Objective: To evaluate an innovative nursing strategy called kangaroo care before and during breastfeeding (KB) for mother-fullterm infant dyads who are having breastfeeding difficulties postbirth. The outcomes of this strategy are measured by breastfeeding exclusivity and duration.
Design: Evaluative
Population, Sample, Setting, Years: The population is healthy mother-fullterm infant dyads who are having breastfeeding difficulties identified at 11-15 hours postbirth. The sample will consist of 30 similar dyads in a large maternity hospital at a tertiary care center in the upper Midwest. This research is in progress and will be completed by May 2002.
Variables: The innovative nursing strategy is kangaroo care during breastfeeding (KB), in which the diaper-clad infant is placed skin-to-skin on the mother’s chest and covered across the back with the mother’s clothing and a blanket 30-60 minutes before the next anticipated KB and the next two KBs. The outcome variable chosen for this report is breastfeeding success as measured by breastfeeding duration and exclusivity (absence of complementation and supplementation with water, formula, or other nutrients).
Methods: After providing signed informed consent, each mother-infant dyad will begin KB 30 to 60 minutes before the next anticipated breastfeeding. Mothers will be encouraged to allow the infants to move freely towards the breast and to be alert for infant feeding cues. If necessary after 30 minutes, the nurse researcher will assist the mother and infant in obtaining a good “latch,” if possible. Education will be offered as well regarding milk transfer, maternal hormonal responses, and signs of infant satiation at the close of breastfeedings. Privacy and comfort will be encouraged and provided to the degree possible to promote relaxation. This protocol will be repeated for the next two KBs.
Exclusivity and duration are measured by the Index of Breastfeeding Status (IBS; Labbok & Krasovec, 1990). The Index of Breastfeeding Status, a research tool developed by WHO and UNICEF along with other global agencies to provide a consistent measure of breastfeeding exclusivity across studies. Exclusivity is necessary for optimal milk supply and successful birth control. The concept of exclusivity is similar to that of the “dose effect” so valued in randomized trials. When controlled in randomized trials, definitive benefits of breastfeeding can be documented.
The IBS will be used to measure each KB, including the subsequent interfeeding interval (i.e., the time period between the end of one breastfeeding and the beginning of the next). The IBS will be repeated at hospital discharge to summarize exclusivity and duration between the end of the third KB and discharge. At one week and one month postbirth, mothers will be contacted by telephone and asked to describe breastfeeding status between data collection time points, (i.e., between discharge and one week post-discharge and between one week and one month). Data will be analyzed using descriptive statistics.
Significance: Women in the United States have become increasingly motivated to breastfeed their newborn infants because of the increasing number of health benefits now documented for mothers and infants. However, intention to breastfeed does not guarantee success. Often mothers, through no fault of their own, suffer breast engorgement, nipple trauma, and disappointment, clearly becoming stressed; their infants become hungry, fussy, and disorganized and seem stressed as well. Persistent breastfeeding difficulties may be refractory to intervention and lead to breastfeeding failure. In contrast, KB breastfeeding, a simple, low-cost, and non-invasive nursing strategy, may be effective in reducing racial disparity in breastfeeding status and in turn infant morbidity and mortality.
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