This chapter deals with the selected studies, which are related to the objectives of the proposed study. A review of research and non research literature relevant to the study was undertaken which helped the investigator to develop deeper insight into the problem and gain information on what have been done in the past.
Polit, Hungler stated that the Review of literature, is a systematic identification, location, scrutiny and summary of written materials that contain information on research problems.
Review of literature is an essential step in the research project. It provides basis for future investigation justifies the need for study and throws light on the feasibility of the study. It reveals constrains of data collection and relates the findings from the study to another with a hope to establish a comprehensive study of scientific knowledge in a professional discipline from which valid and pertinent theories may be developed.
In the present study, the review of literature is organized and presented under the following headings.
PART -A
Section I : Review of literature related to effect of early initiation on breast feeding
Section II : Review of literature related to blood loss in third stage of labour
Section III : Review of literature related to other outcome and effect on early breast
feeding.
PART - B : Conceptual framework
PART-A
2.1 REVIEW OF LITERATURE RELATED TO EARLY INITIATION OF BREAST FEEDING
Nissen, 1995:A study was conducted by Department of women and child Health, in Sweden to find the elevation of oxytoxin levels in postpartum women. Oxytocin was measured in 18 healthy women at 15 minutes intervals, after normal vaginal deliveries. With healthy infants, the mother had their infants put skin to skin on their chest immediately after birth. The infants stayed there up to 2 hours postpartum. The study found that there were significant elevations of oxytocin at 15, 30 and 45 minutes after delivery, when compared with average postpartum levels samples 7-15 minutes before partus. This elevation of oxytocin coincided with the expulsion of placenta
Bullough, Msuku et al., :1995 conducted a study in which a randomized control trial was carried to determine whether suckling immediately after birth reduces the frequency of postpartum Hemorrhage, the mean blood loss and the frequency of retained placenta. The frequency of PPH was 7.9 percent in suckling group and 8.4 percent in control group.
Acta Obstet Gynecol Scand, 1995: A study conducted to know the elevation of oxytocin levels early postpartum in women by department of woman and child health, Karolinska institute, Sweden, where oxytocin was measured in 18 healthy women at 15 minutes interval after normal vaginal deliveries with healthy infants. The mother had their infants put skin to skin on their chest immediately after birth. The infant stayed there up to 2 hours postpartum. They found that oxytocin level were elevated and it coincided with expulsion or placenta.
Baby 2001: One way to ensure proper management of third stage of labour is by active management. This is enhanced by promotion of suckling at the beginning of third stage of labour. Non invasive maneuvers to express the placenta may also shorten the third stage. The risk of hemorrhage during the postpartum period is greater when the third stage is prolonged.
Horis 1986 :In his study reports that the stimulation of nipple, vagina, or cervix causes oxytocin secretion.
Salariya et al., 1992: conducted a study and suggested that it is advantage for the baby to be suckled with in the first hour which is generally while the mother is in the delivery room.
Robinson and short 1988:In his study revealed that during the pregnancy, the skin of areola is relatively insensitive to tactile stimulation but becomes more sensitive immediately after delivery.
Righard & Alade 1990 :studied the effect of early contact on early suckling. They compared two groups of infants assigned (the decision being made by the midwife and mother) to a 'contact' or 'separation' group immediately after birth. The contact group (38 infants) had immediate contact from birth for at least one hour. Twenty-four of them were suckling correctly after a mean of 49 minutes. The separation group (34 infants) started contact immediately after birth, were separated at 20 minutes and returned 20 minutes later. Only 7 of them suckled effectively, the difference being significant (P<0.001).
Sosa et al (1976) studied 40 Guatemalan women who were randomly assigned to an early contact or a control group, and followed up by home visits. Early contact was initiated after delivery of the placenta and episiotomy repair and continued for 45 min. The control group had their first contact 24 hours postpartum. After 3 months, 72% in the early contact group were still breastfeeding and only 42% in the control group. The mean duration of breastfeeding was 196 days in the early contact group and 104 days in the control group (P<0.05).
De Chateau & Wiberg 1977 : studied 40 primiparae in Sweden. Mothers were randomly assigned to a control group and an intervention group which had "extra contact" (15-20 min suckling and skin-to-skin contact during the first hour after delivery). At 3 months, 58% of mothers in the extra contact group were still breastfeeding compared with 26% in the control group (P<0.05).
