RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / MRS.SHEIK MEERA BEGAM.S.M.
NAVANEETHAM COLLEGE OF NURSING, BANASWADI, BANGALORE-43.
KARNATAKA
2 / NAME OF THE INSTITUTION / NAVANEETHAM COLLEGE OF NURSING BANGALORE-43
3 / COURSE OF STUDY AND SUBJECT / M.S.C.NURSING 1ST YEAR
OBSTETRICS AND GYNAECOLOGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE / 30-05-2009
5 / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF BREAST FEEDING POSITIONING INTERVENTIONS TO MINIMIZE FATIGUE AMONG CESAREAN MOTHERS DURING BREAST FEEDING IN SELECTED HOSPITALS IN KARNATAKA”

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Mothers are not dropped from heaven. They are born as undervalued, neglected girls and grow as exploited uneducated children. We must look at the suffering and disadvantages, would be mother has experienced. She must become self confident and self reliant and for that she needs to be educated and employed. [Singh.H, 1998].

Breast feeding practices play an important role in reducing child mortality and morbidity.[Madhu.K, 2009]

In the Near future, it appears prudent to continue recommending full breastfeeding for the term infant. Formulas will never equal breast milk...... no living cell.[Lewis Barness,September,2009]

It has been estimated that the 1993 cost of purchasing infant formula for the 1st year after birth was $855.During the 1st 6 weeks of lactation ,maternal caloric intake is no greater for the breastfeeding mother than the non-lactating mother. After that period, food and fluid intakes are greater, but the cost of this increased caloric intake is about half the cost of purchasing formula. Thus,a saving of >$400 per child for food purchases can be expected due to breastfeeding. American Academy of Pediatrics:-Breastfeed and the use of Human milk [February,2005}

6.1. NEED FOR THE STUDY

Breast feeding is an ancient practice of most women in the country. Breast feeding is best feed for babies. Since it is an unique source of nutrition that plays an important role in the growth and development and survival of infants. The investigator during her clinical experience in labour ward and postnatal ward, observed the despair and problems of cesarean mother while breast feed their babies. They were lacking in appropriate knowledge and skill in feeding the babies and made no effort to learn them which in turn deprived the newborn baby to be adequately fed and the process of research in actual sense could not be established. It was also observation that the health care staff including doctors, staff nurses and Nursing students did not make any effort to help the cesarean mother in breast feeding.

Human milk is uniquely superior for infant feeding and is species-specific; all substitute feeding options differ markedly from it. The breastfed infant is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short-and long-term outcomes.

Therefore the investigator strongly felt the need to assess the knowledge and care regarding breast feeding. And improve them to establish successful breast feeding after cesarean.

Thus there is a strong need to conduct a study which will help the cesarean mother to develop knowledge, skill and confidence in breast feed their babies.


6.2. REVIEW OF LITERATURE

Review of Literature is not mere reading, but focusing and directing one's reading towards a specific purpose .The main purpose of review of literature is to gain a background knowledge of the research topic, to identify data sources used by other researchers and to learn how others structure their reports. [KRISHNASWAMI]

In the present study, the researcher has carried out different types of literature review at different stages of her research process, which she has categorized under the following sections.

Section: 1

Reviews related to Breastfeeding Positioning and Fatigue:

1.Sally Inch, January [2009] conducted a study on "Good positions for breast feeding”. In that he found the following Breast feeding Techniques. Lying down with the mother's bodies parallel, Holding the baby across the mother's lap, supporting him with the same arm as the mother's breast, the mother could also hold him underarm, sitting cross-legged on the side of the bed, or using two chairs at the right angles, and if the mother have twins and want to feed them together any combination is possible. If the mother have mastitis/blocked ducts, the mother might be advised to hold the baby in a different.

2.On December,2007,J.J.Runquist conducted a study on “A depressive symptoms responsiveness model for differentiating fatigue from depression in the postpartum period”. He summarized as, Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is experienced by most non-depressed women. Healthcare providers experientially know that not all women who experience postpartum fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they have not yet identified a means for describing or measuring this distinctness. A new model proposing how fatigue may be differentiated from depression after childbirth is presented. The depressive symptoms responsiveness model proposes that depression-related postpartum fatigue may potentially be differentiated from non-depression-related postpartum fatigue on the basis of whether depressive symptoms abate when fatigue is relieved. The ability to differentiate between fatigue and depression in postpartum women has the potential to improve women's health through improvements in practice and resource utilization. Furthermore, differentiation may lead to a better understanding of the role of fatigue in postpartum depression.

