A study to assess the Lactation initiation practices among Intranatal Mothers admitted at labor room in Pravara Rural Hospital, Loni and its effects on Maternal and Fetal outcome
Kaveri D. Patole Thete1, Bharti Weljale2
1Clinical Instructor, Pravara Institute of Medical Sciences (DU), College of Nursing,
Loni (Bk), Maharashtra-413709.
2Associate Professor, Pravara Institute of Medical Sciences (DU), College of Nursing,
Loni (Bk), Maharashtra-413709.
*Corresponding Author E-mail: kaveripatole4@gmail.com
ABSTRACT:
Background: Lactation is the secretion of milk by the mammary glands. The action of suckling an infant. Early initiation of breastfeeding is the first step in the success of a baby to learn to suckle first early after birth so that breast milk remains in production. Breast feeding is one of the oldest practices known to mankind for all infant, breast feeding remains the simple. Healthier and least expensive feeding method that fulfills the infant needs. It is considering as the most complete nutritional source for infants because breast milk contains the essential fats, carbohydrates, protein &immunological factors early initiation of breast feeding with one hours of birth is associated with a reduced risk of neonatal mortality. Methods: A observational research study was undertaken in labor room of Pravara Rural Hospital Loni Bk. A total of 60 intranatal mothers was selected with the help of systematic random sampling technique was used to assess the lactation initiation practices among intanatal mothers and to assess the maternal and neonatal outcome Latch score and APGAR SCORE was used to assess the neonatal outcome. Observational checklist was used to assess the lactation initiation practices and maternal outcome. Study Findings: The result showed that (81%) new born had all essential newborn care after the birth only the 5% of it did not get enough new born care. in relation to LATCH score was assessed the score shows that mean score was (2±1.92) which indicates poor score of latching where as in audible swallowing mean score was (0.67±0.81) it also indicates poor latch score in type of nipple mean score was (2.41±7.71) it indicates moderate latch score comfortable position mean score was 1.91±0.86 it indicates poor score Holding position mean score (2.15±0.94) it indicates poor score. Frequency and Percentage wise distribution LACH Score neonatal shows that L-in that highest frequency and percentage i.e. score 0 shows 38(63%), score 1shows 35(58%),Score 2shows 34(17%), A-Audible swallowing in that 0score shows 20(33%),1score shows22(36%),2 score s19(31%), T-Type of nipple in that 0score shows that 43(18%) 1Score shows 18(30%) score 2 shows 16(26% ) C-Comfort level in which 0 score shows 56(38%) 1 score shows 63(38%) 2 score shows 63(35%) H-Holding position 0score shows 35(58%) 1score shows 43(17%) 2 score shows 42(70%).APGAR score after the delivery within 15min new born APGAR score 91% newborn were mild depression ,5%were moderately depressed, 5% were severe depression it interprets that no neonatal mortality and morbidity. Conclusion: The intranatal mothers have lack of knowledge about breast feeding practices. This problem significantly have impact on maternal and fetal outcome, it was evident that nursing interventions such as lactation initiation practices does have significant impact in enhancing the maternal and fetal outcome.
KEYWORDS: Lactation initiation practices, intranatal mothers, maternal and fetal outcome.
