The Risk of Sudden Unexpected Death in Infants - Research Paper Example

MOTHERS AND BABIES Student’s Name Institutional Affiliation Instructor Course Justification for the Choice of the Theme A lot of studies have shown that mothers swaddle their infants immediately after giving birth. Swaddling have has advantages as well as drawbacks. For instance, swaddling has been shown to lead to longer and sound sleep to newborn babies. Swaddling is the act of wrapping a baby in a blanket for protection and security. Early skin- to- skin contact involves wrapping the baby at the back while the front side is made to contact the bare chest of the mother. Swaddling increases the amount of rapid eye movement sleep which babies usually get. This explains the reason why wrapped babies do not get awaken easily in case of noise. Swaddling is also believed to soothe a crying baby. In addition, swaddling a baby and allowing them to sleep in supine positions is known to reduce the risk of Sudden Unexpected Death in Infants (SUD) (Swaddling babies 2013). This explains the reason why it is recommended that babies should sleep in supine position. Swaddling on the other hand makes the baby less likely to shift or fidget while sleeping or breastfeeding. However, swaddling has its own drawbacks. Immediately after birth, midwives swaddle a baby for warmth and later give the baby to the mother for breast feeding. Swaddling affects the health weight of a newborn due to delays in breast feeding. Swaddling also increases a baby’s risk of hip dysplasia. The cells of the hip undergo uncontrolled proliferation leading to the extension of the hip and knee (Swaddling babies, 2013)). In long run, a baby may develop developmental dysplasia of the hip. This condition may cause the baby to develop conditions such as arthritis, decreased mobility as well as differing lengths of the baby’s legs as they grow. Saddling has also been shown to have an effect on baby’s body heat. Babies who are not swaddled immediately after birth are usually able to stay warmer later than their swaddled counterparts. Another drawback worth discussing is that swaddling interferes with the beginning of the breastfeeding. Babies who are allowed to maintain skin-to- skin contacts with their mothers immediately after birth has been shown to take to the breast earlier and suckle better than those who are swaddled. This is because babies who are wrapped are not in a position to use their hands to manipulate the breast. Babies use their hands in locating, moving and shaping the nipples to breastfeed properly. As it can be seen from the above discussion, the reason for keeping a baby wrapped are obviously outweighed by the reasons why a new born should not be swaddled. The reason of I am interested in this theme is to emphasize on the importance of keeping the skin – to –skin contact between the mother and the baby the first few days after birth. More importantly, the contact should be maintained the first hour after the child is born. The importance of skin- to –skin contact between the mother and the baby include; the baby is usually able to signal or indicate to her mother when they want to be breastfed. Their body temperatures, rates of respiration as well as blood pressure are maintained normal. The baby usually cries less and is able to breastfeed longer and exclusively (International breastfeeding centre n.d). Last and not least is that the baby is usually able to latch faster and well than those who are swaddled. Many women have been complaining that their babies usually take longer to latch. Interestingly most of them have responded by saying that they did not they did not maintain skin to skin contact with the baby immediately after birth. Majority of those whose babies took a lesser time to latch confirm having maintained skin -to -skin contact. It is therefore imperative to bring this question on board. Question In infants, is swaddling important as compared to skin- to skin contact between the mother and the baby in maintaining the overall child health and performance? Process I used the PICO process in writing my question P for population- The population being considered in this case is newborn infants and their mothers I for intervention- The intervention being mostly undertaken is swaddling of babies in hospitals immediately they are born C for comparator or control- Skin -to -skin contact should be maintained between the mother and the baby immediately and even few hours after birth. This involves placing the nude baby on the mother’s bare chest immediately after birth. O for outcome- Maintaining the baby overall health and performance especially through breastfeeding Article reference Population Intervention Comparison Limitations and outcomes Moore, ER, Anderson, GC, Bergman, N, & Dowswell, T, (2012) Randomized controlled trials 2177 participants (Mother-infant dyads). Effect of early skin-to-skin contact on breastfeeding To access the effects of SSC on breastfeeding Randomized clinical trial which compared early SSC with the usual hospital care Significant positive effect of early SSC on breastfeeding during the first one to four months after birth Limitations included methodological quality and variation in interventions Anderson GC, Moore E, Hepworth J, Bergman N, (2003) 806 participants ( mother and babies) To investigate the effects of early skin –to –skin contact on breastfeeding Randomized clinical trials comparing early SSC with usual hospital care Evidence of improved summary scores for maternal affectionate love and touch on breastfeeding during the first few days post birth. Limitations included variations in outcome variability, Variation in implementation of interventions as well as methodological quality Moore, ER, Anderson, GC, & Bergman, N, (2007) 17 studies which involved 806 participants To investigate the effects of early skin-to-skin contact on breastfeeding Randomized and quasi randomized clinical trials comparing early SSC with the usual hospital care The touch during the first few days post birth showed to have a positive effect on breast feeding Harcke, HT, Karatas, AF, Cummings S, Bowen,JR, (2015) 30 infants in hospital suspected of hip dysplasia. 