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To evaluate patient access to Spanish-language-concordant care on a postpartum unit and to identify facilitators and barriers to the use of interpretation services.Mixed-methods research study, comprising a cross-sectional chart review from September to December 2019 and semistructured interviews from June to December 2020.A tertiary academic medical center in the southeastern United States where individuals with limited English proficiency are at risk for poor health outcomes when they are unable to communicate with clinicians in their preferred language.We conducted a chart review of 50 randomly selected birthing parent-newborn couplets and interviews with 14 inpatient health care team members.The chart review examined patient characteristics, health care team composition including Spanish language proficiency, length of stay, number of interpreter requests, and time between clinician interpreter requests and interpreter arrival on the unit. Interviews evaluated facilitators and barriers to interpreter use.Access to a clinician certified in medical Spanish or an interpreter was offered to 12 of 50 (24%) couplets upon admission to the unit and to 7 of 50 (14%) of couplets for daily maternal and newborn medical rounds. Clinicians reported long and unpredictable wait times to access interpreters, which led them to rely on hand gestures, broken Spanish, and smartphone apps to "get by" when communicating with patients without certified interpretation services. Participants described low usage of interpreters for "noncritical" encounters.Interpreters and other forms of Spanish-language-concordant care were underused on the postpartum unit. This deviation from national standards may put families at risk for harm. Recommendations from this study include advancing a culture of respectful care, improving the interpreter request workflow, addressing safe staffing, facilitating direct patient access to interpreters, and providing ongoing evaluation and support.

The aim of this study was to evaluate differences in the use of pasteurized donor human milk (PDHM) by maternal race-ethnicity during postpartum hospitalization using electronic medical records (EMRs).A retrospective cohort study of all live-born infants at our academic research institution from July 1, 2014, to June 30, 2016, was conducted. EMR data were used to determine whether each infant received mother's own milk (MOM), PDHM, or formula. These data were stratified based on whether the infant received treatment in the Neonatal Critical Care Center. Generalized estimating equation models were used to calculate the odds of receiving PDHM by maternal race-ethnicity, adjusting for gestational age, birth weight, insurance, preferred language, nulliparity, and mode of delivery.Infant feeding data were available for 7097 infants, of whom 49% were fed only MOM during their postpartum hospitalization. Among the 15.9% of infants admitted to neonatal critical care, infants of non-Hispanic Black (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.31-0.72), Hispanic (OR 0.65, 95% CI 0.36-1019), and Other (OR 0.63, 95% CI 0.32-1.26) mothers had lower rates of PDHM feedings than infants of non-Hispanic White mothers in the adjusted models. Among well infants, the use of PDHM was lower among non-Hispanic Black and Hispanic mothers (OR 0.25, 95% CI 0.18-0.36, and OR 0.38, 95% CI 0.26-0.56) compared with non-Hispanic White mothers.Inequities in exclusive human milk feeding and use of PDHM by maternal race-ethnicity were identified. Antiracist interventions are needed to promote equitable access to skilled lactation support and counseling for PDHM use.

Objective The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine endorse checklist use to improve obstetric care. However, there is limited research into development, implementation, and sustained use of perinatal emergency checklists to inform individual institutions. This study aimed to investigate the development and implementation of perinatal emergency checklists in diverse hospital settings in the United States. Study Design A qualitative study was conducted individually with clinicians from three health care systems. The participants developed and implemented institution-tailored perinatal emergency checklists. Interview transcriptions were coded using the Consolidated Framework for Implementation Research. Results The study sites included two health care systems and one individual hospital. Delivery volumes ranged from 3,500 to 48,000 deliveries a year. Interviews were conducted with all 10 participants approached. Checklists for 19 perinatal emergencies were developed at the three health care systems. Ten of the checklist topics were the same at all three institutions. Participants described the checklists as improving patient care during crises. The tools were viewed as opportunities to promote a shared mental model across clinical roles, to reduce redundancy and coordinate obstetric crisis management. Checklist were developed in small groups. Implementation was facilitated by those who developed the checklists. Participants agreed that simulation was essential for checklist refinement and effective use by response teams. Barriers to implementation included limited clinician availability. There was also an opportunity to strengthen integration of checklists workflow early in perinatal emergencies. Participants articulated that culture change took time, active practice, persistence, reinforcement, and process measurement. Conclusion This study outlines processes to develop, implement, and sustain perinatal emergency checklists at three institutions. Participants agreed that multiple, parallel implementation tactics created the culture shift for integration. The overview and specific Consolidated Framework for Implementation Research components may be used to inform adaptation and sustainability for others considering implementing perinatal emergency checklists. Key Points