3.The study on "Fatigue during pregnancy predicts cesarean deliveries" was conducted by Li-Yin Chien ScD RN and Yi-Li Ko EdD RN.I n this study the participants were 633 women who were 20-36 weeks pregnant without evidence of obstetrical complications at the time of interview Pregnancy outcomes were abstracted from the hospital records after delivery. The researcher concluded that fatigue is a significant problem for pregnant women. Fatigue assessment should include morbidities during pregnancy as well as household and work related factors. Special attention should be paid to women who do not work outside the home. Staff should elicit information about fatigue and intervene early, as this may help decrease the number of cesarean deliveries.

4.D.Jenson,S.Wallace,and P.Kelsy[2006],conducted a study on,"LATCH:

A breastfeeding charting system and documentation tool". We could find that the Nurses most often use a subjective "Well/poor/fair" system to assess and document breastfeeding. LATCH is a breastfeeding charting system that provides a systematic method for gathering information about individual breastfeeding sessions. The system assigns a numerical score of 0,1,2, to five key components of breastfeeding. Each letter of the acronym LATCH denotes an area of assessment.

“L” is for how well the infant latches onto the breast

“A” is for the amount of audible swallowing noted

“T” is for the mother’s nipple type

“C” is for the mother’s level of comfort

“H” is for the amount of help the mother needs to hold her infant to the breast

The system is visually represented in the same form of the Apgar scoring grid, and the numbers are handled in the same way. With the LATCH system, the nurse can assess maternal and infant variables, define areas of needed intervention, and determine priorities in providing patient care and teaching.

5.On February 28,2006,RNmommy conducted a research on "LATCH:a breast feeding charting system and documentation tool”. He explained in his study that we use the latch scoring system, it is ok....it is nice to see the assessment broken down into specific parts as opposed to just fair, good, poor. Another poster mentioned giving a score for an attempt ,we do that here. say the baby is licking and rooting but does not latch, you don’t here any swallows ,the mom has great nipples ,she is a little sore ,and she needs some help with positioning. This was an attempt, but the latch score would be 4 out of 10.

Latch-L=0

Audible swallow-A=0

Type of nipple-T=2

Comfort-C=1

Hold-H=1

6.Savitri.P,Kumar did a study on “The LATCH Scoring system and prediction of breastfeeding duration”. In this study specifically designed to examine the effects of epidural anesthesia during labour on breastfeeding success and bottle supplementation,115 mother-infant pairs in which the mother received epidural anesthesia were compared with 116 pairs in which the mother received no epidural anesthesia [Baumgarder, Muehl, Fischer & Pribbenow,2003]. All of the infants were healthy, full term, and born vaginally. The primary outcome of interest included two successful breastfeeding encounters by 24 hours of age, defined as having a LATCH score of 7 or greater. LATCH scoring awards two points for each of 5 indicators.

7.On December 2008,the research "Crying babies ,tired mothers: What do we know? A Systematic review" was conducted by Elisabeth Kurth RM. Evidence from this review indicated that the amount of infant crying during the first three months postpartum is associated with the experience of tiredness and fatigue in new mothers. Significant associations were found in five of six quantitative studies. The four identified qualitative studies describe how infant crying disrupts new mothers' circadian rhythms, reducing opportunities to rest and exacerbating tiredness. Incremental exhaustion diminished parents' ability to concentrate, raising the fear of harming their children, triggering depressive symptoms and burdening parent-child interaction.

8."Normal Nipple Position in term infants Measured on Breastfeeding Ultrasound “study was conducted on October 31,2009 by the researchers Lorilli Audrey Jacobs, Jan E.Dickinson, Shani Jean Faulkner. He found in this study that Nipple position is believed to influence breastfeeding success. To investigate this belief, sub mental ultrasound images were obtained during breastfeeding of normal term infants. This study measured nipple to hard-soft palate distance in 18 mother-infant pairs during the 1st and 4th weeks of life.The nipple was not stationary during feeding, with mean nipple movement of 4.0=1.3mm.Further research is required with more infants to confirm the boundaries of normality for ultrasound measurements of nipple position during successful breastfeeding.