INTRODUCTION:
Lactation the production and secretion of breast milk by the mammary glands is called as lactation1. Breast milk is the most ideal and valuable food for the growing infant it fulfills the nutritional requirements if it is given in adequately and in appropriate manner. In developing countries, the infant mortality rate was six to ten times higher in non-breast-fed infants in the first months of life by 2015, Millennium Development Goals (MDG-targets aim at having the neonatal mortality and improving newborn health along with reduction of under-five mortality rates by two thirds, between 1990 and 2015.2 This will be achieved by adopting optimal breastfeeding practices as recommended by WHO for example, breastfeeding to be initiated within half an hour of birth and exclusive breastfeeding to be continued for 6 months. Hence continued support with counseling is mandatory to mothers during antenatal period and postnatal period3
Breastfeeding is a normal physiological process. There are so many benefits of breastfeeding for baby as well as mother for the baby. Babies who are fed breast milk have a lower risk of Gastrointestinal infections (e.g. diarrhea and vomiting), Atopic disease (including eczema and asthma), Middle ear infections, Urinary tract infections, Respiratory infections, Obesity in childhood and later life, Type 1 and 2 diabetes in childhood or later life, Some childhood cancers, Sudden infant death syndrome (SIDS)4
Breastfed babies are also less likely to be hospitalized for illnesses and infections. Growth and development Breast milk contains important components to protect and build the baby’s immature immune system. Breast milk is more easily digested than infant formulas, and changes from feed to feed to suit each baby’s unique needs, making it the ideal food to promote healthy growth and development. Psychological benefits the close interaction and frequent skin-to-skin contact during breastfeeding can enhance bonding and emotional attachment between mother and baby.5
For the mother research shows that breastfeeding has significant health benefits for mothers. Breastfeeding Assists the uterus to return to its pre-pregnant state fasten, Can help women to lose weight after baby’s birth, May reduce the risk of mothers with gestational diabetes developing type 2 diabetes, Reduces the risk of ovarian cancer and pre-menopausal breast cancer, May reduce the risk of osteoporosis for society, Environmentally friendly Breast milk has no waste products and leaves no carbon footprint, Economical Breast milk does not cost money, and the decreased risk of illness results in reduced hospital admissions and healthcare costs. Breastfeeding gives babies the best start for a healthy life and has benefits for the health and wellbeing of mothers and babies. 6
PROBLEM STATEMENT:
A study to assess the lactation initiation practices among intranatal mothers admitted at labor room in Pravara rural hospital, Loni and its effects on maternal &fetal outcome.
· Assess the lactation initiation practices on intranatal mothers.
· Assess maternal and fetal outcome in lactation initiation practices.
· Find out correlation between lactation initiation and its effects on maternal fetal outcome.
· Find out the association between lactation initiation practices on selected socio-demographic and clinical variable with maternal &fetal outcome
MATERIAL AND METHODS:
Research design and approach: -
Quantitative evaluatory approach.
Research design:
Pretest Post Control group design
Research variables:
Independent variable: Lactation initiation practices.
Dependent variable: - Maternal and fetal outcome.
Extraneous variables: Age, educational status, occupation, religion, type of family, family income.
Setting of the study: PIMS Loni (BK), Ahmednagar.
Population: Intranasal mothers
Sample Size: -60
Sampling Technique:
Purposive sampling
Inclusion criteria
Primigravida mother who were:
· Intranatal Mothers
· Willing to participate in study...
· Able to read and write Marathi.
Exclusion criteria:
Primigravida mother who were,
· Not willing to participate in study
· Not available during data collection
Methods of data collection:
Objective structured questionnaire
Reliability:
The tool was found to be reliable with the r value for the anxiety (r = 0.94)
Data Collection Procedure:
Ethical approval from the Institutional ethical committee of (PIMS/CON/R/IEC/PG/002/2019) at Pravara Institute of Medical Sciences (DU). The legal permission was sought from Medical Superintendent and HOD of Obstetric department, Pravara rural hospital, Loni and Informed consent was taken from all the intrantal mothers prior to investigation. All data were treated confidentially.
Analysis and Interpretation od study findings: -
Section A: Steps for lactation initiation practices in labor room:
Table No. 1: Frequency and percentage wise distribution of Steps for lactation initiation practices in labor room N=60
|
Sr. No. |
Steps |
F |
P |
|
1 |
Have a written breastfeeding policy that is routinely communicated to all healthcare staff |
59 |
98% |
|
2 |
Train all healthcare staff in skills necessary to implement this policy |
59 |
98% |
|
3 |
Inform all pregnant women about the benefits and management of breastfeeding. |
59 |
98% |
|
4 |
Help mothers initiate breastfeeding within the first (half) hour of birth. |
59 |
98% |
|
5 |
Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants. |
59 |
98% |
|
6 |
Give new-born infants no food or drink other than human milk, unless medically indicated |
59 |
98% |
|
7 |
Practice rooming-in—that is, allow mothers and infants to remain together—24 h/d. |
59 |
98% |
|
8 |
Encourage breastfeeding on demand |
59 |
98% |
|
9 |
Give no artificial teats or pacifiers to breastfeeding infants |
59 |
98% |
|
10 |
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. |
59 |
98% |
Frequency and Percentage wise distribution of 10 Steps for lactation initiation practices in labour room shows that 98% mothers had followed lactation initiation practices in labour room.