Background: Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization. Research Aims: To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed. Methods: This was a prospective cross-sectional survey study. Through secure online survey, participants submitted ( N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics. Results: Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood. Conclusion: Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand.

Purpose: This quality improvement project evaluated implementation of social determinants of health screening and referral for food insecurity. Methods: Four obstetric providers used study-developed resources to screen and refer English-speaking patients (n=14) during clinic visits. Providers and patients completed post-visit questionnaires. Provider feedback informed improvements to the intervention approach for consecutive study shifts. Results: Providers and patients reported high satisfaction with encounters. Referrals were made for four patients. Challenges to implementation included resource organization, time constraints, and integration into clinic workflow. Conclusion: Processes for universal screening and tailored information provision are areas to continue to strengthen for establishing equitable health care.

Assessing hospital environment conditions is necessary for healthcare providers and patients to coordinate safe care. The aims of this research included: a) identifying patterns in hospital visit feedback transcripts regarding bathroom doors and lights in the hospital room and b) interpreting the results to make recommendations for more enabling clinical environments. The methods used by the research team included organizing transcript data, assigning codes, and conducting an interrater reliability test to assess codebook efficacy. Finally, working with maternal and infant mortality experts, recommendations for the hospital were developed. We identified four possible interventions to address barriers: a) implement low-height, dimmable lighting along the base of the patient room, b) provide personal lights, such as penlights, to staff for nighttime assessments, c) install and improve on existing grab bars in patient room bathrooms and d) replace the standard patient room bathroom door with a different kind of auditory/visual privacy barrier.

OBJECTIVE To evaluate whether the frequency of pain assessment and treatment differed by patient race and ethnicity for women after cesarean birth. METHODS We performed a retrospective cohort study of all women who underwent cesarean birth resulting in a liveborn neonate at a single institution between July 1, 2014, and June 30, 2016. Pain scores documented and medications administered after delivery were grouped into 0-24 and 25-48 hours postpartum time periods. Number of pain scores recorded, whether any pain score was 7 of 10 or greater, and analgesic medication administered were calculated. Models were adjusted for propensity scores incorporating maternal age, body mass index, gestational age, nulliparity, primary compared with repeat cesarean delivery, classical hysterotomy, and admission to the neonatal intensive care unit. RESULTS A total of 1,987 women were identified, and 1,701 met inclusion criteria. There were 30,984 pain scores documented. Severe pain (7/10 or greater) was more common among black (28%) and Hispanic (22%) women than among women who identified as white (20%) or Asian (15%). In the first 24 hours after cesarean birth, non-Hispanic white women had more documented pain assessments (adjusted mean 10.2) than, black, Asian, and Hispanic women (adjusted mean 8.4-9.5; P