9.Rigard L,Alade MO conducted a study on "Sucking technique and its effect on success of breastfeeding" on December 1992.They investigated the prognostic value of sucking technique during the 1st week after birth relation to the long-term success of breastfeeding. At discharge from the maternity ward,82 healthy mother-infant pairs were observed for assessment of breastfeeding technique and followed for 4 months by regular telephone checkups. The study population was divided into 3 groups: one in which faulty sucking technique was corrected when observed[n=29],one with faulty but uncorrected technique[n=25],and a control group with a correct technique[n=28].At the 4-month follow-u assessment, the faulty but uncorrected group was characterized by a greater proportion of mothers with breastfeeding problems and early cessation of breastfeeding than the other 2 groups.

10.Kumar SP,Mooney R,Havstad S,Wieser LJ conducted a study on “The LATCH scoring system and prediction of breastfeeding duration’. In this study he aimed to determine whether LATCH scores assessed by professional staff during in-hospitals stays are predictive of breastfeeding at 6 weeks .participants were english-speaking breastfeeding women,18 years or older, with healthy singletons .LATCH scores were obtained once every 8 hours on day 1 and daily subsequently until discharge. Data were obtained from hospital charts and telephone interviews on day 4 and week 6 post delivery. At 6weeks,188 of 248[76%] women were contacted and 66.5% were breastfeeding. LATCH scores were higher among women breastfeeding than those who had weaned. Using receiver operating characteristic [ROC] curves, a score of 9 or above at 16 to 24 hours was the most discriminate of the 5 time periods examined [area under the ROC curve = [072] furthermore, women who met this criterion were 1.7 times more likely to be breastfeeding at 6 weeks than women with lower. The LATCH assessment tool is a modest predictor of breastfeeding duration.


Section: 2

Reviews related to Breastfeeding and Infant feeding:

1. Thapa.S,Short.RV,Potts.M,J.Obstet Gynaecol East Cent.Africa,[1988] conducted a study on "Breast feeding and birth spacing save lives. He found in his study that Breast feeding provides an infant all its nutritional needs and therefore is the best and most cost effective food for infants. In addition antibodies in the Breast milk protects the Infant from Gastro Intestinal illnesses and some respiratory infections. Full breast feeding is also good for the mother because prolonged lactational amenorrhea will preserve Hb stores and for the 1st 6 months, she is unable to conceive. Therefore breast feeding assists in the spacing of births, thereby reducing maternal and infant mortality. Infants born 2 years after a preceding sibling are twice as likely to die as those born after an interval of 2 years.

2.Wilaiporn Rojjanasrirat, Wejdan khatar and Karen wambech [April2, 2005] conducted a descriptive comparative study on "A comparative study of Infant feeding Intention among pregnant adolescents, in the setting of multiple prenatal clinics in a Midwesker U.S.City, with the subjects of 113 primigravid adolescents,15 to 18 years old, completed the modified breastfeeding prediction attrition tool during their second trimester of pregnancy. The objective is to explore the similarities and differences in Infant feeding intentions, knowledge, attitudes and perceived behavioral control over breastfeeding among pregnant adolescents based on how they were fed as infants :breast milk, formula milk, or unknown feeding. Finally, no significant differences were found in breastfeeding knowledge or attitude scores.

3.A Study on "Socio-demographic correlates of breastfeeding in urban slums of Chandigarh“ was conducted by Dinesh kumar, Neeraj Agarwal, HM.Swami [2006], Out of all 270 respondents,159[58.9%]initiated breastfeeding within 6 h of birth, only 43[15.9%]discarded colostrums and 108[40%]mothers gave pre lacteal feed. Illiterate/just literate mothers who delivered at home were found at significantly higher risk of delay in initiation of breastfeeding on the basis of multiple logistic regression analysis. In this study promotion of institutional deliveries and imparting health education to mothers for protecting and promoting optimal breastfeeding practices are suggested.

4."Breastfeeding knowledge among health workers in rural South Africa” was conducted by Shah. S,Rollins. NC,BlandR [February 2005].The aim of the study was to conduct a rapid assessment of breastfeeding knowledge amongst health workers in an area of high HIV prevalence. Knowledge of community health workers differed most from WHO recommendations: only 37%[n=6]knew that breastfeeding should be initiated within 30 min of delivery,68%[n=11]thought breastfeeding should be on schedule and not on demand ,and the majority would recommend supplements to infants under 6 months of age. Findings from this study will be used to develop a family centered educational intervention involving the mothers, grandmothers, and partners of pregnant patients to promote the benefits of breastfeeding in this community.