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      Nurses and midwives professional support increases with improved attitudes - design and effects of a longitudinal randomized controlled process-oriented intervention

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          Abstract

          Background

          Becoming parents for the first time is challenging. Mothers need both social and professional support to handle these challenges. Professionals’ attitudes affect quality of care and support. So to improve professional support, an intervention consisting of a process-oriented training was performed. Due to the positive results of the intervention there is a need to illuminate the methodological approach further. The overall aim was therefore to describe a methodological approach to improve and evaluate health care professionals’ attitudes toward breastfeeding and parental support in order to improve quality of care in childbearing.

          Methods

          This study was a longitudinal randomized control intervention study, in which groups of mothers received care in childbearing from midwives and child health nurses. These health professionals had gone through a process-oriented training, or not. In order to improve attitudes of health professionals the training was based on evidence, practical skills and reflective processes (both private and professional experiences) in relation to breastfeeding and parental support. Included in the longitudinal study were health professionals from five intervention municipalities n = 36 and health professionals from five control municipalities n = 45. All mothers who fulfilled the inclusion criteria were consecutively identified from the hospital register and asked to participate in the study. Mothers who accepted to participate were included in the interventions group ( n = 206) or control groups ( n = 162, n = 172 respectively) based on which municipality they belonged to.

          Results

          The results of the process-oriented training improved the professionals’ attitudes toward breastfeeding and parental support. These improved attitudes in health professionals increased intervention-group mother’s satisfaction with professional and social support. Intervention-group mother’s relation to and feelings for their baby as well as breastfeeding was also improved.

          Conclusion

          These results stress the importance of professionals’ attitude in quality of care during childbearing, as well as pointing to the possibility to improve professionals’ attitudes with a process-oriented training.

          Trial registration

          Australian New Zealand Clinical Trials Registry (ANZCTR), trial registration: ACTRN12611000354987.

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          Most cited references44

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          Social support: a conceptual analysis.

          Using the methodology of Walker and Avant, the purpose of this paper was to identify the most frequently used theoretical and operational definitions of social support. A positive relationship between social support and health is generally accepted in the literature. However, the set of dimensions used to define social support is inconsistent. In addition, few measurement tools have established reliability and validity. Findings from this conceptual analysis suggested four of the most frequently used defining attributes of social support: emotional, instrumental, informational, and appraisal. Social network, social embeddedness, and social climate were identified as antecedents of social support. Social support consequences were subsumed under the general rubric of positive health states. Examples were personal competence, health maintenance behaviours, effective coping behaviours, perceived control, sense of stability, recognition of self-worth, positive affect, psychological well-being, and decreased anxiety and depression. Recommendations for future research were made.
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            Cesarean childbirth and psychosocial outcomes: a meta-analysis.

            A comprehensive literature review with meta-analysis examines the differences between vaginal and cesarean delivery on 23 psychosocial outcomes of childbirth. The most robust findings suggest that cesarean mothers, compared with mothers who delivered vaginally, expressed less immediate and long-term satisfaction with the birth, were less likely ever to breast-feed, experienced a much longer time to first interaction with their infants, had less positive reactions to them after birth, and interacted less with them at home. Some differences were also found between unplanned and planned cesarean sections; none were found between birthing methods for maternal confidence for infant caretaking soon after birth, maternal anxiety in the hospital and at home, maternal stress at home, maternal return to work, and continuation of breast-feeding once begun. Implications of these findings for theory, research, and childbirth practice are discussed.
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              Breastfeeding support from partners and grandmothers: perceptions of Swedish women.

              Support from the mother's network of relatives, friends, and professional caregivers during childbirth is likely to be important for breastfeeding success. Few studies have been conducted to examine mothers' perceptions of breastfeeding support. The objective of this study was to describe breastfeeding support and feelings of confidence of primiparas and multiparas in relation to duration of breastfeeding. Mothers who delivered vaginally were eligible for inclusion. After receiving a questionnaire when their children were 9 to 12 months of age, 194 primiparas and 294 multiparas responded to questions on breastfeeding history and on perceived and overall breastfeeding support and feelings of confidence. Feelings of overall breastfeeding support were correlated with duration of exclusive breastfeeding in both primiparas (p < 0.001) and multiparas (p < 0.001). Multiparas who knew how long they were breastfed as a child showed a longer duration of exclusive (p = 0.006) and total (p = 0.007) breastfeeding than multiparas who did not know. The time during which the partner was present after labor was correlated with the duration of exclusive (p < 0.001) and total breastfeeding (p = 0.002) in primiparas. Feelings of confidence when the baby was 6 to 12 months old, as retrospectively rated on a visual analog scale, was correlated with feelings of confidence in the partner during childbirth in both primiparas (p < 0.001) and multiparas (p < 0.001) and the experience of overall breastfeeding support (primiparas, p = 0.002; multiparas, p < 0.001). Both groups were more content with breastfeeding information they received from midwives in the maternity wards, compared with that from antenatal midwives and postnatal nurses (p < 0.001). A helpful support strategy for mothers with respect to breastfeeding outcome is for health professionals to discuss the grandmother's perception of breastfeeding with the mother. It is important for perinatal caregivers to provide an environment that enables the family to stay together after delivery. A helpful support strategy for health professionals might be to mobilize grandmothers with positive breastfeeding perception to provide support for their daughters' breastfeeding.
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                Author and article information

                Contributors
                +46 500 44 84 14 , anette.ekstrom@his.se
                stina.thorstensson@his.se
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                26 October 2015
                26 October 2015
                2015
                : 15
                : 275
                Affiliations
                School of health and education, University of Skövde, Post box 408, S 541 28 Skövde, Sweden
                Article
                712
                10.1186/s12884-015-0712-z
                4621925
                26503218
                8378ad6f-4425-4667-aa86-a3ed7ba5706d
                © Ekström and Thorstensson. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 June 2015
                : 19 October 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Obstetrics & Gynecology
                childbirth,childbearing,breastfeeding,parental support,interaction,pedagogy,professional support,professional attitudes

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