BACKGROUND: Emotional and physical support for birthing parents is positively associated with realization of their breastfeeding goals. However, few studies have investigated maternal descriptions of their postnatal unit experience of these domains. RESEARCH AIM: The objective was to investigate maternal report of their birthing facility experiences and quantify the extent to which accounts of postpartum support were associated with meeting their breastfeeding goals. METHODS: After IRB review, data were obtained through an online survey distributed from November 2016-May 2017. This analysis utilizes data from 2,771 birthing parents who were at least 18 years of age, experienced maternity care in the United States within five years, and reported that they had intended to breastfeed. Bivariate analysis was followed by logistic regression controlling for significant covariates. RESULTS: In this sample of primarily non-Hispanic white birthing parents with intent to exclusively breastfeed, the following postnatal unit variables were associated with higher odds of meeting their breastfeeding goals, birthing parents feeling: welcomed (adjusted OR=1.36), that health care promoted their physical health (adjusted OR=1.41), that care promoted their emotional health (adjusted OR=1.38), that they were supported (adjusted OR=1.56), and that they were recognized by their health care team (adjusted OR=1.30). All the measured postnatal unit support variables were significantly correlated with each other, with correlation coefficients ranging from 0.15 to 0.81. CONCLUSIONS: Before the COVID-19 pandemic, birthing parents’ experiences on the postnatal unit were interrelated and associated with meeting their breastfeeding goals. As health care services are reviewed and prioritized during the COVID-19 pandemic and as part of ongoing strengthening of systems, qualitative and observational research can address the mechanisms underlying breastfeeding outcomes to inform the provision of more holistic and effective support.

The weeks and months after birth are vital not only for infant health but also for the health and well-being of women and families as a whole. The first 12 weeks postpartum, also known as the 4th trimester, is part of a continuum of pregnancy to recovery and family adjustment. In the United States, this transitional period has been a neglected area for women's health, especially considering the inherent biological, physical, and social changes experienced by millions of women each year. The Patient-Centered Outcomes Research Institute supported the 4th Trimester Project to partner with new mothers, health care providers, and health advocates to better describe and understand unmet maternal postpartum health needs. Through woman-centered engagement, the patient-researcher-clinician-advocate team co-developed priority areas for research, policy, communication, and health care service delivery.

After childbirth, most American women are not scheduled for follow-up care for 6 weeks, and this visit is poorly attended. Many new mothers feel unprepared for the common health issues they encounter and are uncertain of whom to contact. To improve care, the 4th Trimester Project is bringing together mothers, health care providers, and other stakeholders to explore what families need most from birth to 12 weeks postpartum. Eighty-seven individuals convened in March 2016 in Chapel Hill, NC. Four major topic areas emerged: (1) the intense focus on women's health prenatally is unbalanced by infrequent and late postpartum care; (2) medical practice guidelines often do not align with women's experiences and constraints; (3) validation of women as experts of their infants and elevating their strengths as mothers is necessary to achieve health goals; and (4) mothers need comprehensive care, which is difficult to provide because of numerous system constraints. Considerations for improving postpartum services include enabling more convenient care for families that is holistic, culturally appropriate, conversation based, and equitable. Maternal health issues in the fourth trimester intersect and can compound one another. Enhanced collaboration among health care providers may improve the focus of clinical interactions to address the interrelated health issues most important to women.

In this chapter, we use an evolutionary lens to deepen understanding of maternal and family needs in the early postpartum period so that health care can be more aligned with confronted realities. The discussion is centered around the concept of the 4th trimester, which is the period between birth and the first 3 months postpartum. This framework encourages a holistic understanding of perinatal health by drawing attention to evolved maternal-infant needs. By addressing these ultimate-level contributors to health issues, we can facilitate more effective clinical support, comprehensive research, and a fuller “village” to enable new families to thrive. Core to this approach is the concept of trade-offs between parents and offspring, exemplified by lactation as a prime example of the complexities of dyadic needs and gap between the current culture of health and optimal support.

Parents in the United States increasingly report bed-sharing with their infants (i.e., sleeping on a shared sleep surface), but the relationship between bed-sharing and child socioemotional outcomes are not well understood. The current study examines the links between mother-infant bed-sharing at 3 months and infant affect and behavior during a dyadic challenge task at 6 months. Further, we examine nighttime mother-infant contact at 3 months as a possible mechanism that may mediate linkages between bed-sharing and infant outcomes. Using observational data from a sample of 63 mother-infant dyads, we found that infants who bed-shared for any proportion of the observation period at 3 months displayed significantly more self-regulatory behaviors during the still-face episode of the Still-Face Paradigm (SFP) at 6 months, compared to non-bed-sharing infants. Also, infants of mothers who bed-shared for the entire observation period displayed significantly less negativity during the reunion episode than non-bed-sharing infants. There was no evidence that the relations between mother-infant bed-sharing practices and infant affect and behavior during the SFP were mediated through nighttime mother-infant contact. Results suggest that infant regulation at 6 months postpartum may vary based on early nighttime experiences, with bed-sharing potentially promoting more positive and well-regulated behavior during dyadic interaction.

