Thesis (Ph.D.)--University of Western Australia, 2007.

This quasi-experimental study, using Orem's Nursing Systems Construct as a theoretical base, was conducted to determine the effects of education and support given by a lactation consultant on early breastfeeding problem incidence and resolution. Mothers were recruited in the hospital and interviewed by telephone two to three weeks postpartum to determine problem incidence, rate of resolution, perception of the problems' interference, self-care measures, and support network characteristics. The study sample consisted of 16 first-time breastfeeding mothers placed in naturally occurring experimental (n = 7) and control (n = 9) groups. The groups did not differ significantly in age, education, ethnicity, mode of birth, or presence of a support person in the home. The groups did not differ significantly in number of problems, problem resolution length, or perceptions regarding problems' severity. A significant difference was found in the use of formula supplements, with the control group using supplementation more than the experimental group.

[Truncated abstract] Mastitis during lactation is a severe illness and approximately one in five breastfeeding women in Australia suffer at least one episode in the first 3-6 months post partum. Despite this, there is little understanding of the physiological and pathological processes occurring before, during and following mastitis. In this study 26 women who, on the basis of my previous research, were assessed to be at risk for developing mastitis, were recruited during the first week post partum and followed prospectively throughout the course of their lactation. Breastmilk, and 24 hour urine samples were collected at Days 5, 14, 30, 60 and 90 post partum and blood was collected at Days 5 and 14 post partum. If participants experienced inflammation of the breast at any time, either during the 90 day reference sampling period or later in their lactation, samples were then collected daily for the duration of symptoms and then, as a follow up, again one week following resolution of symptoms. Breastmilk samples were analysed for a range of biochemical components that reflect immunological (sIgA, lactoferrin) and acute phase (C-reactive protein) response, synthetic activity (lactose, glucose), and permeability of the paracellular pathway (sodium, chloride, lactose and serum albumin) within the breast. Blood and 24 hour urine samples were analysed for lactose, and blood was also analysed for C-reactive protein (CRP). Bacteriological examination of milk samples was undertaken where clinical mastitis was present. Results from these analyses were compared to the severity of breast and systemic symptoms experienced. Twenty-two episodes of mastitis and 13 episodes of blocked duct(s) were identified during the study period. When adjusted for co-existing breast pathology milk composition in the breast affected by blocked duct(s) was generally not different from that of healthy breasts. One mother, who was IgA deficient, experienced six of the 13 episodes of blocked duct(s). It is possible that the absence of sIgA in the milk of this mother increased her susceptibility to inflammation of the breast. During mastitis there was a significant increase in sodium, chloride, and serum albumin to a median concentration of 23 mmol⁄l; (p<0.001); 30 mmol⁄l; (p<0.001) and 0.8g⁄l; (p<0.001) respectively, and a decrease in the median concentration of lactose in milk to 152mmol⁄l; (p<0.016) from the mastitis breast when compared to the contralateral asymptomatic breast. Increased permeability of the paracellular pathway was confirmed by a significant increase in the median daily excretion of lactose in urine to 7.5 mmol⁄24hour (p<0.001). The rate of excretion of lactose in urine over a 24 hour period proved to be, not only a reliable means of assessing breast permeability, but also allowed the researcher to discern whether milk sampled from the breast affected was representative of milk at the site of the inflammation. The changes in lactose in urine were generally consistent with the changes in sodium, chloride and lactose in milk confirming milk expressed for sample analysis was representative of milk from the site of the inflammation

[Truncated abstract] There is a large body of evidence describing the benefits and risks, to the human fetus, of antenatal glucocorticoid treatment, but no published research on the effects on lactation. The withdrawal of progesterone, in the presence of high levels of endogenous glucocorticoids and prolactin, triggers the onset of copious milk secretion (lactogenesis II) at the end of pregnancy. The alteration of lactogenesis II by exogenous glucocorticoids could potentially have adverse impacts on postnatal nutrition in both term and preterm infants. I aimed to determine the effects of maternal antenatal glucocorticoid treatment on lactogenesis II in both ewes and women. I found profound adverse effects on lactation in ewes, and similar but more subtle effects on lactation in women . . . This thesis represents the first investigation of the effects of antenatal glucocorticoid treatment on lactogenesis II in both ewes and women. I found that, in ewes, antenatal glucocorticoid treatment stimulated premature lactogenesis II, and this was caused by disruptions to hormonal regulation during pregnancy. This event was followed by profound delays in lactogenesis II after term parturition. More subtle effects in women suggest that antenatal glucocorticoid treatment did not have a major, prolonged impact on postnatal lactogenesis II. Very preterm gestational age strongly predicted delays in lactogenesis II stressing the importance of assistance for these mothers when they are establishing lactation.