Andrew Radford, 2001: UNICEF plays a crucial role in promoting and supporting suckling. Health care facilities which implement best practice for protection, promotion and support of breast feeding can be assessed and accredited as baby friendly. The standards combine the foundations of good practice which changes to practice like promoting skin to skin contact rooming in, exclusive breast feeding and good co-operation between the different parts of the health service and the voluntary sector
Erickson 1998: Breast milk is the perfect food for the baby. Sucking on breast, close to the mother, helps baby feel safe, also slows down the maternal bleeding after birth. The baby should try to get as much of the coloring part of the breast in its mouth as possible, not just the nipple. Early breast feeding is good for the mother and baby, since it makes the womb to contract and helps placenta to come out and prevent heavy bleeding.
Komara2004: A study was conducted, concerning the effects of early initiation of breast feeding on newborns. The study was conducted with 100 participants. They found that 84% of newborn whose mothers breastfed in labour delivery recovery room had an early latch on. Results also indicated that breast feeding in the labour delivery recovery room decreased dietary supplements with formula feed. 100% of the mothers who breastfed in labour delivery recovery room indented to continue breastfeeding.
Salariya et al 1978 reported that early initiation of breast feeding with in 10 minutes of birth was related to longer duration of breastfeeding. They compared 4 groups of mothers, two of whom experienced early contact with their newborns (n=27 and n=26) and the other 2 groups (n29 & n 27) who had delayed contact. Within the early & delayed contact groups, one sub group breastfed second hourly while the other group breastfed 4th hourly. They concluded that early initiation and frequent feeding had positive influence on longer duration of breast feeding.
Olfactory stimulation:
About 1-2% of the human genome is allocated to produce receptors for the olfactory epithelium. Fetal olfactory learning seems to occur in uterus itself. Evidence indicates as that natural odour plays an important role in the medication of the newborn's behavior. Newborn are generally responsive to breast odour produced by lactating women. - winberg & porter 1998.
Varendi and porter 2000: conducted a study regarding breast odour maternal stimulus elicits initiation. Newborn suckled preferentially from an untreated breast rather than the alternative breast that had been washed to eliminate its natural odour. This study investigated the influence of breast odour on oriented physical movements of newborn. In total 22 newborns were observed during two trails on a warming bed. In a trail a pad carrying the mother's breast odour was placed 17 cms in front of the newborn's nose in the other trail a clean pad was used. Most of the newborn's moved towards and reached the breast pad than the clean pad. It concludes that natural breast odour unsupported by other maternal stimuli therefore appear to be sufficient to attract and guide newborns to the odour source.
Varedi et al 1996 showed that within the first hour of birth, the most of the newborn's spontaneously selected a breast treated with amniotic fluid rather than alternative untreated breast.
Klacks & kennel 2001 It appears that amniotic fluid contain some substance that are similar to a certain secretions of the breast. The newborn was the taste and smell of amniotic fluid on its hands to make a connection with a certain lipid substances on the nipple related to the amniotic fluid.
Visual stimulation:
Newborn can recognize their mother's face (Bushell,et al 1989) and follow it for a short distance (Brazelton & cramer 1990). Stating that a newborn shows more interest in a black and white pattern than in a blank grey card. Perhaps that is the main reason why the areola is hyperpigmented.
Auditory
The mother's voice has been reported to be the most intense acoustic signal measured in the amniotic environment. Newborns are capable of responding to speech stimuli. Newborn prefer the sound of the maternal voice and also suckle for longer time when they hear it. Decasper & fifer 1980 & fifer moon 1994. They can discriminate the language that they hear in utero from another language mehler et al 1988.
The rhythmic sound of the mother's heart beat can also have a calming influence on the newborn. Sounds that initiate heart beat at a frequency of about 70 per minute during the first few days not only calmed the newborn but also reduced weight loss in first few weeks-Salk 1960.
Neuro endocrine component
Swedish researchers noted that if an infant's lips touched her mother's nipple in the first hour of life, Plasma oxytocin was found to be elevated. Following birth in women who held their infants skin-to-skin; notably the oxytocin peaked after expulsion of the placenta. After one or two suckling periods, the blood oxytocin became elevated with each breastfeeding. These increased levels may enhance the bonding of the mother to her infant as well as contract the uterine muscle to prevent bleeding.