We sought to report the frequency of, circumstances surrounding, and outcomes of newborn falls in our hospital. We evaluated the impact of specific interventions on the frequency of newborn falls and the time between falls.We performed a retrospective study of newborn falls reported on our postpartum unit over a 13-year period. Demographic information and circumstances of falls were collected via an electronic event reporting system and medical record review.There were 63 633 births and 29 newborn falls, yielding an average of 4.6 falls per 10 000 live births (median: 2 per year; range 0-5 per year). Newborns who sustained a fall were exclusively breastfeeding (75.9%), 24 to 48 hours of age at the time of the fall (58.6%), and had first-time parents (62.1%). At the time of the fall, most newborns were with the mother compared with being with the father or both parents (65.5% vs 34.5%); in the mother's bed compared with being elsewhere, such as on a couch or chair, with a parent, or in the parent's arms (62.1% vs 37.9%); and feeding at the time of the fall versus not (79.3% vs 20.7%). All newborns were monitored after the fall, with no adverse outcomes. Despite interventions, we continued to see cases of newborn falls, although the overall trend revealed decreasing falls per 10 000 patient-days and longer time between falls over the study period.Newborn falls in our hospital are infrequent but continue to occur despite preventive efforts, highlighting the importance of continuous awareness and education.

BACKGROUND Comprehensive prenatal education on infant feeding is recommended by many United States health organizations because of the need to maximize maternal preparedness for managing lactation physiology. Ready, Set, BABY (RSB) is a curriculum developed for counseling women about breastfeeding benefits and management including education on optimal maternity care practices. We hypothesized that RSB would be acceptable to mothers and that mothers' strength of breastfeeding intentions would increase, and their comfort with the idea of formula feeding would decrease after educational counseling using the materials. We also hypothesized that mothers' knowledge of optimal maternity care practices would increase after participation. METHODS Materials were sent to a total of seven sites in the United States and Puerto Rico. Local health care practitioners completed training before counseling mothers with the curriculum. A pre- and postintervention questionnaire was administered to participants. Statistical analysis of results included paired t tests, Wilcoxon signed-rank tests, and McNemar's tests. RESULTS Four hundred and sixteen expectant women participated. In the pre- and postintervention comparison, maternal participation in RSB significantly improved Infant Feeding Intentions Scale scores (P

The current study compares sleep variables obtained from videosomnography, actigraphy, and sleep diaries, three of the most common sleep assessment methods used in infant sleep studies. Using a sample of 90 African American 3-month olds, we compare correlations and discrepancies for seven sleep variables across each of the three pairs of assessment methods for one night of a week-long sleep study. These seven variables are indicative of sleep schedule (e.g. sleep onset time, rise time), duration (e.g. sleep period, sleep time, wake time), and fragmentation (e.g. night wakings, longest sleep period). We find that across all sleep assessment methods, correlations are highest for variables indicative of sleep schedule, and lowest for variables indicative of sleep fragmentation. Comparing the magnitude and significance of the discrepancies, we find that actigraphy and sleep diaries significantly overestimate sleep period duration and underestimate the number of night waking episodes, compared with videosomnography. Actigraphy and sleep diaries were more concordant with one another than with videosomnography. Epoch-by-epoch analyses indicated that actigraphy had low sensitivity to detect wakefulness, compared with videosomnography. Contrary to our hypothesis, the discrepancies between sleep assessment methods did not vary widely based on infant sleep location (own room vs. parent's room) or sleep surface (own bed vs. parent's bed). Limitations and implications of these findings for future research are discussed.