Objetivo: Investigar a influência do posicionamento mãe/bebê e da pega do bebê nas freqüências de amamentação exclusiva e na ocorrência de traumas mamilares no primeiro mês de vida do bebê. Métodos: Estudo de coorte, contemporâneo, em que foram observadas mamadas de 211 pares mães/bebês sadios na maternidade e aos sete e 30 dias, no domicílio. Foram comparadas as freqüências de cinco itens desfavoráveis ao posicionamento mãe/bebê e três itens desfavoráveis à pega do bebê, bem como as médias do número de itens desfavoráveis, entre as duplas em amamentação exclusiva e as que haviam abandonado essa prática aos 7 e aos 30 dias. Compararam-se também as médias do número de itens desfavoráveis nas mulheres com e sem lesões mamilares na maternidade. Resultados: Não houve associação entre técnica de amamentação na maternidade e freqüência de amamentação exclusiva aos 7 e aos 30 dias. No entanto, aos 30 dias, as duplas em amamentação exclusiva apresentaram melhor posicionamento e pega. Os seguintes itens desfavoráveis foram mais freqüentes entre as duplas que já haviam abandonado a amamentação exclusiva: cabeça e tronco do bebê não alinhados (RR=1,5; IC95%=1,2-1,9), boca pouco aberta (RR=2,3; IC95%=1,3-4,2) e pega não assimétrica (RR=1,6; IC95%=1,3-1,9). Não houve diferença na qualidade da pega entre as mulheres que apresentaram ou não traumas mamilares na maternidade, porém as mulheres que apresentaram lesões nos mamilos mostraram melhor posicionamento na avaliação. Conclusões: A técnica de amamentação na maternidade não foi preditiva para a prática da amamentação exclusiva no primeiro mês. No entanto, aos 30 dias, ela mostrou associação com essa prática. / Objective: To investigate the influence of mother/baby's positioning and the baby's latch on the frequency of exclusive breastfeeding and on the occurrence of nipple traumas in the first month of the baby's life. Methods: Through a prospective cohort study, we observed breastfeeding sessions of 211 healthy mother/baby couples in rooming-in and at day 30 at home. We compared the frequencies of 5 items unfavorable to positioning of the couple and 3 items unfavorable to baby latch between the couples in exclusive breastfeeding and those who had abandoned this practice at days 7 and 30. We also compared the means of numbers of unfavorable items in women with and without nipple lesions in the maternity hospital. Results: No association between the breastfeeding technique in the maternity and the frequency of exclusive breastfeeding at days 7 and 30 was found. However, at day 30, the couples on exclusive breastfeeding presented better positioning and latch. The following unfavorable items were more frequent in the couples that had already abandoned exclusive breastfeeding: unaligned head and trunk of the baby (RR=1.5; IC 95%+1.2-1.9), mouth not opened enough (RR= 2.3; IC 95% = 1.3-4.2), and asymmetrical latch (RR=1.6; IC 95% =1.3-1.9). No difference was found on latch quality for the women with or without nipple traumas in the maternity, but the women with nipple lesions showed better positioning in the evaluation. Conclusions: In the maternity, the breastfeeding technique was not predictive of exclusive breastfeeding practice in the first month. However, at day 30, it showed an association with this practice.

Objetivo: Investigar a influência do posicionamento mãe/bebê e da pega do bebê nas freqüências de amamentação exclusiva e na ocorrência de traumas mamilares no primeiro mês de vida do bebê. Métodos: Estudo de coorte, contemporâneo, em que foram observadas mamadas de 211 pares mães/bebês sadios na maternidade e aos sete e 30 dias, no domicílio. Foram comparadas as freqüências de cinco itens desfavoráveis ao posicionamento mãe/bebê e três itens desfavoráveis à pega do bebê, bem como as médias do número de itens desfavoráveis, entre as duplas em amamentação exclusiva e as que haviam abandonado essa prática aos 7 e aos 30 dias. Compararam-se também as médias do número de itens desfavoráveis nas mulheres com e sem lesões mamilares na maternidade. Resultados: Não houve associação entre técnica de amamentação na maternidade e freqüência de amamentação exclusiva aos 7 e aos 30 dias. No entanto, aos 30 dias, as duplas em amamentação exclusiva apresentaram melhor posicionamento e pega. Os seguintes itens desfavoráveis foram mais freqüentes entre as duplas que já haviam abandonado a amamentação exclusiva: cabeça e tronco do bebê não alinhados (RR=1,5; IC95%=1,2-1,9), boca pouco aberta (RR=2,3; IC95%=1,3-4,2) e pega não assimétrica (RR=1,6; IC95%=1,3-1,9). Não houve diferença na qualidade da pega entre as mulheres que apresentaram ou não traumas mamilares na maternidade, porém as mulheres que apresentaram lesões nos mamilos mostraram melhor posicionamento na avaliação. Conclusões: A técnica de amamentação na maternidade não foi preditiva para a prática da amamentação exclusiva no primeiro mês. No entanto, aos 30 dias, ela mostrou associação com essa prática. / Objective: To investigate the influence of mother/baby's positioning and the baby's latch on the frequency of exclusive breastfeeding and on the occurrence of nipple traumas in the first month of the baby's life. Methods: Through a prospective cohort study, we observed breastfeeding sessions of 211 healthy mother/baby couples in rooming-in and at day 30 at home. We compared the frequencies of 5 items unfavorable to positioning of the couple and 3 items unfavorable to baby latch between the couples in exclusive breastfeeding and those who had abandoned this practice at days 7 and 30. We also compared the means of numbers of unfavorable items in women with and without nipple lesions in the maternity hospital. Results: No association between the breastfeeding technique in the maternity and the frequency of exclusive breastfeeding at days 7 and 30 was found. However, at day 30, the couples on exclusive breastfeeding presented better positioning and latch. The following unfavorable items were more frequent in the couples that had already abandoned exclusive breastfeeding: unaligned head and trunk of the baby (RR=1.5; IC 95%+1.2-1.9), mouth not opened enough (RR= 2.3; IC 95% = 1.3-4.2), and asymmetrical latch (RR=1.6; IC 95% =1.3-1.9). No difference was found on latch quality for the women with or without nipple traumas in the maternity, but the women with nipple lesions showed better positioning in the evaluation. Conclusions: In the maternity, the breastfeeding technique was not predictive of exclusive breastfeeding practice in the first month. However, at day 30, it showed an association with this practice.

