Knowledge and practice on skin-to-skin contact and early breastfeeding methods of women with vaginal delivery at ha noi obstetrics and gynecology hospital

Nội dung text: Knowledge and practice on skin-to-skin contact and early breastfeeding methods of women with vaginal delivery at ha noi obstetrics and gynecology hospital

1. RESEARCH ARTICLE KNOWLEDGE AND PRACTICE ON SKIN-TO-SKIN CONTACT AND EARLY BREASTFEEDING METHODS OF WOMEN WITH VAGINAL DELIVERY AT HA NOI OBSTETRICS AND GYNECOLOGY HOSPITAL Pham Thuy Quynh1, Pham Van Tan1, Tran Mai Huyen1, Pham Thi Kim Hoan1, Le Tung Lam1 1Hanoi Medical College ABSTRACT Objective: To describe the knowledge, pregnant women reported that colostrum is practice of skin to skin and early rich in antibodies, 37.7% of children were breastfeeding of women with vaginal breastfed immediately after skin-to-skin delivery at the Hanoi Obstetrics and contact with mother; 19.1% of women were Gynecology Hospital. 2. To examine the not supported while breastfeeding the first factors related to the practice of skin-to- meal, 19.1% of the women were assisted skin and early breastfeeding of women with to breastfeed their baby. No relationship vaginal delivery at the Hanoi Obstetrics and has been found between women ’s age, Gynecology Hospital. Method: Postpartum education and occupation, and skin-to- women at ward A2, Hanoi Obstetrics and skin practice and early breastfeeding. Gynecology Hospital were recruited to the Conclusion: 38.9% of children were skin- study. Results: 97% of pregnant women to-skin contact with their mothers in the knew the method of skin-to-skin treatment postpartum room; 37.7% of children were for their infants; 81.5% of the women knew breastfed the immediately after skin-to-skin that the benefit of skin-to-skin care is to keep contact with their mothers. the baby warm; Only 38.9% of infants were Keywords: Knowledge, practice, skin allowed to skin-to-skin contact with their to skin, early breastfeeding mothers in the postpartum room. 79.4% of 1. INTRODUCTION Newborn health care is a problem that is 24.3% of children under 6 months of age attracting the attention of countries around were exclusively breastfed and only about the world. Therefore, the Ministry of Health 26.5 % of infants were breastfed within the identified infant health as a priority in the first hour of life [2]. EENC implementation in National Child Survival Action Plan for the 8 priority countries in the Western Pacific, period 2015-2020 [1] only 32% of children were breastfed before According to UNICEF, in Viet Nam, the isolating with mother. report on survey of children and women The consequences of neonatal objectives (MICS 2014) found that only morbidity and mortality were severe, and interventions available within the maternity- child health care program may save the lives of most infants. Warm incubation with Cor. author: Pham Thuy Quynh skin-to-skin method and early breastfeeding Email: phamthuyquynhcdythn@gmail.com were simple and easy interventions that Received: Feb 08, 2021 contributed to improving health and Revised: Feb 15, 2021 reducing infant mortality. In addition to Accepted: Mar 05, 2021 adjusting body temperature, the skin-to- Journal of Nursing Science - Vol. 04 - No. 01 115
2. RESEARCH ARTICLE skin method between mother and infant - Women with cognitive impairment. immediately after birth also had many other 2.2. Methods: effects such as: increasing the rate of early and exclusive breastfeeding, increasing the 2.2.1. Research design: The research affection of mother and child, developing used cross-sectional descriptive design. cognitition, reducing stress, and reducing 2.2.2. Sample size: infections in infants [1], [3]. * Skin to skin part Hanoi Obstetrics and Gynecology Hospital always wants to take care of Sample size using the formula for descriptive study: n= z2 p(1-p)/d2 pregnant women and newborns with the new (1- a/2) and most effective methods. In order to be * In which: able to apply skin-to-skin and early lactation n: required sample size; in the first days after birth, there is a need to assess the practice of women on skin- a: statistical significance level; to-skin and early breastfeeding of women z(1-a/2): confidence index (với a = 0,05 thì after giving birth. Therefore, the research z = 1,96); was conducted with 2 objectives: Describe (1-a/2) the current state of knowledge, practice p1 = 0.867 (rate of women with skin to of skin to skin and early breastfeeding of skin at Hanoi Obstetrics Hospital) [4]; women after giving birth at Hanoi Obstetrics d = 0.05 (maximum permissible error); and Gynecology Hospital. Examine factors Therfore, we have the sample size of the