Portuguese nationality, ages 18 to 35 years, living with baby’s father for at least one year, low/medium social class, uncomplicated pregnancy, 38 to 42 weeks pregnancy, and labor not lasting more than 24 hours. All had identical labor analgesics (50-mg. pethidine, 100-mg. promethazine), vaginal delivery, minimum Apgar score of 8 at one minute, 10 at five minutes, and infant weight between 10th and 90th percentile. Sex distribution of infants was equal (although this was only coincidental). The group was separated randomly in half.
Study Design: Direct observation (15 minutes) of mothers and infants during feeding on the first day in the hospital, third day in the hospital, and the 28th day at home.
Findings: Scores were similar (using the Mann-Whitney test) for the 1st day in the hospital during feeding for both groups. Significantly higher interactive processes were found on the 3rd and 28th days for the mother-infant group that was provided early contact. Mothers in the experimental group had a greater tendency to soothe their infants when they cried. On the 28th day observations, the mothers in the experimental group scored significantly higher in the affectionate behavior dimension as well. No differences were found between the experimental and control groups with regard to infants’ behavior directly observed during feeding.
Research reviewed by Inga McDonald, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 3:
Premise: Extra skin-to-skin contact in the first hour postpartum is linked to positive growth and development of the infant and the mother-infant bond.
Research Hypothesis: Whether or not a link exists between extra contact of the mother and infant in the first postpartum hour and the growth and development of the infant and the mother-infant bond.
Background: Close, uninterrupted contact between mother and infant in the first hour postpartum was found to increase the development and growth of the infant, as well as the mother-infant bond.
Subjects: A total of 42 mother-infant pairs. All mothers were primiparous women, aged 20 to 29 years. Their length of pregnancy was 38 to 42 weeks. None of the mothers had a history of previous abortion or miscarriage. None were taking medication apart from supplementation with iron and vitamins during pregnancy. Each experienced normal weight gain, normal blood pressure and Hb percentage, and no proteinuria, Each spontaneously started labor, with the duration of labor no more than 24 hours. Each was given no more than 200 mg. pethidine (or equivalent) 1-6 hours before parturition.
Study Design: Prospective longitudinal study with follow-up at one year. At the one-year study evaluation, nine mother-infant pairs were lost to factors such as relocation, unwillingness to return, or employers not allowing a day off.
Findings: At one year, mothers who were provided extra contact with their infants postpartum displayed more empathy towards their infants and expressed more body postures indicative thereof (holding infant closely to body). Mothers with male children had overall greater responses. No significant differences existed between groups in psychomotor development; however, a trend did exist in that the P+ group was ahead in four of the five parts of the psychomotor testing.
Research reviewed by Inga McDonald, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 4:
Premise: That delivery ward routines affect the success of first breastfeed.
Research Hypothesis: Development of correct or incorrect breastfeeding technique depends on delivery ward routine.
Subjects: A total of 80 mothers were asked to participate; 72 mothers consented. All women had uncomplicated pregnancies, spontaneous deliveries, and a minimum of 9 or 10 on 5-minute Apgar. All infants had normal birth weights.
Study Design: Direct observation of infants and mothers in the first two hours postpartum during feeding. Successful sucking was classified as infant opening mouth wide, with its tongue under the areola, and milk being expressed from the breast with deep sucks.
Findings: Greater rates of successful infant sucking are observed when contact between mother and infant is uninterrupted during the first hour after birth or before the first breastfeed has been accomplished. The use of drugs during labor, such as pethidine, affected infants’ ability to suck at the breast in the first hour postpartum.
Research reviewed by Inga McDonald, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 5:
Premise: Clothing the infant slows the speed with which the mother develops intimate maternal touch.
Research Questions: During the first 18 hours of life, will mothers of undressed infants progress through stages of maternal touch faster than mothers of dressed infants? Will multipara mothers progress through stages of maternal touch faster than primipara mothers?
Background: Early tactile touch enters into the infant’s patterns of learning.
Subjects: Twenty-four mothers-infant pairs from uncomplicated labors, first or second infant, and at least 38 weeks gestation and without apparent complications or abnormalities.
Study Design: The data were gathered with a video camera mounted on a tripod to record a 12-minute interaction. The camera was set up before the infant was brought into the room, then the infant and mother were videotaped for 12 minutes without interruption.
Findings: Four stages of maternal touch were defined: a) Mother uses one-finger touch to infant’s face and extremities; b) mother uses fingertips to touch baby’s trunk; c) mother touches the infant with her hand, including the palm; d) mother holds infant "en face" (infant against mother’s body, establishing eye contact). All mothers except one reached stage 1 during the first minute. The exception reached the first stage during the third minute. Stages 2, 3, and 4 were reached significantly faster with undressed infants than dressed infants. No significant differences were noted between multiparas and primiparas.