16 infants treated in palvik harness and 14 untreated infants. The aim of the study was to confirm the ability to perform a hip sonography when swaddled and to ascertain whether various swaddling techniques being used influenced hip positions and dynamics. Comparison involved observing thee behaviors off unswaddled on similar aspects such as instability and range of motion restriction Different swaddling techniques were shown to have different effects on infants hip stability and it was therefore advisable that midwives should be able to know which are appropriate. One of the limitation was that to some of the infants brought to the hospital, hip instability could have been caused by other factors Neu M, Robinson J, (2010) 65 mothers-infants dyads with mean gestational age at birth of 33 weeks. 50% percent of the infants were male while 50% were non-white To investigate whether nursing intervention which promoted kangaroo holding during the early weeks of the early life of the infant facilitated co regulation between the mother and the infant Uninterrupted holding with either the blanket or the kangaroo holding were used Randomized controlled trials Dyads who were supported in kangaroo holding displayed more co regulation behavior that those who were placed in blanket holdings. The PICO process worked effectively with answering this question. This is because the problem (swaddling babies completely immediately after birth) is well identified and the participants well presented. The current practice after the baby is born (intervention) is swaddling and is well illustrated. The alternative, which is still the recommendation (Early skin- to- skin contact) has been given. The outcome of the study which includes breastfeeding among other health benefits is given. The primary research papers on the topic are available. The search strategy using the key words in the title is enabling one to locate the information relevant to the study. The major keywords in the question include; infant, swaddling, and skin-to- skin contact which are providing easy access to the sources or previous research work related to the question. I had to fine tune the question so that it fits to the outcome I needed to bring about. For instance, the main aim is discussing the issue in reference to breast feeding but I found the topic to be broader than I expected. Actually, at first I was not aware of some of the negative effects of swaddling and I had to reframe the question so as to include them. This was the reason why I had to change from breastfeeding to the overall performance in the outcome of the question. Another instance I had to fine tune the question was in deciding where to include the mother and the baby. As it can be seen in the discussion, the contact is between the mother and the baby and it could have therefore been included together as part of the population. However, the problem, interventions and the outcomes of either skin-to- skin contact or swaddling rests on the baby. I therefore had to find away to fine tune the question so that it appears that the effects of the two alternatives lest on the baby alone while including mother to precisely fit in the question. I also did the tuning after trying to locate the right information failed. The first search words were baby and skin -to -skin contact with the mother but it was not giving the precise information. I tuned to newborn which was giving me many hits and did not give a precise hit. I tuned to infant which gave me a limited number of hits. I then tried to add the word swaddling but it still got very large number of hits, some of which were very far from the information I actually needed. After that combination of words failed to give me a precise answer, I phrased the question to include all the key words but searched swaddling and skin-to-skin contact differently. This way, I was able to get the information I needed as defined by the question. Why the Question is important to Nursing or Midwifery practice Usually, midwives are the health professionals who are responsible for caring for pregnant women and their babies during pregnancy, during labor, birth as well as postpartum period (Role, responsibilities and practice of midwives, n.d). As the primary care providers, midwives provide maternity services to pregnant women and the infant and are responsible for major clinical decisions and management within the realms of their practice. Midwifery model of care ensures normal birth, ensures that women make sound and informed choices concerning themselves as well as those of children and continues to provide care and support during childbearing. Midwives ensure the wellness of the child