related to skin-to-skin practice and early study: n1 = 1.962 x 0.867 x 0.133 / 0.052 breastfeeding of women after giving birth at (women). Hanoi Obstetrics and Gynecology Hospital. → according to the above formula was 2. RESEARCH METHOD calculated: n1 = 177,19 2.1. Participants: Postpartum women at * Breastfeeding: ward A2, Hanoi Obstetrics and Gynecology Hospital were recruited to the study. Sample size using sample size formula for descriptive study: n= z2 p(1-p)/d2 2.1.1. Inclusion criteria: (1- a/2) In which: - Over 18 years; n: required sample size; - Fullterm pregnancy from 37-41 weeks as expected; a: statistical significance level; - Healthy babies; z(1-a/2): confidence limit factor (với a = 0,05 thì z = 1,96); - Can speak, read, listen and understand (1-a/2) VietNamese; p2 = 0.779 (rate of women breast- feeding early in the first hour after birth)[5]; - Volunteer to participate in research; d = 0.05 (maximum permissible error). 2.1.2. Exclusion criteria: Therfore, we have the sample size of the - Women with deformity; study: n2 = 1.962 x 0.779 x 0.221 / 0.052 - Women with some internal and surgical (women). diseases: cardiovascular, hypertension, → according to the above formula is bronchial asthma, calculated: n2 = 264.54 116 Journal of Nursing Science - Vol. 04 - No. 01
3. RESEARCH ARTICLE Because n1> n2, the women participating 3. RESULTS in the study were 265 women. 3.1. General information of paticipants * The research sampling: a convenient Table 1. General information of sampling method was used to recruit the women (n=265) sample until n enough. Number % 2.3. Research period: from October 18-24 years 2020 to January 2021 54 20,4 old 2.4. Instruments: Age 25-34 years 186 70,2 old Data was collected using pre-designed ≥35 years old 25 9,4 questionnaires and skin-to-skin and early Primary breastfeeing procedures based on research 4 1,5 school objectives and clinical experience. The High school 47 17,7 questionnaire consists of 3 parts: Education Professional 5 1,9 Part 1: General information: 9 questions; level school College, Part 2: Measuring knowledge and university, 209 78,9 practicing warming by skin-to-skin method: postgraduate 18 questions; Officer 138 52,1 Part 3: Measuring knowledge and Student 7 2,6 practice of early breastfeeding: 15 Occupation Worker 23 8,7 questions. Farmer 9 3,4 Other 88 33,2 The questionnaire was referenced from a number of other research topics such as The most common age of study authors Truong Thi Hai and Pham Van Tung participants was the 25-34 group, [6], [7]. The toolkit was tested by Cronbach accounting for 70.2%. alpha before the study. 3.2. Knowledge and practice of Training research assistant: before mother about skin-to-skin method conducting the measurements, research Table 2. Knowledge of skin-to-skin method assistant were trained. The training content was mainly for research assistant to Number % understand the content of the questionnaire Know Yes 257 97,0 skin to and the purpose of the study. No 8 3,0 skin 2.5. Ethical issues Total 265 100 This was a study aimed at contributing Keep your baby 216 81,5 to the health of women and their babies. warm The information obtained is only used for mother and child 209 78,9 research purposes and not for any other Skin- pounding purpose. Before conducting the study, to-skin Breastfeeding 160 60,4 all participants were asked to agree to benefits early participate in the study. The research did Easy to follow 90 34,0 not affect the care and childbirth process of children the women. Do not know 2 0,8 Journal of Nursing Science - Vol. 04 - No. 01 117
4. RESEARCH ARTICLE 97% of pregnant women knew the skin- 3.3. Knowledge and practice on early to-skin method for their newborn babies. breastfeeding 81.5% of women knew that the benefit of skin-to-skin care is to keep the baby warm, only 13.6% of women knew all 4 benefits above. Figure 2. Knowledge of the benefits of colostrum (n=257) o o o 79.4% of women knew that colostrum is rich in antibodies. Figure 1. Practice adjusting the temperature while the skin-to-skin (n=257) Table 4. Knowledge of time when babies were breastfed for the first time 12.5% of women adjusted the room temperature suitable for children under Number Proportion % 28oC; 2.3% of women adjusted the room Within the temperature above 30oC first hour after 231 89,9 giving birth Table 3. Practice lying position of Over the first babies in the postpartum room hour after 21 8,2 giving birth Number Proportion % Do not know 5 1,9 Skin to skin Total 257 100 100 38,9 with mother 89.9% of women know that they need to breastfeed in the first hour after giving Lying next to 157 61,1 birth. mother 3.5. Knowledge of early breastfeeding Total 257 100 Table 5. A person supporting woman to breastfeed her baby for the first time 38.9% of children were lying skin-to- skin contact with their mothers, 61.1% of Number % children had no skin-to-skin contact with A midwife 49 19,1 their mothers in the postpartum room. Other medical staff 85 33,0 Relatives, friends 74 28,8 None 49 19,1 Total 257 100 118 Journal of Nursing Science - Vol. 04 - No. 01