Research reviewed by Kay Liska, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 6:
Premise: Rooming in promotes maternal-child attachment earlier than in mothers not provided rooming-in opportunities.
Research Hypothesis: Mothers who experienced rooming in will have higher maternal attachment scores during monitored newborn feedings than a control group who gave birth prior to the availability of rooming in, and a control group who requested but did not receive the rooming-in facilities.
Background: The conceptual framework is based on Bowlby’s integrated theory of attachment and separation.
Subjects: A total of 80 rooming-in mothers, 35 mothers who wanted to room-in but did not, and 72 mothers who gave birth without rooming-in. All were first-time mothers and medically indigent. All had vaginal deliveries of term infants, uncomplicated labor and deliveries, and an uncomplicated postpartum course.
Study Design: Mothers entered the study during hospitalization. Rooming-in infants remained with the mothers all day. All other infants were taken to the mother’s room every four hours for approximately 45 minutes for feedings. The study was explained to mothers and consent was obtained. Mothers were primarily observed during the 9 a.m. feeding on the second or third postpartum day for the first 30 of 15 consecutive minutes. Maternal-infant attachment was measured by the Maternal Attachment Behavior Scale, which monitored for affection, proximity, care taking, and attention.
Findings: Using analysis variance, rooming-in mothers scored higher on maternal attachment test than the non-rooming-in group and higher than the group of mothers that wanted to room in and could not. Rooming-in scores, 88.9 (+/-20.6); wanted-to-room-in, 80.2 (+/- 19.9); non-rooming-in, 82.2 (+/- 21.0). Results indicate that rooming in helps first-time mothers form early attachments to their newborns. All mothers, and especially mothers at risk for parenting/attachment issues, including low income and adolescent mothers, can benefit from a rooming-in environment.
Research reviewed by Suzanne Winder, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 7:
Premise: The greater amount of contact between mother and child provided in facilities that offer rooming-in leads to a closer mother-child relationship measured by feeling and thought toward the infant and in the mother’s ability to competently care for the infant.
Research Hypothesis: The greater the period of contact between mother and infant during the postpartum period, the less time is required for development of an affectional mother-child relationship.
Subjects: A total of 20 mothers: 10 rooming-in and 10 in a maternity ward. All of the participants were first-time mothers, married, and interviewed on the second day postpartum.
Study Design: Occurred over an 8-week period on Tuesdays and Thursdays. Mothers selected from the census book approximately 48 hours postdelivery. Charts were reviewed and staff was consulted. Patients were informed about the study and permission was obtained. A single person conducted private interviews using an open-end questionnaire. The questionnaire covered topics such as mothers’ thoughts, feelings, and beliefs about pregnancy and delivery, preference of rooming-in, experience with children, and concerns about caring for a newborn infant.
Findings: Socioeconomic variables were equally distributed between the two groups. Nine out of 10 mothers on the maternity ward were concerned about basic infant care after discharge. One mother in the rooming-in unit was concerned about discharge and infant care. Rooming-in mothers were more interested in long-term concerns such as a sick child. All 10 rooming-in mothers believed they would not feel as close to their infant if they were on the maternity ward. Five of the maternity ward mothers believed they would feel closer if they had experienced rooming-in. Infant contact hours rooming-in: 14. Maternity ward contact hours: 2. Mothers who received the benefits of more contact hours with their infant provided in a rooming-in unit felt closer to their infants and demonstrated a greater level of competence and confidence in newborn care activities.
Research reviewed by Suzanne Winder, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 8:
Premise: The postnatal cry may be a human counterpart to the separation distress call, as observed in many mammalian species upon separation.
Research Question: Do infants have the ability to recognize their being physically separated from their mother?
Background: Mammals elicit distress signals when separated from maternal contact and continue until comfort support is elicited. Human neonates express a similar distress signal by crying.
Subjects: A total of 44 full-term, healthy infants without visible malformations whose mothers experienced an uneventful pregnancy and uncomplicated vaginal delivery.
Study Design: In a randomized trial, the newborn’s cry was registered during the first 90 minutes after birth. Fourteen infants were kept on a cot, 15 infants received skin-to-skin contact with the mother, and 15 were placed on a cot for the first half then switched to maternal contact for the second half. All periods were tape-recorded.
Findings: Human infants recognize physical separation from their mothers and start to cry. Crying stopped at reunion. The most appropriate location of the healthy, full-term newborn baby after birth is in close contact with the mother.
Research reviewed by Melissa Vaughan, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.