Background breast-feeding outcomes are often worse after caesarean section compared to vaginal childbirth. Objectives this study characterises mothers' breast-feeding intentions and their infant feeding experiences after caesarean childbirth. Methods data are from 115 mothers on a postnatal unit in Northeast England during February 2006–March 2009. Interviews were conducted an average of 1.5 days (range 1–6 days) after the women underwent unscheduled or scheduled caesarean. Results thematic analysis of the data suggested was mostly considered the ‘right thing to do,' preferable, natural, and ‘supposedly healthier,' but tiring and painful. Advantages of supplementation involved more satiated infants, feeding ease, and longer sleep bouts. The need for ‘thinking about yourself' was part of caesarean recovery. Infrequent feeding was concerning but also enabled maternal rest. Other breast-feeding obstacles were maternal mobility limitations, positioning difficulties, and frustration at the need for assistance. Participants were confused about nocturnal infant wakings, leading many to determine that they had insufficient milk. Mothers were surprised that sub-clinically poor infant condition was common following caesarean section. Some breast-feeding difficulty stemmed from ‘mucus' expulsion that had to occur before the infants could be ‘interested' in feeding. Women who cited motivations for breast feeding that included benefit to themselves were more likely to exclusively breast feed on the postnatal unit after their caesareans than those who reported infant-only motivations. Conclusions for the majority of mothers, breast feeding after a caesarean is affected by interrelated and compounding difficulties. Provision of more relational breast-feeding information may enable families to better anticipate early feeding experiences after caesarean section childbirth.

Late preterm birth is associated with lower rates of breastfeeding and earlier breastfeeding cessation than term birth.The objectives of this secondary analysis were to compare the incidence of exclusive breastfeeding after late preterm and term childbirth and to examine the association between infant feeding outcomes and maternal emotional well-being.Participants were 105 mother-infant dyads (54 late preterm and 51 term) at a southeastern US medical center. Face-to-face data collection and telephone follow-up occurred during 2009-2012.Late preterm mothers were less likely to exclusively provide their milk than were term mothers during hospitalization. Feeding at 1 month did not differ between late preterm and term infants. Among late preterm mothers, (1) formula supplementation during hospitalization was associated with greater severity of anxiety than among those exclusively providing formula and (2) exclusive provision of human milk at 1 month was associated with less severe depressive symptoms than among those supplementing or exclusively formula feeding. Among term mothers, feeding outcome was not related to emotional well-being measures at either time point.Mothers of late preterm infants may particularly benefit from anticipatory guidance and early mental health screening, with integrated, multidisciplinary lactation teams to support these interrelated healthcare needs.Prospective research is critical to document women's intentions for infant feeding and how experiences with childbirth and the early postpartum period impact achievement of their breastfeeding goals.

The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative. Research aim: This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity.The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies.Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women's partners or family are involved. However, varying study quality and lack of standardized assessment of participants' breastfeeding intentions limited the ability to recommend any single intervention as most effective.Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions.

This paper presents a new conceptual model that generates predictions about breastfeeding decisions and identifies interactions that affect outcomes. We offer a contextual approach to infant feeding that models multi-directional influences by expanding on the evolutionary parent–offspring conflict and situation-specific breastfeeding theories. The main hypothesis generated from our framework suggests that simultaneously addressing breastfeeding costs and benefits, in relation to how they are interpreted by mothers, will be most effective. Our approach focuses on contributors to the attitudes and commitment underlying breastfeeding outcomes, beginning in the prenatal period. We conclude that some maternal–offspring conflict is inherent with the dynamic infant feeding relationship. Guidance that anticipates and addresses family trade-offs over time can be incorporated into breastfeeding support for families.

