Promoting Breastfeeding Through the Use of a Unique Skin-to-Skin Intervention at an Urban Hospital

Crenshaw, Jeannette T.

Tuesday, 1 November 2011: 10:20 AM

Jeannette T. Crenshaw, MSN, RN, IBCLC, LCCE, NEA-BC¹
Kajsa Hilarie Brimdyr, PhD, CLC²
Karin Cadwell, PhD, RN, FAAN²
Ann-Marie Widström, PhD, RN, MTD³
Kristin Svennson, RN, MTD³
Renee' Jones, MSN, WHCNP⁴
Armara Dickey, BSN, RNC-OB⁵
Carol Gentry, BSN, RNC-OB⁵
Nuala Murphy, RN, IBCLC⁶
Elizabeth H. Winslow, PhD, RN, FAAN⁷
(1)College of Nursing, University of Texas at Arlington, Arlington, TX
(2)Healthy Children Project, East Sandwich, MA
(3)Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden
(4)Labor and Delivery, Texas Health Presbyterian Hospital of Dallas, Dallas, TX
(5)Labor and Delivery, Women's and Infants Services, Texas Health Presbyterian Hospital of Dallas, Dallas, TX
(6)Lactation Department, Women's and Infant's Services, Texas Health Presbyterian Hospital of Dallas, Dallas, TX
(7)Patient Care Resources, Texas Health Presbyterian Hospital of Dallas, Dallas, TX

Learning Objective 1: Explain a unique 5-day quality improvement intervention to enhance the rates of skin-to-skin care after birth and exclusive breast milk feeding at hospital discharge.

Learning Objective 2: Discuss the PRECESS method(Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success)and results from using this intervention.

Improving breastfeeding rates is a healthcare priority. Skin-to-skin care after birth improves maternal and newborn outcomes and is an effective strategy to address the Joint Commission perinatal core measure for exclusive breast milk feeding at discharge. Optimal skin-to-skin begins immediately after birth and continues, uninterrupted, until after the first feeding. Skin-to-skin care often is not done, is interrupted, or is delayed until multiple procedures are completed (e.g., infant weights, episiotomy repair; cesarean surgery), despite evidence supporting the practice. We conducted a unique 5-day project to improve skin-to-skin care and measured the results.

The project team (nurses from the Sweden, Massachusetts, and the study site, and a video-ethnographer) used the PRECESS method (Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success). This method involves educating clinicians on skin-to-skin care and support of newborns’ 9 instinctive stages while skin-to-skin; expert mentoring, video-recording skin-to-skin care; interactively analyzing video-recordings; and, continued application of skills.

We used descriptive and inferential statistics to analyze results. Eleven mothers and babies participated in the PRECESS intervention; 5 (56%) of the 9 mothers who planned to breastfeed were exclusively breast milk feeding at hospital discharge; 5 (100%) of the babies who went through all 9 instinctive stages during skin-to-skin were exclusively breast milk feeding at discharge; staff identified and overcame barriers to skin-to-skin care; mothers who had cesarean section reported immediate skin to skin care reduced stress during surgery. Monthly rates of skin-to-skin improved (p<0.000); rates among cesarean births improved (p<0.000).

The PRECESS intervention may be an effective method for improving skin-to-skin care in short periods of time. Babies who undergo all 9 stages during skin-to-skin care may be more likely to leave the hospital having been exclusively breastfed. Skin-to-skin care may reduce maternal stress during cesarean surgery. More research is needed to confirm these promising trends.

See more of: Global Initiatives on Breastfeeding Practices
See more of: Oral Paper & Poster: Evidence-Based Practice Contest