Objetivo: Investigar a influência do posicionamento mãe/bebê e da pega do bebê nas freqüências de amamentação exclusiva e na ocorrência de traumas mamilares no primeiro mês de vida do bebê. Métodos: Estudo de coorte, contemporâneo, em que foram observadas mamadas de 211 pares mães/bebês sadios na maternidade e aos sete e 30 dias, no domicílio. Foram comparadas as freqüências de cinco itens desfavoráveis ao posicionamento mãe/bebê e três itens desfavoráveis à pega do bebê, bem como as médias do número de itens desfavoráveis, entre as duplas em amamentação exclusiva e as que haviam abandonado essa prática aos 7 e aos 30 dias. Compararam-se também as médias do número de itens desfavoráveis nas mulheres com e sem lesões mamilares na maternidade. Resultados: Não houve associação entre técnica de amamentação na maternidade e freqüência de amamentação exclusiva aos 7 e aos 30 dias. No entanto, aos 30 dias, as duplas em amamentação exclusiva apresentaram melhor posicionamento e pega. Os seguintes itens desfavoráveis foram mais freqüentes entre as duplas que já haviam abandonado a amamentação exclusiva: cabeça e tronco do bebê não alinhados (RR=1,5; IC95%=1,2-1,9), boca pouco aberta (RR=2,3; IC95%=1,3-4,2) e pega não assimétrica (RR=1,6; IC95%=1,3-1,9). Não houve diferença na qualidade da pega entre as mulheres que apresentaram ou não traumas mamilares na maternidade, porém as mulheres que apresentaram lesões nos mamilos mostraram melhor posicionamento na avaliação. Conclusões: A técnica de amamentação na maternidade não foi preditiva para a prática da amamentação exclusiva no primeiro mês. No entanto, aos 30 dias, ela mostrou associação com essa prática. / Objective: To investigate the influence of mother/baby's positioning and the baby's latch on the frequency of exclusive breastfeeding and on the occurrence of nipple traumas in the first month of the baby's life. Methods: Through a prospective cohort study, we observed breastfeeding sessions of 211 healthy mother/baby couples in rooming-in and at day 30 at home. We compared the frequencies of 5 items unfavorable to positioning of the couple and 3 items unfavorable to baby latch between the couples in exclusive breastfeeding and those who had abandoned this practice at days 7 and 30. We also compared the means of numbers of unfavorable items in women with and without nipple lesions in the maternity hospital. Results: No association between the breastfeeding technique in the maternity and the frequency of exclusive breastfeeding at days 7 and 30 was found. However, at day 30, the couples on exclusive breastfeeding presented better positioning and latch. The following unfavorable items were more frequent in the couples that had already abandoned exclusive breastfeeding: unaligned head and trunk of the baby (RR=1.5; IC 95%+1.2-1.9), mouth not opened enough (RR= 2.3; IC 95% = 1.3-4.2), and asymmetrical latch (RR=1.6; IC 95% =1.3-1.9). No difference was found on latch quality for the women with or without nipple traumas in the maternity, but the women with nipple lesions showed better positioning in the evaluation. Conclusions: In the maternity, the breastfeeding technique was not predictive of exclusive breastfeeding practice in the first month. However, at day 30, it showed an association with this practice.

Diss. (sammanfattning). Uppsala : Sveriges lantbruksuniv., 2003. / Härtill 4 uppsatser.