Skin to Skin Bonding: Maternal Infant Nursing is Fun!

Cacal, Felicitas T.

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.

Implementation:

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

Evaluation/Outcomes:

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