Effects Of Childbirth Research Articles

Approaches to early detection of atypical hemolytic-uremic syndrome after childbirth

Introduction. Differentiating conditions accompanied by the development of thrombotic microangiopathy (TMA) in obstetrics is still rather challenging. Our present opinion is that the effect of childbirth on the TMA symptom regression is the key to differential diagnosis. If hemolysis and thrombocytopenia regress after childbirth, we can talk about HELLP syndrome. If not, we should think about atypical hemolytic uremic syndrome (aHUS). aHUS is an extremely rare disease characterized by TMA predominantly involving acute kidney injury. However, the diagnostic task can also be difficult due to possible overlapping one process with another: for example, HELLP syndrome can trigger aHUS, but which of the patients is more susceptible to this transformation is unclear.Aim. To identify clinical and laboratory criteria that can be used to early detect aHUS immediately after childbirth.Materials and methods. A total of 230 patients were enrolled in the study, of whom 71 women were diagnosed with aHUS, 124 patients with HELLP syndrome, and 35 patients without signs of TMA were enrolled in the control group. We assessed and compared the main clinical, anamnestic and laboratory findings.Results. Women with HELLP syndrome and aHUS were comparable in terms of age, frequency of operative delivery and gestational age at delivery, and adverse perinatal outcomes. Peak serum creatinine and LDH values after delivery were the most useful to early predict aHUS. Serum creatinine > 142 μmol/L and LDH > 1391 U/L were associated with the transformation of HELLP syndrome into aHUS.Conclusion. We concluded that standard laboratory data, most specifically peak serum creatinine and LDH, may be used to aid in the early diagnosis of aHUS.

The evolution of family policies and couples' housework division after childbirth in Germany, 1994–2019

AbstractObjectiveWe examine how the re‐traditionalization effect of childbirth on couples' division of housework has evolved over time as a result of major family policy change.BackgroundSupportive family policies are associated with a more egalitarian division of labor. However, it remains unclear how a country's transition from a modernized male breadwinner regime that supports maternal care to family policies that promote maternal employment and paternal caregiving change couples' gender‐typical division of housework in the long run.MethodWe use representative survey data from the German Socio‐Economic Panel (1994–2019, N = 14,648) and estimate the re‐traditionalization effect of childbirth on mothers' absolute and relative time‐use on housework over four policy periods with linear fixed‐effects regression models.ResultsAcross all periods, mothers took on larger absolute and relative levels of housework after childbirth, with a more pronounced and persistent gender‐typical division in West than in East Germany. However, mothers spent somewhat less absolute and relative time on housework in recent periods with stronger levels of de‐familiarizing and dual‐earner/dual‐carer policies than in earlier periods with policies supporting maternal caregiving.ConclusionWe find somewhat smaller and less persistent re‐traditionalization effects of childbirth in more supportive work–family policy periods. In sum, the small changes illustrate that even in contexts of enormous policy change, progress toward a less gender‐typical division of housework has been slow and rather small.

The Effect of Childbirth on Women’s Formal Labour Market Trajectories: Evidence from Uruguayan Administrative Data

The motherhood penalty for developed countries is well-established in the economic literature. Childbirth intensifies the traditional gender roles that affect paid and unpaid work and contributes to the persistence of the gender labour gap. However, little is known about this phenomenon for developing contexts. This paper investigates the motherhood effects on women’s formal employment and wage trajectories in Uruguay. We document significant and robust motherhood penalties in the labour market, applying an event study method to almost 20 years of social security administrative data. One year after childbirth, formal monthly labour earnings decrease by 22 per cent. This drop fails to recover over time, and ten years after the arrival of children, women’s earnings are 40 per cent below their level just before childbirth. This penalty is mainly driven by a drop in formal employment and, to a lesser extent, a wage decline for those remaining employed. Heterogeneous analysis shows that low-wage women face higher motherhood penalties than high-wage women. Interestingly, these negative effects on wages and formal employment have reduced over time, and recent mothers face lower motherhood penalties.

Is urethral pressure associated with parity and delivery mode?