This study examined the direct and interactive effects of infants' respiratory sinus arrhythmia (RSA) and maternal depressive symptoms (MDS) during the first 6 months of life in the prediction of children's sleep problems at age 18 months. Participants included 156 children and their mothers who were followed from 3 to 18 months of age. At ages 3 and 6 months, infants' cardiac activity was recorded at rest and during the still-face paradigm, a mother-child social challenge task, and estimates of infant baseline RSA (RSAB) and RSA withdrawal (RSAW) were calculated. Mothers reported about their depressive symptoms at 3, 6, and 18 months, and about infants' sleep problems at age 18 months. Less RSAW and higher levels of MDS predicted more sleep problems at age 18 months. Additionally, RSAB moderated the link between MDS and children's sleep problems such that MDS were related to more sleep problems only for infants with high levels of RSAB. Results illustrate the importance of RSA as both a direct predictor and a moderator of maternal influences in the prediction of early sleep problems.

Objective To test the effects of kangaroo care (KC) on breastfeeding outcomes in preterm infants compared with two control groups and to explore whether maternal–infant characteristics and the mother's choice to use KC were related to breastfeeding measures. Design Secondary analysis of a multisite, stratified, randomized three-arm trial. The treatment groups used KC, auditory–tactile–visual–vestibular (ATVV) intervention, or received preterm infant care information. Setting Neonatal intensive care units from 4 hospitals in the United States from 2006 to 2011. Participants Racially diverse mothers (N = 231) and their preterm infants born weighing less than 1,750 g. Methods Mothers and their infants were enrolled once the infants were no longer critically ill, weighed at least 1,000 g, and could be safely held outside the incubator by parents. Participants were instructed by study nurses; those allocated to the KC or ATVV groups were asked to engage in these interactions with their infants for a minimum of 3 times a week in the hospital and at home until their infants reached age 2 months adjusted for prematurity. Results Feeding at the breast during hospitalization, the duration of postdischarge breastfeeding, and breastfeeding exclusivity after hospital discharge did not differ statistically among the treatment groups. Regardless of group assignment, married, older, and more educated women were more likely to feed at the breast during hospitalization. Mothers who practiced KC, regardless of randomly allocated group, were more likely to provide their milk than those who did not practice KC. Breastfeeding duration was greatest among more educated women. Conclusion As implemented in this study, assignment to the KC group did not appear to influence the measured breastfeeding outcomes.

This chapter illustrates an alternative approach to video ethnography, in which video case studies are described alongside semi-structured interview responses to detail night-time challenges of mothers, newborns, and hospital staff on a postnatal ward. Data from three original, inter-related research projects were combined. We uncovered five themes: maternal need for support, response to infant cues, negative experiences, bedsharing as a way of coping, and insufficient staffing. In detailing these issues, we draw attention to previously unknown or unacknowledged obstacles for new mothers and their infants, as well as the constraints on the staff involved in their care.

To compare maternal report of planned and practiced home sleep locations of infants born late preterm (34 0/7 to 36 6/7 gestational weeks) with those infants born term (≥37 0/7 gestational weeks) over the first postpartum month. Open-ended semi-structured maternal interviews were conducted in a US hospital following birth and by phone at 1 month postpartum during 2010-2012. Participants were 56 mother-infant dyads: 26 late preterm and 30 term. Most women planned to room share at home with their infants and reported doing so for some or all of the first postpartum month. More women reported bed sharing during the first postpartum month than had planned to do so in both the late preterm and term groups. The primary reason for unplanned bed sharing was to soothe nighttime infant fussiness. Those participants who avoided bed sharing at home commonly discussed their fear for infant safety. A few parents reported their infants were sleeping propped on pillows and co-sleeping on a recliner. Some women in both the late preterm and term groups reported lack of opportunity to obtain a bassinet prior to childbirth. The discrepancy between plans for infant sleep location at home and maternally reported practices were similar in late preterm and term groups. Close maternal proximity to their infants at night was derived from the need to assess infant well-being, caring for infants, and women's preferences. Bed sharing concerns related to infant safety and the establishment of an undesirable habit, and alternative arrangements included shared recliner sleep.