a) Maternal Outcome:
Table No. 2: Description of Maternal outcome N=60
|
SN |
Type of delivery |
Frequency |
Percentage |
|
1 |
FTND |
30 |
50% |
|
2 |
Instrumental Delivery (forceps, vacuum) |
20
|
33% |
|
4 |
Caesarean Section |
10 |
16% |
|
|
Progress of labour: |
|
|
|
|
Its stage |
|
|
|
1 |
6hrs |
36 |
60% |
|
2 |
6hrs |
19 |
30% |
|
3 |
18hrs |
6 |
10% |
|
|
IInd stage (spontaneous) |
|
|
|
1 |
2min |
29 |
40% |
|
2 |
30min |
31 |
50% |
|
3 |
5 to 10min |
9 |
10% |
|
|
III Stage (Retained) |
|
|
|
1 |
30min |
3 |
50% |
|
2 |
10-15min |
9 |
30% |
|
3 |
5-10min |
12 |
20% |
|
|
Weight of placental |
|
|
|
1 |
>500gm |
49 |
80% |
|
2 |
<500mg |
29 |
20% |
Distribution of maternal outcome according to frequency and percentage shows that majority of mothers had instrumental delivery i.e. 15(25%) ,4(6%)had full term normal delivery.14(23%)had Caesarean Section. in full term normal 48% mothers progress spontaneously and 5% had augmented 15% mothers had oxytocin drip all it interprets that 48% had normal delivery with episiotomy without laceration and tear.
Table No. 3: Description of maternal outcome N=60
|
SN. |
Temperature |
Frequency |
Percentage |
|
1. |
36-380c |
56 |
93% |
|
2. |
<36c0 |
12 |
20% |
|
3. |
>390c |
22 |
36% |
|
|
Pulse |
|
|
|
1. |
60-100 beats/min |
12 |
20% |
|
2. |
<60 |
22 |
36% |
|
3. |
>100 |
49 |
81% |
|
|
Blood Pressure |
|
|
|
1. |
120/80 of mmHg |
26 |
43% |
|
2. |
100/70 of mm Hg |
41 |
68% |
|
3. |
140/90 of mm Hg |
14 |
23% |
Distribution according to frequency and percentage shows that 93%mothers had 36-380c (hyperthermia)and 36%had hypothermia.,81% mothers had bradycardias 20%mothers had tachycardia and 43%mothers had normal blood pressure where 68%had hypotension and 23%had hypertension
Table No 4: Description of fetal outcome N=60
|
Sr. No |
APGAR sore |
Frequency |
Percentage |
||||
|
No depression |
Mild depression |
Severe depression |
No depression |
Mild depression |
Severe depression |
||
|
1 |
5min |
50 |
6 |
2 |
83% |
10% |
3% |
|
2 |
10min |
50 |
9 |
60 |
83% |
15% |
100% |
|
3 |
15min |
55 |
3 |
5 |
91% |
5% |
5% |
Table No.5: Description of overall MEAN and SD of APGAR score N=60
|
Sr. No. |
Sample no. |
5Min |
10Min |
15Min |
|||
|
Mean |
SD |
Mean |
SD |
Mean |
SD |
||
|
1 |
60 |
7.1 |
±1.44 |
7.2 |
±1.O4 |
7.75 |
±1.17 |
Table No. 6: Description of overall Mean and SD LACTH Score N=60
|
LATCH |
A-Audible swallowing |
T-Type of nipple |
C-Comfort level(breast/nipple) |
H-Hold position |
|||||
|
Mean |
SD |
Mean |
SD |
Mean |
SD |
Mean |
SD |
Mean |
SD |
|
2 |
±1.92 |
0.67 |
±0.81 |
2.41 |
±7.710 |
1.91 |
±0.86 |
2.15 |
±0.94 |
Comparison of overall means score of APGAR in 5min shown (7.1±1.44) in relation to 10min (7.2±1.04) and lastly on 15 it was (7.75±1.17). (table-5)
The table-6 shows the overall mean /SD of latch score in relation to various aspects A-Audible swallowing was (2.0±1.92) which was in poor latching. T-Type of nipple mean score was (2.41±7.71) which was showed moderate condition of nipple. Comfort level which had (1.9±0.86) which was poor score of latch, Holding position (2.15±0.94) poor score.