2.2 REVIEW OF LITERATURE RELATED TO BLOOD LOSS IN THIRD STAGE OF LABOUR.
Xueying, 1996:A study conducted by Department of obstetrics and Gynecology of south studies, to determine the effect of nipple stimulation on uterine activity during third stage of labor, found that compared to controls, uterine pressure was higher during nipple stimulation. The duration of third stage and blood loss tend to be reduced with nipple stimulation compared to controls (29.3 min vs. 12.3 min) and 257 ml and 166ml) respectively. They have concluded that for women in developing countries where parenteral oxytocics are not available, nipple stimulation might reduce the incidence of postpartum Hemorrhage
Caroline, 1994: Oxytocin is the same hormone that stimulates uterine contractions during labor. The laboring women can experience let down, but that may be evidenced by leakage of colostrum. This readies the breast for immediate feeding by the infant after birth. Oxytocin has the important function of contracting mothers uterus, after the birth to control postpartum bleeding and promote uterine involution. Mothers who breast feed immediately, are at a decreased risk of postpartum hemorrhage. In the immediate postpartum period, nurse is instrumental in helping the mother to initiate suckling as soon as possible after birth.
Klaus, 1996: Department of physiology and Karolinska institute, sweden found out that, release of oxytocin during suckling, stimulates uterine contraction and milk secretion which promotes development of maternal behaviour and also bonding between mother and offspring. The distribution of somato sensory afferents in the nipple and mammary gland release oxytocin in connection with milk ejection, decreases bleeding in postnatal mothers
vimal, 1996: A retrospective analysis of 6938 singleton vaginal deliveries from Jan 1998 to June 1999 was conducted at Municipal college, Ahmadabad. In 66 percent cases, placenta was delivered spontaneously within 5 minutes and in about 95 percent, placenta was delivered by 10 minutes. 1.31 percent cases had a third stage longer than 30 minutes. The incidence of postpartum Hemorrhage, transfusion operative interference, obstetric shock and even mortality increases progressively, if thirdstage prolongs more than thirty minutes, and it was observed in mothers with preterm deliveries, multiparty and previous abortion.
Arul Kumaran, 1998: Department of obstetrics and Gynecology, National University of Singapore conducted a study on 47 women, to find the challenge in uterine activity after the administration of uterotonic agent, correlated with the amount of blood loss during the same period of time, found that change in uterine activity is associated with the total blood loss.
Bullough, 1995: A study conducted to compare, the effectiveness of I/V oxytocin with saline solution, in the management of postpartum Hemorrhage, found that oxytocin administered was associated with significant reduction in mean blood loss (22 percent), and approximately 40 percent in frequencies of postpartum Hemorrhage and postpartum hemoglobin level less than 10gm/dl.
Goodburn, 1996: Soon after birth, oxytocin makes the muscles of uterus contract. This helps in delivery of placenta, control hemorrhage, and also helps the uterus to regain its normal size. Synthetic oxytocin has exactly the same effect on the body as the natural hormone.
Ashok kumar, 1995: By use of information registered in a database in 1997-99 at Rogaland Central Hospital, 11,681 women with vaginal birth were investigated. In 1997, all women received I0 IU oxytocin routinely after delivery. In 1998 and 1999, the use of oxytocin was restricted to special indications. The results was mean bleeding was 360 ml, 1123 women had a blood loss of more than 500 ml, 91 of them had blood loss of more than 1500 ml. First delivery, twins, big baby, induction of labour, operative vaginal delivery, episiotomy and tears were associated with increased bleeding.
Catherine, 1992: From birth of infant until separation of placenta, the character and quantity of blood passed may suggest excessive bleeding. Excessive bleeding may occur during the period from the separation of placenta to its expulsion or removal. Such excessive bleeding is the result of complete placental separation, undue manipulation of fundus, or excessive traction on the cord. After placenta has been expelled or removed, persistent or excessive bleeding usually is result of anatomy of uterus.