is maintained during the first few weeks after birth as well as educating the mother on the same. They prepare the woman for breastfeeding as well as parenthood which includes aspects of the well being of the child (Midwife n.d). It is therefore within their scope of practice to ensure skin-to –skin contact between the mother and the child is maintained. This gives the baby the chance to identify themselves with the bodies of their mother while promoting the benefits discussed above. More importantly, the ability of the child to latch at the first contact with their mothers ensures that they are able to breastfeed as much as they can hence ensuring that the baby grows healthy. The fact that skin-to skin contact between the mother and the child reduces the frequency of the baby crying is very vital. Early skin-to-skin contact has been shown to improve breastfeeding with no either short term or long term effect. Swaddling with restricted motion of the legs may lead to hip instability. The midwives should therefore ensure that women are educated on the proper ways of wrapping or swaddling their babies to prevent the negative effects associated with improper swaddling. Electronic Database used PubMed Reasons for Using PubMed 1. A person does not need to subscribe and it is offered for free. PubMed is accessible to everyone since it is sponsored by the government. One can stay in the interface long enough to get the information you need as there are no data bundles that are consumed. 2. It offers automatic term mapping. In addition to medical subject’s headings in the search, PubMed also includes synonyms which make retrieval in PubMed more comprehensive as compared to the retrieval from other sources in the MEDLINE. 3. PubMed usually obtains data before the commercial versions of Medline which provides a quicker access to the newly published articles. 4. PubMed has a fast search interface. It allows efficient information retrieval by the end users i.e. clinicians, medical scientists, and nurses. Keywords Used Infant, swaddling, skin-to-skin contact, mother, baby, breastfeeding, sudden unexpected death, wearable blankets, hip swaddling, nude, naked, and lactating. Search Strategy 1. Infant or child 2. Infant or newborn 3. Infant or new born not child 4. Infant or new born and mother 5. Or/ 1-4- This combines all of the above words to represent the participants or the population 6. Swaddling or wearable blankets 7. Wearable blankets 8. Swaddling not wearable blankets 9. Swaddling and wearable blankets 10. Or/ 6-9- This combines all the above words to represent the interventions 11. Nude 12. Nude or naked 13. Naked or skin-to-skin not nude 14. Skin-to-skin not nude not naked 15. Or/ 11-14- This combines all the above words to represent the comparisons 16. Lactating 17. Breastfeeding 18. Lactating not breastfeeding 19. Breastfeeding not lactating 20. Sudden unexpected death or crying 21. Sudden unexpected death not crying 22. Sudden unexpected death and hips wadding 23. Hips wadding not sudden unexpected death 24. Or/ 16-23- This combines all the above words to represent the outcomes 25. 5 and 10 and 15 and 16 and 24- This combination will now search for specific publications containing infant, newborn, skin-to-skin, hips wadding, swaddling and wearable blankets. In order to alive in the 5 articles, I used the Boolean operators to sort them from hundreds of hits that i got. Firstly, I identified PICO as the process to use in answering the question. At this stage, I knew what my topic was all about. To get the information right and first, I constructed my sentences interchangeably using synonyms of various words. By this I would write a sentence more than one time, using the Boolean operator –or- where I have used a synonym in the next search sentence. Moreover, to enable me get the all the information I needed in just the five websites, I used the Boolean operator-and- which allowed me to combine all the information I needed in a limited number of articles. The Boolean article helped me in damping the words and synonyms that were not generating the right information. By using all the three Boolean together guided by the PICO process structured question, I arrived at the 5 articles. The five articles were useful as they were addressing primarily the same issues. For instance, two of the articles were addressing the intervention part i. e. Swaddling, while the other three articles were handling the comparison issue i. e. skin to skin contact. These two extremes were the main factors that were affecting the outcomes. The process of writing a research question has indeed broadened my understanding and appreciation of having evidence for nursing and midwifery practice. It has reminded me that every paper that I write is most likely to be argumentative and I will therefore need to provide substantial evidence to prove and emphasize my position. The main reason why nurses do not apply evidence based research is because they lack the necessary skills needed in accessing the research and evaluating its quality (DiCenso 2003). Nurses and midwives should show commitment in fostering evidence based nursing practice. Nurses cannot make clinical decisions based on the knowledge for their clinical expertise. For instance, based on the research question discussed above, it can be seen that some midwives may grow to believe that swaddling the whole of the baby’s body is the best practice, believing