Commentary on: Paul IM, Hohman EE, Loken E, et al . Motherinfant room-sharing and sleep outcomes in the INSIGHT study. Pediatrics 2017;140:e20170122. Night-time parenting is a critical part of life that is understudied. The need to improve the evidence base for health recommendations so that parents have improved opportunity for informed decision-making is urgent. Currently, too little attention is paid to safe postpartum interactions. Mothers are cautious about reporting issues such as infant sleep in clinical visits.1 Fear-based messaging about infant sleep locations can …

Background: Postnatal unit rooming-in promotes breastfeeding. Previous research indicates that side-cars (3-sided bassinets that lock onto the maternal bed frame) facilitate breastfeeding after vaginal birth more than stand-alone bassinets (standard rooming-in). No study has previously investigated side-car bassinet use after cesarean, despite the constraints on maternal-infant interactions that are inherent in recovery from this birth mode. Objective: To test the effect of the side-car bassinet on postnatal unit breastfeeding frequency and other maternal-infant behaviors compared to a stand-alone bassinet following cesarean birth. Methods: Participants were recruited and prenatally randomized to receive the side-car or stand-alone bassinet for their postnatal unit stay between January 2007 and March 2009 in northeastern England. Mother-infant interactions were filmed over the second postpartum night. Participants completed face-to-face interviews before and after filming. The main outcome measures were infant location, bassinet acceptability, and breastfeeding frequency. Other outcomes assessed were breastfeeding effort, maternal-infant contact, sleep states, midwife presence, and infant risk. Results: Differences in breastfeeding frequency, maternal-infant sleep overlap, and midwife presence were not statistically significant. The 20 dyads allocated to side-car bassinets breastfed a median of 0.6 bouts/ hour compared to 0.4 bouts/hour for the 15 stand-alone bassinet dyads. Participants expressed overwhelming preference for the side-car bassinets. Bed sharing was equivalent between the groups, although the motivation for this practice may have differed. Infant handling was compromised with stand-alone bassinet use, including infants positioned on pillows while bed sharing with their sleeping mothers. Conclusions: Women preferred the side-car, but differences in breastfeeding frequency were not statistically significant. More infant risks were observed with stand-alone bassinet use.

This paper presents a new conceptual model that generates predictions about breastfeeding decisions and identifies interactions that affect outcomes. We offer a contextual approach to infant feeding that models multi-directional influences by expanding on the evolutionary parent–offspring conflict and situation-specific breastfeeding theories. The main hypothesis generated from our framework suggests that simultaneously addressing breastfeeding costs and benefits, in relation to how they are interpreted by mothers, will be most effective. Our approach focuses on contributors to the attitudes and commitment underlying breastfeeding outcomes, beginning in the prenatal period. We conclude that some maternal–offspring conflict is inherent with the dynamic infant feeding relationship. Guidance that anticipates and addresses family trade-offs over time can be incorporated into breastfeeding support for families.

Objective To compare the emotional responses of mothers of late‐preterm infants (34 0/7 to 36 6/7 weeks gestation) with those of mothers of full‐term infants. Design A mixed method comparative study. Setting A southeastern tertiary academic medical center postpartum unit. Participants Sixty mothers: 29 mothers of late‐preterm infants and 31 mothers of full‐term infants. Methods Measures of maternal emotional distress (four standardized measures of anxiety, postpartum depression, posttraumatic stress symptoms, and worry about infant health) and open‐ended semistructured maternal interviews were conducted in the hospital following birth and by phone at one month postpartum. Results Mothers of late‐preterm infants experienced significantly greater emotional distress immediately following delivery, and their distress levels continued to be higher at one month postpartum on each of the standardized measures. Mothers of late‐preterm infants also discussed the altered trajectories in their birth and postpartum experiences and feeling unprepared for these unexpected events as a source of ongoing emotional distress. Conclusion Mothers of late‐preterm infants have greater emotional distress than mothers of term infants for at least one month after delivery. Our findings suggest that it may not be a single event that leads to different distress levels in mothers of late‐preterm and full‐term infants but rather the interaction of multiple alterations in the labor and delivery process and the poorer‐than‐expected infant health outcomes. In the future, researchers need to examine how and when mothers' emotional responses change over time and how their responses relate to parenting and infant health and development.