Stress urinary incontinence is the most prevalent type of urinary incontinence and childbirth is a risk factor. The aim of this study is to evaluate the association between delivery mode and urethral sphincter function as measured by the maximum urethral pressure (MUP). A retrospective study on women seen in a tertiary urogynaecological center for urodynamic testing between January 2017 to December 2019. Women were classified into the following groups: (1) nulliparous; (2) caesarean section only; (3) at least one spontaneous vaginal delivery but no instrumental deliveries; (4) at least one vacuum delivery but no forceps; (5) at least one forceps delivery. The complete data sets of 1238 women were analysed; 1112 (90%) were vaginally parous. Mean age was 58 (18-95) years. Mean parity was 2.6 (0-9); 57 (4.6%) were nulliparous, 69 (5.6%) had only been delivered by caesarean section, 762 (61.6%) had at least one spontaneous vaginal delivery but no instrumental deliveries, 41 (3.3%) had at least one vacuum but no forceps delivery, and 309 (25%) had at least one forceps delivery. Mean MUP was 41.8 cmH2O. There was a significant association between vaginal parity and MUP (P < 0.001). On ANOVA test, delivery mode was significantly associated with MUP. This became nonsignificant on regression analysis, with only age significantly associated with MUP (P < 0.001). The effect of childbirth on urethral sphincter function seems to be largely due to the first vaginal birth. We failed to show an effect of instrumental delivery.

Gender Disparities in Career Advancement across the Transition to Parenthood: Evidence from the Marine Corps

We isolate the effect of childbirth on mothers' and fathers' job-relevant physical performance using data from the US Marines. We estimate event study models around the first birth. We assign “placebo births” to non-parents using LASSO-selected predictors of parenthood to estimate counterfactual trends. We find large and persistent effects of motherhood on performance. Two years postbirth, mothers' physical performance remains 0.2 standard deviations lower than non-mothers'. For fathers, the birth also initially lowers performance, but fathers are able to recover. This research demonstrates a potential mechanism behind the child penalty to mothers' earnings.

Child Birth and its Effect on Functional Status of Women: A Review

Though highly satisfying motherhood comes with its own challenges. Often underestimated, the effect of child birth on maternal function is a huge and can invariably effect not only the individual but the society in general. Yet there seems to be an attitude of “its all part and parcel of motherhood” when it comes to the functional status of mothers. To improve the functional status of women one needs to quantify it and a scale for Indian mothers are not in existence yet. No matter the mode of delivery , the maternal function is compromised, its said that the physiological healing is complete at 6 weeks post delivery but the researchers are not able to come to terms regarding time needed to achieve the pre pregnancy functional status or in many cases if it ever returns. Hence the gravity of situation is dare and needs acknowledgment not only from the health care professionals but from the society in general. In this article, we are examining the different modes of delivery and its subsequent effect on physical functions of women.

Is There A Difference In Strength, Flexibility, Range Of Motion Between Postpartum And Nulliparous Runners?

Research has shown that women are returning to sport as soon as two weeks after birth with most resuming running by two months postpartum. There are significant musculoskeletal and physiologic changes during pregnancy as well as the effects of childbirth that a postpartum runner to recover from to return to running. Research on returning to running guidelines are nonexistent in the postpartum population. PURPOSE: To investigate the differences in strength, range of motion (ROM), and, flexibility between postpartum runners (PP) and nulliparous controls (NC). METHODS: Healthy postpartum (up to 3 years) and nulliparous runners were recruited from local running groups. Three trials of strength, ROM and flexibility of the hip, knee and ankle were collected using a hand held dynamometer, inclinometer or goniometer respectively and then averaged. An independent samples t-test was performed to compare groups. RESULTS: 28 runners participated (14 PP, 14 NC) and were matched for BMI (24.2 kg/sq.m). There were no significant differences in strength of the hip, knee and ankle between the groups. Right and left ankle dorsiflexion was significantly greater in PP group (Right Soleus: PP, 10.33±3.9cm; NC, 6.75±2.68cm; p=0.01; Left soleus: PP, 11.32±3.8cm; NC, 7.34±2.74cm; p=0.004; Right Gastrocnemius: PP, 7.95±2.74°; NC, 4.67±4.59°; p=0.032; Left Gastrocnemius: PP, 8.48±3.39°; NC, 4.5±5.23°; p=0.026). Knee and Hip ROM were not significantly different between the groups. CONCLUSION: The current study shows that postpartum runners have significantly more dorsiflexion ROM than controls. When breastfeeding, hormones that influence elasticity like prolactin are still present in the body which may be allowing for the postpartum women to have significantly more ROM than nulliparous controls. Future studies should investigate the effect of breastfeeding duration on range of motion in runners as well as if while breastfeeding return to running guidelines should be different than women that cease breastfeeding at different stages.

