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Notes: Background: Newborns not exposed to analgesia, when placed on the mother's chest, exhibit an inborn prefeeding behavior. This study was performed to assess the effects of different types of analgesia during labor on the development of spontaneous breastfeeding movements, crying behavior, and skin temperature during the first hours of life in healthy term newborns. Methods: Video recordings were made of 28 newborns who had been dried and placed in skin-to-skin contact between their mother's breasts immediately after delivery. The video recordings were analyzed blindly with respect to infant exposure to analgesia. Defined infant behaviors were assessed every 30 seconds. Group 1 mothers (n = 10) had received no analgesia during labor, group 2 mothers (n= 6) had received mepivacaine via pudendal block, and group 3 mothers (n= 12) had received pethidine or bupivacaine or more than one type of analgesia during labor.Results:All infants made finger and hand movements, but the infant's massagelike hand movements were less frequent in infants whose mothers had received labor analgesia. A significantly lower proportion of group 3 infants made hand-to-mouth movements (p 〈 0.001), and a significantly lower proportion of the infants in groups 2 and 3 touched the nipple with their hands before suckling (p 〈 0.01), made licking movements (p 〈 0.01), and sucked the breast (p 〈 0.01). Nearly one-half of the infants, all in groups 2 or 3, did not breastfeed within the first 2.5 hour of life. The infants whose mothers had received analgesia during labor had higher temperatures (p= 0.03) and they cried more (p= 0.05) than infants whose mothers had not received any analgesia.Conclusions:The present data indicate that several types of analgesia given to the mother during labor may interfere with the newborn's spontaneous breast-seeking and breastfeeding behaviors and increase the newborn's temperature and crying.

Notes: Background. Zambia, one of the world's poorest countries, also has one of the highest maternal mortality rates in the world. Most pregnant women in Zambia (96%) attend antenatal care, while 53% deliver at home. This may be related to socio-economic and cultural factors, but cultural childbirth practices and beliefs in Zambia have been little documented.Aim. The aim of this study was to explore cultural childbirth practices and beliefs in Zambia as related by women accompanying labouring women to maternity units. These social support women were also interviewed about their views on providing companionship to labouring women.Methods. Thirty-six women accompanying labouring women to urban and rural maternity units in Zambia were interviewed A thematic guide with closed and open-ended questions was used. EPI INFO, an epidemiological statistical software package, was used to analyse the quantitative data; qualitative data were analysed using content analysis.Findings. Eighteen of the women considered themselves to be mbusas, or traditional birth assistants and the rest said that they followed labouring women to maternity units. Those who considered themselves traditional birth assistants advised childbearing women on appropriate cultural childbirth practices and assisted with deliveries at home. They also advised women on the use of traditional medicine, for example, to widen the birth canal and to precipitate labour. If something went wrong during labour, they relied on traditional beliefs and witchcraft to explain the mishap and expected the woman in labour to confess her purported ‘bad’ behaviour. Twelve of the women were in favour of providing support to labouring women in maternity units and learning about childbirth care from midwives.Conclusion. These social support women, including those who considered themselves as mbusas, lacked understanding of the causes of obstetric complications during childbirth, and had inadequate knowledge of the appropriate management of labour. Culturally-specific knowledge from this study should be used to guide policy-makers and health planners in the future development of safe motherhood initiatives in developing countries. Midwives have a unique opportunity to ensure that care given during childbirth is clinically safe and culturally sensitive.

Notes: Background.  Early pregnancy and unplanned childbirth have far-reaching physical, psychological and social consequences to the adolescent girl and her offspring and is therefore a public health problem for concern. At Mbabane Government Hospital 25% of the deliveries are by women aged 10–19 years. Little has been documented about family and community support for adolescent mothers in Swaziland.Aim.  The aim of this study was to generate more systematic data on support to adolescent mothers and their newborns during the early postpartum period by families, communities and health professionals.Methods.  Thirty-one adolescent mothers were recruited from Mbabane Obstetric Unit after childbirth and were visited in their homes 7 days after delivery and interviewed about the family, community and health professional support experienced for themselves and their newborns. A semi-structured interview guide was used to obtain both quantitative and qualitative data.Findings.  Support from families, community and health professionals were generally poor, and pregnancies among adolescents were unplanned. There was poor or no communication, and information from parents and the community on sexuality and reproductive health had been grossly lacking. Peers were the primary source of information about sexuality and reproduction. Communities did not offer services aimed at providing adolescents with information and skills regarding safe sexual behaviour.Conclusions.  Adolescents need contraceptive counselling and services in order to prevent pregnancies at a young age. Communication among parents and their daughters needs to be encouraged in order to monitor postpartum care and also to ensure continuity of maternity care.

Notes: Background: Newborns placed skin-to-skin with their mothers show an inborn sequence of behavior similar to that seen in other mammals. The purpose of this study was to make a detailed exploration of hand movements and sucking behavior in healthy term newborns who were placed skin-to-skin on their mothers' chests, and to study maternal oxytocin release in relation to these behaviors. Methods: Ten vaginally delivered infants whose mothers had not been exposed to maternal analgesia were video-recorded from birth until the first breastfeeding. Video protocols were developed based on observations of the videotapes. Each infant's hand, finger, mouth, and tongue movements, positions of the hand and body, and sucking behavior were assessed every 30 seconds. Maternal blood samples were collected every 15 minutes, and oxytocin levels were analyzed by radioimmunoassay. A statistical test for establishing the relationship between maternal oxytocin levels and infants' hand movements or sucking behavior was developed. Results: Infants used their hands to explore and stimulate their mother's breast in preparation for the first breastfeeding. A coordinated pattern of infant hand and sucking movements was also identified. When the infants were sucking, the massagelike hand movements stopped and started again when the infants made a sucking pause. Periods of increased massagelike hand movements or sucking of the mother's breast were followed by an increase in maternal oxytocin levels (p 〈 0.005). Conclusions:The findings indicate that the newborns use their hands as well as their mouths to stimulate maternal oxytocin release after birth, which may have significance for uterine contraction, milk ejection, and mother-infant interaction.