5. RESEARCH ARTICLE 19.1% of women were not supported while breastfeeding the first time, 19.1% of the midwives assisted mother in breastfeeding their baby Figure 3. The time the baby was breastfed for the first time 37.7% of children were breastfed the first meal immediately after skin-to-skin contact with their mothers. Table 6. Relationship between several common characteristics to skin-to-skin practice and early breastfeeding (n=257) Practice skin to OR, early breastfeed OR Factor skin p p 95%CI 95%CI Yes No Yes No 90 143 89 144 0,05 (33,3%) (66,7%) >0,05 (0,35-2,32) (0,47-3,47) 100 157 97 160 TS (38,9%) (61,1%) (37,7%) (62,3%) 75 133 81 127 CĐ,ĐH, SĐH (36,0%) (64,0%) (38,9%) (61,1%) 25 24 16 33 Education ≤THPT 0,54 1,31 (51,0%) (49,0%) >0,05 (32,7%) (67,3%) >0,05 level (0,27-1,06) (0,65-2,72) 100 157 97 160 TS (38,9%) (61,1%) (37,7%) (62,3%) 48 87 47 88 CBCC (35,6%) (64,4%) (34,8%) (65,2%) 52 70 50 72 CN,ND, Khác 0,74 0,77 Occupation (42,6%) 57,4%) >0,05 (41,0%) (59,0%) >0,05 (0,43-1,26) (0,45-1,31) 100 157 97 160 TS (38,9%) (61,1%) (37,7%) (62,3%) The study results indicated that there were no relationship between age, education level and occupation, and early breastfeeding practice and skin-to-skin care of women. Journal of Nursing Science - Vol. 04 - No. 01 119
6. RESEARCH ARTICLE .4. DISCUSSION According to Lozoff’s research, in underdeveloped countries, infant skin-to- 4.1. Discuss on knowledge and skin warming is rarely practiced because practice of of women to skin-to-skin there was no special effort to help mothers method and babies come into skin-to-skin contact When studying over 265 pregnant women during the first minutes after birth [9]. giving birth at the Hanoi Obstetrics and However, a number of studies where Gynecology Hospital, 97% of women knew applied, supported, and instructed pregnant about the method of skin to skin for babies. women to practice skin-to-skin warming for The high rate of women who knew about their babies, this practice was significantly skin-to-skin method because this method higher. According to Awi, the proportion had been very interested in women recently, of women applying the skin-to-skin warm the people’s intellectual level had been method to their babies within 30 minutes increasingly improved. In addition, it was of giving birth in a Nigerian hospital (2005) impossible not to mention the development was 38.4% [10]. At Hanoi Obstetrics and of media as well as social networks that had Gynecology Hospital, skin-to-skin care provided mass of knowledge for pregnant immediately after giving birth was done women about infant care, including skin-to- quite well (86.7%) [4], however, in order for skin methods. On July 14, 2015, in Hanoi, women to take initiative of skin-to-skin care the World Health Organization launched for their newborn babies, there was a need the campaign “The first hug” in Viet Nam, more specific instructions from the medical highlighting simple steps that could save staff. thousands of babies and prevent Hundreds As well as the results of studies of thousands of complications each year are performed where the skin-to-skin method caused by harmful or obsolete practices in had not been introduced and was only infant care in Viet Nam [8], which also partly applied to infants immediately after birth, made pregnant women knew skin-to-skin. the study was also considered as a primary When analyzed further, women’s investigation at Department A2, Hanoi understanding of this method was quite Obstetrics and Gynecology Hospital. The high, but not enough. With the question rate of women who practice skin-to-skin for of multiple choices about the benefits of their children was low because this method skin-to-skin contact, the percentage of the was hardly applied here. The women in keep-warm effect accounted for the highest the study had not received consultation, percentage (81.5%), followed by the benefit training and support in applying skin-to-skin of mother-to-child attachment (78.9%), the care for newborn babies after giving birth benefit for early breastfeeding 60.4%, the from health workers and midwives as well lowest was the follow-up benefit (34%). as at prenatal antenatal check-ups. Women knew this method mainly through the mass With the knowledge of women on skin media. to skin, only 13.6% of women knew all 4 above benefits because there was limited The hot and humid weather conditions in knowledge about skin-to-skin benefits, Viet Nam may also be one of the reasons therefore, the rate of women keeping their why the rate of women practicing skin-to- babies warm was very low proportion to skin warming for their children was low. practice skin-to-skin method immediately In addition, the inadequate understanding after delivery. Only 100 women (38.9%) of the skin-to-skin method also explained had this practice for their babies. the difference between the knowledge and 120 Journal of Nursing Science - Vol. 04 - No. 01
