The Perinatal Microbiome

Time-frame: 60-90 minutes
CERP: yes

There is much to learn about the perinatal microbiome, What is it? What can it do? What do we do about it? How do our practices in the birth arena affect the long term health of women and their children? This presentation will scratch the surface of this exciting new area of research.

Jarold (Tom) Johnston

Country: United States of America
Phone number: 910-964-7679
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COVID-19 Illness: Mother-Baby Separation, Viruses, and Breastfeeding

This study highlights the long known, but easily overlooked benefits to breastfeeding in the face of infectious diseases. Initial fears over infection lead the CDC and health care professionals to isolate newborns from their COVID positive mothers, effectively doubling the chance that the newborn would become COVID positive while in isolation.

Objectives: Some hospitals have instituted separation of mothers and their newborn(s) when SARS-CoV-2 is suspected or confirmed in the mother. Limited data are available for SARS-CoV-2 vertical transmission, including studies on breast milk. This article looks at SARS CoV-2 case
studies and data to date as well as prior pertinent research.
Methods: Informal searches of PUBMED, CINAHL and Ovid Emcare were used to identify early reports of vertical transmissions of the novel Coronavirus, case reports, and population based reports of early evolving protocols and their outcomes. As this is a novel virus the authors used
previously identified anti-infectivity and antiviral mechanisms of human milk on other similar viruses to guide analysis. Further this article reviewed the well established literature regarding the risks of undue infant separation which negatively affect nearly every aspect of infant and
maternal health.
Results: Informal searches conducted in the spring and early summer of 2020 identified 14 early reports attempting to analyze the initial and evolving global response to SARS-CoV-2 and the effects of the virus on the maternal-infant dyad.
Conclusion: The feasibility of single-family rooms and support for breastfeeding as an alternative approach that addresses many of the risks favorably and reduces economic cost, both in lifetime disease burden and direct care are discussed. Initial reports seem to indicate that immediate
separation of the mother from her newborn is likely to increase the risk to both mother and infant.

Development and Interrater Reliability of the Lactation Assessment Care Tool (LACT)

This study is a validity and reliability study for a discharge screening tool for newborns with breastfeeding difficulty.

Background: There have been no comprehensive predictive measurement instruments published that account for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Care Assessment Tool (LACT) was developed by the authors as a predictive measure of lactation acuity to identify families at risk for breastfeeding difficulty and facilitate access to the most effective level of care. Research Aim: To describe the development, content validation, and interrater reliability of the LACT.

Methods: This study was a cross-sectional, online survey. Upon reading a standardized case scenario reflective of common experiences among families with goals to breastfeed, participants (N = 82) anonymously completed the LACT, which consisted of 16 measures based upon research relevant to maternal, infant, and functional factors affecting breastfeeding success. Descriptive statistics were used to summarize and describe the characteristics of the study sample. Interrater reliability was evaluated using Krippendorff’s alpha.
Results: An acceptable degree of interrater reliability (α = 0.70) among participants was detected for the 16 measures included in the instrument.

Conclusion: This instrument supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of care after discharge from the hospital by identifying families in need of referral to a level of care consistent with their lactation acuity. Future research is necessary to determine appropriate levels of care and support based on the instrument scores in diverse breastfeeding dyads during early lactation and through the duration of breastfeeding.

Incorporating “Father-Friendly” Breastfeeding language in maternity settings

The purpose of this commentary is to provide perinatal providers with the tools they need to incorporate fathers into the breastfeeding relationship. Research shows that engaged fathers increase initiation rates, decrease the rate of breastfeeding complications that lead to premature cessation, and increase the duration and exclusivity of a mother’s breastfeeding efforts. Despite this evidence, studies frequently show that fathers report being ignored or excluded from breastfeeding education. This is likely an oversight on the behalf of perinatal providers rather than a conscious effort. Ultimately, however, perinatal providers need to be prepared to address the concerns of all parents who will provide care to the infant and not the mother alone. This commentary discusses the value of fathers as breastfeeding supporters and offers evidence-based teaching strategies requested by fathers. This commentary also identifies and describes 4 father-friendly breastfeeding promotion resources and highlights the techniques used to draw fathers into the mother’s breastfeeding efforts.

Johnston & LeRoy (2018) Engaging and Supporting Fathers with Breastfeeding Partners. Clinical Lactation 9(1); 18-22

This article explores the need for healthcare professionals to address fathers’ concerns regarding engagement and supportiveness with breastfeeding partners. Fathers often feel left out during the partner’s perinatal care and do not get the same amount of education and support, especially regarding breastfeeding. The desire to have practical information that is specifically related to the paternal figure is a common complaint among fathers. Educational classes involving childcare and breastfeeding information provide positive results regarding an increase in breastfeeding rates. The purpose of this article is to address the need to acquire interventions that engage and assist fathers with supporting their partners. Currently, two known programs exist to attempt to speak directly to fathers seeking practical breastfeeding advice: “Dads and Breastfeeding” and “Cribside Assistance.” However, there is still a lack of research regarding effective interventions that assist fathers and increase breastfeeding duration.


Document Type: Research Article

Publication date: February 1, 2018

“Clinical Lactation” in A Guide to Mastery in Clinical Nursing

This chapter is a brief description of Human Lactation for the nurse generalist.  It includes the major concepts of human lactation (Milk Synthesis, Milk Production, and Milk Transfer). The chapter also offers an explanation and description of the clinical assessment skills required to provide basic breastfeeding supportive care.  This chapter is intended for the generalist nurse or the newly qualified registered nurse.

“Self-Efficacy” in The Encyclopedia of Nursing Research, 4th Ed.

This chapter is a brief description of Albert Bandura’s Self-Efficacy Theory.  It includes examples of the application of Self-Efficacy Theory in Modern Nursing Research

Labor and Delivery in my Pocket: “Fetal Death”

Tom contributed a small section on perinatal loss and bereavement care to the first and second edition of this handy little pocket guide for Labor and Delivery nurses.

New route of Danazol for Endometriosis needs more study

Johnston, JT & Ericson-Owens, D. (2004) “New route of Danazol for Endometriosis needs more study” JNMWH 49(6) p. 546-8

In this article the authors discuss the use of a Danazol loaded IUD tested for the treatment of endometriosis.

On Bed Sharing [Letter]

On Bed Sharing [letter]  JOGNN 37(6), p. 619-21. Nov/Dec

In this letter to the editor the authors discuss a recent study regarding the hazards of bed sharing and attempt to counter arguments that American mothers continue to sleep with their babies despite knowing the risks.  The Authors took issue with the statistics used and the exaggerated risks portrayed in the original published article.