Frequency and Percentage wise distribution of APGAR soring exhibits that first 5min 83% of newborn had no depression and 10%mild depression,3% newborn was had no depression. In 10 min of Apgar score 83% had no depression, 15%new born was in mild depression and 100%was in severe depression. Lastly in 15min 91%was in no depression, 5%had mild depression and 5%newborn was in severe depression.
Comparison of Breast feeding Practices with APGAR Score:
This table shows the overall mean /SD of APGAR score with lactation initiation practices in relation to various aspects 1.-5min. Mean/SD (7.16±1.53), 10min (7.6±0.97), 15 min (7.92±4.45) I. Mild moderate and severe depression. 2. 5min. Mean /SD (7.1±1.53), 10 min 7.05±7.6) 15 min 7.6±1.21) 3 5 min 5.4± 2.64 10min (6.1±1.32). 15 min (7.2±1.23) it interprets that mild, moderate and severe depression.
Comparison of Breast feeding Practices with LATCH Score:
This table shows the overall mean /SD of LATCH score in relation to various aspects LATCH-(1.92±0.92), A-Audible swallowing (1.44±1), T-Type of Nipple (1.8±1.12) Comfort Level (1.79±0.9) H-Holding position (2±1.0) it interprets Poor latch, moderate latch High score of latch.
Table No 7: Comparison of socio-demographic factors with LATCH score (Age) N=60
|
Sr. No |
Age |
4-7(score) |
8-10 (score) |
||||
|
F |
Mean |
SD |
F |
Mean |
SD |
||
|
1. |
19-22 |
23 |
6.78 |
±1.17 |
18 |
8.55 |
0.78 |
|
2. |
23-26 |
4 |
6.5 |
±0.57 |
10 |
8.5 |
±0.70 |
|
3. |
27-30 |
3 |
6 |
±0 |
1 |
8 |
- |
|
4. |
<37 |
1 |
1 |
- |
1 |
1 |
- |
Comparison of Mean score of LATCH Shows that irrespective of age the intranatal mothers had more or less similar score i.e. (6.78±1.17) and (6.5±0.57) respectively it indicates that age does not have any influence on LATCH score. (Table-7).
Table No 8: Comparison of socio-demographic factors with LATCH score (Parity) N=60
|
Sr. No |
|
4-7(score) |
8-10(score) |
||||
|
F |
Mean |
SD |
F |
Mean |
SD |
||
|
1. |
Primigravida |
22 |
6.40 |
± 0.85 |
21 |
8.52 |
± 0.67 |
|
2. |
Multigravida |
8 |
6 |
± 1.30 |
9 |
8.66 |
± 6.87 |
Comparison of Mean score of LATCH Shows that irrespective of parity of the intranatal mothers had more or less similar score i.e in primigravida (8.52±0.67) and in multigravida (8.66±6.87) respectively it indicates that parity have highly influence on LATCH score.