7. RESEARCH ARTICLE practice levels of women (81.5% of women proved that the knowledge of breastfeeding knew but only 38.9% practiced to warm the timing after giving birth of women was very baby). good, it was quite reasonable because 76.7% of women believed that colostrum To prevent hypothermia in infants, the contained many antibodies, helping the ideal room temperature should be 28-30ºc. baby increase resistance. The results In this study, it was also shown that 12.5% ​​ were higher than those of Ton Thi Anh Tu of women said that the room temperature and Nguyen Thu Tinh while the number of should only be below 28oC, which also women who believed that breastfeeding greatly affected the hypothermia of the within the first hour after birth was 69.45% newborn. Especially in the total number of [13]. newborns dying at the hospital in the first 24 hours after delivery, up to 32% of mothers Although the knowledge of breastfeeding showed signs of hypothermia. A study timing and the benefits of early breastfeeding in Hai Phong showed that hypothermia was quite good, the results showed that accounted for 35% of all neonatal deaths the proportion of women who breastfeed [11]. The results in the study showed that within the first hour after birth was quite it was necessary to further improve the low. (37.7%), most children (57.2%) understanding of pregnant women and were breastfed after the first 2-6 hours health workers about knowledge and postpartum. Currently, breastfeeding was a practice of keeping warm babies after popular practice in the world, however, the birth, through communication, education. rate of breastfeeding within the first hour Providing appropriate information may after birth was generally low. In Asia, only limit hypothermia, prevent morbidity and nearly 20% of babies were breastfed within mortality related to the cause of hypothermia the first 24 hours of life. Research in Jinan in infants. City, China showed that 51% of women breastfed for the first time after an hour 4.2. Discuss on knowledge and practice about early breastfeeding for According to a study by Le Thi Huong women and Do Huu Hanh in Yen Bai province in 2008, 66% of pregnant women breastfed Breast milk is the best food for babies early within the first half hour after birth [14]. and young children. Women ‘s knowledge The reasons not to breastfeed within the about the benefits of colostrum was first hour of birth were mainly due to lack of relatively high. Up to 79.4% of women knew understanding of the benefits of colostrum, that colostrum contained many antibodies the benefits of early breastfeeding, and in and 76.7% knew colostrum contained many many places, old and long-term customs nutrients. Meanwhile, according to research of local life or tired women after birth. Only results of Le Thi Yen Phi, the number of 19.1% of the women received the assistance women who knew the benefits of colostrum of the midwife to breastfeed their baby was 95% and that of Truong Thi Hai was and 33% were from other health workers. 99.8% [6], [12]. Department of Pediatrics A2 is assigning Along with the proportion of women who care to teams, groups, so each team and knew the concept of colostrum, the women group will have their own specific work, such who had the correct knowledge about the as taking care of pregnant women in labor, time of first breastfeeding in the study taking care of women after giving birth. accounted for 89.9% of them that they should Care for pregnant women in stage II labor breastfeed immediately after birth. This also needed to better complete counseling Journal of Nursing Science - Vol. 04 - No. 01 121
