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Exclusive breastfeeding is the ideal source of nutrition for the first 6 months of life. Although skin-to-skin contact (SSC) has been shown to be associated with greater rates of exclusive breastfeeding, the results are heterogeneous. SSC involves placing a naked infant on its mother's bare chest immediately after birth. We examined the association between SSC immediately after birth and exclusive breastfeeding at 4 months.A retrospective cohort of healthy, term, singleton infants who were liveborn from 2008 to 2019 was constructed from the Nova Scotia Atlee Perinatal Database. Our main outcome was exclusive breastfeeding at 4 months, available for a subset of the cohort through linkage to a primary care database (n=256). Our secondary outcome was exclusive breastfeeding at hospital discharge, available for the broader cohort (n=56,459). Odds ratios (OR) for the association between SSC and exclusive breastfeeding at 4 months were estimated from logistic regression models.The odds of breastfeeding exclusively at 4 months were 4.14 (95% confidence interval (CI) 1.89-9.25) times greater among those who had SSC than among those who did not. The odds of breastfeeding exclusively at hospital discharge were 3.81 (95% CI 3.64-3.99) times greater among those who had SSC than among those who did not. The association between SSC and exclusive breastfeeding at hospital discharge was heterogeneous by birth year (OR 4.35, CI 4.07-4.65 in 2008-2011; OR 2.81, CI 2.57-3.07 in 2012-2015; OR 1.89, CI 1.63-2.10 in 2016-2019).Skin-to-skin contact appears to be associated with greater odds of exclusive breastfeeding at discharge and 4 months postpartum. Early SSC should continue to be supported for breastfeeding promotion.RéSUMé: OBJECTIFS: L’allaitement exclusif est la source de nutrition idéale pour les six premiers mois de la vie. Bien qu’il ait été démontré que le contact peau à peau (SSC) est associé à des taux plus élevés d’allaitement exclusif, les résultats sont hétérogènes. La SSC consiste à placer un enfant nu sur la poitrine nue de sa mère immédiatement après la naissance. Nous avons examiné l’association entre la SSC immédiatement après la naissance et l’allaitement exclusif à quatre mois. MéTHODES: Une cohorte rétrospective de nourrissons seuls à terme en bonne santé de 2008 à 2019 a été construite à partir de la Nova Scotia Atlee Perinatal Database. Notre critère de jugement principal était l’allaitement exclusif à quatre mois, disponible pour un sous-ensemble de la cohorte grâce à un couplage à une base de données de soins primaires (n = 256). Notre critère de jugement secondaire était l’allaitement exclusif à la sortie de l’hôpital, disponible pour la cohorte plus large (n = 56 459). Les rapports de cotes (OR) pour l’association entre la SSC et l’allaitement exclusif à quatre mois ont été estimés à partir de modèles de régression logistique. RéSULTATS: Les chances d’allaiter exclusivement à quatre mois étaient 4,14 (intervalle de confiance (IC) à 95 % 1,89-9,25) fois plus élevées chez celles qui avaient le SSC que chez celles qui n’en avaient pas. Les chances d’allaiter exclusivement à la sortie de l’hôpital étaient 3,81 (IC à 95 % 3,64 à 3,99) fois plus élevées chez celles qui avaient la SSC que chez celles qui n’en avaient pas. L’association entre la CSS et l’allaitement exclusif à la sortie de l’hôpital était hétérogène selon l’année de naissance (OR 4,35, IC 4,07-4,65 en 2008-2011; OR 2,81, IC 2,57-3,07 en 2012-2015; et OR 1,89, IC 1,63-2,10 en 2016-2019). CONCLUSION: Le contact peau à peau semble être associé à une plus grande probabilité d’allaitement exclusif à la sortie de l’hôpital et à quatre mois après l’accouchement. La SSC tôt avec les nouveau-nés doit continuer à être soutenue en tant qu’aspect des pratiques de promotion de l’allaitement.

Obstetrical anal sphincter injury (OASIS) is a common consequence of vaginal delivery in nulliparas and carries the risk of short- and long-term morbidity. The objective of this study was to estimate the association between the duration of the second stage of labour and OASIS risk.A population-based, retrospective cohort of nulliparas delivering singleton, vertex, non-anomalous fetuses at term in Nova Scotia, Canada, from 2005 to 2019, were identified using the Nova Scotia Atlee Perinatal Database. Poisson regression models were used to estimate risk ratios (RR) with robust 95% confidence intervals (CI) adjusting for confounding variables to investigate the association between the length of the second stage and OASIS in the entire cohort and in operative vaginal deliveries.Of 36,662 participants, 7.6% sustained an OASIS (6.8% third-degree, 0.8% fourth-degree tear). The proportion of participants who sustained an OASIS increased over the study period. For each 30-min increase in the length of second stage, the OASIS risk increased by 11% (RR 1.11, 95% CI 1.10-1.12). When stratified by mode of delivery, second stage length ≥ 90 min was associated with an increased OASIS risk in spontaneous (RR 1.35, 95% CI 1.15-1.58) and vacuum-assisted vaginal deliveries (RR 1.42, 95% CI 1.11-1.81). In forceps-assisted vaginal deliveries, OASIS risk was increased, with shorter and longer durations of the second stage.Increasing length of the second stage of labour was associated with increasing risk of OASIS overall, but the association was heterogeneous between modes of delivery. Length of the second stage should be considered in counseling about OASIS risk.

Infants born preterm are exposed to repeated painful procedures during neonatal intensive care unit admission. Particularly in preterm infants, trajectories of pain response are not well understood. The aim of this study was to classify pain response trajectories over 2 minute following medically indicated heel lances in preterm infants.This study used existing clinical trial data (NCT01561547) that evaluated the efficacy of kangaroo care and sucrose for infant pain control. Pain was measured using the Premature Infant Pain Profile at 30, 60, 90, and 120 seconds following a heel lance. Group-based trajectory modeling was used to classify pain response in this 2 minute period.A total of 236 infants with median gestational age of 33 weeks contributed 610 procedures. A model with 5 trajectory classes best fit the data. Three trajectories were stable over time at different levels of intensity from low-mild to low-moderate pain. One trajectory reflected a linear reduction from high-moderate to low-moderate pain. The final trajectory showed variable moderate-high pain. At all times points, 3 classes were at least 1-point different from the overall sample mean pain score. Only 21 (9%) infants maintained the same class for all 3 procedures.In this sample of preterm infants receiving pain relief, most pain trajectories reflected mild to low-moderate pain that was stable over 2 minute after heel lance initiation. Trajectories were not consistent over multiple procedures within infants, and an overall mean pain score for the sample may misrepresent subgroups of pain response.

We conducted a retrospective cohort study to evaluate the relation between the level of total trihalomethanes in drinking water and adverse birth outcomes. The study population comprised women residing in an area with municipal surface water who had a singleton birth in Nova Scotia between January 1, 1988, and December 31, 1995, or a pregnancy termination for a major fetal anomaly. We found little association between trihalomethane level and the outcomes related to fetal weight or gestational age, but we found an elevated relative risk for stillbirths for average trihalomethane levels during pregnancy of 100 microg/liter or greater (adjusted relative risk = 1.66; 95% confidence interval = 1.09-2.52) relative to women exposed to trihalomethane levels of 0-49 microg/liter. We saw little evidence of an elevated prevalence or dose-response pattern for congenital anomalies, with the possible exception of chromosomal abnormalities (adjusted prevalence ratio = 1.38 and 95% confidence interval = 0.73-2.59 for women exposed to trihalomethane levels of 100 microg/liter or greater).