Expanding on Step 7, regarding 24-hour rooming-in with mother and infant, we'll look at a study about rooming-in. Tully and Ball (2012) researched the effect of a side-car bassinet on postnatal unit breastfeeding frequency and other maternal-infant behaviors compared to a stand-alone bassinet following cesarean birth. They explain, "Cesarean birth presents a practical barrier to breastfeeding due to limited maternal mobility and persistent postpartum maternal pain".
Despite the high incidence of cesarean, little is known about how hospital practices contribute to or compound the adverse effects of this childbirth context on the establishment of breastfeeding. For the study, a total of 35 mothers were recruited in northeast England over a two year period and randomized into the two types of sleep surfaces. All mothers were exclusively breastfeeding. Nighttime interactions were videotaped and all mothers were interviewed at the end of their study period.
"Mothers expressed overwhelming enthusiasm for the side-car. Participants who received the stand-alone bassinet spontaneously offered that the intervention "would have made a huge difference.” Most women (29 of 35) reported that the bassinet types affected their interactions with their infants...Maternal accounts of their experience indicated breastfeeding after cesarean childbirth is constrained by inability to easily access their newborns while rooming-in. The side-car provided maternal benefit through 'easier,' but not more frequent, breastfeeding." Research documents well the physical barriers the post-surgical delivery mother may have in accessing her infant for frequent in-hospital feeds. Additionally, this provides significant safety issues.
Although the ease of infant access was noted in this study, the sleep surface itself did not have a statistically significant difference on breastfeeding frequency or duration. In their conclusion, the authors state, "Decisions about appropriate postnatal unit arrangements should take into account that families will have individualized needs. Acknowledgment of the risks associated with cesarean does not currently extend to breastfeeding disruption or infant handling issues, despite the extensive debate over the trade-offs of cesarean in relation to vaginal birth. The stand-alone bassinet may not just be inconvenient for mothers after a cesarean, it may be an unnecessary breastfeeding obstacle and institutionalized risk for infants."
What does your birthing unit currently use for infant sleeping surfaces? Do you use the side-car bassinet? Do you allow co-bedding? What are your feelings and ideas about how to provide safety as well as convenience for the breastfeeding cesarean mother and her infant?
The research study was originally printed in The Journal of Human Lactation but can be accessed free-of-charge here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746007/
Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA CHC
Professional Development Educator
Tully, K.P. and Ball, H.L. (2012). Postnatal unit bassinet types when rooming-in after cesarean birth: Implications for breastfeeding and infant safety. Journal of Human Lactation, 28(4):495-505.
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