Early Skin-to-Skin in the Operating Room Following Cesarean Birth

Background:

World Heatlh Organization (WHO) and The United Nations International Children’s Fund (UNICEF) have identified “Ten Steps to Successful Breastfeeding”. The “Ten Steps” use evidenced-based care to optimize breastfeeding outcomes and ultimately improve health outcomes, both short and long-term, for both mother and infant.  Many hospitals in the United States, are working toward the implementation of all ten steps and ultimately the title of “baby friendly” through the organization Baby Friendly Hospital Initiative (BFHI).  

For this project, the fourth step, to “initiate breastfeeding in the first hour of life”, was identified as a quality improvement project, with cesarean births having the greastest need.  In order to accomplish this goal, it was decided that an early skin-to-skin program was needed for mothers and babies immediately following cesarean birth, to encourage the initiation of breastfeeding in the first hour of life.

Purpose Statement:

To examine the effectiveness of the implementation of an early skin-to-skin intervention program for mothers and babies following a cesarean birth. A secondary aim was to examine the association between mothers whose baby was placed skin-to-skin after cesarean birth, and exclusivity of breastfeeding at time of discharge.   

Methods:

An early skin-to skin program for mothers and babies following cesarean birth was developed by a team of healthcare providers at a women’s healthcare center in the Southern Midwest. Preparation for implementation of the new skin-to-skin program was completed through meetings, educational in-services and competencies with nursing staff, physicians and operating room staff.

Data was collected by conducting retrospective chart reviews to obtain rates of cesarean born infants going skin to skin in the operating room and exclusivity of breastfeeding at discharge.  Exclusions for skin to skin were given for medically unstable infants and mothers and if the mothers declined to participate in the skin-to-skin program.  Ongoing results of the monthly rates of skin-to-skin and exclusivity of breastfeeding were posted in the staff break room, with individual staff recognition for complete documentation and consistency of implementation.

Results:

The early skin-to-skin program for mothers and babies following cesarean birth was initiated in October 2014, and data collection on the project was begun in November 2014. Currently, the preliminary data for the rates of early skin-to-skin contact for eligible mothers and babies following cesarean birth has risen from 0% at the initiation of the program to 76%. Data collection is currently ongoing for both the early skin-to-skin program as well as exclusivity of breastfeeding at discharge.

Conclusion:

Through the implementation of the new standard of care, education, documentation changes, encouraging the heart and data collection, we had an increase of 76% for eligible mothers and babies experiencing skin to skin in the operating room from implementation of the program.

It was recognized early in the implementation of the project that this was one step in the journey to becoming a baby friendly hospital. The ease and swiftness to which the early skin-to-skin program for mothers and babies following cesarean birth was implemented was unexpected. The success is thought to be due to both the education of the nursing staff on the importance of early breastfeeding, and an ongoing gradual change in the women’s health center towards a breastfeeding friendly culture.