Temporal interdependencies in mobility decisions over the life course: A household-level analysis using dynamic Bayesian networks

Life trajectory analysis has been shown a powerful approach to understand the interdependencies between key life events, critical incidents and long-term mobility decisions such as residential move, job change and change in vehicle possession, which in turn constitute the context of daily activity-travel decisions. Because people in multi-earner households share resources, some of these long-term decisions affect them equally, while job change affects them differently because their job location likely differs. Current life course models in transportation research, however, have typically considered individuals' trajectories. To contribute to the further development of the relatively thin line of research in transportation studies, a dynamic Bayesian network approach is proposed to investigate the temporal interdependencies between life course events from a household perspective. Results show that the effects of child birth are much larger on residential and car ownership change than on job change for both household heads in dual-earner households. Moreover, the probability of residential and car ownership change increases when both spouses have relatively long commuting times. In case only the husband faces an excessive commuting time, households have a larger probability of moving house or purchasing an additional car. By contrast, in case only the wife faces an excessive commuting time, she is more likely to change job rather than the household taking particular actions to adjust to the problematic situation.

Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial.

BackgroundThe frenzy of postbirth events often takes a toll on mothers’ mental well-being, leaving them susceptible to postpartum psychological disorders such as postnatal depression (PND). Social support has been found to be effective in restoring the emotional well-being of new mothers. Therefore, mothers need to be supported during the crucial postpartum period to buffer the negative after effects of childbirth and to promote healthier maternal well-being.ObjectiveThis study aimed to evaluate the effectiveness of a technology-based peer-support intervention program (PIP) on maternal outcomes during the early postpartum period.MethodsA randomized, parallel-armed controlled trial was conducted. The study recruited 138 mothers (69 in intervention group, 69 in control group) at risk of PND from a tertiary hospital in Singapore. To support these mothers, 20 peer volunteers were recruited by word of mouth and trained by a psychiatrist in social support skills before the intervention commenced. The 4-week–long intervention included a weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received postnatal standard care. Maternal outcomes (PND, postnatal anxiety [PNA], loneliness, and perceived social support) were measured with reliable and valid instruments. Data were collected immediately postpartum, at 1 month postpartum and at 3 months postpartum. The general linear model was used to compare the groups for postpartum percentage changes in the outcome variables at first and third months, and the linear mixed model was used to compare the trend over the study period.ResultsThere was a statistically significant difference in Edinburgh Postnatal Depression Scale scores (d=–2.11; 95% CI −4.0 to −0.3; P=.03) between the intervention and control groups at 3 months postpartum after adjusting for covariates. The intervention group had a significant change over time compared with the control group.ConclusionsThe technology-based PIP was found to be effective in reducing the risk of PND among new mothers and showed a generally positive trend in reducing PNA and loneliness and increasing perceived social support. This study highlights the importance of training paraprofessionals to provide needed support for new mothers postpartum. A further long-term evaluation of the PIP on maternal and family outcomes and its cost-effectiveness is needed to inform clinical practices.Trial RegistrationISRCTN Registry ISRCTN14864807; https://www.isrctn.com/ISRCTN14864807International Registered Report Identifier (IRRID)RR2-10.2196/resprot.9416

The effect of childbirth on urinary incontinence: a matched cohort study in women aged 40–64 years

