Skin to Skin Bonding: Maternal Infant Nursing is Fun!

Saturday, 7 November 2015

Felicitas T. Cacal, MSN, RNC-OB, C-EFM
Laura L. Peters, MSN, RNC-OB, C-EFM
Women's Services, Northwest Community Healthcare, Arlington Heights, IL, USA

Title: Skin to Skin Bonding: Maternal Infant Nursing is FUN!

Implementation of the Golden Hour



Problem:  In the  fast paced Labor and Delivery and Mother Baby Units, patient care is focused on care that is perceived by patients as family centered and providing a birth experience that is unique and memorable.  Recent evidence has shown that allowing a mother and her healthy full-term infant a period of uninterrupted skin to skin bonding within the first hour of life will help the infant transition from fetal to newborn life with more stable temperature, improved glucose control and effortless respiratory transition. Numerous evidence-based research studies demonstrated that early mother-infant skin to skin stimulate the most innate biological instinct that evokes breastfeeding and early interaction. Skin to skin bonding is a unique experience that should occur during the first meeting of the parents and the infant. This is the golden hour that should be respected and treasured. Protocols in a hospital may be adapted to support the initiative of uninterrupted skin to skin soon after the birth of the stable infant and mother. The most recent results collected by Quality Improvement for exclusivity in breastfeeding and skin to skin revealed that interventions are needed to increase the scores.  Current data for skin to skin = 58%, Breastfeeding in the first hour = 60% and Exclusivity in Breastfeeding revealed score of 38.9%. Nursing is focused on completing task rather than allowing family to experience uninterrupted bonding between infant and parents in the first hour of life.

Purpose:   The purpose of the quality improvement project is to achieve the target measure of skin to skin to a minimum of 1 hour immediately after birth to promote achievability of the interventions and for staff to accept and achieve early adoption. The aim is also to increase the bonding time between the mother and baby dyad and promote Family Unit Nursing (FUN)

 Program Development:

Iowa Based Model of Evidence Based Practice and Lewin’s Theory of Change were utilized to improve quality care.

  • Two evidence based research articles were sent by email to the Transitional Workforce Team. This team consists of staff from Labor and Delivery and Mother Baby Units
  • Transitional Team meeting was held and the need for change was discussed
  • Survey was sent to staff to review skin to skin definition as it applied to the Golden Hour
  • Golden Hour Optimization ( Skin to skin and initiation of breastfeeding in the first hour of life) for term newborn was addressed
  • Golden Hour signs were made available to patients, families and visitors posted on each of the labor rooms and Family Waiting Area.
  • Partnership between Mother Baby staff and Labor and Delivery staff is evident  when admission process for the mother and infant is done  at bedside. This collaboration fosters teamwork that is significant to best practice.


  1. Identified trigger
  2. Obtained support from leadership and administration that the change is necessary
  3. Transitional Workforce Team was utilized as catalyst to the change
  4. Assembled and reviewed the evidence at the Transitional Workforce Team meeting
  5. Transformed research into practice through analysis
  6. Piloted the change
  7. Full implementation utilizing the pilot evaluation and feedback of staff from Labor and Delivery and Mother Baby units


  • The APN, Educator and Quality Team from Labor and Delivery  and Mother Baby Units are currently collecting data for  skin to skin and breastfeeding in the first hour.
  • Exclusivity in Breastfeeding data is being collected by Quality Department
  • Skin to skin as it relates to the Golden Hour survey was sent to 84 staff members
  • 26 responses ( 30%)were received with 80% correct responses to skin to skin as it related to the Golden Hour
  • Positive comments from patients, family and providers are consistent
  • Collaboration between the Labor and Delivery continues to be strong
  • Leadership rounding is maintained to obtain feedback from patients and families