Skin-to-skin contact and suckling in early postpartum : Effects on temperature, breastfeeding and mother-infant interaction

Sammanfattning: The overall aim of this thesis was to explore the role of closeness versus separation on infant and maternal temperature adaptation, breastfeeding outcome and mother-infant interaction. In addition, we aimed to study a potential influence of swaddling on all outcomes measured. Material and design. A randomized factorial design and a longitudinal approach were used. One hundred and seventy six (176) mother-infant pairs from Maternity Home 13 in St. Petersburg were randomized into four groups. Group I infants were placed skin-to-skin with their mothers after birth, and had rooming-in two hours later. Group II infants were dressed and placed in their mothers arms after birth, and had rooming-in two hours later. Group III infants were kept in the nursery both after birth and during the rest of maternity stay. Group IV infants were kept in the nursery after birth, but roomed-in with their mothers two hours later. Equal numbers of infants were either swaddled or dressed in baby clothes. Methods included assessment of infant axillar, thigh, back and foot temperature and maternal axillar and breast temperature, at 15-minute intervals from 30 to 120 minutes after birth. A diary was filled in daily by mothers with their estimation of feeling low/blue (Visual Analogue Scale), perception of physiological breast engorgement, and number of breastfeeds. In addition, on day 4 time of breastfeeds, milk amount ingested and extra food given to the infants were registered. Recovery of the neonatal weight loss was calculated. The duration of nearly exclusive breastfeeding was noted. At the age of one year infants were video-filmed with their mothers and interaction scored according to the Parent-Child Early Relational Assessment (PCERA) method. Results. Maternal axillar and breast temperature exhibited a small but significant rise after delivery in all groups. In contrast, the variation in maternal breast temperature increased by close contact and suckling. Infant skin temperature, except for foot temperature in the Nursery group, rose in all groups and was the highest in infants with skin-to-skin contact. The rise of foot temperature was most pronounced in the Skin-toskin group, and it remained high during the maternity stay. Furthermore, in unseparated mother-infant dyads maternal axillar temperature was positively related to the infant foot temperature at 120 minutes postpartum. Infant foot temperature rose about 2 units per unit of change in the maternal axillar temperature. Breastfeeding. Infants who stayed in the nursery and had standardized breastfeeding frequency (7 times per 24 hours) ingested less breast-milk, suckled for a shorter time and received more supplements day 4, than rooming-in infants. Supplementation was one of the main factors reducing milk production/ingestion. Swaddling did not affect these breastfeeding parameters. In contrast, swaddled infants separated in the nursery, who were in addition supplemented by formula, had significantly less weight gain. Milk production/ingestion on day 4 postpartum in primiparas was positively correlated with early suckling, with the level of perception of breast engorgement and with the suckling frequency of the previous day. It was negatively correlated with high levels of feeling low/blue. Milk production/ingestion in multiparas was related to early suckling and rooming-in. The duration of nearly exclusive breastfeeding was related to amount of breast-milk produced/ingested on day 4 after birth. Maternal-infant interaction. Skin-to-skin contact between the mother and infant during the first two hours after birth significantly influenced the level of maternal sensitivity, infant ability to regulate behavior (selfregulation), and mutuality and reciprocity in the dyad when the infant was one year old. In the absence of skin-to-skin contact, early suckling induced these effects. Swaddling of the infant decreased the mother s ability for positive affective involvement in the infant and also mutuality and reciprocity in the dyad. These results were revealed using the PCERA. Conclusions. The data suggest that regulation of skin temperature and of milk production seems to be mediated by different and independent physiological mechanisms. In addition, the data show that early skinto- skin contact influences the development of maternal-infant interaction recorded at the age of one year, suggesting the existence of an early sensitive period.