The relative impact of age, pregnancy and vaginal delivery on urinary incontinence is still an unresolved issue that involves the controversial question about the protective effect of cesarean delivery. The purpose of this study was to estimate and compare the effect size of 1 pregnancy, 1 vaginal delivery, and the derived protective effect of cesarean delivery for different aspects of urinary incontinence in women 40-64 years old, all 20 years after birth. This Swedish nationwide matched cohort study involved 14,335 women. Data from 3 restricted, randomly selected, source cohorts of (1) nulliparous women who were unexposed to childbirth (n=9136), (2) primiparous women who had experienced cesarean delivery and who had been exposed to 1 pregnancy (n=1412), and (3) primiparous women who had been exposed to 1 pregnancy followed by vaginal delivery (n=3787) were retrieved from The Swedish Medical Birth Register and Statistics Sweden and surveyed in 2008 and 2014, respectively. Parous women were all assessed 20 years postnatally. One-to-one matching with an interval for pairing of 3 years and 3 body mass index units was used in women 40-64 years old with information about body mass index (kilograms/square meters) and urinary incontinence. The procedure succeeded in 2630 of 2635 women (99.8%) and resulted in an adequate distribution of age and body mass index between groups. The surveys used a postal- and an internet-based questionnaire with validated questions for various aspects of urinary incontinence. Fisher's exact test and the Mann-Whitney U test were used for comparisons between matched groups; trend was analyzed with Mantel-Haenszel statistics. Predicted, age-related values of different aspects of urinary incontinence were obtained by logistic regression analysis. Pregnancy increased the prevalence of urinary incontinence from 20.1-30.1% (odds ratio, 1.71; 95% confidence interval, 1.43-2.05; P<.0001]. Urinary incontinence increased further after vaginal delivery to 43.0% (odds ratio, 1.75; 95% confidence interval, 1.49-2.05; P<.0001); "moderate" and "severe" urinary incontinence increased from 12.7-19.5% (odds ratio, 1.67; 95% confidence interval, 1.35-2.07; P <.0001). There was a parallel increase in urinary incontinence from 40-65 years of age in nulliparous and vaginally and cesarean delivered women. Cesarean delivery, compared with vaginal delivery, was associated with a 30.0% reduction of urinary incontinence (P<.0001) and a 35-52% reduction of more severe grades of urinary incontinence (P<.0001) and was unaffected by age. Both pregnancy and vaginal delivery incurred an increased risk of urinary incontinence in the long term. The age-related gap for urinary incontinence between nulliparous and primiparous women who were delivered by vaginal delivery or cesarean delivery was constant between parallel trajectories that spanned ages from 40-64 years. The calculated protective effect of cesarean delivery was unaltered and significant during the same age interval.

Relationship of bipolar disorder with psychiatric comorbidity in the postpartum period-a scoping review.

Childbirth can trigger a variety of psychiatric disorders; however, no disorder is as profoundly affected by childbirth as bipolar disorder. Rates of psychiatric comorbidity especially anxiety disorders, obsessive compulsive disorder, and substance use disorders are quite high in individuals with bipolar disorder. The purpose of this scoping review is to ascertain the effect of childbirth on the relationship between the onset of bipolar disorder and comorbid psychiatric disorders. On June 27, 2017, a search of the Medline, PsycINFO, CINHAL, EMBASE, SCOPUS, COCHRANE, and ISI-Web of Science (WOS) databases was performed using the terms mental disorders, mental disease, major depressive disorder, major depression, depression, panic disorder, bipolar disorder, comorbidity, anxiety disorders, obsessive compulsive disorder, post-traumatic stress disorder, schizophrenia, eating disorders, reactive attachment disorder, childbirth, parturition, puerperium, postpartum, postpartum period and postnatal period. Reference lists of identified papers were manually searched, and all relevant papers published in English were included. A total of eight relevant articles were identified and included in the review. There is some evidence to suggest that occurrence of certain psychiatric disorders in the postpartum period may predict later onset of bipolar disorder. It is unknown whether childbirth raises the risk of postpartum recurrence of comorbid disorders. Whether patients who have past histories of psychiatric disorders are at increased risk for onset of bipolar disorder in the postpartum period also remains unclear. Additional research is needed to increase our understanding of the impact of childbirth on bipolar disorder and comorbid psychiatric disorders. A better understanding of this issue could lead to more accurate and timely detection, improved treatment planning, and optimal delivery of care for these disorders.