to be protecting the child from injury or bad weather conditions. Through research, nurses and midwives can be able to familiarize themselves with the new methods of practice in their area of expertise. This way they will be able to make effective decisions based on the evidence from the research work. The process of writing research question has also given me the skill to identify the right kind of evidence to support my argument. The assignment prompt or the problem to be solved assists in guiding them on the kind of evidence to look for. For instance, primary source of evidence are more appropriate sources of evidence since they contain a detailed amount of information and minimizes errors which might be carried on and magnified in the subsequent secondary and tertiary research papers (Eamon 2004). The nurses and midwives can be able to learn how to synthesize sources of evidence and then combine the sources to generate meaningful information relevance to the question at hand. This implies using an analytical mode to make connections between various articles and bring them into a dialogue. It also provides with an opportunity and ability to identify any information that is unnecessary to the research question at hand. Notably, nurses and midwives usually lack the confidence to implement change. This is because, a number of them identify a problem but they lack substantial evidence to prove their case. For example, a midwife may want to recommend a change to the management of the health care at which he or she is affiliated. For instance, she might want to recommend to her institution to consider ensuring that skin-to skin contact is important in ensuring that the breastfeeding capacity of the baby is enhanced as compared to those who are completely wrapped the first hour and being born. Despite the recommendation being genuine and the fact that she is making out of her expertise, few midwives, who are still professionals are likely to object. If she proves her case with a well documented research supported with evidence from credible sources, the other professionals are likely to accept quickly. It will also give her confidence to proposing and implementing a change. Therefore, the evidence based research enables nurses and the midwives to make appropriate decisions concerning the patients under their care. The current expectation of providing quality healthcare services such as maternity services depends on provision of clinically effective as well as patient -centered care. The aim of evidence based research is to ensure quality care for the individual patients. For instance mortality rate in some countries such as the United Kingdom have declined due to the implementation of previous reports on research work. To ensure that this quality care is reached, nurses and midwives should strictly follow the process of evidence- based practice. This process includes 5 steps. Firstly, they should design a question based research in which an answer can be provided. Secondly, they should identify and access the right evidence that can answer the question. Thirdly, they should do a comprehensive evaluation of the evidence in order to select the ones which fit the best in answering the question. Once the best evidence has been chosen, it should now be applied in that specific case in the question. By using this criteria, quality decision making on matters concerning the clients are guaranteed. It can be therefore be concluded that, nurses and midwives should use individualized expertise hand in hand with the best available evidence that they can be able to access .when making decisions of how to handle various issues affecting clients under their care, evidence based research is the only method that the quality of the decisions and services are maximized. References Moore, ER, Anderson, GC, Bergman, N, & Dowswell, T, 2012, Early Skin-to-skin Contact for Mothers and their Healthy Newborn Infants, (5), Cochrane Database of Systematic reviews, art. No, CD003519. DOI: 10.1002/14651858.CD003519.pub3 Moore, ER, Anderson, GC, & Bergman, N, 2007, Early Skin-to- Skin Contact for Mothers and their Healthy Newborn Infants, (3) Cochrane Database of Systematic reviews10.1002/14651858.CD003519.pub110.1002/14651858.CD003519.pub110.1002/14651858.CD003519.pub110.1002/14651858.CD003519. Neu M, Robinson J, 2010, Maternal Holding of Preterm Infants During the Early Weeks after Birth and Dyad Interaction at Six Months, 39(4), DOI:  10.1111/j.1552-6909.2010.01152.x Harcke, HT, Karatas, AF, Cummings S, Bowen , JR, 2015, Sonographic Assesment of Hip swaddling techniques in infants with and Without DDH, PMID: 25851676 Swaddling babies may lead to hip problems later in life, October 30, 2013. Available from: < http://www.nydailynews.com/life-style/health/pros-cons-swaddling-baby-article-1.1501346>. [19th June 2015). International Breastfeeding Centre, 2009, the importance of skin to skin contact. Available from < http://www.nbci.ca/index.php?option=com_content&id=82:the-importance-of-skin-to-skin-contact-&Itemid=17>. [19th June 2015]. Midwife, n.d. Available from: < http://www.prospects.ac.uk/midwife_job_description.htm>. [29th June 2015). DiCenso, A., 2003, Nursing leadership, 16 (4). DOI:10.12927/cjnl.2003.16257 10.12927/cjnl.2003. Eamon M., 2004, Defining primary and Secondary sources. Available from: < https://www.collectionscanada.gc.ca/education/008-3010-e.html#tphp>. [19th 06 2015).   Read More