8. RESEARCH ARTICLE and support for the baby to breastfeed the Another study conducted in Nigerian first breast-feeding meal. For that reason, mothers in 2004 on skin-to-skin contact 19.1% of women were not supported to practice found that maternal education did breastfeed their babies, so they ate some not have a statistically significant effect other foods to replace breast milk. This was on skin-to-skin practice. The research completely not beneficial for the newborn results showed that mother’s education because the baby does not receive breast level was similar to the above results on milk with antibodies. skin-to-skin practice and early postpartum In India, 70% of the rural women and breastfeeding. Specifically, for mothers’ more than 50% of the educated women in education, those with college, university Bombay gave their babies other foods and or post-graduate education had practiced drinks before the first breastfeeding. Another breastfeeding within the first hour after birth study by Chhabra in Delhi, India also showed (38.9%) for women with upper secondary that 76.9% of babies were given other foods education (32.7%), however this difference and drinks before their first breast-feeding. was statistically significant with p 0.05. In Truong Thi Hai’s study, maternal women knew that the benefit of skin-to-skin education was related to skin-to-skin care was keeping their babies warm, and warming practice. Specifically, in those with only 38.9% of babies had skin-to-skin-to- higher educational attainment (intermediate skin care in the postpartum room. and above), the practice rate of skin-to-skin - 79.4% of women knew that colostrum warming was 11.9 times higher with OR = was rich in antibodies, 37.7% of children 11.9; 95% CI (1.9 - 489.7) [6]. were breastfed for the first time after skin- 122 Journal of Nursing Science - Vol. 04 - No. 01
9. RESEARCH ARTICLE to-skin contact with mothers; with children aged 0-6 months in Nam Dinh city in 2017 after educational intervention, - There was no relationship between Master’s thesis in nursing, Nam Dinh the age, education level and occupation University of Nursing. [In VietNamese] and the skin-to-skin practice and early breastfeeding of women. 8. Western Pacific Regional Office (2015). Infant Health. REFERENCES who.int/Viet Nam/topics /newborn_health/ 1. Ministry of Health (2016). National factsheet/en/ action plan on maternal, infant and child 9. Lozoff B. (1983). Birth and ‘bonding’ health care for the period 2016 - 2020, in non-industrial societies. Dev Med Child issued together with Decision 4177 / QD- Neurol, (25), 595–600. BYT, dated August 3, 2016. [In VietNamese] 10. Awi D.D. & Alikor E. a. D. (2004). The 2. UNICEF (2014). The 2013-2014 influence of pre- and post-partum factors on Mother and Infant Goals and Goals the time of contact between mother and her Assessment Survey, General Statistics new-born after vaginal delivery. Niger J Med Office Publisher, Hanoi. [In VietNamese] J Natl Assoc Resid Dr Niger, (13), 272–275. 3. Charpak N., Ruiz J.G., Zupan J. et al, 11. Doan Thi Thanh Huong (1998). (2005). Kangaroo Mother Care: 25 years Relationship between weight, temperature after. Acta Paediatr Oslo Nor 1992, (94), and Apgar score at birth and neonatal 514–522 mortality. Hai Phong 1996-1997. The fourth 4. Pham Thuy Quynh (2018). Assessment scientific conference of Hanoi Medical of maternal satisfaction and the situation University. [In VietNamese] of essential care for mothers and infants 12. Le Thi Yen Phi (2009). Knowledge, during and immediately after birth at Hanoi attitudes and practices of breastfeeding Obstetrics and Gynecology Hospital in for postpartum mothers at Hung Vuong 2018, Master Thesis of Nursing, Nam Dinh Hospital in 2009. Hung Vuong Hospital. [In University of Nursing. [In VietNamese] VietNamese] 5. Le Thi Mong Tuyen and Tran Dinh 13. Ton Thi Anh Tu and Nguyen Thu Tinh Le Khanh (2016). Evaluate the results (2011). Knowledge, attitudes and practices of applying essential care procedures on breastfeeding of mothers with children for mothers and newborns during and under six months old at Children’s Hospital immediately after delivery at the Da I from December 1, 2009 to April 30, 2010. Nang Obstetrics and Pediatrics Hospital [In VietNamese] Department. Da Nang Obstetrics & Pediatrics Hospital, December 2016. [In 14. Le Thi Huong and Do Huu Hanh VietNamese] (2008). Maternal knowledge of nutritional practices and children’s nutritional status in 6. Truong Thi Hai (2016). Knowledge and Yen Bai province. [In VietNamese] practice on skin-to-skin warming and early breastfeeding methods of women at Bach 15. Prasad B. & Costello A.M. (1995). Mai Hospital. Bachelor of Arts in Nursing, Impact and sustainability of a “baby Hanoi Medical University. [In VietNamese] friendly” health education intervention at a district hospital in Bihar, India. BMJ, (310), 7. Pham Van Tung (2017). Changes in 621–623. awareness of breastfeeding among mothers Journal of Nursing Science - Vol. 04 - No. 01 123