The Effects of Childbirth on Activity Levels in a Cohort of Adolescent Girls

The Effects of Childbirth on Activity Levels in a Cohort of Adolescent Girls

Effects of childbirth on podocyturia in women with normotensive, uncomplicated pregnancies

Changes in hemodynamics and blood pressure occur shortly before and after childbirth regardless of the mode of delivery. This study aimed to test the hypothesis that parturition induces a temporal increase in podocyturia monitored by podocyte-specific protein podocin mRNA expression levels (Pod-mRNA). A total of 105 urine specimens, consisting of 43 and 62 from 18 and 20 otherwise healthy women with vaginal delivery (VD) and elective cesarean delivery (ECS), respectively, were studied. Determination of urine protein and creatinine (Cr) concentrations and quantitative analyses of Pod-mRNA, nephrin mRNA (Nep-mRNA), synaptopodin mRNA (Syn-mRNA), and aquaporin 2 mRNA expression were performed using RT-PCR in pelleted urine samples. Levels of mRNA expression were corrected by urine Cr concentration. Podocyturia increased significantly, concomitant with a significantly decreased Nep:Pod-mRNA ratio (NPR) in the urine, collected immediately before or after childbirth regardless of the delivery mode compared with urine collected before commencement of labor or on postpartum day 3 or later. Podocyturia was significantly negatively correlated with NPR [correlation coefficient (r) = -0.614/-0.750 for VD/ECS women, respectively], as well as the Syn:Pod-mRNA ratio. Systolic blood pressure exceeded 140 mmHg during labor in 50% of VD women, and mean arterial pressure was significantly positively correlated with podocyturia during labor in VD women (r = 0.733). Thus parturition induces a transient increase in urine podocytes with reduced Nep- and Syn-mRNA expressions. Glomerular podocytes with reduced Nep- and Syn-mRNA levels were suggested to be likely to detach from the glomerular basement membrane around childbirth.

Do Pregnancy And Childbirth Improve Elite Marathon Performance? An Analysis Of Available Evidence.

It has been reported that pregnancy and childbirth lead to improved athletic performance in women, often referred to as “pregnancy doping”. This ergogenic phenomenon is said to occur for up to one year following childbirth. The mainstream media regularly reports on this theory, citing performances of elite marathoners such as Paula Radcliffe, Kara Goucher, and Ingrid Kristiansen as evidence. PURPOSE: To assess evidence that childbirth has a performance enhancing effect on female marathoners. METHODS: LexisNexis Academic and Google News databases were searched for news articles discussing pregnancy doping theory. Search terms included ((‘pregnancy doping’ OR ‘childbirth’ OR ‘pregnancy’) AND (‘performance enhancing’ AND ‘athletes’ OR ‘runners’ OR ‘marathoners’)). Leads to other news stories on the topic were also explored. Elite marathoners who competed in marathons before and after childbirth were identified from retrieved articles. Information on each identified athlete was collected from IAAF profile and other reputable resources, including athlete’s birthdate, pre-childbirth marathon personal record (PR) and post-childbirth PR, dates of each PR, and date of childbirth. Pre- and post-childbirth marathon PR’s were compared relative to time of childbirth. RESULTS: Eight elite marathoners were identified. Five of the seven elite marathoners (Goucher, Keitany, Kristiansen, O’Sullivan, and Tulu) had faster marathon PR’s after childbirth. However, only Goucher ran faster within a year after childbirth. Keitany achieved a PR 15 months after childbirth, and the three others achieved lifetime PR’s >3.5 years post-childbirth. Radcliffe, Kastor, and DeReuck never improved upon their pre-pregnancy PR’s after childbirth. CONCLUSIONS: Though physiologic adaptations to exercise during pregnancy have been studied, there are no scientific studies regarding the effect of childbirth on competitive racing performance. Only one of eight marathoners commonly cited as evidence for the ergogenic effects of pregnancy actually improved her marathon PR within a year of childbirth. While anecdotal evidence is commonly used to support expert opinion that pregnancy has a year long ergogenic effect on marathon performance, actual performance outcome data are currently insufficient to support this theory.

Voiding difficulties in the elderly.

Voiding difficulties are more common in the elderly. This occurs because of physiological changes such as replacement of muscle fibres with collagen, from life effect insults such as the effects of childbirth, lead to a reduction in contractility and changes in the nerve supply from cholinergic to NANC fibres lead to a change in sensation leading to a delay in first sensation. Symptoms are often similar to those of overactive bladder and the history in older women should include those of hesitancy and poor flow. Likewise, the diagnosis should be considered in women presenting with recurrent urinary tract infections. A failure to consider voiding difficulties can precipitate a crisis and simple strategies such as teaching self-catheterization and using estrogen cream may prevent problems occurring. When acute problems occur, catheterization is required and a review of precipitating factors may identify medications contributing to the condition. The mainstay for treatment, however, remains draining with an indwelling catheter or clean intermittent clean catheterisation.