Bonnar, 2000: Massive obstetric Hemorrhage is a major cause of maternal death and morbidity. Abruptio placenta, placenta previa and postpartum Hemorrhage being main causes. A delay in the correction of hypovolemia, a delay in diagnosis and treatment of defective coagulation and a delay in surgical control of bleeding are the avoidable factors in most maternal deaths caused by hemorrhage.
Kathleen, 1994: Postpartum Hemorrhage is a common and serious complication of the third stage of labor resulting in anemia and increased morbidity in the puerperium administration of uterotonic drugs and suitable mechanical assistance in delivery of placenta may significantly reduce the hazard.
B. S. Kodkany and R. J. Derman: Three studies conducted at JNMC, Belgaum, Karnataka, Indiastrongly suggest that the BRASSS-V drape is an accurate and practical tool to measure blood loss occurring in the third stage of labor. While, among women with little blood loss, the ranges of blood loss were similar in both visual and drape assessment, the actual visual assessment amount was considerably less compared with the calibrated drape values. This observation further underscores the inaccuracy of the visual estimation method as described in the literature, whereas differences between the drape and spectrophotometry values were found to be 37.15 ml, with the drape having the higher value (an average error of 16.1%). The drape measured blood loss equally and as efficiently as gold-standard spectrophotometry (Pearson's correlation coefficient of 0.928; p = 0.01.
Cecilia Palm, Hakan Rydhstroem, 1997: studied the association between blood loss during delivery and hemoglobin before and after delivery (3 days and 10 weeks, respectively. Blood loss for 693 women, 93.9% of all parturients during the study period, was extracted from the original medical records. hemoglobin was analyzed at the antenatal maternal health care unit at the last visit before delivery, in capillary samples taken on the ward on the 3rd day, or 10 weeks after delivery. Associations were estimated,. 31.3% of all parturients had a higher hemoglobin value on the 3rd day after delivery than on the last visit to the maternal health care unit before delivery; the mean intra-partum blood loss was 375 ml (range 100-2,200 ml. Only 14 (blood loss < 600 ml), or 11% (blood loss > 600 ml) of the variation in the hemoglobin was accounted for by the amount of blood loss.
2.3 REVIEW OF LITERATURE RELATED TO OTHER OUTCOME AND EFFECT ON EARLY BREAST FEEDING
Adele, 1991: Both mother and partner usually want to see and touch their newborn, immediately after birth. It is also important in initiating a parent child relationship. If a women wishes to breast feed, this is an optimal time for her to begin. An infant suckling at the breast, stimulate release of endogenous oxytocin, which aids in uterine contractions and involution or return of uterus to its pre pregnant stage.
WHO, 1996: The best time to start breast feeding is within 20-30 minutes of the baby's birth, if there are no complications with delivery. In addition to the benefits of bonding and immune protection, breast feeding also releases oxytocin, hormone that helps shrink the mothers uterus down to its normal size.
Brodish 1995: In a study to determine the relationship between early bonding in the immediate post delivery period and initial infant feeding patterns in bottle fed newborns data was gathered from charts of 85 full term normal infants 57 of them had an early extra bonding experience in the postpartum recovery room, whereas 28 did not in comparing the bond and no bond groups for weights loss and formula intake the 't' test analysis showed a statistically significant effect of bonding that was beneficial to infant status.
Erickson, 1996: It is established that release of oxytocin during suckling causes milk ejection and stimulates uterine contractions, which promotes the development of maternal behaviour and bonding between mother and offspring.
PART - B
CONCEPTUAL FRAMEWORK
The conceptual framework provides a foundation for suggestions and relationship among variables. It is developed to explain which concepts contributes to the partially cause and out come. The presentation of the framework in a published study, gives the careful, thoughtful work required to arrive at the point. The conceptual framework provides a certain frame of reference for clinical practice, research and education.
The study is based on the concept that administration of selected intervention i.e early breast feeding among the intranatal mothers who are in third stage of labour will reduce the duration of third stage of labour and blood loss. The investigator adopted the Roys Adaptation theory as a base for conceptual framework. The theory has three factors
Input - It refers to the early breast feeding
Throughput - It refers to the measures that is initiation of breast feeding
observation of duration of third stage of labour and blood loss.
Output - It refers to the effect of early breast feeding on duration of
third stage of labour and blood loss (Fig 1.1)