Comparison of Mean score of LATCH Shows that irrespective of ANC visits of the intranatal mothers had more or less similar score i.e in 4 mothers with three visits had mean score of (8±2.80) and (in multigravida (8.66±6.87) respectively it indicates that ANC visits does not have any influence on LATCH score. Comparison of Mean score of LATCH Shows irrespective of week of pregnancy of the intranatal mothers had more or less similar score i.e <40week had (0.28±1.69) it indicates that weeks of pregnancy does not have any influence on LATCH score. Comparison of Mean score of APGAR Shows irrespective of Gender of the baby had more or less similar score i.e Male had (6.40±0.85) and in Female (6±0.30) it indicates that Gender of baby does not have any influence on APGAR score. Comparison of Mean score of APGAR Shows irrespective of Weight of the baby had more or less similar score i.e (8.52±0.37) it indicates that weight of baby have high influence on APGAR score
DISCUSSION:
Percentage wise distribution of intranatal mothers according to their age shows that among 60 intranatal mother i.e 37(61%) where between the age group of 19-22 years. It was consistent with the study conducted by .Mise.j Pooja who noted that majority of 86(76.7%) mothers who were in age group of 21-30 years. 7
Majority (53%) had monthly income>41430Rs it was concurrence with the study carried out by Laila Shehata Dorgham who noted that 49.5%of mothers were getting income between 5001-10000. 8
Majority 16%had multigravida it was concurrent with study carried out by Takahashi Kenzo (2017) how noted 56.9% mothers were multigravida. Highest frequency and percentage i.e 58%mothers were in <37 weeks of gestation it was in line with study conducted by Takahashi Kenzo (2017) who noted that 89.7 mothers have gestation weeks >37-41.9
Most of intranatal mothers 63%gave ANC visit it was in line with study conducted by Anselm S. (2016) who noted that 53.2%mothers had four ANC visits.10
CONCLUSION:
The major conclusion drawn from this is there is positive correlation found between selected maternal factors and newborn characteristics. It emphasis that, selected maternal factors are good predictors of newborn characteristics. There by the future risk for complications, morbidity and mortality rate of mothers and newborns can be minimized with planed regular health checkup along with awareness regarding MCH services or policies, and improvement in baby friendly hospital initiative must be practice by mothers to improve and maintain the health status of self along with their neonates.
ACKNOWLEDGEMENT:
The authors are grateful to the authorities of Pravara Medical Trust’s, College of Nursing Loni, Bk. District: -Ahmednagar (MH) India 413736.
CONFLICT OF INTEREST:
The authors declare no conflict of interest.
REFERENCES:
1. Wikipedia, (2013): Breastfeeding [cited on 2020 April 22]; available from URL: https://en.wikipedia.org/wiki/Breastfeeding
2. Wikipedia, (2009): Lactation [cited on 2020 April 22];available from URL: https://en.wikipedia.org/wiki/Lactation
3. WHO. Breast feeding importance. Geneva, 2020 Available froURL:https://www.who.in
4. Dhungana, Dharel S Bansnet RD.et.al. Breastfeeding practices within the first six months of age in mid-western and eastern regions of Nepal: health facility based cross sectional study. BMC Pregnancy Childbirth 20, 59 (2020) cited on 22/12/19. https://doi.org/10.1186/s12884-020-2754-0
5. UNICEF calls for the protection of children in the Gaza Strip.10th April 2018 Available from URL: https://www.unicef.org.\
6. Mise Pooja. J. Mise. AJ et.al. Study of breast feeding practices and problems among postnatal mothers: a hospital base study, International journal of reproductive, contraceptive, obstetrics and Gynecology 2017 6(8):3343-3346, www.ijrcog.org.: 11July 2017 15July 2017.cited on 26/7/20
7. Laila Shehata Doregham, Samar K et.al., Lifescience Journal 2014(11)http://www.lifesciece.com
8. Takahashi.Kenzo, Ganchimeg Togoobaatar, Joshus OP et.al. Prevalence of early initiation of breastfeeding and determinants delayed initiation of breastfeeding, secondary analysis of the WHO Global Sci. Rep 2017:44868 PMCCID: PMC535998
9. Anselm S., Berdel and Siddika et.al. BMC pregnancy and childbirth (2016) Arnold school of Public health, University of South Carolina, Columbia. Cited on 27/7/2020.
10. Mise Nikita. J. Mise. AJ et.al. Study of breast feeding practices and problems among postnatal mothers: a hospital base study, International journal of reproductive, contraceptive, obstetrics and Gynecology 2017 6(8):3343-3346, www.ijrcog.org.: 11July 2017 14July 2017.cited on 27/7/20.
Received on 27.05.2021 Modified on 17.11.2021
Accepted on 03.01.2022 ©A&V Publications All right reserved
Int. J. of Advances in Nur. Management. 2022; 10(1):9-13.
DOI: 10.52711/2454-2652.2022.00003