Biomechanical pregnant pelvic system model and numerical simulation of childbirth: impact of delivery on the uterosacral ligaments, preliminary results

We created a pregnant woman pelvic model to perform a simulation of delivery to understand the pathophysiology of urogenital prolapse by studying the constraints on the pelvic components (muscles, ligaments, pelvic organs) during childbirth. These simulations will also provide valuable tools to understand and teach obstetrical mechanics. We built a numerical model of the pelvic system from a term pregnant woman, using the finite element method on a mesh built from magnetic resonance images of a nulliparous pregnant woman. Mechanical properties of pelvic tissues already determined by the team were adapted to account for pregnancy. The system allows delivery to be simulated. When a fetal head at the 50th percentile for the term goes through the pelvic system, uterosacral ligaments undergo a deformation of around 30 %. Uterosacral ligaments are the major pelvic sustaining structures, their lesion may be a potential cause of urogenital prolapse. We built a model of childbirth as a function of pregnancy term by varying volumes of fetal head and uterus. The impact on uterosacral ligaments is higher when the fetal head is larger. Our modelling is rather complete considering that it involves many organs including ligaments. It allows us to analyse the effect of childbirth on uterosacral ligaments and to understand how they impact on pelvic statics. First results are promising, but optimisation and future simulations will be needed. We also plan to simulate various delivery scenarios (cephalic, breech presentation, instrumental extraction), which will be useful to study perineal lesions and also to teach obstetrical mechanics.

Causal Effects on Employment after First Birth – A Dynamic Treatment Approach

The effects of childbirth on future labor market outcomes are a key issue for policy discussion. This paper implements a dynamic treatment approach to estimate the effect of having the first child now versus later on future employment for the case of Germany, a country with a long maternity leave coverage. Effect heterogeneity is assessed by estimating ex post outcome regressions. Based on SOEP data, we provide estimates at a monthly frequency. The results show that there are very strong negative employment effects after childbirth. Although the employment loss is reduced over the first five years following childbirth, it does not level off to zero. The employment loss is lower for mothers with a university degree. It is especially high for medium-skilled mothers with long prebirth employment experience. We find a significant reduction in the employment loss for more recent childbirths.

Causal effects on employment after first birth — A dynamic treatment approach

The effects of childbirth on future labor market outcomes are a key issue for policy discussion. This paper implements a dynamic treatment approach to estimate the effect of having the first child now versus later on future employment for the case of Germany, a country with a long maternity leave coverage. Effect heterogeneity is assessed by estimating ex post outcome regressions. Based on SOEP data, we provide estimates at a monthly frequency. The results show that there are very strong negative employment effects which are causally due to childbirth. Although the employment loss is reduced over the first five years following childbirth, it does not level off to zero. We find a significant reduction in the employment loss over time.

Maternal Infanticide in Australia: Mental Disturbance During the Postpartum Period

The crime of infanticide is recognised in a number of Australian states. Generally, the legislation requires that a mother kill her child aged less than 12 months, and, at the time of the offence, her mental balance is disturbed by the effect of childbirth or lactation. According to research, however, the relationship between childbirth-related mental disturbance and infanticide, is unclear. Research is warranted to explore this relationship further using Australian data. In particular, given the highly diverse nature of the population, specific focus should be given to vulnerable Indigenous infants as well as to culturally diverse groups.

Mother-friendly childbirth practices and breastfeeding

Childbirth, connecting the stages of pregnancy and postpartum, deeply affects maternal motivation with regard to initiating and continuing postnatal breastfeeding and ultimate breastfeeding success. Although promoting breastfeeding is a strategy critical to achieving wellbeing in both mothers and infants, there remains a lack of professional attention and related research into the effect of childbirth on breastfeeding. Promoting successful breastfeeding is a central component of childbirth-friendly nursing care. Therefore, this paper introduces the origin and concepts of mother-and-infant-friendly childbirth, then analyzes the influences on breastfeeding of medicalized birth practices and suggests how to implement childbirth-friendly interventions. This paper was written to help nurses better understand how the childbirth process affects breastfeeding and provide a reference for creating conditions during childbirth that encourage successful breastfeeding practices.